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Adverse events remain the third leading cause of death in hospitals today, after heart disease and cancer. However, adverse events remain underreported. The purpose of this integrative review is to synthesize adverse event reporting priorities in acute care hospitals from quantitative, qualitative, and mixed-methods research articles.A comprehensive review of articles was conducted using nursing, medicine, and communication databases between January 1, 1999, and May 3, 2021. The literature was described using standard reporting criteria.Twenty-nine studies met the eligibility criteria. Four key priorities emerged: understanding and reducing barriers, improving perceptions of adverse event reporting within healthcare hierarchies, improving organizational culture, and improving outcomes measurement.A paucity of literature on adverse event reporting within acute care hospital settings was found. Perceptions of fear of blaming and retaliation, lack of feedback, and comfort level of challenging someone more powerful present the greatest barriers to adverse event reporting. Based on qualitative studies, obtaining trusting relationships and sustaining that trust, especially in hierarchical healthcare systems, are difficult to achieve. Given that patient safety training is a common strategy clinically to improve organizational culture, only 4 published articles examined its effectiveness. Further research in acute care hospitals is needed on all 4 key priorities. The findings of this review may ultimately be used by clinicians and researchers to reduce adverse events and develop future research questions.

This study compared post- and preintervention trauma-informed care attitudes, explored relationships among outcomes, and identified self-care behavior changes participants are willing to make.A quasi-experimental study with content analysis was conducted with 96 adults that took part in a Trauma Awareness Intervention including a novel self-care clock.Participants' trauma-informed care attitudes improved (p ≤ 0.05) compared to baseline and were positively related to their post-intervention compassion scores (p 0.05). Qualitative analyses revealed self-awareness, self-care, empathy, applying a trauma lens, changing the narrative, and student-centeredness as the main themes in participants' responses.This university-based initiative had a positive impact on attitudes toward trauma and should be explored in other settings, as there is an unmet need for trauma-informed care strategies at the community level.

The 2016 National Task Force on Quality Nurse Practitioner Education described a preceptor as having the educational preparation or extensive clinical experience for clinical supervision. Preceptors are often unaware of teaching techniques, effective communication, and objective evaluation modes of student performance. Four 1-hour training modules for preceptors were developed to address these issues. Each illustrates communication and evaluation techniques to help nurse practitioner preceptors guide students as they learn to implement evidence-based practice. The online link to the continuing education training modules is provided for all interested schools of nursing, nurse practitioner preceptors, and other allied health professionals at no cost.

Purpose: To identify and describe the complexity of diagnosing bipolar disorder, including the diagnostic process and patient experiences of being newly diagnosed with bipolar disorder.Design: A mi...

Background: Systematic reviews (SRs) and meta-analyses (MAs) have proliferated with a concomitant increase in reviews of SRs/MAs or “meta-reviews” (MRs). As uncovered by the 2018 US Physical Activity Guidelines Advisory Committee (PAGAC), there is a paucity of best practice guidance on MRs on physical activity health-related research. This manuscript aims to fill this gap. Methods: In total, the PAGAC conducted 38 literature searches across 3 electronic databases and triaged 20,838 titles, 4913 abstracts, and 2139 full texts from which 1130 articles qualified for the PAGAC Scientific Report. Results: During the MR process, the following challenges were encountered: (1) if the SR/MA authors had limited experience in synthesis methodology, they likely did not account for risk of bias in the conclusions they reached; (2) many SRs/MAs reviewed the same primary-level studies; (3) many SRs/MAs failed to disclose effect modifier analyses; (4) source populations varied; (5) physical activity exposures were nonstandardized; and (6) dose–response effects or effect modification of the physical activity exposure could not be identified. Conclusions: Using examples from the PAGAC Scientific Report, we provide (1) a high-level introduction to MRs; (2) recommended steps in conducting a MR; (3) challenges that can be encountered; and (4) guidance in addressing these challenges.

Background and Objective: In the midst of a type 2 diabetes epidemic in China where hemoglobin A1C needs to be better controlled, clinicians strive to examine and work to correct patients’ poor insulin pen injection practices. We explored insulin injection techniques, injection site problems, and A1C. Methods: In a large cross-sectional study of adult patients with type 2 diabetes (n=455) from 10 medical centers, patients answered an in-depth questionnaire and had their insulin injection technique observed. Researchers assessed for lipohypertrophy (LH) by observing and palpating injection sites. Logistic regression and linear regression were used to examine factors related to presence of LH and A1C. Results: Mean years taking insulin was 5.20, and 83.30% injected insulin ≥2 times/day. Mean needle reuse was 8.95 times (range 1-59), but was not correlated with LH or A1C. Percent with incorrect site rotation was 22.80% and presence of LH was 11.14%. A1C was 9.03±2.13%. Presence of LH was significantly associated with longer duration of insulin injection (OR=1.10, p=0.01, 95% CI [1.02, 1.17]) and total number of insulin injections/day (OR=2.27, p Conclusion: Needle reuse is a major problem in Chinese patients with type 2 diabetes, and A1C is poorly controlled. Patients with LH are more likely to have higher A1C. Given the diabetes epidemic in China, immediate measures must be implemented to improve insulin injection techniques and prevent LH for better glycemic control. This study indicated that 4 mm needles may have an advantage over 5 mm needles in regard to the presence of LH, yet further studies are needed to examine this relationship. Disclosure F. Li: None. A. Fish: None. U. Tokac: None.

BACKGROUND: Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder. OBJECTIVE: The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening. DESIGN: An integrative review was conducted using standard criteria for evaluating research articles. RESULTS: Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed. CONCLUSIONS: Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.

Objective To examine the association of carotid artery plaque with the incident coronary heart disease and stroke events in Chinese patients and explore whether the association differs between patients with and without hyperglycemia. Methods We evaluated plaque, and blood pressure, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting serum insulin, fasting plasma glucose, 2 h postprandial glucose and Homeostasis model assessment of insulin resistance in 253 Chinese patients. T-test and X2 test were used to compare the clinical characteristics and Binary logistic regression was applied to analyze the association of coronary heart disease and stroke between patients with and without hyperglycemia. Results Among 253 patients, 162 patients had hyperglycemia (i. e., diabetes, impaired glucose regulation and stress induced hyperglycemia) and 155 (61.3%) patients had plaque. Fasting plasma glucose, 2 h postprandial glucose and Homeostasis model assessment of insulin resistance, triglycerides, plaque were significantly higher in the hyperglycemia group than non-hyperglycemia. The incident coronary heart disease and stroke events in patients with plaque were 2.254 (95%CI,1.203–4.224) and 2.437 (95%CI,1.042–5.701) times higher than those without plaque, respectively. Among hyperglycemia subgroup, plaque was an independent risk factor for coronary heart disease (OR,3.075,95%CI,1.353–6.992) and stroke (OR,3.571,95%CI,1.460–8.737). The slopes (associations between coronary heart disease/stroke and plaque) were steeper in the hyperglycemia group than those in the non-hyperglycemia group (coronary heart disease OR,3.075 vs. 2.614; stroke OR,3.571 vs. 3.307). Conclusions The incident coronary heart disease and stroke events in patients with plaque were higher than those without plaque, and this difference was more pronounced for patients with hyperglycemia vs. those without hyperglycemia.

This article describes the Hage framework for theory construction and its application to the clinical problem of glycemic control in college-aged students with type 1 diabetes. College-aged students with type 1 diabetes struggle to self-manage their condition. Glycated hemoglobin (HbA1c), if controlled within acceptable limits (6-8%), is associated with the prevention or delay of serious diabetic complications such as kidney and cardiovascular disease. Diabetes educators provide knowledge and skills, but young adults must self-manage their condition on a daily basis, independent of parents. The Hage framework includes five tasks of theory construction: narrowing and naming the concepts, specifying the definitions, creating the theoretical statements, specifying the linkages, and ordering components in preparation for model building. During the process, concepts within the theory were revised as the literature was reviewed, and measures and hypotheses, foundational to research, were generated. We were successful in applying the framework and creating a model of factors affecting glycemic control, emphasizing that physical activity, thought of as a normal part of wellness, can be a two-edged sword producing positive effect but also serious negative effects in some college-aged students with type 1 diabetes. Contextual factors important to self-management in college-aged students are emphasized. The Hage framework, already used to a small extent in nursing curricula, deserves more attention and, because of its generic nature, may be used as a template for theory construction to examine a wide variety of nursing topics.

Diabetes-related distress is one of the psychological disorders affecting patients with diabetes, yet there are few studies about diabetes-related distress in Chinese patients. To assess the level of psychological distress and examine its associated factors, we conducted a cross-sectional analysis of patients with type 2 diabetes mellitus from a Chinese tertiary hospital. The Diabetes Distress Scale (DDS) and the General Self-Efficacy Scale (GSES) were administered. There were 210 (57.85%) patients with little or no diabetes-related distress, 84 (23.14%) with moderate diabetes-related distress and 69 (19.01%) with high diabetes-related distress. Stepwise multiple linear regression showed that sleep time was significantly related to the DDS total score and the subscale scores of emotional burden (EB) (β=-0.190, -0.379), respectively. GSES was associated with the DDS total score (β=-0.128) and the EB score (β=-0.153). Oral medication plus insulin was significantly related to regimen-related distress (RD) (β=0.137), physician-related distress (PD) (β=0.152) and interpersonal distress (ID) (β=0.103). Physical activity (β=-0.185) and making meal plan with health care professionals(HCP) (β=-0.169) were associated with RD. The prevalence of diabetes-related distress among patients with type 2 diabetes mellitus was high in China. DDS and EB were associated with poorer sleep time and lower self-efficacy. Interventions to improve sleep are needed. Qualitative and longitudinal studies are required to understand why type 2 diabetic patients are not getting enough sleep.

Purpose The purpose was to test a published model of body image in the bariatric surgery patient in the clinical office setting. Background A model was created based on clinical observations during field work and the literature. It focuses on five concepts of body image: body attitude, body checking, appearance orientation, perceived body size, and perceived body space. Testing this model 3 months after surgery is important because morphology changes rapidly influencing early changes in body image, yet there is a paucity of research at this time point. Methods For this study of 67 bariatric surgery patients, sequential sampling was used. Body image and anthropometric measures (body mass index and other weight loss indicators) were obtained at baseline and 3-months postoperatively. Established model testing criteria were used. Results Over 3 months, mean body mass index was significantly reduced. Mean body image was significantly improved regarding all concepts in the model, except body checking. Body image improvement varied widely when individual responses were examined. Conclusions The model was successfully tested. Data on the five concepts in the model provided a body image profile at 3 months indicating individuals' degree of improvement. Areas of non-improvement in the early postoperative phase may signal the need for interventions, like support or psychological counseling, for patients who might be struggling with views of themselves after surgery. Preliminary recommendations are made regarding several of the instruments and their use clinically. Researchers should take into consideration the study's short 3-month time frame when designing future studies.

As diabetes rates continue to rise and health care continues to change, nurse practitioners will be a key component in improving the care of patients with diabetes and related comorbidities. This quality improvement project determined if a nurse practitioner–led, computer-based diabetes education intervention would be feasible in an office practice setting and if it would enhance diabetes care. An improvement in hemoglobin A1C was observed, and study participants, practice staff, and office managers had an overall positive response to the intervention's use.

Objective To examine the effect of case management on glycemic control and behavioral outcomes in adults with Type 2 diabetes in China. Methods Participants were randomly assigned to a 1-year case management (CM) group (n = 60) or control group (n = 60). Monthly case management visits included identifying individuals’ diabetes-related problems, setting goals, planning self-care, and evaluating progress. During a 1-year follow-up, all participants attended visits every 3 months without intervention. Results In the CM vs. the control group, HbA1c was reduced at 6 months compared to baseline (P = 0.034), with trends at 12 and 24 months, and empowerment ability improved (P < 0.05). Also in the CM vs. controls, total self-care behaviors, the frequency of exercise, blood glucose testing, and foot care were higher (P < 0.001) at 12 months, and the percentage of individuals with HbA1c ≤ 7.0% was higher (P = 0.035) at 24 months. Conclusion The case management intervention in China was effective at 6 months and, based on trends in HbA1c at 12 and 24 months and results for behavioral outcomes, the intervention shows promise and warrants more research. Practice implications A case management approach can enhance behavior change and glycemic control in Chinese with diabetes.

Background The use of dramatization in health professional education is one method to teach students about implicit bias and cultural difference, yet it has not been widely studied among graduate students of nursing. Objectives The purpose of this article is to present a qualitative analysis of data regarding doctoral nursing students' responses to a new dramatic exercise as part of a funded project to facilitate cultural learning in a diversity-enhanced nursing curriculum. Design We employed a cross-sectional posttest design with qualitative data collection and hermeneutic analysis. Setting and. Participants Subjects were students from two cohorts in a Doctor of Nursing Practice program at a large metropolitan university in the Midwestern United States (n = 136). Methods Following a dramatic exercise facilitated by a local theatre group, students debriefed and provided feedback via paper-based surveys collected by their instructor. The research team reviewed and analyzed student feedback with an eye toward new learning or insights around cultural difference. Results Students rated the dramatic exercise highly. Their written feedback provided for a deeper exploration of how they internalized messages about cultural difference. These experiences were thematized in the following way: (a) Awareness is facilitated through integrating nonverbal (kinesthetic) and verbal encounters, (b) Hesitancy to participate in unfamiliar activities creates tension, and (c) Safety is a foundational aspect of learning sensitive issues. Conclusion Dramatization of culturally sensitive scenarios for advanced practice nurses can lead to new understanding. Educators who understand the need for thoughtful introduction of dramatization experiences can better prepare nurses for interaction in cross-cultural clinical environments.

To assess the efficacy and safety of wet cupping in adults with hypertension, we conducted a systematic review and meta-analysis using 13 databases. Wet cupping alone or in combination with antihypertensive medication or acupuncture was used. Seven randomized trials were included, most not of high methodological quality. A few small studies suggested that wet cupping alone versus antihypertensive medication significantly reduced blood pressure and Traditional Chinese Medicine syndrome (hypertension-related symptoms). However based on current evidence, no firm conclusions can be drawn and no clinical recommendations made. Research projects included need validation. Studies indicate that wet cupping is a safe therapy.

Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder.The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening.An integrative review was conducted using standard criteria for evaluating research articles.Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed.Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Motor neurons are affected in certain patterns, such as cervical, thoracic, lumbar, and bulbar (facial) regions. Although initial presentations can vary, eventually upper and lower motor neurons are lost in the two types of ALS: familial and sporadic. A case study highlighting the reality of living with bulbar ALS relays Sister A's journey from early to late ALS. Etiology, pathophysiology, diagnosis, treatment, and clinical care are discussed.

Background The aim of the present study was to assess the frequency and severity of female sexual dysfunction (FSD) in those with T2D (T2D) compared with non-diabetic controls. In addition, risk factors for FSD were analyzed. Methods Sexual dysfunction, measured using the Female Sexual Function Index (FSFI), was evaluated using a questionnaire in 184 women with T2D and 146 non-diabetic controls at three study sites in China. In the T2D group, FSD was examined by education level, correlations between FSD and other variables were analyzed, and risk factors were studied. Results The frequency of FSD in the T2D group was 75.0%, much higher than in the control group (56.2%; P = 0.001). The severity of FSD in the T2D group was 17.84 ± 8.47 (mean ± SD), significantly lower than in the control group (21.14 ± 8.08; P = 0.001). In patients with T2D, being older (P = 0.001), taking oral antidiabetic medications (P = 0.013), and having diabetic neuropathy (P = 0.036) were risk factors for FSD. Conclusions The rate of FSD is high in China and, as seen in the literature, more severe in diabetics than non-diabetics. Being older, taking oral antidiabetic medications, and diabetic neuropathy are risk factors for FSD.

Bariatric (weight loss) surgery is more popular than ever. The American Society for Metabolic and Bariatric Surgery in 2016 reported that 216,000 bariatric procedures were performed in the United States. Bariatric surgery has major physiological benefits; its use is expected to increase globally. However, patients may not anticipate the profound impact that rapid and massive weight loss may have on their body image after bariatric surgery. The construct of body image in this population needs to be explicated to facilitate continued research regarding this increasingly prevalent healthcare procedure. This article describes the formulation of a model of relevant concepts and dimensions within the construct of body image in the bariatric surgery patient. In the process of creating the model, we identified many factors influencing body image in patients before and after bariatric surgery, summarized eight measures, and developed a new definition based on prior work. Theoretical considerations are discussed. The long-term objective of this model building approach is to encourage researchers and clinicians to test the feasibility of systematic clinical measurement of body image at office visits before as well as multiple times after bariatric surgery.

Background Many research studies conducted today in critical care have a genomics component. Patients' surrogates asked to authorize participation in genomics research for a loved one in the intensive care unit may not be prepared to make informed decisions about a patient's participation in the research. Objectives To examine the effectiveness of a new, computer-based education module on surrogates' understanding of the process of informed consent for genomics research. Methods A pilot study was conducted with visitors in the waiting rooms of 2 intensive care units in a Midwestern tertiary care medical center. Visitors were randomly assigned to the experimental (education module plus a sample genomics consent form; n = 65) or the control (sample genomics consent form only; n = 69) group. Participants later completed a test on informed genomics consent. Results Understanding the process of informed consent was greater (P = .001) in the experimental group than in the control group. Specifically, compared with the control group, the experimental group had a greater understanding of 8 of 13 elements of informed consent: intended benefits of research (P = .02), definition of surrogate consenter (P= .001), withdrawal from the study (P = .001), explanation of risk (P = .002), purpose of the institutional review board (P = .001), definition of substituted judgment (P = .03), compensation for harm (P = .001), and alternative treatments (P = .004). Conclusions Computer-based education modules may be an important addition to conventional approaches for obtaining informed consent in the intensive care unit. Preparing patients' family members who may consider serving as surrogate consenters is critical to facilitating genomics research in critical care.

PURPOSE To review what is known about the assessment, diagnosis, treatment, and outcomes of patients with bath salt-induced psychosis. Design and Methods Comprehensive review and synthesis of research, case reports, and state-level data. Findings Of the 42 case reports found, only 18 confirmed the presence of bath salts through laboratory testing. Twelve of the confirmed cases died. In most of the case reports, law enforcement was involved prior to hospitalization due to bizarre behaviors, delusions, and hallucinations. Practice Implications Due to the severity of both physical and psychological symptoms in patients in bath salt-induced psychosis, nurses, other healthcare providers, police, and hospital security personnel must work collaboratively to provide safe care. Language: en

To evaluate the prevalence of hyperglycemia among inpatients in internal medicine, and specifically, to assess the glycemic management of inpatients in non-endocrinology departments in three large urban hospitals in China.A multicenter observational study was conducted using electronic health records, and a survey of 1939 patients who were admitted to internal medicine units and followed until discharge. Those with previously diagnosed diabetes, newly diagnosed diabetes, or impaired fasting glucose were included. Aspects of glycemic management examined were (a) hyperglycemia, (b) endocrinology consultation for hyperglycemia and (c) hypoglycemia.The prevalence of hyperglycemia in internal medicine was 45.7% (886 out of 1939). A total of 741 (83.6%) patients were treated by non-endocrinology departments; of those, 230 (31.1%) were in poor glycemic control and needed an endocrinology consultation. Yet only 57 (24.8%) received one. In 4 cases, the physician did not follow the consultants' advice. Among the remaining 53 consulted patients, 35 (66.1%) were still in poor glycemic control, yet only about half received a second consultation. Finally, among patients treated in non-endocrinology departments, 58 (7.8%) had hypoglycemia; less than half retested their blood glucose after treatment.The majority of patients with hyperglycemia were in non-endocrinology departments. Their glycemic management was poor; the endocrinology consultation rate was low and the result was suboptimal. Also, the management of hypoglycemia was not ideal. Therefore, improving glycemic management is urgently needed in Chinese hospitals.

Background Pericardial adipose tissue (PAT) is an emerging cardiovascular risk factor, yet much less is understood about PAT volume in Chinese adults, especially in relation to physical activity. The study explores associations between demographic and clinical variables and PAT volume, using multidetector computed tomography (MDCT) scanning in China. We also examined the relationship between PAT volume and coronary artery disease (CAD). Methods An observational, correlational study design was used. Chinese (n=163) attended a study visit and underwent MDCT scanning between September 2014 and December 2015. Results Participants were 48.5% male and had a mean age of 60.6 (SD 9.4) years. PAT volume was higher ( p =0.001) in males than in females. PAT volume was correlated with age (r=0.388, p =0.001), systolic blood pressure (r=0.205, p =0.009), body mass index (r=0.466, p =0.001), high-density cholesterol (r=−0.282, p =0.001), low-density cholesterol (r=0.177, p =0.024), and triglycerides (r=0.248, p =0.001). Both moderate intensity physical activity energy consumption (r=−0.363, p =0.001) and total physical activity (r=−0.290, p =0.001) had inverse relationships with PAT volume. Total sedentary energy consumption was positively related to PAT volume (r=0.266, p =0.001). Multiple regression revealed that age, male gender, BMI, LDL-C and total physical activity energy consumption were significant predictors of PAT volume (R 2 =0.465). The relationship between PAT volume and CAD was found to be significant in the adjusted models. Conclusions Age, male gender, BMI, LDL-C and total physical activity energy consumption were significant predictors of PAT volume, and PAT volume itself is a predictor of CAD.

Caries, the most infectious chronic disease of childhood in America, leads to health, learning, and quality-of-life issues. Using the Missouri Preventive Service Program model, a pilot oral health program for children from ages birth to 5 years in a rural health clinic was the first to implement the application of fluoride varnish.

A rapid and accurate identification of necrotic myocardium is of great importance for diagnosis, risk stratification, clinical decision-making, and prognosis evaluation of myocardial infarction. Here, we explored technetium-99m labeled rhein derivatives for rapid imaging of the necrotic myocardium. Three hydrazinonicotinic acid-linker-rhein (HYNIC-linker-rhein) derivatives were synthesized, and then, these synthetic compounds were labeled with technetium-99m using ethylenediaminediacetic acid (EDDA) and tricine as coligands [99mTc(EDDA)-HYNIC-linker-rhein]. The necrosis avidity of the three 99mTc-labeled rhein derivatives was tested in a mouse model of ethanol-induced muscular necrosis by gamma counting, histochemical staining, and autoradiography. A lead tracer for visualization of necrotic myocardium was assessed by single photon emission computed tomography/computed tomography (SPECT/CT) imaging in a rat model with reperfused myocardial infarction. The necrosis avidity mechanism of the tracer was explo...

To examine physiological and health-related quality of life (HRQOL) outcomes in community living adults attending a 12-week combined lifestyle wellness program.A sample of overweight and obese adults (n=319) and a subgroup who also had diabetes (n=46 of 319) were studied. The program focuses on dietary, physical activity, and behavioral strategies to promote cardiovascular health. Baseline and 12-week measures were obtained.In the total sample, all physiological and HRQOL outcomes improved (p.05), except HDL. High attendance was associated with the highest weight loss. In the diabetic subgroup, weight, steps/day, low density lipoprotein, and most aspects of HRQOL improved significantly.Physiological and HRQOL benefits can be gained from a 12-week combined lifestyle program; greater benefits were obtained with higher attendance. Although the diabetic subgroup was not large, positive outcomes were realized.The 12-week combined lifestyle program shows promise for improving outcomes in community living overweight and obese adults who may also be diabetic. By attending class, participants are reminded about strategies they are to apply during the 12-week program and, by program end, they are equipped with a tool kit of strategies for use in everyday life.

Purpose: To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another. Design: Systematic review of literature based on Cochrane review criteria. Methods: Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies. Findings: Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly. Conclusions: Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken. Clinical Relevance: This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed.

Surrogate decision makers may be poorly prepared to give informed consent for genomics research for their loved ones in intensive care. A review of the challenges and strategies associated with obtaining surrogates’ consent for genomics research in intensive care patients revealed that few well-controlled studies have been done on this topic. Yet, a major theme in the literature is the role of health care professionals in guiding surrogates through the informed consent process rather than simply witnessing a signature. Informed consent requires explicit strategies to approach potential surrogates effectively, educate them, and ensure that informed consent has been attained.

Many women with elevated blood pressure who seek exercise opportunities require a flexible program with systematic follow-up. The study framework included motivational readiness (exercise stage of change) from the Transtheoretical Model and self-efficacy theory. This pilot study, which used a one-group repeated measures design, tested the feasibility of a stage-specific education/counseling intervention aimed at improving exercise outcomes in women with elevated blood pressure. Forty women completed a 2.5-hour session including prescription for moderate-vigorous exercise on their own, practice on equipment, maintenance of an exercise diary, and contracting; three follow-up calls (Weeks 1, 2, 3); a visit (Week 4); and a final call (Week 5). After the intervention, 85% of women moved to or remained in the action or maintenance stages of change, the highest levels of readiness; none relapsed. Exercise self-efficacy and benefits increased and barriers decreased (P

This study was to identify current A1c understanding status among Chinese patients with type 2 diabetes, assess if knowledge of A1c affects their diabetes self-management and their glycemic control and recognize the factors influencing knowledge of A1c among patients with type 2 diabetes. A multi-center, cross-sectional survey was conducted between April and July 2010 in 50 medical centers in the Mainland China. Participants were recruited from inpatients and outpatients who were admitted to or visited those medical centers. The survey included core questions about their demographic characteristics, diabetes self-management behavior, and A1c knowledge. Overall, of 5957 patients, the percentage of patients with good understanding was 25.3%. In the multivariable logistic regression model, the variables related to the knowledge of A1c status are presented. We discovered that patients with longer diabetes duration (OR = 1.05; 95%CI = 1.04–1.06) and having received diabetes education (OR = 1.80; 95%CI = 1.49–2.17) were overrepresented in the good understanding of A1c group. In addition, compared to no education level, higher education level was statistically associated with good understanding of A1c (P

Quality of life is a major focus of health care today. In published studies on patients with type 2 diabetes, findings on quality of life are mixed. Those with diabetes have chronic illness and must adhere to a complicated care regimen daily, which for many patients is challenging. This study analyzed psychosocial factors and metabolic control as potential predictors of quality of life among these patients.A cross-sectional study of 397 patients with type 2 diabetes was conducted in a hospital in Nanjing, China. Demographic information and clinical characteristics were collected from the medical record. The World Health Organization Quality of Life-BREF, General Self-Efficacy Scale, Diabetes Distress Scale, and Diabetes Empowerment Scale-Short Form were administered.The mean score of quality of life was 67.80 ± 13.44 on a 100-point scale. General self-efficacy (β = 0.340, P 0.001), diabetes distress (β = -0.266, P 0.001), and diabetes empowerment ability (β = 0.207, P 0.001) were predictors of quality of life. In contrast, other factors including HbA1c, diabetes complications, and the duration of diabetes were not associated with quality of life (P 0.05).Our study indicated that psychosocial factors such as self-efficacy, diabetes distress, and diabetes empowerment ability are related to quality of life. Assessment and interventions aimed at reducing psychosocial problems should be applied in diabetes care.

OBJECTIVE Prior studies of quality of life among cardiac patients have examined mostly men. This study evaluated gender differences in quality of life and examined the degree to which social support was associated with quality of life. METHODS A sample of 536 patients (35% women) was recruited during a 14-month period from the inpatient cardiology service of a University-based hospital. Participants completed assessments at baseline and at 3-month intervals over the subsequent 12 months, for a total of 5 assessments. Measures at each assessment included quality of life [Mental Component Score (MCS) and Physical Component Score (PCS) from the Medical Outcomes Study--Short Form 36] and social support [Interpersonal Support Evaluation List--Short Form]. RESULTS A total of 410 patients completed the baseline assessment and at least one follow-up, and were included in the data analyses. Linear mixed effects modeling of the MCS score revealed a significant effect of gender (p =.028) and time (p

© 2015 NATCO, The Organization for Transplant Professionals. Despite the known benefits of kidney transplant, less than 30% of the 615 000 patients living with end-stage renal disease (ESRD) in the United States have received a transplant. More than 100 000 people are presently on the transplant waiting list. Although the shortage of kidneys for transplant remains a critical factor in explaining lower transplant rates, another important and modifiable factor is patients' lack of comprehensive education about transplant. The purpose of this article is to provide an overview of known best practices from the broader literature that can be used as an evidence base to design improved education for ESRD patients pursuing a kidney transplant. Best practices in chronic disease education generally reveal that education that is individually tailored, understandable for patients with low health literacy, and culturally competent is most beneficial. Effective education helps patients navigate the complex health care process successfully. Recommendations for how to incorporate these best practices into transplant education design are described. Providing more ESRD patients with transplant education that encompasses these best practices may improve their ability to make informed health care decisions and increase the numbers of patients interested in pursuing transplant.

To review what is known about the assessment, diagnosis, treatment, and outcomes of patients with bath salt-induced psychosis.Comprehensive review and synthesis of research, case reports, and state-level data.Of the 42 case reports found, only 18 confirmed the presence of bath salts through laboratory testing. Twelve of the confirmed cases died. In most of the case reports, law enforcement was involved prior to hospitalization due to bizarre behaviors, delusions, and hallucinations.Due to the severity of both physical and psychological symptoms in patients in bath salt-induced psychosis, nurses, other healthcare providers, police, and hospital security personnel must work collaboratively to provide safe care.

Past research suggests that continuous handrail support during exercise attenuates physiologic responses to exercise and reduces aerobic benefits; however, this phenomenon has not been systematically studied in women exercising on the step treadmill. The effects of three levels of handrail support (continuous light, continuous very light, or no handrail support) on oxygen uptake and heart rate during step treadmill exercise were examined in 15 healthy women. Measures were obtained during 6 bouts of exercise, 3 bouts at 25 steps/min followed by 3 bouts at 33 steps/min. At both step rates, mean oxygen uptake was significantly reduced during continuous light and continuous very light handrail support as compared with no handrail support, and mean heart rate was significantly reduced during continuous light versus no handrail support. At 25 steps/min only, mean heart rate was significantly reduced during continuous very light versus no handrail support. Findings indicate that women who use even continuous light or continuous very light handrail support attenuate physiologic responses during step treadmill exercise, thereby reducing aerobic requirements and gaining suboptimal benefits from exercise.

Angiotensin II, a known vasopressor agent, recently has been implicated as a growth factor in the heart and vascular smooth muscle. Angiotensin converting enzyme (ACE) inhibitors, which block angiotensin II synthesis, have been found to prevent or reverse cellular growth in the heart and vasculature--a novel mechanism of action. Further study is required to determine the precise mechanisms through which angiotensin II promotes growth as well as the mechanisms through which ACE inhibitors block growth. Large scale clinical trials are needed to delineate further the effectiveness of ACE inhibitors in humans, especially regarding vascular smooth muscle growth.

To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another.Systematic review of literature based on Cochrane review criteria.Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies.Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly.Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken.This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed.