Medicine and Health Sciences Commons^™

Clarifying Workforce Flexibility From A Division Of Labor Perspective: A Mixed Methods Study Of An Emergency Department Team, Sarah Wise, Christine Duffield, Margaret Fry, Michael Roche

Research outputs 2014 to 2021

Background: The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team's division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly.

Methods: The explanatory sequential mixed methods study was set in the …

Predictors Of Ceasing Or Reducing Statin Medication Following A Large Increase In The Consumer Copayment For Medications: A Retrospective Observational Study, Karla Seamon, Frank Sanfilippo, Max Bulsara, Libby Roughead, Anna Kemp-Casey, Caroline Bulsara, Gerald F. Watts, David Preen

Research outputs 2014 to 2021

OBJECTIVES:

Previous Australian research has shown that following the 21% increase in patient copayments for medications on the Pharmaceutical Benefits Scheme (PBS) in 2005, the use of lipid-lowering therapy declined by 5%. This study aimed to determine the demographic and clinical characteristics of individuals who continued, reduced or ceased their use of statin medication in 2005.

STUDY TYPE:

Retrospective observational study using routinely collected administrative data.

METHOD:

We used pharmaceutical claims, hospital separations and mortality records from 2000 to 2005 for the Western Australian population. The cohort comprised stable users of statin medication in 2004. Based on changes in statin …

What Predicts Regression From Pre-Diabetes To Normal Glucose Regulation Following A Primary Care Nurse-Delivered Dietary Intervention? A Study Protocol For A Prospective Cohort Study, Kirsten Coppell, Trish Freer, Sally Abel, Lisa Whitehead, David Tipene-Leach, Andrew R. Gray, Tony Merriman, Trudy Sullivan, Jeremy Krebs, Leigh Perreault

Research outputs 2014 to 2021

Introduction Pre-diabetes is a high-risk state for the development of type 2 diabetes mellitus (T2DM) and cardiovascular disease. Regression to normoglycaemia, even if transient, significantly reduces the risk of developing T2DM. The primary aim of this mixed-methods study is to determine if there are clinically relevant differences among those with pre-diabetes and excess weight who regress to normoglycaemia, those who have persistent pre-diabetes and those who progress to T2DM following participation in a 6-month primary care nurse-delivered pre-diabetes dietary intervention. Incidence of T2DM at 2 years will be examined.

Methods and analysis Four hundred participants with pre-diabetes (New Zealand definition …

Newborn Care Practices Of Mothers In Arab Societies: Implication For Infant Welfare, Diana H. Arabiat, Lisa Whitehead, Mohammad A. Al Jabery, Muhammad Darawad, Sadie Geraghty, Suhaila Halasa

Research outputs 2014 to 2021

INTRODUCTION: There are at least 22 Arab league states and sections in Northern Africa, southwestern Asia, and Europe that incorporate the vast Middle Eastern culture. The purpose of this study was to identify the cultural variations in newborn care practices, self-management of common illnesses, and their potential impact on infant welfare.

METHOD: A qualitative design using a focus group approach with 37 Arab mothers in Jordan was used.

RESULTS: Findings revealed strong similarities in terms of beliefs, care practices, and the experience of intergenerational conflict in establishing and maintaining traditional practices among mothers. Potentially harmful practices included restrictive swaddling, rubbing …

Sexual Trafficking: Developing A Teaching Strategy For Emergency Department Registered Nurses, Sarah Ford

Honors College

Human trafficking is a rapidly growing problem in the United States. This multibillion dollar criminal industry denies freedom to approximately 21 to 27 million people around the world. Through coercion or withholding of an individual’s legal documents, vulnerable people are forced to perform labor or sexual acts for the benefit or personal gain of others. Over 80% of victims seek medical help during their captivity, but go unnoticed due to healthcare professional’s lack of knowledge and training on the population. This study consisted of a two-step approach. The first involved a literary review of sexual trafficking. Next, a pilot study …

Multiple Dimensions Of The Symptom Experience In Patients With Advanced Cancer And Their Impact On Quality Of Life, Stephanie Gilbertson-White

Stephanie Gilbertson-White

Many people with advanced cancer experience multiple severe symptoms as their disease progresses such as pain, sleep problems, fatigue, and depression. These symptoms can be a result of the cancer itself, cancer treatment or an interaction of the two. The studies reported in this dissertation uses the patients' own responses to survey questions to describe the multiple dimensions of the symptom experience; the factors that predict the total number of symptoms; as well as the optimal cutpoint between a low and a high number of symptoms and the between group differences in patient outcomes (i.e., depression, anxiety, quality-of-life).

Electronic Documentation Systems: The Impact On Pain Documentation, Stephanie Gilbertson-White, S. Shapiro

Stephanie Gilbertson-White

No abstract provided.

Documentation On Withdrawal Of Life Support In Adult Patients In The Intensive Care Unit [Corrected] [Published Erratum Appears In Am J Crit Care 2004 Sep;13(5):370], K. Kirchhoff, P. Anumandla, K. Foth, S. Lues, Stephanie Gilbertson-White

Stephanie Gilbertson-White

BACKGROUND: Patients' charts have been a source of data for retrospective studies of the quality of end-of-life care. In the intensive care unit, most patients die after withdrawal of life support. Chart reviews of this process could be used not only to assess the quality of documentation but also to provide information for quality improvement and research. OBJECTIVE: To assess the documentation of end-of-life care of patients and their families by care providers in the intensive care unit. METHOD: Charts of 50 adult patients who died in the intensive care unit at a large midwestern hospital after initiation of withdrawal …

The Stability Of Patient Subgroups Identified Using Cluster Analysis, Stephanie Gilbertson-White, C. Miaskowski, K. Lee, M. Dodd, C. West, B. Cooper

Stephanie Gilbertson-White

No abstract provided.

Supernumerary Minute Ring Chromosome 14 In A Man With Primary Infertility And Left Varicocele, B. Stahl, S. Patil, Craig Syrop, Amy Sparks, M. Wald

Amy E.T. Sparks

OBJECTIVE: To describe a case of supernumerary minute ring chromosome (SMRC) in an infertile man, with the concurrent finding of a left varicocele. DESIGN: Case report. SETTING: Urologic infertility clinic in a university hospital. PATIENT(S): Male patient presenting with primary infertility. INTERVENTION(S): Karyotyping, genetic counseling, and microsurgical left varicocelectomy. MAIN OUTCOME MEASURE(S): Sperm concentration and motility, chromosomal number and structure. RESULT(S): Fluorescence in situ hybridization revealing SMRC 14. Sperm concentration and motility improved after left varicocele repair. CONCLUSION(S): A karyotype should be included in the evaluation of severe oligospermia. Although SMRC 14 may be associated with fertility problems, repair of …

Optimization Of Dose And Image Quality For Computed Radiography And Digital Radiography, J. Aldrich, Eyup Duran, P. Dunlop, J. Mayo

Eyup Hakan Duran

The surface doses to patients during chest, abdomen and pelvis radiography were measured over a period of 3 years, during which time computed radiography (CR) and digital radiography (DR) systems were introduced to replace film-screen systems. For film-screen and CR the surface doses were measured with thermoluminescent dosimeters. For DR the surface doses were calculated from the dose-area product (DAP) meter readings. Measurements were made for each type of examination and detector type on 10 average-size patients. Measurements were made immediately after the new systems were introduced, and subsequently as adjustments were made to optimize dose and image quality. Published …

Incidence Of Anti-Heparin/Platelet Factor 4 Antibodies And Heparin-Induced Thrombocytopenia In Medical Patients [Turkish], M. Demir, E. Tekgündüz, M. Edis, Eyup Duran, T. Kürüm

Eyup Hakan Duran

OBJECTIVE: Heparin-induced thrombocytopenia (HIT) is a life threatening complication of heparin therapy, causing thrombosis. The aim of our study was to find out the frequencies of HIT antibody seroconversion and clinical HIT in Turkish medical patients on different forms of heparins. METHODS: Our study included 61 patients who were on unfractionated heparin (UFH) (n: 37) and low molecular weight heparin (LMWH) (n: 24) therapies. The frequency of HIT antibody formation was determined by means of antigenic (ELISA), and functional assays (serotonin release assay-SRA). RESULTS: The seroconversion rates in UFH and LMWH groups were found to be 18.9% and 4.1% (ELISA), …

Research And Professional Briefs. Folate, Zinc, And Vitamin B-12 Intake During Pregnancy And Postpartum, M. Berg, D. Van Dyke, C. Chenard, Jennifer Niebyl, S. Hirankarn, A. Bendich, P. Stumbo

Jennifer R Niebyl

No abstract provided.

Quantitative And Qualitative Relationships Between Fetal Heart Rate Accelerations And Fetal Movement, Trb Johnson, R. Besinger, R. Thomas, D. Strobino, Jennifer Niebyl

Jennifer R Niebyl

No abstract provided.

Cervical Cancer Diagnosed Shortly After Pregnancy: Prognostic Variables And Delivery Routes, A. Sood, J. Sorosky, N. Mayr, B. Anderson, R. Buller, Jennifer Niebyl

Jennifer R Niebyl

No abstract provided.

Maternal Parenting Stress And Mothers' Reports Of Their Infants' Mastery Motivation, T. Sparks, Stephen Hunter, T. Backman, G. Morgan, R. Ross

Stephen K. Hunter

No abstract provided.

Antidepressants May Mitigate The Effects Of Prenatal Maternal Anxiety On Infant Auditory Sensory Gating, Stephen Hunter, J. Mendoza, K. D'Anna, G. Zerbe, L. Mccarthy, C. Hoffman, R. Freedman, R. Ross

Stephen K. Hunter

OBJECTIVE: Prenatal maternal anxiety has detrimental effects on the offspring's neurocognitive development, including impaired attentional function. Antidepressants are commonly used during pregnancy, yet their impact on offspring attention and their interaction with maternal anxiety has not been assessed. The authors used P50 auditory sensory gating, a putative marker of early attentional processes measurable in young infants, to assess the impact of maternal anxiety and antidepressant use. METHOD: A total of 242 mother-infant dyads were classified relative to maternal history of anxiety and maternal prenatal antidepressant use. Infant P50 auditory sensory gating was recorded during active sleep at a mean age …

Social Support, Psychological Distress, And Natural Killer Cell Activity In Ovarian Cancer, S. Lutgendorf, A. Sood, B. Anderson, S. Mcginn, H. Maiseri, M. Dao, J. Sorosky, Koen De Geest, J. Ritchie, D. Lubaroff

Koen De Geest

PURPOSE: Psychosocial stress has been related to impaired immunity in cancer patients. However, the extent to which these relationships exist in immune cells in the tumor microenvironment in humans has not been explored. We examined relationships among distress, social support, and natural killer (NK) cell activity in ovarian cancer patients in peripheral-blood mononuclear cells (PBMC), ascitic fluid, and tumor-infiltrating lymphocytes (TIL). PATIENTS AND METHODS: Patients awaiting surgery for a pelvic mass suspected of being ovarian cancer completed psychological questionnaires and gave a presurgical sample of peripheral blood. Samples of tumor and ascites were taken during surgery, lymphocytes were then isolated, …

Social Influences On Clinical Outcomes Of Patients With Ovarian Cancer, Susan Lutgendorf, Koen De Geest, David Bender, Amina Ahmed, Michael Goodheart, Laila Dahmoush, , M, Bridget Zimmerman, Frank, J. Penedo

Koen De Geest

PURPOSE Previous research has demonstrated relationships of social support with disease-related biomarkers in patients with ovarian cancer. However, the clinical relevance of these findings to patient outcomes has not been established. This prospective study examined how social support relates to long-term survival among consecutive patients with ovarian cancer. We focused on two types of social support: social attachment, a type of emotional social support reflecting connections with others, and instrumental social support reflecting the availability of tangible assistance. PATIENTS AND METHODS Patients were prospectively recruited during a presurgical clinic visit and completed surveys before surgery. One hundred sixty-eight patients with …

Hyaluronidase For The Treatment Of Extravasation In Neonates, Kirsten Hanrahan

Kirsten M. Hanrahan

No abstract provided.

Development Of The Distraction Coaching Index, Charmaine Kleiber, Ann Mccarthy, Kirsten Hanrahan, L. Myers, N. Weathers

Kirsten M. Hanrahan

Children's distress during medical procedures can be decreased when professionals or parents provide distraction coaching, but the quality of distraction may contribute to the variation in the results. This article describes the development of the Distraction Coaching Index (DCI), a tool for measuring the quality and frequency of distraction coaching. Nominal group technique and consensus agreement were used for concept clarification and development of behavioral indicators and descriptors. Videotapes of untrained parents, trained parents, and expert professional coaches, who provided distraction to children (4-10 years old) undergoing peripheral intravenous catheter insertion, were used to assess interrater reliability and construct validity. …

Impact Of Parent-Provided Distraction On Child Responses To An Iv Insertion, Ann Mccarthy, Charmaine Kleiber, Kirsten Hanrahan, M. Zimmerman, N. Westhus, S. Allen

Kirsten M. Hanrahan

This study evaluates the impact of parent-provided distraction on children's responses (behavioral, physiological, parent, and self-report) during an IV insertion. Participants were 542 children, 4 to 10 years old, randomized to an experimental group that received a parent distraction coaching intervention or to routine care. Experimental group children had significantly less cortisol responsivity (p = .026). Children that received the highest level of distraction coaching had the lowest distress on behavioral, parent report, and cortisol measures. When parents provide a higher frequency and quality of distraction, children have lower distress responses on most measures.

Social Influences On Clinical Outcomes Of Patients With Ovarian Cancer, Susan Lutgendorf, Koen De Geest, David Bender, Amina Ahmed, Michael Goodheart, Laila Dahmoush, M. Zimmerman, Frank Penedo

David P Bender

PURPOSE Previous research has demonstrated relationships of social support with disease-related biomarkers in patients with ovarian cancer. However, the clinical relevance of these findings to patient outcomes has not been established. This prospective study examined how social support relates to long-term survival among consecutive patients with ovarian cancer. We focused on two types of social support: social attachment, a type of emotional social support reflecting connections with others, and instrumental social support reflecting the availability of tangible assistance. PATIENTS AND METHODS Patients were prospectively recruited during a presurgical clinic visit and completed surveys before surgery. One hundred sixty-eight patients with …

Comparison Of Selected Teaching Strategies Incorporating Simulation And Student Outcomes, Elizabeth Swanson, Anita Nicholson, Teresa Boese, Ellen Cram, Anita Stineman, Kimberly Tew

Elizabeth A. Swanson

No abstract provided.

Healthy People 2000. A Fall Prevention Program For Elderly Individuals: Exercise In Long-Term Care Settings, Deborah Schoenfelder

Deborah P. Schoenfelder

No abstract provided.

Traumatic Injury Rates In Meatpacking Plant Workers, Kennith Culp, M. Brooks, Kerri Rupe, C. Zwerling

Kerri A. Rupe

This was a 3-year retrospective cohort study of traumatic injuries in a midwestern pork meatpacking plant. Based on n = 5410 workers, this was a diverse workforce: Caucasian (56.6%), Hispanic (38.9%), African American (2.7%), Asian (1.1%) and Native American (0.8%). There were n = 1655 employees with traumatic injuries during this period. At 6 months of employment, the probability of injury was 33% in the harvest workers who were responsible for slaughter operations. The overall incidence injury rate was 22.76 per 100 full-time employees per year. Women experienced a higher incidence for injury than men. The risk ratio (RR) for …

Innovativeness In Nursing: A Phenomenological And Constructivist Study, Maria Joseph

Maria (Lindell) Joseph

Hospital administration and the medical field have maintained the status quo of nursing practice, in which nurses have adopted bureaucratic structures where conformity and regimentation are maintained to ensure large-scale efficiency. The lack of control to act on nursing knowledge and expert judgment is linked to work conditions of oppression, lack of autonomy, dissatisfaction, concomitant patient mortality, and morbidity. A climate of innovativeness is one strategy to reverse the negative impact caused by hospital administration and the medical field. The purpose of this phenomenological study was to explore the behavioral characteristics of lived experiences and knowledge of innovativeness among nurses …

Literacy-Appropriate Educational Materials And Brief Counseling Improve Diabetes Self-Management, Andrea Wallace, H. Seligman, T. Davis, D. Schillinger, C. Arnold, B. Bryant-Shilliday, J. Freburger, D. Dewalt

Andrea S. Wallace

OBJECTIVE: In this pilot study, we evaluated the impact of providing patients with a literacy-appropriate diabetes education guide accompanied by brief counseling designed for use in primary care. METHODS: We provided the Living with Diabetes guide and brief behavior change counseling to 250 English and Spanish speaking patients with type 2 diabetes. Counseling sessions using collaborative goal setting occurred at baseline and by telephone at 2 and 4 weeks. We measured patients' activation, self-efficacy, diabetes distress, knowledge, and self-care at baseline and 3-month follow-up. RESULTS: Statistically significant (p

Race, Care Seeking, And Utilization For Chronic Back And Neck Pain: Population Perspectives, T. Carey, J. Freburger, G. Holmes, A. Jackman, S. Knauer, Andrea Wallace, J. Darter

Andrea S. Wallace

We analyzed a statewide survey of individuals with chronic back and neck pain to determine whether prevalence and care use varied by patient race or ethnicity. We conducted a telephone survey of a random sample of 5,357 North Carolina households in 2006. Adults with chronic (>3 months duration or >24 episodes of pain per year), impairing back or neck pain were identified and were asked to complete a survey about their health and care utilization. 837 respondents (620 white, 183 black, 34 Latino) reported chronic back or neck pain. Whites and blacks had similar rates of chronic back pain. …

Accessing Asthma Care: A Case Study Of Urban Children, Andrea Wallace

Andrea S. Wallace

The purpose of this exploratory, descriptive study was to identify factors that facilitate or impede the use of health care resources by urban children with asthma. Using an embedded case study design, the study considered the issue of health care access for urban children with asthma by focusing on attributes that impede and facilitate these children's access to health care resources. Interview, demographic, survey, and medical records data were analyzed for 34 parent-child dyads accessing asthma care in one metropolitan health care system. Interview data from 14 health care professionals were also analyzed. These findings were then compared with utilization …