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Background: Outcome and survival after primary total hip arthroplasty (THA) can be affected by patient characteristics. We examined the effect of case-mix on revision after primary THA using the Dutch Arthroplasty Register., Methods: Our cohort included all primary THAs (n = 218,214) performed in patients with osteoarthritis in the Netherlands between 2007 and 2018. Multivariable logistic regression analysis was used to calculate the difference in survivorship in patients with different patient characteristics (age, gender, American Society of Anesthesiologists [ASA] score, body mass index [BMI], Charnley score, smoking, and previous operations to the hip)., Results: Case-mix factors associated with an increased risk for revision 1 year after THA were the following: a high ASA score (II and III-IV) (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.0 and OR 3.0, 95% CI 1.7-5.3), a higher BMI (30-40 and >40) (OR 1.4, 95% CI 1.2-1.5 and OR 2.0, 95% CI 1.4-1.7), age ≥75 years (OR 1.5, 95% CI 1.1-2.0), and male gender (OR 1.3, 95% CI 1.2-1.4). A similar model for 3-year revision showed comparable results. High BMI (OR 1.9, 95% CI 1.3-2.9), a previous hip operation (OR 1.8, 95% CI 1.3-2.5), ASA III-IV (OR 1.2, 95% CI 1-1.6), and Charnley score C (OR 1.5, 95% CI 1.1-2.2) were associated with increased risk for revision. Main reasons for revision in obese and ASA II-IV patients were infection, dislocation, and periprosthetic fracture. Patients with femoral neck fracture and late post-traumatic pathology were more likely to be revised within 3 years, compared to osteoarthritis patients (OR 1.5, 95% CI 1.3-1.7 and OR 1.5, 95% CI 1.2-1.7)., Conclusion: The short-term risk for revision after primary THA is influenced by case-mix factors. ASA score and BMI (especially >40) were the strongest predictors for 1-year revision after primary THA. After 3 years, BMI and previous hip surgery were independent risk factors for revision. This will help surgeons to identify and counsel high-risk patients and take appropriate preventive measures., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This study tested the revised Beliefs About Personal Weight Survey-2 (BPWS-2) in 200 African American women, 18 to 40 years of age. Confirmatory factor analysis of a priori hypothesized factors resulted in 5 subscales-weight acceptance (8 items); excess weight acknowledgment (5 items); conventional weight regulation (3 items); circumstantial weight regulation (9 items); and weight concern (10 items). The Cronbach α ranged from 0.67 to 0.89. The factors demonstrated patterns of association with eating behavior, body mass index, body image, and psychosocial (depression and perceived stress) variables associated with weight. The BPWS-2 is the first instrument designed to measure beliefs about one's personal weight, thus results make important new contributions to the understanding of weight management.

The purpose of this study was to develop the Beliefs about Personal Weight Survey among African American women. Sixty-five items were developed from literature and sample participants to characterize beliefs about personal weight in 3 domains: descriptors, causes, and consequences. The items were administered to 150 community-dwelling African American women, 18 to 40 years old, recruited from 5 sites. Factor analysis supported a 4-factor solution with the following dimensions: overweight acceptance, overweight concern, conventional weight regulation, and circumstantial weight regulation. These factors were significantly associated with weight management behaviors and body mass index. Profile analysis indicated distinct factor belief profiles by 3 weight categories.

Hypertension disproportionately affects all African-Americans and lack of adequate blood pressure control could contribute to cognitive decline among older adult African-Americans. Cognitive difficulties might impair the self-management ability of these individuals, further limiting their blood pressure control. The purpose of this study, therefore, was to determine the personal characteristics that were associated with cognitive difficulties in order to identify older adults who needed environmental supports to enhance their self-management capabilities. A sample of 102 African-Americans from 60 to 89 years of age with diagnosed hypertension was recruited. Forty-nine percent (n = 50) of the sample had cognitive impairments that could hinder hypertension self-management. Depressive symptoms were also associated with a decrease in cognitive function (i.e., orientation and complex cognitive skills), as well as being negatively associated with social support. These findings support the need for nurses to assess personal characteristics in order to plan self-management strategies that help clients compensate for cognitive deficits.

African Americans bear a disproportionate burden of hypertension. A causal-modeling design, using Donabedian's Quality Framework, tested hypothesized relationships among structure, process, and outcome variables to assess quality of care provided to this population. Structural assessment revealed that administrative and staff organization affected patients' trust in their provider and satisfaction with their care. Interpersonal process factors of racism, cultural mistrust, and trust in providers had a significant effect on satisfaction, and perceived racism had a negative effect on blood pressure (BP). Poorer quality in technical processes of care was associated with higher BP. Findings support the utility of Donabedian's framework for assessing quality of care in a disease-specific population.

The purpose of this study was to examine the relationship of racism and blood pressure (BP). Participants were 162 urban African American adults. Measurements included the Racism and Life Experiences Scale, Krieger Racial Discrimination Questionnaire, State-Trait Personality Inventory (anxiety and depression), State-Trait Anger Expression Inventory, and automated measures of BP. Correlational and multiple regression analyses were done to examine relationships among key variables, t tests and ANOVA tested group differences by age, gender, and racism category. There was a high prevalence of perceived racism, which was not associated with higher BP. The racism/BP relationship was moderated by age with significant age related differences noted. Older participants (40 years or older) experienced more distress from racism, more anger suppression, and higher BP but lower levels of stress emotions. The highest levels of BP were noted in older adults reporting the lowest level of perceived racism, raising the issue of "internalized oppression."

Hypertensive disorders occur in 6% to 8% of all pregnancies, are the second leading cause of maternal death, and contribute to significant neonatal morbidity and mortality. This is a problem not only in inpatient settings, as ambulatory and home-care nurses are increasingly being called upon to monitor women who are at high risk and may have hypertensive disorders. To prevent hypertension-induced problems in pregnant women, nurses must have strong assessment, advocacy, and counseling skills. Nurses also must provide care based on the latest national standards as described in this article.

Background: Early identification of persons at risk for kidney disease provides an opportunity to prevent or delay its progression and decrease morbidity and mortality. Our hypothesis was that implementation of a targeted screening program in communities with high-risk populations would detect previously unidentified persons with or at high risk for chronic kidney disease (CKD) with a prevalence that exceeds that predicted for CKD in the general population., Methods: Persons with hypertension or diabetes or a first-order relative with hypertension, diabetes, or kidney disease were screened for kidney disease risk factors. Blood pressure, blood glucose level, serum creatinine level, hemoglobin level, microalbuminuria, hematuria, pyuria, body mass index, and estimated glomerular filtration rate (EGFR) were evaluated., Results: Six thousand seventy-one eligible persons were screened from August 2000 through December 2001: of these persons, 68% were women, 43% were African American, 36% were white, 10% were Hispanic, and 5% were Native American. Most reported high-school education or more (84%) and health insurance coverage (86%). Twenty-seven percent met the screening definitions for diabetes; 64%, for hypertension; 29%, for microalbuminuria; 8%, for anemia; 18%, for hematuria; 13%, for pyuria; 5%, for elevated serum creatinine level; 16%, for reduced EGFR; and 44%, for obesity. Among participants without a reported history of specified conditions, screening identified 82 participants (2%) with diabetes, 1,014 participants (35%) with hypertension, 277 participants (5%) with elevated serum creatinine levels, 839 participants (14%) with reduced EGFRs, and 1,712 participants (29%) with microalbuminuria. Thirty-five percent of participants with a history of diabetes had elevated serum glucose levels at screening (> or =180 mg/dL [10 mmol/L]), and 64% with a history of hypertension did not have blood pressure controlled to less than 140/90 mm Hg. Only 18% of participants with a history of diabetes and 31% with a reduced EGFR had blood pressure controlled to less than 130/80 mm Hg and less than 135/85 mm Hg, respectively., Conclusion: Targeted screening is effective in identifying persons with previously unidentified or poorly controlled kidney disease risk factors, as well as persons with a moderately decreased EGFR.

In 2000, the National Kidney Foundation implemented the Kidney Early Evaluation Program (KEEP 2.0) to increase awareness of kidney disease among those at highest risk, and improve outcomes through early detection and referral for care. The KEEP 2.0 screening program identified significant numbers of persons with reduced kidney function, with previously undetected kidney disease risk factors, and with inadequate risk factor control. These data support the evolution to KEEP 3.0, which will continue to identify individuals at high risk for kidney disease, and will address the educational needs of health care providers and consumers, given that preventing and managing kidney disease requires their joint effort. Consumers need to embrace lifestyle behaviors that reduce risk, and adhere to medical recommendations in managing their existing conditions. At the same time, providers need to ensure that the latest evidence-based guidelines in diagnosis and treatment are being implemented in their clinical practice. KEEP 3.0 participants will be randomly assigned to one of several educational programs that vary on whether they provide individually tailored or nontailored information, with long-term follow-up for evaluation of clinical outcomes. Tailored programs may be more successful in supporting behavioral change as these consider the individuals' "readiness to change." In addition, participant-identified providers will be randomly assigned to one of several educational protocols designed to provide evidence-based recommendations for clinical and pharmaceutical management of kidney disease and risk factors; these programs vary on whether they require active or passive participation of providers. Analytic evaluations will examine changes from baseline in participant kidney disease and risk factor status during follow-up, and estimate the influence of the various educational protocols on both process of care measures and clinical outcomes.

Historically, policies guiding the American health care delivery system have focused primarily on financing disease care. This emphasis on disease, rather than health, has sustained the idea of medical primacy while resulting in poor economic and health outcomes. Nursing's unique health-oriented contributions are undervalued and underutilized in the present system. This article addresses how and why nurse administrators should become involved in the policy arena. The article also emphasizes the need for skilled nurse leaders to influence the national agenda through political activism so that comprehensive nursing care is available and accessible.

Hypertension is a major public health problem in the U.S. Salt sensitivity is an important factor associated with hypertension and its complications, yet it has not been addressed in the nursing literature. Salt sensitivity is a directionally appropriate rise or fall in blood pressure when salt is added or removed, respectively. The change in blood pressure in salt-sensitive subjects occurs to a degree exceeding random blood pressure fluctuations. Salt sensitivity is present in 30% of normotensive and over 50% of hypertensive persons. It is more prevalent among African Americans, older persons, and individuals with renal insufficiency or diabetes. This paper provides nurses with an overview of salt sensitivity and its significance in hypertension. It presents conceptual and operational definitions of salt sensitivity, identifies factors contributing to its development, and describes implications for nursing practice.

America has no overall health policy agenda that provides direction for improving the health of the nation. Historically, policies have focused on financing medical care. However, the philosophical model underlying that care is disease, not health, oriented. Health is only implicitly conceptualized and then only as the absence of disease. While the clinical model has provided for technological excellence and sophisticated medical care, it has also led to many problems within the health care delivery system. Skyrocketing costs; decreased access to care; poor health outcomes; and significant disparities in health among groups in America are the result of policies based on the model's limited conceptualization of health. This article describes the pervasiveness of the clinical model in influencing health policy. It analyzes both the health and economic outcomes of such policies, and explains the necessity of developing policy from a broader perspective of health. Using a nested model of health is encouraged. This allows policy makers to clearly visualize both the level of client and the focus of care that is being addressed. Delineating the focus of care may help in the development of policies that are truly aimed at improving the health of the nation.

As the future of healthcare changes, there will be an increased demand for community-focused care, especially in the areas of health promotion and disease prevention. However, to meet these future demands, nurses must develop a population-focused, wellness-oriented approach to practice. This article briefly describes why many nurses may lack this focus, and then presents a model for teaching these essential community health principles to baccalaureate nursing students. The model uses a secondary school as the setting for the community health clinical experience.

Early in 1985, after being questioned about duplicate data in two of his papers, Robert A. Slutsky, M.D., resigned his appointments as a radiology resident (trainee) and nonsalaried associate clinical professor in the Department of Radiology at the University of California, San Diego. During the following year, faculty committees investigated Slutsky's entire bibliography of 137 articles published in seven years; 77 (including reviews) were classified as valid, 48 were judged questionable, and 12 were deemed fraudulent. The majority of these papers were published while Slutsky was a research or clinical trainee in cardiology, nuclear medicine, and then radiology. Our analysis of this case leads us to conclude that research fraud, although probably rare, in view of the size of the research establishment, may evade detection, and that there are scientists prepared to run the appreciable risk of submitting inaccurate statements for publication. Sophisticated dishonesty can escape detection by peer review and replication. The emphasis on competition and the pressure to produce, while intended to advance the discovery of truth, may foster a conflict between personal career goals and the intellectual motivation of scientists to seek the truth. The scientific community needs to address the issues raised by recent reports of fraud. Each institution and granting agency must have procedures for investigating suspected fraud or unethical practices, procedures that protect both the person who reports such practices and the accused person from premature disclosure. As we heighten awareness, we must avoid a "witch hunt." Deterrence of research fraud is clearly needed, but institution of practices that might stifle originality or discourage cooperative research would be counterproductive.

Computers have unrealized potential in investigation and clinical care. Computers in Critical Care and Pulmonary Medicine must serve as a catalyst to focus these efforts. The goal must be development of practical, cost effective systems to facilitate the collection, recording and interpretation of data relevant to the management of the ICU patient. The ultimate goal is to provide feedback control where appropriate. To reach this goal, data relevant to the elements of the gas exchange system - the heart, the lungs, and ventilatory pump - are essential and analysis systems are needed. Analysis must interpret the interaction between circulatory and lung function and between lung, chest wall and diaphragm mechanics and gas exchange.