Following NCCN guidelines within one hospital system in the United States: Comparison between cancer centers and genetic counselor utilization.

Genetic testing is an instrumental tool used to determine whether an individual has a predisposition to certain cancers. Knowing of a hereditary cancer predisposition may allow a patient and their family to consider high-risk screening or risk-reducing options. Genetic counselors work with physicians to identify patients at increased risk for genetic testing using available guidelines such as those provided by the National Comprehensive Cancer Network (NCCN). Information within one hospital system's cancer registry was used to identify individuals who qualify for genetic testing. This includes patients with a history of cancer of the breast (diagnosis ≤45, triple negative (TN) ≤60, and male), ovaries, colon (diagnosis ≤50), or uterus (diagnosis ≤50). Within this hospital system's registry, there are six cancer centers. Data were collected from cancer centers that utilized genetic counselors (GCs), and cancer centers that did not (non-GC) to determine whether there was a difference in genetic testing rates between GC and non-GC cancer centers. An analysis of 695 patients demonstrated a significantly higher proportion of eligible patients undergoing genetic testing at the GC cancer centers than at the non-GC cancer centers (91.6% versus 68.7%, p < .001). Further analysis of specific cancers showed a significantly higher uptake of genetic testing for eligible patients with colon cancer (90.8% versus 50%, p < .001), breast cancer ≤45 (99.5% versus 86%, p < .001), and ovarian cancer (91.3% versus 62.8%, p < .001) at the GC cancer centers than at the non-GC cancer centers. There was no significant difference in the proportion of testing of TN breast cancer ≤60 or uterine cancer ≤50 between cancer centers. These data suggest that having a GC working within a cancer center increases the ability to identify and offer testing to patients who meet NCCN genetic testing criteria based on their cancer type.

Differences in health, productivity and quality of care in younger and older nurses.

AIM: To determine if younger and older hospital employed nurses have differences in their self-reported health, health related productivity and quality of care. BACKGROUND: An understanding of age cohort differences may assist nurse managers in understanding the health related productivity and potential quality of care concerns of their staff. METHOD: A cross-sectional survey design was utilised. There were 1171 usable surveys returned (47% response rate). Nurses over the age of 50 made up 26% of the respondents. RESULT: Older nurses had a higher body mass index (BMI), higher mental well-being, higher pain scores, a 12% higher prevalence of having health problems, and reported a higher health related productivity loss than younger nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers must determine if their older nurses are being given more difficult, complex patients because of their experience. Perhaps older nurses, especially those with health problems, need assignments that require their assessment and critical thinking skills rather than their strength and physical abilities.

A generalized class of estimators for sensitive variable in the presence of measurement error and non-response.

In this paper, a general class of estimators is proposed for estimating the finite population mean for sensitive variable, in the presence of measurement error and non-response in simple random sampling. Expressions for bias and mean square error up to first order of approximation, are derived. Impact of measurement errors is examined using real data sets, including the survey conducted at Quaid-i-Azam University, Islamabad. Simulated data sets are also used to observe the performance of the proposed estimators in comparison to some other estimators. We obtain the empirical bias and MSE values for the proposed and the competing estimators.

Pressure Ulcers: Factors Contributing to Their Development in the OR.

The prevention of health care-associated pressure ulcers (HAPUs) is an important quality measure because HAPUs are considered a never event. The literature suggests that the prevalence rate of pressure ulcers is 8.5% or higher among patients who undergo surgical procedures that last longer than three hours. We performed a retrospective chart review to determine what factors contribute to the development of pressure ulcers in patients who undergo surgical procedures. The sample population included patients who acquired a pressure ulcer that was not present at admission and developed during their postoperative hospital stay. The project revealed consistent risk factors that may contribute to the development of pressure ulcers in patients who have undergone surgical procedures. These findings can drive the implementation of preventive measures to reduce the occurrence of HAPUs associated with surgical procedures.

Does providing nutrition information at vending machines reduce calories per item sold?

In 2010, the United States (US) enacted a restaurant menu labeling law. The law also applied to vending machine companies selling food. Research suggested that providing nutrition information on menus in restaurants might reduce the number of calories purchased. We tested the effect of providing nutrition information and 'healthy' designations to consumers where vending machines were located in college residence halls. We conducted our study at one university in Southeast US (October-November 2012). We randomly assigned 18 vending machines locations (residence halls) to an intervention or control group. For the intervention we posted nutrition information, interpretive signage, and sent a promotional email to residents of the hall. For the control group we did nothing. We tracked sales over 4 weeks before and 4 weeks after we introduced the intervention. Our intervention did not change what the residents bought. We recommend additional research about providing nutrition information where vending machines are located, including testing formats used to present information.

Low level of trans-10, cis-12 conjugated linoleic acid decreases adiposity and increases browning independent of inflammatory signaling in overweight Sv129 mice.

The objective of this study was to determine the extent to which a low level of trans-10, cis-12 (10,12) conjugated linoleic acid (CLA) decreases adiposity and increases browning in overweight mice, its dependence on inflammatory signaling and potential synergistic effects of daily exercise. Young, Sv129 male mice were fed a high-fat diet for 5 weeks to make them fat and glucose intolerant and then switch them to a low-fat diet with or without 0.1% 10,12 CLA, sodium salicylate or exercise for another 7 weeks. 10,12 CLA decreased white adipose tissue (WAT) and brown adipose tissue mass, and increased the messenger RNA and protein levels, and activities of enzymes associated with thermogenesis or fatty acid oxidation in WAT. Mice fed 10,12 CLA had lower body temperatures compared to controls during cold exposure, which coincided with decreased adiposity. Although sodium salicylate decreased 10,12 CLA-mediated increases in markers of inflammation in WAT, it did not affect other outcomes. Exercise had no further effect on the outcomes measured. Collectively, these data indicate that 10,12 CLA-mediated reduction of adiposity is independent of inflammatory signaling, and possibly due to up-regulation of fatty acid oxidation and heat production in order to regulate body temperature. Although this low level of 10,12 CLA reduced adiposity in overweight mice, hepatomegaly and inflammation are major health concerns.

The relationship between chronic pain, immune function, depression, and health behaviors.

The objectives of this study were 1) to determine the relationships between pain perceptions, immune function, depression and health behaviors and 2) to examine the effects of chronic pain on immune function using depression and health behaviors as covariates. A nonexperimental cross-sectional design was used to compare 24 chronic back pain patients with 33 asymptomatic no-pain healthy subjects. Immune function measures using natural killer (NK) cell activity, percent and numbers of NK cells, and T-cell lymphocyte proliferation with mitogens concanavalin A (ConA) and pytohemagglutinin (PHA) as well as self-report measures for depression and health behaviors were collected on all subjects. Pain perceptions showed positive significant correlations with depression (P = 0.01) and total percent of NK cells (P = 0.04). Depression and health behaviors were negatively correlated (P = 0.01). Positive associations were observed for depression and 2 PHA mitogen levels (P < 0.05). Comparison of group means, controlling for depression and health behaviors, showed that chronic pain patients' immune function, as measured by the combined NK effector to target (E:T) cell ratio levels, was significantly higher than the no-pain comparison group. Pain perceptions may have a deleterious effect on enumerative NK cell measures and depression levels. However, people with chronic pain may not experience attenuation in functional immune parameters.

Factors related to the number of fast food meals obtained by college meal plan students.

OBJECTIVES: This study tested whether days on campus, financial access through a meal plan, and health consciousness were associated with number of meals that college students obtained from fast food restaurants. PARTICIPANTS AND METHODS: In April 2013, all students currently enrolled in a meal plan were invited to participate in an online survey (N = 1,246). Students were asked to report the total number of meals eaten in the past week and where they obtained them. RESULTS: Negative binomial regression was used, and it was found that the number of meals obtained from fast food restaurants was positively associated with financial access and negatively associated with health consciousness. An association between days on campus and the number of meals obtained from fast food restaurants was not found. CONCLUSIONS: Increasing levels of health consciousness and reducing access to fast food restaurants through flex plans may reduce college students' consumption of fast food.

Nurses' presenteeism and its effects on self-reported quality of care and costs.

OBJECTIVE: Although research has been conducted on how nurse staffing levels affect outcomes, there has been little investigation into how the health-related productivity of nurses is related to quality of care. Two major causes of worker presenteeism (reduced on-the-job productivity as a result of health problems) are musculoskeletal pain and mental health issues, particularly depression. This study sought to investigate the extent to which musculoskeletal pain or depression (or both) in RNs affects their work productivity and self-reported quality of care and considered the associated costs. METHODS: Using a cross-sectional survey design, a random sample of 2,500 hospital-employed RNs licensed in North Carolina were surveyed using a survey instrument sent by postal mail. Specific measures included questions on individual and workplace characteristics, self-reported quality of care, and patient safety; a numeric pain rating scale, a depression tool (the Patient Health Questionnaire), and a presenteeism tool (the Work Productivity and Activity Impairment Questionnaire: General Health) were also incorporated. A total of 1,171 completed surveys were returned and used for analysis. RESULTS: Among respondents, the prevalence of musculoskeletal pain was 71%; that of depression was 18%. The majority of respondents (62%) reported a presenteeism score of at least 1 on a 0-to-10 scale, indicating that health problems had affected work productivity at least "a little." Pain and depression were significantly associated with presenteeism. Presenteeism was significantly associated with a higher number of patient falls, a higher number of medication errors, and lower quality-of-care scores. Baseline cost estimates indicate that the increased falls and medication errors caused by presenteeism are expected to cost $1,346 per North Carolina RN and just under $2 billion for the United States annually. Upper-boundary estimates exceed $9,000 per North Carolina RN and $13 billion for the nation annually. CONCLUSION: More attention must be paid to the health of the nursing workforce to positively influence the quality of patient care and patient safety and to control costs.