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Recent Research Publications and Funding

  •  | January 4, 2016 6:00AM

    Background: Cardiac rehabilitation improves physical, cognitive and psychosocial functioning, yet services are greatly underutilized with increasing patterns of attrition over time. Tai Chi has been suggested as a possible adjunct to cardiac rehabilitation exercise training.

    Aim: To describe differences in physical, cognitive and psychosocial functioning among adults ≥ 45 years old attending phase III cardiac rehabilitation, who have or have not self-selected Tai Chi exercise as an adjunct physical activity.

    Methods: A cross-sectional design compared subjects attending group-based Wu style Tai Chi classes plus cardiac rehabilitation, with cardiac rehabilitation only. Subjects had a battery of physical and cognitive functioning tests administered to examine aerobic endurance, balance, strength, and flexibility, verbal retrieval/recall, attention, concentration and tracking. Subjects completed a health survey to ascertain cardiac event information, medical history, and psychosocial functioning (i.e. health-related quality of life, stress, depressive symptoms, social support, and Tai Chi self-efficacy).

    Results: A total of 51 subjects (75% married, 84% college-educated, 96% White/European-American) participated. Subjects were on average 70 (± 8) years old and had attended cardiac rehabilitation for 45 (± 37) months. Approximately 45% (n = 23) attended Tai Chi classes plus cardiac rehabilitation, while 55% (n = 28) attended cardiac rehabilitation only. Subjects attending Tai Chi plus cardiac rehabilitation had better balance, perceived physical health, and Tai Chi self-efficacy compared to those attending cardiac rehabilitation only (p ≤ 0.03).

    Conclusion: Tai Chi can be easily implemented in any community/cardiac rehabilitation facility, and may offer adults additional options after a cardiac event.

  •  | January 1, 2016 6:00AM

    Background: Growing scrutiny of readmissions has placed hospitals at the center of readmission prevention. Little is known, however, about hospital nursing - a critical organizational component of hospital service system - in relation to readmissions.

    Objectives: To determine the relationships between hospital nursing factors - nurse work environment, nurse staffing, and nurse education - and 30-day readmissions among Medicare patients undergoing general, orthopedic, and vascular surgery.

    Method and Design: We linked Medicare patient discharge data, multi-state nurse survey data, and American Hospital Association Annual Survey data. Our sample included 220,914 Medicare surgical patients and 25,082 nurses from 528 hospitals in four states (CA, FL, NJ, & PA). Risk-adjusted robust logistic regressions were used for analyses.

    Results: The average 30-day readmission rate was 10% in our sample (general surgery: 11%; orthopedic surgery: 8%; vascular surgery: 12%). Readmission rates varied widely across surgical procedures and could be as high as 26% (upper limb and toe amputation for circulatory system disorders). Each additional patient per nurse increased the odds of readmission by 3% (OR=1.03, 95% CI: 1.00-1.05). Patients cared in hospitals with better nurse work environments had lower odds of readmission (OR=0.97, 95% CI: 0.95-0.99). Administrative support to nursing practice (OR=0.96, 95% CI: 0.94-0.99) and nurse-physician relations (OR=0.97, 95% CI: 0.95-0.99) were two main attributes of the work environment that were associated with readmissions.

    Conclusions: Better nurse staffing and work environment were significantly associated with 30-day readmission, and can be considered as system-level interventions to reduce readmissions and associated financial penalties.

  •  | December 30, 2015 6:00AM

    Introduction: Gait velocity is an objective, fundamental indicator of post-stroke walking ability. Most stroke survivors have diminished aerobic endurance or paretic leg strength affecting their walking ability. Other reported underlying factors affecting gait velocity include functional disability, balance, cognitive impairment, or the distance they are required to walk.

    Objective: To examine the relationship between gait velocity and measures of physical and cognitive functioning in chronic stroke.

    Methods: Cross-sectional design using baseline data from community-dwelling stroke survivors enrolled in an exercise intervention study. Functional disability (modified Rankin Scale), aerobic endurance (2-min step-test), leg strength (timed 5-chair stand test), balance (single-leg stance) and cognitive impairment (Mini-Mental Status Exam) were assessed. Gait velocity was assessed using a timed 4-m walk test. Multiple linear regression was used to explore potential independent predictors of gait velocity.

    Results: Subjects had an average gait velocity of 0.75 ± 0.23 m/s, categorized as limited community walkers. Approximately 37% of the variance in gait velocity, could be explained by the 5 independent variables, functional disability, aerobic endurance, leg strength, balance, and cognitive impairment (R2 = 0.37, F5, 74= 8.64, p < 0.01). Aerobic endurance (t1,74 = 3.41, p < 0.01) and leg strength (t1,74 = −2.23, p = 0.03) contributed significantly to gait velocity.

    Conclusion: Diminished aerobic endurance and leg strength are major contributors to slow gait velocity in chronic stroke. Long term rehabilitation efforts are needed to improve gait velocity in chronic stroke, and may need to incorporate multifaceted strategies concurrently, focusing on aerobic endurance and leg strength, to maximize community ambulation and reintegration.

  •  | December 28, 2015 6:00AM

    Exposure to indoor radon and tobacco smoke have a synergistic effect, meaning that the combined risk for lung cancer is more than additive. In a rural, high-radon geographic state, this concern led to a coalition approach to encourage radon testing for Montana residents. A one- page radon background and risk document was included in the orientation packets for “Quit Line” enrollees attempting to quit smoking cigarettes. Free radon kits were sent to interested individuals. Data collection began January 1, 2014 and ended May 15, 2014. Six hundred individuals were invited and fourteen (2.3%) accepted the invitation. Two of the fourteen (14.3%) completed the test kit they requested. This rate is well below the approximately 65% test kit return rate reported from state radon programs. Indoor radon concentrations were less than the recommended action level for both participants. Members of the six agencies involved in the coalition agreed to try an alternative outreach approach for Quit Line participants in January 2015. The results of this pilot-test provide important information for other high-radon states wishing to launch a similar collaboration. 

  •  | November 25, 2015 6:00AM

    Older African Americans face substantial barriers to state-of-the-art cancer care. Implementing culturally appropriate support throughout cancer therapy is critical to improving cancer outcomes and quality of life for this vulnerable population. The purpose of this study was to obtain experiential data regarding cancer diagnosis and treatment, and analyze survivors’ recommendations regarding treatment-related needs, psychosocial support, and strategies and resources. Four main issues emerged from the study: (a) the need for more health-related and cancer-specific education, (b) the importance of faith and spirituality, (c) the availability of support, and (d) participants’ difficulty identifying and articulating financial needs. Few participants reported requesting or receiving assistance (financial or otherwise) outside of the family during their cancer experience. However, treatment-related medication costs posed a significant hardship for many.

  •  | November 9, 2015 6:00AM

    AIMS: The aim of this study was to examine the association of specific personal and environmental factors with eating performance among long-term care residents with moderate-to-severe cognitive impairment.

    BACKGROUND: Eating is the one of the most basic and easiest activities of daily living to perform. While multilevel factors can be associated with eating performance, the evidence among those with dementia was insufficient.

    DESIGN: A secondary analysis of baseline data collected between March and September in 2012 from 199 residents in eight long-term care facilities.

    METHODS: Eating performance was conceptualized using the single self-care 'feeding' item in the Barthel Index and was scored based on four levels of dependence and assistance required. Binary logistic regression was used to examine the adjusted association of specific factors with eating performance.

    RESULTS: Almost one-third of the residents needed help with eating. After adjusting the type of facility, number of comorbidities, chair-sitting balance, agitation and depression, compromised eating performance was associated with severe cognitive impairment and low physical capability.

    CONCLUSION: This study supported the association of eating performance with cognitive impairment and physical capability among long-term care residents with moderate-to-severe cognitive impairment. Targeted interventions should be implemented to reduce the impact of cognitive decline on eating performance and promote physical capability to optimize eating performance. Future work need to use validated multiple-item measures for eating performance and test the association of personal and environmental factors with eating performance among a larger heterogeneous group of long-term care residents to enhance understanding of the factors.

  •  | October 6, 2015 4:00AM

    Stress and psychological distress are known powerful, modifiable risk factors for cardiovascular disease (CVD) 12345 , yet we know little about when or how the processes underlying this relationship begin. Indeed, prospective lifespan research that connects childhood experience with subsequent CVD-related outcomes to inform development of appropriate early interventions has been lacking. Using data from the 1958 British Birth Cohort Study, Winning et al. (6) , in this issue of the Journal , thoughtfully address this gap by providing evidence suggesting that early distress, as reported in childhood, contributes independently to cardiometabolic risk (CMR) decades later in middle adulthood, even when individuals report experiencing little distress as adults. These findings are on the basis of data collected over a 45-year period from 6,714 individuals who were part of a 1-week birth cohort from Great Britain in 1958. Although differential attrition analysis revealed that males with lower socioeconomic status and cognitive ability scores and higher distress at age 7 were more likely to drop out of the study over time, it is important to note that this pattern of attrition suggests that the findings are conservative estimates of the distress-CMR association. When considered in the broader research literature addressing psychological impacts on the development of CVD, this paper is highly relevant with clear implications for research and clinical practice.

  •  | September 30, 2015 4:00AM


    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.

  •  | September 15, 2015 4:00AM

    OBJECTIVE: To examine the relationship between Magnet recognition, an indicator of nursing excellence, and patients' experience with their hospitalization reported in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

    DATA SOURCES: This secondary analysis includes cross-sectional data from the 2010 HCAHPS survey, the American Hospital Association, and the American Nurses Credentialing Center.

    STUDY DESIGN: We conducted a retrospective observational study.

    DATA COLLECTION: Using common hospital identifiers, we created a matched set of 212 Magnet hospitals and 212 non-Magnet hospitals.

    PRINCIPAL FINDINGS: Patients in Magnet hospitals gave their hospitals higher overall ratings, were more likely to recommend their hospital, and reported more positive care experiences with nurse communication.

    CONCLUSIONS: Magnet recognition is associated with better patient care experiences, which may positively enhance reimbursement for hospitals.

  •  | August 16, 2015 4:00AM

    There are 62 million Americans currently residing in rural areas who are more likely to have multiple chronic conditions and be economically disadvantaged, and in poor health, receive less recommended preventive services and attend fewer visits to health care providers. Recent advances in mobile healthcare (mHealth) offer a promising new approach to solving health disparities and improving chronic illness care. It is now possible and affordable to transmit health information, including values from glucometers, automated blood pressure monitors, and scales, through Bluetooth-enabled devices. Additionally, audio and video communications technologies can allow healthcare providers to conduct many parts of a physical exam remotely from varied settings. These technologies could remove geographical distance as a barrier to care and diminish the access to care issues faced by patients who live rurally. However, currently there is lack of studies that provide evidence of feasibility, acceptability, and effectiveness of mHealth initiatives on improved outcomes of care, a needed step to make the translation to implementation studies in healthcare systems. The purpose of this paper is to present the protocol for the first study of mI SMART (mobile Improvement of Self-Management Ability through Rural Technology), a new integrated mHealth