Recent Research Publications and Funding
March 20, 2017 4:00AM
Background: The wide variety of dissemination and implementation designs now being used to evaluate and improve health systems and outcomes warrants review of the scope, features, and limitations of these designs. Methods: This paper is one product of a design workgroup formed in 2013 by the National Institutes of Health to address dissemination and implementation research, and whose members represented diverse methodologic backgrounds, content focus areas, and health sectors. These experts integrated their collective knowledge on dissemination and implementation designs with searches of published evaluations strategies. Results: This paper emphasizes randomized and non-randomized designs for the traditional translational research continuum or pipeline, which builds on existing efficacy and effectiveness trials to examine how one or more evidence-based clinical/prevention interventions are adopted, scaled up, and sustained in community or service delivery systems. We also mention other designs, including hybrid designs that combine effectiveness and implementation research, quality improvement designs for local knowledge, and designs that use simulation modeling.
Effectiveness of LISTEN on Loneliness, Neuroimmunological Stress Response, Psychosocial Functioning, Quality of Life, and Physical Health Measures| February 20, 2017 6:00AM
Objectives: Loneliness is a biopsychosocial determinant of health and contributes to physical and psychological chronic illnesses, functional decline, and mortality in older adults. This paper presents the results of the first randomized trial of LISTEN, which is a new cognitive behavioral intervention for loneliness, on loneliness, neuroimmunological stress response, psychosocial functioning, quality of life, and measures of physical health.
Methods: The effectiveness of LISTEN was evaluated in a sample population comprising 27 lonely, chronically ill, older adults living in Appalachia. Participants were randomized into LISTEN or educational attention control groups. Outcome measures included salivary cortisol and DHEA, interleukin-6, interleukin-2, depressive symptoms, loneliness, perceived social support, functional ability, quality of life, fasting glucose, blood pressure, and body mass index.
Results: At 12 weeks after the last intervention session, participants of the LISTEN group reported reduced loneliness (p = 0.03), enhanced overall social support (p = 0.05), and decreased systolic blood pressure (p = 0.02). The attention control group reported decreased functional ability (p = 0.10) and reduced quality of life (p = 0.13).
Conclusions: LISTEN can effectively diminish loneliness and decrease the systolic blood pressure in community-dwelling, chronically ill, older adults. Results indicate that this population, if left with untreated loneliness, may experience functional impairment over a period as short as 4 months. Further studies on LISTEN are needed with larger samples, in varied populations, and over longer periods of time to assess the long-term effects of diminishing loneliness in multiple chronic conditions.
Diversity Dynamics: The Experience of Male Robert Wood Johnson Foundation Nurse Faculty Scholars: Issues and Strategies to Create Positive Organizations| February 13, 2017 6:00AM
Background: Managing diversity dynamics in academic or clinical settings for men in nursing has unique challenges resulting from their minority status within the profession.
Purpose: Share challenges and lessons learned identified by male scholars in the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program and suggest strategies for creating positive organizations promoting inclusive excellence.
Methods: Multiple strategies including informal mentored discussions and peer-to-peer dialogue throughout the program as well as formal online surveys of scholars and National Advisory Committee members, and review of scholar progress reports were analyzed as part of the comprehensive evaluation plan of the program
Discussion: Diversity dynamic issues include concerns with negative stereotyping, microaggression, gender intelligence, and differences in communication and leadership styles.
Conclusions: Male Nurse Faculty Scholars report experiencing both opportunities and challenges residing in a predominately female-peopled profession. This article attempts to raise awareness and suggest strategies to manage diversity dynamics in service of promoting the development of a culture of health that values diversity and inclusive excellence for both men and women in academic, research and practice contexts.
February 6, 2017 6:00AM
Background: Nursing home (NH) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake.
Objectives: To compare efficacy of three handfeeding techniques for assisting NH residents with dementia with meals: Direct Hand (DH), Over Hand (OH), and Under Hand (UH).
Design: A prospective pilot study using a within-subjects experimental Latin square design with randomization to one of three handfeeding technique sequences.
Setting and Participants: 30 residents living with advanced dementia in 11 U.S. NHs.
Measurements: Time required for assistance; meal intake (% eaten); and feeding behaviors, measured by the Edinburgh Feeding Evaluation in Dementia (EdFED) scale.
Intervention: Research Assistants provided feeding assistance for 18 video-recorded meals per resident (N = 540 meals). Residents were assisted with one designated technique for 6 consecutive meals, changing technique every 2 days.
Results: Mean time spent providing meal assistance did not differ significantly between techniques. Mean meal intake was greater for DH (67 ± 15.2%) and UH (65 ± 15.0%) with both significantly greater than OH (60 ± 15.1%). Feeding behaviors were more frequent with OH (8.3 ± 1.8%), relative to DH (8.0 ± 1.8) and UH (7.7 ± 1.8).
Conclusion: All three techniques are time neutral. UH and DH are viable options to increase meal intake among NH residents with advanced dementia and reduce feeding behaviors relative to OH feeding.
Better nurse staffing and nurse work environments associated with increased survival of in-hospital cardiac arrest patients| January 1, 2017 6:00AM
BACKGROUND: Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes.
OBJECTIVES: To determine the association between nurse staffing, nurse work environments, and IHCA survival.
RESEARCH DESIGN: Cross-sectional study of data from: (1) the American Heart Association's Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics.
SUBJECTS: A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey).
RESULTS: Each additional patient per nurse on medical-surgical units was associated with a 5% lower likelihood of surviving IHCA to discharge (odds ratio=0.95; 95% confidence interval, 0.91-0.99). Further, patients cared for in hospitals with poor work environments had a 16% lower likelihood of IHCA survival (odds ratio=0.84; 95% confidence interval, 0.71-0.99) than patients cared for in hospitals with better work environments.
CONCLUSIONS: Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an IHCA. These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following IHCA.
January 1, 2017 6:00AM
PURPOSE: Rural communities have limited knowledge about genetics and genomics and are also underrepresented in genomic education initiatives. The purpose of this project was to assess genomic and epigenetic knowledge and beliefs in rural West Virginia.
SAMPLE: A total of 93 participants from three communities participated in focus groups and 68 participants completed a demographic survey. The age of the respondents ranged from 21 to 81 years. Most respondents had a household income of less than $40,000, were female and most were married, completed at least a HS/GED or some college education working either part-time or full-time.
METHOD: A Community Based Participatory Research process with focus groups and demographic questionnaires was used.
FINDINGS: Most participants had a basic understanding of genetics and epigenetics, but not genomics. Participants reported not knowing much of their family history and that their elders did not discuss such information. If the conversations occurred, it was only during times of crisis or an illness event. Mental health and substance abuse are topics that are not discussed with family in this rural population.
CONCLUSIONS: Most of the efforts surrounding genetic/genomic understanding have focused on urban populations. This project is the first of its kind in West Virginia and has begun to lay the much needed infrastructure for developing educational initiatives and extending genomic research projects into our rural Appalachian communities. By empowering the public with education, regarding the influential role genetics, genomics, and epigenetics have on their health, we can begin to tackle the complex task of initiating behavior changes that will promote the health and well-being of individuals, families and communities.
Advancing nursing science through community advisory boards: working effectively across diverse communities| December 6, 2016 6:00AM
The movement toward community-engaged research is well aligned with nursing's strong tradition of engaging individuals, families, and communities in designing and evaluating nursing care. As such, nurse scientists should consider engaging the recipients of care in the research process. Community advisory boards are a common way in which communities are engaged in research. The purpose of this article is to provide a framework for effectively working with community advisory boards in diverse communities that is informed by evidence and experiences of the Robert Wood Johnson Foundation Nurse Faculty Scholars. Recommendations can serve as a blueprint for nurse scientists as they engage communities in research promoting health equity.
The Importance of Partnerships in Local Health Department Practice among Communities with Exceptional Maternal and Child Health Outcomes| November 1, 2016 4:00AM
OBJECTIVES: The purpose of this study was to identify unique practices underway in communities that have been empirically identified as having achieved exceptional maternal and child health (MCH) outcomes compared with their peers.
METHODS: We used a qualitative, positive deviance approach to identify practices implemented by local health department (LHD) jurisdictions in Florida, Washington, and New York that achieved better MCH outcomes than expected compared with their in-state peer jurisdictions. We identified a total of 50 LHDs in jurisdictions that had better than expected MCH outcomes compared with their peers, and we conducted 39 hour-long semistructured interviews with LHD staff. We conducted inductive thematic analysis to identify key themes and subthemes across all LHD cases in the sample.
RESULTS: Partnerships with providers, partnerships for data collection/assessment, and partnerships with community-based organizations were associated with exceptional MCH outcomes based on our interviews.
DISCUSSION: This study offers specific examples of practices LHDs can implement to improve MCH outcomes, even with limited resources, based on the practices of high-performing local health jurisdictions.
November 1, 2016 4:00AM
In healthcare, we tend to focus on the patient’s disease, rather than symptoms, though symptoms are central to the patient experience. Symptoms have been found in other settings to be poorly recognized and managed, yet drive healthcare utilization, cost, and patient satisfaction. In home healthcare (HHC) symptoms have not been deeply explored. We examined a 5% sample of 2011–2012 Medicare OASIS, MEDPAR, and Carrier file data (N=2,061,168) to better understand how symptoms effect care. Chi-square analysis showed patients with more severe dyspnea and behavioral symptoms, but not pain had significantly higher rates of utilization and cost (p<.0001). In multivariate analyses readmission at 30-days was significantly greater in severe dyspnea (OR=3.06, p<.0001) and behavioral symptoms (OR=1.34, p<.0001) but NS for pain. When comparing to other studies, this indicates that pain is likely under-reported in HHC, and there is significant room for improvement in assessment and management of symptoms in this setting.
October 31, 2016 4:00AM
Objective: Trauma exposure can precipitate acute/post-traumatic stress responses (AS/PTSD) and disabling cardiovascular disorders (CVD). Identifying acute stress-related physiologic changes that may increase CVD risk could inform development of early CVD-prevention strategies. The endocannabinoid system (ECS) regulates hypothalamic-pituitary-adrenal (HPA) axis response and stress-related cardiovascular function. We examine stress-related endocannabinoid system (ECS) activity and its association with cardiovascular biochemistry/function following acute stress.
Methods: Rodents (n=8-16/group) were exposed to predator odor or saline; elevated plus maze (EPM), blood pressure (BP), serum and cardiac tissue ECS markers, and lipid metabolism were assessed at 24h and 2wks post-exposure.
Results: At 24h the predator odor group demonstrated anxiety-like behavior and had (a) elevated serum markers of cardiac failure/damage (brain natriuretic peptide [BNP]: 275.1 vs. 234.6, p=0.007; troponin-I: 1.50 vs. 0.78, p=0.076), lipogenesis (triacylglycerols [TAG]: 123.5 vs. 85.93, p=0.018), and inflammation (stearoyl delta-9 desaturase activity [SCD-16]: 0.21 vs. 0.07, p<0.001); (b) significant decrease in cardiac endocannabinoid (2-arachidonoyl-sn-glycerol, 2-AG: 29.90 vs. 65.95, p<0.001) and fatty acid ethanolamides (FAE: oleoylethanolamide, OEA: 114.3 vs. 125.4, p=0.047; palmitoylethanolamide, PEA: 72.96 vs. 82.87, p=0.008); and (c) increased cardiac inflammation (IL-1β/IL-6 ratio: 19.79 vs.13.57, p=0.038; TNF-α/IL-6 ratio: 1.73 vs. 1.03, p=0.019) and oxidative stress (thiobarbituric acid reactive substances [TBARS]: 7.81 vs. 7.05, p=0.022), that were associated with cardiac steatosis (higher TAG: 1.09 vs. 0.72, p<0.001). Cardiac lipogenesis persisted, and elevated BP emerged two weeks after exposure.
Conclusions: Acute psychological stress elicits ECS-related cardiac responses associated with persistent, potentially-pathological changes in rat cardiovascular biochemistry/function.