Search

Sterile gloves are essential for plastic surgery, but little research has been published on glove fit. Sterile gloves are produced by all manufacturers, with finger lengths fixed for all sizes. Many wearers have fingers that are shorter or longer than usual, causing functional limitations due to incorrect glove finger length and fingertip fit.A multiquestion confidential electronic survey of glove finger length fit was sent to 6810 plastic surgery glove wearers from three organizations: American Society of Plastic Surgeons, International Society of Plastic and Aesthetic Nurses, and Association of Plastic Surgery Physician Assistants. Data were collected for this descriptive study in 2020-2021, and statistical analyses were performed using SPSS (version 27). Sample gloves from six brands were directly measured for finger length.The survey yielded 500 responses, with some respondents not answering all questions. The response rate from American Society of Plastic Surgeons members was 8.2%, and was 7.3% from all groups combined. The most common reason for glove finger length dissatisfaction was fingers being too long (41.61%). Although there was variation in measured glove finger lengths, the variation was not uniform. Of all responders, 28.6% were very likely, and 16.16%, moderately likely, to want to use gloves with longer or shorter fingers if available, constituting a total of 44. 76%. Of these, 36.55% would pay increased cost (10%-25%) for such gloves.A high percentage of glove users would want gloves with variable finger lengths. Current surgical gloves do not support hand anatomy variations.

Various exposure estimates have been used to assess health impact of unconventional natural gas development (UNGD). The purpose of this study was to (1) use an air pollution dispersal screening model and wind direction to characterize the air emissions from UNGD facilities at each residence and (2) assess association of this exposure estimate with respiratory symptoms. Respiratory symptoms were abstracted from health records of a convenience sample of 104 adults from one county in southwestern PA who had completed a standard clinical interview with a nurse practitioner. Using publicly available air emission data, we applied a "box" air pollution dispersion screening model to estimate the median ambient air level of CO, NOx, PM 2.5, VOCs, and formaldehyde at the residence during the year health symptoms were reported. Sources and median emissions were categorized as north, south, east, or west of the residence to account for the effect of wind direction on dispersion. Binary logistic regression was performed for each respiratory symptom. Number of sources had varying magnitudes of association with some symptoms (i.e., cough, shortness of breath, and "any respiratory symptom") and no association with others (i.e., sore throat, sinus problems, wheezing). Air emissions were not associated with any symptom.

Aim The overall purpose of the study was to develop an instrument to assess empowering nurse leader communication behaviors. Background Effective communication by nurse leaders promotes empowerment, yet communication assessments are often broad in nature without specifying precise behaviors. Methods An instrument development process was used to identify empowering nurse leader communication behaviors. Nurses working in United States military healthcare facilities (n = 240) provided responses to 47 pilot items, along with a 12 item psychological empowerment instrument to test for concurrent criterion validity. Results After review of item performance, 12 items were deleted. An exploratory factor analysis supported either a 2 or 3 factor model, with confirmatory factor analyses conducted to validate the underlying latent variables of empowering and limiting behaviors. The final nurse leader communication assessment consists of 2 factors consisting of 20 positive items (empowering subscale) and 15 negative items (limiting subscale). Conclusion The final 2 factor assessment supports the theoretical premise of the empowering and limiting behaviors. Further testing may provide further dimensional clarity. Implications for nursing management Use of the assessment can provide a basis for the development of training for individual nurse leaders or for facility nurse leaders as a collective.

BACKGROUND Acute myocardial infarction (AMI) sex disparities in management and outcomes have long been attributed to multiple factors, although questions regarding their relevance have not been fully addressed. OBJECTIVE The aim of this study was to identify current factors associated with sex-related AMI management and outcomes disparities in hospitals with comparable quality care standards. METHODS This is a cross-sectional study of 299 women and 540 men with AMI discharged in 2013 from 3 southern California hospitals with tertiary cardiac care. Outcomes (adjusted by demographic/clinical variables using multiple logistic regression) included mortality (in-hospital, 30 days), 30-day readmissions, invasive/revascularization procedures, and quality medication performance measures (aspirin, statins/antilipids, β-blockers, angiotensin-converting enzyme inhibitors

Measurement is an integral part of many disciplines, ranging from the social, healthcare/medical, to management sciences. The field of psychometrics has had a wide-ranging impact in the varied disciplines housed within psychology (e.g., clinical, developmental, etc.) as researchers and test developers aim to construct, refine, and modify their instruments. Given that test validation is a key component in furnishing evidence of validity, the intent of this nontechnical article is to reinforce (or serve as a reminder) for the applied audience the necessary efforts in optimizing the psychometric properties of their measurement tool. This article will be couched as a “lessons learned” document, primarily covering construct and criterion validity, but also, reliability estimation, and then finally, a comment about the confluence of null hypothesis significance testing, sample size and effect size and its relationship to psychometric testing.

Background Limited research explains the quality of life (QOL) among burn survivors during post-hospitalization rehabilitation. Purpose To determine the QOL of military and civilian burn survivors treated in the military burn center. Methods In this longitudinal study, QOL was examined in 131 burn survivors (88 civilians; 43 military). Participants completed the Abbreviated Burn Specific Health Scale (BSHS-A) and the Satisfaction with Life Scale (SWLS) over 5 time points post-discharge. Discussion Civilian and military participants reported improved QOL over time on most BSHS-A subscales. Military participants had higher global BSHS-A scores at discharge, but at 6 months plateaued while civilians improved and had higher global BSHS-A scores at 18 months. Scores on the SWLS were consistently higher for military participants than for civilians. Conclusion Military versus civilian patients may have different expectations about their ability to rehabilitate. The post-hospitalization period needs to be better understood to develop appropriate QOL interventions.

Background Extracorporeal membrane oxygenation (ECMO) has several applications as a resuscitative intervention, including extracorporeal cardiopulmonary resuscitation (ECPR). ECPR is rarely initiated in the emergency department (ED) by emergency physicians outside regional academic institutions. Objectives To evaluate whether ECPR improves clinical outcomes after cardiac arrest when initiated by emergency physicians (EPs) in a nonacademic hospital. Methods and Materials We performed a retrospective analysis of prospectively identified consecutive EP-initiated ECMO subjects from a single community hospital over a 7-year period. Logistic regression and propensity models tested the association between ECPR and survival to hospital discharge compared with concurrent ECPR-eligible control subjects. Results Over 7 years (2010–2017), EPs initiated ECMO on 58 subjects; 44 (76%) were venoarterial cases (43 ECPR) initiated in the ED. Of those, 11 (25%) survived to discharge (n = 9 with cerebral performance category score 1) and most were still alive after 5 years (66%). Adjusting for known covariates, ECPR subjects were more likely than concurrent controls to survive to discharge (odds ratio 8.4; 95% confidence interval 1.2–60.4). Propensity analysis revealed a favorable trend toward survival to discharge after ECPR (odds ratio 2.0; 95% confidence interval 0.51–7.8). Conclusions Emergency physicians initiated ECMO with promising clinical outcomes. Prospective trials are needed to define the efficacy, safety, and cost-effectiveness of EP-initiated ECMO.

Objective We evaluated the effectiveness of a newly designed patient education booklet, the Health Heart Tracker (HHT), in promoting Heart Failure Self-Care (HFSC) behaviors compared to usual patient discharge handouts. Methods We conducted a quasi-experimental, comparative two-group study using patients admitted for HF to four intermediate care units. The HHT was instituted on two units; patients on the other units served as control. We analyzed HFSC measured prior to HF discharge education and at two and six weeks post discharge using repeated measures ANOVA. Results Eighty-four 84 patients completed the study. The sample was 72.6 ( + 12.9) years old, white (75%), educated, and retired (85.8%). All HFSC behaviors improved significantly over time, but there were no significant time by group interactions in HFSC maintenance, symptom perception, and confidence. A notable increase in HFSC management in the HHT group between baseline and 2 weeks was evident, but not sustained to 6 weeks. Conclusions A focused, singular intervention in the form of a patient education booklet designed specifically to improve HFSC did not significantly improve self-care behaviors over time compared to a control group. Practice Implications More work is needed to determine optimal written resources for patients with HF.

The goal of this study was to determine whether motion parameters during laryngoscopy in a manikin differed with experienced operators versus novice trainees and whether motion measurements would predict trainee outcomes when intubating patients.Motion, force, and duration of laryngoscopy on a manikin were compared in two separate experiments between beginning anesthesiology residents (CA1) and anesthesiologists with more than 24 months of anesthesiology training (CA3 or attendings). In one experiment, CA1 residents were also evaluated for the percentage of their laryngoscope path that followed the route used by attending anesthesiologists. The residents were then observed for patient intubation outcomes for 4 weeks after manikin testing. The relationship between manikin test metrics and patient intubation outcomes was analyzed by multilevel modeling.CA1 residents positioned the laryngoscope blade farther right and with less lift than did experienced anesthesiologists. Endpoint position was 0.6 ± 0.3 cm left of midline for residents (n = 10) versus 2.7 ± 0.3 cm for advanced anesthesiologists (n = 8; P = .0003), and 15.6 ± 0.8 versus 17.7 ± 0.2 cm above the table surface, respectively (P = .033). On average, only 74 ± 6% of the CA1 laryngoscopy trajectory coincided with the Attending Route (P.001 versus 100%). For each percentage point increase in Attending Route match, residents' odds of intubating a patient's trachea improved by a factor of 1.033 (95% confidence interval [CI] 1.007-1.059, P = .040), and their rate of failed laryngoscopy attempts decreased by a factor of 0.982 (0.969-0.996, P = .045).Laryngoscopy motion in manikins may predict which trainees can complete a patient intubation successfully in a few attempts. The assessment could help determine readiness for intubating patients with indirect supervision.

Almost 1 out of every 3 homeless women (32%) in the United States, United Kingdom, and Australia has experienced childhood sexual trauma. We assessed lifetime sexual trauma histories among 29 homeless women from three Southern California community sites: one residential safe house and two safe parking areas. More than half of the women (54%) reported a history of sexual trauma. That rate was higher (86%) among women living at the safe home than among women staying at the safe parking sites (only 42%). All four of the women who had served in the military reported having experienced military sexual trauma. The high percentages of sexual trauma found in homeless women highlight the need for effective interventions for sexual trauma.

The purpose of this study was to examine the factor structure of 2 versions of the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp) scale in a sample of Veterans diagnosed with posttraumatic stress disorder (PTSD). The FACIT-Sp has 12- and 23-item versions that have been factor analyzed in other populations with mixed factor solutions. Spiritual well-being is of growing interest in military and veteran populations; valid and reliable measures are needed for research with these groups. A sample of 146 Veterans diagnosed with PTSD was selected for this analysis. Confirmatory factor analysis was used to test competing factorial structures for the 12-item FACIT-Sp. Both a 2-factor and 3-factor model were compared. For the 12-item FACIT-Sp, a more plausible model of spiritual well-being was found with the 3-factor model, separating Meaning from Peace and including Faith subscales. The addition of 11 more items in the 23-item FACIT-Sp did not improve model fit to any substantial degree. Therefore, the 12-item FACIT-Sp with a 3- rather than 2-factor solution (e.g., subscales of Peace, Meaning, and Faith) is recommended as the most accurate representation of the spiritual well-being components in this study of veterans with PTSD

Among women, cardiovascular disease is the leading cause of mortality worldwide. After experiencing an acute cardiovascular event, a woman's physical health, the prevalence of morbidities, likelihood of being treated with coronary artery bypass graft surgery, likelihood for referral for cardiac rehabilitation are less favourable than men. The social support resources of marginality and religiousness are associated with physical and mental health outcomes following cardiovascular crises. This study aimed to evaluate the reliability and validity of the translated versions (Japanese, Ukrainian, Tagalog, Hispanic and Arabic) of the Koci Marginality Index and the Duke University Religion Index among 282 women (aged 35–92 years) representing seven cultures. Results showed that reliability and validity were strong (coefficient alpha of 0.79 and 0.84). Understanding a woman's social isolation and whether she has a connection to religious groups assists health-care professionals to identify a woman's social support resources during recovery following acute cardiovascular episodes.

To assess the efficacy of embedded theta brainwave frequency in music using binaural beat technology (BBT) compared to music alone on the cardiovascular stress response in military service members with postdeployment stress.A double-blinded, randomized, pre- and postintervention trial.Seventy-four military services members with complaint of postdeployment stress were randomized to either music with BBT or music alone. Each group listened to their respective intervention for a minimum of 30 min at bedtime for three consecutive nights a week for a total of 4 weeks. A 20-min pre- and postintervention heart rate variability (HRV) stress test and daily perceived stress via diaries assessed intervention efficacy.There was a statistical difference (p = .01) in low-frequency HRV between the music with BBT group compared to the music only group. The average low-frequency HRV decreased in the music with BBT group 2.5 msWhen placed under an acute stressor, participants who used music with embedded BBT showed a decrease in sympathetic responses and an increase in parasympathetic responses, while participants who used music alone had the opposite effect.The use of BBT in the theta brainwave frequency embedded into music decreases physical and psychological indications of stress. BBT embedded with beta and delta frequencies may improve cognitive functioning and sleep quality, respectively.

Background: Acute Myocardial Infarction (AMI) care and outcomes disparities have been reported worldwide in women and racial-ethnic minorities. In the U.S., some have attributed disparities in Hispanics and other minorities to lower quality of services at hospitals where they seek care. Current information from hospitals with large Hispanic representation and equitable updated resources is needed. Methods: Retrospective observational study of 839 AMI patients discharged in 2013 from three Southern California Community Hospitals (A, B, C) with tertiary cardiac care level. Non-Hispanic Whites (NHW) and Hispanics (H) were the larger racial-ethnic groups (68.3%). Mortality, 30 day readmissions, medication/performance measures (PRx); Aspirin, Statins/anti-lipids, Beta-blockers, Angiotensin Converting Enzyme Inhibitors and Receptor Blockers for Left Ventricular Systolic dysfunction, 2 ), Odds Ratios (OR) with 95% confidence intervals (CI), and Z tests for proportions -independent groups. Results: No significant differences in hospital, 30 day mortality, or PRx were observed between hospitals, NHW and H. Hospital C had 47.3% Hispanics, Hospitals A+B 14.6% (η 2 =.430, p Conclusions: Equitable standards of care offset previously reported disparities in AMI management in Hispanics but not in women’s coronary revascularization procedures.

Disparities in Acute Myocardial Infarction (AMI) care and outcomes have been frequently reported in racial-ethnic minorities in the U.S. Some studies have attributed disparities in Hispanics and other minorities to lower quality of services at hospitals where they seek care. Current information from hospitals with large Hispanic representations and updated quality resources is needed.Retrospective observational study of 839 AMI patients discharged in 2013 from three Southern California Hospitals (A, B, C) with tertiary cardiac care level. Non-Hispanic Whites (NHW) and Hispanics (H) were the larger racial-ethnic groups (68.3%), and the comparison of these two groups constitutes the focus of the study. Mortality, 30day readmissions, medication/performance measures (PRx); aspirin, statins/anti-lipids, beta-blockers, ACEI/ARB for LV systolic dysfunction,90min door-balloon time, and revascularization procedures were compared between hospitals, NHW and H, using Chi-squared tests (χNo significant differences in hospital, 30day mortality, PRx or procedures were observed between NHW, H and other racial-ethnic minority groups, or hospitals. Hospital C had 47.3% H and Hospitals A+B 14.6% (p0.001, effect size=0.430). AMI performance measures exceeded 2013 national rates across all facilities. NHW had more private/commercial insurance (52.5% vs. 25.4%, OR 3.24, 95% CI 2.19-4.80, p0.001) than H.Equitable access to quality hospital services in three Southern California hospitals offset previously reported disparities in AMI management in Hispanics. These results may not necessarily reflect the reality of AMI care for Hispanics in other U.S. regions.

The Self-Care of Heart Failure Index Version 6.2 ( SCHFI v.6.2 ) is widely used, but its psychometric profile is still questioned. In a sample of 659 heart failure patients from Italy, we performed confirmatory factor analysis ( CFA ) to test the original construct of the SCHFI v.6.2 scales ( Self-Care Maintenance, Self-Care Management, and Self-Care Confidence ), with limited success. We then used exploratory factor analysis to determine the presence of separate scale dimensions, followed by CFA in a separate sub-sample. Construct validity of individual scales showed excellent fit indices: CFI = .92, RMSEA = .05 for the Self-Care Maintenance Scale; CFI = .95, RMSEA = .07 for the Self-Care Management Scale; CFI = .99, RMSEA = .02 for the Self-Care Confidence scale. Contrasting groups validity, internal consistency, and test-retest reliability were supported as well. This evidence provides a new understanding of the structure of the SCHFI v.6.2 and supports its use in clinical practice and research.

Women and families are the fastest growing segment of the homeless population. Negative attitudes of nurses toward homeless women are a major barrier to homeless women seeking health care. This cross-sectional, mixed-methods pilot study, conducted primarily by nurses, tested the Mantram Repetition Program for the first time with 29 homeless women. The Mantram Repetition Program is a spiritually based skills training that teaches mantram (sacred word) repetition as a cost-effective, personalized, portable, and focused strategy for reducing stress and improving well-being. For the cross-sectional, pretest-posttest design portion of the study, the hypothesis that at least half of the homeless women would repeat their mantram at least once a day was supported with 88% of the women repeating their mantram 1 week later. The qualitative portion of this study using phenomenology explored the women's thoughts on mantram week 2. Themes of mantram repetition, mantram benefits, and being cared for emerged. This groundbreaking, interventional, mixed-methods pilot study fills a gap in interventional homeless research.

Background A number of studies across different disciplines have investigated students' learning styles. Differences are known to exist between graduate and baccalaureate nursing students. However, few studies have investigated the learning styles of students in graduate entry nursing programs. . Objectives Study objective was to describe graduate entry nursing students' learning styles. Design/Setting/Participants/Methods A descriptive design was used for this study. The Index of Learning Styles (ILS) was administered to 202 graduate entry nursing student volunteers at a southwestern university. Descriptive statistics, tests of association, reliability, and validity were performed. Graduate nursing students and faculty participated in data collection, analysis, and dissemination of the results. Results Predominant learning styles were: sensing – 82.7%, visual – 78.7%, sequential – 65.8%, and active - 59.9%. Inter-item reliabilities for the postulated subscales were: sensing/intuitive (α=0.70), visual/verbal (α=0.694), sequential/global (α=0.599), and active/reflective (α=0.572). Confirmatory factor analysis for results of validity were: χ 2 (896)=1110.25, p Conclusions Predominant learning styles described students as being concrete thinkers oriented toward facts (sensing); preferring pictures, diagrams, flow charts, demonstrations (visual); being linear thinkers (sequencing); and enjoying working in groups and trying things out (active),. The predominant learning styles suggest educators teach concepts through simulation, discussion, and application of knowledge. Multiple studies, including this one, provided similar psychometric results. Similar reliability and validity results for the ILS have been noted in previous studies and therefore provide sufficient evidence to use the ILS with graduate entry nursing students. This study provided faculty with numerous opportunities for actively engaging students in data collection, analysis, and dissemination of results.

Background: The current fragmented healthcare system, characterized by a lack of collaborative, patient-centered care processes, creates significant barriers to providing quality patient care. The clinical nurse leader (CNL) is theorized to provide clinical leadership at the point-of-practice to maintain cross-disciplinary collaborative processes that lead to integrated quality care. Objectives: The aim of this study was to assess the impact of CNL integration into an acute care microsystem on care quality, as measured by patient satisfaction with care. Methods: A short interrupted time series design was used to measure patient satisfaction with multiple aspects of care 10 months before and 12 months after integration of the CNL role on a progressive care unit, compared with a control unit. Data were obtained from Press Ganey surveys, and analysis was completed using a publicly available program for short time series data streams. Results: Clinical nurse leader implementation was correlated with significantly improved patient satisfaction with admission processes (r = + .63, p = .02) and nursing care (r = +.75, p = .004), including skill level (r = .83, p = .003) and keeping patients informed (r = .70, p = .003). There was no significant correlation with improved patient satisfaction with physician care (r = .31, p = .14) or discharge processes (r = .33, p = .23) postimplementation. Control data showed no significant changes in patient satisfaction measures throughout the study time frame. Discussion: The positive correlation between CNL-mediated collaborative care processes and improvements in patient satisfaction with care quality provides empirical evidence of outcomes achievable through CNL implementation. Research is needed to explore the full range of achievable outcomes and to determine the specific processes by which these outcomes are realized. © 2012 Lippincott Williams & Wilkins.

Medical Education 2012: 46: 878–886 Context Medical College Admission Test (MCAT) scores are widely used as part of the decision-making process for selecting candidates for admission to medical school. Applicants who learned English as a second language may be at a disadvantage when taking tests in their non-native language. Preliminary research found significant differences between English language learners (ELLs), applicants who learned English after the age of 11 years, and non-ELL examinees on the Verbal Reasoning (VR) sub-test of the MCAT. The purpose of this study was to determine if relationships between VR sub-test scores and measures of medical school performance differed between ELL and non-ELL students. Methods Scores on the MCAT VR sub-test and student performance outcomes (grades, examination scores, and markers of distinction and difficulty) were extracted from University of California San Diego School of Medicine admissions files and the Association of American Medical Colleges database for 924 students who matriculated in 1998–2005 (graduation years 2002–2009). Regression models were fitted to determine whether MCAT VR sub-test scores predicted medical school performance similarly for ELLs and non-ELLs. Results For several outcomes, including pre-clerkship grades, academic distinction, US Medical Licensing Examination Step 2 Clinical Knowledge scores and two clerkship shelf examinations, ELL status significantly affects the ability of the VR score to predict performance. Higher correlations between VR score and medical school performance emerged for non-ELL students than for ELL students for each of these outcomes. Conclusions The MCAT VR score should be used with discretion when assessing ELL applicants for admission to medical school.

Obesity in Hispanic children is epidemic. Recent recommendations are to focus on parent as role model as a means of prevention. Ways to Enhance Children’s Activity and Nutrition (We Can!) is a public education outreach program from a collaboration of 4 institutes at National Institutes of Health. The purpose of this study was to examine changes in Hispanic mothers’ behaviors, knowledge, and body mass index after participating in a 6-week We Can! program. Thirty-five Hispanic mothers participated in a 6-week program offered in Spanish at an elementary school setting. Height, weight, body mass index, and the We Can! survey were obtained preprogram and postprogram. Findings included significant changes in behaviors identified as risk behaviors for childhood obesity. Outcomes were similar to non-Spanish-speaking families with whom the program was first piloted. Lessons learned from this experience may benefit others who are trying to provide preventive care of Spanish-speaking families.

A number of researchers have argued for the existence of different subtypes of posttraumatic stress disorder (PTSD). In the current paper we present criteria by which to assess these putative subtypes, clarify potential pitfalls of the statistical methods employed to determine them, and propose alternative methods for such determinations. Specifically, three PTSD subtypes are examined: (1) complex PTSD, (2) externalizing/internalizing PTSD, and (3) dissociative/nondissociative PTSD. In addition, three criteria are proposed for subtype evaluation, these are the need for (1) reliability and clarity of definition, (2) distinctions between subtypes either structurally or by mechanism, and (3) clinical meaningfulness. Common statistical evidence for subtyping, such as statistical mean difference and cluster analysis, are presented and evaluated. Finally, more robust statistical methods are suggested for future research on PTSD subtyping.

Purpose: To evaluate physiologic measures of stress with self-reported perceived stress and depressive symptoms among mothers of preterm babies currently hospitalized in an NICU. Study Design and Methods: This was a cross-sectional, descriptive, single-visit study of 20 mothers of hospitalized preterm infants. Data collected included self-report behavioral measures and a brief structured interview. Biological data were available on 17 mothers. Data were analyzed using descriptive and inferential statistics. Results: Mothers reported high levels of stress and depressive symptoms. Higher levels of stress and more depressive symptoms were associated with higher levels of certain serum cytokines, higher levels of waking and afternoon salivary cortisol, and abnormal diurnal patterns of salivary α-amylase. Clinical Implications: A NICU admission is a stressful time for which families typically have not had the opportunity to prepare. Mothers with higher levels of stress and depressive symptoms may be at higher risk for poorer physical and mental health. This study highlights the high levels of stress and depressive symptoms that may be experienced by mothers of preterm infants, and suggests the potential value of developing effective strategies to target maternal psychological

Background: Sleep dysfunction contributes to poor quality of life in adults with heart failure (HF). The purpose of this study was to identify factors associated with sleep dysfunction that may be modifiable. Methods: Data were collected from 266 subjects enrolled from three sites in the U.S. Sleep dysfunction was measured over the past month with the Pittsburgh Sleep Quality Index, using a score > 10 to indicate sleep dysfunction. Potentially modifiable clinical, behavioral, and psychological factors thought to be associated with sleep dysfunction were analyzed with hierarchical logistic regression analysis. Results: When covariates of age, gender, race, data collection site, and New York Heart Association (NYHA) functional class were entered on the first step, only NYHA was a significant correlate of sleep dysfunction. When the clinical, behavioral, and psychological factors were entered, correlates of sleep dysfunction were the number of drugs known to cause daytime somnolence (OR = 2.08), depression (OR = 1.83), worse overall perceived health (OR = 1.64), and better sleep hygiene (OR = 1.40). Although most (54%) subjects had sleep disordered breathing (SDB), SDB was not a significant predictor of sleep dysfunction. Discussion: Factors associated with sleep dysfunction in HF include medications with sleepiness as a side-effect, depression, poorer health perceptions, and better sleep hygiene. Sleep dysfunction may motivate HF patients to address sleep hygiene. Eliminating medications with sleepiness as a side-effect, treating depression and perceptions of poor health may improve sleep quality in HF patients.

Aims. The study aims were to explore the relationships between perceived barriers to research use and the implementation of evidence-based practice among hospital nurses and to investigate the barriers as predictors of implementation of evidence-based practice. Background. Evidence-based practice is critical in improving healthcare quality. Although barriers to research use have been extensively studied, little is known about the relationships between the barriers and the implementation of evidence-based practice in nursing. Design. Cross-sectional study. Method. Data were collected between December 2006–January 2007 for this cross-sectional study using computerised Evidence-Based Practice Questionnaire and BARRIERS surveys. A convenience sample (n = 1301) of nurses from four hospitals in southern California, USA, participated. Hierarchical multiple regression analyses were performed for each of the three dependent variables: practice, attitude and knowledge/skills associated with evidence-based practice. BARRIERS subscales were used as predictor variables. Results. The perceived barriers to research use predicted only 2·7, 2·4 and 4·5% of practice, attitude and knowledge/skills associated with evidence-based practice. Conclusions. It was unexpected that the barriers to research use predicted such small fractions of practice, attitude and knowledge/skills associated with evidence-based practice. The barriers appear to have minimal influence over the implementation of evidence-based practice for most hospital nurses. Relevance to clinical practice. In implementing evidence-based practice, the focus on barriers to research use among general nursing staff may be misplaced. Further studies are needed to identify the predictors of evidence-based practice and to identify the subset of nurses who are most amenable to adopting evidence-based practice.

Aim. This paper is a report of a study describing nurses‘ practices, knowledge, and attitudes related to evidence-based nursing, and the relation of perceived barriers to and facilitators of evidence-based practice. Background. Evidence-based practice has been recognized by the healthcare community as the gold standard for the provision of safe and compassionate healthcare. Barriers and facilitators for the adoption of evidence-based practice in nursing have been identified by researchers. Healthcare organizations have been challenged to foster an environment conducive to providing care based on evidence. Methods. A descriptive, cross-sectional research study was conducted in 2006-2007 with a convenience sample of 458 nurses at an academic medical center in California (Response rate 44.68%). Two reliable and valid questionnaires were electronically formatted and administered using a secured website. Relationships between responses to the two instruments were examined and results compared with previously published data. Results. Organizational barriers (lack of time and lack of nursing autonomy) were the top perceived barriers. Facilitators were learning opportunities, culture building, and availability and simplicity of resources. Statistically significant correlations were found between barriers and practice, knowledge and attitudes related to evidence-based practice. Conclusion. Similar barriers to the adoption of evidence-based practice have been identified internationally. Educators must work with managers and librarians to address organizational barriers and proactively support evidence-based practice.

Heart failure (HF) is a significant health problem among the elderly often requiring multiple lifestyle changes for optimal management. Unfortunately, not all patients are ready to make the needed ...

Introduction The purposes of this study were to (a) analyze the body mass index (BMI) percentile and eating and physical activity habits of adolescents, viewing them by sex, ethnicity, household type, and foreign-born or born in the United States, and (b) evaluate diet and activity analysis software for use by practitioners and adolescent clients. Method A descriptive-correlational study of 74 adolescents from low-income households completed a 24-hour recall of their foods, drinks, and activities, which were analyzed using MyPyramidTracker software. Data were analyzed using parametric and nonparametric methods to test associations and conduct between-group comparisons. Results Girls, Hispanics, adolescents living with single-parent mothers, and those who were foreign born had the highest mean BMI percentiles and the least healthy eating and physical activity habits. BMI percentile fell as daily calorie expenditure rose. MyPyramidTracker software is suitable for use by adolescents and their family members. Discussion To contribute to the reversal of national trends of increasing overweight status among adolescents, practitioners can focus their teaching, counseling, and advocacy on adolescents in these groups.

Background: Heart failure (HF) is a prevalent and costly condition. Technology is increasingly being used to deliver patient self-care programs to provide knowledge and skills for early symptom recognition, prompt treatment, and successful management. Objective: The purpose of this study was to provide a home telemonitoring (HT) and telephonic nurse coach (NC) motivational interviewing (MI) educational intervention. Methods: Thirty participants (M age = 75) were enrolled in a three-arm randomized controlled trial. Group A participants ( n = 9) received HT devices, NC, and MI HF self-care education while Group B ( n = 11) had NC, MI HF self-care, and Group C ( n = 9) received NC health promotion only. Results: Eighty-four percent of participants completed the study. Only 1, of the total 9 readmissions that occurred among the 3 groups, was in Group A but there was no statistical significance regarding readmissions. Both depression ( p = .008) and telemedicine satisfaction ( p = .046) were statistically significant between the groups. Over time, Group A participant depression declined ( p = .047) while Group C demonstrated improved self-care confidence ( p = .047). Implications: There are numerous challenges related to the care and management of chronically ill HF patients. Potential benefits that may result from the use of HT in promoting self-care of HF patients should be further explored.

© 2015, Canadian Anesthesiologists' Society. Background: The combined spinal-epidural (CSE) technique for relief of labour pain offers both rapid onset and superior first-stage analgesia. Nevertheless, the known increased risk for early profound fetal bradycardia (EPFB) following CSE continues to be a concern that often limits its use. The purpose of this study was to determine if giving prophylactic intravenous ephedrine at the time of CSE administration would reduce EPFB. Methods: We conducted this clinical trial at a large community hospital and enrolled healthy patients requesting epidural analgesia for labour. Patients were randomly assigned to receive either normal saline placebo or ephedrine 10 mg iv at the time of CSE. The primary outcome of EPFB (defined as bradycardia < 90 beats·min−1for > two minutes and occurring within the first 30 min after CSE) was compared between groups. The secondary outcomes included the incidence of urgent cesarean delivery, the requirement for additional doses of ephedrine, maternal blood pressure, uterine hypertonus and tachysystole, and abnormal fetal heart rate (FHR) patterns before and after CSE. Results: There were 299 women randomized to the ephedrine (EPH) group and 297 randomized to the normal saline placebo (NS) group. There was no difference between groups in the incidence of EPFB (2.7% EPH group vs 4.7% NS group; relative risk, 0.57; 95% confidence interval, 0.24 to 1.33; P = 0.184). There was also no difference between groups in the incidence of urgent cesarean delivery, uterine hypertonus, uterine tachysystole, and abnormal FHR patterns. Conclusions: We conclude that prophylactic intravenous ephedrine administration at the time of CSE during labour was ineffective at reducing the risk for EPFB associated with CSE. Nevertheless, a lower than expected rate of EPFB resulted in the trial being underpowered. This trial was registered at ClinicalTrials.gov, identifier: NCT02062801.

Worldwide, 3.4 million women die each year from cardiovascular disease. After experiencing a cardiovascular event, a woman’s physical health, the women’s likelihood of being treated with coronary artery bypass graft surgery, likelihood for referral for cardiac rehabilitation are less favorable than men. An established conceptual model depicts psychosocial stressors and the influence of behavioral risk factors on the pathogenesis of atherosclerosis and the occurrence of CV events. The woman’s social stressors of role quality and behavioral risk factors of low self-efficacy for physical activity are associated with physical and mental health outcomes following cardiovascular crises. The study aimed to evaluate the reliability of the translated versions (Japanese, Ukrainian, Tagalog, Hispanic and Arabic) of the worker, partner, mother Role Quality and the Self Efficacy of Lifestyle Physical Activity indices among 282 women (aged 35-92 years) representing seven cultures. The study was performed in a multi-center, multicultural context. Translations followed an established process. Results showed reliability was strong (coefficient alphas of 0.93 and 0.88). These instruments underwent first-time confirmatory factor analyses with acceptable, though borderline fit, thus providing valuable input for strengthening in future studies. Understanding a woman’s role quality and self-efficacy for lifestyle physical activity provides valuable information that assists health-care professionals to co-develop with the woman an individualized plan to reduce role stress and to initiate increased physical activity following cardiovascular episodes.

Among women, cardiovascular disease is the leading cause of mortality worldwide. After experiencing an acute cardiovascular event, a woman's physical health, the prevalence of morbidities, likelihood of being treated with coronary artery bypass graft surgery, likelihood for referral for cardiac rehabilitation are less favourable than men. The social support resources of marginality and religiousness are associated with physical and mental health outcomes following cardiovascular crises. This study aimed to evaluate the reliability and validity of the translated versions (Japanese, Ukrainian, Tagalog, Hispanic and Arabic) of the Koci Marginality Index and the Duke University Religion Index among 282 women (aged 35-92 years) representing seven cultures. Results showed that reliability and validity were strong (coefficient alpha of 0.79 and 0.84). Understanding a woman's social isolation and whether she has a connection to religious groups assists health-care professionals to identify a woman's social support resources during recovery following acute cardiovascular episodes.

Hispanics are a growing ethnic minority in the United States and one at significant risk for heart failure. Health-related quality of life (HRQL) is poor in individuals with heart failure, especially during and immediately following hospitalization. No prior research into the HRQL of Hispanics with heart failure was located. A sample of 80 individuals with heart failure, evenly divided by primary language and matched on functional status using the New York Heart Association classification system and age, was studied for 6 months following hospital discharge. Data on HRQL were collected using Spanish and English versions of the Minnesota Living with Heart Failure Questionnaire. Scores improved over time in both groups but significantly more so in the Hispanics when compared to the non-Hispanics. Group differences in HRQL could not be explained by demographics, clinical characteristics, treatment received, perceived support, or instrument response characteristics. Further exploration of this naturally occurring phenomenon may provide insight into how HRQL can be improved in the general heart failure population.

• Background Clinicians need easy methods of screening for cognitive impairment in patients with heart failure. If correlates of cognitive impairment could be identified, more patients with early cognitive impairment could be treated before the problem interfered with adherence to treatment. • Objectives To describe cognitive impairment in patients with heart failure, to explore the usefulness of 4 measures of cognitive impairment, and to assess correlates of cognitive impairment. • Methods A descriptive, correlational design was used. Four screening measures of cognition were assessed in 42 patients with heart failure: Commands subtest and Complex Ideational Material subtest of the Boston Diagnostic Aphasia Examination, Mini-Mental State Examination, and Draw-a-Clock Test. Cognitive impairment was defined as performance less than the standardized (T-score) cutoff point on at least 1 of the 4 measures. Possible correlates of cognitive impairment included age, education, hypotension, fluid overload (serum osmolality • Results Cognitive impairment was detected in 12 (28.6%) of 42 participants. The 4 screening tests varied in effectiveness, but the Draw-a-Clock Test indicated impairment in 50% of the 12 impaired patients. A summed standardized score for the 4 measures was not significantly associated with age, education, hypotension, fluid overload, or dehydration in this sample. • Conclusions Cognitive impairment is relatively common in patients with heart failure. The Draw-a-Clock Test was most useful in detecting cognitive impairment, although it cannot be used to detect problems with verbal learning or delayed recall and should not be used as the sole screening method for patients with heart failure. Correlates of cognitive impairment require further study.

Background:The Minnesota Living with Heart Failure Questionnaire (LHFQ) is a commonly used measure of health-related quality of life in persons with heart failure. Researchers have questioned whether LHFQ is sensitive to subtle differences and sufficiently responsive to clinical interventions because the instrument has demonstrated variable performance in clincial trials.Objectives:A secondary analysis was conducted to assess the LHFQ for sensitivity to different clinical states and responsiveness to varying intensities of clinical intervention.Methods:A convenience sample of nine experimental or quasi-experimental studies from eight clinical sites in the United States yielded data from 1,136 patients with heart failure. Data in the studies had been collected at enrollment and one, three, and/or six months later. Data were analyzed using descriptive, univariate, and multivariate techniques.Results:Total and subscale scores on LHFQ were poorer in those with worse New York Heart Association functional class, although there was no difference in the LHFQ scores between classes III and IV. No difference in LHFQ scores was found when patients were classified by ejection fraction. Scores improved significantly following hospital discharge, even in those in the control group. Changes in LHFQ scores were greatest in those receiving high intensity interventions.Conclusions:The LHFQ is sensitive to major differences in symptom severity but may not be sensitive to subtle differences. It is responsive to high intensity interventions. Investigators are cautioned against using this instrument without first maximising intervention power or without a control group for comparison.

Background: Heart failure (HF) is as common in Hispanic as it is in non-Hispanic populations. However, there do not appear to be any published reports of HF disease management programs which include Hispanic populations. Objective:To test the effectiveness of a standardized telephonic disease management intervention, Pfizer Inc.’s At Home With Heart Failure™, in decreasing acute care resource use and cost in Hispanic patients with HF. Participants and methods: A factorial design was used to analyze data obtained in a randomized controlled clinical trial. Patients with HF were enrolled in the trial when admitted to hospital, randomized to the intervention or usual care control groups, and followed for 6 months. Of the 358 participants, 93 (26%) were Hispanic (35 in the intervention group, 58 in the usual care group). Data were analyzed to determine if comparable decreases in acute care resource use were evident in Hispanic and non-Hispanic intervention group patients. Intervention: Registered nurses telephoned patients after hospital discharge to provide advice, solve problems, encourage adherence, and facilitate access to needed services. Results: Acute care resource use was lowered as effectively in the Hispanic patients as in the non-Hispanic patients, despite significant between-group differences in education, income, and living situations. When a fully crossed (language by group) analysis was conducted, no significant differences were found between the Hispanic and non-Hispanic intervention groups. However, in most categories there was a trend towards lower resource use in the Hispanic intervention group. The cost of inpatient care was more than $US1000 (2000 values) less in the Hispanic than the non-Hispanic intervention group. Conclusion: The results of this study suggest that Hispanic patients with HF are receptive of, and responsive to, a case management intervention provided in a culturally competent manner, despite differences in cultural views on chronic illness and self-care as discussed in the literature.

This paper describes the factor analysis testing and construct validation of the Japanese version of the Caffrey Cultural Competence Health Services (J-CCCHS). The inventory, composed of 28 items, was translated using language and subject matter experts. Psychometric testing (exploratory factor, alpha reliability, and confirmatory factor analyses) was undertaken with nurses (N = 7494, 92% female, mean age 32.6 years) from 19 hospitals across Japan. Principal components extraction with varimax rotation yielded a 5-factor solution (62.31% variance explained) that was labeled: knowledge, comfort-proximal, comfort-distal, awareness, and awareness of national policy. Cronbach α for the subscales ranged from 0.756 to 0.892. In confirmatory factor analysis using the robust maximum likelihood estimator, the chi-square test was as follows: χ2(340) = 14604.44, P

The current debate about the merits of null hypothesis significance testing, even though provocative, is not particularly novel. The significance testing approach has had defenders and opponents for decades, especially within the social sciences, where reliance on the use of significance testing has historically been heavy. The primary concerns have been (1) the misuse of significance testing, (2) the misinterpretation of P values, and (3) the lack of accompanying statistics, such as effect sizes and confidence intervals, that would provide a broader picture into the researcher's data analysis and interpretation. This article presents the current thinking, both in favor and against, on significance testing, the virtually unanimous support for reporting effect sizes alongside P values, and the overall implications for practice and application.

BACKGROUND: Invalidism has been discussed in the cardiovascular literature for decades. Researchers have studied health perceptions, emotional distress, and dependency in patients after acute myocardial infarction in an attempt to understand the phenomenon. However, no theory of the manner in which these variables interact has been proposed. OBJECTIVES: Using previous research, a model of invalidism was specified in which individuals' perceptions that their health is poor lead to emotional distress and increased dependency. As health perceptions improve over time, emotional distress and dependency decrease. METHOD: Survey data were collected from 111 men and women 1 and 4 months after a first myocardial infarction and were tested using structural equation modeling. RESULTS: The model was rejected using a confirmatory approach (chi2(89) = 141.40; p= .00034). The fit indices, however, suggested an adequate fit of the model to the data (CFI = .96; NNFI = .94). CONCLUSION: The conclusion is that the model is reasonable and serves as a starting point for a theory-based empirical exploration of the invalidism process.

OBJECTIVE: Dependency is frequently mentioned in the literature as a response of patients with cardiac disease. The purpose of this study was to develop and test a measure of dependency occurring in response to a cardiac illness. Illness dependency is defined as the need for emotional protection and social support after a significant change in health. DESIGN: Instrument development study. SAMPLE: Convenience sample of 311 patients with cardiac disease. RESULTS: The final version of the instrument has 25 items, each of which is measured on a 5-point Likert-type scale. Content validity was demonstrated using a panel of experts. Internal consistency of the total scale was 0.90; subscale alpha coefficients ranged from 0.64 to 0.81. Exploratory factor analysis supported a four factor solution: Attention, Reassurance, Concern, and Assistance, which accounted for 57.4% of the variance in scores. Discriminant validity was demonstrated by a low correlation with neuroticism. Social desirability of responses was minimal. CONCLUSION: Internal consistency reliability, content validity, and discriminant validity of the illness Dependency Scale have initial support. This instrument is ready for use in research in which the investigator wishes to measure dependency associated with cardiac illness.

Mothers of preterm infants are at risk for poor sleep quality, which may adversely affect their health, maternal-infant attachment, and infant caretaking activities. This study examined the relationship of an 8-week relaxation guided imagery intervention on sleep quality and the association between sleep quality and maternal distress (perceived stress, depressive symptoms, and state anxiety) in 20 mothers of hospitalized preterm infants. Mothers received a CD (compact disc) with three 20-minutes recordings and were asked to listen to at least 1 recording daily for 8 weeks. This analysis used self-report data gathered at baseline and 8 weeks. Pearson correlations were used to examine the relationships between mean cumulative relaxation guided imagery use and measures of maternal distress and sleep quality scores at 8 weeks. Complete data on 19 mothers were available for analysis. At 8 weeks, higher mean relaxation guided imagery use was inversely correlated with sleep quality scores (r = -0.30); sleep quality scores were positively correlated with stress (r = 0.42), depressive symptoms (r = 0.34), and anxiety (r = 0.39) scores. In mothers of preterm infants, sleep quality was negatively affected by mental distress and may be improved by a guided imagery intervention.

Background: Caregivers make an important contribution to the self-care of patients with heart failure ( HF ), but few instruments are available to measure this contribution. Objective: The objective of this study was to test the psychometric properties of the Caregiver Contribution to Self-care of Heart Failure Index ( CC-SCHFI ), an instrument derived from the Self-care of Heart Failure Index version 6.2. The CC-SCHFI measures the contribution of caregivers to the self-care maintenance and self-care management of HF patients, as well as their confidence in their ability to contribute to the patients’ HF self-care. Methods: A cross-sectional design was used to study 291 Italian caregivers whose HF patients were cared for in 17 cardiovascular centers across Italy. Caregivers completed the CC-SCHFI and a sociodemographic questionnaire. Caregivers were retested on the CC-SCHFI 2 weeks later to assess test-retest reliability. Results: Most caregivers were women ( 66% ) with a mean age of 59 years. First- and second-order confirmatory factor analysis ( CFA ) for each CC-SCHFI scale showed good model fit: [chi]2 = 37.22, P = .08, Comparative Fit Index ( CFI ) = 0.97, Non-Normed Fit Index ( NNFI ) = 0.96 for caregiver contribution to self-care maintenance ( second-order CFA ); [chi]2 = 14.05, P = .12, CFI = 0.96, NNFI = 0.93 for caregiver contribution to self-care management ( first-order CFA ); and [chi]2 = 10.63, P = .15, CFI = 0.99, NNFI = 0.98 for caregiver confidence in contributing to self-care ( second-order CFA ). The CC-SCHFI was able to discriminate statistical and clinical differences between 2 groups of caregivers who had received or not received HF self-care education. Internal consistency reliability measured by factor score determinacy was more than .80 for all factors and scales except for 1 factor in the caregiver contribution to self-care management scale ( .65 ). Test-retest reliability computed by intraclass correlation coefficient was high ( > 0.90 ) for most factors and scales. Conclusion: The CC-SCHFI showed good psychometric properties of validity and reliability and can be used to measure the contribution of caregiver to HF patient self-care.