Lose the Whoosh: An Evidence-Based Project to Improve NG Tube Placement Verification in Infants and Children in the Hospital Setting.

PURPOSE: The purpose of this EBP project was to align NG and OG tube placement and verification practices with evidence-based recommendations for children. PRACTICE CHANGE: An evidence-based NG/OG Tube Placement Algorithm was developed. The algorithm provided an individualized approach based on patient condition as well as a tiered approach that incorporated radiographs, tube measurement and marking, and pH testing. METHODS: A systematic appraisal of literature identified 40 studies supporting the development of the practice change. A 9-item questionnaire was administered to nurses across five pediatric units to assess current tube verification practices. Education was provided in participating units through a Competency Fair. Post-implementation evaluation included re-administering the practice survey and conducting a chart audit of NG/OG events occurring in the year following the practice change. RESULTS: Seventy-one nurses completed the pre-implementation survey; 64 nurses completed the post-implementation survey. Strategies for checking NG/OG placement varied across units prior to implementation; however, auscultation was the most likely to be used strategy and assessing pH was the least likely to be used strategy across units. Post-implementation, aspiration and checking pH were the most frequently endorsed assessment strategy, and auscultation was the least endorsed strategy. The post-implementation chart audit revealed that 73% of NG/OG tubes were checked for placement on insertion with radiograph or aspirate pH. CONCLUSIONS: Implementation of an NG/OG Tube Placement Algorithm standardized NG/OG care across five pediatric units. Additional efforts are underway to further improve adherence to protocol in order to ensure safe, evidence-based practice for children with NG/OG tubes.

Quantitative systematic review of the effects of non-pharmacological interventions on reducing apathy in persons with dementia.

AIM: To review the quantitative evidence concerning the effects of non-pharmacological interventions on reducing apathy in persons with dementia. BACKGROUND: Apathy, a prevalent behavioural symptom among persons with Alzheimer Disease, is defined as a disorder of motivation with deficits in behavioural, emotional and cognitive domains and is associated with serious social and physical obstacles. Non-pharmacological interventions show promise as symptom control modalities among persons with dementia. DESIGN: Quantitative systematic review. DATA SOURCES: CINAHL, PubMed, PSYCHinfo and Cochrane Trials databases were searched for published English language research inclusive through December 2014, with no early year limiters set. REVIEW METHODS: Comprehensive searches yielded 16 international randomized controlled trials or quasi-experimental studies based on inclusion criteria and a rigorous quality appraisal process. RESULTS: A narrative summary analysis revealed that non-pharmacological interventions for apathy varied substantially and lacked specificity, conceptual clarity and were methodologically heterogeneous. Select interventions demonstrated effectiveness, but lacked systematic long-term follow-up. Limitations include publication bias and lack of a meta-analytic approach due to the methodological heterogeneity of included studies. CONCLUSION: Study results demonstrate promise for the use of non-pharmacological interventions, particularly music-based interventions, in reducing apathy levels in individuals with dementia. Intervening to reduce apathy may have a positive clinical impact and healthcare providers should be encouraged to incorporate positive sources of interest and intellectual stimulation into care. However, future research is needed to examine the aetiologic mechanism and predictors of apathy, to improve evidence-based interventions and specificity and to optimize dosage and timing of non-pharmacological interventions across the disease trajectory.

Pedigree structure and kinship measurements of a mid-Michigan community: a new North American population isolate identified.

Previous studies identified a cluster of individuals with an autosomal recessive form of deafness that reside in a small region of mid-Michigan. We hypothesized that affected members from this community descend from a defined founder population. Using public records and personal interviews, we constructed a genealogical database that includes the affected individuals and their extended families as descendants of 461 settlers who emigrated from the Eifel region of Germany between 1836 and 1875. The genealogical database represents a 13-generation pedigree that includes 27,747 descendants of these settlers. Among these descendants, 13,784 are presumed living. Many of the extant descendants reside in a 90-square-mile area, and 52% were born to parents who share at least one common ancestor. Among those born to related parents, the median kinship coefficient is 3.7 × 10(-3). While the pedigree contains 2,510 founders, 344 of the 461 settlers accounted for 67% of the genome in the extant population. These data suggest that we identified a new population isolate in North America and that, as demonstrated for congenital hearing loss, this rural mid-Michigan community is a new resource to discover heritable factors that contribute to common health-related conditions.

Bridging the gap: perceived educational needs in the inpatient to home care setting for the person with a new ostomy.

PURPOSE: The purpose of this study was to investigate what specific ostomy self-care educational content is considered the most useful by the new ostomy patient after discharge. DESIGN: A cross-sectional, correlational design was used to address study aims. SUBJECTS AND SETTING: The sample comprised 33 men and 27 women with a mean age of 55.58 ± 15.56 (mean ± SD) years, range 27 to 79 years old. The study setting was a 587-bed teaching hospital, level 1 trauma center in the Midwest, with Magnet designation. METHODS: Demographic data were collected during the patients' hospital stay as part of routine care. This information is used for follow-up with all ostomy patients who have surgery in this hospital. All of the participants in this study completed an interview administered by phone or in person. A semistructured interview guide was used to elicit participant perceptions of the usefulness of 4 categories of ostomy care, including (1) ostomy information (ostomy function), (2) activities of daily living (strategies to manage travel, bathing, intimacy, odor), (3) ostomy care (strategies for managing the ostomy), and (4) other informational needs (social support resources). Participants were asked to rate these 4 areas from most useful to least useful, using a 4-point scale. At the end of the interview, participants were asked, "Has there been anything that has happened or event related to your ostomy that your ostomy teaching did not prepare you for?" The interview took place several weeks after surgery or during their readmission visit for surgical ostomy takedown. RESULTS: Sixty-two patients were enrolled into the study, and 60 participants completed the data collection. The sample included 26 (43%) patients with ileostomies, 18 (30%) with colostomies, and 16 (27%) with urostomies. Ninety percent ranked the education category of ostomy self-care as the most useful content, 55% ranked information on resuming activities of daily living as the second most useful category, and 55% ranked general information as third most useful content area. Fifty respondents (83%) ranked ostomy support as the least useful. Nine (15%) of the participants felt unprepared for their first pouch leak, and 2 (3%) reported difficulty adjusting to the feel of the stool entering the pouch. Two patients would have liked more photos of peristomal skin conditions and how to treat them. CONCLUSIONS: Since the category of ostomy self-care ranked highest, patient teaching for the new ostomy patient should focus on this skill set, including stoma care, how, and when to empty and change the pouch.

The implications of genomics on the nursing care of adults with neuropsychiatric conditions.

PURPOSE: Neuropsychiatric disorders contribute substantially to disease burden and quality of life across the lifespan and the globe. The purpose of this article is to review the state of the science regarding genomic contributions to selected common neuropsychiatric conditions and to examine the consequent immediate and future implications for nursing practice and research. ORGANIZING CONSTRUCT: Our work is guided by an ecological model that recognizes that common diseases are complex or multifactorial, meaning that multiple genomic and environmental factors contribute to their etiology. METHODS: A review of the literature was conducted to determine the state of the science in relationship to the genomic contributions to selected neuropsychiatric disorders. FINDINGS: Neuropsychiatric conditions are genomically heterogeneous, both within a single disorder and across groups of disorders. While recent genomic research yields clinically validated and useful information for a small subset of persons (e.g., predictive genetic testing for Huntington disease and early-onset Alzheimer disease), broad clinical application of genetic information is not yet available. In addition, the implications of genomics for the development and targeting of nonpharmacologic treatment strategies is largely unexplored. CONCLUSIONS: Further research is needed to expand knowledge beyond genomic risk for the presence of disease to knowledge about the genomic risk for symptoms, symptom burden, and tailored symptom management interventions. CLINICAL RELEVANCE: Knowledge about the genomic influences on neuropsychiatric conditions suggests important implications for practicing nurses in the identification of persons at risk, provision of follow-up support, and in the administration of medications.

Exploration of a symptoms experience in people with obesity-related nonalcoholic fatty liver disease.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent condition strongly associated with obesity that can result in premature death. Little is known about the symptoms experience in this progressive disease, preventing health care providers from intervening in the early stages. PURPOSE: This study explicated symptoms in persons with NAFLD at higher risk of disease progression defined as the presence of one or two copies of the PNPLA3 (rs738409)-G allele. METHOD: Guided by the Symptoms Experience Model, 42 persons older than 21 years of age with diagnosed NAFLD were recruited from Western Michigan specialty offices in this cross-sectional descriptive study design. The Memorial Symptom Assessment Scale was used to measure the symptoms experience. DISCUSSION: Participants (97%) experienced 1 or more symptoms (average number of symptoms 12.02, standard deviation = 8.817). There was no statistically significant relationship between symptoms and the PNPLA3 (rs738409) variants. Significant predictors of mean frequency, severity, and distress of symptoms (the Total Memorial Symptom Scale) (F[15, 25] = 2.609, p = .016) were identified. CONCLUSION: People with NAFLD experience an average of 12 symptoms.

Genetic testing and Alzheimer's disease: implications for psychiatric-mental health nursing.

Alzheimer's disease (AD), the most common cause of irreversible dementia, continues to grow in prevalence as well as public health impact. Extensive research into the genetic etiology of AD has yielded knowledge of some genetic factors that are causative and other genetic factors that increase risk for disease. Consequently, the possibility of genetic testing in individuals with or at risk for AD is a question that nurses may be asked. Psychiatric-mental health (PMH) professionals are in key positions to influence the care of individuals who are considering the effect of genetic information on their health care decisions. Whether by working within interdisciplinary genetic counseling teams to provide direct specialty services or by developing skills to identify and refer individuals at risk for or concerned about their risk for AD, PMH nurses can play an important role in the health care of individuals and families experiencing AD.

Perceived Hearing Impairment in a Rural Community.

CoSAGE Community Advisory and Ethics Committee; Age-related hearing impairment yields many negative outcomes, including alterations in mental health, functional impairments, and decreased social engagement. The purpose of the current study was to examine perceived hearing impairment and its relationship with person-centered outcomes among adults in a rural community setting. A cross-sectional, descriptive correlational design was used. Survey packets of validated instruments were distributed following all weekend services at a rural community church; 72 completed surveys were returned (26% response rate). Descriptive and inferential statistics, including Spearman's rank correlations (rs), were used to address the study aims. Mean age of participants was 54 years (SD = 17 years), 58% were female, and 97% attended church regularly. Thirty-one percent of respondents reported moderate to severe hearing impairment. Perceived hearing impairment was associated with more depressive symptoms (rs = 0.24, p = 0.052), poorer attentional function (rs = -0.29, p = 0.016), and decreased quality of life in the mental health domain (rs = -0.21, p = 0.081). Findings expand evidence supporting the relationship between hearing and person-centered outcomes, including a functional measure of cognition. These results serve as a foundation for the design of a community-driven, church-based hearing health intervention. [Research in Gerontological Nursing, 16(1), 21-32.].

Linking Hospitals to Communities Through Evidence-Based Practice.

ABSTRACT: Evidence-based practice (EBP) and innovation are critical to quality and improved outcomes in the acute care setting and are often driven by bedside caregiver and clinical nurse specialist collaboration. Several EBP models and frameworks exist to guide these efforts. Although existing models do not preclude external evidence and community-based stakeholders, they largely do not explicitly connect the hospital-based effort to the community either. In our experience in facilitating EBP projects within an acute care hospital in the upper Midwest, we observed multiple situations in which nurse-led EBP projects intersected with the surrounding community in multiple phases of the project. The purpose of this article is to demonstrate an explicit connection between hospital-placed EBP processes and community/population health. To illustrate this assertion, 3 exemplars of nurse-driven, hospital-placed innovation are presented. Implications for practice and research are discussed.

Saitohin and APOE polymorphisms influence cognition and function in persons with advanced Alzheimer Disease.

BACKGROUND/AIMS: Alzheimer disease (AD) is characterized by variability in the onset and progression of cognitive, functional and behavioral symptoms. The purpose of this study was to identify genetic correlates of symptom variability in persons with moderate-to-advanced AD. METHODS: Repeated measures of cognition, function and behavior were collected from institutionalized persons with AD over 12 months. Candidate genes were assayed. RESULTS: Single polymorphisms within the saitohin and APOE genes were associated with increased cognitive impairment and functional dependence. The APOE-ε4 allele was associated with increased baseline physical agitation. CONCLUSION: The development of predictive profiles for the clinical symptoms of AD may increase our ability to identify clinical subgroups for more targeted intervention.

Development of the Huntington disease family concerns and strategies survey from focus group data.

Health concerns and management strategies among families of young and middle-age adults with Huntington's disease (HD) are unknown. This study developed and tested psychometric properties of the Huntington Disease Family Concerns and Strategies Survey (HDFCSS). Focus group data from 91 adult family members were used to develop content. Content analysis yielded four domains that were transferred into Personal, Person With HD, Community Health Care Services, and Strategies scales. Focus group data, expert validation, and cognitive interviews demonstrated survey content validity. Cronbach's alpha internal consistency coefficients for the scales were 0.83 or above. The measure can be used to generate reliable and valid data to identify adult family members' health-related concerns and management strategies for themselves and persons with HD.

Genetic Predictors of Knee Pain in Persons With Mild to Moderate Osteoarthritis.

The purpose of this study was to examine genetic variability and knee pain in persons with osteoarthritis (OA). Seventy-five participants with medial compartment knee OA were recruited from a large Midwestern tertiary care center. Participants exhibited a mean age of 56.3 years; females comprised 61% of the sample. Measures of pain included subjective pain intensity at rest and with movement, cutaneous mechanical sensation and pain testing, heat pain threshold, and pressure pain threshold. Seventy-four participants were genotyped for 25 genetic variants across 15 candidate genes for central or peripheral pain pathways. Analysis suggests a role for four genes (EDNRA, COMT, BDRKB1, and IL1B) in several components of pain in persons with knee OA. The results from this study will help guide the development and evaluation of tailored strategies to decrease pain, improve function, and prevent the development of new chronic pain syndromes in older adults experiencing OA. [Research in Gerontological Nursing, xx(x), xx-xx.].

Effects of genotype on TENS effectiveness in controlling knee pain in persons with mild to moderate osteoarthritis.

BACKGROUND: This study examined the extent to which genetic variability modifies Transcutaneous Electrical Nerve Stimulation (TENS) effectiveness in osteoarthritic knee pain. METHODS: Seventy-five participants with knee osteoarthritis were randomly assigned to either: (a) High-frequency TENS, (b) Low-frequency TENS or (c) Transient Placebo TENS. Pain measures were collected pre- and post-treatment. Participants were genotyped on genes implicated in central or peripheral pain pathways: NGFB, NTRK1, EDNRA, EDNRB, EDN1, OPRM1, TAC1, TACR1, BDNF, BDKRB1, 5HTT, COMT, ESR2, IL6 and IL1B. Genetic association using linear regression modelling was performed separately for the transient placebo TENS subjects, and within the High-frequency TENS + Low-frequency TENS participants, including TENS level as a covariate. RESULTS: In the placebo group, SNPs rs165599 (COMT) was significantly associated with an increased heat pain threshold (ß = -1.87; p = .003) and rs6827096 (EDNRA) with an increased resting pain (ß = 2.68; p = .001). Within the treatment groups, TENS effectiveness was reduced by the SNP rs6537485 (EDNRA) minor allele in relationship to mechanical sensation (ß = 184.13; p = 5.5E-9). Individuals with the COMT rs4680 minor allele reported lowered pain at rest after TENS (ß = -42.30; p = .001), with a higher magnitude of pain reduction (28 unit difference) in the low-frequency TENS group compared to the high-frequency TENS group (ß = 28.37; p = .0004). CONCLUSIONS: EDNRA and COMT are implicated in osteoarthritic knee pain and provide a basis for tailoring TENS interventions according to individual characteristics. SIGNIFICANCE: Findings from this study demonstrate that genetic variation within the COMT and EDNRA genes influences the effectiveness of TENS, a non-pharmacologic pain-reduction intervention, in the context of osteoarthritic knee pain. Evidence such as this may contribute to risk models that provide a clinically useful tool for personalizing TENS interventions according to individual characteristics in order to best control pain and maximize functional status.

Genetic Variants and the Cortisol Response in Children: An Exploratory Study.

OBJECTIVE: We examined genomic variation potentially associated with the cortisol stress response in children having a painful medical procedure. DESIGN: Children 4-10 years old having a peripheral intravenous line inserted provided saliva samples for evaluation of the cortisol response as a biological measure of distress: two on the day of the procedure and two at home on a nonstressful day for comparison values. Children and biological parents also provided samples for genotyping of variants with known or suspected association with the cortisol stress response. Analysis included child-only association and family-based transmission disequilibrium tests (TDTs). RESULTS: Genotype and phenotype data on the cortisol stress response were available from 326 children for child-only association analyses and 376 complete family trios for TDTs. Children were 50% female, an average of 7.5 years old, and mostly (83%) White/non-Hispanic. We identified four single-nucleotide polymorphisms (SNPs) potentially associated with the cortisol stress response: rs1176744 ( HTR3B), rs10062367 ( CRHBP), rs634479 ( OPRM1), and rs8030107 ( NTRK3). Family-based analysis identified a two-SNP haplotype in HTR1B suggestive for association with the cortisol response (rs6296, rs11568817). Allelic TDTs identified rs7897947 ( NFKB2) as potentially related to cortisol response. CONCLUSIONS: Findings provide preliminary evidence for genes potentially important in cortisol response to an acute stressor in children in the serotonin, dopamine, and brain-derived neurotrophic factor pathways, the hypothalamic-pituitary-adrenal axis, and the inflammatory response. Combined with analyses of related phenotypes and clinical data, these results could help identify patients at increased risk of adverse responses to painful medical procedures who might benefit from tailored interventions.

Experiences of teens living in the shadow of Huntington Disease.

Research on families with Huntington Disease (HD) has primarily focused on adult decision-making surrounding predictive genetic testing and caregiver stress. Little is known about the experiences of teens living in these families. This qualitative study explored the experiences of 32 teens living in families with HD. Six focus groups were conducted across the U.S. and Canada. Data were analyzed using descriptive qualitative analysis. Huntington disease appeared to cast a shadow over the experiences described by teens. Four themes were identified: watching and waiting; alone in the midst of others; family life is kind of hard; and having to be like an adult. These experiences highlight the need for genetic counselors, health care providers, and school personnel to be aware of issues facing teens living in families with HD. Recognizing patterns of teen experiences may help health care providers develop strategies to support coping by teens in HD families.

Consumer health informatics: from genomics to population health.

Innovations in health information technology have ushered in a new era of health care. The use of emerging information and communication technology to improve or enable health and health care is the central focus of consumer health informatics (CHI). Traditionally, CHI interventions to promote health and well-being have targeted the individual or family. Advances in genomic health and the emergence of public health informatics call for broadening the scope of CHI. The authors discuss CHI from the point-of-view of the consumer (e.g., from individuals to policy makers) and the level of health data from the subcellular (e.g., genetic or protein structures) to population (e.g., geographically-referenced information).

Predictors of topical anesthetic effectiveness in children.

UNLABELLED: Some children report significant pain with peripheral intravenous catheter (IV) insertion, despite the appropriate use of topical lidocaine anesthetics. This analysis of data from an existing study identified factors related to variation in topical anesthetic effectiveness used for IV insertion. The children (n = 218) in this investigation were 4 to 10 years old and undergoing a scheduled IV insertion. Inclusion criteria were (1) topical anesthetic was used according to manufacturer's recommendations, (2) DNA material was available, and (3) child completed a self-report measure of pain intensity (Oucher scale). Low pain phenotype was defined as a pain intensity score of 0 to 3, and high pain phenotype was an intensity score of 4 to 10. Potential predictor variables included child age, gender, number of previous painful procedures, state and trait anxiety, temperament characteristics, and alleles in 3 candidate genes in a pain pathway influenced by topical anesthetics (endothelin-1 [EDN1], endothelin receptor A [EDNRA], endothelin receptor B [EDNRB]). All subjects were genotyped for a single-nucleotide polymorphism in each gene. Children in the high pain group (n = 89) were significantly younger (P < .0001), more active (P = .0029), scored higher for trait (P = .0009) and state anxiety (P = .0312), and had the EDNRA TT genotype (high pain group, TT 67.35%; low pain group, TT 39.47%; P = .026). PERSPECTIVE: The identification of factors that influence peripheral pain sensation aids in selecting the most appropriate pharmacologic and nonpharmacologic interventions. Until genotyping is available at a clinically prescriptive level, other predictors (eg, age and activity level) can be used to tailor pain-relieving strategies for children undergoing needle sticks.

Relationship of Genetic Variants With Procedural Pain, Anxiety, and Distress in Children.

OBJECTIVE: This study used a candidate gene approach to examine genomic variation associated with pain, anxiety, and distress in children undergoing a medical procedure. STUDY DESIGN: Children aged 4-10 years having an IV catheter insertion were recruited from three Midwestern children's hospitals. Self-report measures of pain, anxiety, and distress were obtained as well as an observed measure of distress. Samples were collected from children and biological parents for analysis of genomic variation. Genotyped variants had known or suspected association with phenotypes of interest. Analyses included child-only association and family-based transmission disequilibrium tests. RESULTS: Genotype and phenotype data were available from 828 children and 376 family trios. Children were 50% male, had a mean age of 7.2 years, and were 84% White/non-Hispanic. In family-based analysis, one single-nucleotide polymorphism (SNP; rs1143629, interleukin ( IL1B) 1ß) was associated with observed child distress at Bonferroni-corrected levels of significance ( p = .00013), while two approached significance for association with high state anxiety (rs6330 Nerve Growth Factor, Beta Subunit, [ NGFB]) and high trait anxiety (rs6265 brain-derived neurotrophic factor [ BDNF]). In the child-only analysis, multiple SNPs showed nominal evidence of relationships with phenotypes of interest. rs6265 BDNF and rs2941026 cholecystokinin B receptor had possible relationships with trait anxiety in child-only and family-based analyses. CONCLUSIONS: Exploring genomic variation furthers our understanding of pain, anxiety, and distress and facilitates genomic screening to identify children at high risk of procedural pain, anxiety, and distress. Combined with clinical observations and knowledge, such explorations could help guide tailoring of interventions to limit procedure-related distress and identify genes and pathways of interest for future genotype-phenotype studies.

Integrating molecular genetics analyses into clinical research.

The integration of molecular genetics approaches into the study of complex health phenomena is an increasingly important and available strategy for researchers across the health science disciplines. Pain sensation and response to painful stimuli are examples of complex health phenomena that are particularly amenable to molecular genetics approaches. Both human and animal model research suggests that differences in these responses may be related, in part, to variation in the genes that modulate sensation and behavior. The authors are currently managing a large cross-disciplinary research effort to identify child characteristics, including genotypes, that predict the degree of distress displayed by children following a painful medical procedure (i.e., IV insertion). The purpose of this article is to describe the strategies used to integrate molecular genetics methods into this project. The authors discuss the steps needed to complete this process, including (a) establishing a collaboration with genetics researchers and laboratory facilities, (b) developing and implementing a plan to manage biologic samples, and (c) incorporating genetics into the informed consent process.

Alzheimer disease and genetics: anticipating the questions.

Three genes with autosomal dominant mutations have been identified that may lead to Alzheimer symptoms in carriers before they reach age 60. Genetic tests exist for Alzheimer disease, but they are considered useful only for the small number of families with a history of early-onset illness. As researchers continue to uncover evidence of genetic links to Alzheimer disease, nurses can expect to field questions from family members about genetic testing. The article presents a variety of questions nurses may be asked, as well as possible answers.