Reduction in avoidance mediates effects of brief behavioral therapy for pediatric anxiety and depression.

Brief behavioral therapy (BBT) is an efficacious transdiagnostic intervention for pediatric anxiety and depression that targets behavioral avoidance as a key mechanism. It is unknown if change in avoidance mediates treatment effects, as theorized. Data on avoidance at baseline and Week 16 were available on 52 youth (ages 8-16 years) from a randomized controlled trial (Weersing, Jeffreys, et al., 2017) comparing BBT and assisted referral to community care (ARC). BBT had significant effects on youth-reported behavioral avoidance, and significant indirect effects on functioning and anxiety, statistically mediated through changes in youth-reported behavioral avoidance. Change in youth-reported avoidance was not a significant mediator of depression. Parent-report of avoidance was not impacted by treatment and was not a significant mediator. Overall, BBT appears to be an effective treatment for targeting behavioral avoidance, which in turn, may improve functioning and lessen anxiety. CLINICAL TRIAL REGISTRATION INFORMATION: https://clinicaltrials.gov; NCT01147614.

Patterns of Change in Pain-related Physical, Mental, and Social Health Outcomes in a Military Population.

OBJECTIVE: Military persons frequently experience pain conditions stemming from noncombat and combat injuries. This study assessed the patterns of change over time and the associations of pain intensity and interference with physical, mental, and social health domains in a military sample. METHODS: A secondary analysis of Pain Assessment Screening Tool and Outcomes Registry (PASTOR) was conducted using data collected over 10 months. Participants selected for analysis completed ≥3 assessments with an interval of ≥14 days between assessments. The Defense and Veterans Pain Rating Scale (DVPRS) measured average and worst pain intensity, and Patient-Reported Outcomes Measurement Information System (PROMIS®) T-scores measured pain and health outcomes. RESULTS: The sample (N = 190) majority reported being active duty (96%); serving in the U.S. Army (93%); and being enlisted (86%). The percent difference from assessment one to assessment three showed improvement for DVPRS average pain (-4.85%) and worst pain (-2.16%), and PROMIS Pain Interference T-score (-1.98%). Improvements were observed for all PROMIS outcomes except depression. The Defense and Veterans Pain Rating Scale average and worst pain intensity and PROMIS pain interference were strongly correlated with physical function. Multilevel models showed that an increase in average and worst pain, and pain interference were associated with a decrease in satisfaction with social roles. CONCLUSION: Analysis identified patterns of change over time in physical, mental, and social health outcomes, as well as associations important to understanding the complexities of pain. This work has implications for pain management nursing in ambulatory settings where ongoing collection and analyses of multivariable outcomes data can inform clinical care.

An Unmet Need: Surgical Gloves with Variable Finger Lengths.

Sterile gloves are essential for plastic surgery, but little research has been published on glove fit. Sterile gloves are produced by all manufacturers, with finger lengths fixed for all sizes. Many wearers have fingers that are shorter or longer than usual, causing functional limitations due to incorrect glove finger length and fingertip fit. Methods: A multiquestion confidential electronic survey of glove finger length fit was sent to 6810 plastic surgery glove wearers from three organizations: American Society of Plastic Surgeons, International Society of Plastic and Aesthetic Nurses, and Association of Plastic Surgery Physician Assistants. Data were collected for this descriptive study in 2020-2021, and statistical analyses were performed using SPSS (version 27). Sample gloves from six brands were directly measured for finger length. Results: The survey yielded 500 responses, with some respondents not answering all questions. The response rate from American Society of Plastic Surgeons members was 8.2%, and was 7.3% from all groups combined. The most common reason for glove finger length dissatisfaction was fingers being too long (41.61%). Although there was variation in measured glove finger lengths, the variation was not uniform. Of all responders, 28.6% were very likely, and 16.16%, moderately likely, to want to use gloves with longer or shorter fingers if available, constituting a total of 44. 76%. Of these, 36.55% would pay increased cost (10%-25%) for such gloves. Conclusions: A high percentage of glove users would want gloves with variable finger lengths. Current surgical gloves do not support hand anatomy variations.

An evolutionary investigation of depressed mood: The relationship between daily stressors and patterns of depressive symptoms.

BACKGROUND AND OBJECTIVES: The situation-symptom congruence hypothesis (SSCH; (Keller & Nesse, 2006), grounded in evolutionary theory, argues that different types of adversity should lead to distinct patterns of depressive symptoms that help individuals deal with adaptive challenges. Situation-symptom congruence hypotheses were tested in this study using experience sampling methodology. METHODS: Two hundred and sixty-five individuals, including 54% who scored at least 16 on the Center for Epidemiologic Studies Revised Depression Scale, responded to text prompts daily for up to 9 days, reporting depressive symptoms as well as the most stressful event or issue they had experienced or focused on within the past 24 h. RESULTS: Multilevel modeling analyses indicated that the relationships between stressors and depressive symptom patterns were largely consistent with SSCH predictions. All stressors were significantly associated with symptoms hypothesized to be adaptive in response to those stressors. Moreover, in separate analyses, nine of the ten symptoms examined were either predicted by the stressors hypothesized to lead to that symptom or negatively related to stressors hypothesized to not elicit those symptoms. LIMITATIONS: It is unclear whether the results generalize to those diagnosed with a major depressive disorder; the study did not assess actual life events. CONCLUSIONS: Findings suggest that depressive symptoms may, in part, be adaptations that have evolved through natural selection to help individuals cope with adverse situations.

Developing an instrument to assess empowering nurse leader communication behaviours.

AIM: The overall purpose of the study was to develop an instrument to assess empowering nurse leader communication behaviours. BACKGROUND: Effective communication by nurse leaders promotes empowerment, yet communication assessments are often broad in nature without specifying precise behaviours. METHODS: An instrument development process was used to identify empowering nurse leader communication behaviours. Nurses working in United States military health care facilities (n = 240) provided responses to 47 pilot items, along with a 12-item psychological empowerment instrument to test for concurrent criterion validity. RESULTS: After review of item performance, 12 items were deleted. An exploratory factor analysis supported either a 2- or 3-factor model, with confirmatory factor analyses conducted to validate the underlying latent variables of empowering and limiting behaviours. The final nurse leader communication assessment consists of 2 factors consisting of 20 positive items (empowering subscale) and 15 negative items (limiting subscale). CONCLUSION: The final 2-factor assessment supports the theoretical premise of the empowering and limiting behaviours. Further testing may provide further dimensional clarity. IMPLICATIONS FOR NURSING MANAGEMENT: Use of the assessment can provide a basis for the development of training for individual nurse leaders or for facility nurse leaders as a collective.

Assessing exposure to unconventional natural gas development: using an air pollution dispersal screening model to predict new-onset respiratory symptoms.

Various exposure estimates have been used to assess health impact of unconventional natural gas development (UNGD). The purpose of this study was to (1) use an air pollution dispersal screening model and wind direction to characterize the air emissions from UNGD facilities at each residence and (2) assess association of this exposure estimate with respiratory symptoms. Respiratory symptoms were abstracted from health records of a convenience sample of 104 adults from one county in southwestern PA who had completed a standard clinical interview with a nurse practitioner. Using publicly available air emission data, we applied a "box" air pollution dispersion screening model to estimate the median ambient air level of CO, NOx, PM 2.5, VOCs, and formaldehyde at the residence during the year health symptoms were reported. Sources and median emissions were categorized as north, south, east, or west of the residence to account for the effect of wind direction on dispersion. Binary logistic regression was performed for each respiratory symptom. Number of sources had varying magnitudes of association with some symptoms (i.e., cough, shortness of breath, and "any respiratory symptom") and no association with others (i.e., sore throat, sinus problems, wheezing). Air emissions were not associated with any symptom.

Emergency Physician-Initiated Resuscitative Extracorporeal Membrane Oxygenation.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has several applications as a resuscitative intervention, including extracorporeal cardiopulmonary resuscitation (ECPR). ECPR is rarely initiated in the emergency department (ED) by emergency physicians outside regional academic institutions. OBJECTIVES: To evaluate whether ECPR improves clinical outcomes after cardiac arrest when initiated by emergency physicians (EPs) in a nonacademic hospital. METHODS AND MATERIALS: We performed a retrospective analysis of prospectively identified consecutive EP-initiated ECMO subjects from a single community hospital over a 7-year period. Logistic regression and propensity models tested the association between ECPR and survival to hospital discharge compared with concurrent ECPR-eligible control subjects. RESULTS: Over 7 years (2010-2017), EPs initiated ECMO on 58 subjects; 44 (76%) were venoarterial cases (43 ECPR) initiated in the ED. Of those, 11 (25%) survived to discharge (n = 9 with cerebral performance category score 1) and most were still alive after 5 years (66%). Adjusting for known covariates, ECPR subjects were more likely than concurrent controls to survive to discharge (odds ratio 8.4; 95% confidence interval 1.2-60.4). Propensity analysis revealed a favorable trend toward survival to discharge after ECPR (odds ratio 2.0; 95% confidence interval 0.51-7.8). CONCLUSIONS: Emergency physicians initiated ECMO with promising clinical outcomes. Prospective trials are needed to define the efficacy, safety, and cost-effectiveness of EP-initiated ECMO.

Evaluation of the effectiveness of the healthy heart tracker on heart failure self-care.

OBJECTIVE: We evaluated the effectiveness of a newly designed patient education booklet, the Health Heart Tracker (HHT), in promoting Heart Failure Self-Care (HFSC) behaviors compared to usual patient discharge handouts. METHODS: We conducted a quasi-experimental, comparative two-group study using patients admitted for HF to four intermediate care units. The HHT was instituted on two units; patients on the other units served as control. We analyzed HFSC measured prior to HF discharge education and at two and six weeks post discharge using repeated measures ANOVA. RESULTS: Eighty-four 84 patients completed the study. The sample was 72.6 (+ 12.9) years old, white (75%), educated, and retired (85.8%). All HFSC behaviors improved significantly over time, but there were no significant time by group interactions in HFSC maintenance, symptom perception, and confidence. A notable increase in HFSC management in the HHT group between baseline and 2 weeks was evident, but not sustained to 6 weeks. CONCLUSIONS: A focused, singular intervention in the form of a patient education booklet designed specifically to improve HFSC did not significantly improve self-care behaviors over time compared to a control group. PRACTICE IMPLICATIONS: More work is needed to determine optimal written resources for patients with HF.

Functional health status of adults with serious mental illness and diabetes mellitus: A latent profile analysis.

OBJECTIVE: Adults with serious mental illness are at increased risk for diabetes mellitus and diabetes-related complications. This article classifies subgroups among people with serious mental illness and comorbid diabetes with respect to functional status and examines differences among those groups. METHODS: This analysis used a baseline sample of 157 adults with serious mental illness and diabetes mellitus enrolled in a National Institute of Health-funded research study. Latent profile analysis was used to distinguish health status profiles and investigate how these subgroups differed across assessment domains. RESULTS: Participants with depression, schizophrenia, and bipolar disorder (n = 157) were included in the study. Mean age was 52.9 years (standard deviation = 9.8), and 62 (40%) were African American. From the latent profile analysis, a three-class model appeared to provide the best fit. Class 1 (34.9%) had a very low functional health status approximately two standard deviations below the general population mean. Class 2 (43.7%) had a low functional status approximately one standard deviation below the general mean. Class 3 (21.4%) had moderate functional status with scores near population mean. Groups differed on measures of personal characteristics, clinical status and symptom severity, self-care behaviors, and environmental characteristics. CONCLUSIONS: Although individuals with schizophrenia generally have poor prognosis once they develop diabetes, latent profile analysis identified distinct health status subgroups. Although all three groups demonstrated illness burden, the pattern of differences between these groups across measures may suggest the need for different interventions for highly diverse adults who received care within safety-net primary care.

Important Considerations When Selecting a Risk Assessment Tool.

Measurement is an integral part of many disciplines, ranging from the social, healthcare/medical, to management sciences. The field of psychometrics has had a wide-ranging impact in the varied disciplines housed within psychology (e.g., clinical, developmental, etc.) as researchers and test developers aim to construct, refine, and modify their instruments. Given that test validation is a key component in furnishing evidence of validity, the intent of this nontechnical article is to reinforce (or serve as a reminder) for the applied audience the necessary efforts in optimizing the psychometric properties of their measurement tool. This article will be couched as a "lessons learned" document, primarily covering construct and criterion validity, but also, reliability estimation, and then finally, a comment about the confluence of null hypothesis significance testing, sample size and effect size and its relationship to psychometric testing.

Sex Differences in Acute Myocardial Infarction Hospital Management and Outcomes: Update From Facilities With Comparable Standards of Quality Care.

BACKGROUND: Acute myocardial infarction (AMI) sex disparities in management and outcomes have long been attributed to multiple factors, although questions regarding their relevance have not been fully addressed. OBJECTIVE: The aim of this study was to identify current factors associated with sex-related AMI management and outcomes disparities in hospitals with comparable quality care standards. METHODS: This is a cross-sectional study of 299 women and 540 men with AMI discharged in 2013 from 3 southern California hospitals with tertiary cardiac care. Outcomes (adjusted by demographic/clinical variables using multiple logistic regression) included mortality (in-hospital, 30 days), 30-day readmissions, invasive/revascularization procedures, and quality medication performance measures (aspirin, statins/antilipids, ß-blockers, angiotensin-converting enzyme inhibitors, <90-minute door-balloon time). RESULTS: Performance was similar to the top 10% National Inpatient Quality AMI Measures. Women had similar mortality, 30-day readmission rates, and performance on medication quality measures compared with men; readmissions were higher in patients with County Services/Medicaid or no medical insurance regardless of sex. Women had similar cardiac catheterization and ST-segment elevation myocardial infarction percutaneous coronary intervention rates but significantly less percutaneous coronary intervention for non-ST-segment elevation myocardial infarction (39.1% vs 52.1%, P = .008) and coronary artery bypass graft (6.7% vs 14.1%, P < .001) than men. CONCLUSIONS: Women with AMI had similar early mortality, 30-day readmissions and quality performance measures compared with men across hospitals with current quality care standards. Type of medical insurance influenced readmission rates for both sexes. Sex disparities in coronary revascularization procedures were likely determined by differences in AMI type and coronary disease vascular expression.

Manikin Laryngoscopy Motion as a Predictor of Patient Intubation Outcomes: A Prospective Observational Study.

BACKGROUND: The goal of this study was to determine whether motion parameters during laryngoscopy in a manikin differed with experienced operators versus novice trainees and whether motion measurements would predict trainee outcomes when intubating patients. METHODS: Motion, force, and duration of laryngoscopy on a manikin were compared in two separate experiments between beginning anesthesiology residents (CA1) and anesthesiologists with more than 24 months of anesthesiology training (CA3 or attendings). In one experiment, CA1 residents were also evaluated for the percentage of their laryngoscope path that followed the route used by attending anesthesiologists. The residents were then observed for patient intubation outcomes for 4 weeks after manikin testing. The relationship between manikin test metrics and patient intubation outcomes was analyzed by multilevel modeling. RESULTS: CA1 residents positioned the laryngoscope blade farther right and with less lift than did experienced anesthesiologists. Endpoint position was 0.6 ± 0.3 cm left of midline for residents (n = 10) versus 2.7 ± 0.3 cm for advanced anesthesiologists (n = 8; P = .0003), and 15.6 ± 0.8 versus 17.7 ± 0.2 cm above the table surface, respectively (P = .033). On average, only 74 ± 6% of the CA1 laryngoscopy trajectory coincided with the Attending Route (P < .001 versus 100%). For each percentage point increase in Attending Route match, residents' odds of intubating a patient's trachea improved by a factor of 1.033 (95% confidence interval [CI] 1.007-1.059, P = .040), and their rate of failed laryngoscopy attempts decreased by a factor of 0.982 (0.969-0.996, P = .045). DISCUSSION: Laryngoscopy motion in manikins may predict which trainees can complete a patient intubation successfully in a few attempts. The assessment could help determine readiness for intubating patients with indirect supervision.

Quality of life of burn survivors treated in the military burn center.

BACKGROUND: Limited research explains the quality of life (QOL) among burn survivors during post-hospitalization rehabilitation. PURPOSE: To determine the QOL of military and civilian burn survivors treated in the military burn center. METHODS: In this longitudinal study, QOL was examined in 131 burn survivors (88 civilians; 43 military). Participants completed the Abbreviated Burn Specific Health Scale (BSHS-A) and the Satisfaction with Life Scale (SWLS) over 5 time points post-discharge. DISCUSSION: Civilian and military participants reported improved QOL over time on most BSHS-A subscales. Military participants had higher global BSHS-A scores at discharge, but at 6 months plateaued while civilians improved and had higher global BSHS-A scores at 18 months. Scores on the SWLS were consistently higher for military participants than for civilians. CONCLUSION: Military versus civilian patients may have different expectations about their ability to rehabilitate. The post-hospitalization period needs to be better understood to develop appropriate QOL interventions.

Update on quality of care in Hispanics and other racial-ethnic groups in the United States discharged with the diagnosis of Acute Myocardial Infarction in 2013.

BACKGROUND: Disparities in Acute Myocardial Infarction (AMI) care and outcomes have been frequently reported in racial-ethnic minorities in the U.S. Some studies have attributed disparities in Hispanics and other minorities to lower quality of services at hospitals where they seek care. Current information from hospitals with large Hispanic representations and updated quality resources is needed. METHODS: Retrospective observational study of 839 AMI patients discharged in 2013 from three Southern California Hospitals (A, B, C) with tertiary cardiac care level. Non-Hispanic Whites (NHW) and Hispanics (H) were the larger racial-ethnic groups (68.3%), and the comparison of these two groups constitutes the focus of the study. Mortality, 30day readmissions, medication/performance measures (PRx); aspirin, statins/anti-lipids, beta-blockers, ACEI/ARB for LV systolic dysfunction, <90min door-balloon time, and revascularization procedures were compared between hospitals, NHW and H, using Chi-squared tests (χ2), Odds Ratios (OR) with 95% confidence intervals (CI), and Z tests for proportions - independent groups. RESULTS: No significant differences in hospital, 30day mortality, PRx or procedures were observed between NHW, H and other racial-ethnic minority groups, or hospitals. Hospital C had 47.3% H and Hospitals A+B 14.6% (p<0.001, effect size=0.430). AMI performance measures exceeded 2013 national rates across all facilities. NHW had more private/commercial insurance (52.5% vs. 25.4%, OR 3.24, 95% CI 2.19-4.80, p<0.001) than H. CONCLUSIONS: Equitable access to quality hospital services in three Southern California hospitals offset previously reported disparities in AMI management in Hispanics. These results may not necessarily reflect the reality of AMI care for Hispanics in other U.S. regions.

Evaluating cultural competence among Japanese clinical nurses: Analyses of a translated scale.

This paper describes the factor analysis testing and construct validation of the Japanese version of the Caffrey Cultural Competence Health Services (J-CCCHS). The inventory, composed of 28 items, was translated using language and subject matter experts. Psychometric testing (exploratory factor, alpha reliability, and confirmatory factor analyses) was undertaken with nurses (N = 7494, 92% female, mean age 32.6 years) from 19 hospitals across Japan. Principal components extraction with varimax rotation yielded a 5-factor solution (62.31% variance explained) that was labeled: knowledge, comfort-proximal, comfort-distal, awareness, and awareness of national policy. Cronbach α for the subscales ranged from 0.756 to 0.892. In confirmatory factor analysis using the robust maximum likelihood estimator, the chi-square test was as follows: χ2 (340) = 14604.44, P < .001. After correlated errors were introduced, there was evidence of improved model fit (χ2 (335) = 8681.61, P < .05) but the other indices showed improvement (RMSEA = .058 [90% CI, 0.057-0.059], TLI = .891, CFI = .903, and SRMR = .059). The discriminating power of the J-CCCHS was indicated by statistically mean differences in J-CCCHS subscale scores between predefined groups. Taking into consideration that this is the first foray into construct validation for this instrument, and that fit was improved when a subsequent data driven model was tested, and it has the ability to distinguish between known groups that are expected to differ in cultural competence, the instrument can be of value to clinicians and educators alike.

The Effect of Binaural Beat Technology on the Cardiovascular Stress Response in Military Service Members With Postdeployment Stress.

PURPOSE: To assess the efficacy of embedded theta brainwave frequency in music using binaural beat technology (BBT) compared to music alone on the cardiovascular stress response in military service members with postdeployment stress. DESIGN: A double-blinded, randomized, pre- and postintervention trial. METHODS: Seventy-four military services members with complaint of postdeployment stress were randomized to either music with BBT or music alone. Each group listened to their respective intervention for a minimum of 30 min at bedtime for three consecutive nights a week for a total of 4 weeks. A 20-min pre- and postintervention heart rate variability (HRV) stress test and daily perceived stress via diaries assessed intervention efficacy. FINDINGS: There was a statistical difference (p = .01) in low-frequency HRV between the music with BBT group compared to the music only group. The average low-frequency HRV decreased in the music with BBT group 2.5 ms2 /Hz, while in the music only group it increased 7.99 ms2 /Hz. There was also a significant difference (p = .01) in the high-frequency HRV measures, with the music with BBT group showing an increase in HRV by 2.5 ms2 /Hz compared to the music only group, which decreased by 7.64 ms2 /Hz. There were significant (p = .01) differences found in total power measures, with the music only group decreasing by 1,113.64 ms2 /Hz compared to 26.68 ms2 /Hz for the music with BBT group. Finally, daily diaries consistently showed that participants who used BBT reported less stress over the course of the 4 weeks. CONCLUSIONS: When placed under an acute stressor, participants who used music with embedded BBT showed a decrease in sympathetic responses and an increase in parasympathetic responses, while participants who used music alone had the opposite effect. CLINICAL RELEVANCE: The use of BBT in the theta brainwave frequency embedded into music decreases physical and psychological indications of stress. BBT embedded with beta and delta frequencies may improve cognitive functioning and sleep quality, respectively.

Assessing Learning Styles of Graduate Entry Nursing Students as a Classroom Research Activity: A quantitative research study.

BACKGROUND: A number of studies across different disciplines have investigated students' learning styles. Differences are known to exist between graduate and baccalaureate nursing students. However, few studies have investigated the learning styles of students in graduate entry nursing programs. . OBJECTIVES: Study objective was to describe graduate entry nursing students' learning styles. DESIGN/SETTING/PARTICIPANTS/METHODS: A descriptive design was used for this study. The Index of Learning Styles (ILS) was administered to 202 graduate entry nursing student volunteers at a southwestern university. Descriptive statistics, tests of association, reliability, and validity were performed. Graduate nursing students and faculty participated in data collection, analysis, and dissemination of the results. RESULTS: Predominant learning styles were: sensing - 82.7%, visual - 78.7%, sequential - 65.8%, and active - 59.9%. Inter-item reliabilities for the postulated subscales were: sensing/intuitive (α=0.70), visual/verbal (α=0.694), sequential/global (α=0.599), and active/reflective (α=0.572). Confirmatory factor analysis for results of validity were: χ2(896)=1110.25, p<0.001, CFI=0.779, TLI=0.766, WRMR=1.14, and RMSEA =0.034. CONCLUSIONS: Predominant learning styles described students as being concrete thinkers oriented toward facts (sensing); preferring pictures, diagrams, flow charts, demonstrations (visual); being linear thinkers (sequencing); and enjoying working in groups and trying things out (active),. The predominant learning styles suggest educators teach concepts through simulation, discussion, and application of knowledge. Multiple studies, including this one, provided similar psychometric results. Similar reliability and validity results for the ILS have been noted in previous studies and therefore provide sufficient evidence to use the ILS with graduate entry nursing students. This study provided faculty with numerous opportunities for actively engaging students in data collection, analysis, and dissemination of results.

Mantram Repetition With Homeless Women: A Pilot Study.

Women and families are the fastest growing segment of the homeless population. Negative attitudes of nurses toward homeless women are a major barrier to homeless women seeking health care. This cross-sectional, mixed-methods pilot study, conducted primarily by nurses, tested the Mantram Repetition Program for the first time with 29 homeless women. The Mantram Repetition Program is a spiritually based skills training that teaches mantram (sacred word) repetition as a cost-effective, personalized, portable, and focused strategy for reducing stress and improving well-being. For the cross-sectional, pretest-posttest design portion of the study, the hypothesis that at least half of the homeless women would repeat their mantram at least once a day was supported with 88% of the women repeating their mantram 1 week later. The qualitative portion of this study using phenomenology explored the women's thoughts on mantram week 2. Themes of mantram repetition, mantram benefits, and being cared for emerged. This groundbreaking, interventional, mixed-methods pilot study fills a gap in interventional homeless research.

Assessing sexual trauma histories in homeless women.

Almost 1 out of every 3 homeless women (32%) in the United States, United Kingdom, and Australia has experienced childhood sexual trauma. We assessed lifetime sexual trauma histories among 29 homeless women from three Southern California community sites: one residential safe house and two safe parking areas. More than half of the women (54%) reported a history of sexual trauma. That rate was higher (86%) among women living at the safe home than among women staying at the safe parking sites (only 42%). All four of the women who had served in the military reported having experienced military sexual trauma. The high percentages of sexual trauma found in homeless women highlight the need for effective interventions for sexual trauma.

Adjusting Bowel Regimens When Prescribing Opioids in Women Receiving Palliative Care in the Acute Care Setting.

In palliative medicine, constipation is the third most common symptom after pain and anorexia, causing some patients to discontinue opioid therapy. Women experience higher incidence of constipation than men. The prevalence of infrequent bowel movements (<3 times/wk) and adherence to an established bowel regimen among women receiving opioids were studied. Referral to the palliative care team decreased the prevalence of infrequent bowel movements from 72% to 45%, and algorithm adherence increased from 38% to 78%. Education of oncology nurses decreased the prevalence of infrequent bowel movements among patients with cancer from 71% to 60%, and algorithm adherence increased from 0% to 10%. Patients benefit from stool softeners and stimulants when receiving opioids.