Medicine and Health Sciences Commons^™

Transdisciplinary Assignments In Graduate Health Education As A Model For Future Collaboration, Catherine Christie, A Russell Smith Jr., Michele Bednarzyk

Catherine Christie

Transdisciplinary health care continues to be at the forefront of patient treatment in the medical arena, in part due to escalating health care costs, an increasing aging population, and the development of multiple chronic diseases. Gaining the knowledge, experience, and principles associated with transdisciplinary teamwork to successfully prepare for modern-day practice is therefore essential for individuals of various health care professions. This report describes an assignment developed and implemented to facilitate professional interaction between graduate physical therapy, nutrition, and nursing students. The objectives of this assignment were to determine through student evaluation the effects of a transdisciplinary experience on students' …

Development Of An Evidence-Based Clinical Practice Guideline On Linear Growth Measurement Of Children, Jan Foote, L. Brady, A. Burke, J. Cook, M. Dutcher, K. Gradoville, J. Groos, K. Kinkade, R. Meeks, P. Mohr, D. Schultheis, B. S. Walker, K. Phillips

Jan M. Foote

Growth is an important indicator of child health; however, measurements are frequently inaccurate and unreliable. This article reviews the literature on linear growth measurement error and describes methods used to develop and evaluate an evidence-based clinical practice guideline on the measurement of recumbent length and stature of infants, children, and adolescents. Systematic methods were used to identify evidence to answer clinical questions about growth measurement. A multidisciplinary team critically appraised and synthesized the evidence to develop clinical practice recommendations using an evidence-based practice rating scheme. The guideline was prospectively evaluated through internal and external reviews and a pilot study to …

Pyloric Channel Stricture Secondary To High-Dose Ibuprofen Therapy In A Patient With Cystic Fibrosis, E. Bell, R. Grothe, V. Zivkovich, Jan Foote, J. Wellendorf

Jan M. Foote

OBJECTIVE: To describe a case of pyloric channel stricture secondary to high-dose ibuprofen therapy in a pediatric patient with cystic fibrosis. CASE SUMMARY: A 12-year-old white girl started taking high-dose ibuprofen to treat the pulmonary manifestations of cystic fibrosis. The peak plasma concentration at dose initiation was within the accepted therapeutic range. Approximately one month later, the patient developed emesis and intolerance of solid foods, which persisted for several months and resulted in a weight loss of seven kilograms. The patient was referred to a pediatric gastroenterologist, who performed an upper endoscopy and subsequently diagnosed a pyloric channel stricture. The …

Getting A Healthy Start. Feeding Issues In The First Year Of Life, Jan Foote

Jan M. Foote

No abstract provided.

Promoting Adherence And Retention To Clinical Trials In Special Populations: A Women's Health Initiative Workshop, Sara Wilcox, Sally Shumaker, Deborah Bowen, Michelle Naughton, Milagros Rosal, Shari Ludlam, Elizabeth Dugan, Julie Hunt, Stephanie Stevens

Elizabeth Dugan

This paper describes a Women's Health Initiative workshop on promoting adherence and retention in randomized clinical trials among ethnic minority women, participants of lower socioeconomic status, and older women. Workshop objectives were: (1) to increase knowledge of demographic and cultural characteristics of diverse groups, (2) to increase awareness of how diversity can affect interactions in clinical research, (3) to explore how research staff behavior can influence adherence and retention, and (4) to increase knowledge of strategies to enhance adherence and retention in special populations. The workshop emphasized the importance of understanding beliefs, values, and experiences that are common in diverse …

Development Of Abbreviated Measures To Assess Patient Trust In A Physician, A Health Insurer, And The Medical Profession, Elizabeth Dugan, Felicia Trachtenberg, Mark Hall

Elizabeth Dugan

BACKGROUND: Despite the recent proliferation in research on patient trust, it is seldom a primary outcome, and is often a peripheral area of interest. The length of our original scales to measure trust may limit their use because of the practical needs to minimize both respondent burden and research cost. The objective of this study was to develop three abbreviated scales to measure trust in: (1) a physician, (2) a health insurer, and (3) the medical profession. METHODS: Data from two samples were used. The first was a telephone survey of English-speaking adults in the United States (N = 1117) …

Patient Education About Anticoagulant Medication: Is Narrative Evidence Or Statistical Evidence More Effective?, Kathleen Mazor, Joann Baril, Elizabeth Dugan, Frederick Spencer, Pamela Burgwinkle, Jerry Gurwitz

Elizabeth Dugan

OBJECTIVE: To determine the relative impact of incorporating narrative evidence, statistical evidence or both into patient education about warfarin, a widely used oral anticoagulant medication.

METHODS: 600 patients receiving anticoagulant therapy were randomly assigned to view one of three versions of a video depicting a physician-patient encounter where anticoagulation treatment was discussed, or usual care (no video). The videos differed in whether the physician used narrative evidence (patient anecdotes), statistical evidence, or both to highlight key information. 317 patients completed both the baseline and post-test questionnaires. Questions assessed knowledge, beliefs and adherence to medication and laboratory monitoring regimens.

RESULTS: All …

Engaging Racial Autoethnography As A Teaching Tool For Womanist Inquiry, Janette Taylor, Melissa Lehan Mackin, A. Oldenburg

Melissa Lehan Mackin

Racial autobiography, self-narratives on how one learned about the idea of race, has been underutilized as a tool to familiarize and orient students in the process of critical inquiry for nursing research. The aims of this article are to explore how racial autoethnography: (1) repositions students to effect an epistemological change, (2) challenges dominant ideology, and (3) functions as a link between the student and critical theories for use in nursing research. Students engage in and share reflective narrative about a variety of instructional materials used in the course. Reflective narratives are presented in a framework that addresses white racial …

Fall Prevention Practices In Adult Medical-Surgical Nursing Units Described By Nurse Managers, L. Shever, M. Titler, Melissa Lehan Mackin, A. Kueny

Melissa Lehan Mackin

The purpose of this article was to describe nursing practices (e.g., assessment, interventions) around fall prevention, as perceived by nurse managers in adult, medical-surgical nursing units. One hundred forty nurse managers from 51 hospitals from across the United States participated. Descriptive frequencies are used to describe nurse manager responses. The most commonly used fall risk assessment tool was the Morse Fall Risk Assessment Tool (40%). The most common fall prevention interventions included bed alarms (90%), rounds (70%), sitters (68%), and relocating the patient closer to the nurses' station (56%). Twenty-nine percent of nurse managers identified physical restraints as an intervention …

The Burden Of Moderate-To-Heavy Soil-Transmitted Helminth Infections Among Rural Malaysian Aborigines: An Urgent Need For An Integrated Control Programme, Init Ithoi

Init Ithoi

Background: Soil-transmitted helminth (STH) infections, among the most common neglected tropical diseases, continue to be a major threat to the health and socioeconomic wellbeing of infected people especially children in developing countries. Methods: A cross-sectional study among 254 aboriginal schoolchildren was conducted in order to determine the current prevalence and intensity of infections and to investigate the potential risk factors associated with moderate-to-heavy burden of STH infections among these children. Results: Overall, 93.7% of children were found to be infected with one or more STH species. The prevalence of trichuriasis, ascariasis and hookworm infections were 84.6%, 47.6% and 3.9%, respectively. …

Becoming A Registered Nurse: The Nurse Extern Experience, K. Starr, Virginia Conley

Virginia M. Conley

Little is known about the perceptions of nursing students externing in newly developed hospital-based programs that focus on socialization and transition to the registered nurse (RN) role rather than on institutional recruitment and retention goals. This qualitative study explored student nurse externs' expectations, experiences, and benefits of participation in a student-focused externship program. Externs wanted to gain experience with skills and learn what it was like to be an RN. Goals were met or exceeded by becoming comfortable in the externship role, growing in skill performance and confidence, and becoming members of the healthcare team. The experience fostered growth from …

Integrating Massage Into Rural Caregiving At End-Of-Life, Virginia Conley, D. Kempson

Virginia M. Conley

No abstract provided.

Informational Needs Of Caregivers Of Terminal Patients In A Rural State, Virginia Conley, M. Burman

Virginia M. Conley

Home care of a terminally ill family member is stressful, especially in rural areas. This qualitative study sought to determine informational needs of rural caregivers and how that information is obtained. Although most caregivers stated satisfaction with available information, mostly obtained from physicians and nurses, their behavior belied their satisfaction. Assertive and self-reliant, they used informal communications rather than written information to meet most of their needs. Approaches home care nurses can use to help caregivers obtain important information are presented.

National Health Policy Influence On Medicare Home Health, Virginia Conley, M. Walker

Virginia M. Conley

National health policy regulates the delivery of Medicare home health services. These services have grown exponentially over the past several years. Current challenges to service delivery revolve around attempts to contain costs while ensuring quality of and access to care. To meet these challenges, providers must be aware of the societal and ideological influences on national health policies that impact service delivery. This article uses Wong's model of the progression of health care reform to address past health policy influences on Medicare home health delivery, investigate recent sociological trends for relevance to health policy, and propose changes based on current …

Patient And Parent/Guardian Perspectives On The Health Care Of Adults With Mental Retardation, Sarah Voss Horrell, William Maclean, Virginia Conley

Virginia M. Conley

Individuals with mental retardation and their parents/guardians have long been neglected in health care research. In this study we used a qualitative methodology to describe the experiences adults with mental retardation and their parents/guardians have with the delivery of primary care services. Semi-structured in-depth interviews were conducted with 12 adults who had mental retardation and 9 parents/guardians. The grounded theory approach was utilized to guide data collection and analysis. Findings suggest an overall positive experience with primary care services. Unique themes were identified that distinguished parent/guardian experiences from those of adults with mental retardation, who focused on immediate, concrete issues …

Reconceptualizing The Core Of Nurse Practitioner Education And Practice, M. Burman, A. Hart, Virginia Conley, J. Brown, P. Sherard, P. Clarke

Virginia M. Conley

PURPOSE: The movement to the doctor of nursing practice (DNP) is progressing rapidly with new programs emerging and curricular documents being developed. We argue that the implementation of the DNP is a good move for nursing, provided that we use the opportunity to reconceptualize the core of advanced practice nursing, especially nurse practitioner (NP) practice. DATA SOURCES: Theory and research articles from nursing focused on advanced practice nursing, NPs, and doctoral education. CONCLUSIONS: The foundation of NP education is currently based essentially on borrowed or shared content in assessment, pharmacology, and pathophysiology. We argue that the heart and soul of …

Beyond Knowledge Deficit To A Proposal For Information-Seeking Behaviors, Virginia Conley

Virginia M. Conley

TOPIC: Nursing assessment of knowledge of informational needs. PURPOSE: To present of a brief evolutionary analysis of knowledge deficit in terms of its significance, application, and use, and to present a proposal diagnosis, "information-seeking behaviors." SOURCES: Literature review of knowledge deficit and "information-seeking behaviors." CONCLUSIONS: Knowledge deficit is a nursing diagnosis that is significant for identifying a patient's need for education or knowledge. Its application has revealed limitations to validity and subsequent use. "Information-seeking behaviors" is proposed as an alternative diagnosis. Antecedents and defining characteristics are presented and areas for future research proposed.

Developing A Scholarship Community, S. Cumbie, C. Weinert, S. Luparell, Virginia Conley, J. Smith

Virginia M. Conley

PURPOSE: To report the results of a multidisciplinary, interinstitutional writing support group established to facilitate faculty scholarly productivity. ORGANIZING CONCEPT: The road to scholarship can be filled with many obstacles, among them time constraints, teaching and meeting demands, student needs, office interruptions, and lack of colleagueship. The problems associated with lack of colleagueship, in particular, can be compounded for faculty who work in isolated contexts with few, if any, senior faculty to serve as mentors. METHODS OF DEVELOPMENT: The Western Writers Coercion Group evolved over a 2-year period from a small group of nursing faculty at a single institution to …

Nitric Oxide-Mediated Inhibition Of Hdm2-P53 Binding, Christopher Schonhoff, Marie-Claire Daou, Stephen Jones, Celia Schiffer, Alonzo Ross

Celia A. Schiffer

It has become increasingly evident that nitric oxide exerts its effects, in part, by S-nitrosylation of cysteine residues. We tested in vitro whether nitric oxide may indirectly control p53 by S-nitrosylation and inactivation of the p53 negative regulator, Hdm2. Treatment of Hdm2 with a nitric oxide donor inhibits Hdm2-p53 binding, a critical step in Hdm2 regulation of p53. The presence of excess amounts of cysteine or dithiothreitol blocks this inhibition of binding. Moreover, nitric oxide inhibition of Hdm2-p53 binding was found to be reversible. Sulfhydryl sensitivity and reversibility are consistent with nitrosylation. Finally, we have identified a critical cysteine residue …

Co-Evolution Of Nelfinavir-Resistant Hiv-1 Protease And The P1-P6 Substrate, Madhavi Kolli, Stephane Lastere, Celia Schiffer

Celia A. Schiffer

The selective pressure of the competitive protease inhibitors causes both HIV-1 protease and occasionally its substrates to evolve drug resistance. We hypothesize that this occurs particularly in substrates that protrude beyond the substrate envelope and contact residues that mutate in response to a particular protease inhibitor. To validate this hypothesis, we analyzed substrate and protease sequences for covariation. Using the chi2 test, we show a positive correlation between the nelfinavir-resistant D30N/N88D protease mutations and mutations at the p1-p6 cleavage site as compared to the other cleavage sites. Both nelfinavir and the substrate p1-p6 protrude beyond the substrate envelope and contact …

Mechanism Of Substrate Recognition By Drug-Resistant Human Immunodeficiency Virus Type 1 Protease Variants Revealed By A Novel Structural Intermediate, Moses Prabu-Jeyabalan, Ellen A. Nalivaika, Keith Romano, Celia A. Schiffer

Celia A. Schiffer

Human immunodeficiency virus type 1 (HIV-1) protease processes and cleaves the Gag and Gag-Pol polyproteins, allowing viral maturation, and therefore is an important target for antiviral therapy. Ligand binding occurs when the flaps open, allowing access to the active site. This flexibility in flap geometry makes trapping and crystallizing structural intermediates in substrate binding challenging. In this study, we report two crystal structures of two HIV-1 protease variants bound with their corresponding nucleocapsid-p1 variant. One of the flaps in each of these structures exhibits an unusual "intermediate" conformation. Analysis of the flap-intermediate and flap-closed crystal structures reveals that the intermonomer …

Point Mutants Of Ehec Intimin That Diminish Tir Recognition And Actin Pedestal Formation Highlight A Putative Tir Binding Pocket, Hui Liu, Padhma Radhakrishnan, Loranne Magoun, Moses Prabu-Jeyabalan, Kenneth Campellone, Pamela Savage, Feng He, Celia Schiffer, John Leong

Celia A. Schiffer

Attachment to host cells by enterohaemorrhagic Escherichia coli (EHEC) is associated with the formation of a highly organized cytoskeletal structure containing filamentous actin, termed an attaching and effacing (AE) lesion. Intimin, an outer membrane protein of EHEC, is required for the formation of AE lesions, as is Tir, a bacterial protein that is translocated into the host cell to function as a receptor for intimin. We established a yeast two-hybrid assay for intimin-Tir interaction and, after random mutagenesis, isolated 24 point mutants in intimin, which disrupted Tir recognition in this system. Analysis of 11 point mutants revealed a correlation between …

Structural And Thermodynamic Basis For The Binding Of Tmc114, A Next-Generation Human Immunodeficiency Virus Type 1 Protease Inhibitor, Nancy King, Moses Prabu-Jeyabalan, Ellen Nalivaika, Piet Wigerinck, Marie-Pierre De Bethune, Celia Schiffer

Celia A. Schiffer

TMC114, a newly designed human immunodeficiency virus type 1 (HIV-1) protease inhibitor, is extremely potent against both wild-type (wt) and multidrug-resistant (MDR) viruses in vitro as well as in vivo. Although chemically similar to amprenavir (APV), the potency of TMC114 is substantially greater. To examine the basis for this potency, we solved crystal structures of TMC114 complexed with wt HIV-1 protease and TMC114 and APV complexed with an MDR (L63P, V82T, and I84V) protease variant. In addition, we determined the corresponding binding thermodynamics by isothermal titration calorimetry. TMC114 binds approximately 2 orders of magnitude more tightly to the wt enzyme …

Lack Of Synergy For Inhibitors Targeting A Multi-Drug-Resistant Hiv-1 Protease, Nancy King, Laurence Melnick, Moses Prabu-Jeyabalan, Ellen Nalivaika, Shiow-Shong Yang, Yun Gao, Xiaoyi Nie, Charles Zepp, Donald Heefner, Celia Schiffer

Celia A. Schiffer

The three-dimensional structures of indinavir and three newly synthesized indinavir analogs in complex with a multi-drug-resistant variant (L63P, V82T, I84V) of HIV-1 protease were determined to approximately 2.2 A resolution. Two of the three analogs have only a single modification of indinavir, and their binding affinities to the variant HIV-1 protease are enhanced over that of indinavir. However, when both modifications were combined into a single compound, the binding affinity to the protease variant was reduced. On close examination, the structural rearrangements in the protease that occur in the tightest binding inhibitor complex are mutually exclusive with the structural rearrangements …

Contribution Of Ser386 And Ser396 To Activation Of Interferon Regulatory Factor 3, Weijun Chen, Hema Srinath, Suvana Lam, Celia Schiffer, William Royer, Kai Lin

Celia A. Schiffer

IRF-3, a member of the interferon regulatory factor (IRF) family of transcription factors, functions in innate immune defense against viral infection. Upon infection, host cell IRF-3 is activated by phosphorylation at its seven C-terminal Ser/Thr residues: (385)SSLENTVDLHISNSHPLSLTS(405). This phosphoactivation triggers IRF-3 to react with the coactivators, CREB-binding protein (CBP)/p300, to form a complex that activates target genes in the nucleus. However, the role of each phosphorylation site for IRF-3 phosphoactivation remains unresolved. To address this issue, all seven Ser/Thr potential phosphorylation sites were screened by mutational studies, size-exclusion chromatography, and isothermal titration calorimetry. Using purified proteins, we show that CBP …

Nursing Management Innovations: A Need For Systematic Evaluation, J. C. Mccloskey, M. Mass, Carol Watson, C. Gongaware, Diane Huber, M. Blegen, M. Johnson, A. Kasparek, C. Delaney, K. Kelly

Diane Huber

While emphasis in nursing is placed on research on clinical interventions, there has been little attention to the equally important management interventions. The concept of a management intervention or innovation is introduced here and five types of management innovations in nursing are identified. An overview of the research base for four of the innovations demonstrates the need for systematic evaluation.

Assessing Postpartum Fatigue, Diane Gardner, B. Campbell

Diane Huber

No abstract provided.

The Ccmc's National Study Of Case Manager Job Descriptions: An Understanding Of The Activities, Role Relationships, Knowledges, Skills, And Abilities, H. Tahan, Diane Huber

Diane Huber

Defining the roles and functions of case managers is crucial in today's healthcare environment and necessary for the case management field. One way to address this issue is through the examination of case managers' job descriptions used in various healthcare organizations. The study reported herein used qualitative analysis procedures and the latent class cluster analysis method to examine a national sample of 1028 job descriptions of case managers. The study identified the activities, role relationships, knowledge, skills, and abilities of case managers working in varied settings. It also described the changes that occurred in the practice of case management, based …

Case Managers' Roles And Functions: Commission For Case Manager Certification's 2004 Research, Part Ii, H. Tahan, W. Downey, Diane Huber

Diane Huber

The Commission for Case Manager Certification (CCMC) conducted its third case managers' role and functions study in 2004 for the purpose of validating the currency and relevancy of the certified case manager examination. The results of this study are shared in an article of 2 parts. Part I, which was published in the previous issue of this journal, discussed the process the CCMC used for the development of the Case Managers' Role and Functions Survey Instrument and the identification of new 6 essential functions and 6 knowledge areas that describe case management practice. These findings were based on the survey …

Managing Forces Of Change: Commission For Case Manager Certification Looks To The Future, Diane Huber, H. Tahan

Diane Huber

No abstract provided.