Medicine and Health Sciences Commons^™

Saitohin And Apoe Polymorphisms Influence Cognition And Function In Persons With Advanced Alzheimer Disease, D. Schutte, D. Reed, S. Decrane, Anne Ersig

Anne L. Ersig

BACKGROUND/AIMS: Alzheimer disease (AD) is characterized by variability in the onset and progression of cognitive, functional and behavioral symptoms. The purpose of this study was to identify genetic correlates of symptom variability in persons with moderate-to-advanced AD. METHODS: Repeated measures of cognition, function and behavior were collected from institutionalized persons with AD over 12 months. Candidate genes were assayed. RESULTS: Single polymorphisms within the saitohin and APOE genes were associated with increased cognitive impairment and functional dependence. The APOE-epsilon4 allele was associated with increased baseline physical agitation. CONCLUSION: The development of predictive profiles for the clinical symptoms of AD may …

Body Mass Index Misclassification Of Obesity Among Community Police Officers, M. Alasagheirin, M. Clark, Sandra Ramey, E. Grueskin

M. Kathleen Clark

Occupational health nurses are at the forefront of obesity assessment and intervention and must be aware of potential inaccuracies of obesity measurement. The purpose of this study was to identify the prevalence of obesity among a sample of 84 male police officers 22 to 63 years old and determine the accuracy of body mass index (BMI) in estimating obesity compared to body fat percent (BF %). BMI identified 39.3% of the participants as obese, compared to 70.2% by BF %. BMI misclassified normal-weight officers as obese or overweight and obese officers as normal 48.8% (n = 41) of the time. …

Effectiveness Of Transcutaneous Electrical Nerve Stimulation On Postoperative Pain With Movement, Barbara Rakel, Rita Frantz

Barbara A. Rakel

This study tested the effectiveness of episodic transcutaneous electrical nerve stimulation (TENS) as a supplement to pharmacologic analgesia on pain with movement and at rest after abdominal surgery and evaluated whether its use during walking and vital capacity maneuvers enhances performance of these activities. TENS, with a modulated frequency, intensity as high as the subject could tolerate, and electrodes placed on either side and parallel to the incision, was compared to placebo TENS and pharmacologic analgesia alone (control) by using a crossover design. Self-report of pain intensity, walking function, and vital capacity were assessed on 33 subjects. TENS resulted in …

Committee Meetings: An Electronic Alternative, Barbara Rakel

Barbara A. Rakel

All too often, meetings are called without much thought as to whether or not they are necessary, wasting the staff's time and the organization's money. Sharing information and gathering input through electronic mail eliminates unproductive meetings and increases member productivity.

Nonpharmacologic Treatment Of Pain, M. Titler, B. Rakel

Barbara A. Rakel

Nonpharmacologic interventions for pain treatment are important complementary therapies but are not substitutes for pharmacologic management of pain. Use of nonpharmacologic pain treatments in critical care settings is helpful to decrease pain, but the challenge remains for nurses to have the knowledge, time, and skill to use these interventions in a busy daily practice with severely ill patients. Although numerous studies testing the effectiveness of nonpharmacologic interventions for pain management are available, the varying methods and interventions used in these studies make it difficult to draw conclusions. Further research on the use of these interventions for pain reduction is necessary …

A New Transient Sham Tens Device Allows For Investigator Blinding While Delivering A True Placebo Treatment, Barbara Rakel, N. Cooper, H. Adams, B. Messer, L. Frey Law, D. Dannen, C. Miller, A. Polehna, R. Ruggle, C. Vance, D. Walsh, K. Sluka

Barbara A. Rakel

This study compared a new transient sham transcutaneous electrical nerve stimulation (TENS) that delivers current for 45 seconds to an inactive sham and active TENS to determine the degree of blinding and influence on pain reduction. Pressure-pain thresholds (PPT), heat-pain thresholds (HPT), and pain intensities to tonic heat and pressure were measured in 69 healthy adults before and after randomization. Allocation investigators and subjects were asked to identify the treatment administered. The transient sham blinded investigators 100% of the time and 40% of subjects compared to the inactive sham that blinded investigators 0% of the time and 21% of subjects. …

Interventions Related To Patient Teaching, Barbara Rakel

Barbara A. Rakel

This study validated 13 nursing interventions related to patient teaching. Four of the labels address the process of patient teaching, whereas the other nine concern content specific to teaching efforts. With the help of 46 master's-prepared nurses from across the country, critical (major) and supporting (minor) activities for each label were identified. This study is one of many steps toward the construction of a taxonomy of nursing interventions focused on direct care treatments that nurses perform on behalf of patients. The ultimate goal is to provide nurses with a standardized language that can be used to document their unique role …

From Book To Bedside: Putting Evidence To Use In The Care Of The Elderly, M. Titler, J. Mentes, Barbara Rakel, L. Abbott, S. Baumler

Barbara A. Rakel

BACKGROUND: Infusion of research findings into clinical practice is a challenging part of the research process. Because the length of time between discovery and use of knowledge averages 20 years, methods are needed to speed translation of research findings into practice. Few efforts have been made to coordinate the generation of new knowledge with the dissemination of findings from research to improve care of the elderly. RESEARCH-BASED PRACTICE PROTOCOLS: The Research Development and Dissemination Core (RDDC) of the Gerontological Nursing Interventions Research Center (GNIRC) at the University of Iowa emphasizes development of research-based (RB) protocols, which requires collecting relevant literature, …

Clinical Outcome Of Emergency Repeat Coronary Artery Bypass Surgery, J. Lemmer, D. Ferguson, Barbara Rakel, N. Rossi

Barbara A. Rakel

To determine the clinical outcome of patients requiring emergency repeat coronary artery bypass graft (CABG) procedures, we reviewed 23 such procedures performed for ongoing myocardial ischemia refractory to medical management. The operative mortality was 17%. On follow-up, an average of 24.9 months after emergency reoperation, 14 of the 19 survivors (74%) had recurrent angina. As compared to a randomly selected group of 25 patients who underwent elective repeat CABG procedures during the same time period, the incidence of late cardiac events was significantly higher (79% in the emergency group, 30% in the elective surgery group) and fewer patients had received …

Physical Modalities In Chronic Pain Management, Barbara Rakel, J. Barr

Barbara A. Rakel

The following conclusions can be made based on review of the evidence: There is limited but positive evidence that select physical modalities are effective in managing chronic pain associated with specific conditions experienced by adults and older individuals. Overall, studies have provided the most support for the modality of therapeutic exercise. Different physical modalities have similar magnitudes of effects on chronic pain. Therefore, selection of the most appropriate physical modality may depend on the desired functional outcome for the patient, the underlying impairment, and the patient's preference or prior experience with the modality. Certain patient characteristics may decrease the effectiveness …

Split-Thickness Skin Graft Donor Site Care: A Quantitative Synthesis Of The Research, Barbara Rakel, M. Bermel, L. Abbott, S. Baumler, M. Burger, C. Dawson, J. Heinle, I. Ocheltree

Barbara A. Rakel

Split-thickness skin grafting (STSG) is a frequently used reconstructive technique but is associated with a large variation in practice. The purposes of this article are to integrate and synthesize the available empirical evidence regarding STSG donor site dressings, identify which dressings are associated with the best outcomes, and provide practice recommendations. This review of 33 studies found transparent film to be the best dressing for the care of STSG donor site wounds. Transparent film was associated with one of the fastest healing rates (9.47 days), a smooth epithelialized surface, a low infection rate (10 out of 394 patients or 3%), …

Development Of Alterations In Learning: Situational Learning Disabilities, Barbara Rakel, G. Bulechek

Barbara A. Rakel

Until now the nursing diagnosis knowledge deficit has served as a label for all teaching/learning situations. This is inadequate and does not effectively give direction to correct intervention(s). The purpose of this article is to present the diagnostic concept, situational learning disability (SLD), a component of Alterations in Learning, which has been identified as an area to be developed in the Knowing pattern of the NANDA taxonomy. A thorough review of the literature and empirical support involving 20 cardiology patients on a 27-bed telemetry step-down unit is provided. The data support the development of two nursing diagnoses: (1) situational learning …

Implementation Of The Agency For Health Care Policy And Research Pain Guidelines, K. Schmidt, M. Alpen, Barbara Rakel

Barbara A. Rakel

Implementation of clinical practice guidelines in a large setting is a complex process. This article describes the many issues encountered in trying to implement Agency for Health Care Policy and Research acute pain and cancer pain guidelines in an academic medical center. Issues addressed include the membership of the task forces involved, incorporation of the guidelines into the institution-specific standards of care, selection and implementation of self-reporting tools for assessment of pain throughout the institution, issues involved in standardizing documentation of pain throughout the institution, measurement of the current status of pain control and integration into the existing quality assessment …

Effectiveness Of Transcutaneous Electrical Nerve Stimulation For Treatment Of Hyperalgesia And Pain, J. Desantana, D. Walsh, C. Vance, Barbara Rakel, K. Sluka

Barbara A. Rakel

Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacologic treatment for pain relief. TENS has been used to treat a variety of painful conditions. This review updates the basic and clinical science regarding the use of TENS that has been published in the past 3 years (ie, 2005-2008). Basic science studies using animal models of inflammation show changes in the peripheral nervous system, as well as in the spinal cord and descending inhibitory pathways, in response to TENS. Translational studies show mechanisms to prevent analgesic tolerance to repeated application of TENS. This review also highlights data from recent randomized, placebo-controlled trials …

A Randomized Trial Of Heparin And Saline For Maintaining Intravenous Locks In Neonates, J. Heilskov, Charmaine Kleiber, K. Johnson, J. Miller

Charmaine Kleiber

PURPOSE: To determine the effects of saline, heparin 2 units (U) per ml saline, and heparin 10 U/ml saline flush solutions on the duration of intravenous (i.v.) locks and the incidence of i.v. infiltration in neonates. DESIGN: Randomized double-blind experiment. SETTING: Tertiary-care nursery. PARTICIPANTS: Neonates (N = 90) hospitalized at birth in the intensive, intermediate care, or newborn units. MAIN OUTCOME MEASURES: Total hours from the time the i.v. was inserted to the time the i.v. was removed; hours from the time the i.v. was first flushed to the time the i.v. was removed; number of i.vs. removed because of …

A Randomized Trial Of Heparin And Saline For Maintaining Intravenous Locks In Neonates, J. Heilskov, Charmaine Kleiber, K. Johnson, J. Miller

Charmaine Kleiber

PURPOSE: To determine the effects of saline, heparin 2 units (U) per ml saline, and heparin 10 U/ml saline flush solutions on the duration of intravenous (i.v.) locks and the incidence of i.v. infiltration in neonates. DESIGN: Randomized double-blind experiment. SETTING: Tertiary-care nursery. PARTICIPANTS: Neonates (N = 90) hospitalized at birth in the intensive, intermediate care, or newborn units. MAIN OUTCOME MEASURES: Total hours from the time the i.v. was inserted to the time the i.v. was removed; hours from the time the i.v. was first flushed to the time the i.v. was removed; number of i.vs. removed because of …

Telephone Management In Substance Abuse Treatment, J. A. Hall, Diane L. Huber

Diane Huber

The purpose of this article is to describe the results of a clinical trial in which telephonic case management was evaluated as a supplement to substance abuse treatment. An interactive voice response system (IVR) was developed by the research team for use in the case management of randomly assigned participants in a clinical trial research project. The features of the software program facilitated a double caseload for the case manager as well as real-time data capture. At intake, no significant differences were found between participants in the telecommunication condition and the general project. Thus, the effectiveness of random assignment was …

The Meaning Of Parenteral Hydration To Family Caregivers And Patients With Advanced Cancer Receiving Hospice Care., Marlene Z. Cohen, Isabel Torres-Vigil, Beth E. Burbach, Allison De La Rosa, Eduardo Bruera

Journal Articles: College of Nursing

CONTEXT: In the U.S., patients with advanced cancer who are dehydrated or have decreased oral intake almost always receive parenteral hydration in acute care facilities but rarely in the hospice setting.

OBJECTIVES: To describe the meaning of hydration for terminally ill cancer patients in home hospice care and for their primary caregivers.

METHODS: Phenomenological interviews were conducted at two time points with 85 patients and 84 caregivers enrolled in a randomized, double-blind, controlled trial examining the efficacy of parenteral hydration in patients with advanced cancer receiving hospice care in the southern U.S. Transcripts were analyzed hermeneutically by the interdisciplinary research …

A Two-Stage Cluster Sampling Method Using Gridded Population Data, A Gis, And Google Earth(Tm) Imagery In A Population-Based Mortality Survey In Iraq, Lp Galway, Nathaniel Bell, Al Shatari Sae, Amy Hagopian, Gilbert Burnham, Abraham Flaxman, Wiliam M. Weiss, Julie Rajaratnam, Tim K. Takaro

Faculty Publications

BACKGROUND:

Mortality estimates can measure and monitor the impacts of conflict on a population, guide humanitarian efforts, and help to better understand the public health impacts of conflict. Vital statistics registration and surveillance systems are rarely functional in conflict settings, posing a challenge of estimating mortality using retrospective population-based surveys.

RESULTS:

We present a two-stage cluster sampling method for application in population-based mortality surveys. The sampling method utilizes gridded population data and a geographic information system (GIS) to select clusters in the first sampling stage and Google Earth TM imagery and sampling grids to select households in the second sampling …

Maternal Genes And Facial Clefts In Offspring: A Comprehensive Search For Genetic Associations In Two Population-Based Cleft Studies From Scandinavia, A. Jugessur, M. Shi, H. K. Gjessing, R. T. Lie, A. J. Wilcox, C. R. Weinberg, K. Christensen, A. L. Boyles, Sandra Daack-Hirsch, T. T. Nguyen, L. Christiansen, A. C. Lidral, J. C. Murray

Sandra Daack-Hirsch

BACKGROUND: Fetal conditions can in principle be affected by the mother's genotype working through the prenatal environment. METHODOLOGY/PRINCIPAL FINDINGS: Genotypes for 1536 SNPs in 357 cleft candidate genes were available from a previous analysis in which we focused on fetal gene effects. After data-cleaning, genotypes for 1315 SNPs in 334 autosomal genes were available for the current analysis of maternal gene effects. Two complementary statistical methods, TRIMM and HAPLIN, were used to detect multi-marker effects in population-based samples from Norway (562 case-parent and 592 control-parent triads) and Denmark (235 case-parent triads). We analyzed isolated cleft lip with or without cleft …

Genetic Determinants Of Facial Clefting: Analysis Of 357 Candidate Genes Using Two National Cleft Studies From Scandinavia, A. Jugessur, M. Shi, H. K. Gjessing, R. T. Lie, A. J. Wilcox, C. R. Weinberg, K. Christensen, A. L. Boyles, Sandra Daack-Hirsch, T. N. Trung, C. Bille, A. C. Lidral, J. C. Murray

Sandra Daack-Hirsch

BACKGROUND: Facial clefts are common birth defects with a strong genetic component. To identify fetal genetic risk factors for clefting, 1536 SNPs in 357 candidate genes were genotyped in two population-based samples from Scandinavia (Norway: 562 case-parent and 592 control-parent triads; Denmark: 235 case-parent triads). METHODOLOGY/PRINCIPAL FINDINGS: We used two complementary statistical methods, TRIMM and HAPLIN, to look for associations across these two national samples. TRIMM tests for association in each gene by using multi-SNP genotypes from case-parent triads directly without the need to infer haplotypes. HAPLIN on the other hand estimates the full haplotype distribution over a set of …

Parent Behavior And Child Distress During Urethral Catheterization, Charmaine Kleiber, Ann Marie Mccarthy

Ann Marie McCarthy

ISSUES AND PURPOSE: Researchers need a clear understanding of the natural behaviors parents use to help their children cope. This study describes the relationships between naturally occurring parent behaviors and child distress behaviors during urethral catheterization. DESIGN AND METHODS: In this descriptive study, researchers videotaped the behaviors of parent-child interactions during urethral catheterization. RESULTS: Parents used distraction to maintain calm behavior during the first part of the procedure and used more reassurance when the children started to become distressed. Seven of the nine children displayed calm behavior at least half the time following distraction. Parental reassurance did not decrease distress …

Medical Sequencing Of Candidate Genes For Nonsyndromic Cleft Lip And Palate, A. R. Vieira, J. R. Avila, Sandra Daack-Hirsch, E. Dragan, T. M. Felix, F. Rahimov, J. Harrington, R. R. Schultz, Y. Watanabe, M. Johnson, J. Fang, S. E. O'Brien, I. M. Orioli, E. E. Castilla, D. R. Fitzpatrick, R. Jiang, M. L. Marazita, J. C. Murray

Sandra Daack-Hirsch

Nonsyndromic or isolated cleft lip with or without cleft palate (CL/P) occurs in wide geographic distribution with an average birth prevalence of 1/700. We used direct sequencing as an approach to study candidate genes for CL/P. We report here the results of sequencing on 20 candidate genes for clefts in 184 cases with CL/P selected with an emphasis on severity and positive family history. Genes were selected based on expression patterns, animal models, and/or role in known human clefting syndromes. For seven genes with identified coding mutations that are potentially etiologic, we performed linkage disequilibrium studies as well in 501 …

Parent Behavior And Child Distress During Urethral Catheterization, Charmaine Kleiber, Ann Marie Mccarthy

Charmaine Kleiber

ISSUES AND PURPOSE: Researchers need a clear understanding of the natural behaviors parents use to help their children cope. This study describes the relationships between naturally occurring parent behaviors and child distress behaviors during urethral catheterization. DESIGN AND METHODS: In this descriptive study, researchers videotaped the behaviors of parent-child interactions during urethral catheterization. RESULTS: Parents used distraction to maintain calm behavior during the first part of the procedure and used more reassurance when the children started to become distressed. Seven of the nine children displayed calm behavior at least half the time following distraction. Parental reassurance did not decrease distress …

A Randomized Trial Of Heparin And Saline For Maintaining Intravenous Locks In Neonates, J. Heilskov, Charmaine Kleiber, K. Johnson, J. Miller

Charmaine Kleiber

PURPOSE: To determine the effects of saline, heparin 2 units (U) per ml saline, and heparin 10 U/ml saline flush solutions on the duration of intravenous (i.v.) locks and the incidence of i.v. infiltration in neonates. DESIGN: Randomized double-blind experiment. SETTING: Tertiary-care nursery. PARTICIPANTS: Neonates (N = 90) hospitalized at birth in the intensive, intermediate care, or newborn units. MAIN OUTCOME MEASURES: Total hours from the time the i.v. was inserted to the time the i.v. was removed; hours from the time the i.v. was first flushed to the time the i.v. was removed; number of i.vs. removed because of …

Telephone Management In Substance Abuse Treatment, J. A. Hall, Diane L. Huber

Diane Huber

The purpose of this article is to describe the results of a clinical trial in which telephonic case management was evaluated as a supplement to substance abuse treatment. An interactive voice response system (IVR) was developed by the research team for use in the case management of randomly assigned participants in a clinical trial research project. The features of the software program facilitated a double caseload for the case manager as well as real-time data capture. At intake, no significant differences were found between participants in the telecommunication condition and the general project. Thus, the effectiveness of random assignment was …

Parent Behavior And Child Distress During Urethral Catheterization, Charmaine Kleiber, Ann Marie Mccarthy

Ann Marie McCarthy

ISSUES AND PURPOSE: Researchers need a clear understanding of the natural behaviors parents use to help their children cope. This study describes the relationships between naturally occurring parent behaviors and child distress behaviors during urethral catheterization. DESIGN AND METHODS: In this descriptive study, researchers videotaped the behaviors of parent-child interactions during urethral catheterization. RESULTS: Parents used distraction to maintain calm behavior during the first part of the procedure and used more reassurance when the children started to become distressed. Seven of the nine children displayed calm behavior at least half the time following distraction. Parental reassurance did not decrease distress …

Parent Behavior And Child Distress During Urethral Catheterization, Charmaine Kleiber, Ann Marie Mccarthy

Charmaine Kleiber

ISSUES AND PURPOSE: Researchers need a clear understanding of the natural behaviors parents use to help their children cope. This study describes the relationships between naturally occurring parent behaviors and child distress behaviors during urethral catheterization. DESIGN AND METHODS: In this descriptive study, researchers videotaped the behaviors of parent-child interactions during urethral catheterization. RESULTS: Parents used distraction to maintain calm behavior during the first part of the procedure and used more reassurance when the children started to become distressed. Seven of the nine children displayed calm behavior at least half the time following distraction. Parental reassurance did not decrease distress …

A Randomized Trial Of Heparin And Saline For Maintaining Intravenous Locks In Neonates, J. Heilskov, Charmaine Kleiber, K. Johnson, J. Miller

Charmaine Kleiber

PURPOSE: To determine the effects of saline, heparin 2 units (U) per ml saline, and heparin 10 U/ml saline flush solutions on the duration of intravenous (i.v.) locks and the incidence of i.v. infiltration in neonates. DESIGN: Randomized double-blind experiment. SETTING: Tertiary-care nursery. PARTICIPANTS: Neonates (N = 90) hospitalized at birth in the intensive, intermediate care, or newborn units. MAIN OUTCOME MEASURES: Total hours from the time the i.v. was inserted to the time the i.v. was removed; hours from the time the i.v. was first flushed to the time the i.v. was removed; number of i.vs. removed because of …

Telephone Management In Substance Abuse Treatment, J. A. Hall, Diane L. Huber

Diane Huber

The purpose of this article is to describe the results of a clinical trial in which telephonic case management was evaluated as a supplement to substance abuse treatment. An interactive voice response system (IVR) was developed by the research team for use in the case management of randomly assigned participants in a clinical trial research project. The features of the software program facilitated a double caseload for the case manager as well as real-time data capture. At intake, no significant differences were found between participants in the telecommunication condition and the general project. Thus, the effectiveness of random assignment was …