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Koleck TA, Mitha S, Biviano A, Caceres BA, Corwin EJ, Goldenthal I, Creber RM, Turchioe MR, Hickey KT, Bakken S. Response to Mental Health of Cardiac Procedure Patients Should Be a Priority for All Healthcare Providers. J Cardiovasc Nurs 2023; 38:118-119. [PMID: 36752762 PMCID: PMC10042584 DOI: 10.1097/jcn.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
| | | | - Angelo Biviano
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, ColuAcmbia University Irving Medical Center
| | | | | | | | | | | | - Kathleen T. Hickey
- School of Nursing, Columbia University
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, ColuAcmbia University Irving Medical Center
| | - Suzanne Bakken
- School of Nursing, Columbia University
- Department of Biomedical Informatics, Columbia University
- Data Science Institute, Columbia University
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Mitrani LR, Goldenthal I, Leskowitz J, Wan EY, Dizon J, Saluja D, Creber RM, Turchioe MR, Sciacca RR, Garan H, Hickey KT, Korner J, Biviano AB. Risk factor management of atrial fibrillation using mHealth: The Atrial Fibrillation – Helping Address Care with Remote Technology (AF-HEART) Pilot Study. Cardiovascular Digital Health Journal 2021; 3:14-20. [PMID: 35265931 PMCID: PMC8890079 DOI: 10.1016/j.cvdhj.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Personalized treatment of atrial fibrillation (AF) risk factors using mHealth and telehealth may improve patient outcomes. Objective The purpose of this study was to assess the feasibility of the Atrial Fibrillation Helping Address Care with Remote Technology (AF-HEART) intervention on the following patient outcomes: (1) heart rhythm tracking; (2) weight, alcohol, blood pressure (BP), and sleep apnea reduction; (3) AF symptom reduction; and (4) quality-of-life (QOL) improvement. Methods A total of 20 patients with AF undergoing antiarrhythmic therapy, cardioversion, and/or catheter ablation were enrolled and followed for 6 months. The AF-HEART intervention included remote heart rhythm, weight, and BP tracking; televisits with a dietician focusing on AF risk factors; and referrals for sleep apnea and hypertension treatment. Results Patients transmitted a median of 181 rhythm recordings during the 6-month follow-up period. Patients lost an average of 3.5 kilograms at 6 months (P = .005). Patients had improved SF-12 scores (P = .01), AFSS score (P = .01), EQ-5D score (P = .006), and AFEQT Global Score (P = .03). There was significant correlation between weight loss and decrease in symptom severity (r = -0.45, P = .05), and between % weight loss and decrease in symptom severity (r = -0.49, P = .03). Conclusion This study described the feasibility of the AF-HEART intervention for (1) consistent remote tracking of heart rhythm, weight, and BP; (2) achievement of weight loss; (3) reduction of symptoms; and (4) improvement in QOL. Expansion to a larger randomized study is planned.
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Affiliation(s)
- Lindsey R. Mitrani
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Isaac Goldenthal
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jamie Leskowitz
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Elaine Y. Wan
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jose Dizon
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Deepak Saluja
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Ruth Masterson Creber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | | | - Robert R. Sciacca
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Judith Korner
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Angelo B. Biviano
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
- Address reprint requests and correspondence: Dr Angelo B. Biviano, Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY 10032.
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Caceres BA, Hickey KT, Bakken SB, Biviano AB, Garan H, Goldenthal IL, Koleck TA, Masterson-Creber R, Turchioe MR, Jia H. Mobile Electrocardiogram Monitoring and Health-Related Quality of Life in Patients With Atrial Fibrillation: Findings From the iPhone Helping Evaluate Atrial Fibrillation Rhythm Through Technology (iHEART) Study. J Cardiovasc Nurs 2021; 35:327-336. [PMID: 32015256 PMCID: PMC7299739 DOI: 10.1097/jcn.0000000000000646] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with high recurrence rates and poor health-related quality of life (HRQOL) but few effective interventions to improve HRQOL exist. OBJECTIVE The aim of this study was to examine the impact of the "iPhone Helping Evaluate Atrial Fibrillation Rhythm through Technology" (iHEART) intervention on HRQOL in patients with AF. METHODS We randomized English- and Spanish-speaking adult patients with AF to receive either the iHEART intervention or usual care for 6 months. The iHEART intervention used smartphone-based electrocardiogram monitoring and motivational text messages. Three instruments were used to measure HRQOL: the Atrial Fibrillation Effect on Quality of Life (AFEQT), the 36-item Short-Form Health survey, and the EuroQol-5D. We used linear mixed models to compare the effect of the iHEART intervention on HRQOL, quality-adjusted life-years, and AF symptom severity. RESULTS A total of 238 participants were randomized to the iHEART intervention (n = 115) or usual care (n = 123). Of the participants, 77% were men and 76% were white. More than half (55%) had an AF recurrence. Both arms had improved scores from baseline to follow-up for AFEQT and AF symptom severity scores. The global AFEQT score improved 18.5 and 11.2 points in the intervention and control arms, respectively (P < .05). There were no statistically significant differences in HRQOL, quality-adjusted life-years, or AF symptom severity between groups. CONCLUSIONS We found clinically meaningful improvements in AF-specific HRQOL and AF symptom severity for both groups. Additional research with longer follow-up should examine the influence of smartphone-based interventions for AF management on HRQOL and address the unique needs of patients diagnosed with different subtypes of AF.
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Hickey KT, Wan E, Garan H, Biviano AB, Morrow JP, Sciacca RR, Reading M, Koleck TA, Caceres B, Zhang Y, Goldenthal I, Riga TC, Masterson Creber R. A Nurse-led Approach to Improving Cardiac Lifestyle Modification in an Atrial Fibrillation Population. J Innov Card Rhythm Manag 2020; 10:3826-3835. [PMID: 32494426 PMCID: PMC7252822 DOI: 10.19102/icrm.2019.100902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/01/2018] [Indexed: 02/01/2023] Open
Abstract
Atrial fibrillation (AF) is a major public health problem and the most common cardiac arrhythmia encountered in clinical practice at this time. AF is associated with numerous symptoms such as palpitations, shortness of breath, and fatigue, which can significantly reduce health-related quality of life and result in serious adverse cardiac outcomes. In light of this, the aim of the present pilot study was to test the feasibility of implementing a mobile health (mHealth) lifestyle intervention titled “Atrial Fibrillation and Cardiac Health: Targeting Improving Outcomes via a Nurse-Led Intervention (ACTION),” with the goal of improving cardiac health measures, AF symptom recognition, and self-management. As part of this study, participants self-identified cardiac health goals at enrollment. The nurse used web-based resources from the American Heart Association (Dallas, TX, USA), which included the Life’s Simple 7® My Life Check® assessment, to quantify current lifestyle behavior change needs. Furthermore, on the My AFib Experience™ website (American Heart Association, Dallas, TX, USA), the patient used a symptom tracker tool to capture the date, time, frequency, and type of AF symptoms, and these data were subsequently reviewed by the cardiac nurse. Throughout the six-month intervention period, the cardiac nurse used a motivational interviewing approach to support participants’ cardiac health goals. Ultimately, the ACTION intervention was tested in 53 individuals with AF (mean age: 59 ± 11 years; 76% male). Participants were predominantly overweight/obese (79%), had a history of hypertension (62%) or hyperlipidemia (61%), and reported being physically inactive/not preforming any type of regular exercise (52%). The majority (88%) of the participants had one or more Life’s Simple 7® measures that could be improved. Most of the participants (98%) liked having a dedicated nurse to work with them on a biweekly basis via the mHealth portal. The most commonly self-reported symptoms were palpitations, fatigue/exercise intolerance, and dyspnea. Seventy percent of the participants had an improvement in their weight and blood pressure as documented within the electronic health record as well as a corresponding improvement in their Life’s Simple 7® score at six months. On average, there was a three-pound (1.36-kg) decrease in weight and a 5-mmHg decrease in systolic blood pressure between baseline and at six months. In conclusion, this pilot work provides initial evidence regarding the feasibility of implementing the ACTION intervention and supports testing the ACTION intervention in a larger cohort of AF patients to inform existing AF guidelines and build an evidence base for reducing AF burden through lifestyle modification.
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Affiliation(s)
- Kathleen T Hickey
- Department of Medicine, Columbia University, New York, NY, USA.,Department of Nursing, Columbia University, New York, NY, USA
| | - Elaine Wan
- Department of Medicine, Columbia University, New York, NY, USA
| | - Hasan Garan
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - John P Morrow
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - Meghan Reading
- Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | | | - Billy Caceres
- Department of Nursing, Columbia University, New York, NY, USA
| | - Yiyi Zhang
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - Teresa C Riga
- Department of Medicine, Columbia University, New York, NY, USA
| | - Ruth Masterson Creber
- Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA
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Hickey KT, Bakken S, Byrne MW, Bailey DCE, Demiris G, Docherty SL, Dorsey SG, Guthrie BJ, Heitkemper MM, Jacelon CS, Kelechi TJ, Moore SM, Redeker NS, Renn CL, Resnick B, Starkweather A, Thompson H, Ward TM, McCloskey DJ, Austin JK, Grady PA. Corrigendum to Precision health: Advancing symptom and self-management science. Nurs Outlook 2020; 68:139-140. [PMID: 32046859 DOI: 10.1016/j.outlook.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- K T Hickey
- Cardiac Electrophysiology, Columbia University School of Nursing, Columbia University Medical Center, New York, NY
| | - S Bakken
- School of Nursing and Department of Biomedical Informatics, Columbia University, New York, NY.
| | - M W Byrne
- Department of Anesthesiology, Columbia University School of Nursing, Columbia University College of Physicians and Surgeons, New York, NY; Center for Children and Families, Columbia University School of Nursing, Columbia University College of Physicians and Surgeons, New York, NY
| | | | - G Demiris
- University of Pennsylvania, School of Nursing, Philadelphia, PA
| | | | - S G Dorsey
- Department of Pain and Translational Symptom Science, School of Medicine, University of Maryland Baltimore, Baltimore, MD; Department of Anesthesiology, School of Medicine, University of Maryland Baltimore, Baltimore, MD
| | - B J Guthrie
- Bouve College of Health Sciences, Northeastern University School of Nursing, Boston, MA
| | - M M Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA
| | - C S Jacelon
- University of Massachusetts Amherst College of Nursing, Amherst, MA
| | - T J Kelechi
- Medical University of South Carolina, College of Nursing, Charleston, SC
| | - S M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - N S Redeker
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT
| | - C L Renn
- Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD
| | - B Resnick
- Organizational Systems and Adult Health Nursing Department, University of Maryland Baltimore, Baltimore, MD
| | | | - H Thompson
- University of Washington School of Nursing, Seattle, WA
| | - T M Ward
- University of Washington School of Nursing, Seattle, WA
| | - D J McCloskey
- National Institute of Nursing Research, Bethesda, MD
| | - J K Austin
- National Institute of Nursing Research, Bethesda, MD; Indiana University School of Nursing, Bloomington, IN
| | - P A Grady
- National Institute of Nursing Research, Bethesda, MD
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Fu MR, Kurnat-Thoma E, Starkweather A, Henderson WA, Cashion AK, Williams JK, Katapodi MC, Reuter-Rice K, Hickey KT, Barcelona de Mendoza V, Calzone K, Conley YP, Anderson CM, Lyon DE, Weaver MT, Shiao PK, Constantino RE, Wung SF, Hammer MJ, Voss JG, Coleman B. Precision health: A nursing perspective. Int J Nurs Sci 2019; 7:5-12. [PMID: 32099853 PMCID: PMC7031154 DOI: 10.1016/j.ijnss.2019.12.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/03/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
Precision health refers to personalized healthcare based on a person’s unique genetic, genomic, or omic composition within the context of lifestyle, social, economic, cultural and environmental influences to help individuals achieve well-being and optimal health. Precision health utilizes big data sets that combine omics (i.e. genomic sequence, protein, metabolite, and microbiome information) with clinical information and health outcomes to optimize disease diagnosis, treatment and prevention specific to each patient. Successful implementation of precision health requires interprofessional collaboration, community outreach efforts, and coordination of care, a mission that nurses are well-positioned to lead. Despite the surge of interest and attention to precision health, most nurses are not well-versed in precision health or its implications for the nursing profession. Based on a critical analysis of literature and expert opinions, this paper provides an overview of precision health and the importance of engaging the nursing profession for its implementation. Other topics reviewed in this paper include big data and omics, information science, integration of family health history in precision health, and nursing omics research in symptom science. The paper concludes with recommendations for nurse leaders in research, education, clinical practice, nursing administration and policy settings for which to develop strategic plans to implement precision health.
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Affiliation(s)
- Mei R. Fu
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
- Corresponding author. Barry Family & Goldman Sachs Endowed Professor, William F. Connell School of Nursing, Boston College, Office 228 Maloney Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Emma Kurnat-Thoma
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
- School of Nursing and Health Studies, Georgetown University, Washington, DC, USA
| | | | | | - Ann K. Cashion
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | - Kathleen Calzone
- National Cancer Institute, Center for Cancer Research, Genetic Branch, Bethesda, MD, USA
| | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | - Pamela K. Shiao
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Shu-Fen Wung
- College of Nursing The University of Arizona, Tucson, AZ, USA
| | - Marilyn J. Hammer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA, USA
| | - Joachim G. Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Bernice Coleman
- Nursing Research and Development, Cedars-Sinai Medical Center, Los Angeles, USA
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7
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Goldenthal IL, Sciacca RR, Riga T, Bakken S, Baumeister M, Biviano AB, Dizon JM, Wang D, Wang KC, Whang W, Hickey KT, Garan H. Recurrent atrial fibrillation/flutter detection after ablation or cardioversion using the AliveCor KardiaMobile device: iHEART results. J Cardiovasc Electrophysiol 2019; 30:2220-2228. [PMID: 31507001 PMCID: PMC6819233 DOI: 10.1111/jce.14160] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/15/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study evaluated the impact of daily ECG (electrocardiogram) self-recordings on time to documented recurrent atrial fibrillation (AF) or atrial flutter (AFL) and time to treatment of recurrent arrhythmia in patients undergoing catheter radiofrequency ablation (RFA) or direct current cardioversion (DCCV) for AF/AFL. BACKGROUND AF recurrence rates after RFA and DCCV are 20% to 45% and 60% to 80%, respectively. Randomized trials comparing mobile ECG devices to standard of care have not been performed in an AF/AFL population after treatment. METHODS Of 262 patients consented, 238 were randomized to either standard of care (123) or to receive the iHEART intervention (115). Patients in the intervention group were provided with and trained to use an AliveCor KardiaMobile ECG monitor, and were instructed to take and transmit daily ECG recordings. Data were collected from transmitted ECG recordings and patients' electronic health records. RESULTS In a multivariate Cox model, the likelihood of recurrence detection was greater in the intervention group (hazard ratio = 1.56, 95% confidence interval [CI]: 1.06-2.30, P = .024). Hazard ratios did not differ significantly for RFA and DCCV procedures. Recurrence during the first month after ablation strongly predicted later recurrence (hazard ratio = 4.53, 95% CI: 2.05-10.00, P = .0006). Time from detection to treatment was shorter for the control group (hazard ratio = 0.33, 95% CI: 0.57-2.92, P < .0001). CONCLUSIONS The use of mobile ECG self-recording devices allows for earlier detection of AF/AFL recurrence and may empower patients to engage in shared health decision-making.
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Affiliation(s)
- Isaac L. Goldenthal
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| | | | - Teresa Riga
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| | | | - Maurita Baumeister
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| | - Angelo B. Biviano
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| | - Jose M. Dizon
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| | - Daniel Wang
- Department of Medicine ‐ CardiologyWhite Plains HospitalNew YorkNew York
| | - Ketty C Wang
- Columbia University School of NursingNew YorkNew York
| | - William Whang
- Department of Medicine ‐ CardiologyIcahn School of MedicineNew YorkNew York
| | | | - Hasan Garan
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
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Starkweather A, Jacelon CS, Bakken S, Barton DL, DeVito Dabbs A, Dorsey SG, Guthrie BJ, Heitkemper MM, Hickey KT, Kelechi TJ, Kim MT, Marquard J, Moore SM, Redeker NS, Schiffman RF, Ward TM, Adams LS, Kehl KA, Miller JL. The Use of Technology to Support Precision Health in Nursing Science. J Nurs Scholarsh 2019; 51:614-623. [PMID: 31566870 DOI: 10.1111/jnu.12518] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE This article outlines how current nursing research can utilize technology to advance symptom and self-management science for precision health and provides a roadmap for the development and use of technologies designed for this purpose. APPROACH At the 2018 annual conference of the National Institute of Nursing Research (NINR) Research Centers, nursing and interdisciplinary scientists discussed the use of technology to support precision health in nursing research projects and programs of study. Key themes derived from the presentations and discussion were summarized to create a proposed roadmap for advancement of technologies to support health and well-being. CONCLUSIONS Technology to support precision health must be centered on the user and designed to be desirable, feasible, and viable. The proposed roadmap is composed of five iterative steps for the development, testing, and implementation of technology-based/enhanced self-management interventions. These steps are (a) contextual inquiry, focused on the relationships among humans, and the tools and equipment used in day-to-day life; (b) value specification, translating end-user values into end-user requirements; (c) design, verifying that the technology/device can be created and developing the prototype(s); (d) operationalization, testing the intervention in a real-world setting; and (e) summative evaluation, collecting and analyzing viability metrics, including process data, to evaluate whether the technology and the intervention have the desired effect. CLINICAL RELEVANCE Interventions using technology are increasingly popular in precision health. Use of a standard multistep process for the development and testing of technology is essential.
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Affiliation(s)
- Angela Starkweather
- Mu, Associate Dean, Professor, University of Connecticut, School of Nursing, Storrs, CT, USA
| | - Cynthia S Jacelon
- Beta Zeta, Interim Associate Dean for Academic Affairs, Professor, PhD Program Director, University of Massachusetts Amherst, College of Nursing, Amherst, MA, USA
| | - Suzanne Bakken
- Alpha Zeta, Professor of Biomedical Informatics, Alumni Professor of the School of Nursing, Columbia University, New York, NY, USA
| | - Debra L Barton
- Professor, Associate Dean for Research and Rackham Graduate Studies, Department of Systems, Populations and Leadership, University of Michigan, School of Nursing, Ann Arbor, MI, USA
| | - Annette DeVito Dabbs
- Eta, Professor, Department Chair Acute & Tertiary Care, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | - Susan G Dorsey
- Pi, Professor and Chair, Department of Pain and Translational Symptom Science, School of Nursing, and Professor, Department of Anesthesiology, School of Medicine, and Professor, Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Barbara J Guthrie
- Professor & Associate Dean for Faculty, Bouve College of Health Sciences, School of Nursing, Northeastern University, Boston, MA, USA
| | - Margaret M Heitkemper
- The Elizabeth Sterling Soule Endowed Chair in Nursing, Affiliate Professor, Division of Gastroenterology, School of Medicine, University of Washington, School of Nursing, Seattle, WA, USA
| | - Kathleen T Hickey
- Alpha Eta, Professor of Nursing at Columbia University Medical Center, Columbia University, School of Nursing, New York, NY, USA
| | - Teresa J Kelechi
- Gamma Omicron, David and Margaret Clare Endowed Chair and Professor, Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Miyong T Kim
- Epsilon Theta, Professor, Associate Vice President for Community Health Engagement, LaQuinta Centennial Endowed Professor, University of Texas-Austin, School of Nursing, Austin, TX
| | - Jenna Marquard
- Associate Professor, Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Shirley M Moore
- Delta Xi, The Edward J. and Louise Mellen Professor of Nursing, Distinguished University Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Nancy S Redeker
- Delta Mu, Beatrice Renfield Term Professor of Nursing, Yale School of Nursing, Orange, CT, USA
| | - Rachel F Schiffman
- Alpha Chi and Eta Nu, Associate Dean and Professor, University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, WI, USA
| | - Teresa M Ward
- Alpha Eta and Psi at Large, Professor, University of Washington, School of Nursing, Seattle, WA, USA
| | - Lynn S Adams
- Health Scientist Administrator, National Institute of Nursing Research, Bethesda, MD, USA
| | - Karen A Kehl
- Beta Eta at Large, Health Scientist Administrator, National Institute of Nursing Research, Bethesda, MD, USA
| | - Jeri L Miller
- Chief, OEPCR and NINR Research Centers Program, National Institute of Nursing Research, Bethesda, MD, USA
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9
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Bakken S, Arcia A, Koleck T, Merrill JA, Hickey KT. Informatics and Data Science for the Precision in Symptom Self-Management Center. Stud Health Technol Inform 2019; 264:1827-1828. [PMID: 31438363 DOI: 10.3233/shti190668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goal of the Precision in Symptom Self-Management (PriSSM) Center is to advance the science of symptom self-management for Latinos through a social ecological lens that takes into account variability in individual, interpersonal, organizational, and environmental factors across the life course. Informatics and data science methods are foundational to PriSSM's research activities including its pilot studies and research resources. This work highlights three areas: Latino Data Repository, Information Visualization, and Center Evaluation.
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Affiliation(s)
- Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA.,Data Science Institute, Columbia University, New York, New York, USA
| | - Adriana Arcia
- School of Nursing, Columbia University, New York, New York, USA
| | - Theresa Koleck
- School of Nursing, Columbia University, New York, New York, USA
| | - Jacqueline A Merrill
- School of Nursing, Columbia University, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA.,Data Science Institute, Columbia University, New York, New York, USA
| | - Kathleen T Hickey
- School of Nursing, Columbia University, New York, New York, USA.,Department of Medicine, Columbia University, New York, New York, USA
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10
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Musunuru K, Arora P, Cooke JP, Ferguson JF, Hershberger RE, Hickey KT, Lee JM, Lima JAC, Loscalzo J, Pereira NL, Russell MW, Shah SH, Sheikh F, Wang TJ, MacRae CA. Interdisciplinary Models for Research and Clinical Endeavors in Genomic Medicine: A Scientific Statement From the American Heart Association. Circ Genom Precis Med 2019; 11:e000046. [PMID: 29844141 DOI: 10.1161/hcg.0000000000000046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The completion of the Human Genome Project has unleashed a wealth of human genomics information, but it remains unclear how best to implement this information for the benefit of patients. The standard approach of biomedical research, with researchers pursuing advances in knowledge in the laboratory and, separately, clinicians translating research findings into the clinic as much as decades later, will need to give way to new interdisciplinary models for research in genomic medicine. These models should include scientists and clinicians actively working as teams to study patients and populations recruited in clinical settings and communities to make genomics discoveries-through the combined efforts of data scientists, clinical researchers, epidemiologists, and basic scientists-and to rapidly apply these discoveries in the clinic for the prediction, prevention, diagnosis, prognosis, and treatment of cardiovascular diseases and stroke. The highly publicized US Precision Medicine Initiative, also known as All of Us, is a large-scale program funded by the US National Institutes of Health that will energize these efforts, but several ongoing studies such as the UK Biobank Initiative; the Million Veteran Program; the Electronic Medical Records and Genomics Network; the Kaiser Permanente Research Program on Genes, Environment and Health; and the DiscovEHR collaboration are already providing exemplary models of this kind of interdisciplinary work. In this statement, we outline the opportunities and challenges in broadly implementing new interdisciplinary models in academic medical centers and community settings and bringing the promise of genomics to fruition.
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Caceres BA, Hickey KT, Heitkemper EM, Hughes TL. An intersectional approach to examine sleep duration in sexual minority adults in the United States: findings from the Behavioral Risk Factor Surveillance System. Sleep Health 2019; 5:621-629. [PMID: 31377249 DOI: 10.1016/j.sleh.2019.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 05/20/2019] [Accepted: 06/18/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Investigate sexual identity differences in sleep duration and the multiplicative effect of sexual identity and race/ethnicity among US adults. DESIGN Cross-sectional. PARTICIPANTS The sample consisted of 267,906 participants from the Behavioral Risk Factor Surveillance System. MEASUREMENTS Sleep duration was categorized as very short (≤4 hours), short (5-6 hours), adequate (7-8 hours), or long (≥9 hours). Sex-stratified multinomial logistic regressions were used to examine sexual identity differences in sleep duration. We then examined sleep duration by comparing sexual minorities to (1) same-race/-ethnicity heterosexuals and (2) White participants with the same sexual identity. RESULTS Sexual minority women had higher odds of very short sleep compared to heterosexual women, regardless of race/ethnicity. Black gay men had higher rates of very short sleep but lower rates of long sleep relative to Black heterosexual men. Latino and Asian/Pacific Islander bisexual men reported higher rates of short sleep than their heterosexual counterparts. Black lesbian and other-race bisexual women were more likely to have very short sleep than their heterosexual peers. Black lesbian women also had higher rates of long sleep. Analyses examining racial/ethnic differences by sexual identity found that Black and Latino gay men reported higher rates of very short sleep compared to White gay men. Black bisexual women had higher rates of short sleep duration than White bisexual women. CONCLUSIONS More research is needed to understand how to promote sleep health among sexual minorities, particularly racial/ethnic minorities, and the impact of inadequate sleep duration on health outcomes in this population.
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Affiliation(s)
- Billy A Caceres
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032.
| | - Kathleen T Hickey
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
| | - Elizabeth M Heitkemper
- Department of Biomedical Informatics, Columbia University, 622 W 168th St, PH20, New York, NY 10032
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
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Hickey KT, Bakken S, Byrne MW, Bailey DCE, Demiris G, Docherty SL, Dorsey SG, Guthrie BJ, Heitkemper MM, Jacelon CS, Kelechi TJ, Moore SM, Redeker NS, Renn CL, Resnick B, Starkweather A, Thompson H, Ward TM, McCloskey DJ, Austin JK, Grady PA. Precision health: Advancing symptom and self-management science. Nurs Outlook 2019; 67:462-475. [PMID: 30795850 PMCID: PMC6688754 DOI: 10.1016/j.outlook.2019.01.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Precision health considers individual lifestyle, genetics, behaviors, and environment context and facilitates interventions aimed at helping individuals achieve well-being and optimal health. PURPOSE To present the Nursing Science Precision Health (NSPH) Model and describe the integration of precision health concepts within the domains of symptom and self-management science as reflected in the National Institute of Nursing Research P30 Centers of Excellence and P20 Exploratory Centers. METHODS Center members developed the NSPH Model and the manuscript based on presentations and discussions at the annual NINR Center Directors Meeting and in follow-up telephone meetings. DISCUSSION The NSPH Model comprises four precision components (measurement; characterization of phenotype including lifestyle and environment; characterization of genotype and other biomarkers; and intervention target discovery, design, and delivery) that are underpinned by an information and data science infrastructure. CONCLUSION Nurse scientist leadership is necessary to realize the vision of precision health as reflected in the NSPH Model.
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Affiliation(s)
- Kathleen T Hickey
- Cardiac Electrophysiology, Columbia University School of Nursing, Columbia University Medical Center, New York, NY
| | - Suzanne Bakken
- School of Nursing and Department of Biomedical Informatics, Columbia University, New York, NY.
| | - Mary W Byrne
- Department of Anesthesiology, Columbia University School of Nursing, Columbia University College of Physicians and Surgeons, New York, NY; Center for Children and Families, Columbia University School of Nursing, Columbia University College of Physicians and Surgeons, New York, NY
| | | | - George Demiris
- University of Pennsylvania, School of Nursing, Philadelphia, PA
| | | | - Susan G Dorsey
- Department of Pain and Translational Symptom Science, School of Medicine, University of Maryland Baltimore, Baltimore, MD; Department of Anesthesiology, School of Medicine, University of Maryland Baltimore, Baltimore, MD
| | - Barbara J Guthrie
- Bouve College of Health Sciences, Northeastern University School of Nursing, Boston, MA
| | - Margaret M Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA
| | | | - Teresa J Kelechi
- Medical University of South Carolina, College of Nursing, Charleston, SC
| | - Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Nancy S Redeker
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT
| | - Cynthia L Renn
- Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD
| | - Barbara Resnick
- Organizational Systems and Adult Health Nursing Department, University of Maryland Baltimore, Baltimore, MD
| | | | | | - Teresa M Ward
- University of Washington School of Nursing, Seattle, WA
| | | | - Joan K Austin
- National Institute of Nursing Research, Bethesda, MD; Indiana University School of Nursing, Bloomington, IN
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Abstract
Background: Sexual minority women (SMW; such as lesbian, bisexual, and mostly lesbian) exhibit excess cardiometabolic risk, yet factors that contribute to cardiometabolic risk in this population are poorly understood. Trauma exposure has been posited as a contributor to cardiometabolic risk in SMW. Materials and Methods: An analysis of data from Wave 3 of the Chicago Health and Life Experiences of Women Study was conducted. Multinomial logistic regression was used to examine correlates of trauma. Next, multiple logistic regression was used to examine the associations of different forms of trauma throughout the life course (childhood, adulthood, and lifetime), with psychosocial and behavioral risk factors and self-reported cardiometabolic risk (obesity, hypertension, and diabetes) in SMW adjusted for relevant covariates. Results: A total of 547 participants were included. Older age was associated with higher rates of childhood and adulthood trauma. SMW of color reported higher rates of childhood trauma than white participants. Higher education was associated with lower rates of adulthood trauma. All forms of trauma were associated with probable diagnosis of post-traumatic stress disorder and lower perceived social support. Adult trauma was associated with anxiety, whereas childhood and lifetime trauma were associated with higher odds of depression. No significant associations between forms of trauma and behavioral risk factors were noted, except that childhood trauma was associated with higher odds of past-3-month overeating. Logistic regression models examining the association of trauma and cardiometabolic risk revealed that childhood trauma was an independent risk factor for diabetes. Adulthood and lifetime trauma were significantly associated with obesity and hypertension. Conclusions: Trauma emerged as an independent risk factor for cardiometabolic risk in SMW. These findings suggest that clinicians should screen for trauma as a cardiovascular risk factor in SMW, with special attention to SMW most at risk.
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Affiliation(s)
| | | | | | - Tonda L Hughes
- Columbia University School of Nursing, New York, New York
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Gopinathannair R, Cornwell WK, Dukes JW, Ellis CR, Hickey KT, Joglar JA, Pagani FD, Roukoz H, Slaughter MS, Patton KK. Device Therapy and Arrhythmia Management in Left Ventricular Assist Device Recipients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e967-e989. [DOI: 10.1161/cir.0000000000000673] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure with reduced ejection fraction. Although these devices effectively improve survival, atrial and ventricular arrhythmias are common, predispose these patients to additional risk, and complicate patient management. However, there is no consensus on best practices for the medical management of these arrhythmias or on the optimal timing for procedural interventions in patients with refractory arrhythmias. Although the vast majority of these patients have preexisting cardiovascular implantable electronic devices or cardiac resynchronization therapy, given the natural history of heart failure, it is common practice to maintain cardiovascular implantable electronic device detection and therapies after LVAD implantation. Available data, however, are conflicting on the efficacy of and optimal device programming after LVAD implantation. Therefore, the primary objective of this scientific statement is to review the available evidence and to provide guidance on the management of atrial and ventricular arrhythmias in this unique patient population, as well as procedural interventions and cardiovascular implantable electronic device and cardiac resynchronization therapy programming strategies, on the basis of a comprehensive literature review by electrophysiologists, heart failure cardiologists, cardiac surgeons, and cardiovascular nurse specialists with expertise in managing these patients. The structure and design of commercially available LVADs are briefly reviewed, as well as clinical indications for device implantation. The relevant physiological effects of long-term exposure to continuous-flow circulatory support are highlighted, as well as the mechanisms and clinical significance of arrhythmias in the setting of LVAD support.
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Abstract
Objectives: This study proposed to examine sexual identity differences in sleep duration and sleep health (use of sleep medications or sedatives, trouble sleeping, and diagnosis of sleeping disorders) among American adults. Methods: Data from the National Health and Nutrition Examination Survey (2005-2014) were used. Sex-stratified multiple logistic regression models were used to compare sleep duration and sleep health between sexual minority (gay/lesbian, bisexual, not-sure) and heterosexual participants, adjusted for predetermined covariates. Heterosexual participants were the reference group. Results: The analytic sample included 16,332 participants. No differences in sleep duration or sleep health were detected when gay and bisexual men were compared to heterosexual men. Not-sure men had significantly higher rates of adequate sleep duration than heterosexual men (aOR 2.35 [1.16-4.79]. Compared to heterosexual women, bisexual women reported higher rates of short sleep duration (aOR 1.29 [95% CI = 1.01-1.65]). Bisexual women were also more likely than heterosexual women to use sleep medication or sedatives (aOR 1.85 [95% CI = 1.19-2.88]), to have ever told a health professional they had trouble sleeping (aOR 1.64 [95% CI = 1.15-2.34), and to have been told by a health professional they had a sleeping disorder (aOR 2.38 [95% CI = 1.50-3.80). Lesbian and not-sure women exhibited no differences in sleep duration or sleep health compared to heterosexual women. Conclusions: Findings suggest there is a need to promote sleep health and further investigate sleeping disorders among bisexual women. Additional research should incorporate objective measures of sleep health and examine whether sleep health is associated with chronic disease in sexual minorities.
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Affiliation(s)
- Billy A. Caceres
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032
| | - Kathleen T. Hickey
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032,
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Homan EA, Reyes MV, Hickey KT, Morrow JP. Clinical Overview of Obesity and Diabetes Mellitus as Risk Factors for Atrial Fibrillation and Sudden Cardiac Death. Front Physiol 2019; 9:1847. [PMID: 30666210 PMCID: PMC6330323 DOI: 10.3389/fphys.2018.01847] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022] Open
Abstract
The epidemics of obesity and diabetes mellitus are associated with an increased incidence of both atrial fibrillation (AF), the most common sustained arrhythmia in adults, and sudden cardiac death (SCD). Obesity and DM are known to have adverse effects on cardiac structure and function. The pathologic mechanisms are thought to involve cardiac tissue remodeling, metabolic dysregulation, inflammation, and oxidative stress. Clinical data suggest that left atrial size, epicardial fat pad thickness, and other modifiable risk factors such as hypertension, glycemic control, and obstructive sleep apnea may mediate the association with AF. Data from human atrial tissue biopsies demonstrate alterations in atrial lipid content and evidence of mitochondrial dysfunction. With respect to ventricular arrhythmias, abnormalities such as long QT syndrome, frequent premature ventricular contractions, and left ventricular hypertrophy with diastolic dysfunction are commonly observed in obese and diabetic humans. The increased risk of SCD in this population may also be related to excessive cardiac lipid deposition and insulin resistance. While nutritional interventions have had limited success, perhaps due to poor long-term compliance, weight loss and improved cardiorespiratory fitness may reduce the frequency and severity of AF.
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Affiliation(s)
- Edwin A Homan
- Columbia University Medical Center, New York, NY, United States
| | - Michael V Reyes
- Columbia University Medical Center, New York, NY, United States
| | | | - John P Morrow
- Columbia University Medical Center, New York, NY, United States
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Caceres BA, Makarem N, Hickey KT, Hughes TL. Cardiovascular Disease Disparities in Sexual Minority Adults: An Examination of the Behavioral Risk Factor Surveillance System (2014-2016). Am J Health Promot 2018; 33:576-585. [PMID: 30392384 DOI: 10.1177/0890117118810246] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Investigate sexual orientation differences in cardiovascular disease risk and cardiovascular disease. DESIGN Cross-sectional. SETTING The 2014 to 2016 Behavioral Risk Factor Surveillance System. PARTICIPANTS A total of 395 154 participants. MEASURES The exposure measure was sexual orientation. Self-report of cardiovascular disease risk factors and cardiovascular disease was assessed. ANALYSIS Sex-stratified logistic regression analyses to examine sexual orientation differences in cardiovascular disease risk and cardiovascular disease (heterosexuals = reference group). RESULTS Sexual minority men reported higher rates of mental distress (gay adjusted odds ratio [AOR]: 1.59; bisexual AOR: 1.88) and lifetime depression (gay AOR: 2.48; bisexual: AOR 2.67). Gay men reported higher rates of current smoking (AOR: 1.28), but lower rates of obesity (AOR: 0.82) compared to heterosexual men. Sexual minority women reported higher rates of several cardiovascular risk factors including mental distress (lesbian AOR: 1.37; bisexual AOR: 2.33), lifetime depression (lesbian AOR: 1.96; bisexual AOR: 3.26), current smoking (lesbian AOR: 1.65; bisexual AOR: 1.29), heavy drinking (lesbian AOR: 2.01; bisexual AOR: 2.04), and obesity (lesbian AOR: 1.50; bisexual AOR: 1.29), but were more likely to exercise than heterosexual women (lesbian AOR: 1.34; bisexual AOR: 1.24). Lesbian women reported lower rates of heart attack (AOR: 0.62), but bisexual women had higher rates of stroke than heterosexual women (AOR: 1.46). CONCLUSIONS Findings can inform the development of prevention efforts to reduce cardiovascular disease risk in sexual minorities.
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Affiliation(s)
- Billy A Caceres
- 1 Columbia University School of Nursing, New York City, NY, USA
| | - Nour Makarem
- 2 Division of Cardiology, Columbia University Medical Center, New York City, NY, USA
| | | | - Tonda L Hughes
- 1 Columbia University School of Nursing, New York City, NY, USA
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18
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Abstract
The discovery of the human genome has ushered in a new era of molecular testing, advancing our knowledge and ability to identify cardiac channelopathies. Genetic variations can affect the opening and closing of the potassium, sodium, and calcium channels, resulting in arrhythmias and sudden death. Cardiac arrhythmias caused by disorders of ion channels are known as cardiac channelopathies. Nurses are important members of many interdisciplinary teams and must have a general understanding of the pathophysiology of the most commonly encountered cardiac channelopathies, electrocardiogram characteristics, approaches to treatment, and care for patients and their families. This article provides an overview of cardiac channelopathies that nurses might encounter in an array of clinical and research settings, focusing on the clinically relevant features of long QT syndrome, short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and arrhythmogenic right ventricular dysplasia/cardiomyopathy.
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Affiliation(s)
- Kathleen T Hickey
- Kathleen T. Hickey is Professor of Nursing, Columbia University Medical Center, 622 W 168th St, New York, NY 10032 . Amir Elzomor is a premedical student at the Albert Dorman Honors College at the New Jersey Institute of Technology, Newark, New Jersey
| | - Amir Elzomor
- Kathleen T. Hickey is Professor of Nursing, Columbia University Medical Center, 622 W 168th St, New York, NY 10032 . Amir Elzomor is a premedical student at the Albert Dorman Honors College at the New Jersey Institute of Technology, Newark, New Jersey
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19
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Reading M, Baik D, Beauchemin M, Hickey KT, Merrill JA. Factors Influencing Sustained Engagement with ECG Self-Monitoring: Perspectives from Patients and Health Care Providers. Appl Clin Inform 2018; 9:772-781. [PMID: 30304745 PMCID: PMC6179719 DOI: 10.1055/s-0038-1672138] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/19/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patient-generated health data (PGHD) collected digitally with mobile health (mHealth) technology has garnered recent excitement for its potential to improve precision management of chronic conditions such as atrial fibrillation (AF), a common cardiac arrhythmia. However, sustained engagement is a major barrier to collection of PGHD. Little is known about barriers to sustained engagement or strategies to intervene upon engagement through application design. OBJECTIVE This article investigates individual patient differences in sustained engagement among individuals with a history of AF who are self-monitoring using mHealth technology. METHODS This qualitative study involved patients, health care providers, and research coordinators previously involved in a randomized, controlled trial involving electrocardiogram (ECG) self-monitoring of AF. Patients were adults with a history of AF randomized to the intervention arm of this trial who self-monitored using ECG mHealth technology for 6 months. Semistructured interviews and focus groups were conducted separately with health care providers and research coordinators, engaged patients, and unengaged patients. A validated model of sustained engagement, an adapted unified theory of acceptance and use of technology (UTAUT), guided data collection, and analysis through directed content analysis. RESULTS We interviewed 13 patients (7 engaged, 6 unengaged), 6 providers, and 2 research coordinators. In addition to finding differences between engaged and unengaged patients within each predictor in the adapted UTAUT model (perceived ease of use, perceived usefulness, facilitating conditions), four additional factors were identified as being related to sustained engagement in this population. These are: (1) internal motivation to manage health, (2) relationship with health care provider, (3) supportive environments, and (4) feedback and guidance. CONCLUSION Although it required some modification, the adapted UTAUT model was useful in understanding of the parameters of sustained engagement. The findings of this study provide initial requirement specifications for the design of applications that engage patients in this unique population of adults with AF.
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Affiliation(s)
- Meghan Reading
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, United States
| | - Dawon Baik
- School of Nursing, Columbia University, New York, New York, United States
| | - Melissa Beauchemin
- School of Nursing, Columbia University, New York, New York, United States
| | - Kathleen T. Hickey
- School of Nursing, Columbia University, New York, New York, United States
| | - Jacqueline A. Merrill
- School of Nursing, Columbia University, New York, New York, United States
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
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20
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Abstract
There are limited data on racial and ethnic disparities related to quality of life (QoL) and health literacy in adults with multiple cardiac conditions. This article evaluates the relationship between health literacy and QoL among patients with cardiac conditions in a multiethnic community in New York City.
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Affiliation(s)
- Kathleen T Hickey
- Kathleen T. Hickey is a professor of nursing and an NP at Columbia University School of Nursing, New York, N.Y. Ruth M. Masterson Creber is an associate research scientist at Columbia University School of Nursing, New York, N.Y. Meghan Reading is a doctoral student at Columbia University School of Nursing, New York, N.Y. Robert R. Sciacca is a variable hours officer at Columbia University, New York, N.Y. Teresa C. Riga is a clinical research coordinator at Columbia University Medical Center, New York, N.Y. Ashton P. Frulla is a dermatology NP in New York, N.Y. Jesus M. Casida is an assistant professor at the University of Michigan, School of Nursing, Ann Arbor, Mich
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21
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Hickey KT, Taylor JY, Barr TL, Hauser NR, Jia H, Riga TC, Katapodi M. Nursing genetics and genomics: The International Society of Nurses in Genetics (ISONG) survey. Nurse Educ Today 2018; 63:12-17. [PMID: 29407254 PMCID: PMC6461386 DOI: 10.1016/j.nedt.2018.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/04/2018] [Indexed: 05/02/2023]
Abstract
BACKGROUND The International Society of Nursing in Genetics (ISONG) fosters scientific and professional development in the discovery, interpretation, and application of genomic information in nursing research, education, and clinical practice. OBJECTIVES Assess genomic-related activities of ISONG members in research, education and practice, and competencies to serve as global leaders in genomics. DESIGN Cross-sectional survey (21-items) assessing genomic-related training, knowledge, and practice. SETTINGS An email invitation included a link to the anonymous online survey. PARTICIPANTS All ISONG members (n = 350 globally) were invited to partake. METHODS Descriptive statistics and Wilcoxon Rank Sum Test for between-group comparisons. RESULTS Respondents (n = 231, 66%), were mostly Caucasian, female, with a master's degree or higher. Approximately 70% wanted to incorporate genomics in research, teaching, and practice. More than half reported high genomic competency, and over 95% reported that genomics is relevant the next 5 years. CONCLUSIONS Findings provide a foundation for developing additional educational programs for an international nursing workforce in genomics.
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Affiliation(s)
- Kathleen T Hickey
- Columbia University School of Nursing, 622 W. 168th St., New York, NY 10032, United States.
| | - Jacquelyn Y Taylor
- Yale School of Nursing, 400 West Campus Drive, Orange, CT 06477, United States.
| | - Taura L Barr
- Valtari Bio Inc., United States; Case Western Reserve University, 8 Medical Center Drive, Morgantown, WV 26506, United States.
| | - Nicole R Hauser
- Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, United States.
| | - Haomiao Jia
- Columbia University School of Nursing, 617 W. 168th St., New York, NY 10032, United States.
| | - Teresa C Riga
- Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, United States.
| | - Maria Katapodi
- Faculty of Medicine, University of Basel, Switzerland; University of Michigan School of Nursing, 4056 Basel, Switzerland.
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Page GG, Corwin EJ, Dorsey SG, Redeker NS, McCloskey DJ, Austin JK, Guthrie BJ, Moore SM, Barton D, Kim MT, Docherty SL, Waldrop-Valverde D, Bailey DE, Schiffman RF, Starkweather A, Ward TM, Bakken S, Hickey KT, Renn CL, Grady P. Biomarkers as Common Data Elements for Symptom and Self-Management Science. J Nurs Scholarsh 2018; 50:276-286. [PMID: 29575635 DOI: 10.1111/jnu.12378] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Biomarkers as common data elements (CDEs) are important for the characterization of biobehavioral symptoms given that once a biologic moderator or mediator is identified, biologically based strategies can be investigated for treatment efforts. Just as a symptom inventory reflects a symptom experience, a biomarker is an indicator of the symptom, though not the symptom per se. The purposes of this position paper are to (a) identify a "minimum set" of biomarkers for consideration as CDEs in symptom and self-management science, specifically biochemical biomarkers; (b) evaluate the benefits and limitations of such a limited array of biomarkers with implications for symptom science; (c) propose a strategy for the collection of the endorsed minimum set of biologic samples to be employed as CDEs for symptom science; and (d) conceptualize this minimum set of biomarkers consistent with National Institute of Nursing Research (NINR) symptoms of fatigue, depression, cognition, pain, and sleep disturbance. DESIGN AND METHODS From May 2016 through January 2017, a working group consisting of a subset of the Directors of the NINR Centers of Excellence funded by P20 or P30 mechanisms and NINR staff met bimonthly via telephone to develop this position paper suggesting the addition of biomarkers as CDEs. The full group of Directors reviewed drafts, provided critiques and suggestions, recommended the minimum set of biomarkers, and approved the completed document. Best practices for selecting, identifying, and using biological CDEs as well as challenges to the use of biological CDEs for symptom and self-management science are described. Current platforms for sample outcome sharing are presented. Finally, biological CDEs for symptom and self-management science are proposed along with implications for future research and use of CDEs in these areas. FINDINGS The recommended minimum set of biomarker CDEs include pro- and anti-inflammatory cytokines, a hypothalamic-pituitary-adrenal axis marker, cortisol, the neuropeptide brain-derived neurotrophic factor, and DNA polymorphisms. CONCLUSIONS It is anticipated that this minimum set of biomarker CDEs will be refined as knowledge regarding biologic mechanisms underlying symptom and self-management science further develop. The incorporation of biological CDEs may provide insights into mechanisms of symptoms, effectiveness of proposed interventions, and applicability of chosen theoretical frameworks. Similarly, as for the previously suggested NINR CDEs for behavioral symptoms and self-management of chronic conditions, biological CDEs offer the potential for collaborative efforts that will strengthen symptom and self-management science. CLINICAL RELEVANCE The use of biomarker CDEs in biobehavioral symptoms research will facilitate the reproducibility and generalizability of research findings and benefit symptom and self-management science.
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Affiliation(s)
- Gayle G Page
- Nu Beta, Professor and Independence Foundation Chair in Nursing Education, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Elizabeth J Corwin
- Alpha Epsilon, Professor and Associate Dean for Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Susan G Dorsey
- Pi, Professor and Chair, Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD, USA
| | - Nancy S Redeker
- Delta Mu, Beatrice Renfield Term Professor of Nursing, Professor, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT
| | - Donna Jo McCloskey
- Clinical Advisor, Contractor, National Institute of Nursing Research, NIH, Bethesda, MD, USA
| | - Joan K Austin
- Alpha, Distinguished Professor Emerita, Indiana University School of Nursing, Indianapolis, IN and National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Barbara J Guthrie
- Professor, Director of the PhD Program, Northeastern University, Boston, MA, USA
| | - Shirley M Moore
- Delta Xi, Edward J. and Louise Mellen Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Debra Barton
- Mary Lou Willard French Professor of Oncology Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Miyong T Kim
- Epsilon Theta, Professor, Associate Vice President for Community Health Engagement, University of Texas at Austin, Austin, TX, USA
| | - Sharron L Docherty
- Iota Omicron, Associate Professor, School of Nursing; Associate Professor, Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Drenna Waldrop-Valverde
- Associate Professor and Assistant Dean for Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Donald E Bailey
- Beta Epsilon and Theta Iota, Associate Professor, Duke University, Durham, NC, USA
| | - Rachel F Schiffman
- Alpha Chi and Eta Nu, Professor and Associate Dean for Research, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Teresa M Ward
- Psi-at-Large, Associate Professor, University of Washington School of Nursing, Seattle, WA, USA
| | - Suzanne Bakken
- Alpha Eta, The Alumni Professor of Nursing and Professor of Biomedical Informatics Director, Columbia University, New York, NY, USA
| | - Kathleen T Hickey
- Alpha Eta, Professor of Nursing at Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Cynthia L Renn
- Pi, Associate Professor Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD, USA
| | - Patricia Grady
- Tau, Director, National Institute of Nursing Research, National Institutes or Health, Bethesda, MD, USA
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Hickey KT, Sciacca RR, Chen B, Drew BJ, Pickham D, Carter EV, Castillo C, Doering LV. Electrocardiographic Correlates of Acute Allograft Rejection Among Heart Transplant Recipients. Am J Crit Care 2018; 27:145-150. [PMID: 29496772 DOI: 10.4037/ajcc2018862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Acute allograft rejection appears to be associated with increases in QT/QTc intervals. OBJECTIVES To determine the relationship between acute allograft rejection and electrocardiogram changes in patients undergoing an orthotopic heart transplant. METHODS The study population comprised 220 adult patients undergoing heart transplant and enrolled in the NEW HEART study. Electrocardiograms obtained within 72 hours of endomyocardial biopsy were analyzed; electrocardiograms obtained fewer than 10 days after transplant surgery were excluded. Repeated-measures analysis was performed with statistical models including effects for rejection severity (mild and moderate/severe) and time trends independent of rejection status. RESULTS The 151 male and 69 female transplant recipients (mean age [SD], 54 [13] years) had 969 biopsy/electrocardiogram pairs: 677 with no rejection, 280 with mild rejection, and 12 with moderate/severe rejection. Moderate to severe organ rejection was associated with significant increases in QRS duration (P < .001), QT (P = .009), QTc (P = .003), and PR interval (P = .03), as well as increased odds of right bundle block branch (P = .002) and fascicular block (P = .009) occurring. CONCLUSIONS Moderate to severe acute allograft rejection was associated with electrocardiographic changes after transplant surgery. Studies are needed to assess the value of computerized electrocardiogram measurement algorithms for detecting acute allograft rejection.
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Affiliation(s)
- Kathleen T Hickey
- Kathleen T. Hickey is a professor of nursing, Columbia University School of Nursing, and a nurse practitioner, Columbia University Division of Cardiology, New York, New York. Robert R. Sciacca is a statistician, and Carmen Castillo is a clinical research coordinator, Columbia University School of Nursing. Belinda Chen is a project director and Lynn V. Doering is a professor of nursing, University of California, Los Angeles, School of Nursing, Los Angeles, California. Barbara J. Drew is a professor of nursing, University of California, San Francisco, School of Nursing, San Francisco, California. David Pickham is a clinical assistant professor, Stanford University School of Medicine, Stanford, California. Erik V. Carter is an assistant professor, Wayne State University, Detroit, Michigan.
| | - Robert R Sciacca
- Kathleen T. Hickey is a professor of nursing, Columbia University School of Nursing, and a nurse practitioner, Columbia University Division of Cardiology, New York, New York. Robert R. Sciacca is a statistician, and Carmen Castillo is a clinical research coordinator, Columbia University School of Nursing. Belinda Chen is a project director and Lynn V. Doering is a professor of nursing, University of California, Los Angeles, School of Nursing, Los Angeles, California. Barbara J. Drew is a professor of nursing, University of California, San Francisco, School of Nursing, San Francisco, California. David Pickham is a clinical assistant professor, Stanford University School of Medicine, Stanford, California. Erik V. Carter is an assistant professor, Wayne State University, Detroit, Michigan
| | - Belinda Chen
- Kathleen T. Hickey is a professor of nursing, Columbia University School of Nursing, and a nurse practitioner, Columbia University Division of Cardiology, New York, New York. Robert R. Sciacca is a statistician, and Carmen Castillo is a clinical research coordinator, Columbia University School of Nursing. Belinda Chen is a project director and Lynn V. Doering is a professor of nursing, University of California, Los Angeles, School of Nursing, Los Angeles, California. Barbara J. Drew is a professor of nursing, University of California, San Francisco, School of Nursing, San Francisco, California. David Pickham is a clinical assistant professor, Stanford University School of Medicine, Stanford, California. Erik V. Carter is an assistant professor, Wayne State University, Detroit, Michigan
| | - Barbara J Drew
- Kathleen T. Hickey is a professor of nursing, Columbia University School of Nursing, and a nurse practitioner, Columbia University Division of Cardiology, New York, New York. Robert R. Sciacca is a statistician, and Carmen Castillo is a clinical research coordinator, Columbia University School of Nursing. Belinda Chen is a project director and Lynn V. Doering is a professor of nursing, University of California, Los Angeles, School of Nursing, Los Angeles, California. Barbara J. Drew is a professor of nursing, University of California, San Francisco, School of Nursing, San Francisco, California. David Pickham is a clinical assistant professor, Stanford University School of Medicine, Stanford, California. Erik V. Carter is an assistant professor, Wayne State University, Detroit, Michigan
| | - David Pickham
- Kathleen T. Hickey is a professor of nursing, Columbia University School of Nursing, and a nurse practitioner, Columbia University Division of Cardiology, New York, New York. Robert R. Sciacca is a statistician, and Carmen Castillo is a clinical research coordinator, Columbia University School of Nursing. Belinda Chen is a project director and Lynn V. Doering is a professor of nursing, University of California, Los Angeles, School of Nursing, Los Angeles, California. Barbara J. Drew is a professor of nursing, University of California, San Francisco, School of Nursing, San Francisco, California. David Pickham is a clinical assistant professor, Stanford University School of Medicine, Stanford, California. Erik V. Carter is an assistant professor, Wayne State University, Detroit, Michigan
| | - Erik V Carter
- Kathleen T. Hickey is a professor of nursing, Columbia University School of Nursing, and a nurse practitioner, Columbia University Division of Cardiology, New York, New York. Robert R. Sciacca is a statistician, and Carmen Castillo is a clinical research coordinator, Columbia University School of Nursing. Belinda Chen is a project director and Lynn V. Doering is a professor of nursing, University of California, Los Angeles, School of Nursing, Los Angeles, California. Barbara J. Drew is a professor of nursing, University of California, San Francisco, School of Nursing, San Francisco, California. David Pickham is a clinical assistant professor, Stanford University School of Medicine, Stanford, California. Erik V. Carter is an assistant professor, Wayne State University, Detroit, Michigan
| | - Carmen Castillo
- Kathleen T. Hickey is a professor of nursing, Columbia University School of Nursing, and a nurse practitioner, Columbia University Division of Cardiology, New York, New York. Robert R. Sciacca is a statistician, and Carmen Castillo is a clinical research coordinator, Columbia University School of Nursing. Belinda Chen is a project director and Lynn V. Doering is a professor of nursing, University of California, Los Angeles, School of Nursing, Los Angeles, California. Barbara J. Drew is a professor of nursing, University of California, San Francisco, School of Nursing, San Francisco, California. David Pickham is a clinical assistant professor, Stanford University School of Medicine, Stanford, California. Erik V. Carter is an assistant professor, Wayne State University, Detroit, Michigan
| | - Lynn V Doering
- Kathleen T. Hickey is a professor of nursing, Columbia University School of Nursing, and a nurse practitioner, Columbia University Division of Cardiology, New York, New York. Robert R. Sciacca is a statistician, and Carmen Castillo is a clinical research coordinator, Columbia University School of Nursing. Belinda Chen is a project director and Lynn V. Doering is a professor of nursing, University of California, Los Angeles, School of Nursing, Los Angeles, California. Barbara J. Drew is a professor of nursing, University of California, San Francisco, School of Nursing, San Francisco, California. David Pickham is a clinical assistant professor, Stanford University School of Medicine, Stanford, California. Erik V. Carter is an assistant professor, Wayne State University, Detroit, Michigan
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Abstract
PURPOSE The purpose of this article is to provide an overview of strategies to build and sustain a career as a nurse scientist. This article examines how to integrate technologies and precision approaches into clinical practice, research, and education of the next generation of nursing scholars. DESIGN This article presents information for shaping a sustainable transdisciplinary career. Programs of research that utilize self-management to improve quality of life are discussed throughout the article. The ongoing National Institute of Nursing Research-funded (R01 grant) iPhone Helping Evaluate Atrial Fibrillation Rhythm through Technology (iHEART) study is the first prospective, randomized controlled trial to evaluate whether electrocardiographic monitoring with the AliveCor™ device in the real-world setting will improve the time to detection and treatment of recurrent atrial fibrillation over a 6-month period as compared to usual cardiac care. METHODS Opportunities to sustain a career as a nurse scientist and build programs of transdisciplinary research are identified. These opportunities are focused within the area of research and precision medicine. FINDINGS Nurse scientists have the potential and ability to shape their careers and become essential members of transdisciplinary partnerships. Exposure to clinical research, expert mentorship, and diverse training opportunities in different areas are essential to ensure that contributions to nursing science are visible through publications and presentations as well as through securing grant funding to develop and maintain programs of research. CONCLUSIONS Transcending boundaries and different disciplines, nurses are essential members of many diverse teams. CLINICAL RELEVANCE Nurse scientists are strengthening research approaches, clinical care, and communication and improving health outcomes while also building and shaping the next generation of nurse scientists.
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Affiliation(s)
- Kathleen T Hickey
- Professor of Nursing, Columbia University School of Nursing, New York, NY, USA
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Hickey KT, Drew BJ, Sciacca RR, Chen B, Pickham D, Carter EV, Castillo C, Doering LV. ECG correlates of acute allograft rejection among heart transplant recipients in the NEW HEART study. J Electrocardiol 2018. [DOI: 10.1016/j.jelectrocard.2017.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Carter EV, Castillo C, Chen B, Doering LV, Drew BJ, Hickey KT, Pickham D, Sciacca RR. ECG correlates of acute allograft rejection among heart transplant recipients in the NEW HEART study. J Electrocardiol 2017. [DOI: 10.1016/j.jelectrocard.2017.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hickey KT, Riga TC, Mitha S, Reading M, Warren KN, Sciacca R, Byrne MW. Genetic Knowledge of Parents and Children With Inherited Cardiac Syndromes. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Advances in DNA sequencing technology have resulted in an abundance of personalized data with challenging clinical utility and meaning for clinicians. This wealth of data has potential to dramatically impact the quality of healthcare. Nurses are at the focal point in educating patients regarding relevant healthcare needs; therefore, an understanding of sequencing technology and utilizing these data are critical. AIM The objective of this study was to explicate the role of nurses and nurse scientists as integral members of healthcare teams in improving understanding of DNA sequencing data and translational genomics for patients. APPROACH A history of the nurse role in newborn screening is used as an exemplar. DISCUSSION This study serves as an exemplar on how genome sequencing has been utilized in nursing science and incorporates linkages of other omics approaches used by nurses that are included in this special issue. This special issue showcased nurse scientists conducting multi-omic research from various methods, including targeted candidate genes, pharmacogenomics, proteomics, epigenomics, and the microbiome. From this vantage point, we provide an overview of the roles of nurse scientists in genome sequencing research and provide recommendations for the best utilization of nurses and nurse scientists related to genome sequencing.
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Affiliation(s)
- Jacquelyn Y Taylor
- Jacquelyn Y. Taylor, PhD, PNP-BC, RN, FAHA, FAAN, is Associate Professor and Associate Dean of Diversity and Inclusion, School of Nursing, Yale University, Orange, Connecticut. Michelle L. Wright, PhD, RN, is Assistant Research Professor, School of Nursing, Emory University, Atlanta, Georgia. She was a Postdoctoral Associate, School of Nursing, Yale University, Orange, Connecticut, at the time this work was completed Kathleen T. Hickey, EdD, FNP, ANP, FAHA, FAAN, is Associate Professor, School of Nursing, Columbia University, New York, New York. David E. Housman, PhD, is Virginia and D. K. Ludwig Scholar for Cancer Research and Professor of Biology, Department of Biology, Massachusetts Institute of Technology, Cambridge
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T Hickey K, B Biviano A, Garan H, Sciacca RR, Riga T, Warren K, Frulla AP, Hauser NR, Wang DY, Whang W. Evaluating the Utility of mHealth ECG Heart Monitoring for the Detection and Management of Atrial Fibrillation in Clinical Practice. J Atr Fibrillation 2017; 9:1546. [PMID: 29250277 DOI: 10.4022/jafib.1546] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 12/18/2022]
Abstract
Background Little attention has focused on the integration of mobile health (mHealth) technology with self-management approaches to improve the detection and management of atrial fibrillation (AF) in clinical practice. Objective The objective of this study was to investigate the differences between mHealth and usual care over a 6-month follow-up period among patients with a known history of atrial fibrillation. Methods A pilot cohort from within the larger ongoing randomized trial, iPhone® Helping Evaluate Atrial fibrillation Rhythm through Technology (iHEART), was evaluated to determine differences in detection of AF and atrial flutter (AFL) recurrence rates (following treatment to restore normal rhythm) between patients undergoing daily smartphone ECG monitoring and age and gender matched control patients. SF-36v2TM QoL assessments were administered at baseline and 6 months to a subset of the patients undergoing daily ECG monitoring. Differences between groups were assessed by t-test, Fisher's exact test, and Cox proportional hazard models. Results Among the 23 patients with smartphone ECG monitors (16 males and 7 females, mean age 55 ± 10), 14 (61%) had detection of recurrent AF/AFL versus 30% of controls. During the follow-up period, patients given smartphone ECG monitors were more than twice as likely to have an episode of recurrent AF/AFL detected (hazard ratio: 2.55; 95% CI: 1.06 - 6.11; p = 0.04). Among the 13 patients with baseline and 6 month QoL assessments, significant improvements were observed in the physical functioning (p = 0.009), role physical (p = 0.007), vitality (p = 0.03), and mental health domains (p = 0.02). Conclusions Cardiac mHealth self-monitoring is a feasible and effective mechanism for enhancing AF/AFL detection that improves quality of life.
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Affiliation(s)
- Kathleen T Hickey
- Associate Professor of Nursing, Columbia University School of Nursing
| | - Angelo B Biviano
- Associate Professor of Medicine, Columbia University Medical Center
| | - Hasan Garan
- Professor of Medicine, Columbia University Medical Center
| | | | - Teresa Riga
- Clinical Research Coordinator, Columbia University Medical Center
| | - Kate Warren
- Clinical Research Coordinator, Columbia University Medical Center
| | - Ashton P Frulla
- Clinical Research Coordinator, Columbia University Medical Center
| | - Nicole R Hauser
- Clinical Research Coordinator, Columbia University Medical Center
| | - Daniel Y Wang
- Assistant Professor of Medicine, Columbia University College of Physicians
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Hickey KT, Garan H, Mancini DM, Colombo PC, Naka Y, Sciacca RR, Abrams MP, Solove M, Zeoli N, Flannery M, Garan AR, Biviano AB. Atrial Fibrillation in Patients With Left Ventricular Assist Devices. JACC Clin Electrophysiol 2016; 2:793-798. [DOI: 10.1016/j.jacep.2016.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/24/2016] [Accepted: 03/10/2016] [Indexed: 11/27/2022]
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Hickey KT, Katapodi MC, Coleman B, Reuter-Rice K, Starkweather AR. Improving Utilization of the Family History in the Electronic Health Record. J Nurs Scholarsh 2016; 49:80-86. [PMID: 28094908 DOI: 10.1111/jnu.12259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this article is to provide an overview of Family History in the Electronic Health Record and to identify opportunities to advance the contributions of nurses in obtaining, updating and assessing family history in order to improve the health of all individuals and populations. ORGANIZING CONSTRUCT The article presents an overview of the obstacles to charting Family History within the Electronic Health Record and recommendations for using specific Family History tools and core Family History data sets. METHODS Opportunities to advance nursing contributions in obtaining, updating, and assessing family history in order to improve the health of all individuals were identified. These opportunities are focused within the area of promoting the importance of communication within families and between healthcare providers to obtain, document, and update family histories. FINDINGS Nurses can increase awareness of existing resources that can guide collection of a comprehensive and accurate family history and facilitate family discussions. In this paper, opportunities to advance nursing contributions in obtaining, updating, and assessing family history in order to improve the health of all individuals were identified. CONCLUSIONS Aligned with the clinical preparation of nurses, family health should be used routinely by nurses for risk assessment and to help inform patient and family members on screening, health promotion, and disease prevention. The quality of family health information is critical in order to leverage the use of genomic healthcare information and derive new knowledge about disease biology, treatment efficacy, and drug safety. These actionable steps need to be performed in the context of promoting evidence-based applications of family history that will be essential for implementing personalized genomic healthcare approaches and disease prevention efforts. CLINICAL RELEVANCE Family health history is one of the most important tools for identifying the risk of developing rare and chronic conditions, including cardiovascular disease, cancer, and diabetes, and represents an integration of disease risk from genetic, environmental, and behavioral/lifestyle factors. In fact, family history has long been recognized as a strong independent risk factor for disease and is the current best practice used in clinical practice to guide risk assessment.
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Affiliation(s)
| | - Maria C Katapodi
- Professor of Nursing Science, University of Basel Institute of Nursing Science, Basel, Switzerland
| | - Bernice Coleman
- Nurse Scientist II, Nurse Practitioner, Heart Transplantation and Mechanical Assist Device Programs, Nursing Research and Development, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Karin Reuter-Rice
- Associate Professor, Duke University School of Nursing, Durham, NC, USA
| | - Angela R Starkweather
- Professor and Director, Center for Advancement in Managing Pain, University of Connecticut School of Nursing, Storrs, CT, USA
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Chen LY, Bigger JT, Hickey KT, Chen H, Lopez-Jimenez C, Banerji MA, Evans G, Fleg JL, Papademetriou V, Thomas A, Woo V, Seaquist ER, Soliman EZ. Effect of Intensive Blood Pressure Lowering on Incident Atrial Fibrillation and P-Wave Indices in the ACCORD Blood Pressure Trial. Am J Hypertens 2016; 29:1276-1282. [PMID: 26476086 DOI: 10.1093/ajh/hpv172] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are no proven strategies to prevent atrial fibrillation (AF) in patients with type 2 diabetes (T2DM). We compared standard blood pressure (BP) lowering vs. intensive BP lowering in reducing incidence of AF or P-wave indices (PWI-ECG markers of left atrial abnormality that are considered intermediate phenotypes of AF) in patients with T2DM. METHODS We analyzed data from the ACCORD BP trial-a randomized controlled nonblinded trial (2001-2009) which randomized patients with T2DM and systolic BP (SBP) 130-180mm Hg on ≤3 antihypertensive medications aged 40-79 years with cardiovascular disease (CVD) or aged 55-79 years with subclinical CVD or ≥2 CVD risk factors to standard BP lowering (SBP <140mm Hg) vs. intensive BP lowering (SBP <120mm Hg). The primary outcome was a composite of incident AF and PWI. RESULTS Data from 3,087 participants (mean age, 62.2 years; women, 48.2%; non-White, 39.2%) were analyzed. During a mean follow-up of 4.4 years, the primary outcome occurred in 1,063 participants (incidence rate, 84.5 per 1,000 person-years in the standard-therapy group vs. 73.9 per 1,000 person-years in the intensive-therapy group). The adjusted hazard ratios (95% confidence intervals) of intensive-therapy group for the primary outcome and for incident PWI alone were 0.87 (0.77-0.98), P = 0.02 and 0.87 (0.76-0.98), P = 0.02, respectively. The effect of intensive therapy on the incidence of AF alone did not reach statistical significance. CONCLUSIONS In patients with T2DM, intensive BP lowering reduces the incidence of the composite outcome of AF and PWI, suggesting a potential benefit from stringent BP control in patients with T2DM. clinical trials registration Trial Number NCT00000620.
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Affiliation(s)
- Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - J Thomas Bigger
- Columbia University Department of Medicine, Division of Cardiology, New York, New York, USA
| | - Kathleen T Hickey
- Columbia University Department of Medicine, Division of Cardiology, New York, New York, USA
- Columbia University School of Nursing, New York, New York, USA
| | - Haiying Chen
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carlos Lopez-Jimenez
- Columbia University Department of Medicine, Division of Cardiology, New York, New York, USA
| | | | - Gregory Evans
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jerome L Fleg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Abraham Thomas
- Endocrinology, Diabetes, Bone and Mineral Disorders Division, Henry Ford Hospital, Detroit, Michigan, USA
| | - Vincent Woo
- Section of Endocrinology and Metabolism, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth R Seaquist
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Winston-Salem, North Carolina, USA
- Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Mital S, Musunuru K, Garg V, Russell MW, Lanfear DE, Gupta RM, Hickey KT, Ackerman MJ, Perez MV, Roden DM, Woo D, Fox CS, Ware S. Enhancing Literacy in Cardiovascular Genetics: A Scientific Statement From the American Heart Association. ACTA ACUST UNITED AC 2016; 9:448-467. [PMID: 27672144 DOI: 10.1161/hcg.0000000000000031] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Advances in genomics are enhancing our understanding of the genetic basis of cardiovascular diseases, both congenital and acquired, and stroke. These advances include finding genes that cause or increase the risk for childhood and adult-onset diseases, finding genes that influence how patients respond to medications, and the development of genetics-guided therapies for diseases. However, the ability of cardiovascular and stroke clinicians to fully understand and apply this knowledge to the care of their patients has lagged. This statement addresses what the specialist caring for patients with cardiovascular diseases and stroke should know about genetics; how they can gain this knowledge; how they can keep up-to-date with advances in genetics, genomics, and pharmacogenetics; and how they can apply this knowledge to improve the care of patients and families with cardiovascular diseases and stroke.
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Masterson Creber RM, Hickey KT, Maurer MS. Gerontechnologies for Older Patients with Heart Failure: What is the Role of Smartphones, Tablets, and Remote Monitoring Devices in Improving Symptom Monitoring and Self-Care Management? Curr Cardiovasc Risk Rep 2016; 10. [PMID: 28713481 DOI: 10.1007/s12170-016-0511-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Older adults with heart failure have multiple chronic conditions and a large number and range of symptoms. A fundamental component of heart failure self-care management is regular symptom monitoring. Symptom monitoring can be facilitated by cost-effective, easily accessible technologies that are integrated into patients' lives. Technologies that are tailored to older adults by incorporating gerontological design principles are called gerontechnologies. Gerontechnology is an interdisciplinary academic and professional field that combines gerontology and technology with the goals of improving prevention, care, and enhancing the quality of life for older adults. The purpose of this article is to discuss the role of gerontechnologies, specifically the use of mobile applications available on smartphones and tablets as well as remote monitoring systems, for outpatient disease management among older adults with heart failure. While largely unproven, these rapidly developing technologies have great potential to improve outcomes among older persons.
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Affiliation(s)
| | - Kathleen T Hickey
- Columbia University, School of Nursing, New York, NY, USA.,Division of Cardiology, NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Mathew S Maurer
- Division of Cardiology, NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.,College of Physicians & Surgeons, Columbia University, New York, NY, USA
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Hickey KT, Hauser NR, Valente LE, Riga TC, Frulla AP, Masterson Creber R, Whang W, Garan H, Jia H, Sciacca RR, Wang DY. A single-center randomized, controlled trial investigating the efficacy of a mHealth ECG technology intervention to improve the detection of atrial fibrillation: the iHEART study protocol. BMC Cardiovasc Disord 2016; 16:152. [PMID: 27422639 PMCID: PMC4947299 DOI: 10.1186/s12872-016-0327-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/22/2016] [Indexed: 01/09/2023] Open
Abstract
Background Atrial fibrillation is a major public health problem and is the most common cardiac arrhythmia, affecting an estimated 2.7 million Americans. The true prevalence of atrial fibrillation is likely underestimated because episodes are often sporadic; therefore, it is challenging to detect and record an occurrence in a “real world” setting. To date, mobile health tools that promote earlier detection and treatment of atrial fibrillation and improvement in self-management behaviors and knowledge have not been evaluated. This study will be the first to address the epidemic problem of atrial fibrillation with a novel approach utilizing advancements in mobile health electrocardiogram technology to empower patients to actively engage in their healthcare and to evaluate impact on quality of life and quality-adjusted life years. Furthermore, sending a daily electrocardiogram transmission, coupled with receiving educational and motivational text messages aimed at promoting self-management and a healthy lifestyle may improve the management of chronic cardiovascular conditions (e.g., hypertension, diabetes, heart failure, etc.). Therefore, we are currently conducting a randomized controlled trial to assess the efficacy of a mobile health intervention, iPhone® Helping Evaluate Atrial fibrillation Rhythm through Technology (iHEART) versus usual cardiac care. Methods The iHEART study is a single center, prospective, randomized controlled trial. A total of 300 participants with a recent history of atrial fibrillation will be enrolled. Participants will be randomized 1:1 to receive the iHEART intervention, receiving an iPhone® equipped with an AliveCor® Mobile ECG and accompanying Kardia application and behavioral altering motivational text messages or usual cardiac care for 6 months. Discussion This will be the first study to investigate the utility of a mobile health intervention in a “real world” setting. We will evaluate the ability of the iHEART intervention to improve the detection and treatment of recurrent atrial fibrillation and assess the intervention's impact on improving clinical outcomes, quality of life, quality-adjusted life-years and disease-specific knowledge. Trial registration NCT02731326; Verified April 2016
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Affiliation(s)
- Kathleen T Hickey
- Columbia University School of Nursing, 622 W. 168th St., New York, NY, 10032, USA.
| | - Nicole R Hauser
- Columbia University Medical Center, 630 W. 168th St., New York, NY, 10032, USA
| | - Laura E Valente
- Columbia University School of Nursing, 622 W. 168th St., New York, NY, 10032, USA
| | - Teresa C Riga
- Columbia University Medical Center, 630 W. 168th St., New York, NY, 10032, USA
| | - Ashton P Frulla
- Columbia University Medical Center, 630 W. 168th St., New York, NY, 10032, USA
| | | | - William Whang
- Columbia University Medical Center, 630 W. 168th St., New York, NY, 10032, USA
| | - Hasan Garan
- Columbia University Medical Center, 630 W. 168th St., New York, NY, 10032, USA
| | - Haomiao Jia
- Columbia University School of Nursing, 622 W. 168th St., New York, NY, 10032, USA
| | - Robert R Sciacca
- Columbia University School of Nursing, 622 W. 168th St., New York, NY, 10032, USA
| | - Daniel Y Wang
- Columbia University Medical Center, 630 W. 168th St., New York, NY, 10032, USA
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Hickey KT, Doering LV, Chen B, Carter EV, Sciacca RR, Pickham D, Castillo C, Hauser NR, Drew BJ. Clinical and gender differences in heart transplant recipients in the NEW HEART study. Eur J Cardiovasc Nurs 2016; 16:222-229. [PMID: 27189203 DOI: 10.1177/1474515116651178] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Little attention has focused on gender differences in cardiac comorbidities and outcomes in patients undergoing orthotropic heart transplant. OBJECTIVE The objective of this study was to investigate gender differences at baseline and during follow-up among heart transplant patients. METHODS An observational cohort within the NEW HEART study was evaluated to determine gender differences in relation to age, coexisting cardiac comorbidities, and outcomes. Differences were assessed by t-test, Fisher's exact test, and logistic regression analysis. RESULTS Male transplant recipients ( n = 238) were significantly older than female recipients ( n = 92), with a greater percentage over 60 years of age (45% vs. 24%, p = 0.0006). Males were more likely to have hypertension (63% vs. 49%, p = 0.034), dyslipidemia (62% vs. 45%, p = 0.006), a history of smoking (52% vs. 35%, p = 0.009), and diabetes (42% vs. 21%, p = 0.0002). Analysis of endomyocardial biopsies obtained during the 1-year follow-up period demonstrated that women averaged more episodes of acute rejection than men (3.9 vs. 3.0, p = 0.009). While most episodes of rejection were mild, women were more likely than men to have episodes of moderate or severe rejection (14% vs. 5%, p = 0.012) and to be hospitalized for acute rejection (15% vs. 6%, p = 0.013). There were no significant differences in mortality. CONCLUSIONS Men were more likely than women to be older and to have diabetes, dyslipidemia, hypertension, and a history of smoking. Women were more likely to experience moderate or severe allograft rejection and to be hospitalized for acute rejection. Future investigation of the reasons for these gender differences is warranted and may improve clinical care of women undergoing cardiac transplantation.
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Affiliation(s)
| | - Lynn V Doering
- 2 University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Belinda Chen
- 2 University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Erik V Carter
- 3 University of California San Francisco School of Nursing, San Francisco, CA, USA
| | | | - David Pickham
- 4 Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Barbara J Drew
- 3 University of California San Francisco School of Nursing, San Francisco, CA, USA
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Masterson Creber RM, Maurer MS, Reading M, Hiraldo G, Hickey KT, Iribarren S. Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS). JMIR Mhealth Uhealth 2016; 4:e74. [PMID: 27302310 PMCID: PMC4925936 DOI: 10.2196/mhealth.5882] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 12/17/2022] Open
Abstract
Background Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. Objective The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. Methods We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, “heart failure,” “cardiology,” “heart failure and self-management”). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Results Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. Conclusions This review suggests that few apps meet prespecified criteria for quality, content, or functionality, highlighting the need for further refinement and mapping to evidence-based guidelines and room for overall quality improvement in heart failure symptom monitoring and self-care related apps.
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Zhao Y, Liu N, Wang Y, Hickey KT. A rolling-horizon pharmacokinetic pharmacodynamic model for warfarin inpatients in transient clinical states. Per Med 2016; 13:21-32. [DOI: 10.2217/pme.15.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To design a pharmacokinetic pharmacodynamic model to make individualized and adaptive international normalized ratio (INR) predictions for warfarin inpatients in changing clinical status. Methods: We tested a new model on 60 inpatients at Columbia University. The model personalizes four submodels and minimizes the number of parameters to be estimated. Prediction accuracy was assessed by prediction error, absolute prediction error and percentage absolute prediction error. Results: The INRs were accurately predicted 5 days into the future. Median prediction error: 0.01–0.12; median absolute prediction error: 0.17–0.5 and median percentage absolute prediction error: 9.85–26.06%. Conclusion: Patients exhibit interindividual and intertemporal variability. The model captures the variability and provides accurate and personalized INR predictions.
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Affiliation(s)
- Yao Zhao
- Department of Supply Chain Management, Rutgers Business School, Rutgers – the State University of New Jersey, Newark, NJ, USA
| | - Nan Liu
- Department of Health Policy & Management, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yijun Wang
- Department of Supply Chain Management, Rutgers Business School, Rutgers – the State University of New Jersey, Newark, NJ, USA
| | - Kathleen T Hickey
- Columbia University School of Nursing, Columbia University Medical Center, NY, USA
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Hickey KT, Taylor JY, Sciacca RR, Aboelela S, Gonzalez P, Castillo C, Hauser N, Frulla A. Cardiac genetic testing: a single-center pilot study of a Dominican population. Hisp Health Care Int 2015; 12:183-8. [PMID: 25521782 DOI: 10.1891/1540-4153.12.4.183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The impact of undergoing genetic testing in a Dominican population is not well understood. The objective of this investigation was to evaluate the psychological well-being and perceived cardiac risk among Dominicans who underwent genetic testing. Participants completed a qualitative interview and the Short Form-36 (SF-36) questionnaire after cardiac genetic testing. There were 31 subjects evaluated (mean age 42 ± 11 years). Participants revealed three common themes: (a) fear of dying prematurely, (b) guilt of possibly passing on a mutation to their children, and (c) fear of having an implantable cardioverter defibrillator (ICD) shock. Physical components of the SF-36 were within normal limits (46.2 ± 6.6) but elevated for mental components (59.9 ± 5.3). The quality of life and specific themes results determined in this investigation warrant further research in the Dominican population.
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Kulage KM, Schnall R, Hickey KT, Travers J, Zezulinski K, Torres F, Burgess J, Larson EL. Time and costs of preparing and submitting an NIH grant application at a school of nursing. Nurs Outlook 2015; 63:639-49. [PMID: 26566959 DOI: 10.1016/j.outlook.2015.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/28/2015] [Accepted: 09/13/2015] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
| | | | | | | | | | | | | | - Elaine L Larson
- Columbia University School of Nursing, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Musunuru K, Hickey KT, Al-Khatib SM, Delles C, Fornage M, Fox CS, Frazier L, Gelb BD, Herrington DM, Lanfear DE, Rosand J. Basic concepts and potential applications of genetics and genomics for cardiovascular and stroke clinicians: a scientific statement from the American Heart Association. ACTA ACUST UNITED AC 2015; 8:216-42. [PMID: 25561044 DOI: 10.1161/hcg.0000000000000020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kulage KM, Hickey KT, Honig JC, Johnson MP, Larson EL. Establishing a program of global initiatives for nursing education. J Nurs Educ 2014; 53:371-8. [PMID: 24971731 DOI: 10.3928/01484834-20140617-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/15/2014] [Indexed: 11/20/2022]
Abstract
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.
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Hickey KT, Hodges EA, Thomas TL, Coffman MJ, Taylor-Piliae RE, Johnson-Mallard VM, Goodman JH, Jones RA, Kuntz S, Galik E, Gates MG, Casida JM. Initial evaluation of the Robert Wood Johnson Foundation Nurse Faculty Scholars program. Nurs Outlook 2014; 62:394-401. [PMID: 25085329 DOI: 10.1016/j.outlook.2014.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 06/10/2014] [Accepted: 06/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Robert Wood Johnson Foundation Nurse Faculty Scholars (RWJF NFS) program was developed to enhance the career trajectory of young nursing faculty and to train the next generation of nurse scholars. Although there are publications that describe the RWJF NFS, no evaluative reports have been published. The purpose of this study was to evaluate the first three cohorts (n = 42 scholars) of the RWJF NFS program. METHODS A descriptive research design was used. Data were derived from quarterly and annual reports, and a questionnaire (seven open-ended questions) was administered via Survey Monkey Inc. (Palo Alto, CA, USA). RESULTS During their tenure, scholars had on average six to seven articles published, were teaching/mentoring at the graduate level (93%), and holding leadership positions at their academic institutions (100%). Eleven scholars (26%) achieved fellowship in the American Academy of Nursing, one of the highest nursing honors. The average ratings on a Likert scale of 1 (not at all supportive) to 10 (extremely supportive) of whether or not RWJF had helped scholars achieve their goals in teaching, service, research, and leadership were 7.7, 8.0, 9.4, and 9.5, respectively. The majority of scholars reported a positive, supportive relationship with their primary nursing and research mentors; although, several scholars noted challenges in connecting for meetings or telephone calls with their national nursing mentors. CONCLUSIONS These initial results of the RWJF NFS program highlight the success of the program in meeting its overall goal-preparing the next generation of nursing academic scholars for leadership in the profession.
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Affiliation(s)
| | - Eric A Hodges
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC
| | - Tami L Thomas
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Maren J Coffman
- University of North Carolina at Charlotte School of Nursing, Charlotte, NC
| | | | | | | | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA
| | - Sandra Kuntz
- Montana State University College of Nursing, Bozeman, MT
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Johnson MP, Hickey KT, Scopa-Goldman J, Andrews T, Boerem P, Covec M, Larson E. Manikin Versus Web-Based Simulation for Advanced Practice Nursing Students. Clin Simul Nurs 2014. [DOI: 10.1016/j.ecns.2014.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hickey KT, Sciacca RR, Biviano AB, Whang W, Dizon JM, Garan H, Chung WK. The effect of cardiac genetic testing on psychological well-being and illness perceptions. Heart Lung 2014; 43:127-32. [PMID: 24594249 DOI: 10.1016/j.hrtlng.2014.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 01/14/2014] [Accepted: 01/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the effects of positive cardiac genetic diagnoses, ICD discharges, and arrhythmias on measures of psychological well-being. METHODS Fifty-eight adults with prior cardiac genetic testing were enrolled. Patient well-being was determined using the SF-36 (QoL), HADS-A and HADS-D (anxiety/depression), and IPQ-R (patients' perceptions of illness). Patients with positive and negative cardiac genetic test results were compared using non-parametric statistics. RESULTS Genetic testing yielded 76% with a positive diagnosis and 29% reported an ICD shock. QoL assessments (n = 33) were within normal ranges (mean of 50) with the exceptions of general health (44.1 ± 12.2, p < 0.01) and bodily pain (55.1 ± 9.1, p < 0.01) domains, but only the bodily pain domain showed differences between those with positive and negative cardiac genetic test results. Subjects with ICD discharges had higher scores than those without shocks in consequential and emotional IPQR subscales as well as greater perceived risks of experiencing a serious cardiac event, developing additional symptoms, or limitations in daily activities. CONCLUSION Positive genetic results did not negatively impact patient well-being with the exception of the bodily pain domain of the SF-36.
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Affiliation(s)
- Kathleen T Hickey
- Columbia University School of Nursing, Columbia University Medical Center, New York, NY, USA.
| | | | - Angelo B Biviano
- Department of Cardiac Electrophysiology, Columbia University Medical Center, New York, NY, USA
| | - William Whang
- Department of Cardiac Electrophysiology, Columbia University Medical Center, New York, NY, USA
| | - Jose M Dizon
- Department of Cardiac Electrophysiology, Columbia University Medical Center, New York, NY, USA
| | - Hasan Garan
- Department of Cardiac Electrophysiology, Columbia University Medical Center, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University Medical Center, New York, NY, USA
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Hickey KT, Dizon J, Frulla A. Detection of Recurrent Atrial Fibrillation Utilizing Novel Technology. J Atr Fibrillation 2013; 6:936. [PMID: 28496909 DOI: 10.4022/jafib.936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 11/10/2022]
Abstract
The true prevalence of AF is likely underestimated because episodes are often sporadic and challenging to detect in a "real world" setting. This case report will describe a 58-year-old atrial fibrillation patient with multiple cardiac risk factors. After two ablations and one cardioversion, the patient failed to remain in normal sinus rhythm. Shortly after AF returned, the decision was made to perform a second cardioversion. Post-procedure, the patient was given a novel FDA-approved, wireless ECG monitoring device compatible with the iPhone®. This device has the capability of recording and transmitting a single-channel ECG. Within days, the patient began feeling symptomatic again and used his device to transmit an ECG to his healthcare provider. Recurrent AF was detected and the patient was directed to seek further evaluation. The success of this novel device to detect recurrent AF highlights the "real world" applicability of using mHealth technology more readily in patient care.
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Affiliation(s)
- Kathleen T Hickey
- Assistant Professor of Nursing Columbia University School of Nursing Columbia University Medical Center, New York, NY, USA
| | - Jose Dizon
- Associate Professor of Clinical Medicine Department of Cardiac Electrophysiology Columbia University Medical Center. New York, NY
| | - Ashton Frulla
- Clinical Research Coordinator Department of Cardiac Electrophysiology Columbia University Medical Center. New York, NY
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Abstract
This article presents an overview of hypertrophic cardiomyopathy (HCM) and the associated clinical findings, treatment, and management for nurse practitioners. Topics include an overview of the condition, major and minor criteria for diagnosis, clinical course and pathophysiology, genetic inheritance and testing, and dysrhythmias associated with HCM.
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Hickey KT, Reiffel J, Sciacca RR, Whang W, Biviano A, Baumeister M, Castillo C, Talathothi J, Garan H. Correlating perceived arrhythmia symptoms and quality of life in an older population with heart failure: a prospective, single centre, urban clinic study. J Clin Nurs 2013; 22:434-44. [PMID: 23301579 PMCID: PMC3748605 DOI: 10.1111/j.1365-2702.2012.04307.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2012] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To determine the relationship between quality of life and perceived self-reported symptoms in an older, ambulatory, urban population living with heart failure. BACKGROUND While arrhythmias in older individuals with heart failure are well documented, the association between perceived arrhythmia symptoms and quality of life is not well-defined. DESIGN Prospective, cross-sectional single-centre study. METHODS A single-centre, prospective study was conducted with heart failure patients recruited from an urban outpatient cardiology clinic in the United States. Fifty-seven patients completed a baseline quality of life survey with 42 of these completing the six-month follow-up survey. Quality of life was evaluated with the SF-36v2(™) and frequency of symptoms with the Atrial Fibrillation Severity Scale. Subjects wore an auto triggered cardiac loop monitor (LifeStar AF Express(®) ) for two weeks to document arrhythmias. Data analysis utilised Spearman's rank correlation and logistic regression. RESULTS Baseline and six-month quality of life measures did not correlate with recorded arrhythmias. However, perceptions of diminished general health correlated significantly with symptoms of exercise intolerance, lightheadedness/dizziness, palpitations and chest pain/pressure. By multivariable logistic regression, more severe perceived episodes, symptoms of exercise intolerance and lightheadedness/dizziness were independently associated with diminished quality of life. CONCLUSION Quality of life was significantly worse in patients with perceptions of severe arrhythmic episodes and in those with symptoms of dizziness and exercise intolerance. RELEVANCE TO CLINICAL PRACTICE The findings of this study indicate that symptomatic heart failure patients suffer from poor quality of life and that interventions are needed to improve quality of life and decrease symptom severity. Nurses who care for heart failure patients play an essential role in symptom evaluation and management and could significantly improve overall quality of life in these patients by carefully evaluating symptomatology and testing interventions and educational programmes aimed at improving quality of life.
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Abstract
PURPOSE This article provides an update on cardiovascular genomics using three clinically relevant exemplars, including myocardial infarction (MI) and coronary artery disease (CAD), stroke, and sudden cardiac death (SCD). ORGANIZATIONAL CONSTRUCT: Recent advances in cardiovascular genomic research, testing, and clinical implications are presented. METHODS Genomic nurse experts reviewed and summarized recent salient literature to provide updates on three selected cardiovascular genomic conditions. FINDINGS Research is ongoing to discover comprehensive genetic markers contributing to many common forms of cardiovascular disease (CVD), including MI and stroke. However, genomic technologies are increasingly being used clinically, particularly in patients with long QT syndrome (LQTS) or hypertrophic cardiomyopathy (HCM) who are at risk for SCD. CONCLUSIONS Currently, there are no clinically recommended genetic tests for many common forms of CVD even though direct-to-consumer genetic tests are being marketed to healthcare providers and the general public. On the other hand, genetic testing for patients with certain single gene conditions, including channelopathies (e.g., LQTS) and cardiomyopathies (e.g., HCM), is recommended clinically. CLINICAL RELEVANCE Nurses play a pivotal role in cardiogenetics and are actively engaged in direct clinical care of patients and families with a wide variety of heritable conditions. It is important for nurses to understand current development of cardiovascular genomics and be prepared to translate the new genomic knowledge into practice.
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Abstract
The purpose of this study was to describe the clinical, research, educational, and professional activities that nurses are engaged in following participation in a 2 month intramural genetics training program. An online survey was administered in 2010 to graduates of the program sponsored by the US National Institute of Nursing Research from 2000 to 2009, in Bethesda, Maryland, USA. The electronic, voluntary survey was sent to 189 graduates via email. The survey included demographic characteristics, educational preparation, professional roles and responsibilities, and attitudes about genetic testing and privacy issues. Of the 95 graduates responding to the survey, 74% had doctorates and 70% were advanced practice nurses. All respondents reported incorporating genetics knowledge into daily clinical, academic, or research practices since completing the program, with 72% reporting being involved in genetically-focused research (52% with research funding), 32% incorporating genetics into patient care, and 79% providing genetics education. Respondents working in a hospital setting or academic institution were more likely to desire additional training in genetics. National Institute of Nursing Research graduates have successfully integrated genomics into a variety of nursing practices.
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