Quantifying nanomolar levels of nitrite in biological samples by HPLC-Griess method: special reference to arterio-venous difference in vivo.

Tohoku J Exp Med. 2008 May;215(1):1-11

Authors: Ishibashi T, Miwa T, Shinkawa I, Nishizawa N, Nomura M, Yoshida J, Kawada T, Nishio M

Nitrite (NO(2)(-)) is assumed to play an important role in regulation of vascular tone as a reservoir of nitric oxide (NO). To examine its physiological contribution, however, a sensitive method is required for determination of the true level of NO(2)(-) in biological samples. To this end, practical consideration to avoid NO(2)(-) contamination through the quantification procedure is important. We present here a highly sensitive and accurate method for determining NO(2)(-) in plasma by improving the HPLC-Griess system with minimal NO(2)(-) contamination in the samples. The system achieved high sensitivity (detection limit of 2 nM and sensitivity to 1 nM) and complete separation of the NO(2)(-) signal peak by modifying the system setup and mobile phase. Using this method, we achieved acceptable quantification of low NO(2)(-) levels in plasma. Deproteinization by ultrafiltration and exposure to atmosphere before measurement were identified as the major sources of NO(2)(-) contamination during sample processing. We addressed these issues by the use of methanol for deproteinization and gas-tight caps. These countermeasures allowed us to detect small arterio-venous NO(2)(-) differences in rabbit plasma that may indicate kinetic difference of NO(2)(-) in a small number of samples (n = 6). This difference became prominent when NO(2)(-) or a NO releasing agent, NOR1, was intravenously applied. Our results indicate that application of a sensitive method with careful handling is important for accurate determination of NO(2)(-) and that our method is applicable for further examination of the kinetic features of NO(2)(-) in vivo.

PMID: 18509230 [PubMed - in process]

Factors Associated With Hospital Retention of RNs in the New York City Metropolitan Area: An Analysis of the 1996, 2000, and 2004 National Sample Survey of Registered Nurses.

Policy Polit Nurs Pract. 2008 May 28;

Authors: Rosenfeld P, Adams RE

The nursing shortage is well documented, and government estimates indicate that shortfalls will worsen in the future. As the largest employer of registered nurses (RNs), hospitals are the most seriously affected by shortages, as they compete with other employment settings for limited nursing resources. Recruitment remains the primary avenue for ensuring staffing levels, but retention is increasingly important as applicant pools shrink because of demographic and employment trends. Effective retention strategies must address the factors that contribute to exodus of RNs from hospitals, as well as isolating the factors that enable RNs to remain in hospital employment. This secondary analysis of the 1996, 2000, and 2004 National Sample Survey of Registered Nurses examines the demographic, employment, and educational factors associated with working in hospitals, having full-time status, and holding patient care positions. The findings suggest that hospitals must address nonwork issues to retain nursing personnel. Relevant policy issues are examined and strategies for effective retention are offered.

PMID: 18509198 [PubMed - as supplied by publisher]

Sex-Specific Differences in Chromosome-Dependent Regulation of Vascular Reactivity in Female Consomic Rat Strains from a SS x BN Cross.

Am J Physiol Regul Integr Comp Physiol. 2008 May 28;

Authors: Kunert MP, Dwinell MR, Drenjancevic-Peric I, Lombard JH

High-throughput studies in the Medical College of Wisconsin Program for Genomic Applications (Physgen) were designed to link chromosomes with physiological function in consomic strains derived from a cross between Dahl salt sensitive SS/JrHsdMcwi (SS) and Brown Norway normotensive BN/NHsdMcwi (BN) rats. The specific goal of the vascular protocol was to characterize the responses of aortic rings from these strains to vasoconstrictor and vasodilator stimuli (phenylephrine, acetylcholine, sodium nitroprusside and bath hypoxia) in order to identify chromosomes that either increase or decrease vascular reactivity to these vasoactive stimuli. Because previous studies demonstrated sex-specific quantitative trait loci (QTLs) related to regulation of cardiovascular phenotypes in an F2 cross between the parental strains, males and females of each consomic strain were included in all experiments. As there were significant sex-specific differences in aortic sensitivity to vasoconstrictor and vasodilator stimuli compared to the parental SS strain, we report the results of the females separately from the males. There were also sex-specific differences in aortic ring sensitivity to these vasoactive stimuli in consomic strains that were fed a high salt diet (4% NaCl) for three weeks to evaluate salt-induced changes in vascular reactivity. Differences in genetic architecture could contribute to sex-specific differences in the development and expression of cardiovascular diseases via differential regulation and expression of genes. Our findings are the first to link physiological traits with specific chromosomes in female SS rats, and support the idea that sex is an important environmental variable that plays a role in the expression and regulation of genes. Key words: phenylephrine, acetylcholine, sodium nitroprusside, hypoxia, vascular reactivity.

PMID: 18509103 [PubMed - as supplied by publisher]

Biochemical markers in persons with preclinical familial Alzheimer disease.

Neurology. 2008 May 28;

Authors: Ringman JM, Younkin SG, Pratico D, Seltzer W, Cole GM, Geschwind DH, Rodriguez-Agudelo Y, Schaffer B, Fein J, Sokolow S, Rosario ER, Gylys KH, Varpetian A, Medina LD, Cummings JL

BACKGROUND: Persons at risk for familial Alzheimer disease (FAD) provide a model in which biomarkers can be studied in presymptomatic disease. METHODS: Twenty-one subjects at risk for presenilin-1 (n = 17) or amyloid precursor protein (n = 4) mutations underwent evaluation with the Clinical Dementia Rating (CDR) scale. We obtained plasma from all subjects and CSF from 11. Plasma (Abeta40, Abeta42, F2-isoprostanes) and CSF (F2-isoprostanes, t-tau, p-tau181, Abeta40, Abeta42, and Abeta42/Abeta40 ratio) levels were compared between FAD mutation carriers (MCs) and noncarriers (NCs). RESULTS: Plasma Abeta42 levels (25.1 pM vs 15.5 pM, p = 0.031) and the ratio of Abeta42/Abeta40 (0.16 vs 0.11, p = 0.045) were higher in presymptomatic MCs. Among MCs, those with CDR scores of 0.5 had lower plasma Abeta42 levels than those with CDR scores of 0 (14.1 pM vs 25.1, p = 0.02). The ratio of Abeta42 to Abeta40 was also reduced in the CSF (0.08 vs 0.15, p = 0.046) of nondemented MCs compared to NCs. Total CSF tau and p-tau181 levels were elevated in presymptomatic FAD MCs. CSF levels of F2-isoprostanes were also elevated in MCs (n = 7, 48.6 pg/mL) compared to NCs (n = 4, 21.6 pg/mL, p = 0.031). CONCLUSIONS: Our data indicate that Abeta42 is elevated in plasma in familial Alzheimer disease (FAD) mutation carriers (MCs) and suggests that this level may decrease with disease progression prior to the development of overt dementia. We also demonstrated that the ratio of Abeta42 to Abeta40 was reduced in the CSF of nondemented MCs and that elevations of t-tau and p-tau181 are sensitive indicators of presymptomatic disease. Our finding of elevated F2-isoprostane levels in the CSF of preclinical FAD MCs suggests that oxidative stress occurs downstream to mismetabolism of amyloid precursor protein.

PMID: 18509095 [PubMed - as supplied by publisher]

A Microcosting Study of Intensive Care Unit Stay in the Netherlands.

J Intensive Care Med. 2008 May 28;

Authors: Tan SS, Hakkaart-van Roijen L, Al MJ, Bouwmans CA, Hoogendoorn ME, Spronk PE, Bakker J

The primary objective of this study was to estimate the actual daily costs of intensive care unit stay using a microcosting methodology. As a secondary objective, the degree of association between daily intensive care unit costs and some patient characteristics was examined. This multicenter, retrospective cost analysis was conducted in the medical-surgical adult intensive care units of 1 university and 2 general hospitals in the Netherlands for 2006, from a hospital perspective. A total of 576 adult patients were included, consuming a total of 2868 nursing days. The mean total costs per intensive care unit day were euro1911, with labour (33%) and indirect costs (33%) as the most important cost drivers. An ordinary least squares analysis including age, Nine Equivalent of Nursing Manpower Use score/Therapeutic Intervention Scoring System score, mechanical ventilation, blood products, and renal replacement therapy was able to predict 50% of the daily intensive care unit costs.

PMID: 18508839 [PubMed - as supplied by publisher]

[Clinical aspects of hepatitis C virus infection in child-bearing aged women.]

Orv Hetil. 2008 Jun 1;149(22):1017-21

Authors: Lombay B, Gasztonyi B, Szalay F

It is difficult to define the optimal timing of antiviral treatment in women infected with viral hepatitis C, who have child-bearing potential. Antiviral treatment is strictly contraindicated during pregnancy and the breast-feeding period. Data are conflicting about the question of treatment with modern drugs (peginterferon and ribavirin) before or after pregnancy. The risk of vertical transmission from mother to child is estimated about 5%. The mother’s viraemia seems to be the main transmission factor. There is a worse prognosis in nulliparous and postmenopausal women in the natural history of viral hepatitis C. Poor outcome in gestational age, maturity and Apgar score were not associated with hepatitis C virus infection. Combined treatment has frequent gynecological and other side effects. The timing of antiviral therapy in women in child-bearing period is recommended individually.

PMID: 18508735 [PubMed - in process]

Endothelial connexins are down-regulated by atherogenic factors.

Front Biosci. 2008;13:3549-57

Authors: Hou CJ, Tsai CH, Yeh HI

Connexins are single polypeptides that assemble to form paired connexon hexamers participating in gap-junctional intercellular communication. In addition, unpaired connexons at cell membrane also act as channels connecting cytosols and extracellular space. These channels’ properties plus other unique functions of connexins give the molecules significant roles in endothelial cells, which mainly express connexin43 (Cx43), Cx40, and Cx37. In vitro studies have shown that expression of endothelial connexins are regulated by both physiological and pathological factors, a majority of which are involved in atherogenesis. In vascular disorders, endothelial connexins are differentially regulated. However, down-regulation of gap junctions is a common phenomenon. These findings suggest that reduced expression of endothelial gap junctions is a potential indicator of endothelial dysfunction and warrant investigators to explore the molecular mechanisms as well as therapeutic implications.

PMID: 18508454 [PubMed - in process]

Expression of androgen, estrogen and progesterone receptors in mucinous carcinoma of the breast.

Kaohsiung J Med Sci. 2008 May;24(5):227-32

Authors: Cho LC, Hsu YH

Hormone receptors play important roles in breast cancer. We investigated the expression of hormone receptors in breast cancer to evaluate the importance of hormone receptors in the clinicopathology of breast cancer. Androgen receptor (AR), estrogen receptor (ER) and progesterone receptor (PR) expression characteristics were evaluated using immunohistochemistry stain, comparing patient age, tumor size and axillary lymph node status for 23 pure mucinous and 105 non-mucinous infiltrating ductal carcinomas in the human female breast. Mucinous carcinoma with axillary lymph node metastasis occurred less frequently than non-mucinous carcinoma (11.8% vs. 55.2%; p = 0.01). Compared with the non-mucinous type, mucinous carcinoma specimens showed less AR expression (21.7% vs. 51.4%; p = 0.01) but more ER expression (78.3% vs. 52.4%; p = 0.02). In addition, AR expression was also associated with ER and/or PR coexpression (37/74, 50%) in infiltrating ductal carcinoma. But only three of 20 (15%) mucinous carcinoma specimens with AR expression had associated ER and/or PR coexpression. Our findings revealed that mucinous carcinoma samples from the breast show distinct clinicopathologic and hormone receptor expression features compared to non-mucinous carcinoma.

PMID: 18508419 [PubMed - in process]

Impact of hip fracture, heart failure and weight loss on the risk of institutionalization of community-dwelling patients with dementia.

Int J Geriatr Psychiatry. 2008 May 29;

Authors: Harboun M, Dorenlot P, Cohen N, Steinhagen-Thiessen E, Ankri J

OBJECTIVES: This study sought to identify the influence of medical symptoms and diseases on the risk of nursing home placement in a prospective cohort of newly diagnosed community-dwelling patients with dementia. STUDY DESIGN AND SETTING: This study included 348 patients with dementia, consecutively diagnosed, recruited and followed at a geriatric outpatient center (mean age: 81 years, 65.5% with Alzheimer’s disease, mean baseline MMSE score: 20.5, mean follow-up: 20.5 months). RESULTS: After adjustment for factors commonly associated with institutionalization in this population, hip fracture in the 3 years preceding diagnosis, acute congestive heart failure during follow-up and weight loss of more than 5% in any year during follow-up were independently associated with nursing home placement. CONCLUSION: This study confirms the independent contribution of specific medical symptoms and diseases to earlier institutionalization of patients with dementia. These results stress the importance of better knowledge of the specific characteristics of hip fracture, weight loss and congestive heart failure in the context of dementia, to make more effective prevention possible in this patient population. Copyright (c) 2008 John Wiley & Sons, Ltd.

PMID: 18508392 [PubMed - as supplied by publisher]

PAX3/7 expression coincides with myod during chronic skeletal muscle overload.

Muscle Nerve. 2008 May 28;

Authors: Hyatt JP, McCall GE, Kander EM, Zhong H, Roy RR, Huey KA

Paired box (Pax) proteins 3 and 7 are key determinants for embryonic skeletal muscle development by initiating myogenic regulatory factor (MRF) gene expression. We show that Pax3 and 7 participate in adult skeletal muscle plasticity during the initial responses to chronic overload (</=7 days) and appear to coordinate MyoD expression, a member of the MRF family of genes. Pax3 and 7 mRNA were higher than control within 12 h after initiation of overload, preceded the increase in MyoD mRNA on day 1, and peaked on day 2. On days 3 and 7, Pax7 mRNA remained higher than control, suggesting that satellite cell self-renewal was occurring. Pax3 and 7 and MyoD protein levels were higher than control on days 2 and 3. These data indicate that Pax3 and 7 coordinate the recapitulation of developmental-like regulatory mechanisms in response to growth-inducing stimuli in adult skeletal muscle, presumably through activation of satellite cells. Muscle Nerve, 2008.

PMID: 18508329 [PubMed - as supplied by publisher]

Introduction of a Self-report Version of the Prescription Drug Use Questionnaire and Relationship to Medication Agreement Noncompliance.

J Pain Symptom Manage. 2008 May 27;

Authors: Compton PA, Wu SM, Schieffer B, Pham Q, Naliboff BD

The Prescription Drug Use Questionnaire (PDUQ) is one of several published tools developed to help clinicians better identify the presence of opioid abuse or dependence in patients with chronic pain. This paper introduces a patient version of the PDUQ (PDUQp), a 31-item questionnaire derived from the items of the original tool designed for self-administration, and describes evidence for its validity and reliability in a sample of patients with chronic nonmalignant pain and on opioid therapy. Further, this study examines instances of opioid medication agreement violation-related discontinuation from pain treatment in this population, and the relationship of these with problematic opioid misuse behaviors, PDUQ and PDUQp scores. A sample of 135 consecutive patients with chronic nonmalignant pain was recruited from a multidisciplinary Veterans Affairs chronic pain clinic, and prospectively followed over one year of opioid therapy. Using the PDUQ as a criterion measure, moderate to good concurrent and predictive validity data for the PDUQp are presented, as well as item-by-item comparison of the two formats. Reliability data indicate moderate test stability over time. Of those patients whose opioid treatment was discontinued due to medication agreement violation-related discontinuation (n=38 or 28% of sample), 40% of these (n=11) were due to specific problematic opioid misuse behaviors. Based upon specificity and sensitivity analyses, a suggested cutoff PDUQp score for predicting medication agreement violation-related discontinuation is provided. This study supports the PDUQp as a useful tool for assessing and predicting problematic opioid medication use in a chronic pain patient sample.

PMID: 18508231 [PubMed - as supplied by publisher]

Bed-exit alarm effectiveness.

Arch Gerontol Geriatr. 2008 May 26;

Authors: Capezuti E, Brush BL, Lane S, Rabinowitz HU, Secic M

This study describes the accuracy of two types of bed-exit alarms to detect bed-exiting body movements: pressure-sensitive and a pressure-sensitive combined with infrared (IR) beam detectors (dual sensor system). We also evaluated the occurrence of nuisance alarms, or alarms that are activated when a participant does not attempt to get out of bed. Fourteen nursing home residents were directly observed for a total of 256 nights or 1636.5h; an average of 18.3+/-22.3 (+/-S.D.) nights/participant for an average of 6.4+/-1.2h/night. After adjusting for body movements via repeated measures, Poisson regression modeling, the least squares adjusted means (LSM) show a marginally significant difference between the type of alarm groups on the number of true positives (NTP) (mean/S.E.M.=0.086/1.617) for pressure-sensitive versus dual sensor alarm (0.593/1.238; p=0.0599) indicating that the dual sensor alarm may have a higher NTP. While the dual sensor bed-exit alarm was more accurate than the pressure-sensitive alarm in identifying bed-exiting body movements and reducing the incidence of false alarms, false alarms were not eliminated altogether. Alarms are not a substitute for staff; adequate staff availability is still necessary when residents need or wish to exit bed.

PMID: 18508138 [PubMed - as supplied by publisher]

Growing old at home - A randomized controlled trial to investigate the effectiveness and cost-effectiveness of preventive home visits to reduce nursing home admissions: study protocol [NCT00644826].

BMC Public Health. 2008 May 28;8(1):185

Authors: Fleischer S, Roling G, Beutner K, Hanns S, Behrens J, Luck T, Kuske B, Angermeyer MC, Riedel-Heller SG, Heinrich S, Konig HH, Lautenschlager C

ABSTRACT: BACKGROUND: Regarding demographic changes in Germany it can be assumed that the number of elderly and the resulting need for long term care is increasing in the near future. It is not only an individual’s interest but also of public concern to avoid a nursing home admission. Current evidence indicates that preventive home visits can be an effective way to reduce the admission rate in this way making it possible for elderly people to stay longer at home than without home visits. As the effectiveness and cost-effectiveness of preventive home visits strongly depends on existing services in the social and health system existing international results cannot be merely transferred to Germany. Therefore it is necessary to investigate the effectiveness and cost-effectiveness of such an intervention in Germany by a randomized controlled trial. METHODS: The trial is designed as a prospective multi-center randomized controlled trial in the cities of Halle and Leipzig. The trial includes an intervention and a control group. The control group receives usual care. The intervention group receives three additional home visits by non-physician health professionals (1) geriatric assessment, (2) consultation, (3) booster session. The nursing home admission rate after 18 months will be defined as the primary outcome. An absolute risk reduction from a 20% in the control-group to a 7% admission rate in the intervention group including an assumed drop out rate of 30% resulted in a required sample size of N= 320 (n = 160 vs. n = 160). Parallel to the clinical outcome measurement the intervention will be evaluated economically. The economic evaluation will be performed from a society perspective. DISCUSSION: To the authors’ knowledge for the first time a trial will investigate the effectiveness and cost-effectiveness of preventive home visits for people aged 80 and over in Germany using the design of a randomized controlled trial. Thus, the trial will contribute to the existing evidence on preventive home visits especially in Germany.

PMID: 18507840 [PubMed - as supplied by publisher]

Staff attitudes about event reporting and patient safety culture in hospital transfusion services.

Transfusion. 2008 May 23;

Authors: Sorra J, Nieva V, Fastman BR, Kaplan H, Schreiber G, King M

BACKGROUND: Little is known about how transfusion service staff view issues pertaining to event reporting and patient safety. The goal of this study was to assess transfusion service staff attitudes about these issues. STUDY DESIGN AND METHODS: A survey was developed and administered to 945 transfusion service staff from 43 hospital transfusion services in the United States and 10 in Canada. The overall response rate was 73 percent (693 responses), with a mean of 15 respondents per site. RESULTS: While events resulting in patient harm are reported (91%) as well as mistakes not corrected that could cause harm (79%), less than one-third of respondents report deviations from procedures with no apparent potential to harm (31%) and mistakes that staff catch and correct on their own (27%). Staff indicated that the main reasons mistakes happen are interruptions (51%) and staff in other departments not knowing or understanding proper procedures (49%). Staff had overall positive attitudes about event reporting, but a significant minority were afraid of punitive consequences. Most were positive about their supervisor’s safety actions and believed that their transfusion service tries to identify causes of mistakes. Only 31 percent, however, agreed that nursing staff would work with the transfusion service to reduce mistakes. CONCLUSION: Overall, the transfusion services had very positive attitudes about event reporting and safety culture. Transfusion services do well recording events that result in patient harm or have the potential for harm, but there is a need to increase reporting of deviations from procedures and mistakes that staff catch and correct on their own. In addition, there are a few areas of safety culture that warrant improvement, particularly the transfusion service’s work relationship with nursing staff. The study provides useful descriptive information about how staff view event reporting and safety-related issues and identifies strengths and areas for improvement.

PMID: 18507747 [PubMed - as supplied by publisher]

Lack of effect of chronic dextromethorphan on experimental pain tolerance in methadone-maintained patients.

Addict Biol. 2008 May 26;

Authors: Compton PA, Ling W, Torrington MA

Good evidence exists to suggest that individuals on opioid maintenance for the treatment of addiction (i.e. methadone) are less tolerant of experimental pain than are matched controls or ex-opioid addicts, a phenomenon theorized to reflect opioid-induced hyperalgesia (OIH). Agonist activity at the excitatory ionotropic N-methyl-D-aspartate (NMDA) receptor on dorsal horn neurons has been implicated in the development of both OIH and its putative expression at the clinical level-opioid tolerance. The aim of this study was to evaluate the potential utility of the NMDA-receptor antagonist, dextromethorphan (DEX), to reverse or treat OIH in methadone-maintenance (MM) patients. Utilizing a clinical trial design and double-blind conditions, changes in pain threshold and tolerance [cold pressor (CP) and electrical stimulation (ES)] following a 5-week trial of DEX (titrated to 480 mg/day) in comparison with placebo was evaluated in a well-characterized sample of MM patients. The sample (n = 40) was 53% male and ethnically diverse (53% Latino, 28% African American, 10% White, 9% other), with a mean age of 48.0 years (SD = 6.97). Based on t-test analyses, no difference was found between groups on CP pain threshold, CP pain tolerance, ES pain threshold or ES pain tolerance, both pre- and postmedication. Notably, DEX-related changes significantly differed by gender, with women tending to show diminished tolerance for pain with DEX therapy. These results support that chronic high-dose NMDA antagonism does not improve tolerance for pain in MM patients, although a gender effect on DEX response is suggested.

PMID: 18507735 [PubMed - as supplied by publisher]

Options for intrauterine contraception.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):375-83

Authors: Fantasia HC

The IUD is a convenient and effective contraceptive option for many women. Currently, there are two different types of intrauterine contraception available to women in North America: the levonorgestrel-releasing intrauterine system and the copper T IUD. A greater understanding of the benefits and limitations of these two contraceptive options will assist women’s health care providers to better meet the family planning needs of their patients.

PMID: 18507611 [PubMed - in process]

The latest advances in hormonal contraception.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):369-74

Authors: Fontenot HB, Harris AL

Millions of women each year start or continue to use some type of hormonal contraceptive method. Choosing a method may be anxiety provoking. In this article, we review some of the latest advances in and options for hormonal contraception, including extended-dose oral contraceptives, the vaginal ring, injectable methods, and emergency contraception. Nurses can facilitate women’s decision making for healthy reproductive options.

PMID: 18507610 [PubMed - in process]

Implanon: a new contraceptive implant.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):361-8

Authors: Fischer MA

Women who cannot use hormonal contraception containing estrogen have a variety of progestin-only contraceptive methods from which to choose. Implanon is a new single-rod progestin-only contraceptive implant that is easily inserted and can remain in place for up to 3 years. It is highly effective with a rapid onset of action and an equally rapid return of fertility once removed. Counseling is important to help women decide if this method is appropriate for their needs.

PMID: 18507609 [PubMed - in process]

The Hysteroscopic Approach to Sterilization.

J Obstet Gynecol Neonatal Nurs. 2008 May;37(3):356-360

Authors: Theroux R

Permanent sterilization is the most common form of contraception in the United States today. Previously, this was accomplished via the laparoscopic method. A new less invasive method has been developed, in which the Essure microinsert is inserted through a hysteroscope into the fallopian tubes. A subsequent benign inflammatory process results in tubal occlusion within 3 months of insertion. Approved since 2002, this method offers high efficacy without incisions, general anesthesia, or a prolonged recovery period.

PMID: 18507608 [PubMed - as supplied by publisher]

If margaret sanger could see us now.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):353

Authors: Theroux R, Hawkins JW

PMID: 18507606 [PubMed - in process]

Annotated Bibliography of NINR Findings on Women’s Health in Pregnancy and Childbirth: 2008 Update.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):350-2

Authors: Bingham RJ

PMID: 18507605 [PubMed - in process]

A literature update on maternal-fetal attachment.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):315-28

Authors: Alhusen JL

Objective: To critically review and synthesize original research published since 2000 designed to measure factors that influence maternal-fetal attachment. Data Sources: EBSCOhost Research Databases that included PubMed, CINAHL Plus, PsycINFO, and SCOPUS were searched for journal articles published in the past 7 years (2000-2007) that examined variables thought to increase, decrease, or cause no change in level of maternal-fetal attachment. Keyword searches included maternal-fetal attachment, parental attachment, and prenatal attachment. Study Selection: Twenty-two studies were selected that met the inclusion criteria of original research, clear delineation of the measurement of maternal-fetal attachment, measurement of maternal-fetal attachment during pregnancy, and inclusion of women or couples, or both. Data Extraction: Studies measuring maternal-fetal attachment included a broad range of variables as potential risk or protective factors, or both. Factors associated with higher levels of maternal-fetal attachment included family support, greater psychological well-being, and having an ultrasound performed. Factors such as depression, substance abuse, and higher anxiety levels were associated with lower levels of maternal-fetal attachment. Data Synthesis: The large majority of studies reviewed were limited by small, homogenous samples deemed insufficient to detect significant differences, inconsistent measurement of maternal-fetal attachment during gestational periods, and cross-sectional designs. Conclusions: Further research is essential to identify factors influencing maternal-fetal attachment. Specifically, research needs to be conducted on larger sample sizes of greater racial and ethnic diversity.

PMID: 18507602 [PubMed - in process]

A systematic review of telephone support for women during pregnancy and the early postpartum period.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):301-14

Authors: Dennis CL, Kingston D

Objective: To assess the effects of telephone-based support on smoking, preterm birth, low birthweight, breastfeeding, and postpartum depression. Data Sources: Cochrane Pregnancy and Childbirth Group trials register (March 2006), Cochrane Central Register of Controlled Trials (March 2006), Medline (1966-2006), EMBASE (1980-2006), and CINAHL (1982-2006). Secondary references were scanned and experts in the field were contacted. Study Selection: All published, unpublished, and ongoing randomized controlled trials of telephone support interventions in which the primary aim was smoking, preterm birth, low birthweight, breastfeeding, or postpartum depression were reviewed. Data extraction: Data were independently extracted by both authors and double entered into the Cochrane Collaboration’s Review Manager (2003) software. Data Synthesis: Trials evaluating different primary outcomes were analyzed separately. For dichotomous data, results were presented as summary relative risk with 95% confidence intervals. For continuous data, weighted mean difference was used. Conclusions: Proactive telephone support may (a) assist in preventing smoking relapse, (b) play a role in preventing low birthweight, (c) increase breastfeeding duration and exclusivity, and (d) decrease postpartum depressive symptomatology. No telephone interventions were effective in improving preterm birth or smoking cessation rates. Additional research is encouraged.

PMID: 18507601 [PubMed - in process]

Perinatal beliefs and practices of immigrant punjabi women living in Canada.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):290-300

Authors: Grewal SK, Bhagat R, Balneaves LG

Objective: To describe new immigrant Punjabi women’s perinatal experiences and the ways that traditional beliefs and practices are legitimized and incorporated into the Canadian health care context. Design: Naturalistic qualitative descriptive. Participants/Setting: Fifteen first-time mothers who had immigrated in the past 5 years to Canada from Punjab, India, and had given birth to a healthy infant in the past 3 months in a large urban center in British Columbia, Canada. Five health professionals and community leaders also took part in a focus group to confirm the study findings and to offer recommendations. Results: Three major categories emerged: the pervasiveness of traditional health beliefs and practices related to the perinatal period (e.g., diet, lifestyle, and rituals), the important role of family members in supporting women during the perinatal experiences, and the positive and negative interactions women had with health professionals in the Canadian health care system. Conclusions: Change is required at the levels of the health professional, the heath care system, and the community to ensure that culturally safe care is provided to immigrant Punjabi women and their families during the perinatal period, which is an important and sensitive period of interaction with the Canadian health care system.

PMID: 18507600 [PubMed - in process]

Maternal bedsharing practices, experiences, and awareness of risks.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):274-81

Authors: Ateah CA, Hamelin KJ

Objectives: The objectives of this study were to determine mothers’ practices and experiences of bedsharing with their infants and also to determine their knowledge of the risks. Design: A self-report questionnaire was mailed to 1,122 mothers of infants. Setting: Manitoba, Canada. Participants: The participants in this study were the mothers of infants aged 3 months whose contact information was obtained through the Manitoba Health Information Privacy Committee. Main Outcome Measure: Maternal-infant bedsharing practices and maternal knowledge of risks. Results: There were 293 completed questionnaires received (26% return rate). Key findings suggest that although 89% of participants agreed that sleeping with one’s baby has some risks associated with it, 72% reported that they bedshared with their baby on either a regular or an occasional basis. Mothers who breastfed were twice as likely to have bedshared. Approximately 13% of respondents who had bedshared reported an experience(s) with bedsharing in which they had rolled onto or partway onto their infant. Conclusions: Although the majority of participants agreed that bedsharing had risks for infants, almost three quarters of respondents reported bedsharing on a regular or an occasional basis. Reports by respondents of rolling onto or partway onto their infants support the conclusion that health care professionals should promote safe sleeping environments that include a separate sleep surface for infants.

PMID: 18507598 [PubMed - in process]

Predictors of wheezing in prematurely born children.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):262-73

Authors: Holditch-Davis D, Merrill P, Schwartz T, Scher M

Objective: To examine the degree to which neonatal illness severity, postneonatal health problems, child characteristics, parenting quality as measured by the HOME Inventory, and maternal characteristics are related to the development of wheezing in prematurely born children over the first 27 months after term. Design: Longitudinal predictive study. Setting: Infants were recruited from two neonatal intensive care units, one in southeast and one in Midwest. Participants: One hundred thirteen preterm infants who weighed less than 1,500 g or required mechanical ventilation and their mothers. Main Outcome Measures: The presence of wheezing was obtained from maternal report at 2, 6, 9, 13, 18, 22, and 27 months. Wheezing was considered to be medically significant if the child was using bronchodilators or pulmonary antiinflammatory medications. Results: Sixty-eight percent of the children had wheezing at least one or more ages; 47% of the children were also taking bronchodilators or pulmonary antiinflammatory medications and thus had medically significant wheezing. Conclusion: Postneonatal health problems and the social environment appear to be more important in developing wheezing in prematurely born children than neonatal medical complications.

PMID: 18507597 [PubMed - in process]

On the redesign of JOGNN.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):254

Authors: Hershberger PE

PMID: 18507595 [PubMed - in process]

Keeping the editor “in focus”.

J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):251-2

Authors: Kearney MH

PMID: 18507593 [PubMed - in process]

Marginalization of midwives in the United States: new responses to an old story.

Birth. 2008 Jun;35(2):158-61

Authors: Rooks JP, Ernst EK, Norsigian J, Guran LA

This column addresses issues raised by an intensive study of the circumstances and actions that resulted in the closure of two long-standing, successful nurse-midwifery services in a large United States city in 2003. Dr. Steffie Goodman of the School of Nursing, University of Colorado Health Science Center in Denver, USA, conducted 52 in-depth interviews with midwives, nurses, administrators, childbirth educators, policymakers, and physicians in an effort to understand how and why these two services were closed and what their closures revealed about the general underutilization of midwives in contemporary U.S. health care. Goodman concluded that economics, power, and authority converge in a way that allows persons in positions of institutional power and authority to make self-serving decisions that diminish access to midwifery services and that they can do so without any public accountability for their actions.

PMID: 18507588 [PubMed - in process]

Creating cross-disciplinary research alliances to advance nursing science.

J Nurs Scholarsh. 2008;40(2):195-201

Authors: Loeb SJ, Penrod J, Kolanowski A, Hupcey JE, Haidet KK, Fick DM, McGonigle D, Yu F

Purpose: To demonstrate the utility of a developmental approach to building and sustaining cross-disciplinary research alliances. Organizing Construct: Cross-disciplinary collaborations offer great promise for advancing an evolving program of research. Funding agencies’ commitment to interdisciplinary work further heightens these collaborations. Nurse researchers, however, are not necessarily equipped with the knowledge and skills needed to strategically and successfully build and maintain cross-disciplinary collaborations. Methods: Successful strategies for forging, extending, and sustaining alliances are organized using a developmental approach and illustrated by exemplars. Findings: The initial phase of forging alliances is focused on creating a limited network to support relatively clear-cut research goals. The cohesive cross-disciplinary team is subsequently extended beyond the initial team to strategically address broader research goals. As the team matures, emphasis shifts toward sustaining the team through shared leadership that more actively focuses on the development of the field than the development of individual programs of research. Conclusions: The advancement of nursing science requires nurse researchers to rethink the developmental phases of building appropriate research teams. Strategic approaches for forging, extending, and sustaining cross-disciplinary alliances position nurse researchers as leaders in innovative cross-disciplinary research. The development of cross-disciplinary teams supports translational research and, by extension, the science that undergirds practice. Clinical Relevance: Research that reflects cross-disciplinary perspectives is particularly well suited to addressing the complex health issues encountered by patients, families, and communities.

PMID: 18507576 [PubMed - in process]

Advanced and specialist nursing practice: attitudes of nurses and physicians in Israel.

J Nurs Scholarsh. 2008;40(2):187-94

Authors: Brodsky E, Van Dijk D

Background: With the introduction of new and advanced nursing roles, the nursing profession is undergoing dynamic change. Realizing changes will be easier to accomplish if the nursing community and other healthcare professionals welcome the process. Recently the nursing staff mix in Israel has been undergoing a transformation: encouraging registered nurses to enhance their status by acquiring academic degrees and advanced professional training, and initiating the adoption of new nursing roles. Objective: Our goal is to evaluate Israeli nurses’ and physicians’ attitudes to the introduction of new nursing roles and to expanding the scope of nursing practice. Methods: Two hundred and fifteen nurses and 110 physicians from three large general hospitals and 15 community clinics filled in a questionnaire. Findings: In general the majority of the nurses supported expansion of nursing practice, and such expansion did not cause significant opposition among physicians. However when the task affected patients’ health, physicians were less willing to permit nurses to perform skills previously their responsibility alone. In addition, using multiple logistic regressions, support of the expansion of nursing practice was significantly higher among nurses in management or training positions, and among academically accredited nurses. Support for expanded roles was prominent among hospital physicians, graduates from Israeli schools of medicine, and less-tenured physicians. Conclusions: We suggest that confirmation by various groups of physicians and nurses of standardized definitions of the new boundaries in the scope of nursing practice roles could successfully promote development of new roles and facilitate integration of the Israeli healthcare system into the global context of change. Clinical Relevance: Inter- and intra-professional collaboration, agreement, and understanding regarding advanced nursing practice roles and their introduction into the healthcare system might improve the relationship between healthcare professions and ultimately increase quality of care and patient satisfaction.

PMID: 18507575 [PubMed - in process]

The expatriate experience: teaching nursing across eastern and Western cultures.

J Nurs Scholarsh. 2008;40(2):184-6

Authors: Yu F

PMID: 18507574 [PubMed - in process]

The experiences of Western expatriate nursing educators teaching in eastern Asia.

J Nurs Scholarsh. 2008;40(2):176-83

Authors: Melby CS, Dodgson JE, Tarrant M

Purpose: To describe the lived experience of English-speaking Western nurse educators teaching in East Asian countries. Design: The study design was an application of existential phenomenological approach to qualitative data collection and analysis. Eight expatriate nurse educators who had taught more than 2 years in an East Asian country were interviewed about their experiences between January 2004 and November 2005. Methods: Narrative data were analyzed using a phenomenological approach aimed at distilling the experience of the educators. Each member of the research team analyzed the data, then through group discussions a consensus was reached, paying close attention to developing clear understandings of language nuances and maintaining the participants’ voices. Findings: Four themes emerged from the data: (a) differing expectations, (b) the cost of the expatriate experience, (c) bridging pedagogies, and (d) adapting and finding purpose. The tacit meanings of cultural differences affecting participants’ experiences are presented. Conclusions: The ways that a collectivist-oriented culture may affect nurse educators coming from a Western individualist worldview needs to continue to be researched to develop better mutual understandings that will lead to culturally collaborative models of nursing practice, education and research. Clinical Relevance: Nurses providing direct care and nurse educators who work with people from cultures other than their own will find the discussion of cross-cultural misunderstandings useful.

PMID: 18507573 [PubMed - in process]

Health beliefs and mammography rates of Turkish women living in rural areas.

J Nurs Scholarsh. 2008;40(2):170-5

Authors: Avci IA, Kurt H

Objectives: Breast cancer is the most frequently occurring cancer among women globally as well as in Turkey and mammography is known to be an effective screening tool for this disease. This study was undertaken to characterize health beliefs and practices related to mammography of women in Turkey and also to survey mammography rates. Design: Cross-sectional. The study was performed between September 2006 and January 2007 in Samsun, Turkey. Of 503 women, aged 35 years or older and registered at a local Health Center, 387 (76.94%) agreed to participate in this study. Methods: A self-administered descriptive questionnaire and the Champion Revised Health Belief Model Scale for breast cancer screening (CHBMS) were used as data collection instruments. Analysis included descriptive statistics, Chi-square, and independent t test. Logistic regression analysis was conducted to identify the extent to which individual variables significantly predicted mammography use. Results: Study participants did not undergo mammography at optimal rates (23.5%), but perceived benefits were higher than were perceived barriers to the procedure after education about mammography. Consequently women reported they were likely to adopt the practice of regular mammography in the future. Conclusions: Mammography rates were low in this rural area in Turkey, but may improve after education about the procedure. Clinical Relevance: Mammography is an important tool in the early diagnosis of breast cancer. Many women still do not understand the benefit of mammograms and further education may help increase rates of early screening.

PMID: 18507572 [PubMed - in process]

The effect of high nursing surveillance on hospital cost.

J Nurs Scholarsh. 2008;40(2):161-9

Authors: Shever LL, Titler MG, Kerr P, Qin R, Kim T, Picone DM

Purpose: The purpose of this study was to determine the cost of one nursing treatment, surveillance, for older, hospitalized adults at risk for falling. Design: An observational study using information from data repositories at one Midwestern tertiary hospital. The inclusion criteria included patients age >60 years, admitted to the hospital between July 1, 1998 and June 31, 2002, at risk for falls or received the nursing treatment of fall prevention. Methods: Data came from clinical and administrative data repositories that included Nursing Interventions Classification (NIC). The nursing treatment of interest was surveillance and total hospital cost associated with surveillance was the dependent variable. Propensity-score analysis and generalized estimating equations (GEE) were used as methods to analyze the data. Independent variables related to patient characteristics, clinical conditions, nurse staffing, medical treatments, pharmaceutical treatments, and other nursing treatments were controlled for statistically. Findings: The total median cost per hospitalization was $9,274 for this sample. The median cost was different (p = 0.050) for patients who received high versus low surveillance. High surveillance delivery cost $191 more per hospitalization than did low surveillance delivery. Conclusion: Propensity scores were applied to determine the cost of surveillance among hospitalized adults at risk for falls in this observational study. The findings show the effect of high surveillance delivery on total hospital cost compared to low surveillance delivery and provides an example of a useful method of determining cost of nursing care rather than including it in the room rate. More studies are needed to determine the effects of nursing treatments on cost and other patient outcomes in order for nurses to provide cost-effective care. Propensity scores were a useful method for determining the effect of nursing surveillance on hospital cost in this observational study. Clinical Relevance: The results of this study along with possible clinical benefits would indicate that frequent nursing surveillance is important and might support the need for additional nursing staff to deliver frequent surveillance.

PMID: 18507571 [PubMed - in process]

Predictors of home healthcare nurse retention.

J Nurs Scholarsh. 2008;40(2):151-60

Authors: Ellenbecker CH, Porell FW, Samia L, Byleckie JJ, Milburn M

Purpose: To examine the level of job satisfaction and test a theoretical model of the direct and indirect effects of job satisfaction, and individual nurse and agency characteristics, on intent to stay and retention for home healthcare nurses. Design: A descriptive correlation study of home healthcare nurses in six New England states. Methods: Home healthcare nurse job satisfaction self-report data was collected with the HHNJS survey questionnaire & Retention Survey Questionnaire. Findings: Based on a structural equation model, job tenure and job satisfaction were the strongest predictors of nurse retention. Conclusions: Understanding the variables associated with home healthcare nurse retention can help agencies retain nurses in a time of severe nurse shortages and increased patient demand. Clinical Relevance: Predicted nursing shortages and increasing demand have made the retention of experienced, qualified nursing staff essential to assure access to high-quality home healthcare services in the future.

PMID: 18507570 [PubMed - in process]

Maternal worries, home safety behaviors, and perceived difficulties.

J Nurs Scholarsh. 2008;40(2):137-43

Authors: Hendrickson SG

Purpose: The aim of the study was to explore the worries, safety behaviors, and perceived difficulties in keeping children safe at home in a purposive sample of low-income, predominantly non-English speaking mothers as a foundation for later nursing interventions. Design: This study was a qualitative, descriptive design with content analysis to identify maternal concerns, behaviors, and perceptions of home safety as part of a larger study. Methods: Eighty-two mothers, 64% of whom were monolingual Spanish-speakers, responded in writing to three semistructured interview questions. When mothers were unable to read and write the researcher wrote the responses, then read the content aloud for verification. A standardized probe for each question was posed to obtain richer responses. Data management included use of the software program NUD*IST and coding analyses following the Miles and Huberman guidelines (1994). Interpretations were translated into English for this report. Findings: The major worries were falling, health, kidnapping, and being hit by a car. The leading maternal behaviors were coded as being physically, verbally, and environmentally preventive. Mothers said that it was their role to provide safety, and that this role could be wearisome, such that constant supervision was difficult. Conclusions: Low-income mothers described their worries for their 1 to 4 year-old children, explored their behaviors for preventing injury, and discussed what made keeping children from harm difficult. Understanding how mothers keep children safe, the barriers to home safety, and effective safety behaviors are important to the health of children. Clinical Relevance: The clinical relevance of this study includes building trust as clinicians plan assessment, intervention and evaluation of home safety to encourage dialog about concerns, safety behaviors, and barriers to keeping children from injury.

PMID: 18507568 [PubMed - in process]

Relative contribution of intrapersonal and partner factors to contraceptive behavior among taiwanese female adolescents.

J Nurs Scholarsh. 2008;40(2):131-6

Authors: Wang RH, Chiou CJ

Purpose: To explore the relative contribution of intrapersonal factors (demographic data, sexual history, and self-efficacy for contraception) and partner factors (perceptions of support from sexual partners for contraception, and relationship power) to contraceptive behaviors among sexually active female adolescents in Taiwan. Design: A cross-sectional design. Female adolescents who have had a steady male sexual partner in the past 3 months (N= 375) were recruited as participants. Methods: Questionnaires including demographic data, sexual history, contraceptive behavior, self-efficacy for contraception, perceptions of support from sexual partner for contraception, and perceptions of relationship power were submitted anonymously for this study. Findings: Participants who had their first sexual experience at less than 14 years of age and were from one-parent families had the least comprehensive contraceptive behavior than did other participants. Number of steady sexual partners was significantly negatively correlated with contraceptive behavior. Self-efficacy, perceptions of support from sexual partner for contraception, and relationship power all were positively correlated with contraceptive behavior. The important explanatory variables of contraceptive behavior were self-efficacy, age of first sexual intercourse, intervals between sexual intercourse, and perceptions of support from sexual partner for contraception. These accounted for 39.1% of variance in contraceptive behavior. Conclusions: Intrapersonal factors (self-efficacy, age of first sexual intercourse, and intervals between sexual intercourse) were more important than were partner factors (perceptions of support from sexual partners for contraception and relationship power) in influencing contraceptive behavior among sexually active female adolescents in Taiwan. Clinical Relevance: Intervention to increase contraceptive behavior among female adolescents should be focused more on intrapersonal factors than on partner factors.

PMID: 18507567 [PubMed - in process]

Maternal factors associated with child behavior.

J Nurs Scholarsh. 2008;40(2):124-30

Authors: Hall LA, Rayens MK, Peden AR

Background: Knowledge of the relative contributions of risk factors in predicting young children’s behavior problems may provide insights for the development of preventive interventions. Objective: The purpose of this cross-sectional study was to identify maternal predictors of children’s internalizing and externalizing behaviors in a volunteer sample of 205 low-income, single mothers with children between 2 and 6 years of age. Method: Data were collected on chronic stressors, self-esteem, negative thinking, depressive symptoms, and child behavior during in-home interviews with the mothers. Results: Mothers’ reports of internalizing and externalizing behaviors did not differ by sex or race of the child. Chronic stressors and depressive symptoms, in addition to control variables, explained 27% of the variability in internalizing behavior while these two variables accounted for 21% of the variability in externalizing behavior. For both internalizing and externalizing behavior, chronic stressors exerted the largest total effects. The effects of self-esteem and negative thinking were indirect, with the latter playing a stronger role. The indirect effect of negative thinking on child behavior was exerted through depressive symptoms, while self-esteem was linked with child behavior through both negative thinking and depressive symptoms. Conclusions: Decreasing mothers’ negative thinking, a variable amenable to intervention, may not only decrease a mother’s depressive symptoms but also improve her perception of the child’s behavior. Clinical Relevance: Decreasing mothers’ negative thinking may provide a way to reduce their depressive symptoms and result in fewer behavior problems among their young children. Nurses working in primary care and community-based settings are in key positions to address this problem and improve the mental health of low-income mothers and positively affect the behavior of their children.

PMID: 18507566 [PubMed - in process]

Testing a bioecological model to examine social support in postpartum adolescents.

J Nurs Scholarsh. 2008;40(2):116-23

Authors: Logsdon MC, Hertweck P, Ziegler C, Pinto-Foltz M

Purpose: The purpose was twofold and included examining a bioecological model as a framework to describe social support in postpartum adolescents. The second purpose was to determine the relationship between a comprehensive view of the context of social support and symptoms of depression. Design: Cross-sectional design with convenience sampling (n= 85) of adolescents at 4-6 weeks postpartum, recruited from two community hospitals. Methods: Approval wa