Search

Background: In 2014, the Hawaii Department of Education (DOE), the only statewide school system in the United States, predominately enrolled children (keiki) from underserved communities and lacked school nurses or a school health program. Chronic absenteeism due to health concerns was identified as a barrier to academic success., Methods: The DOE and a public university created Hawaii Keiki: Healthy and Ready to Learn (HK), a program to provide school-based services for 170 Title 1 schools in urban and rural settings and build momentum for statewide collective action. HK has maintained support from public and private entities to address student health., Results: This paper describes 5 years of program development, implementation, and continuing challenges. Most recently in 2020-2021, HK pivoted in the face of school campus closings due to COVID-19 with strategic plans, including telehealth, to move forward in this changed school environment., Conclusions: The HK program has increased awareness of students' needs and is addressing the imperative to build health services within public schools. The multipronged approach of building awareness of need, providing direct services, educating future care providers, and supporting sound policy development, has an impact that goes beyond any one individual area., (© 2021 American School Health Association.)

Achieving a decade long successful academic-practice partnership between a university-based school of nursing and a large private healthcare organization during a time of healthcare payment transformation is a significant accomplishment. Goals of the partnership are to provide evidence that 1. research collaboration and mentoring are instrumental in improving patient care by shaping nursing infrastructure and capacity and 2. consultation and mentoring activities will effectively engage faculty and staff nurses in an academic-practice research partnership. Nursing faculty and practicing clinicians collaborate on organizational priorities to improve patient care outcomes. Of the 28 approved studies, 17 are completed, five are in progress, and six were not completed. Dissemination products directly related to this partnership include: three publications, 23 podium presentations, and eight poster presentations delivered at local, national, and/or international conferences. Findings from seven of the 17 completed projects have been translated to improve practice. Several partnership participants have continued their academic progression and continue to conduct studies. This innovative partnership is a successful endeavor that bridges education and practice in our community, while developing research capacity in both institutions. This article adds to the emerging literature on models of academic-practice partnership to develop nursing research., (Copyright © 2019 Elsevier Inc. All rights reserved.)

PROBLEM STATEMENT: Rigorous evaluation assures that research endeavors meet their purpose and achieve stated goals. This is especially true for federally funded exploratory research centers, which tend to be more complex due to the involvement of multiple, interdisciplinary investigators. This study provides an overview of the approach used to develop an evaluation strategy and reports the lessons learned during the initial development of the Center for Ohana Self-Management of Chronic Illness (COSMCI) at the University of Hawai'i at Mānoa School of Nursing and Dental Hygiene. The COSMCI is composed of an interdisciplinary team of researchers and practitioners and aims to advance knowledge in the field of self management of chronic disease in the community setting. APPROACH: A systematic approach was utilized that included formative and summative strategies for ongoing evaluation. The problem was solved by addressing five key concerns: (1) development of research structure, (2) observing the process of the research pilot projects, (3) scholarly activity of COSMCI faculty, (4) dissemination and translation and (5) sustainability prospects. The method of research included formulating process strategies and determine if the plans for developing the Center were followed and whether these plans were effective. Interviews were also conducted at year one and at mid-point though the project. RESULTS: Themes that emerged from our evaluation included inclusion, timelines, realistic expectations, ongoing evaluation and preparing for changes in the team. This provided timely recognition of successes and challenges and facilitated a rapid response for interventions especially during the early development stage of the center. CONCLUSION/RECOMMENDATIONS: Effective development of a successful Center is highly dependent upon having a strong evaluation process in place that can inform ongoing development. An exploratory research center requires ongoing evaluation that allows for celebration of successes, as well as early identification of problems and rapid response.

Prevention and successful treatment of chronic disease require a scientific understanding of the impacts and interactions of ethnicity, culture, and illness on self-management interventions. This article presents one approach to developing effective methods to address the needs of ethnic minorities living with chronic illnesses. Described is the University of Hawaii Center for Ohana Self-Management of Chronic Illnesses (COSMCI) located in the School of Nursing & Dental Hygiene and funded by the National Institute of Nursing Research (Award Number P20NR010671). The interdisciplinary center focuses on family and community self-management interventions in ethnically diverse populations with chronic illnesses. Areas discussed are: 1) the operational structure for creating an environment conducive to interdisciplinary ohana self-management chronic illness research in ethnically diverse populations; and 2) the development of sustainable interdisciplinary, biobehavioral research capacity. The COSMCI uses a social cognitive theory framework to guide the application of established self-management interventions to Asian and Pacific Island populations (API) through three conceptually linked research projects on HIV infection, type 2 diabetes, and chronic obstructive pulmonary disease. COSMI addresses the feasibility of sharing of lessons learned among the approaches taken. The interdisciplinary nature of COSMCI increases the potential success of the intervention efforts., (Hawaii Medical Journal Copyright 2010.)

An informal coalition of nurses, educators, health care providers and policy makers recognizing that administrative rules for advanced practice registered nurse (APRN) practice limited consumer access to care in Hawai'i, developed an initiative to bring about legislative and regulatory change using the National Council of State Boards of Nursing APRN Scope of Nursing Practice and Standards Related to the APRN. The authors report on the process including challenges and keys to success toward the passage of Hawai'i Act 169 (2009). The authors also discuss key components of the legislation, which removed barriers to full scope of practice for APRNs. The potential for comprehensive reform was realized due to the actions of a broad coalition in support of increasing access to care for underserved and rural populations in Hawai'i.

Today's nursing leaders are setting the stage for the next evolution--bringing together skilled clinicians and administrators with peers in education to create new approaches to leading the profession forward. Partnerships share goals, common purpose, mutual respect, willingness to negotiate and compromise, informed participation, information giving, and shared decision making. The shared practice academia effort between a public university and a private health care system situated in the island state of Hawai'i is described. The medical center and school of nursing pursued individual strategic efforts to build research capacity and used the opportunity to fund academic practice research projects. The mutual need and recognition of the high stakes involved, in concert with stable, committed leaders at all levels, were key to the early success of their efforts. Through the formal research partnership mechanism, a discrete focus was created for efforts and used to move to tactical, operational, and interpersonal integration in this relationship.

A paraesophageal hernia was diagnosed in a 67-year-old female patient suffering from epigastric pain and gastroesophageal reflux disease. The patient underwent laparoscopy. Beside the paraesophageal hernia, a Morgagni hernia was also observed, with a significant part of the omentum herniated in the sac. A 360-degree Nissen fundoplication was performed, the Morgagni hernia sac was not resected, and its closure was performed with interrupted sutures. No complications were observed in the postoperative period and on one-year follow-up the patient was free of symptoms.

Objectives: This study examines quality of life (QOL) among school-aged children with perinatally acquired HIV infection and compares QOL outcomes between treatment groups that differ according to the use of protease inhibitor (PI) combination therapy (PI therapy). To gain insights into how PI therapy might influence QOL, associations between severity of illness and QOL were also investigated., Methods: Cross-sectional data for 940 children, 5 to 18 years of age, who were enrolled in Pediatric AIDS Clinical Trials Group Late Outcomes Protocol 219 were used to examine domains of caregiver-reported QOL, as assessed with the General Health Assessment for Children, during 1999. The General Health Assessment for Children is an age-specific, modular, QOL assessment that was developed for the study with previously validated measures. QOL differences between treatment groups were estimated with linear and logistic regressions that controlled for sociodemographic characteristics (age, gender, race/ethnicity, maternal/caregiver education, and respondent) and severity-of-illness indicators related to receipt of PI therapy (AIDS status, log(10) CD4+ cell counts, and height-for-age z scores)., Results: The mean age of participants was 9.7 years. Most children were non-Hispanic black (54%) or Hispanic (31%), and 49% of the participants were female. At the 1999 study visit, approximately 14% of children had severe immune suppression (<15% CD4+ cells), whereas 62% of children had > or =25% CD4+ cells, ie, no immune suppression. Participants did exhibit some lag in growth, with mean height and weight z scores of -0.70 and -0.20, respectively. Twenty-eight percent of the children were reported to have met criteria for AIDS at study entry (1993-1999). When treatment groups were compared, children receiving PI therapy (72%) were older, had lower CD4+ cell percentages, and had lower height and weight z scores than did those receiving non-PI therapies. They were also more likely to have met criteria for AIDS at study entry. The most commonly used PIs were ritonavir (46%) and nelfinavir (63%). Health perceptions ratings for most children were at the upper end of the scale, whereas ratings for 25% of the children ranged over the lower 70% of scale scores. Almost one half of the children had at least some limitations in physical functioning, with more frequent limitations in energy-demanding activities (46%) than in basic activities of daily living (32%). The Behavior Problems Index was used to assess psychologic functioning. The mean total Behavior Problems Index score (9.34) and the proportion of children with extreme scores (23%) were consistent with values reported for chronically ill children and those at social and economic risk. One or more limitations in social/school functioning were reported for 58% of children. More than one third of the children (38%) experienced > or =1 physical symptoms that were at least moderately distressing. Health perceptions, physical functioning, psychologic functioning, social/school functioning, and overall HIV symptom scores did not differ between treatment groups. However, receipt of PI therapy was associated with an increased rate of diarrhea (28 vs 13%; adjusted odds ratio: 2.59; 95% confidence interval: 1.74-3.85). Severity of illness was associated with QOL in all domains except psychologic functioning. Higher log(10) CD4+ cell counts, higher height-for-age z scores, and absence of AIDS at study entry were independently associated with fewer social/school limitations and better HIV symptom scores. Health perceptions and physical functioning scores were associated with log(10) CD4+ cell counts and height z scores, respectively., Conclusions: QOL among children receiving PI therapy differed little from that among children receiving non-PI therapy, despite clinical indications of more advanced disease. Importantly, the study found no evidence of direct negative effects of PI therapy on QOL outcomes, other than an increased rate of diarrhea. Findings suggest that the effects of PI combination therapies to slow or to prevent disease progression and to increase CD4+ cell counts and height growth have the potential to improve QOL among children with HIV infection. However, many children do experience a constellation of functional impairments indicated by behavioral problems and clinical symptoms, with limitations in activities and in school performance. Comprehensive health services will continue to be required to minimize long-term illness and disability and to maximize children's potential as they move into adolescence and adulthood.

The authors analyse non septic, surgical complications and their treatment in 131 patients with acute necrotizing pancreatitis. Bleeding occurred in 13 patients 16 times. There were 3 cases with large intestine perforation, small intestine perforation twice in one patient and hydrothorax in 12 patients. The patients APACHE-II score was in the range of 15, 5, which was quite high. They experienced complications such as bleeding and bowel perforations mostly in those who underwent several reoperations. For the bleeding from acute duodenal ulcer conservative and surgical therapy (suturing) was executed. In the cases of intraabdominal bleeding they used several options such as, ligature, collagen mesh, Surgicell net and tamponation. Large intestine perforations were surgically treated with Hartmann's procedure or loop colostomy. The small intestine perforation was simply sutured. From the 12 patients with hydrothorax 8 underwent thoracic drainage. We lost 7 patients with bleeding, 3 with bowel perforations and 2 with hydrothorax. The authors believe that complications during therapy of acute necrotizing pancreatitis are high risk factor, but their treatment is not hopeless.

Caring for children with HIV infection is a much more optimistic process than in the beginning of the epidemic. Antiretroviral therapies are available, and additional drugs are receiving approval from the US Food and Drug Administration. Cautious optimism must be tempered with an understanding that living with the disease is a complicated and daunting process for these children and their families. Although scientific knowledge and medical treatments are moving forward, the social and environmental uncertainties remain for families. Comprehensive care is a balance of health care services and supportive, community-based services offered in a compassionate manner.

Perinatally transmitted HIV infection is an emerging public health problem, particularly in communities impacted by substance abuse. This article presents an overview of clinical presentation and management throughout the various stages of infection. Recent advances in antiretroviral therapy have the potential to improve quality of life and increase survival for infected children. Nursing intervention is required for all children and families regardless of the severity of disease. Family education and support can be integrated within existing health care systems to assure delivery of competent and comprehensive care.