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Chronic illness, advances in medical technology, and the rising costs of health care have led to an increased need for family caregivers. Although most caregiver research focuses on the experience [...], This study explored experiences associated with burden, depressive symptoms, and perceived health in six male caregivers of persons with end stage renal disease (ESRD) using qualitative interviews. Analysis employed open coding and analysis to generate codes and categories. Eighty-three percent of the participants reported significant subjective and objective burden. Linkages occurred between sociodemographic characteristics, care recipient attributes, and caregiver-care recipient relationship, and caregivers' experience of burden and depressive symptoms. Findings suggest the need for intervention trials targeting new coping strategies to help improve the well-being of this population. Key Words: Caregivers, depression, end stage renal disease, ESRD, male, qualitative research.

By the end of 2015, over 2.5 million individuals had been diagnosed with end stage renal disease (ESRD), and this number continues to increase by approximately 21,000 annually. In addition, [...], This literature review examined burden, depressive symptoms, and perceived health reported by male caregivers of persons with end stage renal disease. These studies suggest that male caregivers often experience negative outcomes. Compared to non-caregivers, male caregivers had higher levels of anxiety and depressive symptoms. Qualitative studies suggest depression is common and associated with conflict between caregiving responsibilities and work, poor caregiver health, and fears about the future outcomes of relatives for whom they provide care. Future research will assist healthcare providers to identify at-risk male caregivers and develop effective interventions to support this understudied caregiver population. Key Words: Male, caregivers, end stage renal disease (ESRD), burden, depression.

OBJECTIVE--Compared with Caucasians, obese African-American adolescents have a higher risk for type 2 diabetes. Subclinical inflammation and reduced glucagon-like peptide 1 (GLP-1) concentration are linked to the pathogenesis of the [...]

In Brief Critical periods for the development of childhood obesity have been established. Health care providers should recognize these periods for initiation of interventions to prevent obesity because treatment options [...]

Evidence-based practice involves integrating the best available evidence from research with clinical expertise and patient values to achieve optimal patient outcomes (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). Determination of [...]

Lifelong administration of multiple immunosuppressants is usually required to maintain function of a transplanted kidney. Selection of immunosuppressant agents has been geared toward preventing acute rejection and minimizing drug-induced side [...]

Patricia Cowan, PhD, Donna Hathaway, PhD, Mona N. Wicks, PhD, Richard Kreider, PhD, A. Osama Gaber, MD University of Tennessee, Memphis, [...], Impaired HRV has been associated with increased morbidity and mortality in transplant recipients (TR). Exercise has been associated with better HRV in transplant candidates. Exercising TR reported better QoL than non-exercisers, however, diabetics have typically been excluded. This study examined the relationship between HRV, QoL, and FC in 42 TR (42% diabetic) who were 2-8 months post-transplant. TR completed a maximal cardiopulmonary exercise test, evoked and 24-hour HRV measures, and QoL questionnaires [GenQoL and Sickness Impact Profile (SIP)]. Data were analyzed using Pearson's correlation coefficients with an alpha level of .05 set for statistical significance. Higher scores on the SIP reflect greater disability and poorer QoL. Higher peak [VO.sub.2] and FC were significantly associated with less physical disability on the SIP (r = -.34 and -.40). Better GenQoL scores, reflecting global QoL, tended to be associated with better FC (r = .26, p [is less than] 0.10). Higher FC and peak [VO.sub.2] were associated with better evoked HRV (r = .33 to .42) and tended to be associated with better 24-hour HRV frequency measures (r = .28 to .30, p [is less than] 0.10). An age effect was not apparent. Greater duration of diabetes was significantly associated with poorer FC (r = -.35), peak [VO.sub.2] (r = -.31), and GenQoL (r = -.37) but not poorer SIP scores. There was a trend toward poorer parasympathetic and circadian HRV measures with increased length of diabetes. Greater FC was associated with better HRV and QoL in diabetic and non-diabetic TR. The disparity between FC and reported physical disability suggests TR adapted to their limited FC. Interventions to improve FC may also improve HRV and QoL of TRs.

Patricia Cowan, PhD, Donna Hathaway, PhD, Mona Wicks, PhD, Richard Kreider, PhD, Osama Gaber, MD University of Tennessee, Memphis, [...], Although studies suggest exercise training improved KTRs' functional capacity (FC) and peak [VO.sub.2], studies typically exclude diabetic KTR and KPTR. This presentation discusses the development of an exercise rehabilitation program for recent KTR and KPTR, and evaluates the effect of the exercise intervention on peak [VO.sub.2] and FC. At 6-16 weeks post-transplant, a maximal cardiopulmonary exercise tolerance test (ETT) was performed on 41 KTR and KPTR. Both FC (5.44 ± 2.01 METS, range 1.47-11.15) and peak [VO.sub.2] (15.98 ± 4.66 ml/kg/min, range 6.55 - 7.90) measures were lower than values reported in the literature. Four KPTR and 1 KTR (12%) exhibited evidence of myocardial ischemia during the ETT, despite pretransplant cardiac work-ups, and were referred for further evaluation. A subgroup (n=21) completed the 4-month aerobic exercise program, prescribed at 95% of ventilatory anaerobic threshold, and upper body strength exercises. Initially aerobic exercise lasted 10-15 minutes and included treadmill walking, cycling, rowing or arm ergometry. Every 2 weeks aerobic exercise time increased by 5 min, with most recipients progressing to 45 min by study completion. Progression in the number of repetitions, sets, and weights used in strength exercises also occurred. Data were analyzed using repeated measures ANOVA. Exercisers significantly improved FC (21%) and peak [VO.sub.2] (29%) compared to non-significant increases in non-exercisers. Despite their poor FC, KTR and KPTR are capable of participating in a structured exercise program. Exercise rehabilitation improves FC and peak [VO.sub.2] beyond that achieved by non-exercisers. Careful screening is required prior to initiating exercise programs due to the high incidence of early post-transplant myocardial ischemia.

Background:Many changes have occurred in DNP programs since they first began. University of Tennessee Health Science Center began the practice doctoral program in 1999 and today enrolls over 100 new baccalaureate nursing (BSN)-to-Doctor of Nursing Practice (DNP) students each year. More than 500 DNPs have graduated to date.Method:A review of the history and challenges of this program are presented as a potential exemplar for other programs to consider.Results:Several changes have taken place, including a shift from Master of Science in Nursing (MSN)-to-DNP programs to almost all BSN-to-DNP programs, a new appreciation for writing skills, and movement away from a separate DNP project.Conclusion:Understanding these changes may help other schools of nursing as they begin DNP programs or transition from their MSN-to-DNP programs to BSN-to-DNP programs. [Understanding these changes may help other schools of nursing as they begin DNP programs or transition from their MSN-to-DNP programs to BSN-to-DNP programs. [J Nurs Educ. 2016;55(10):563–567.]

Background:The nursing and health care workforce needs diverse clinicians who can provide culturally competent and high-quality care to an increasingly diverse U.S. population. Achieving this goal requires creating learning environments that foster the success of disadvantaged underrepresented minority (URM) students seeking nursing careers.Method:This 4-week summer prematriculation program introduced 33 URM individuals from disadvantaged backgrounds to nursing as a career through financial support, academic enrichment, and social support to enhance nursing program admission success. Federal guidelines were used to establish URM and economically disadvantaged status.Results:To date, one third of program participants have been admitted to nursing programs.Conclusion:Fundamental reforms in pre-college education systems, such as the evidence-based strategies implemented in our summer prematriculation program, may be needed to achieve a diverse, culturally competent workforce that can help eliminate persistent health and health care disparities. [Fundamental reforms in pre-college education systems, such as the evidence-based strategies implemented in our summer prematriculation program, may be needed to achieve a diverse, culturally competent workforce that can help eliminate persistent health and health care disparities. [J Nurs Educ. 2016;55(8):471–475.]

Background:Diverse health care workers are essential to meet the needs of a diverse U.S. population. Ethnic minorities and men are frequently underrepresented in the nursing profession and within schools of nursing. Although many nursing schools have implemented programs to improve retention and academic success of these students, the lack of success is, in part, a reflection of program ineffectiveness.Method:A nursing college developed the multifaceted SUSTAIN (A nursing college developed the multifaceted SUSTAIN (Scholarships for Underrepresented Students in an Accelerated Initial Nursing) program to promote ethnic minority and male students’ success in an accelerated entry-level master of nursing program. Students engaged in mentoring, academic support, and service-learning activities.Results:Participants (Participants (N= 51) achieved 100% retention and graduation rates and a 92% first-time NCLEX-RN®examination pass rate. Program students participated in professional organizations and held leadership roles within the college.Conclusion:Implementation of a program focused on student retention and success is recommended for diverse students enrolled in accelerated entry-level master of nursing programs. [Implementation of a program focused on student retention and success is recommended for diverse students enrolled in accelerated entry-level master of nursing programs. [J Nurs Educ.2015;54(9, Suppl.):S112–S115.]

Context— Weight gain after kidney transplantation affects 50% to 90% of kidney transplant recipients. Factors leading to weight gain in recipients are thought to include a change in lifestyle (eg, dietary intake and physical activity), age, race, sex, and immunosuppressant medications.Objective— To examine dietary intake and physical activity of kidney transplant recipients at baseline and 3 and 6 months after transplantation to identify contributing factors to weight gain.Design— Descriptive, correlational study using secondary data from a larger parent study examining genetic and environmental contributors to weight gain after kidney transplantation.Participants and Setting— Forty-four kidney transplant recipients at a mid-South university hospital-based transplant institute who had dietary intake, physical activity, and clinical data at baseline and 3 and 6 months were included.Main Outcome Measures— Dietary intake, physical activity, weight, and body mass index.Results— Mean weight gain increased by 6% from baseline to 6 months. Interestingly, dietary intake did not change significantly from baseline to 6 months. Hours of sleep per day decreased during the same period (P= .02). Dietary intake, physical activity, age, race, sex, and immunosuppression showed no significant relationship to weight gain at 6 months.Conclusion— Little consideration has been given to dietary intake and physical activity of kidney transplant recipients and the effects of these variables on weight gain. Further studies with a larger sample are needed, as weight gain after transplantation is a significant risk factor for diminished long-term outcomes.

The ability to isolate high-yield pure and viable islets from human cadaver pancreas donors is dependent on donor factor as well as isolation factors. The aim of this study was to examine factors influencing islets recovery and in vivo function with an emphasis on donor and isolation methods as well as to compare the effectiveness of Liberase, widely used in clinical islet isolation, with Serva for the isolation of pure functional islets. The results of 123 islet isolations using Liberase for digestion were compared with those of 113 isolations with Serva. Islet equivalents per gram of tissue were similar between Liberase and Serva (3620 ± 1858 vs. 4132 ± 2104, p < 0.2) as well as the percent purity (75 ± 16 vs. 74 ± 15, p < 0.9). In vivo function of islets from 71 isolations (Liberase = 45, Serva = 26) were further tested by transplantation into NOD-SCID mice following short-term culture (<6 days, n = 71). Our data show that both Liberase- and Serva-isolated islets showed similar function results following short-term culture. These data demonstrate that there is no difference in islet yield, purity, and function between the two enzymes. However, when these 71 isolations were analyzed for in vivo function with emphasis on donor factors, cold ischemia time (12.0 ± 5.3 vs. 15.0 ± 5.7, p < 0.04), islet integrity (1.6 ± 0.7 vs. 1.3 ± 0.5, p < 0.05), and female gender were the only factors that correlated with in vivo function. We also compared the mechanical-shaking method for islets isolation with hand-shaking methods. Our results show that although there is no different in islet yield, purity, and integrity between different enzymes using the same method, hand-shaking method yields more islets with better integrity than mechanical-shaking method.

Background—Relatively few transplant recipients participate in regular physical activity. There is a paucity of information regarding barriers and facilitators to physical activity in kidney transplant recipients.Objective—To investigate factors that transplant recipients perceive as barriers and facilitators to physical activity and whether these barriers and facilitators differ on the basis of transplant patients' reported level of physical activity.Method—Using a descriptive, cross-sectional design, a convenience sample of 100 kidney transplant recipients provided survey data on a physical activity questionnaire on their current levels of physical activity and determinants that influence participation in physical activity.Results—The "rarely/never" (32%) physical activity group reported more frequent barriers and the "often" (20%) group reported the least. Overall, perceived facilitators were reported most frequently by the "often" (80%) physical activity group and least by the "rarely/never" (67%) group.Conclusions—Motivational interventions should focus on diminishing perceived barriers in the less physically active transplant recipients and enhancing perception of health-related facilitators. Nurses should be innovative in customizing interventions, recommending structured physical activity programs, and encouraging less structured, enjoyable ways to increase activities that expend energy. Interventions with achievable outcomes and realistic expectations are more acceptable to patients.

Context—Obesity frequently occurs following kidney transplantation and is of concern because of the associated risk for cardiovascular complications.Objective—To examine weight gain over the first year after kidney transplantation to determine associations with gender, ethnicity, and cardiovascular risk factors.Design—A retrospective analysis was completed on patients who had received transplants between January 1998 and January 2002 and who had matching baseline and 1-year follow-up data and a functional graft.Participants—The sample consisted of 171 recipients (33% women, 58% African Americans, and 39% whites) with a mean age of 44 ± 12.2 years.Main Outcome Measures—Outcome measures included fasting blood sugar, triglycerides, creatinine levels, and body mass index categorized as normal, overweight, or obese.Results—The total group showed a significant increase in mean weight (6.2 ± 10.7 kg) and body mass index (2.1 ± 3.8). Although equivalent at baseline, by 1 year after transplantation there were significantly more obese than normal-weight recipients, regardless of gender or ethnicity, with African Americans increasing more than whites and women more than men. At baseline, those characterized as obese versus normal weight were older (47 vs 41 years; P< .05), with a higher fasting blood sugar. At 1 year, differences in age and fasting blood sugar disappeared; however, the obese group had higher triglycerides (235 vs 165, P=.01).Conclusions—Weight gain after transplantation was not explained by demographic and clinical factors. We speculate additional variables such as genetic factors influence weight gain and warrant study.

Background—A major problem in the islet field is the high selectivity exercised in accepting cadaveric pancreas for islet isolation. This practice is based on experience that indicates that islet yield and posttransplant function are related to donor demographics and injury mechanisms.Objective—To examine factors influencing islets recovery and in vivo function with emphasis on donor-related factors.Methods—Islets were isolated from 99 human donor pancreata, and islet yield was reported as islet equivalent per gram pancreatic tissue. Donor, procurement, and isolation factors were collected for each isolation and correlation statistics were performed between these variables and islet yield.Results—Results indicated a differential effect of enzyme mixes on yield with Collagenase P digestion most suitable for increased ischemic time (R2= 0.1; P<.08), Liberase with small donor pancreas size and elevated preprocurement glucose (R2= 0.15; P<.02), and Serva with female donors (R2= 0.17; P<.06). Islets from 29 isolations were further tested by transplantation under the kidney capsule of immune-deficient NOD-SCID mice. Although all 29 preparations had acceptable in vitro perfusion parameters indicating viability, only 19 functioned in vivo with serum levels of insulin >5 U/mL and C peptide >1.5 ng/mL. No significant differences in donor, procurement, and isolation factors were evident between the islet preparations that functioned in vivo and those that were nonfunctional.Conclusions—These data demonstrate that although yield is affected by a variety of donor factors and enzyme mixes, these factors do not affect islet in vivo function.

Context Cardiac autonomic function has been associated with mortality in patients with end-stage renal disease. It is unknown whether end-stage renal disease patients who have succumbed to sudden cardiac death can be better identified by a newer test of heart rate variability that uses spectral analysis, rather than laboratory evoked measures.Objective This series of studies sought to characterize cardiac autonomic function in patients awaiting kidney transplantation, identify factors associated with heart rate variability, identify tests which distinguish patients at-risk for death, and compare evoked measures with 24-hour heart rate variability measures.Patients Data were collected on 184 nondiabetics, 60 type 1 diabetics, and 34 type 2 diabetics with end-stage renal disease, all of whom had been referred for kidney transplantation.Main Outcome Measures The 278 patients and 67 healthy control subjects underwent evoked tests (changes in heart rate with deep breathing and Valsalva maneuver) and 24-hour heart rate variability Holter monitoring (time and frequency domains). Five patients had sudden cardiac deaths during the study.Results Data showed that end-stage renal disease patients, particularly diabetics, had compromised autonomic function. The standard deviation of all R-to-R intervals for the electrocardiogram recording (<50 minutes in 60% of the deceased patients), a 24-hour heart rate variability time domain measure, holds the promise of identifying patients at increased risk for death. Exercise was identified as a factor associated with better autonomic function. Examining relationships between 24-hour heart rate variability and characteristics of patients who succumb to death could make quantification of the mortality risk for individual pretransplant end-stage renal disease patients possible, much as it has in other populations. The data from this study may also make it possible to design interventions, such as exercise, aimed at reducing mortality risk.

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The article presents quotes from readers of "U.S. Catholic" expressing their views on whether they would or would not choose a Catholic college, includes James C. Gorman, Carole O'Connell and Carol Maleska.