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Recent Research Publications and Funding
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June 1, 2013 4:00AM
BACKGROUND: Depression is a common yet often unrecognized consequence of stroke, affecting between 25% and 70% of all survivors. Untreated depression post-stroke leads to a poorer prognosis and increased mortality. However, the pattern and profile of post-stroke depression in chronic stroke are poorly understood.
OBJECTIVE: The aim of this study was to examine the independent predictors of depressive symptoms in chronic stroke.
METHODS: Community-dwelling stroke survivors (n = 100) completed the Center for Epidemiological Studies-Depression (CES-D) scale, Multidimensional Scale of Perceived Social Support, Medical Outcomes Study Short Form-36, and the Pittsburgh Sleep Quality Index. Functional disability and cognitive impairment were assessed using standardized procedures. Multiple linear regression was conducted to explore potential independent predictors of depressive symptoms.
RESULTS: Subjects were, on average, 70 ± 10 years old and 39 ± 49 months post-stroke. The majority were white/European-American (78%), college educated (79%), and retirees (77%). Annual income was $50 000 or greater for 32%. Hemiparesis was common (right side, 39%; left side, 42%); 35% had a Center for Epidemiological Studies-Depression scale score of 16 or higher, and 21% had a history of major depression. Approximately 64% of the variance in depressive symptoms could be explained by the independent variables in the model: quality of life, sleep quality, social support, cognitive impairment, functional disability, months post-stroke, age, gender, history of major depression, and lesion location (R = 0.64, F12,87 = 12.97, P < .01). Only poor quality of life (t1,87 = -6.99, P < .01) and low social support (t1,87 = -2.14, P = .04) contributed uniquely and significantly to the severity of depressive symptoms among these stroke survivors.
CONCLUSION: Depressive symptoms are prevalent in chronic stroke survivors, even among an educated and economically advantaged population. Our findings are similar to reports by others that poor quality of life and low social support are major contributors to depressive symptoms in chronic stroke and should be routinely assessed and monitored to improve long-term rehabilitation efforts and promote wellness and community reintegration.
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Adaptation of the Illness Trajectory Theory to Describe the Work of Transitional Cancer Survivorship| May 26, 2013 4:00AM
Purpose/Objectives: Although frameworks for understanding survivorship continue to evolve, most are abstract and do not address the complex context of survivors’ transition following treatment completion. The purpose of this theory adaptation was to examine and refine the Illness Trajectory Theory, which describes the work of managing chronic illness, to address transitional cancer survivorship.
Data Sources: CINAHL, PubMed, and relevant Institute of Medicine reports were searched for survivors’ experiences during the year following treatment.
Data Synthesis: Using an abstraction tool, sixty-eight articles were selected from the initial search (N>700). Abstracted data were placed into a priori categories refined according to recommended procedures for theory derivation, followed by expert review.
Conclusions: Derivation resulted in a framework describing “the work of transitional cancer survivorship” (TCS work). TCS work is defined as survivor tasks, performed alone or with others, to carry out a plan of action for managing one or more aspects of life following primary cancer treatment. Theoretically, survivors engage in 3 reciprocally-interactive lines of work: (1) illness-related; (2) biographical; and (3) everyday life work. Adaptation resulted in refinement of these domains and the addition of survivorship care planning under “illness-related work”.
Implications for Nursing: Understanding this process of work may allow survivors/co-survivors to better prepare for the post-treatment period. This adaptation provides a framework for future testing and development. Validity and utility of this framework within specific survivor populations should also be explored.
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May 11, 2013 4:00AM
BACKGROUND: Infants in the newborn intensive care unit (NICU) are exposed to routine procedures that often cause distress and carry a negative burden or load on the infant's neurodevelopment.
AIM: A ratio level index is introduced to estimate procedural load so as to begin to develop a system to monitor the intensity of distress associated with common NICU procedures.
STUDY DESIGN: Two psychophysical methods, magnitude estimation (ME) and the general labeled magnitude scale (gLMS) were used to survey 86 clinicians via the internet to estimate the distress associated with 55 common NICU procedures.
RESULTS: gLMS and ME estimations correlated highly across all procedures (r = 0.97). gLMS values were used to derive the procedural load index (PLI) as a ratio level estimation of procedural distress.
CONCLUSION: The PLI ranks and differentiates distress among common NICU procedures more precisely than current tools. This methodology, if correlated with infant physiological indices and health outcomes, may be operationalized at the bedside to measure procedural distress, and help to guide the ideal timing to perform procedures and minimize their negative consequence.
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May 10, 2013 4:00AM
This article presents an overview of hypertrophic cardiomyopathy (HCM) and the associated clinical fi ndings, treatment, and management for nurse practitioners. Topics include an overview of the condition, major and minor criteria for diagnosis, clinical course and pathophysiology, genetic inheritance and testing, and dysrhythmias associated with HCM.
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May 6, 2013 4:00AM
This paper analyzed the existing literature on risk and protective factors for intimate partner violence among Hispanics using the four-level social-ecological model of prevention.
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May 6, 2013 4:00AM
Background: Rural African American (AA) seniors may experience significant challenges during cancer treatment. Previous research suggests community health workers (CHWs) can provide effective cancer patient navigation (CPN) support.
Objectives: To develop a Train the Trainers (TTT) program for CHWs in rural Central Virginia who would navigate local AA seniors with cancer and train their support persons to provide similar types of assistance.
Methods: We conducted focus groups with rural AA seniors, consulted with experienced CHW trainers, recruited and trained CHWs through a combination of online learning and distance education, evaluated the TTT via surveys and focus groups, and hired CHWs to the study team.
Results/Lessons Learned: Lessons learned from our TTT experience include the value of incorporating CHW trainers and trainees as full members of the research team.
Conclusions: Training should be accessible and flexible, providing trainees community-level resources and enriched educational experiences. Findings have informed a culturally tailored support CHW intervention to address cancer diagnosis and treatment needs for older rural AAs.
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May 2, 2013 4:00AM
BACKGROUND: Relatively few exercise randomized clinical trials (RCTs) among stroke survivors have reported the effectiveness of recruitment and retention strategies, despite its central importance to study integrity.
OBJECTIVE: Our objective is to examine recruitment and retention strategies used among a group of older community-dwelling stroke survivors for an exercise RCT.
METHODS: Recruitment strategies were multidimensional using both paid (ie, newspaper, radio and, television) and unpaid advertisements (ie, staff visits, flyers, and brochures placed at outpatient rehabilitation centers, physician offices, and community facilities working with older adults; free media coverage of the study, presentations at stroke support groups, relatives/friends, and study Web site) to obtain referrals. Retention strategies centered on excellent communication, the study participants' needs, and having dedicated study staff. Attrition rates and adherence to the intervention were used to examine the effectiveness of these retention strategies.
RESULTS: A total of 393 referrals were received, 233 persons were screened, and 145 stroke survivors enrolled in the study. During 3 years of study recruitment, we achieved 97% of our enrollment target. We enrolled 62% of those screened. Study enrollment from paid advertising was 21.4% (n = 31), whereas unpaid advertisements resulted in 78.6% (n = 114) of our participants. Attrition was 10% (n = 14 dropouts), and adherence to the intervention was 85%.
CONCLUSIONS: Recruitment and retention of participants in an exercise RCT are time and labor intensive. Multiple recruitment and retention strategies are required to ensure an adequate sample of community-dwelling stroke survivors. Many of these strategies are also relevant for exercise RCTs among adults with other chronic illnesses.
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May 1, 2013 4:00AM
The purpose of this integrative review is to describe, compare, and synthesize traditional and computer-based family interventions that aim to change adolescents' risky sexual behaviors and substance abuse.
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April 11, 2013 4:00AM
Tami Thomas, PhD, CPNP, RNC, answers questions related to the importance of vaccinating boys and men to prevent the human papillomavirus.
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April 5, 2013 4:00AM
Maternal postpartum depression (PPD) and mother-infant relationship dysfunction have reciprocal effects on each other and thus an integrated approach that addresses both problems simultaneously may lead to improved outcomes. This study aimed to determine the feasibility, acceptability, and preliminary efficacy of a new intervention, Perinatal Dyadic Psychotherapy (PDP), for the early treatment of maternal PPD. PDP is designed to promote maternal mental health and facilitate optimal mother-infant relationships via (a) a supportive, relationship-based, mother-infant psychotherapeutic component, and (b) a developmentally-based infant-oriented component focused on promoting positive mother-infant interactions. This paper describes the pilot use of PDP with six acutely depressed postpartum women. Nurses delivered the intervention over eight home visits. Results indicate that PDP is a feasible, acceptable, and safe intervention with this population. All participants achieved remission of depression with significant reduction in of depression and anxiety symptoms, suggesting that PDP is a promising treatment for PPD.