Medicine and Health Sciences Commons^™

Prevalence And Risk Factors Of Major Depressive Disorder In Hiv/Aids As Seen In Semi-Urban Entebbe District, Uganda, Eugene Kinyanda, Susan Hoskins, Juliet Nakku, Saira Nawaz, Vikram Patel

Dartmouth Scholarship

Background:

Not much is known about the risk factors of major depressive disorder (MDD) in HIV/AIDS in the African socio-cultural context. Therefore a study was undertaken to examine the prevalence and risk factors of MDD in HIV/AIDS in semi-urban Uganda.

Methods:

A cross-sectional study was undertaken among 618 respondents attending two HIV clinics in Uganda.

Results:

Prevalence of MDD was 8.1%. Factors associated with MDD at univariate analysis only were female gender, family history of mental illness, negative coping style, alcohol dependency disorder, food insecurity and stress; not associated with MDD were social support, neurocognitive impairment, CD4 counts and BMI. …

Rice Consumption Contributes To Arsenic Exposure In Us Women, Diane Gilbert-Diamond, Kathryn L. Cottingham, Joann F. Gruber, Tracy Punshon, Vicki Sayarath, A. Jay Gandolfi, Emily R. Baker, Brian P. Jackson, Carol L. Folt, Margaret R. Karagas

Dartmouth Scholarship

Emerging data indicate that rice consumption may lead to potentially harmful arsenic exposure. However, few human data are available, and virtually none exist for vulnerable periods such as pregnancy. Here we document a positive association between rice consumption and urinary arsenic excretion, a biomarker of recent arsenic exposure, in 229 pregnant women. At a 6-mo prenatal visit, we collected a urine sample and 3-d dietary record for water, fish/seafood, and rice. We also tested women's home tap water for arsenic, which we combined with tap water consumption to estimate arsenic exposure through water. Women who reported rice intake (n …

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 …

Relationship Between Vancomycin Trough Concentrations And Nephrotoxicity: A Prospective Multicenter Trial, John A. Bosso, Jean Nappi, Celeste Rudisill, Marlea Wellein, P Brandon Bookstaver, Jenna Swindler, Patrick D. Mauldin

Faculty Publications

Several single-center studies have suggested that higher doses of vancomycin, aimed at producing trough concentrations of >15 mg/liter, are associated with increased risk of nephrotoxicity. We prospectively assessed the relative incidence of nephrotoxicity in relation to trough concentration in patients with documented methicillin-resistant Staphylococcus aureus (MRSA) infections at seven hospitals throughout South Carolina. Adult patients receiving vancomycin for at least 72 h with at least one vancomycin trough concentration determined under steady-state conditions were prospectively studied. The relationship between vancomycin trough concentrations of >15 mg/ml and the occurrence of nephrotoxicity was assessed using univariate and multivariate analyses, controlling for age, …

Practice Theory Development: A Model For Person-Centered Care, S. Cumbie, Virginia Conley, M. Burman, C. Weinert

Virginia M. Conley

No abstract provided.

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 …

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.

Never Did I Know: Iowa Nurses Association Resolution 2010 #2, Virginia Conley

Virginia M. Conley

No abstract provided.

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 …

Autoimmune Enteropathy With A Cd8+ Cd7- T-Cell Small Bowel Intraepithelial Lymphocytosis: Case Report And Literature Review, Shrinivas Bishu, Violeta Arsenescu, Eun Y. Lee, H. David Vargas, Willem J. S. De Villiers, Razvan Arsenescu

Surgery Faculty Publications

Background

Adult onset autoimmune enteropathy (AIE) is a rare condition characterized by diarrhea refractory to dietary therapy diagnosed in patients with evidence of autoimmune conditions. Auto-antibodies to gut epithelial cells and other tissues are commonly demonstrated. Despite increasing awareness, the pathogenesis, histologic, immunologic and clinical features of AIE remain uncertain. There remains controversy regarding the diagnostic criteria, the frequency and types of auto-antibodies and associated autoimmune conditions, and the extent and types of histologic and immunologic abnormalities. CD4+ T-cells are thought to at least responsible for this condition; whether other cell types, including B- and other T-cell subsets are involved, …

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 …

Conflict And Retention Of New Graduate Nurses, Diane Gardner

Diane Huber

No abstract provided.

Career Commitment In Nursing, Diane Gardner

Diane Huber

There are different patterns and styles to careers in nursing. The concept of career commitment in nursing is explored, and the results of some research are discussed for their implications for nursing careers. A longitudinal, repeated-measures descriptive survey was used to measure career commitment and explore its relationship to turnover and work performance in 320 newly employed registered nurses at one hospital. Career commitment scores dropped significantly over the first year. Although career commitment does correlate with turnover, and there is a relationship with job performance, the direct association is weak. Career commitment is not a stable phenomenon in the …

Fatigue In Postpartum Women, Diane Gardner

Diane Huber

Childbirth and the responsibilities of parenting after birth require a great deal of energy. Fatigue in postpartum women is a concern for maternal-child nurses because of the impact on the health and parenting ability of the mother. To determine fatigue levels and types, 35 women who vaginally delivered were surveyed at 2 days, 2 weeks, and 6 weeks postpartum. This sample was found to be mildly fatigued, with situational and/or psychological fatigue. Nurses can intervene by assessing postpartum fatigue and using teaching/counseling methods for knowledge preparation and for clients at risk.

Case Management Workforce In The United States, E. Park, Diane Huber

Diane Huber

PURPOSE: The purpose of this study was to investigate and compare characteristics of the case management (CM) workforce in the US by age, years of experience, and original profession. DESIGN: This study was an exploratory, descriptive secondary analysis of demographic and job characteristics of 24,085 certified case managers (CCMs). METHODS: Descriptive statistics, Chi-square tests, and correlation coefficients were calculated. FINDINGS: The majority of the case-management workforce is made up of RNs (93.3%). The CCMs were older, with a mean age of 55.0 years, than were those in their original profession and started to work as CCMs late in their careers. …

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

Diane Huber

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

Evaluating The Impact Of Case Management Dosage, Diane Huber, M. Sarrazin, T. Vaughn, J. Hall

Diane Huber

BACKGROUND: Because of the broad range of activities involved and high variance in clients' needs, it is challenging to measure the actual dose of case management in order to assess quality and manage outcomes. OBJECTIVE: The purpose of this research is to evaluate the impact of intervention dosage on client outcomes in different case management models within substance abuse treatment. METHOD: A descriptive and repeated measures analysis from a clinical trials data set measured the dosage of case management and evaluated impact on client outcomes. A sample of 598 clients from a substance abuse treatment facility was randomized into one …

Client Satisfaction With Rural Substance Abuse Case Management Services, T. Kopelman, Diane Huber, B. Kopelman, M. Sarrazin, J. Hall

Diane Huber

Although many substance abuse organizations offer case management services, little is known about clients' satisfaction as consumers of case management services. The purpose of this study was to evaluate consumer preferences regarding the delivery of case management services in a rural substance abuse treatment program. For this study, 120 clients (30 in each of four research conditions) were interviewed about their experiences in the Iowa Case Management Project (ICMP), a field-based clinical trial evaluating a strengths-based model of case management for rural clients in drug abuse treatment. A mixed-method approach evaluated clients' responses from a semistructured interview. Most clients preferred …

A Brief Overview Of Adolescent Developmental Problems In Hong Kong, Daniel T. L. Shek, Hing Keung Ma, Rachel C. F. Sun

Pediatrics Faculty Publications

Several adolescent developmental problems in Hong Kong are briefly reviewed in this paper. First, rising adolescent substance abuse trends are described. Second, Internet use problems and Internet addiction among young people are examined. Third, worrying trends in adolescent sexuality are identified. Fourth, phenomena on bullying among young people are reviewed. Finally, phenomena related to adolescent materialistic orientation are focused upon. With reference to these adolescent developmental problems, possible solutions are briefly discussed particularly with reference to the ecological perspective. It is argued that the related scientific literature provides useful pointers for designing the curriculum in the extension phase of the …

Percutaneous Implantation Of The Edwards Sapien Transcatheter Heart Valve For Conduit Failure In The Pulmonary Position: Early Phase 1 Results From An International Multicenter Clinical Trial., Damien Kenny, Ziyad M. Hijazi, Saibal Kar, John Rhodes, Michael Mullen, Raj Makkar, Girish S. Shirali, Mark Fogel, John Fahey, Mary G. Heitschmidt, Christopher Cain

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: The purpose of this study was to evaluate the safety and effectiveness of the Edwards SAPIEN transcatheter heart valve (Edwards Lifesciences LLC, Irvine, California) in the pulmonary position in patients with moderate to severe pulmonary regurgitation with or without stenosis.

BACKGROUND: Transcatheter pulmonary valve replacement is evolving, but to date, experience has been limited to the Melody valve (Medtronic Inc., Minneapolis, Minnesota).

METHODS: Eligible patients with dysfunctional right ventricle-to-pulmonary artery conduits were screened if body weight was ≥35 kg and the in situ conduit diameter was ≥16 mm and ≤24 mm. Standardized implantation and follow-up protocols were used.

RESULTS: …

Outcomes Of Family Involvement In Care Intervention For Caregivers Of Individuals With Dementia, Meridean Maas, D. Reed, M. Park, Janet Specht, D. Schutte, Lisa Skemp Kelley, Elizabeth Swanson, Toni Tripp-Reimer, Kathleen Buckwalter

Elizabeth A. Swanson

BACKGROUND: Despite the increasing number of individuals with dementia relocated from caregiving at home to a nursing home, there is only a small body of literature examining the influence of institutional family-oriented practices on family member perceptions of care and family-staff relationships. OBJECTIVE: The study tested the effects of the Family Involvement in Care partnership intervention on family members' perceptions of their caregiving role, relationships with staff, and satisfaction with the care of relatives with dementia residing in special care units as well as the effects on staff attitudes toward families and staff satisfaction with a caregiving role. METHODS: A …

Russian Citizens' Trusted Sources Of Health Promotion Information, C. Goody, Elizabeth Swanson, A. Bossen, E. Frolova, O. Kuznetsova, S. Plavinski

Elizabeth A. Swanson

This study examined Russian citizens' trusted sources of health information. A random sample of 906 people, from two villages in St. Petersburg, Russia, responded to a health needs assessment questionnaire. Results suggest that medical professionals and special books, such as informational pamphlets about treating a myriad of illnesses, are significant trusted sources of health information for people in Russia. Further, these data suggest differences between trusted sources of health information exist between villages rather than by gender or age group. This work has implications for health care practitioners in Russia, who are advancing the discipline of family practice, as well …

Sensitivity Of Detection Of Radiofrequency Surgical Sponges: A Prospective, Cross-Over Study, Victoria Steelman

Victoria J. Steelman

BACKGROUND: A retained surgical sponge is a serious medical error that results in negative patient outcomes. Radiofrequency (RF) technology has recently been introduced to evaluate for the presence of a retained sponge. The aim of this study was to evaluate the sensitivity and specificity of the detection of surgical sponges embedded with an RF chip through the torsos of subjects of varying body habitus, including the morbidly obese. METHODS: A prospective, crossover, and observer blinded study design was used. Subjects served as their own controls. With the subject supine, 4 surgical sponges were sequentially placed behind the subject's torso in …

Proposed Perioperative Nurse Translation Of The Federal Clinical Practice Guidelines. Association Of Operating Room Nurses, S. Moorhead, M. Golas, S. Kleinbeck, L. Reehling, Victoria Steelman, D. Wahoff-Stice, M. Weisbrich, D. Fogg

Victoria J. Steelman

No abstract provided.

Early- And Late-Onset Group B Streptococcal Infections: Overview And Case Studies, Rebecca Siewert, D. Holida

Rebecca Siewert

Infants that are admitted and cared for in the neonatal intensive care unit are at risk for sepsis. Group B Streptococcus (GBS) is the most common cause of neonatal sepsis and meningitis. Group B Streptococcus is classified into early- and late-onset sepsis. With early onset, infants develop symptoms within 7 days of birth. With late onset, they develop symptoms between 7 days and 3 months of life. Prompt identification and treatment of suspected septic infants are crucial. Infants who develop early- or late-onset GBS sepsis are at risk for sequelae ranging from normal physiologic outcome to devastating long-term conditions and …

Screening And Counseling For Postpartum Depression By Nurses: The Women's Views, Lisa Segre, M. O'Hara, S. Arndt, C. Beck

Lisa S. Segre

PURPOSE: In this part 2 article of research examining a model of care in which nurses screen and counsel postpartum women for postpartum depression, acceptability of such a model to postpartum patients was evaluated with a diverse sample of American women. STUDY DESIGN AND METHODS: Descriptive survey of two groups: 691 predominately white postpartum women with relatively high annual incomes (Sample 1) and 132 low-income women, some of whom were ethnic minorities (Sample 2). The surveys were distributed and needed to be mailed back to the investigators. The response rate was 72% in Sample 1 and 30% in Sample 2. …

The Prevalence Of Postpartum Depression: The Relative Significance Of Three Social Status Indices, Lisa Segre, Michael O'Hara, Stephan Arndt, Scott Stuart

Lisa S. Segre

BACKGROUND: Little is known about the prevalence of clinically significant postpartum depression in women of varying social status. The purpose of the present study was to examine the prevalence of postpartum depression as a function of three indices of social status: income, education and occupational prestige. METHOD: A sample of 4,332 postpartum women completed a demographic interview and the Inventory to Diagnose Depression, a self-report scale developed to identify a major depressive episode in accordance with DSM diagnostic criteria. Logistic regression was used to assess the relative significance of the three social status variables as risk factors for postpartum depression …

Listening Visits: An Evaluation Of The Effectiveness And Acceptability Of A Home-Based Depression Treatment, Lisa Segre, S. Stasik, M. O'Hara, S. Arndt

Lisa S. Segre

Maternal depression affects approximately one in five women, is undertreated, and compromises infant development. In the United Kingdom, public health nurses provide an empirically supported intervention (Listening Visits [LV]) to depressed postpartum women. This study evaluates the effectiveness of LV when delivered by U.S. home visitors. Nineteen women with depressive symptoms received LV. Pre-, post-, and follow-up assessments evaluated depression status, life satisfaction, and treatment acceptability. Listening Visits were associated with a statistically and clinically significant reduction in depression, improvement in life satisfaction, and were acceptable to this sample of postpartum women. The LV intervention shows considerable promise as an …

Measuring Organizational Attributes Of Primary Care Practices: Development Of A New Instrument, P. Ohman-Strickland, A. Orzano, P. Nutting, W. Perry Dickinson, Jill Scott-Cawiezell, K. Hahn, M. Gibel, B. Crabtree

Jill Scott-Cawiezell

OBJECTIVE: To develop an instrument to measure organizational attributes relevant for family practices using the perspectives of clinicians, nurses, and staff. DATA SOURCES/STUDY SETTING: Clinicians, nurses, and office staff (n=640) from 51 community family medicine practices. DESIGN: A survey, designed to measure a practices' internal resources for change, for use in family medicine practices was created by a multidisciplinary panel of experts in primary care research and health care organizational performance. This survey was administered in a cross-sectional study to a sample of diverse practices participating in an intervention trial. A factor analysis identified groups of questions relating to latent …