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June 26, 2016
Background: Our program of research focuses on thermal and circulatory stability in extremely premature infants. In prior studies, we found that infants have long periods of time in which foot temperature (FT) is higher than central temperature. We thus wanted to determine whether blood flow in the foot is increased when FT is elevated. Perfusion index (PI) can be used as a clinical indicator of peripheral perfusion, but reports on use of PI in premature infants are lacking. We employed exploratory methodology to examine foot perfusion and temperature in very low birth weight infants.
Aims: For premature infants after birth: (1) describe foot PI values for the first 2 weeks of life and (2) describe the relationship of longitudinal FT and PI. Study
Design: Case study design with longitudinal FT and PI in 17 infants born at <29 weeks’ gestation with birth weight < 1,200 g for 2 weeks after birth. Results: Infants averaged 851 g at birth and were 24–29 weeks’ gestational age. The mean PI across all infants for 14 days was 1.04, SD ¼ 0.79. Using a repeated measures multilevel model approach confirmed that FT and PI were positively related in these infants.
Conclusions: These findings demonstrate that perfusion is increased in the periphery in extremely premature infants when FT is increased. PI measures can be used as a trend for peripheral perfusion, and these values increase over the first 2 weeks of life in infants weighing more than 750 g.
Optimizing full scope of practice for nurse practitioners in primary care: A proposed conceptual model| March 31, 2016
Background:Nurse practitioners (NPs), if utilized to their optimal potential, could play a key role in meeting the growing demand for primary care.
Purpose: The purpose of this study was to propose a comprehensive model for maximizing NP contributions to primary care which includes the factors affecting NP care and patient outcomes and explains their interrelated impact.
Method: We synthesized the results of the published literature to develop a model, which emphasizes NP scope of practice regulations, institutional policies, NP practice environment, and NP workforce outcomes as determinants of NP care and patient outcomes.
Discussion: Our model provides a framework to help explain how variations in scope of practice regulations at the state-level and institutional policies within organizations directly and indirectly influence the practice environment of NPs, NP workforce outcomes, and patient care and outcomes.
Conclusion: Aligning policy change, organizational innovations, and future research are critical to NP optimal utilization and patient care and outcomes.
January 11, 2016
Cigarette smoking has been shown to be a health hazard. In addition to being considered a negative lifestyle behavior, studies have shown that cigarette smoking has been linked to genetic underpinnings of hypertension. Because African Americans have the highest incidence and prevalence of hypertension, we examined the joint effect of genetics and cigarette smoking on health among this understudied population. The sample included African Americans from the genome wide association studies of HyperGEN (N = 1083, discovery sample) and GENOA (N = 1427, replication sample), both part of the FBPP. Results suggested that 2 SNPs located on chromosomes 14 (NEDD8; rs11158609; raw p = 9.80 × 10−9, genomic control-adjusted p = 2.09 × 10−7) and 17 (TTYH2; rs8078051; raw p = 6.28 × 10−8, genomic control-adjusted p = 9.65 × 10−7) were associated with SBP including the genetic interaction with cigarette smoking. These two SNPs were not associated with SBP in a main genetic effect only model. This study advances knowledge in the area of main and joint effects of genetics and cigarette smoking on hypertension among African Americans and offers a model to the reader for assessing these risks. More research is required to determine how these genes play a role in expression of hypertension.
September 30, 2015
AIM: The purpose of this manuscript it to disseminate findings from a systematic review of the literature related to the NLN/Jeffries SimulationFramework.
BACKGROUND:This review was initiated by the National League for Nursing to illuminate what is currently known about best simulation practices, research to support these practices, and priorities for future research. It is part of a larger project aimed at further developing the NLN/JeffriesSimulation Framework.
METHOD: Searches using CINAHL, the journal Simulation in Healthcare, and reference lists from key documents yielded 1,533 relevant publications for the period January 2000 to September 2014.
RESULTS: The final review of the literature includes 153 studies. Three themes, along with key issues, gaps, and best practices supported by theliterature, were identified.
CONCLUSION: This systematic review provides empirical support for the major components of the NLN/Jeffries Simulation Framework and contributes to its further development.
May 13, 2015
Although most nurse practitioners (NPs) are aware of state-level regulations that influence practice, many are unaware of the ways that federal policies affect NP workforce supply and the delivery of primary care. In this investigation we provide an overview of federal initiatives enacted through the Patient Protection and Affordable Care Act that impact the NP workforce. We explore how the law supports NP workforce supply and settings in which NPs provide care. We then describe challenges that may prevent full utilization of the NP workforce. Examining both federal policies and state-level regulations is essential to achieving an increased NP workforce supply and improved access to care.