Time and costs of preparing and submitting an NIH grant application at a school of nursing

BACKGROUND

Schools of nursing spend considerable time and finances pursuing federal research funding, yet the costs of such efforts are unknown.

PURPOSE

The purpose of this study was to determine the time and costs to a school of nursing to prepare a National Institutes of Health grant application.

METHOD

We prospectively recorded time and calculated costs in grant preparation undertaken by principal investigators and research administrators in one school of nursing.

RESULTS

Principal investigators' time ranged from 69.8 to 162.3 hr, research administrators' time ranged from 33.9 to 56.4 hr, and costs ranged from $4,784 to $13,512 per grant. With funding rates of 5% to 15%, costs for one funded R01 would be $72,460 to $270,240.

DISCUSSION

Grant writing activities represent a major time commitment to faculty and staff and costs to the school. To maximize potential for success, schools of nursing must provide costly resources to support its grant writing enterprise.

CONCLUSIONS

Less costly and more efficient models of attaining research funding are needed for the sustainability of the nursing profession.

Obesity as a Determinant of Staphylococcus aureus Colonization Among Inmates in Maximum-Security Prisons in New York State

Obesity increases a person's susceptibility to a variety of infections, including Staphylococcus aureus infections, which is an important cause of morbidity in correctional settings. Using a cross-sectional design, we assessed the association between obesity and S. aureus colonization, a risk factor for subsequent infection, in New York State maximum-security prisons (2011-2013). Anterior nares and oropharyngeal cultures were collected. Structured interviews and medical records were used to collect demographic, behavioral, and medical data. Body mass index (BMI; weight (kg)/height (m(2))) was categorized as 18.5-24.9, 25-29.9, 30-34.9, or ≥35. The association between BMI and S. aureus colonization was assessed using log-binomial regression. Thirty-eight percent of 638 female inmates and 26% of 794 male inmates had a BMI of 30 or higher. More than 40% of inmates were colonized. Female inmates with a BMI of 25-29.9 (prevalence ratio (PR) = 1.37, 95% confidence interval (CI): 1.06, 1.76), 30-34.9 (PR = 1.52, 95% CI: 1.17, 1.98), or ≥35 (PR = 1.49, 95% CI: 1.13, 1.96) had a higher likelihood of colonization than did those with a BMI of 18.5-24.9 after we controlled for age, educational level, smoking status, diabetes status, and presence of human immunodeficiency virus. Colonization was higher among male inmates with a BMI of 30-34.9 (PR = 1.27, 95% CI: 1.01, 1.61). Our findings demonstrate an association between BMI and S. aureus colonization among female prisoners. Potential contributory biologic and behavioral factors should be explored.

Multicenter Study of Hand Carriage of Potential Pathogens by Neonatal ICU Healthcare Personnel

A multicenter surveillance study was performed to determine the rates of hand carriage of potential pathogens among healthcare personnel in four neonatal intensive care units. Staphylococcus aureus, enterococci, and gram-negative bacilli were recovered from 8%, 3%, and 2% of 1000 hand culture samples, respectively.

Epidemiologic Associations Between Short-Bowel Syndrome and Bloodstream Infection Among Hospitalized Children

BACKGROUND

Children with short bowel syndrome (SBS) suffer from strikingly high rates of morbidity and mortality, due in part to their susceptibility to life-threatening infectious diseases. Few large, multisite studies have evaluated patient-specific factors associated with bacteremia in hospitalized children with and without SBS.

METHODS

We conducted a case-control study to examine the epidemiological associations between SBS and bloodstream infections (BSI) in hospitalized children. Pediatric BSI cases and controls were selected from a prospective cohort study conducted at 3 New York City hospitals.

RESULTS

Among 40 723 hospital admissions of 30 179 children, 1047 diagnoses of BSI were identified. A total of 64 children had a diagnosis of SBS. BSI was identified frequently among hospitalizations for children admitted with SBS (n = 207/450, 46%) compared to hospitalizations for children without the condition (n = 840/40 273, 2.1%, P < .001). While this population represented only 0.2% of our overall cohort, it accounted for nearly 20% of all hospital admissions with BSI. Multivariable analysis identified 8 factors significantly associated with pediatric hospitalizations with BSI. These included a diagnosis of SBS (odds ratio [OR] 19.0), ages 1-5 years (OR 1.33), presence of a non-Broviac-Hickman central venous catheter (OR 6.36), immunosuppression (OR 0.53), kidney injury (OR 6.67), organ transplantation (OR 4.44), admission from a skilled nursing facility (OR 2.66), and cirrhosis (OR 7.23).

CONCLUSIONS

While several clinical characteristics are contributory to the risk of BSI in children, SBS remains the single strongest predictor. Further research into the mediators of this risk will be essential for the development of prevention strategies for this vulnerable population.

Risk Factors for Nosocomial Bacteremia Secondary to Urinary Catheter-Associated Bacteriuria: A Systematic Review

A systematic appraisal of evidence suggests that male patients in hospital may be at higher risk for bacteremia following urinary catheter-associated bacteriuria than females. Other risk factors include immunosuppressant medication, red blood cell transfusion, neutropenia, malignancy, and liver disease.

Health care-associated infection outbreaks in pediatric long-term care facilities

Children in pediatric long-term care facilities (pLTCFs) have complex medical conditions and increased risk for health care-associated infections (HAIs). We performed a retrospective study from January 2010-December 2013 at 3 pLTCFs to describe HAI outbreaks and associated infection control interventions. There were 62 outbreaks involving 700 cases in residents and 250 cases in staff. The most common interventions were isolation precautions and education and in-services. Further research should examine interventions to limit transmission of infections in pLTCFs.

Using Workflow Diagrams to Address Hand Hygiene in Pediatric Long-Term Care Facilities

Hand hygiene (HH) in pediatric long-term care settings has been found to be sub-optimal. Multidisciplinary teams at three pediatric long-term care facilities developed step-by-step workflow diagrams of commonly performed tasks highlighting HH opportunities. Diagrams were validated through observation of tasks and concurrent diagram assessment. Facility teams developed six workflow diagrams that underwent 22 validation observations. Four main themes emerged: 1) diagram specificity, 2) wording and layout, 3) timing of HH indications, and 4) environmental hygiene. The development of workflow diagrams is an opportunity to identify and address the complexity of HH in pediatric long-term care facilities.

Increasing participation in genomic research and biobanking through community-based capacity building

Achieving equitable minority representation in genomic biobanking is one of the most difficult challenges faced by researchers today. Capacity building--a framework for research that includes collaborations and on-going engagement--can be used to help researchers, clinicians and communities better understand the process, utility, and clinical application of genomic science. The purpose of this exploratory descriptive study was to examine factors that influence the decision to participate in genomic research, and identify essential components of capacity building with a community at risk of being under-represented in biobanks. Results of focus groups conducted in Central Harlem with 46 participants were analyzed by a collaborative team of community and academic investigators using content analysis and AtlisTi. Key themes identified were: (1) the potential contribution of biobanking to individual and community health, for example the effect of the environment on health, (2) the societal context of the science, such as DNA criminal databases and paternity testing, that may affect the decision to participate, and (3) the researchers' commitment to community health as an outcome of capacity building. These key factors can contribute to achieving equity in biobank participation, and guide genetic specialists in biobank planning and implementation.

Epidemiological and biological determinants of Staphylococcus aureus clinical infection in New York State maximum security prisons

BACKGROUND

Large outbreaks of Staphylococcus aureus (SA) infections have occurred in correctional facilities across the country. We aimed to define the epidemiological and microbiological determinants of SA infection in prisons to facilitate development of prevention strategies for this underserved population.

METHODS

We conducted a case-control study of SA infection at 2 New York State maximum security prisons. SA-infected inmates were matched with 3 uninfected controls. Subjects had cultures taken from sites of infection and colonization (nose and throat) and were interviewed via structured questionnaire. SA isolates were characterized by spa typing. Bivariate and multivariable analyses were conducted using conditional logistic regression.

RESULTS

Between March 2011 and January 2013, 82 cases were enrolled and matched with 246 controls. On bivariate analysis, the use of oral and topical antibiotics over the preceding 6 months was strongly associated with clinical infection (OR, 2.52; P < .001 and 4.38, P < .001, respectively). Inmates with clinical infection had 3.16 times the odds of being diabetic compared with inmates who did not have clinical infection (P < .001). Concurrent nasal and/or oropharyngeal colonization was also associated with an increased odds of infection (OR, 1.46; P = .002). Among colonized inmates, cases were significantly more likely to carry the SA clone spa t008 (usually representing the epidemic strain USA300) compared to controls (OR, 2.52; P = .01).

CONCLUSIONS

Several inmate characteristics were strongly associated with SA infection in the prison setting. Although many of these factors were likely present prior to incarceration, they may help medical staff identify prisoners for targeted prevention strategies.

Improving the Proficiency of Research Consent Administrators

OBJECTIVE

To describe the development and testing of a module to improve consent administrators' skills when obtaining research consent from culturally and linguistically diverse and low literacy populations.

DESIGN

Development and psychometric testing of video module including community vignettes.

METHODS

Following initial content, face, and construct validity testing by experts, a field trial was conducted with pre- and postknowledge tests and satisfaction surveys completed by 112 consent administrators.

RESULTS

Mean score out of a possible 10 on pretest was 8.6 (±standard deviation [SD], 1.55) and on posttest was 9.1 (±SD, 1.2; paired t-test 95% confidence interval of difference: -0.18 to -0.88; two-tailed p = 0.003). The average years of experience with obtaining consent was 6.42 years (range: 0-35), but years of experience was not significantly associated with either pre- or posttest scores (p = 0.82 and 0.44, respectively). Most user evaluations were positive, although suggestions for improvements were made.

CONCLUSION

Although pretest scores were relatively high, training needs of research consent administrators for consenting diverse and low literacy populations may be unmet. We urge that institutional review boards, researchers, policymakers, educators, and bioethicists address the training needs of research consent administrators and we offer this training module as one potential resource and adjunct to such training.

A decade of investment in infection prevention: a cost-effectiveness analysis

BACKGROUND

Health care-associated infection (HAI) rates have fallen with the development of multifaceted infection prevention programs. These programs require ongoing investments, however. Our objective was to examine the cost-effectiveness of hospitals' ongoing investments in HAI prevention in intensive care units (ICUs).

METHODS

Five years of Medicare data were combined with HAI rates and cost and quality of life estimates drawn from the literature. Life-years (LYs), quality-adjusted LYs (QALYs), and health care expenditures with and without central line-associated bloodstream infection (CLABSI) and/or ventilator-associated pneumonia (VAP), as well as incremental cost-effectiveness ratios (ICERs) of multifaceted HAI prevention programs, were modeled.

RESULTS

Total LYs and QALYs gained per ICU due to infection prevention programs were 15.55 LY and 9.61 QALY for CLABSI and 10.84 LY and 6.55 QALY for VAP. Reductions in index admission ICU costs were $174,713.09 for CLABSI and $163,090.54 for VAP. The ICERs were $14,250.74 per LY gained and $23,277.86 per QALY gained.

CONCLUSIONS

Multifaceted HAI prevention programs are cost-effective. Our results underscore the importance of maintaining ongoing investments in HAI prevention. The welfare benefits implied by the advantageous ICERs would be lost if the investments were suspended.

HIV sexual risk behavior in older black women: a systematic review

BACKGROUND

Human immunodeficiency virus (HIV) is a major public health concern in the United States, particularly among older Black women who comprise approximately 40% of the newly diagnosed cases among women. This systematic review sought to answer the research question: What are the sexual practices in older Black women associated with HIV risk?

METHODS

CINAHL, PubMed, MEDLINE, and Web of Knowledge electronic databases were searched for English-language research studies published between 2003 and 2013 that focused on the HIV sexual risk practices of Black women over the age of 50. Using PRISMA guidelines, two reviewers independently reviewed and appraised the quality of relevant articles; agreement of select studies was achieved by consensus.

RESULTS

Among the 3,167 articles surveyed, 9 met inclusion criteria. The majority (88%) were quantitative, observational studies. All nine articles addressed at least one of three factors that contribute to HIV sexual risk: Behavioral (inconsistent condom use and multiple sexual partners), psychological (risk perception, depression/stress, trauma, and self-esteem issues), and social factors (economics, education, and drugs/alcohol use). Outcome measures varied across studies.

CONCLUSION

Although this systematic review appraised few studies, findings suggest that many older Black women are engaged in HIV risk-taking practices. Clinicians and researchers need to be aware of the HIV risk practices of older Black women to improve health outcomes through education, effective communication and risk appraisal.

MoSAIC: Mobile Surveillance for Acute Respiratory Infections and Influenza-Like Illness in the Community

Surveillance for acute respiratory infection (ARI) and influenza-like illness (ILI) relies primarily on reports of medically attended illness. Community surveillance could mitigate delays in reporting, allow for timely collection of respiratory tract samples, and characterize cases of non–medically attended ILI representing substantial personal and economic burden. Text messaging could be utilized to perform longitudinal ILI surveillance in a community-based sample but has not been assessed. We recruited 161 households (789 people) in New York City for a study of mobile ARI/ILI surveillance, and selected reporters received text messages twice weekly inquiring whether anyone in the household was ill. Home visits were conducted to obtain nasal swabs from persons with ARI/ILI. Participants were primarily female, Latino, and publicly insured. During the 44-week period from December 2012 through September 2013, 11,282 text messages were sent. In responses to 8,250 (73.1%) messages, a household reported either that someone was ill or no one was ill; 88.9% of responses were received within 4 hours. Swabs were obtained for 361 of 363 reported ARI/ILI episodes. The median time from symptom onset to nasal swab was 2 days; 65.4% of samples were positive for a respiratory pathogen by reverse-transcriptase polymerase chain reaction. In summary, text messaging promoted rapid ARI/ILI reporting and specimen collection and could represent a promising approach to timely, community-based surveillance.

Burden of present-on-admission infections and health care-associated infections, by race and ethnicity

BACKGROUND

In the United States incidence of sepsis and pneumonia differ by race, but it is unclear whether this is due to intrinsic factors or health care factors.

METHODS

We conducted a study of 52,006 patients hospitalized during 2006-2008 at a referral hospital in upper Manhattan. We examined how the prevalence of present-on-admission and health care-associated infection compared between non-Hispanic blacks, Hispanics, and non-Hispanic whites adjusting for sociodemographic factors, admission through the emergency department, and comorbid conditions.

RESULTS

Non-Hispanic blacks had 1.59-fold (95% confidence interval [CI], 1.29-1.96) and 1.55-fold (95% CI, 1.35-1.77) risk of community-acquired bloodstream infection and urinary tract infection compared with non-Hispanic whites. Hispanic patients had 1.31-fold (95% CI, 1.15-1.49) risk of presenting with community-acquired urinary tract infection compared with non-Hispanic whites. Controlling for admission through the emergency department, comorbidity, and neighborhood income attenuated the differences in prevalence of infections.

CONCLUSIONS

We found that health disparities in present-on-admission infections might be largely explained by potential lack of ambulatory care, socioeconomic factors, and comorbidity.

Challenges in conducting research in pediatric long-term care facilities

BACKGROUND

Children residing in long-term care facilities (LTCFs) have complex medical problems and unique care needs, yet research in this setting is rare. As part of an intervention study to improve patient safety (Keep It Clean for Kids [KICK]), we describe the challenges encountered and recommend approaches to build a successful and sustained collaborative relationship between pediatric LTCFs and the research team.

METHODS

We implemented a program with 5 components: leadership commitment, active staff participation by the creation of KICK teams, workflow assessments, staff training in the World Health Organization's "5 Moments for Hand Hygiene," and electronic monitoring and feedback to staff regarding hand hygiene practices.

RESULTS

Major challenges encountered were establishing trust, building research teams, enhancing staff participation, and engaging families and visitors. Approaches to deal with these challenges are discussed.

CONCLUSIONS

Conducting research in pediatric LTCFs requires sustained commitment to dealing with challenges and establishing collaborative relationships with administrative and frontline staff.

Common infection control practices in the emergency department: a literature review

BACKGROUND

Health care-associated infections (HAIs) are a major health concern, despite being largely avoidable. The emergency department (ED) is an essential component of the health care system and subject to workflow challenges, which may hinder ED personnel adherence to guideline-based infection prevention practices.

METHODS

The purpose of this review was to examine published literature regarding adherence rates among ED personnel to selected infection control practices, including hand hygiene (HH) and aseptic technique during the placement of central venous catheters and urinary catheters. We also reviewed studies reporting rates of ED equipment contamination. PubMed was searched for studies that included adherence rates among ED personnel to HH during routine patient care, aseptic technique during the placement of central venous catheters and urinary catheters, and rates of equipment contamination.

RESULTS

In total, 853 studies was screened, and 589 abstracts were reviewed. The full texts of 36 papers were examined, and 23 articles were identified as meeting inclusion criteria. Eight studies used various scales to measure HH compliance, which ranged from 7.7% to 89.7%. Seven articles examined central venous catheters inserted in the ED or by emergency medicine residents. Detail of aseptic technique practices during urinary catheterization was lacking. Four papers described equipment contamination in the ED.

CONCLUSION

Standardized methods and definitions of compliance monitoring are needed to compare results across settings.

Establishing a program of global initiatives for nursing education

In the global nursing community, schools of nursing are increasingly developing initiatives and networks across national boundaries. This article describes the process undertaken at a school of nursing to determine its global health priorities and develop a program of global initiatives for nursing education. A series of meetings were held to determine faculty global activities and gauge interest in designing a 5-year strategic plan for the program. A volunteer Strategic Planning Work-group was convened to formalize a mission, vision, and strategic plan for the program, which were presented to, refined by, and vetted by an advisory board and the faculty at large. We recommend this process to schools committed to developing or expanding a program dedicated to global initiatives and a global perspective in educational planning. Involving stakeholders, building on current strengths, and aligning with mission and vision are essential elements for developing a meaningful program of global initiatives for nursing education.

Measuring media use in college students with and without human immunodeficiency virus infection

INTRODUCTION

Media applications have shown promise for health education. The aims of this study were to develop and evaluate a media survey measure and compare media use among college students with and without human immunodeficiency virus (HIV) infection.

METHODS

Using a cross-sectional, descriptive design, a convenience sample of college students (N = 53) were recruited. Psychometric testing of the media instrument was performed, and the tool was then used to compare media use among HIV-infected undergraduates (n = 15), other undergraduates (n = 23), and nursing students (n = 15).

RESULTS

Psychometric testing of the media instrument demonstrated a high degree of reliability (intraclass correlation = .998; 95% confidence intervals = .997, .999). All respondents had computers with Internet access and cellular phones. Among HIV-infected undergraduate students, 86.7% reported spending 5 minutes or more viewing television during the previous 24 hours outside of school and or work, in comparison with 34.8% of the other undergraduate students with no known chronic illness and 46.7% of the nursing students (p = .002 and .05, respectively). Preferred modes to access health information and communicate with health care providers for all respondents were the Internet (86.8%) and telephone (62.3%), respectively.

DISCUSSION

Assessment of media use among adolescents and young adults will aid in planning for their health education needs.

Utility of Electronic Medical Records to Assess the Relationship Between Parenteral Nutrition and Central Line-Associated Bloodstream Infections in Adult Hospitalized Patients

BACKGROUND

Parenteral nutrition is associated with increased central line-associated bloodstream infections (CLABSIs). Electronic databases are important for identifying independent risk factors for prevention strategies. Our aims were to evaluate the utility of using electronic data sources to identify risk factors for CLABSIs, including parenteral nutrition (PN), and to assess the association between CLABSI and PN administration.

METHODS

Data were obtained for all discharges of adult patients in whom a central line was inserted between September 1, 2007, and December 31, 2008, in a large, academically affiliated hospital in New York City. CLABSI was defined electronically using a modified definition from the Centers for Disease Control and Prevention. A manual chart review was also undertaken to assess validity/reliability of the electronic database and gather additional information. Risk factors for CLABSI were examined using logistic regression.

RESULTS

Among 4840 patients, there were 220 CLABSIs, an incidence of 5.4 CLABSIs per 1000 central line days. Risk factors included PN (odds ratio [OR], 4.33; 95% confidence interval [CI], 2.50-7.48), intensive care unit stay (OR, 2.26; 95% CI, 1.58-3.23), renal disease (OR, 2.79; 95% CI, 2.00-3.88), and immunodeficiency (OR, 2.26; 95% CI, 1.70-3.00). Diabetes mellitus was associated with reduced CLABSI rates (OR, 0.63; 95% CI, 0.45-0.88).

CONCLUSIONS

The utility of electronic medical records for determining risk factors is limited by such things as free-text data entry. Using a hybrid between fully electronic and manual chart review, reliable data were obtained. PN is associated with a high risk for CLABSI in a population highly selected for indications for PN.