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Aims Maintaining continence of nursing home (NH) residents promotes dignity and well-being and may reduce morbidity and healthcare treatment costs. To determine the prevalence of older continent adults who received primary prevention of incontinence at NH admission, assess whether there were racial or ethnic disparities in incontinence prevention, and describe factors associated with any disparities. Methods The design was an observational cross-sectional study of a nation-wide cohort of older adults free of incontinence at NH admission (n = 42,693). Four US datasets describing NH and NH resident characteristics, practitioner orders for NH treatment/care, and socioeconomic and sociodemographic status of the community surrounding the NHs were analyzed. Disparities were analyzed for four minority groups identified on the minimum data set using the Peters-Belson method and covariates at multiple levels. Results Twelve percent of NH admissions received incontinence prevention. There was a significant disparity (2%) in incontinence prevention for Blacks ( P < 0.05): Fewer Black admissions (8.6%) were observed to receive incontinence prevention than was expected had they been part of the White group (10.6%). The percentage of White admissions receiving incontinence prevention was 10.6%. Significant factors associated with disparity in receiving incontinence prevention were having greater deficits in ADL function and cognition and more comorbidities. No disparity disadvantaging the other minority groups was found. Conclusions Greater efforts for instituting incontinence prevention at the time of NH admission are needed. Eliminating racial disparities in incontinence prevention seems an attainable goal. Appropriate staff training, organizational commitment, and monitoring progress toward equitable outcomes can help achieve this goal. Neurourol. Urodynam. 36:1124-1130, 2017. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Determining whether racial and ethnic disparities exist for a health‐related outcome requires first specifying how outcomes will be measured and disparities calculated. We explain and contrast two common approaches for quantifying racial/ethnic disparities in health, with an applied example from nursing research. Data from a national for‐profit chain of nursing homes in the US were analyzed to estimate racial/ethnic disparities in incidence of pressure ulcer within 90 days of nursing home admission. Two approaches were used and then compared: logistic regression and Peters–Belson. Advantages and disadvantages of each approach are given. Logistic regression can be used to quantify disparities as the odds of the outcome for one group relative to another. Peters–Belson can be used to quantify an overall disparity between groups as a risk difference and also provides the proportion of that disparity that is explained by available risk factors. Extensions to continuous outcomes, to survival outcomes, and to clustered data are outlined. Both logistic regression and Peters–Belson are easily implementable and interpretable and provide information on the predictors associated with the outcome. These disparity estimation methods have different interpretations, assumptions, strengths, and weaknesses, of which the researcher should be aware when planning an analytic approach. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Incontinence is a common health problem among nursing home (NH) residents. Differences between black and white NH residents in incontinence prevalence have been reported. Although reducing health disparities is a principal objective of the national health care agenda, little is known about disparities in incidence of new incontinence in NHs. The purpose of this study was to assess whether there were racial/ethnic disparities in the time to development of incontinence in adults over age 65 who had been continent on NH admission. If no racial or ethnic disparities in time to incontinence were found, other predictors of time to incontinence would be explored. Three national databases were sources of data on 42,693 adults over 65 admitted to 446 for‐profit NHs in a national chain. Multi‐level predictors of time to any type of incontinence were analyzed, using Cox proportional hazards regression for white Non‐Hispanic NH admissions and the Peters‐Belson method for minority NH admissions: American Indians/Alaskan Natives, Asians/Pacific Islanders, Black non‐Hispanics, and Hispanics. No racial/ethnic disparities in time to incontinence were found. Approximately 30% of all racial/ethnic groups had developed incontinence by 6 months. Those who developed incontinence sooner were older and had greater deficits in activities of daily living (ADL) and cognition. Results were consistent with past evidence and suggest that interventions to maintain continence from the time of admission should be applied across racial/ethnic groups. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Dietary fiber supplements are used to manage fecal incontinence (FI), but little is known about the fiber type to recommend or the level of effectiveness of such supplements, which appears related to the fermentability of the fiber. The aim of this single-blind, randomized controlled trial was to compare the effects of three dietary fiber supplements (carboxymethylcellulose [CMC], gum arabic [GA], or psyllium) with differing levels of fermentability to a placebo in community-living individuals incontinent of loose/liquid feces. The primary outcome was FI frequency; secondary outcomes included FI amount and consistency, supplement intolerance, and quality of life (QoL). Possible mechanisms underlying supplement effects were also examined. After a 14-day baseline, 189 subjects consumed a placebo or 16 g total fiber/day of one of the fiber supplements for 32 days. FI frequency significantly decreased after psyllium supplementation versus placebo, in both intent-to-treat and per-protocol mixed model analyses. CMC increased FI frequency. In intent-to-treat analysis, the number of FI episodes/week after supplementation was estimated to be 5.5 for Placebo, 2.5 for Psyllium, 4.3 for GA, and 6.2 for CMC. Only psyllium consumption resulted in a gel in feces. Supplement intolerance was low. QoL scores did not differ among groups. Patients with FI may experience a reduction in FI frequency after psyllium supplementation, and decreased FI frequency has been shown to be an important personal goal of treatment for patients with FI. Formation of a gel in feces appears to be a mechanism by which residual psyllium improved FI. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objectives To reduce the number of items of the Public Health Nursing Competency Instrument ( PHNCI) and to report the psychometric properties of the abbreviated instrument. Design and Sample The 193-item PHNCI was administered via an online survey tool. A national sample of 2,269 public health nurses was recruited from 25 states. Measures All items of the PHNCI scale were positively stated and participants were asked to rate their skill level via a 4-point Likert scale. Results A principal component exploratory factor analysis with oblique rotation and examination of scree plot resulted in a final abbreviated scale which included 81 items and six factors: (1) Evaluation Competencies, (2) Individual/Family/Community Competencies, (3) Systems' Competencies, (4) Partnership/Collaboration Competencies, (5) Planning Competencies, and (6) Assessment Competencies. The six factors in the resulting PHNCI Abbreviated ( PHNCIa) demonstrated acceptable internal consistency, ranging from 0.92 to 0.98. Conclusion The six factors of the PHNCIa integrate important concepts of both the nursing process and the intervention wheel. The instrument can be used by educators, administrators, managers, and staff members to assess strengths and challenge areas, guide discussions on performance and expectations, and enhance professional development efforts. Next steps for future research are presented. [ABSTRACT FROM AUTHOR]

The Peters-Belson (PB) method was developed for quantifying and testing disparities between groups in an outcome by using linear regression to compute group-specific observed and expected outcomes. It has since been extended to generalized linear models for binary and other outcomes and to analyses with probability-based sample weighting. In this work, we extend the PB approach to right-censored survival analysis, including stratification if needed. The extension uses the theory and methods of expected survival on the basis of Cox regression in a reference population. Within the PB framework, among the groups to be compared, one group is chosen as the reference group, and outcomes in that group are modeled as a function of available predictors. By using this fitted model's estimated parameters, and the predictor values for a comparator group, the comparator group's expected outcomes are then calculated and compared, formally with testing and informally with graphics, with their observed outcomes. We derive the extension, show how we applied it in a study of incontinence in nursing home elderly, and discuss issues in implementing it. We used the 'survival' package in the R system to do computations. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Recruitment of participants to clinical trials remains a significant challenge, especially for research addressing topics of a sensitive nature such as fecal incontinence (FI). In the Fiber Study, a randomized controlled trial on symptom management for FI, we successfully enrolled 189 community-living adults through collaborations with specialty-based and community-based settings, each employing methods tailored to the organizational characteristics of their site. Results show that using the two settings increased racial and ethnic diversity of the sample and inclusion of informal caregivers. There were no differential effects on enrollment, final eligibility, or completion of protocol by site. Strategic collaborations with complementary sites can achieve sample recruitment goals for clinical trials on topics that are sensitive or known to be underreported. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:500-511, 2010 [ABSTRACT FROM AUTHOR]

The article focuses on the estimation of nuclear area ratios with the use of Bethesda Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-grade Squamous Intraepithelial Lesion (LSIL) Size Criteria. It provides information on the methods used in the study which presents forty five participants from medical fields. It states that the overall accuracy for all the participants in estimating nuclear area ratios was low, especially for ratios in the range of ASCUS versus LSIL.

BACKGROUND. The Bethesda 2001 (B2001) classification system raised the thresholdfor reporting atypical squamous cells. The category of Atypical SquamousCells of Undetermined Significance (ASCUS)-favor reactive has been eliminatedwith a recommendation for cytologists to judiciously downgrade those Papanicolaou(Pap) tests that would formerly have been in this category to Negative forIntraepithelial Lesion or Malignancy (NILM). The effect of this change on sensitivityand specificity of the Pap test is not yet known.METHODS. A total of 535 consecutive SurePath Pap tests interpreted as ASCUSduring a period from March 1 through December 31, 2001, with follow-up polymerasechain reaction(PCR)-based human papilloma virus (HPV) testing, wereindependently reviewed by 3 pathologists and 1 cytotechnologist who reinterpretedthese tests according to Bethesda 2001 criteria. Follow-up HPV and biopsyresults were compiled for a 5-year period.RESULTS. By consensus of the 4 observers, 169 (32%) of the ASCUS cases weredowngraded to NILM. These cases showed a lower rate of underlying high-riskHPV infection (11% vs 30%) and cervical intraepithelial neoplasia of grades 2 to 3(CIN 2/3) (5% vs 10%) on follow-up than those tests that were reinterpreted asASCUS or higher. Nine women with follow-up CIN 2/3 would have had the Paptest interpreted as NILM instead of ASCUS under Bethesda 2001 (20% of all CIN2/3 found). Individual reviewers downgraded 29% to 42% Pap tests to NILMincluding those of 5 to 10 women with follow-up CIN 2/3.CONCLUSIONS. The ASCUS threshold established by B2001 prevents a sizeablesubset of women from having follow-up for ASC. However, as a consequence, afew women with CIN 2/3 are downgraded to NILM. The cost savings thusachieved must be weighed against the lost opportunities to detect CIN 2/3. [ABSTRACT FROM AUTHOR]

Background: Blood transfusion with cardiac surgery accounts for 20% of transfusions in the United States. The effect of perioperative transfusion on cardiac surgery outcomes is unknown. We hypothesized that cardiac surgery with perioperative blood transfusion was associated with worse outcomes. Methods: A prospectively maintained (Society of Thoracic Surgeons) institutional database was analyzed from 2000 to 2005. All patients undergoing coronary artery bypass and/or valve operations were evaluated for the association of preoperative and intraoperative risk factors with blood transfusion. The association of transfusion with postoperative complications and mortality was evaluated. Results: During the study period, 2691 patients met inclusion criteria. Sixty-four percent received transfusions. Preoperative risk factors associated with transfusion (p < 0.05) were lung disease, elevated creatinine, peripheral vascular disease, and previous cardiac interventions. Patients requiring transfusion were older (mean 65.2 vs. 61.2 years, p < 0.001). Transfusion was associated with longer cross-clamp (median 78 vs. 88 minutes, p < 0.001) and perfusion times (median 114 vs. 128 minutes, p < 0.001). Perioperative blood transfusion was associated with increased postoperative complications (53.5% vs. 30.5%, p < 0.001). Significant transfusion-associated complications were renal failure, prolonged ventilation time, pneumonia, cardiac arrest, gastrointestinal complications, atrial fibrillation, stroke, myocardial infarction, and bleeding requiring reoperation. Blood transfusion was associated with an increased operative mortality (3.4% vs. 1.7%, p = 0.005) and length of stay after surgery (median 6 vs. 5 days p < 0.001). Conclusion: Identification and management of risk factors associated with transfusion may reduce the transfusion requirement, minimize perioperative complications and improve outcomes. Bloodless cardiac surgery is associated with a decreased morbidity and mortality. [ABSTRACT FROM AUTHOR]

The recruitment of community-living participants for clinical trials of sensitive topics, when the population is largely hidden and reluctant to self-identify, and the study protocols and procedures intensive, creates significant challenges to researchers. The Fiber Study is an ongoing randomized controlled clinical trial conducted to compare the effectiveness of three dietary fibers with different levels of fermentability for symptom management in community-living adults with fecal incontinence. The researchers developed a staged approach to recruitment using three primary recruitment methods and a three-phase approach to the enrollment process. We have been successful in reaching, recruiting, and enrolling participants in a clinical trial, as well as in effectively managing study resources and staff time. © 2006 Wiley Periodicals, Inc. Res Nurs Health 29:233–243, 2006 [ABSTRACT FROM AUTHOR]

This paper describes the development and initial testing of an instrument to measure population-based public health nursing competencies. Although multiple lists of public health competencies exist, literature review did not elicit a valid instrument that could measure changes in public health nursing competency over time. The public health nursing competency instrument, consisting of 195 measurable activities organized in the framework of the nursing process, was developed. Competency scores of practicing public health nurses significantly increased after a continuing education series, and the instrument was confirmed by experts to be a valid reflection of public health nursing practice. The time required for instrument development exceeded expectations because of the multiple stages of delineating competencies and validating data with national experts. [ABSTRACT FROM AUTHOR]

Background. Adenoid cystic carcinoma (ACC) is a neoplasm with unpredictable behavior with frequent late relapses that lacks good prognostic indicators. c-kit tyrosine kinase oncogene has recently been found to be expressed in ACC. The aim of this study is to correlate the expression of c-kit in ACC with clinical follow-up. Methods. Paraffin sections of 45 cases of ACC diagnosed during a 15-year period were immunostained for c-kit. Results. Seventy-eight percent of tumors stained positive for c-kit. Mean follow-up time was 6 years. No degree/pattern of c-kit expression correlated to local or distant tumor recurrence. However, there was a significant association between surgical margin involvement by tumor and cell membrane expression of c-kit. Staining quality was not affected by storage time. Conclusions. Our results suggest that expression of c-kit may not serve as a useful marker for predicting outcome in ACC, although they need to be confirmed in a larger patient population with longer clinical follow-up. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX–XXX, 2005 [ABSTRACT FROM AUTHOR]

Abstract Developing and testing the quality of a research instrument, including its ability to be used by culturally diverse persons, is an important methodological objective. The present study determined the content validity and feasibility of culturally diverse persons to use an instrument to classify stool consistency that has been employed in research on fecal incontinence. Five multidisciplinary clinicians experienced in assessing stool consistency determined the tool to possess content validity. Twenty-four foreign nationals of diverse cultures who spoke English as a second language (ESL) classified the consistency of nine stools using word only or word plus diagram descriptions. The agreement of the ratings of the participants were compared with the those of an experienced investigator. There was no significant difference between the ratings of participants using either type of description. There was good agreement between the classifications of the participants and those of the investigator. The findings of this study contribute to the quality of our instrument and support its use by culturally diverse persons. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the relationship between nurse and client characteristics and the reason for client termination from public health nursing maternal and child home visits. The results indicate that clients who dropped out of services received more contacts from the nurses, missed more appointments with the nurses, and were given advice from the nurses on more topics. They also differed from clients who continued with services until the nursing care plan goals were met in reference to marital status, mental illness, source of payment for services, and use of WIC and food stamps. Nurses whose clients were more likely to continue until goals were met were higher in conscientiousness, learned more from experience, and learned less from coworkers or learning on their own. They also worked more hours per week. These findings have implications for practice and research. [ABSTRACT FROM AUTHOR]

An abstract of the article "Unsatisfactory Liquid-Based Papanicolaou Test (LBPT): Causes and Significance," by Mariam Alsharif, Dan M. McKeon, H. Evin Gulbahce, Kat Savik, and Stefan E. Pambuccian is presented.

An abstract of the article "LSIL/HSIL Ratio: A Marker Of The Screened Population And Triage Practices," by Gabriela M. Oprea-Ilies, Stefan E. Pambuccian, George Birdsong, Kay Savik, Edward B. Stelow, Stuart Cameron, and Brian S. Kendall is presented.

An abstract of the article "Size Criteria for Atypical Squamous Cells of Undetermined Significance (ACS-US) and Low Grade Squamous Intraepithelial Lesion in Liquid-Based Papanicolaou Tests (LBPT): Bethesda Or Sheffield?," by Gabriela M. Oprea-Ilies, H. Evin Gulbahce, Kay Savik, Edward B. Stelow, Dan M. Mckeon, and Stefan E. Pambuccian is presented.