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Abstract: The purpose of this research was to assess home health nurses'' (HHNs) knowledge, comfort levels, barriers, and personal participation in advanced care planning (ACP), a practice that recognizes patient preferences for health care treatment. Licensed nurses who identified home care as their primary area of practice (N = 519) were surveyed about their knowledge of laws governing ACP and their perceptions of patients'' preferences for ACP. Most respondents were women (97%), and the average age of the respondents was 54 years. Most nurses felt knowledgeable and capable of educating patients on advance directives (ADs), although the nurses'' knowledge of laws governing ACP was limited and often inaccurate. Generally, nurses felt comfortable during ACP discussions with patients and families. HHNs perceived patient or family reluctance as the greatest barrier hindering discussions of ACP. No association was found between level of education and whether a nurse had a personal AD. Twenty percent of the nurses had their valid personal AD. A greater knowledge base concerning ACP would facilitate HHN discussions with patients and families. Recognition of patient preferences can be enhanced by understanding and overcoming barriers that hinder discussions of ACP. Educational opportunities focusing on ACP are encouraged for all health care providers. [Copyright &y& Elsevier]

Objective: The purpose of this study was to determine the effect of continuous glucose monitoring (CGM) on glycemic control in children, adolescents, and young adults ages 7-21 years with poorly controlled diabetes HbA1c 9.0% or more (74 mmol/mol IFCC)., Materials and Methods: The primary outcome was improvement in HbA1c. The secondary outcome included self-reported hypoglycemia. This 12-week study used a prospective, one-group, pre- and posttest pre-experimental design with a convenience sample. The study used the Medtronic Guardian CGM with Enlite Sensor., Results and Conclusions: Thirty-three subjects enrolled in the study. The mean age of the participants was 15.57 years, range was 11-20 years, 47.6% were male, and 52.4% were female. Twenty-one (63.6%) completed the final study visit. There was a clinically and statistically significant reduction of 1.46 (SD = 1.6711) (p = .001) in HbA1c at 12 weeks. Fifteen of the 21 participants (71.4%) had an HbA1c reduction of greater than 0.5%. The CGM monitor was worn a mean of 4.262 days a week. None of the subjects reported significant hypoglycemia while wearing the monitor. CGM was effective in improving glycemic control in this population with poorly controlled diabetes., (© 2016, Wiley Periodicals, Inc.)

Purpose/objectives: To determine how and what women learn about breast cancer and screening practices and which factors influence women's breast cancer screening practices., Design: Descriptive analysis of questionnaire data collected at the time of enrollment in a clinical trial., Setting: Breast care center of a mid-Atlantic academic health sciences center., Sample: 185 women in a predominantly Appalachian, entirely rural state., Methods: Participants completed the Modified Toronto Breast Self-Examination Inventory and questions related to personal mammography practices at the time of enrollment before randomization in a longitudinal clinical intervention study., Main Research Variables: Women's demographics, knowledge of breast cancer screening practices, adherence to breast cancer screening guidelines, and motivation, knowledge, and practice proficiency surrounding breast cancer screening., Findings: These educated women had knowledge deficits about breast cancer, breast cancer risk factors, and screening guidelines, particularly the timing and practice behaviors of breast self-examination. Women who had received healthcare and cancer-screening instruction by healthcare providers, including advanced practice nurses, had greater knowledge of breast cancer and detection practices., Conclusions: Women still have knowledge deficits about breast cancer, breast cancer detection, and personal risk factors. In addition, some educated women in this study failed to practice breast cancer screening according to current guidelines., Implications for Nursing: Practitioners must continue to remind and update women about breast disease, and women's cancer-screening practices must be reinforced. All levels of providers should improve their rates of performing clinical breast examinations with physical examinations. Nurses, who greatly influence women's health care, must remain current in their knowledge of breast disease, screening, and treatment.

Background: Although breast self-examination (BSE) has long been recommended by health care practitioners as a complement to mammography and clinical breast examination, only a small percentage of U.S. women report doing monthly BSE, and an even smaller number of women perform this procedure proficiently., Objectives: To measure the effect of a structured training protocol on improving two dimensions of BSE technique (depth of palpation and search time) in each of two search patterns (vertical strip and concentric circle) using biomedical instrumentation., Methods: For this study, 41 young women participated in a structured training protocol for BSE instruction. The dependent variable was thoroughness of search, for which there were two measures: depth of palpation (displacement of the sensors) and duration of the examination. An instrumented breast model designed by the investigator provided quantitative measurements of examination behaviors and was used to test outcomes of the instruction., Results: Multivariate analyses demonstrated an overall difference across examinations (F = 28.03; p = 0.0001). Univariate tests showed treatment effects for both dependent variables: depth of palpation and duration of examination., Conclusions: Individual training in BSE with guided practice improved two measures of thoroughness of search: depth of palpation and duration of search time. Biomedical instrumentation represented a novel approach to the collection of quantitative performance data.

The purpose of this study was to investigate the effects of waterbeds on heart rate (HR) in preterm infants. Subjects were 22 medically stable preterm infants. Across a 10-day study, HR was determined for a 1-hour period on each day. Baseline HRs with infants on the standard incubator mattress were obtained on the first 2 days of the study. They were then placed on the waterbed for 4 days. They were then returned to the incubator mattress and studied for 4 more days. Infants served as their own controls among baseline, on-waterbed (On-WB) and off-waterbed (Off-WB) periods. HR was determined by using a heart beat counting feature of the neonatal cardio-respiratory monitors. Analysis of variance revealed significant HR variability among subjects. There was no difference between baseline HR and on-waterbed HR. The HR increased when infants were transferred back to the standard mattress. The possibility that theophylline acted as a confound existed because doses were changed and levels varied for some subjects within the study period. Eight infants responded to the waterbed with lower HR during the On-WB period compared to the baseline (mean reduction = 5.7 bpm). The findings that HRs rose when the infants were returned to the incubator mattress are similar to those of a previous study. The subjects' reactivity to changes in treatment condition continues to confound the question as to whether waterbed therapy effects a reduction in HR. Since waterbeds have consistently resulted in soothing effects such as improved sleep and lowered activity, failure to produce a concomitant reduction in HR warrants attention toward other factors that may be determinants of heart rate. The high variability within and among subjects raises questions as to the usefulness of the HR variable for determining energy costs.

The purpose of this investigation was to study the effects of nonoscillating waterbeds on three indices of energy expenditure: activity level, heart rate, and behavioral state. Subjects were 22 healthy preterm infants in a neonatal intensive care unit who had reached 31-35 weeks postconceptional age, and whose average weight was 1,482 grams at the onset of the study. Infants were placed on a waterbed for 3 consecutive days and on a standard incubator mattress for 3 consecutive days. Infants served as their own controls on and off the waterbed. Treatment order was randomly counterbalanced. One-hour observations of activity and state occurring in conjunction with heartbeat counts were the repeated measures on each day over both treatment and control conditions. Infants experienced longer durations of quiet sleep, less active awake and fuss states, and fewer state changes and awakenings while on the waterbed. Heart rates were higher after infants were taken off the waterbed. The findings suggest that nonoscillating waterbed flotation is a simple, cost-effective intervention that reduces energy expenditure.