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1.
West J Nurs Res ; : 193945919897541, 2020 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-31941424

RESUMEN

This study examines the influence of chronic stress, varied positive and negative emotions on eating behaviors, and weight among 91 community-dwelling African American women 18-40 years old. Study measures include hair cortisol, Differential Emotional Scale IV, Eating Behavior Pattern Questionnaire, demographic form, waist circumference, and Body Mass Index (BMI). Analysis revealed positive emotions of interest (rs = .27, p = .011) and surprise (rs = .23, p = .029) were associated with low fat eating. Negative emotions of anger (rs = .23, p = .035), shyness (rs = .29, p = .006), and guilt (rs = .24, p = .022) were positively associated with emotional eating. Mediation analysis suggests that emotional eating mediates anger (indirect effect = 0.136), shyness (0.144), guilt (0.187), and BMI among young African American women. Chronic stress and positive and negative emotions impact eating behaviors and should be considered for successful weight management among African American women.

2.
Res Nurs Health ; 43(1): 28-39, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31691321

RESUMEN

The purpose of this study was to identify factors associated with the risk of closed head injury (CHI) in children under age 2 years with suspected minor head injuries based on age-appropriate, or near age-appropriate, mental status on an exam. The study was a secondary data analysis of a public-use dataset from the largest prospective, multicenter pediatric head injury study found in the current literature. An existing, validated clinical decision rule was examined using a sample of 3,329 children under age 2 to determine whether it, or the individual variables within it, could be utilized alone, or in conjunction with other variables to accurately predict the risk of underlying CHI in this sample. Results indicated that the keys to an accurate triage assessment for children under age 2 with suspected minor head injuries include the ability to identify the specific skull region injured, the ability to assess for the presence and size of any scalp hematoma, the ability to identify signs of altered mental status in this age group, and having access to accurate information regarding the child's age and the details of the injury mechanism. The findings from this study add to the body of knowledge regarding what factors are associated with CHI in children under age 2 with suspected minor head injuries and could be used to inform age-specific recommendations for children under age 2 in triage, educational resources, and national trauma criteria.

3.
Res Nurs Health ; 2019 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-31859386

RESUMEN

Failure to rescue (FTR) occurs when a clinician is unable to save a hospitalized patient's life when they experience a complication that was not present on admission. Research suggests that a focus on patient safety, including implementing airline-industry-based-crew-resource management (CRM) training, can improve patient outcomes, however, the effects of CRM on FTR are unknown. This study examined FTR and 30-day in-hospital mortality (IM) outcomes in two hospitals to determine if differences existed in the treatment hospital (received CRM training) and the comparison hospital (did not receive CRM training). Researchers expected there would be lower rates of FTR and IM in the treatment hospital than the comparison hospital. The study utilized a matched two-group comparison, cross-sectional quasi-experimental design. Over 10,000 patients (n = 10,823) comprised the study with 1,764 having at least one FTR complication. Adjusted odds of FTR were 2.9% higher for treatment versus comparison but these results did not reach significance. The adjusted odds of IM were 0.4% higher for treatment versus comparison but not significantly higher. Although the reasons for our findings remain unclear, previous researchers also found that CRM training improved staff outcomes but unexpectedly did not improve patient outcomes. CRM training may best be used to target changes in staff behaviors and improvement in staff outcomes. Refresher CRM training may be needed to prevent drifting back into longstanding behaviors. Reductions in FTR and patients with IM outcomes may require more comprehensive, multipronged interventions in addition to CRM training.

4.
Appl Nurs Res ; 50: 151200, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31735485

RESUMEN

BACKGROUND: Death of one's infant is devastating to parents, negatively impacting couple relationships and their own health. The impact of a prenatally diagnosed life-limiting fetal condition (LLFC) on parents of minority status is unclear. AIM: This comparative mixed methods case study examined the person characteristics, quality of perinatal palliative care (PPC) received and parent health outcomes. METHODS: Bereaved couples, 11 mothers and 3 fathers of minority or mixed races (11 African American and Latino, 1 White Latino and 2 White parents) completed the survey; 7 were interviewed. RESULTS: Parents rated their general health close to good, physical health close to normal but mental health lower than the population norm. Clinical caseness (abnormal levels) of anxiety were reported in 50% of parents whereas depression scores were normal. The experience of fetal diagnosis and infant death had a negative impact on the health of 40% of participants however, parents could not identify what specifically caused their health problems. Most were satisfied with their PPC but some shared that original providers were not supportive of pregnancy continuation. After the baby's death, 71% reported closer/stronger couple relationships. Two contrasting cases are presented. Once parents found PPC, their baby was treated as a person, they spent time with their baby after birth, and found ways to make meaning through continuing bonds. CONCLUSION: Despite high overall satisfaction with PPC, bereaved parents were deeply impacted by their infant's death. Mixed methods case study design illuminated the complicated journeys of parents continuing their pregnancy with a LLFC.

5.
J Youth Adolesc ; 48(9): 1796-1805, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31301028

RESUMEN

Prior research has demonstrated that behavioral, demographic, and mental health characteristics are associated with suicide, particularly among youth and young adults. Although recent research has begun to explore developmental trajectories of suicide-related outcomes, few studies to date have extended beyond late adolescence. Understanding different trajectories of suicide-related thoughts and behaviors from adolescence through mid-adulthood has the potential to refine developmental perspectives on suicide risk and to inform prevention efforts. Using National Longitudinal Study of Adolescent to Adult Health data (n = 9421 respondents with data at all four waves), this study analyzed suicide-related outcomes across ages 12-31 years. Growth mixture modeling (GMM) was used to estimate trajectory classes for past-year suicide ideation and attempts, followed by multinomial logistic regression to explore the association between race/ethnicity and class membership. In weighted descriptive analyses, the sample was 50.0% female; it was 15.5% African American, 2.1% Asian/Pacific Islander, 12.0% Hispanic, 0.9% other, and 65.9% White. GMM results revealed three trajectory classes for ideation: sustained higher risk, sustained lower risk, and adolescent-limited risk. Two trajectory classes emerged for attempts: declining higher risk and sustained lower risk. For ideation, African Americans were less likely than Whites to be in either the sustained higher risk or the adolescent-limited risk trajectory. For attempts, African Americans had significantly lower odds than Whites and Asians/Pacific Islanders had nearly four times the odds of Whites of being in the sustained higher risk trajectory, though the latter was only marginally significant. The finding of associations between race/ethnicity and distinct patterns of suicide-related behavioral development from early adolescence into mid-adulthood suggests new directions for developmental research and provides evidence to inform future suicide prevention efforts.


Asunto(s)
Grupos Étnicos/psicología , Salud Mental/estadística & datos numéricos , Conducta Autodestructiva/psicología , Ideación Suicida , Adolescente , Adulto , Afroamericanos/psicología , Grupos Étnicos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/psicología , Femenino , Hispanoamericanos/psicología , Humanos , Estudios Longitudinales , Masculino , Adulto Joven
6.
J Prof Nurs ; 35(2): 93-100, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30902412

RESUMEN

BACKGROUND: The New Careers in Nursing (NCIN) program provided scholarships and other supports to accelerated degree students at 130 nursing schools and collected data from the scholars at three time-points. PURPOSE: The NCIN database was analyzed to identify gender-based differences in scholars' profile characteristics, program experiences, and post-graduation outcomes. METHOD: An adaptation of Jeffreys's Nursing Universal Retention and Success Model guided the analysis. Gender differences were assessed after multiplicity adjustments for false positive rates. RESULTS: Differences based on gender were found for profile characteristics, student affective factors, academic factors, professional integration factors, environmental factors, as well as academic, psychological and NCIN program outcomes. Results suggest that males were influenced by economic factors more than females when choosing nursing as a career. They had fewer concerns about financial aspects associated with being a student again yet secured employment sooner after graduation than female scholars. They did not view support services as important as did female students. They expressed confidence in their leadership competence more than their female counterparts. CONCLUSION: Efforts are needed to better understand and address the nuanced gender-based perceptions and needs of nursing students who are male.


Asunto(s)
Empleo/economía , Relaciones Interpersonales , Percepción , Estudiantes de Enfermería/estadística & datos numéricos , Adulto , Educación en Enfermería , Empleo/estadística & datos numéricos , Femenino , Humanos , Masculino , Enfermeros/estadística & datos numéricos , Factores Sexuales , Encuestas y Cuestionarios
7.
Dimens Crit Care Nurs ; 38(1): 29-37, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30499790

RESUMEN

BACKGROUND: The type of symptoms that a woman experiences during an acute coronary syndrome (ACS) event influences symptom recognition and interpretation. Women who experience intense, abrupt symptoms are more likely to correctly attribute symptoms to a cardiac etiology and seek care faster than women with less intense, intermittent symptoms. OBJECTIVE: A single-group pretest-posttest design was used to evaluate the feasibility and acceptability of a nurse-delivered education and skill-building intervention designed to improve symptom recognition and interpretation in women with recurrent ACS symptoms. METHODS: Women hospitalized for an ACS event received an individualized education and skill-building intervention that was conceptually framed by the investigator's previous research. Three in-person sessions were followed by 2 telephone sessions for reinforcement. Outcomes and acceptability were evaluated at close-out (approximately 2 months after the index event). RESULTS: All but 2 women approached agreed to participate. Of the 10 women enrolled, 9 completed all study sessions within an average of 55 days. Mean knowledge scores increased by 7.4% measured by the ACS Response Index. Attitudes toward symptom recognition and help seeking increased by 2.4, whereas beliefs toward expectations and actions increased by 3.2. The women were pleased with the intervention (satisfaction scores averaging 1.4 on a 4-point Likert scale, with 1 as "strongly agree" and 4 as "strongly disagree"). All women who completed the study would recommend it to others. CONCLUSION: The nurse-delivered intervention was feasible and acceptable to women in the study. Results support further testing and refinement of the intervention in a longitudinal randomized control study to determine efficacy and sustainability.


Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Autoevaluación Diagnóstica , Educación en Salud/métodos , Rol de la Enfermera , Anciano , Femenino , Humanos , Persona de Mediana Edad , Proyectos Piloto , Recurrencia
8.
J Psychosoc Nurs Ment Health Serv ; 57(3): 25-31, 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-30272807

RESUMEN

The current study examined regional differences in body image perceptions and body mass index (BMI) among young African American women. Three hundred forty-one African American women, 18 to 40 years old, living in three regions of the United States were recruited. Pulver's Figure Rating scale was used to identify body image perceptions. Weight and height were measured for BMI calculation. Analysis of covariance was used to examine body image perception differences. The sample mean age was 27.8 years and mean BMI was 30.3 kg/m2. Participants' body image perceptions were significantly smaller among participants living in the Northeast compared to the Southeast (mean difference = -0.65, 95% confidence interval [CI] [-1.18, -0.11], p = 0.018) and Midwest (mean difference = -0.64, 95% CI [-1.16, -0.12], p = 0.015). No significant differences in BMI were found among regions (F(8,318) = 1.17, p = 0.314). Clinical implications of these findings are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(3), 25-31.].


Asunto(s)
Afroamericanos/estadística & datos numéricos , Imagen Corporal , Percepción , Adulto , Afroamericanos/psicología , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Obesidad/etnología , Estados Unidos/etnología
9.
J Nurs Educ ; 57(11): 687-689, 2018 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-30388292

RESUMEN

BACKGROUND: The complexity of health care systems requires cooperation between system stakeholders, structures, and functions. Nurses need an understanding of systems thinking to work effectively in this complex environment. METHOD: Nurse educators used the Friday Night at the ER simulation game with undergraduate nursing students to simulate complex problem solving and assess their learning. RESULTS: Students had significantly higher scores on the Systems Thinking Scale and reported increased self-perceived proficiency with the quality improvement Quality and Safety Education for Nurses competency after participating in the game. CONCLUSION: Nurse educators should consider incorporating complex problem-solving exercises, such as Friday Night at the ER, into their undergraduate curriculum to challenge and strengthen students' critical and systems thinking. Hospital nurse educators should also consider this intervention to assist practicing nurses in bolstering their critical and systems thinking. [J Nurs Educ. 2018;57(11):687-689.].


Asunto(s)
Bachillerato en Enfermería/métodos , Servicio de Urgencia en Hospital , Docentes de Enfermería , Entrenamiento Simulado/métodos , Estudiantes de Enfermería/psicología , Pensamiento , Humanos , Investigación en Educación de Enfermería , Solución de Problemas
10.
J Aging Res ; 2018: 6059560, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29854460

RESUMEN

The purpose of this study was to examine the effect of a six-month lifestyle-based intervention on health-related quality of life (HRQOL) in older adults with hypertension. A secondary analysis of a randomized controlled trial was conducted to test the differences between the intervention and control groups on HRQOL (N=196). The results indicated that there were no statistically significant differences between the intervention and control groups on change in HRQOL, but the final regression models were statistically significant. SF-36 mental component summary (MCS) score at baseline, stress at baseline, and change in stress were significant predictors for predicting change in the SF-36 MCS. SF-36 physical component summary (PCS) at baseline and change in stress were significant predictors for predicting change in the SF-36 PCS. The findings suggest that the development of an effective intervention in improving HRQOL should be considered within individual, interpersonal, societal, and cultural factors for future research and clinical practice.

11.
J Clin Nurs ; 27(19-20): 3510-3521, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29777549

RESUMEN

BACKGROUND: Research indicates that diabetes mellitus (DM) may be a risk factor for frailty and individuals with DM are more likely to be frail than individuals without DM; however, there is limited research in hospitalised older adults. OBJECTIVES: To determine the extent of frailty in hospitalised older adults with and without DM using a 16-item Frailty Risk Score (FRS) and assess the role of frailty in predicting 30-day rehospitalisation, discharge to an institution and in-hospital mortality. METHODS: The study was a retrospective, cohort, correlational design and secondary analysis of a data set consisting of electronic health record data. The sample was older adults hospitalised on medicine units. Logistic regression was performed for 30-day rehospitalisation and discharge location. Cox proportional hazards regression was used to analyse time to in-hospital death and weighted using propensity scores. RESULTS: Of 278 hospitalised older adults, 49% had DM, and the mean FRS was not significantly different by DM status (9.6 vs. 9.1, p = 0.07). For 30-day rehospitalisation, increased FRS was associated with significantly increased odds of rehospitalisation (AOR = 1.24, 95% CI [1.01, 1.51], p = 0.04). Although 81% were admitted from home, 57% were discharged home and 43% to an institution. An increased FRS was associated with increased odds of discharge to an institution (AOR = 1.48, 95% CI [1.26, 1.74], p < 0.001). The FRS was not significantly associated with increased risk of in-hospital death (p = 0.17), but DM was associated with a 484% increase in the instantaneous risk of death (AHR = 5.84, 95% CI [1.71, 19.9], p = 0.005). CONCLUSION: Diabetes mellitus and frailty were highly prevalent; the mean FRS was not significantly different by DM status. Although increased frailty was significantly associated with rehospitalisation and discharge to an institution, only DM was significantly associated with in-hospital mortality. RELEVANCE TO CLINICAL PRACTICE: Frailty assessment may augment clinical assessment and facilitate tailoring care and determining optimal outcomes in patients with and without DM.


Asunto(s)
Complicaciones de la Diabetes/complicaciones , Fragilidad/complicaciones , Fragilidad/diagnóstico , Hospitalización , Anciano , Anciano de 80 o más Años , Complicaciones de la Diabetes/mortalidad , Registros Electrónicos de Salud , Femenino , Anciano Frágil , Fragilidad/mortalidad , Mortalidad Hospitalaria , Humanos , Modelos Logísticos , Masculino , Alta del Paciente , Prevalencia , Estudios Retrospectivos , Factores de Riesgo
12.
Cell Calcium ; 71: 65-74, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29604965

RESUMEN

Hyperamylinemia is a condition that accompanies obesity and precedes type II diabetes, and it is characterized by above-normal blood levels of amylin, the pancreas-derived peptide. Human amylin oligomerizes easily and can deposit in the pancreas [1], brain [2], and heart [3], where they have been associated with calcium dysregulation. In the heart, accumulating evidence suggests that human amylin oligomers form moderately cation-selective [4,5] channels that embed in the cell sarcolemma (SL). The oligomers increase membrane conductance in a concentration-dependent manner [5], which is correlated with elevated cytosolic Ca2+. These findings motivate our core hypothesis that non-selective inward Ca2+ conduction afforded by human amylin oligomers increase cytosolic and sarcoplasmic reticulum (SR) Ca2+ load, which thereby magnifies intracellular Ca2+ transients. Questions remain however regarding the mechanism of amylin-induced Ca2+ dysregulation, including whether enhanced SL Ca2+ influx is sufficient to elevate cytosolic Ca2+ load [6], and if so, how might amplified Ca2+ transients perturb Ca2+-dependent cardiac pathways. To investigate these questions, we modified a computational model of cardiomyocytes Ca2+ signaling to reflect experimentally-measured changes in SL membrane permeation and decreased sarcoplasmic/endoplasmic reticulum calcium ATPase (SERCA) function stemming from acute and transgenic human amylin peptide exposure. With this model, we confirmed the hypothesis that increasing SL permeation alone was sufficient to enhance Ca2+ transient amplitudes. Our model indicated that amplified cytosolic transients are driven by increased Ca2+ loading of the SR and that greater fractional release may contribute to the Ca2+-dependent activation of calmodulin, which could prime the activation of myocyte remodeling pathways. Importantly, elevated Ca2+ in the SR and dyadic space collectively drive greater fractional SR Ca2+ release for human amylin expressing rats (HIP) and acute amylin-exposed rats (+Amylin) mice, which contributes to the inotropic rise in cytosolic Ca2+ transients. These findings suggest that increased membrane permeation induced by oligomeratization of amylin peptide in cell sarcolemma contributes to Ca2+ dysregulation in pre-diabetes.


Asunto(s)
Calcio/metabolismo , Ventrículos Cardíacos/patología , Polipéptido Amiloide de los Islotes Pancreáticos/farmacología , Modelos Biológicos , Miocitos Cardíacos/metabolismo , Animales , Señalización del Calcio/efectos de los fármacos , Humanos , Iones , Ratones , Ratas , Ratas Sprague-Dawley , Canal Liberador de Calcio Receptor de Rianodina/metabolismo , Sarcolema/efectos de los fármacos , Sarcolema/metabolismo
13.
Clin Nurs Res ; 27(8): 917-935, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-28618835

RESUMEN

Psychosocial stress and negative emotions have been associated with the consumption of highly palatable foods and excess weight. Few studies have examined these variable relationships among young African American women. The purpose of this cross-sectional study was to examine the relationship of perceived stress, depressive symptoms, eating behaviors, and body mass index (BMI) among 191 African American women who were 18 to 40 years old. Multivariate analysis indicated that depressive symptoms had a greater impact on highly palatable eating behaviors compared with perceived stress. This study extends understanding of depressive symptoms on eating behaviors among young African American women.


Asunto(s)
Afroamericanos/psicología , Índice de Masa Corporal , Conducta Alimentaria/psicología , Estrés Psicológico/psicología , Adolescente , Adulto , Estudios Transversales , Depresión/psicología , Femenino , Humanos , Adulto Joven
14.
J Transcult Nurs ; 29(2): 131-138, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-28826343

RESUMEN

PURPOSE: In this article, we report a pilot study that tested the feasibility and initial efficacy of a culturally, linguistically, and developmentally tailored risky sex prevention intervention for middle school-age Latinas and their mothers. DESIGN: We used a one-group pre-test, post-test, and 3-month post-intervention follow-up design. Data were collected at three points on aspects of the girls' communication, beliefs, and behaviors. RESULTS: Promising results included improvements in girl's self-efficacy regarding condom communication and condom consistent use, and in mother-teen sexual risk communication. There were also trends in demonstration of fewer risky sex behaviors. DISCUSSION: These findings suggest that the "Latina-Girls Empowered through Mind and Mission" (L-GEMM) intervention for young Latinas and their mothers is feasible and warrants further testing. IMPLICATIONS: Nurses are uniquely positioned to deliver risky sex preventive interventions to young Latinas. Including mothers and tailoring interventions to build on cultural strengths are important for success.


Asunto(s)
Conductas de Riesgo para la Salud , Hispanoamericanos/psicología , Relaciones Padres-Hijo/etnología , Conducta Sexual/psicología , Adolescente , Niño , Estudios de Factibilidad , Femenino , Humanos , Proyectos Piloto , Conducta Sexual/etnología , Encuestas y Cuestionarios
15.
Addict Behav ; 76: 1-7, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28734192

RESUMEN

INTRODUCTION: Despite important advances of longitudinal research in substance use behaviors, most studies stratify analyses by gender or race, which limits the ability to directly compare the likelihood of a particular developmental pathway across demographic groups. Thus, there is critical need for well-designed research to examine the associations of race/ethnicity with developmental trajectories of substance use behaviors across adolescence through adulthood. METHODS: Using an accelerated longitudinal design, we examined behaviors across ages 12-31 from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health. We performed growth mixture modeling, resulting in estimated trajectories over time. Next, we assessed the association between race/ethnicity and trajectory membership using multinomial logistic regression. RESULTS: Five trajectories resulted for marijuana use, four for cigarette smoking, three for smokeless tobacco use and number of days drunk, and two trajectories for heavy episodic drinking. Controlling for gender and family socioeconomic status, African Americans and Hispanics were less likely than non-Hispanic Whites to use cigarettes or smokeless tobacco early or to use alcohol heavily. CONCLUSIONS: Substance use behavior development follows different pathways for US adolescents and young adults, with some individuals experimenting earlier in adolescence and others beginning to use later in adolescence or in early adulthood. We extend developmental knowledge about these behaviors by demonstrating that the patterns of behavior vary by race/ethnicity; members of lower-risk trajectories (those involving later or no initiation of substance use) are more likely to be African American or Hispanic than to be non-Hispanic White.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Asunción de Riesgos , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Factores de Edad , Niño , Femenino , Humanos , Estudios Longitudinales , Masculino , Factores de Riesgo , Estados Unidos/epidemiología , Adulto Joven
16.
West J Nurs Res ; 39(12): 1533-1546, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-27920345

RESUMEN

Workplace bullying has been experienced by 27% to 80% of nurses who have participated in studies. Bullying behaviors negatively impact the health of nurses. This study examined whether nurses' resilience had an impact on the effects of bullying on the nurse's health. This cross-sectional descriptive study surveyed licensed registered nurses in one state. The sample ( N = 345) was predominately female (89%) and Caucasian (84%), with an average age of 46.6 years. In this sample, 40% of nurses were bullied. Higher incidence of bullying was associated with lower physical health scores ( p = .002) and lower mental health scores ( p = .036). Nurses who are bullied at work experience lower physical and mental health, which can decrease the nurses' quality of life and impede their ability to deliver safe, effective patient care.


Asunto(s)
Acoso Escolar , Relaciones Interprofesionales , Enfermeras y Enfermeros/psicología , Lugar de Trabajo/psicología , Adaptación Psicológica , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/normas , Psicometría/instrumentación , Psicometría/métodos , Sudeste de Estados Unidos , Estrés Psicológico/complicaciones , Estrés Psicológico/psicología , Encuestas y Cuestionarios , Lugar de Trabajo/normas
17.
Biol Res Nurs ; 19(2): 213-228, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-27913742

RESUMEN

INTRODUCTION: Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes. PURPOSE: The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization. METHODS: The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined. RESULTS: The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77-2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]). DISCUSSION: Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.


Asunto(s)
Registros Electrónicos de Salud , Anciano Frágil/estadística & datos numéricos , Evaluación Geriátrica/métodos , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Medición de Riesgo/métodos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sudeste de Estados Unidos , Centros de Atención Terciaria/estadística & datos numéricos
18.
Dimens Crit Care Nurs ; 35(6): 332-338, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27749436

RESUMEN

BACKGROUND: Past research has shown discrepancies between the time of symptom onset for patients with acute coronary syndrome (ACS) as documented in the medical record (MR) and patients' recall of the time assessed through subject interviews done later by researchers. PURPOSE: The aim of this study is to determine if there were differences between the time of symptom onset documented in the MR and subject interview taking into consideration sex, age group, and recall period for patients admitted to the emergency department for symptoms suggestive of ACS. METHODS: A secondary analysis was conducted on data from the PROMOTION (Patient Response to Myocardial Infarction Following a Teaching Intervention Offered by Nurses) trial, a multicenter randomized clinical trial to reduce patient prehospital delay to treatment in ACS. RESULTS: Of the 3522 subjects with CAD enrolled into the trial, 3087 subjects completed 2-year follow-up. Of these, 331 subjects sought treatment in the emergency department for ACS symptoms and 276 patients (83%) had complete information on the time of symptom onset from both sources. Of the 276 patients, 25 (9%) had differing times more than 48 hours and were thus excluded. The median difference between the 2 sources was 45.0 minutes. When both times were examined, there were no significant differences in time by sex (P = .720) or by age group (P = .188). The median number of days between the interview and the date of symptom onset was 29.5 days. There was a significant correlation between differences in the time of symptom onset and the length of recall period (rs = 0.148, P = .023). In multivariable modeling, a longer recall period was associated with greater median differences in the symptom onset time (b = 13.2, P = .023). CONCLUSION: These results suggest that the time of symptom onset obtained at the time of the index event and documented in the MR is not interchangeable with data obtained later by research staff, especially if the interview is not conducted near the time of the index event.


Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Registros Médicos , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo
20.
Clin Infect Dis ; 62(11): 1450-3, 2016 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-26980878

RESUMEN

We tested an intervention designed to increase human immunodeficiency virus (HIV) testing among men who have sex with men and transgender persons within existing and commonly used social media. At follow-up, intervention communities had significantly higher past 12-month HIV testing than the comparison communities. Findings suggest that promoting HIV testing via social media can increase testing.


Asunto(s)
Infecciones por VIH/diagnóstico , Promoción de la Salud , Minorías Sexuales y de Género/estadística & datos numéricos , Medios de Comunicación Sociales , Adolescente , Adulto , Anciano , Estudios Transversales , Promoción de la Salud/métodos , Promoción de la Salud/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Adulto Joven
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