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Melton K, Liu J, Sadeghi H, George M, Smaldone A. Predictors of Transition Outcomes in Cystic Fibrosis: Analysis of National Patient Registry and CF RISE (Responsibility. Independence. Self-care. Education) Data. J Pediatr 2024; 265:113812. [PMID: 37918520 DOI: 10.1016/j.jpeds.2023.113812] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/09/2023] [Accepted: 10/29/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To identify predictors of change in lung function and body weight during health care transition in cystic fibrosis (CF). METHODS We conducted a retrospective cohort study using data from the CF Foundation Patient Registry and the web-based transition program CF RISE (Responsibility. Independence. Self-care. Education) for patients aged 16-25 years who transitioned to adult care from 2013 through 2019. We modeled change in forced expiratory volume in 1 second % predicted and weight using linear regression fit with generalized estimating equations. Predictors included gap in care (time between last pediatric and first adult outpatient visit), transition program engagement, and sociodemographic and medical factors. RESULTS Among 12 420 adolescents and young adults (AYAs), 3876 transitioned to adult care with a median gap in care of 7.6 months. Patients from CF centers with greater rates of CF RISE engagement had improved lung function and weight at their first adult outpatient visit. Coverage on a parent's insurance plan and absence of CF complications predicted increased lung function. History of a nonlung transplant and sinus disease predicted increased weight. Comorbid diabetes mellitus and gaps in care >3 months predicted decreased lung function with longer gaps in care associated with greater decrease. A gap in care of 6-9 months predicted decreased weight. Control variables including baseline forced expiratory volume in 1 second and weight, and exacerbation status were also statistically significant. CONCLUSIONS Findings suggest 2 promising targets to improve transition of AYAs with CF: increasing AYA engagement in CF RISE and reducing gaps in care during the transition period.
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Affiliation(s)
- Katherine Melton
- Department of General Pediatrics, Boston Children's Hospital, Boston, MA; School of Nursing, Columbia University, New York, NY.
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY
| | - Hossein Sadeghi
- Division of Pediatric Pulmonology and Sleep Medicine, Columbia University Irving Medical School, New York, NY
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Celona CA, Jackman K, Smaldone A. Emergency Department Use by Young Adults With Chronic Illness Before and During the COVID-19 Pandemic. J Emerg Nurs 2023; 49:755-764. [PMID: 37256242 PMCID: PMC10133889 DOI: 10.1016/j.jen.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION There was a significant decrease in emergency department encounters during the COVID-19 pandemic. Our large urban emergency department observed decreased encounters and admissions by youths with chronic health conditions. This study aimed to compare the frequency of emergency department encounters for certain young adults before the pandemic and during the COVID-19 pandemic. METHODS A retrospective cohort study using medical records of patients ages 20 to 26 years from October 2018 to September 2019 and February 2020 to February 2021. Files set for inclusion were those with a primary diagnosis of human immunodeficiency virus, diabetes mellitus, epilepsy, cerebral palsy, sickle cell disease, asthma, and certain psychiatric disorders for potentially preventable health events. RESULTS We included 1203 total encounters (853 before the pandemic and 350 during the pandemic), with the total number of subjects included in the study 568 (293 before the pandemic to 239 during the pandemic). During the pandemic, young adults with mental health conditions (53.1%) accounted for most encounters. Encounters requiring hospital admissions increased from 27.4% to 52.5% during the pandemic, primarily among patients with diabetes (41.8% vs 61.1%) and mental health conditions (50% vs 73.3%). DISCUSSION The number of young adults with certain chronic health conditions decreased during COVID-19, with encounters for subjects with mental health conditions increasing significantly. The proportion of admissions increased during the pandemic with increases for subjects with mental health disorders and diabetes. The number of frequent users decreased during COVID-19. Future research is needed to understand better the causes for these disparities in young adults with chronic conditions who use the emergency department as a source of care.
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South K, Smaldone A, Sadeghi H, Piane V, Kowal R, Wei L, George M. Parent and adolescent perceptions of cystic fibrosis management responsibility: A mixed-methods study. Pediatr Pulmonol 2023; 58:2340-2351. [PMID: 37232332 PMCID: PMC10524381 DOI: 10.1002/ppul.26494] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Adolescents with cystic fibrosis (CF) and their parents must navigate changing roles and responsibilities within the family including transfer of disease management responsibilities. AIM/OBJECTIVE The aim of this qualitative study was to explore how families share and transfer CF management responsibility from the perspectives of adolescents with CF and their parents. METHODS Guided by qualitative descriptive methodology, we purposively sampled adolescent/parent dyads. Participants completed two surveys measuring family responsibility (Family Responsibility Questionnaire [FRQ]) and transition readiness (Transition Readiness Assessment Questionnaire [TRAQ]) We conducted semistructured video or phone interviews, used a codebook to guide team coding and analyzed qualitative data using both content analysis and dyadic interview analysis. RESULTS Thirty participants (15 dyads) enrolled (7% Black; 33% Latina/o; 40% female; adolescent age 14.4 ± 2 years; 66% prescribed highly effective modulator therapy; 80% of parents were mothers). Parent FRQ and TRAQ scores were significantly higher than their adolescent indicating differing perceptions of responsibility and transition readiness. We inductively identified four themes: (1) CF management is a delicate balance (CF management is a routine which is easily disrupted), (2) Growing up and parenting under extraordinary circumstances (the burden of CF weighs on families as they navigate adolescence), (3) Differing Perceptions of risk and responsibility (adolescent and parent perceptions of treatment responsibility and the risks of nonadherence do not always align), and (4) Balancing independence and protection (families must weigh the benefits and risks of allowing adolescents increased independence). CONCLUSIONS Adolescents and parents demonstrated differing perceptions of CF management responsibility, which may be related to a lack of communication between family members about this topic. To help facilitate alignment of parent and adolescent expectations, discussion of family roles and responsibility for CF management should begin early during the transition process and be discussed regularly during clinic visits.
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Affiliation(s)
- Katherine South
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
| | - Arlene Smaldone
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
| | - Hossein Sadeghi
- Columbia University Irving Medical School, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY, 10032
| | - Victoria Piane
- Columbia University Irving Medical School, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY, 10032
| | - Rebecca Kowal
- Columbia University Irving Medical School, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY, 10032
| | - Leanna Wei
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
| | - Maureen George
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
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Mitha S, Schwartz J, Hobensack M, Cato K, Woo K, Smaldone A, Topaz M. Natural Language Processing of Nursing Notes: An Integrative Review. Comput Inform Nurs 2023; 41:377-384. [PMID: 36730744 DOI: 10.1097/cin.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/04/2023]
Abstract
Natural language processing includes a variety of techniques that help to extract meaning from narrative data. In healthcare, medical natural language processing has been a growing field of study; however, little is known about its use in nursing. We searched PubMed, EMBASE, and CINAHL and found 689 studies, narrowed to 43 eligible studies using natural language processing in nursing notes. Data related to the study purpose, patient population, methodology, performance evaluation metrics, and quality indicators were extracted for each study. The majority (86%) of the studies were conducted from 2015 to 2021. Most of the studies (58%) used inpatient data. One of four studies used data from open-source databases. The most common standard terminologies used were the Unified Medical Language System and Systematized Nomenclature of Medicine, whereas nursing-specific standard terminologies were used only in eight studies. Full system performance metrics (eg, F score) were reported for 61% of applicable studies. The overall number of nursing natural language processing publications remains relatively small compared with the other medical literature. Future studies should evaluate and report appropriate performance metrics and use existing standard nursing terminologies to enable future scalability of the methods and findings.
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Affiliation(s)
- Shazia Mitha
- Author Affiliations : Columbia University School of Nursing, New York
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5
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DeForge CE, George M, Baldwin MR, South K, Beauchemin M, McHugh ME, Smaldone A. Do Interventions Improve Symptoms Among ICU Surrogates Facing End-of-Life Decisions? A Prognostically-Enriched Systematic Review and Meta-Analysis. Crit Care Med 2022; 50:e779-e790. [PMID: 35997501 PMCID: PMC10193371 DOI: 10.1097/ccm.0000000000005642] [Citation(s) in RCA: 4] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Evaluate the efficacy of interventions to improve symptoms for ICU surrogates at highest risk of developing psychologic distress: those facing end-of-life care decisions. DATA SOURCES MEDLINE, CINAHL, PsycInfo, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched through April 16, 2022. STUDY SELECTION Following an a priori protocol, randomized trials of interventions delivered to surrogates of adult ICU patients who died or had high likelihood of mortality evaluating surrogate symptoms were identified. DATA EXTRACTION Two reviewers performed screening and data extraction and assessed risk of bias (Cochrane Risk of Bias [RoB] 2 tool). Trials were eligible for meta-analysis if group mean symptom scores were provided at 3 or 6 months. Pooled effects were estimated using a random effects model. Heterogeneity was assessed (Cochrane Q, I2 ). Certainty of evidence was assessed (Grading of Recommendations Assessment, Development and Evaluation). DATA SYNTHESIS Of 1,660 records, 10 trials met inclusion criteria representing 3,824 surrogates; eight were included in the meta-analysis. Overall RoB was rated Some Concerns. Most ( n = 8) interventions focused on improving communication and enhancing psychologic support in the ICU. All trials measured anxiety, depression, and posttraumatic stress. Significant improvement was seen at 3 months (depression, mean difference [MD], -0.68; 95% CI, -1.14 to -0.22, moderate certainty; posttraumatic stress, standardized MD, -0.25; 95% CI, -0.49 to -0.01, very low certainty) and 6 months (anxiety, MD, -0.70; 95% CI, -1.18 to -0.22, moderate certainty). Sensitivity analyses suggest significant findings may be unstable. Subgroup analyses demonstrated differences in effect by trial location, interventionist, and intervention dose. CONCLUSIONS Communication and psychological support interventions in the ICU yielded small but significant improvement in psychological symptoms with moderate to very low certainty evidence in a prognostically-enriched sample of ICU surrogates facing end-of-life care decisions. A new approach to interventions that extend beyond the ICU may be needed.
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Affiliation(s)
| | | | - Matthew R Baldwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | | | | | - Marlene E McHugh
- Columbia University School of Nursing, New York, NY
- Palliative Care Service, Department of Family Medicine, Montefiore Medical Center, New York, NY
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, NY
- College of Dental Medicine, Columbia University Irving Medical Center, New York, NY
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6
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South K, George M, Sadeghi H, Piane V, Smaldone A. Moving up: Healthcare transition experiences of adolescents and young adults with cystic fibrosis. J Pediatr Nurs 2022; 65:116-123. [PMID: 35367087 PMCID: PMC9246909 DOI: 10.1016/j.pedn.2022.03.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The experience of healthcare transition from pediatric to adult care in cystic fibrosis (CF) remains poorly understood, particularly among racially and ethnically diverse adolescents and young adults (AYAs) with CF. The objective of this qualitative study was to explore the perspectives of a diverse sample of AYAs with CF at one urban academic medical center regarding healthcare transition. DESIGN AND METHODS Guided by qualitative descriptive methodology, we purposively selected AYAs who represented the pre and post transition experience: some AYAs had experienced the transition preparation program CF R.I.S.E. Demographic information and responsibility for self-management behaviors were collected using an online survey. Semi-structured video interviews were conducted following an iterative interview guide. A codebook directed inductive coding. QSR NVivo Version 12 software was used to organize the data. RESULTS 12 AYAs with CF were enrolled (25% female, 25% Black AYA, 33% Hispanic/Latina/o AYA, 50% White AYA; mean age 20.8 years). Three themes were identified: independent care of the whole self, preparing for change and the unknown and transition experiences vary. CONCLUSIONS Not all participants experienced a smooth transition. Participants identified suggestions for the development of transition preparation interventions, specifically around involving AYAs in transition decisions and beginning transition preparation early in adolescence. PRACTICE IMPLICATIONS Participants expressed uncertainty about transition when they felt little control over the process or lacked sufficient information about adult care. Therefore, comprehensive early transition preparation for all AYAs with CF with a focus on involving AYAs in transition decisions is recommended.
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Affiliation(s)
- Katherine South
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America.
| | - Maureen George
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America
| | - Hossein Sadeghi
- Columbia University Irving Medical Center, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY 10032, United States of America
| | - Victoria Piane
- Columbia University Irving Medical Center, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY 10032, United States of America
| | - Arlene Smaldone
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America
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7
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Kulage KM, Corwin EJ, Liu J, Schnall R, Smaldone A, Soled KR, Usseglio J, Larson EL. A 10-year examination of a one-on-one grant writing partnership for nursing pre- and post-doctoral trainees. Nurs Outlook 2022; 70:465-477. [DOI: 10.1016/j.outlook.2022.01.007] [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] [Received: 08/26/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 10/18/2022]
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Zheng K, Roehlkepartain EC, Santelli JS, Smaldone A, Bruzzese JM. Associations between Developmental Assets and Adolescent Health Status: Findings from the 2016 National Survey of Children's Health. J Sch Health 2022; 92:300-308. [PMID: 35001405 PMCID: PMC10103581 DOI: 10.1111/josh.13131] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/25/2021] [Accepted: 07/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Developmental assets foster positive health outcomes among adolescents, but have not been studied in adolescents with chronic illness or depression, two conditions that impact behaviors in school. We examined parent-reported assets in a national sample of adolescents and compared the number and types of assets by health statuses. METHODS Data were from the 2016 National Survey of Children's Health (N = 15,734 adolescents), which captured 15 of 40 assets in the Developmental Assets Framework. We categorized adolescents as healthy; chronic physical illness alone; depression alone; and chronic physical illness with co-morbid depression. Data were analyzed using analysis of variance and logistic regression. RESULTS Healthy adolescents and those with chronic physical illness alone were comparable in number and types of assets. Adolescents with chronic physical illness and co-morbid depression had fewer assets compared to healthy adolescents and those with chronic physical illness alone. Similar associations were found in comparing healthy adolescents to those with depression without chronic physical illness. CONCLUSIONS The presence of depression, among adolescents with and without chronic physical illness, was associated with fewer internal and external assets. The absence of assets may serve as a unique indicator of underlying depressive symptoms among adolescents in the school setting.
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Affiliation(s)
- Katherine Zheng
- Northwestern University, Feinberg School of Medicine, 633 N. Saint Clair St, 20th floor, Chicago, IL, 60611
| | | | - John S Santelli
- Columbia Mailman School of Public Health, New York, NY, 10032
| | - Arlene Smaldone
- Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032
| | - Jean-Marie Bruzzese
- Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032
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9
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South K, George M, Smaldone A. Gaps in transition readiness measurement: a comparison of instruments to a conceptual model. Journal of Transition Medicine 2022; 4:20220002. [PMID: 35979374 PMCID: PMC9335701 DOI: 10.1515/jtm-2022-0002] [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] [Received: 03/29/2022] [Accepted: 06/26/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Measuring transition readiness is important when preparing young people with chronic illness for successful transition to adult care. The Expanded Socioecological Model of Adolescent and Young Adult Readiness to Transition (Expanded SMART) offers a holistic view of factors that influence transition readiness and outcomes. The aim of this study was to examine conceptual congruency of transition readiness instruments with the Expanded SMART to determine the breadth and frequency of constructs measured. Methods PubMed was searched to identify observational and experimental studies that measured transition readiness across chronic illnesses. Selected instruments were first evaluated on their development and psychometric properties. Next, reviewers independently mapped each instrument item to Expanded SMART constructs: knowledge, skills/self-efficacy, relationships/communication, psychosocial/emotions, developmental maturity, beliefs/expectations, goals/motivation. If items did not map to a construct, a new construct was named inductively through group discussion. Results Three instruments (TRAQ [20 items], STARx [18 items] and TRxANSITION Index [32 items]), reported in 74 studies, were identified. Across instruments, most items mapped to three constructs: skills/self-efficacy, developmental maturity, and knowledge. The psychosocial constructs of goals/motivation and psychosocial/emotions were underrepresented in the instruments. No instrument mapped to every model construct. Two new constructs: independent living and organization were identified. Conclusions Constructs representing transition readiness in three frequently used transition readiness instruments vary considerably from Expanded SMART, a holistic conceptual model of transition readiness, suggesting that conceptualization and operationalization of transition readiness is not standardized. No instrument reflected all conceptual constructs of transition readiness and psychosocial constructs were underrepresented, suggesting that current instruments may provide an incomplete measurement of transition readiness.
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Affiliation(s)
| | - Maureen George
- Columbia University School of Nursing , New York , NY , USA
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10
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Mitha S, Schwartz J, Cato K, Woo K, Smaldone A, Topaz M. Natural Language Processing of Nursing Notes: A Systematic Review. Stud Health Technol Inform 2021; 284:62-64. [PMID: 34920472 DOI: 10.3233/shti210666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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11
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Koleck TA, Topaz M, Tatonetti NP, George M, Miaskowski C, Smaldone A, Bakken S. Characterizing shared and distinct symptom clusters in common chronic conditions through natural language processing of nursing notes. Res Nurs Health 2021; 44:906-919. [PMID: 34637147 PMCID: PMC8641786 DOI: 10.1002/nur.22190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 03/17/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 01/08/2023]
Abstract
Data-driven characterization of symptom clusters in chronic conditions is essential for shared cluster detection and physiological mechanism discovery. This study aims to computationally describe symptom documentation from electronic nursing notes and compare symptom clusters among patients diagnosed with four chronic conditions-chronic obstructive pulmonary disease (COPD), heart failure, type 2 diabetes mellitus, and cancer. Nursing notes (N = 504,395; 133,977 patients) were obtained for the 2016 calendar year from a single medical center. We used NimbleMiner, a natural language processing application, to identify the presence of 56 symptoms. We calculated symptom documentation prevalence by note and patient for the corpus. Then, we visually compared documentation for a subset of patients (N = 22,657) diagnosed with COPD (n = 3339), heart failure (n = 6587), diabetes (n = 12,139), and cancer (n = 7269) and conducted multiple correspondence analysis and hierarchical clustering to discover underlying groups of patients who have similar symptom profiles (i.e., symptom clusters) for each condition. As expected, pain was the most frequently documented symptom. All conditions had a group of patients characterized by no symptoms. Shared clusters included cardiovascular symptoms for heart failure and diabetes; pain and other symptoms for COPD, diabetes, and cancer; and a newly-identified cognitive and neurological symptom cluster for heart failure, diabetes, and cancer. Cancer (gastrointestinal symptoms and fatigue) and COPD (mental health symptoms) each contained a unique cluster. In summary, we report both shared and distinct, as well as established and novel, symptom clusters across chronic conditions. Findings support the use of electronic health record-derived notes and NLP methods to study symptoms and symptom clusters to advance symptom science.
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Affiliation(s)
- Theresa A. Koleck
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, New York
- Data Science Institute, Columbia University, New York, New York
| | - Nicholas P. Tatonetti
- Data Science Institute, Columbia University, New York, New York
- Department of Biomedical Informatics, Columbia University, New York, New York
- Department of Systems Biology, Columbia University, New York, New York
- Department of Medicine, Columbia University, New York, New York
- Institute for Genomic Medicine, Columbia University, New York, New York
| | - Maureen George
- School of Nursing, Columbia University, New York, New York
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California
| | - Arlene Smaldone
- School of Nursing, Columbia University, New York, New York
- College of Dental Medicine, Columbia University, New York, New York
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York
- Data Science Institute, Columbia University, New York, New York
- Department of Biomedical Informatics, Columbia University, New York, New York
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Heitkemper EM, Hafermann KA, Honig JC, Smaldone A. Preparing Teaching Assistants in Nursing: A Mixed-Methods Evaluation. Nurse Educ 2021; 46:E179-E183. [PMID: 33767087 PMCID: PMC8435036 DOI: 10.1097/nne.0000000000001006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Teaching assistants (TAs) serve an important role in schools of nursing, but their educational needs are poorly understood. PURPOSE To better prepare TAs, our School of Nursing identified and evaluated current TA practices to create tailored educational materials. METHODS A 16-item survey captured how faculty used TAs. Focus groups with current faculty and former TAs explored the TA role and identified areas to target for future training. Focus groups were analyzed using thematic content analysis. RESULTS Survey response rate was high (88%). Most faculty meet with TAs before the semester, and typical TA duties included attending lecture (71%) and facilitating examination review sessions (64%). Qualitative themes focused on faculty/TA communication, faculty guidance, knowing the policies, and TA/student boundary negotiation. CONCLUSIONS Findings demonstrate the importance of preparing TAs. Since this study, the university and school of nursing have each developed educational materials to better prepare TAs and faculty.
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Affiliation(s)
- Elizabeth M Heitkemper
- Author Affiliations: Assistant Professor (Dr Heitkemper), School of Nursing, University of Texas at Austin; and Senior Academic Affairs Coordinator (Ms Hafermann), Vice Dean of Academics & Dean of Students (Dr Honig), and Assistant Dean for Scholarship and Research (Dr Smaldone), School of Nursing, and Professor of Nursing in Dental Behavioral Sciences (Dr Smaldone), College of Dental Medicine, New York, New York
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South K, George M, Sadeghi H, Piane V, Smaldone A. 224: Moving up: Health care transition experiences of adolescents and young adults with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01649-0] [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: 11/26/2022]
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14
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Aliyu S, Travers JL, Heimlich SL, Ifill J, Smaldone A. Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis. J Appl Gerontol 2021; 41:892-901. [PMID: 34075829 DOI: 10.1177/07334648211018299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/17/2022] Open
Abstract
Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988-2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran's Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.
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Affiliation(s)
| | - Jasmine L Travers
- New York University Rory Meyers College of Nursing, New York City, USA
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Koleck TA, Tatonetti NP, Bakken S, Mitha S, Henderson MM, George M, Miaskowski C, Smaldone A, Topaz M. Identifying Symptom Information in Clinical Notes Using Natural Language Processing. Nurs Res 2021; 70:173-183. [PMID: 33196504 PMCID: PMC9109773 DOI: 10.1097/nnr.0000000000000488] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Symptoms are a core concept of nursing interest. Large-scale secondary data reuse of notes in electronic health records (EHRs) has the potential to increase the quantity and quality of symptom research. However, the symptom language used in clinical notes is complex. A need exists for methods designed specifically to identify and study symptom information from EHR notes. OBJECTIVES We aim to describe a method that combines standardized vocabularies, clinical expertise, and natural language processing to generate comprehensive symptom vocabularies and identify symptom information in EHR notes. We piloted this method with five diverse symptom concepts: constipation, depressed mood, disturbed sleep, fatigue, and palpitations. METHODS First, we obtained synonym lists for each pilot symptom concept from the Unified Medical Language System. Then, we used two large bodies of text (clinical notes from Columbia University Irving Medical Center and PubMed abstracts containing Medical Subject Headings or key words related to the pilot symptoms) to further expand our initial vocabulary of synonyms for each pilot symptom concept. We used NimbleMiner, an open-source natural language processing tool, to accomplish these tasks and evaluated NimbleMiner symptom identification performance by comparison to a manually annotated set of nurse- and physician-authored common EHR note types. RESULTS Compared to the baseline Unified Medical Language System synonym lists, we identified up to 11 times more additional synonym words or expressions, including abbreviations, misspellings, and unique multiword combinations, for each symptom concept. Natural language processing system symptom identification performance was excellent. DISCUSSION Using our comprehensive symptom vocabularies and NimbleMiner to label symptoms in clinical notes produced excellent performance metrics. The ability to extract symptom information from EHR notes in an accurate and scalable manner has the potential to greatly facilitate symptom science research.
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Zheng K, George M, Roehlkepartain E, Santelli J, Bruzzese JM, Smaldone A. Developmental Assets of Adolescents and Young Adults With Chronic Illness and Comorbid Depression: Qualitative Study Using YouTube. JMIR Ment Health 2021; 8:e23960. [PMID: 33591288 PMCID: PMC7925153 DOI: 10.2196/23960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/20/2020] [Accepted: 12/19/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Developmental assets provide a framework for optimizing development among adolescents but have not been studied in adolescents with chronic illness and comorbid depression, which is a group at risk for poor health outcomes. YouTube postings provide valuable insights to understand this understudied population. OBJECTIVE This study aims to explore asset development from the perspectives of adolescents and young adults (AYAs) with chronic illness and comorbid depression. METHODS YouTube was searched using 12 chronic illnesses (eg, diabetes) coupled with "depression" as keywords. Videos were included if they were uploaded by AYAs aged between 11 and 29 years and discussed living with chronic illness and depression during adolescence. Video transcripts were coded deductively for 40 internal and external assets that constitute the Developmental Assets Framework. Categories not captured by deductive coding were identified using conventional content analysis. Categories and their respective assets were labeled as being discussed either negatively or positively. RESULTS In total, 31 videos from 16 AYAs met the inclusion criteria. A total of 7 asset categories, support, constructive use of time, boundaries and expectations (external assets), identity, commitment to learning, positive values, and social competence (internal assets), reflecting 25 (13 internal; 12 external) assets, were discussed. Internal assets, particularly relating to identity, were commonly discussed by AYAs either in a negative way or fluctuated between positive and negative perspectives. CONCLUSIONS In this sample of AYAs with chronic illness and comorbid depression, internal assets were commonly discussed in a negative way. Future research is needed to better understand how assets develop and if the Developmental Assets Framework adequately represents the experiences of this population.
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Affiliation(s)
- Katherine Zheng
- The Feinberg School of Medicine, Center for Education in Health Sciences, Northwestern University, Chicago, IL, United States.,Columbia University School of Nursing, New York, NY, United States
| | - Maureen George
- Columbia University School of Nursing, New York, NY, United States
| | | | - John Santelli
- Columbia University Mailman School of Public Health, New York, NY, United States
| | | | - Arlene Smaldone
- Columbia University School of Nursing, New York, NY, United States
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Abstract
PhD Summit attendees, as part of moderated roundtable discussions, responded to two questions: What PhD competencies should guide the preparation of PhD prepared nurses to function in current and emerging roles? and How has innovation in programs and curricula changed the landscape to prepare and support PhD students for success? The purpose of this report is to summarize Summit discussion around these issues and assess the current relevance of 2010 AACN competencies and whether they are adequate to meet the needs of emerging nurse scientists.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, NY, United States of America; College of Dental Medicine, Columbia University Medical Center, New York, NY, United States of America.
| | - Elaine L Larson
- Columbia University School of Nursing, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Topaz M, Koleck TA, Onorato N, Smaldone A, Bakken S. Nursing documentation of symptoms is associated with higher risk of emergency department visits and hospitalizations in homecare patients. Nurs Outlook 2020; 69:435-446. [PMID: 33386145 DOI: 10.1016/j.outlook.2020.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 09/08/2020] [Revised: 10/23/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nurses often document patient symptoms in narrative notes. PURPOSE This study used a technique called natural language processing (NLP) to: (1) Automatically identify documentation of seven common symptoms (anxiety, cognitive disturbance, depressed mood, fatigue, sleep disturbance, pain, and well-being) in homecare narrative nursing notes, and (2) examine the association between symptoms and emergency department visits or hospital admissions from homecare. METHOD NLP was applied on a large subset of narrative notes (2.5 million notes) documented for 89,825 patients admitted to one large homecare agency in the Northeast United States. FINDINGS NLP accurately identified symptoms in narrative notes. Patients with more documented symptom categories had higher risk of emergency department visit or hospital admission. DISCUSSION Further research is needed to explore additional symptoms and implement NLP systems in the homecare setting to enable early identification of concerning patient trends leading to emergency department visit or hospital admission.
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Affiliation(s)
- Maxim Topaz
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY; Columbia University School of Nursing, Columbia University Data Science Institute, New York, NY
| | | | - Nicole Onorato
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY.
| | - Arlene Smaldone
- Columbia University School of Nursing, Columbia University College of Dental Medicine, New York, NY
| | - Suzanne Bakken
- Columbia University School of Nursing, Columbia University Department of Biomedical Informatics, Columbia University Data Science Institute, New York, NY
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Abstract
BACKGROUND AND PURPOSE The purpose of this systematic review was to evaluate parental monitoring instruments and the theoretical perspectives informing their development. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, seven databases were searched for original studies using a monitoring instrument. The psychometric properties of each identified instrument were assessed using the "COnsensus-based Standards for the selection of health status Measurement INstruments" (COSMIN) methodology. RESULTS Of 2,245 articles identified, 72 studies representing six parental monitoring instruments met inclusion criteria. Quality of reporting on psychometric properties varied widely across instruments with only three including content validation studies. CONCLUSIONS Findings of this review reveal inattention to the psychometric quality of child self-reported monitoring instruments. Future research must focus on the psychometric quality of instruments used to measure the parent-child relationship.
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20
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Zheng K, Abraham C, Bruzzese JM, Smaldone A. Longitudinal Relationships Between Depression and Chronic Illness in Adolescents: An Integrative Review. J Pediatr Health Care 2020; 34:333-345. [PMID: 32171610 PMCID: PMC7313149 DOI: 10.1016/j.pedhc.2020.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Depression is prevalent among adolescents with chronic illness. However, little is known about how depression affects chronic illness over time. This review aimed to synthesize longitudinal relationships between depression and disease control, self-management behaviors, illness-related morbidity, and quality of life. METHOD Four databases were searched, including PubMed, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and EMBASE. Inclusion criteria were cohort studies examining depression among adolescents aged 10-21 years with a chronic illness and studies published in English. Study quality was appraised using the Newcastle-Ottawa scale and data was synthesized by the outcome. RESULTS Of the 3,463 articles identified, 11 were included in the review. For adolescents with diabetes, increased depressive symptoms predicted decreased metabolic control and monitoring, medication adherence, quality of life, and increased hospitalization. Studies on cystic fibrosis, congenital heart disease, sickle cell disease, and juvenile idiopathic arthritis were limited but demonstrated that depressive symptoms affected the quality of life, disability, pain, and hospitalization rates/costs. DISCUSSION Evidence supports the need for mental health care strategies suitable for adolescents with chronic illness. Future research is needed to examine the effects of depressive symptoms across diversified chronic illness populations.
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Affiliation(s)
- Katherine Zheng
- Columbia University School of Nursing, 560 W. 168 Street, New York, NY 10032
| | - Cilgy Abraham
- Columbia University School of Nursing, 560 W. 168 Street, New York, NY 10032
| | - Jean-Marie Bruzzese
- Columbia University School of Nursing, 560 W. 168 Street, New York, NY 10032
| | - Arlene Smaldone
- Columbia University School of Nursing, 560 W. 168 Street, New York, NY 10032
- College of Dental Medicine, Columbia University, 622 W. 168 Street, New York, NY 10032
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Feller DJ, Burgermaster M, Levine ME, Smaldone A, Davidson PG, Albers DJ, Mamykina L. A visual analytics approach for pattern-recognition in patient-generated data. J Am Med Inform Assoc 2019; 25:1366-1374. [PMID: 29905826 PMCID: PMC6188507 DOI: 10.1093/jamia/ocy054] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Received: 10/20/2017] [Accepted: 04/18/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To develop and test a visual analytics tool to help clinicians identify systematic and clinically meaningful patterns in patient-generated data (PGD) while decreasing perceived information overload. Methods Participatory design was used to develop Glucolyzer, an interactive tool featuring hierarchical clustering and a heatmap visualization to help registered dietitians (RDs) identify associative patterns between blood glucose levels and per-meal macronutrient composition for individuals with type 2 diabetes (T2DM). Ten RDs participated in a within-subjects experiment to compare Glucolyzer to a static logbook format. For each representation, participants had 25 minutes to examine 1 month of diabetes self-monitoring data captured by an individual with T2DM and identify clinically meaningful patterns. We compared the quality and accuracy of the observations generated using each representation. Results Participants generated 50% more observations when using Glucolyzer (98) than when using the logbook format (64) without any loss in accuracy (69% accuracy vs 62%, respectively, p = .17). Participants identified more observations that included ingredients other than carbohydrates using Glucolyzer (36% vs 16%, p = .027). Fewer RDs reported feelings of information overload using Glucolyzer compared to the logbook format. Study participants displayed variable acceptance of hierarchical clustering. Conclusions Visual analytics have the potential to mitigate provider concerns about the volume of self-monitoring data. Glucolyzer helped dietitians identify meaningful patterns in self-monitoring data without incurring perceived information overload. Future studies should assess whether similar tools can support clinicians in personalizing behavioral interventions that improve patient outcomes.
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Affiliation(s)
- Daniel J Feller
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | - Matthew E Levine
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Arlene Smaldone
- Columbia University School of Nursing and College of Dental Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - David J Albers
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
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Smaldone A, Manwani D, Aygun B, Smith-Whitley K, Jia H, Bruzzese JM, Findley S, Massei J, Green NS. HABIT efficacy and sustainability trial, a multi-center randomized controlled trial to improve hydroxyurea adherence in youth with sickle cell disease: a study protocol. BMC Pediatr 2019; 19:354. [PMID: 31615480 PMCID: PMC6792326 DOI: 10.1186/s12887-019-1746-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background Hydroxyurea (HU) is recommended as standard practice for youth with sickle cell disease (SCD). Yet, despite its efficacy, HU adherence in adolescents and young adults is often poor. Poor medication adherence increases disease burden, healthcare cost and widens health disparities. Adolescence is a critical time to improve adherence through improved chronic disease self-management. This study aims to test the efficacy of an intervention delivered to youth/parent dyads by community health workers (CHWs), augmented by tailored text messages on HU adherence (primary outcome). Secondary outcomes are intervention sustainability, youth health-related quality of life, self-management responsibility concordance, acute hospital use and self-reported disease symptoms. Methods Hydroxyurea Adherence for Personal Best in Sickle Cell Disease, “HABIT,” is a 12 month multi-center randomized controlled trial. One hundred four youth, 10 to 18 years of age prescribed HU who meet eligibility criteria, enrolled with their parent as dyads, will be randomized 1:1 to either the HABIT intervention or to usual clinical care plus education handouts. All subjects will complete clinic visits at months 0, 2, 4, 6 (efficacy component), 9 and 12 (sustainability component) for assessment of HbF biomarker, other hematologic parameters, and to complete questionnaires. In addition, dyads assigned to the HABIT intervention will work with CHWs to identify a daily habit (e.g., brushing teeth) on which to build a HU adherence habit. Tailored daily text message reminders to support the habit will be developed by the dyad in collaboration with the CHWs and sent to parent and youth. At the 6 month visit, the intervention will end and the sustainability portion of the trial will begin. All data analyses will be based on intention to treat with all randomized subjects included in the analyses. Discussion Prior retrospective studies demonstrate that a majority of adolescents are poorly adherent to HU. If efficacious, the HABIT intervention has the potential to improve the lives of youth with SCD. Trial registration Clinicaltrials.gov NCT03462511. Registered March 6, 2018, last updated July 26, 2019.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, NY, USA. .,Columbia University College of Dental Medicine, New York, NY, USA.
| | | | - Banu Aygun
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | | | - Haomiao Jia
- Columbia University School of Nursing, New York, NY, USA.,Mailman School of Public Health, New York, NY, USA
| | | | | | - Joshua Massei
- Columbia University School of Nursing, New York, NY, USA
| | - Nancy S Green
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Smaldone A, Heitkemper E, Jackman K, Woo KJ, Kelson J. Dissemination of PhD Dissertation Research by Dissertation Format: A Retrospective Cohort Study. J Nurs Scholarsh 2019; 51:599-607. [PMID: 31313486 PMCID: PMC6742546 DOI: 10.1111/jnu.12504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Accepted: 06/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The study purpose was to compare dissemination of PhD dissertation research by dissertation format: traditional (five-chapter document providing a complete and systematic account of the PhD research) versus an alternate (substudy [document containing three smaller studies but not written as stand-alone manuscripts] or publication [document containing three or more related manuscripts intended for submission or published in a peer-reviewed journal]) format. DESIGN A retrospective study of all PhD dissertations (1999-2019) from one research intensive school of nursing. METHODS Following identification of graduates via the school's PhD database, we searched ProQuest and PubMed databases for the dissertation and first authored peer-reviewed publications of each graduate to determine dissertation format, study design, timing and number of dissertation research publications, and inclusion of dissertation sponsor in authorship. Data were analyzed using descriptive statistics and Wilcoxon rank sum tests. FINDINGS Of 113 graduates, 80 (70.8%) employed a traditional format, with the remaining graduates structuring dissertations using an alternate (substudy [n = 12], publication [n = 21]) format. Of those using the traditional format, 33 graduates (41.3%) never published dissertation research findings in a peer-reviewed journal. For those who published their dissertation research in a peer-reviewed journal, time to first publication was 1.4 ± 2.1 years (median 1.6 years) following degree conferral. In contrast, all graduates who utilized alternate formats published one or more components of their dissertation research with shorter time to first published manuscript (-0.6 ± 1.1 years; median -0.5 years; p < .001). Number of peer-reviewed publications was higher for those who utilized an alternate format compared to the traditional format (2.9 ± 1.5 [median 3.0] vs. 1.8 ± 1.1 [median 1.0], p = .001). Acknowledgment of the sponsor's contribution via publication authorship was higher for those using an alternate format compared to the traditional format (100% vs. 70.2%). CONCLUSIONS Number and timeliness of peer-reviewed publications stemming from dissertation research was higher for PhD graduates who utilized an alternate dissertation format. Alternate dissertation formats should be encouraged by PhD programs as one means to improve dissemination of PhD nursing research. CLINICAL RELEVANCE Dissemination of PhD research through peer-reviewed publications promotes the continued development of nursing science to inform nursing practice and advances the career trajectory of PhD graduates.
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Affiliation(s)
- Arlene Smaldone
- Professor of Nursing and Dental Behavioral Sciences, Assistant Dean, Scholarship and Research, School of Nursing and College of Dental Medicine Columbia University, New York, NY, USA
| | - Elizabeth Heitkemper
- Postdoctoral Research Fellow, Department of Bioinformatics, Columbia University School of Nursing, New York, NY, USA
| | - Kasey Jackman
- Postdoctoral Research Fellow, School of Nursing Columbia University, New York, NY, USA
| | - Kyungmi Joanne Woo
- Postdoctoral Research Fellow, School of Nursing, Columbia University, New York, NY, USA
| | - Judith Kelson
- Assistant Director, PhD program, School of Nursing, Columbia University Medical Center, New York, NY, USA
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Abstract
AIM To strengthen the theoretical understanding of illness acceptance in adolescents and to inform healthcare strategies geared toward supporting adolescents with chronic illness. BACKGROUND Illness acceptance is associated with positive health outcomes. Though well understood in adults with chronic illness, less is known about how this phenomenon ensues in adolescents. Adolescents may have a difficult time accepting an illness due to their unique developmental needs. Consequently, they are vulnerable to poor health outcomes. DESIGN Concept analysis. DATA SOURCES A literature search through 2 databases (PubMed and PsycINFO) and a hand-search through Google were conducted to identify uses of the concept. REVIEW METHODS The Walker and Avant method of concept analysis. RESULTS Four attributes of illness acceptance were identified: understanding of illness, overcoming limitations, normalization, and readiness for responsibility. Antecedents that predisposed illness acceptance included peer and family support, disease management education, and developmental readiness. Positive consequences of illness acceptance included high self-esteem, improved quality of life, resilience, identity formation, and better disease control. CONCLUSIONS Establishing a standardized conceptual understanding of how illness acceptance ensues in adolescents can enable nurses and other health professionals to tailor developmentally appropriate care strategies and optimize the overall quality of life for this unique patient population.
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Affiliation(s)
| | | | - Arlene Smaldone
- Columbia University School of Nursing, New York, New York.,College of Dental Medicine, Columbia University, New York, New York
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25
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Smaldone A, Manwani D, Green NS. Greater number of perceived barriers to hydroxyurea associated with poorer health-related quality of life in youth with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27740. [PMID: 30941907 PMCID: PMC6538386 DOI: 10.1002/pbc.27740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite medical benefits, hydroxyurea adherence in adolescents is often poor. As part of a baseline assessment of 28 youth (10-18 years) parent dyads who participated in a 6-month feasibility trial to improve hydroxyurea adherence, we measured the relationship between greater barriers to adherence and health-related quality of life (HRQL) from youth and parent perspectives. PROCEDURE Barriers were measured using the Adolescent and Parent Medication Barriers Scales with nine hydroxyurea items added. Barriers reported by ≥25% of the sample were considered common. Generic and disease-specific HRQL were measured by PedsQL and PedsQL Sickle Cell Disease modules. Data were analyzed using descriptive statistics, Cronbach alpha, Spearman correlation coefficients, and paired t tests. RESULTS Fifty-six subjects (28 dyads) participated. Youth reported greater barriers compared with parents (5.0 ± 3.9 and 3.5 ± 3.2; P = 0.03), with >80% of respondents reporting ≥1 barriers. Twelve barriers were reported by ≥25% of adolescents, whereas six were reported by ≥25% of parents. Of these, only two were common to both dyad members. Approximately one-third of youth had generic and disease-specific HRQL scores that fell at or below cutoff scores, suggesting being at risk for impaired HRQL. Greater barriers were inversely associated with poorer generic (parent r = -0.43, P = 0.03; youth r = -0.44, P < 0.001) and disease-specific HRQL (parent r = -0.53, P = 0.005; youth r = -0.53, P < 0.001). CONCLUSIONS Hydroxyurea barriers were frequently reported but differed by dyad members' perspective. Greater barriers were associated with poorer generic and disease-specific HRQL. To reduce barriers to hydroxyurea in youth with sickle cell disease, perspectives of both dyad members should be addressed.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, New York
- College of Dental Medicine, Columbia University Medical Center, New York, New York
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | - Nancy S. Green
- Department of Pediatrics, Columbia University Medical Center, New York, New York
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LaCross A, Smaldone A, Angelson J. Ambivalence Toward Pregnancy as an Indicator for Contraceptive Nonuse: A Systematic Review and Meta‐Analysis. J Midwifery Womens Health 2019; 64:385-394. [DOI: 10.1111/jmwh.12969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Allison LaCross
- Department of Obstetrics and GynecologyNorth Central Bronx Hospital Bronx New York
- Columbia University School of Nursing New York New York
| | - Arlene Smaldone
- Columbia University School of Nursing New York New York
- College of Dental MedicineColumbia University Medical Center New York New York
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Handschuh C, La Cross A, Smaldone A. Is Sexting Associated with Sexual Behaviors During Adolescence? A Systematic Literature Review and Meta-Analysis. J Midwifery Womens Health 2018; 64:88-97. [PMID: 30521135 DOI: 10.1111/jmwh.12923] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/21/2018] [Accepted: 09/04/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION A growing body of research has addressed adolescent use of mobile devices to exchange sexually explicit images and messages (sexting). Although there are legal consequences in some states for sexting among adolescents, research findings have also demonstrated associations between sexting and sexual activity. The purpose of this systematic review was to synthesize research examining the association between adolescent sexting and sexual activity. METHODS Five databases (CINAHL, Embase, Ovid MEDLINE, PsycINFO, and Scopus) were searched for studies measuring adolescent sexting and sexual behaviors. Studies were appraised for quality using a modified Downs and Black scale. Studies reporting frequencies or odds ratios were eligible for inclusion in random effects meta-analytic models. RESULTS Of 669 articles retrieved, 9 studies met inclusion criteria for systematic review; of these, 6 were included in meta-analysis. After pooling data from 9676 adolescents, the odds of reporting sexual activity were found to be 6.3 times higher (95% CI, 4.9-8.1; Q = 14.3; I2 = 65.1) for adolescents who sent sexts compared with those who did not. DISCUSSION These data suggest that adolescents who send sexually explicit text messages are more likely to report sexual activity than adolescents who do not. Midwives are well poised to integrate a discussion of sexting into sexual and reproductive health counseling with adolescent and young adult patients.
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Shirazian S, Smaldone A, Rao MK, Silberzweig J, Jacobson AM, Fazzari M, Weinger K. A protocol for a pilot randomized controlled trial to assess the feasibility and effect of a cognitive behavioral intervention on quality of life for patients on hemodialysis. Contemp Clin Trials 2018; 73:51-60. [PMID: 30172036 DOI: 10.1016/j.cct.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Poor health-related quality of life (HrQOL) is highly prevalent in patients on hemodialysis (HD), and is associated with increased hospitalizations and mortality. Cognitive behavioral (CB) techniques have improved HrQOL in HD patients but have not been routinely translated into clinical practice. The investigators present the rationale, study design and protocol of a randomized controlled trial to pilot the feasibility and effect of a translatable, behavioral-education intervention using CB techniques to improve poor HrQOL and self-management in hemodialysis patients. METHODS Forty-eight HD patients will be randomly assigned to either the study intervention which includes 8-12 behavioral-education sessions with incorporated CB techniques delivered over 12 weeks or a control group of dialysis education without incorporated CB techniques. Subjects will be followed for 16 weeks and the primary outcome, change in kidney disease quality of life (KDQOL)-36 scores, will be measured at 0, 8, and 16 weeks. The study will have 85% power to detect an 8-point change in KDQOL-36 scores. At the end of the study, qualitative data will be gathered through end-of-study focus groups, and semi-structured interviews. These data will be used to refine the intervention and help translate it into clinical practice. DISCUSSION There is promising evidence in support of CB-based interventions to improve HrQOL for patients on HD. Despite this, these interventions have not been routinely incorporated into clinical practice. The proposed intervention has the potential to improve both HrQOL and self-management, while also being easily translatable to other HD units.
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Affiliation(s)
- Shayan Shirazian
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
| | - Arlene Smaldone
- School of Nursing and College of Dental Medicine, Columbia University Medical Center, New York, NY, USA
| | - Maya K Rao
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Alan M Jacobson
- Winthrop Research Institute, NYU Winthrop University Hospital, Mineola, NY, USA
| | - Melissa Fazzari
- Winthrop Research Institute, NYU Winthrop University Hospital, Mineola, NY, USA
| | - Katie Weinger
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Smaldone A, Findley S, Manwani D, Jia H, Green NS. HABIT, a Randomized Feasibility Trial to Increase Hydroxyurea Adherence, Suggests Improved Health-Related Quality of Life in Youths with Sickle Cell Disease. J Pediatr 2018; 197:177-185.e2. [PMID: 29571930 PMCID: PMC5970970 DOI: 10.1016/j.jpeds.2018.01.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 10/03/2017] [Revised: 11/29/2017] [Accepted: 01/18/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To examine the effect of a community health worker (CHW) intervention, augmented by tailored text messages, on adherence to hydroxyurea therapy in youths with sickle cell disease, as well as on generic and disease-specific health-related quality of life (HrQL) and youth-parent self-management responsibility concordance. STUDY DESIGN We conducted a 2-site randomized controlled feasibility study (Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment [HABIT]) with 2:1 intervention allocation. Youths and parents participated as dyads. Intervention dyads received CHW visits and text message reminders. Data were analyzed using descriptive statistics, the Wilcoxon signed-rank test, and growth models adjusting for group assignment, time, and multiple comparisons. Changes in outcomes from 0 to 6 months were compared with their respective minimal clinically important differences. RESULTS A total of 28 dyads (mean age of youths, 14.3 ± 2.6 years; 50% Hispanic) participated (18 in the intervention group, 10 in the control group), with 10.7% attrition. Accounting for group assignment, time, and multiple comparisons, at 6 months intervention youths reported improved generic HrQL total score (9.8 points; 95% CI, 0.4-19.2) and Emotions subscale score (15.0 points; 95% CI, 1.6-28.4); improved disease-specific subscale scores for Worry I (30.0 points; 95% CI, 8.5-51.5), Emotions (37.0 points, 95% CI, 9.4-64.5), and Communication I (17.8 points; 95% CI, 0.5-35.1); and 3-month dyad self-management responsibility concordance (3.5 points; 95% CI, -0.2 to 7.1). There were no differences in parent proxy-reported HrQL measures at 6 months. CONCLUSIONS These findings add to research examining effects of behavioral interventions on HrQL outcomes in youths with sickle cell disease. TRIAL REGISTRATION ClinicalTrials.gov: NCT02029742.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, NY; College of Dental Medicine, Columbia University Medical Center, New York, NY.
| | - Sally Findley
- Mailman School of Public Health, Columbia University, New York, NY
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, New York, NY
| | - Haomiao Jia
- Columbia University School of Nursing, New York, NY,Mailman School of Public Health, Columbia University, New York, NY
| | - Nancy S. Green
- Department of Pediatrics, Columbia University Medical Center, New York, NY
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Heitkemper EM, Mamykina L, Travers J, Smaldone A. Do health information technology self-management interventions improve glycemic control in medically underserved adults with diabetes? A systematic review and meta-analysis. J Am Med Inform Assoc 2018; 24:1024-1035. [PMID: 28379397 DOI: 10.1093/jamia/ocx025] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 03/01/2017] [Indexed: 11/14/2022] Open
Abstract
Objective The purpose of this systematic review and meta-analysis was to examine the effect of health information technology (HIT) diabetes self-management education (DSME) interventions on glycemic control in medically underserved patients. Materials and Methods Following an a priori protocol, 5 databases were searched. Studies were appraised for quality using the Cochrane Risk of Bias assessment. Studies reporting either hemoglobin A1c pre- and post-intervention or its change at 6 or 12 months were eligible for inclusion in the meta-analysis using random effects models. Results Thirteen studies met the criteria for the systematic review and 10 for the meta-analysis and represent data from 3257 adults with diabetes (mean age 55 years; 66% female; 74% racial/ethnic minorities). Most studies ( n = 10) reflected an unclear risk of bias. Interventions varied by HIT type: computer software without Internet ( n = 2), cellular/automated telephone ( n = 4), Internet-based ( n = 4), and telemedicine/telehealth ( n = 3). Pooled A1c decreases were found at 6 months (-0.36 (95% CI, -0.53 and -0.19]; I 2 = 35.1%, Q = 5.0), with diminishing effect at 12 months (-0.27 [95% CI, -0.49 and -0.04]; I 2 = 42.4%, Q = 10.4). Discussion Findings suggest that medically underserved patients with diabetes achieve glycemic benefit following HIT DSME interventions, with dissipating but significant effects at 12 months. Telemedicine/telehealth interventions were the most successful HIT type because they incorporated interaction with educators similar to in-person DSME. Conclusion These results are similar to in-person DSME in medically underserved patients, showing that well-designed HIT DSME has the potential to increase access and improve outcomes for this vulnerable group.
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Affiliation(s)
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University Medical Center
| | - Jasmine Travers
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Arlene Smaldone
- School of Nursing, Columbia University Medical Center, New York, NY, USA.,Department of Dental Behavioral Sciences, College of Dental Medicine, Columbia University Medical Center
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Stonbraker S, Smaldone A, Luft H, Cushman LF, Lerebours Nadal L, Halpern M, Larson E. Associations between health literacy, HIV-related knowledge, and information behavior among persons living with HIV in the Dominican Republic. Public Health Nurs 2017; 35:166-175. [PMID: 29285785 DOI: 10.1111/phn.12382] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 11/30/2022]
Abstract
OBJECTIVES To determine the health literacy levels of persons living with human immunodeficiency virus (HIV) (PLWH) at a health clinic in the Dominican Republic (DR) and assess associations between health literacy, HIV-related knowledge, and health information behavior (how patients need, seek, receive, and use information). DESIGN AND SAMPLE Cross-sectional, descriptive. Participants were 107 PLWH attending the Clinic. MEASURES A theoretically based, 64-item survey assessing information behavior and HIV-related knowledge was administered in Spanish through individual interviews. Health literacy was assessed using the Short Assessment of Health Literacy-Spanish and English. RESULTS On average, participants were 40.8 years old and had lived with HIV for 7.7 years. The majority (69.2%) had low health literacy. HIV-related knowledge and information behavior varied by health literacy level and uncertainty regarding a main indicator of disease progression, viral load, was demonstrated regardless of health literacy level. Participants with low health literacy were less likely to answer questions or answer questions correctly and many participants (39.2%) indicated viral transmission can occur through supernatural means. CONCLUSIONS Findings demonstrate unmet information need and that information received may not always be understood. Methods to improve health education are needed to ensure patients receive health information in an understandable way.
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Affiliation(s)
- Samantha Stonbraker
- Columbia University School of Nursing, New York, NY, USA.,Clínica de Familia, La Romana, Dominican Republic
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, NY, USA.,Columbia University College of Dental Medicine, New York, NY, USA
| | - Heidi Luft
- Columbia University School of Nursing, New York, NY, USA
| | - Linda F Cushman
- Department of Population and Family Health, Mailman School of Public Health, New York, NY, USA
| | | | - Mina Halpern
- Clínica de Familia, La Romana, Dominican Republic
| | - Elaine Larson
- Columbia University School of Nursing, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
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Abstract
A recent evaluation of a school nurse-led obesity intervention demonstrated a 5% implementation rate. The purpose of this study was to explore school nurses' perceived barriers to and facilitators of the intervention in order to understand reasons for the low implementation rate. Methods included semi-structured individual interviews with school nurses. Data were analyzed using content analysis and heat mapping. Nineteen nurses participated and eight themes were identified. Parental and administrative gatekeeping, heavy nurse workload, obesogenic environments, and concerns about obesity stigma were barriers to implementation. Teamwork with parents and school staff was a key facilitator of implementation. Nurses also noted the importance of cultural considerations and highlighted the need to tailor the intervention to the unique needs of their school environment and student population. These findings suggest that for school nurses to play a key role in school-based obesity interventions, barriers must be identified and addressed prior to program implementation.
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Affiliation(s)
- Krista Schroeder
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Green NS, Manwani D, Matos S, Hicks A, Soto L, Castillo Y, Ireland K, Stennett Y, Findley S, Jia H, Smaldone A. Randomized feasibility trial to improve hydroxyurea adherence in youth ages 10-18 years through community health workers: The HABIT study. Pediatr Blood Cancer 2017. [PMID: 28643377 PMCID: PMC6538388 DOI: 10.1002/pbc.26689] [Citation(s) in RCA: 25] [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: 12/20/2022]
Abstract
INTRODUCTION The main therapeutic intervention for sickle cell disease (SCD) is hydroxyurea (HU). The effect of HU is largely through dose-dependent induction of fetal hemoglobin (HbF). Poor HU adherence is common among adolescents. METHODS Our 6-month, two-site pilot intervention trial, "HABIT," was led by culturally aligned community health workers (CHWs). CHWs performed support primarily through home visits, augmented by tailored text message reminders. Dyads of youth with SCD ages 10-18 years and a parent were enrolled. A customized HbF biomarker, the percentage decrease from each patients' highest historical HU-induced HbF, "Personal best," was used to qualify for enrollment and assess HU adherence. Two primary outcomes were as follows: (1) intervention feasibility and acceptability and (2) HU adherence measured in three ways: monthly percentage improvement toward HbF Personal best, proportion of days covered (PDC) by HU, and self-report. RESULTS Twenty-eight dyads were enrolled, of which 89% were retained. Feasibility and acceptability were excellent. Controlling for group assignment and month of intervention, the intervention group improved percentage decrease from Personal best by 2.3% per month during months 0-4 (P = 0.30), with similar improvement in adherence demonstrated using pharmacy records. Self-reported adherence did not correlate. Dyads viewed CHWs as supportive for learning about SCD and HU, living with SCD and making progress in coordinated self-management responsibility to support a daily HU habit. Most parents and youth appreciated text message HU reminders. CONCLUSIONS The HABIT pilot intervention demonstrated feasibility and acceptability with promising effect toward improved medication adherence. Testing in a larger multisite intervention trial is warranted.
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Affiliation(s)
- Nancy S. Green
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | - Sergio Matos
- Community Health Worker Network of New York City, New York, New York
| | - April Hicks
- Community Health Worker Network of New York City, New York, New York
| | - Luisa Soto
- Community League of the Heights, New York, New York
| | | | - Karen Ireland
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | | | - Sally Findley
- Mailman School of Public Health, Columbia University, New York, New York
| | - Haomiao Jia
- Columbia University School of Nursing, New York, New York
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Heitkemper EM, Mamykina L, Tobin JN, Cassells A, Smaldone A. Baseline Characteristics and Technology Training of Underserved Adults With Type 2 Diabetes in the Mobile Diabetes Detective (MoDD) Randomized Controlled Trial. Diabetes Educ 2017; 43:576-588. [PMID: 29059017 DOI: 10.1177/0145721717737367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose The purpose of this study is to describe the characteristics and technology training needs of underserved adults with type 2 diabetes mellitus (T2DM) who participated in a health information technology (HIT) diabetes self-management education (DSME) intervention. Methods The baseline physiological, psychosocial, and technology use characteristics for 220 adults with poorly controlled T2DM were evaluated. Intervention participants received a 1-time intervention training, which included basic technology help, introduction to the Mobile Diabetes Detective (MoDD) website and text message features, and account activation that included subject-specific tailoring. Four additional on-site sessions for participants needing computer or Internet access or technology support were made available based on need. Data regarding on-site visits for usual care were collected. Data were analyzed using descriptive statistics and bivariate analysis. Results The participants were predominately Hispanic and female with a baseline mean A1C of 10% (86 mmol/mol). Only half of the participants regularly used computers or text messages in daily life. The average introductory MoDD training session lasted 73.6 minutes. Following training, approximately one-third (35%) of intervention participants returned for basic and MoDD-specific technology assistance at their federally qualified health center. The most frequently reported duration for the extra training sessions was 30 to 45 minutes. Conclusions Training and support needs were greater than anticipated. Diabetes educators should assess technology abilities prior to implementing health information technology (HIT) diabetes self-management education (DSME) in underserved adults. Future research must invest resources in technology access, anticipate subject training, and develop new training approaches to ensure HIT DSME use and engagement.
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Affiliation(s)
- Elizabeth M Heitkemper
- School of Nursing, Columbia University Medical Center, New York, New York (Dr Heitkemper, Dr Smaldone)
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University Medical Center, New York, New York (Dr Mamykina)
| | - Jonathan N Tobin
- Center for Clinical and Translational Science, The Rockefeller University, New York, New York (Dr Tobin)
| | - Andrea Cassells
- Clinical Directors Network (CDN), Inc, New York, New York (Dr Tobin, Ms Cassells)
| | - Arlene Smaldone
- School of Nursing, Columbia University Medical Center, New York, New York (Dr Heitkemper, Dr Smaldone).,Department of Dental Behavioral Sciences, College of Dental Medicine, Columbia University Medical Center, New York, New York (Dr Smaldone)
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Schroeder K, Jia H, Wang YC, Smaldone A. Implementation of a School Nurse-led Intervention for Children With Severe Obesity in New York City Schools. J Pediatr Nurs 2017; 35:16-22. [PMID: 28728763 PMCID: PMC6057478 DOI: 10.1016/j.pedn.2017.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/16/2017] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The Healthy Options and Physical Activity Program (HOP) is a school nurse-led intervention for children with severe obesity. HOP was developed by experts at the New York City Department of Health and Mental Hygiene and implemented in New York City schools beginning in 2012. The purpose of this study was to evaluate HOP implementation with the goal of informing HOP refinement and potential future HOP dissemination. DESIGN AND METHODS This study entailed a retrospective analysis of secondary data. Analytic methods included descriptive statistics, Wilcoxon rank sum and Chi square tests, and multivariate logistic regression. RESULTS During the 2012-2013 school year, 20,518 children were eligible for HOP. Of these, 1054 (5.1%) were enrolled in the program. On average, enrolled children attended one HOP session during the school year. Parent participation was low (3.2% of HOP sessions). Low nurse workload, low school poverty, higher grade level, higher BMI percentile, and chronic illness diagnosis were associated with student enrollment in HOP. CONCLUSIONS As currently delivered, HOP is not likely to be efficacious. Lessons learned from this evaluation are applicable to future nurse-led obesity interventions. PRACTICE IMPLICATIONS Prior to implementing a school nurse-led obesity intervention, nursing workload and available support must be carefully considered. Interventions should be designed to facilitate (and possibly require) parent involvement. Nurses who deliver obesity interventions may require additional training in obesity treatment. With attention to these lessons learned, evidence-based school nurse-led obesity interventions can be developed.
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Affiliation(s)
| | - Haomiao Jia
- Columbia University School of Nursing, New York, NY, USA.
| | - Y Claire Wang
- Columbia University Mailman School of Public Health, New York, NY, USA.
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Aliyu S, Smaldone A, Larson E. Prevalence of multidrug-resistant gram-negative bacteria among nursing home residents: A systematic review and meta-analysis. Am J Infect Control 2017; 45:512-518. [PMID: 28456321 DOI: 10.1016/j.ajic.2017.01.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/13/2017] [Accepted: 01/19/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Multidrug-resistant gram-negative bacteria (MDR-GNB) are associated with an increasing proportion of infections among nursing home (NH) residents. The objective of this systematic review and meta-analysis was to critically review evidence of the prevalence of MDR-GNB among NH residents. METHODS Following Meta-Analysis of Observational Studies in Epidemiology guidelines, a systematic review of literature for the years 2005-2016 using multiple databases was conducted. Study quality, appraised by 2 reviewers, used Downs and Black risk of bias criteria. Studies reporting prevalence of MDR-GNB colonization were pooled using a random effects meta-analysis model. Heterogeneity was assessed using Cochran Q and I2 statistics. RESULTS Of 327 articles, 12 met the criteria for review; of these, 8 met the criteria for meta-analysis. Escherichia coli accounted for the largest proportion of isolates. Reported MDR-GNB colonization prevalence ranged from 11.2%-59.1%. Pooled prevalence for MDR-GNB colonization, representing data from 2,720 NH residents, was 27% (95% confidence interval, 15.2%-44.1%) with heterogeneity (Q = 405.6; P = .01; I2 = 98.3). Two studies reported MDR-GNB infection rates of 10.9% and 62.7%. CONCLUSION Our findings suggest a high prevalence of MDR-GNB colonization among NH residents, emphasizing the need to enhance policies for infection control and prevention (ICP) in NHs.
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Affiliation(s)
- Sainfer Aliyu
- Columbia University School of Nursing, New York, NY.
| | | | - Elaine 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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Northrup AA, Smaldone A. Maternal Attitudes, Normative Beliefs, and Subjective Norms of Mothers of 2- and 3-Year-Old Children. J Pediatr Health Care 2017; 31:262-274. [PMID: 27745978 DOI: 10.1016/j.pedhc.2016.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This exploratory study examined maternal attitudes, normative beliefs, subjective norms, and meal selection behaviors of mothers of 2- and 3-year-old children. METHODS Guided by the Theory of Reasoned Action, we had mothers complete three surveys, two interviews, and a feeding simulation exercise. Data were analyzed using descriptive and bivariate statistics and multivariate linear regression. RESULTS A total of 31 mothers (50% Latino, 34% Black, 46.9% ≤ high school education, 31.3% poor health literacy) of 32 children (37.5% overweight/obese) participated in this study. Maternal normative beliefs (knowledge of U.S. Department of Agriculture recommendations) did not reflect actual U.S. Department of Agriculture recommendations. Collectively, regression models explained 13% (dairy) to 51% (vegetables) of the variance in behavioral intent, with normative belief an independent predictor in all models except grain and dairy. DISCUSSION Meal selection behaviors, on average, were predicted by poor knowledge of U.S. Department of Agriculture recommendations. Dietary guidance appropriate to health literacy level should be incorporated into well-child visits.
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Schultz AT, Smaldone A. Components of Interventions That Improve Transitions to Adult Care for Adolescents With Type 1 Diabetes. J Adolesc Health 2017; 60:133-146. [PMID: 27939878 DOI: 10.1016/j.jadohealth.2016.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [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] [Received: 06/30/2016] [Revised: 09/15/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Abstract
Adolescents with type 1 diabetes struggle with glycemic control with decline further exacerbated by transfer from pediatric to adult care. The purpose of this systematic review/meta-analysis was to examine which components of transition programs are effective in improving outcomes following transfer. We searched six databases for studies that assessed the efficacy of a transition program on diabetes outcomes. Studies reporting hemoglobin A1c (HbA1c) or its change for the intervention versus control group pretransition and posttransition were pooled using a random effects meta-analysis model. Of 4,689 studies identified, 18 (1 randomized control trial, 6 quasi-experimental, 1 prospective, and 10 retrospective cohort) met inclusion criteria. Findings represent data from 3,382 youth with type 1 diabetes (52% male, age 16-23 years) undergoing transition. Programs varied and included transition coordinators (n = 7), transition clinics (n = 10), and group education meetings (n = 5). Average age of transfer was 17.7 years. All but one study reported improvement/maintenance of HbA1c posttransition. However, pooling data from four studies with a control group (418 youth), there were no differences in HbA1c at 12 months (-.11 [95% confidence interval: -.31, .08]). Of other outcomes studied (clinic attendance [n = 12], severe hypoglycemia [n = 8], and diabetic ketoacidosis [n = 7]), transition programs showed greatest consistency in reducing diabetic ketoacidosis episodes. Findings suggest that transition interventions may be effective in maintaining glycemic control and reducing diabetic ketoacidosis episodes posttransition. Further research is needed to determine which program types are most effective.
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Affiliation(s)
- Alan T Schultz
- Columbia University School of Nursing, New York, New York
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, New York; College of Dental Medicine, Columbia University Medical Center, New York, New York.
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Lancioni GE, Smaldone A, O'Reilly MF, Singh NN, Oliva D. Automatic Prompting to Reduce Persistent Tongue Protrusion in a Woman with Severe to Profound Mental Retardation. Percept Mot Skills 2016; 101:515-8. [PMID: 16383088 DOI: 10.2466/pms.101.2.515-518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/15/2022]
Abstract
This study assessed whether an intervention approach relying on auditory prompting delivered automatically through a portable device was effective to reduce tongue protrusion in a woman with severe to profound mental retardation. The device involved (a) an optic sensor, i.e., a miniphotocell kept under the lower lip with medical tape, (b) a small signal transmission box, and (c) a Walkman for presenting the prompts. Initially, the automatic prompting condition was combined with occasional praise from a research assistant for having the tongue in the mouth. Analysis showed that the occurrence of tongue protrusion dropped from about 65% of the observation time during the initial baseline to less than 5% through the intervention. The study lasted 4.5 mo.
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Affiliation(s)
- G E Lancioni
- Department of Psychology, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy.
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Usinger KM, Gola SB, Weis M, Smaldone A. Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review. J Pediatr Adolesc Gynecol 2016; 29:659-667. [PMID: 27386754 DOI: 10.1016/j.jpag.2016.06.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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] [Received: 01/20/2016] [Revised: 04/07/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Adolescents are at high risk for unintended pregnancies. Although intrauterine devices (IUDs), long-acting reversible contraceptives (LARCs), are known to be highly effective in preventing pregnancy, little is known about IUD adherence in adolescents. In this systematic review (SR) we examined IUD continuation rates compared with other forms of contraception in young women aged 25 years and younger. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A systematic search of Ovid Medline, Cochrane Library, and Embase was conducted for the years 1946-2015. Included studies examined IUD use in women 25 years of age and younger, compared IUD use with another form of contraception, and measured continuation rates at 12 months. The quality of each study was appraised using the Downs and Black criteria, and 12-month continuation rates among studies were pooled and analyzed according to contraceptive type. RESULTS Of 3597 articles retrieved, 9 studies met criteria for SR. Synthesized across studies, 12-month continuation was significantly higher for IUD users (86.5%, 12,761/14,747) compared with oral contraceptives (39.6%, 1931/4873), Depo-Provera (Pfizer Inc, New York, NY) hormonal injection (39.8%, 510/1282), vaginal ring (48.9%, 196/401), and transdermal patch (39.8%, 37/93; all P values < .001). There was no statistically significant difference in 12-month continuation between the IUD and another LARC method, the subdermal etonogestrel implant (85.3%, 4671/5474). CONCLUSION Findings of this SR suggest that continuation rates for IUDs are generally higher compared with other contraceptive methods for women aged 25 years and younger. In a population with high rates of unintended pregnancies, generally low adherence, and imperfect use with other non-LARCs, IUD use should be encouraged.
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Affiliation(s)
- K M Usinger
- Columbia University School of Nursing, New York, New York
| | - S B Gola
- Columbia University School of Nursing, New York, New York
| | - M Weis
- Columbia University School of Nursing, New York, New York
| | - A Smaldone
- Columbia University School of Nursing, New York, New York.
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Hsu LL, Green NS, Donnell Ivy E, Neunert CE, Smaldone A, Johnson S, Castillo S, Castillo A, Thompson T, Hampton K, Strouse JJ, Stewart R, Hughes T, Banks S, Smith-Whitley K, King A, Brown M, Ohene-Frempong K, Smith WR, Martin M. Community Health Workers as Support for Sickle Cell Care. Am J Prev Med 2016; 51:S87-98. [PMID: 27320471 PMCID: PMC4918511 DOI: 10.1016/j.amepre.2016.01.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 11/25/2022]
Abstract
Community health workers are increasingly recognized as useful for improving health care and health outcomes for a variety of chronic conditions. Community health workers can provide social support, navigation of health systems and resources, and lay counseling. Social and cultural alignment of community health workers with the population they serve is an important aspect of community health worker intervention. Although community health worker interventions have been shown to improve patient-centered outcomes in underserved communities, these interventions have not been evaluated with sickle cell disease. Evidence from other disease areas suggests that community health worker intervention also would be effective for these patients. Sickle cell disease is complex, with a range of barriers to multifaceted care needs at the individual, family/friend, clinical organization, and community levels. Care delivery is complicated by disparities in health care: access, delivery, services, and cultural mismatches between providers and families. Current practices inadequately address or provide incomplete control of symptoms, especially pain, resulting in decreased quality of life and high medical expense. The authors propose that care and care outcomes for people with sickle cell disease could be improved through community health worker case management, social support, and health system navigation. This paper outlines implementation strategies in current use to test community health workers for sickle cell disease management in a variety of settings. National medical and advocacy efforts to develop the community health workforce for sickle cell disease management may enhance the progress and development of "best practices" for this area of community-based care.
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Affiliation(s)
- Lewis L Hsu
- Department of Pediatrics, University of Illinois, Chicago, Illinois
| | - Nancy S Green
- Department of Pediatrics, Columbia University, New York, New York.
| | - E Donnell Ivy
- Health Resources and Services Administration, Rockville, Maryland
| | - Cindy E Neunert
- Department of Pediatrics, Columbia University, New York, New York
| | - Arlene Smaldone
- Department of Pediatrics, Columbia University, New York, New York
| | - Shirley Johnson
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Sheila Castillo
- Department of Pediatrics, University of Illinois, Chicago, Illinois
| | - Amparo Castillo
- Department of Pediatrics, University of Illinois, Chicago, Illinois
| | - Trevor Thompson
- Sickle Cell Disease Foundation of Tennessee, Memphis, Tennessee
| | - Kisha Hampton
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - John J Strouse
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rosalyn Stewart
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - TaLana Hughes
- Sickle Cell Disease Association of Illinois, Chicago, Illinois
| | - Sonja Banks
- Sickle Cell Disease Association of America, Baltimore, Maryland
| | - Kim Smith-Whitley
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allison King
- Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Mary Brown
- Sickle Cell Disease Foundation of California, Los Angeles, California
| | - Kwaku Ohene-Frempong
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wally R Smith
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Molly Martin
- Department of Pediatrics, University of Illinois, Chicago, Illinois
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Smaldone A, Findley S, Bakken S, Matiz LA, Rosenthal SL, Jia H, Matos S, Manwani D, Green NS. Study protocol for a randomized controlled trial to assess the feasibility of an open label intervention to improve hydroxyurea adherence in youth with sickle cell disease. Contemp Clin Trials 2016; 49:134-42. [PMID: 27327779 DOI: 10.1016/j.cct.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/28/2016] [Revised: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Community health workers (CHW) are increasingly recognized as a strategy to improve health outcomes for the underserved with chronic diseases but has not been formally explored in adolescents with sickle cell disease (SCD). SCD primarily affects African American, Hispanic and other traditionally underserved populations. Hydroxyurea (HU), an oral, once-daily medication, is the only approved therapeutic drug for sickle cell disease and markedly reduces symptoms, morbidity and mortality and improves quality of life largely by increasing hemoglobin F blood levels. This paper presents the rationale, study design and protocol for an open label randomized controlled trial to improve parent-youth partnerships in self-management and medication adherence to HU in adolescents with SCD. METHODS/DESIGN A CHW intervention augmented by text messaging was designed for adolescents with SCD ages 10-18years and their parents to improve daily HU adherence. Thirty adolescent parent dyads will be randomized with 2:1 intervention group allocation. Intervention dyads will establish a relationship with a culturally aligned CHW to identify barriers to HU use, identify cues to build a habit, and develop a dyad partnership to improve daily HU adherence and achieve their individualized "personal best" hemoglobin F target. Intervention feasibility, acceptability and efficacy will be assessed via a 2-site trial. Outcomes of interest are HU adherence, dyad self-management communication, quality of life, and resource use. DISCUSSION Despite known benefits, poor HU adherence is common. If feasible and acceptable, the proposed intervention may improve health of underserved adolescents with SCD by enhancing long-term HU adherence. TRIAL REGISTRATION NCT02029742.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, NY, United States; College of Dental Medicine, Columbia University Medical Center, New York, NY, United States
| | - Sally Findley
- Mailman School of Public Health, New York, NY, United States
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, United States; Department of Biomedical Informatics, Columbia University Medical Center, New York, NY, United States
| | - L Adriana Matiz
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States; New York Presbyterian Hospital, New York, NY, United States
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States; Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Haomiao Jia
- Columbia University School of Nursing, New York, NY, United States; Mailman School of Public Health, New York, NY, United States
| | - Sergio Matos
- Community Health Worker Network of New York City, United States
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein Medical School and Montefiore Hospital, NY, NY, United States
| | - Nancy S Green
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States
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Schroeder K, Travers J, Smaldone A. Are School Nurses an Overlooked Resource in Reducing Childhood Obesity? A Systematic Review and Meta-Analysis. J Sch Health 2016; 86:309-21. [PMID: 27040469 PMCID: PMC4939612 DOI: 10.1111/josh.12386] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/28/2015] [Accepted: 10/29/2015] [Indexed: 05/31/2023]
Abstract
BACKGROUND Schools are a key setting for childhood obesity interventions, yet nurses are not often included in delivering these interventions. The objective of this systematic review and meta-analysis was to examine school-based interventions involving nurses in a role beyond anthropometric measurement for effect on change in body measures. METHODS We performed a systematic review and meta-analysis of these papers. RESULTS The literature search produced 2412 articles. Eleven met inclusion criteria for the systematic review (4 randomized controlled trail [RCT], 7 quasi-experimental) and 8 for the meta-analysis. None have been included in prior meta-analyses. Four studies restricted eligibility to overweight and/or obese children; 7 included all children regardless of body weight. Random effects meta-analytic models represent data from 6050 (body mass index [BMI]), 5863 (BMIz), and 416 (BMI percentile) children, respectively. Pooled analyses demonstrated statistically significant decreases in BMI (6 studies: -0.48 [95% CI -0.84, -0.12]; I(2) =91.2%, Q=68.1), BMIz (5 studies: -0.10 [95% CI: -0.15, -0.05]; I(2) =0, Q=2.3), and BMI percentile (3 studies: -0.41 [95% CI: -0.60, -0.21]; I(2) =0, Q=2.0). CONCLUSIONS These findings are similar to those of other meta-analyses of school-based interventions and suggest that school nurses can play a key role in implementing sustainable, effective school-based obesity interventions.
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Affiliation(s)
- Krista Schroeder
- Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032..
| | - Jasmine Travers
- Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032..
| | - Arlene Smaldone
- Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032..
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Edelstein BL, Ureles SD, Smaldone A. Very High Salivary Streptococcus Mutans Predicts Caries Progression in Young Children. Pediatr Dent 2016; 38:325-330. [PMID: 27557922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Culturing mutans streptococci (MS) from children's saliva has high utility in caries risk assessment. The purpose of this retrospective cohort study was to examine its ability in predicting caries progression and determine sensitivity, specificity, and likelihood ratios of a very high ["too numerous to count (TNTC) MS test result. METHODS 200 preschoolers (3.3±1.2 years, 50 percent no recoverable MS, 50 percent TNTC MS at first dental visit) were followed for five or more years. Caries experience of both groups was compared to identify predictors of caries presence and its progression. RESULTS Controlling for demographic, oral health, and dental visit factors, TNTC preschoolers had both greater presence and extent of caries at the first dental visit (adjusted odds ratio [aOR] 8.0, 95 percent confidence interval [CI] 2.5 to 25.5) and caries progression at five or more years (aOR 6.0, 95 percent CI 2.4 to 15.0). Fewer TNTC preschoolers remained caries free over five years or longer (13 percent versus 77 percent for no MS). Overall, sensitivities and specificities exceeded 75 percent. CONCLUSIONS Despite engagement in preventive dental care, children with TNTC MS were six times more likely to experience cavity increments than preschoolers with no recoverable MS at first visit.
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Affiliation(s)
- Burton L Edelstein
- Dental Medicine and Health Policy and Management, Columbia University Medical Center, New York, N.Y, USA
| | - Steven D Ureles
- Children's Dental Associates of New London County, New London, Conn., USA; Dental Medicine, Columbia University Medical Center, New York, N.Y, USA
| | - Arlene Smaldone
- Dental Behavioral Sciences (in Dental Medicine), Columbia University Medical Center, New York, N.Y, USA.
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Abstract
AIM To report an analysis of the concept of food insecurity in order to (a) propose a theoretical model of food insecurity useful to nursing; and (b) discuss its implications for nursing practice, nursing research, and health promotion. BACKGROUND A total of 48 million Americans are food insecure. As food insecurity is associated with multiple negative health effects, nursing intervention is warranted. DESIGN Concept analysis. DATA SOURCES A literature search was conducted in May 2014 in Scopus and MEDLINE using the exploded term "food insecur*." No year limit was placed. Government websites and popular media were searched to ensure a full understanding of the concept. REVIEW METHODS Iterative analysis, using the Walker and Avant method. RESULTS Food insecurity is defined by uncertain ability or inability to procure food, inability to procure enough food, being unable to live a healthy life, and feeling unsatisfied. A proposed theoretical model of food insecurity, adapted from the Socio-Ecological Model, identifies three layers of food insecurity (individual, community, society), with potential for nursing impact at each level. CONCLUSION Nurses must work to fight food insecurity. There exists a potential for nursing impact that is currently unrealized. Nursing impact can be guided by a new conceptual model, Food Insecurity Within the Nursing Paradigm.
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Abstract
A health-care workforce representative of our nation's diversity is a health and research priority. Although racial and ethnic minorities represent 37% of Americans, they comprise only 16% of the nursing workforce. The purpose of this study was to examine the effect of state legislation on minority recruitment to nursing. Using data from the National Conference of State Legislatures, American Association of Colleges of Nursing, and U.S. census, we compared minority enrollment in baccalaureate nursing programs of states (Texas, Virginia, Michigan, California, Florida, Connecticut, and Arkansas) before and 3 years after enacting legislation with geographically adjacent states without legislation. Data were analyzed using descriptive and chi-square statistics. Following legislation, Arkansas (13.8%-24.5%), California (3.3%-5.4%), and Michigan (8.0%-10.0%) significantly increased enrollment of Blacks, and Florida (11.8%-15.4%) and Texas (11.2%-13.9%) significantly increased enrollment of Hispanic baccalaureate nursing students. States that tied legislation to funding, encouragement, and reimbursement had larger enrollment gains and greater minority representation.
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Abstract
OBJECTIVES To characterize associations among psychosocial well-being, physical phenotype, and sex hormones in a sample of youth with Klinefelter syndrome (KS). We hypothesized that KS physical traits (phenotype) are associated with adverse psychosocial health measures and that testosterone levels are associated with adverse psychosocial health. STUDY DESIGN Forty-three boys with KS (ages 8-18 years) participated in a cross-sectional study. Participants underwent physical examination, hormone analyses, and psychosocial health questionnaires. RESULTS Using an investigator-developed Klinefelter Phenotype Index Scale, the number of KS physical traits ranged from 1-13 (mean 5.1 ± 1.9). Pubertal boys presented with more KS traits compared with prepubertal boys (5.6 vs 4.2, P = .01). Boys diagnosed prenatally had a milder phenotype compared with those diagnosed postnatally. Gonadotropins were elevated without androgen deficiency in 45%. Psychosocial health scores indicated adverse quality of life (QOL) (67%), low self-esteem (38%), poor self-concept (26%), and risk for depression (16%) without a difference between pubertal groups. Linear regression showed that 22% of the variance in QOL (P = .0001) was explained by phenotype. Testosterone level was not associated with psychosocial health measures. CONCLUSIONS Depending on the degree of phenotypic abnormality, boys with KS may be at risk for impaired QOL. Testosterone levels were not shown to influence psychosocial health. The Klinefelter Phenotype Index Scale may be a useful tool to characterize KS features in boys.
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Affiliation(s)
- Sharron Close
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Columbia University School of Medicine, New York, NY
| | | | - Nancy Reame
- Columbia University School of Nursing and Irving Institute for Clinical and Translational Research, Columbia University Medical Center, New York, NY
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Swan M, Ferguson S, Chang A, Larson E, Smaldone A. Quality of primary care by advanced practice nurses: a systematic review. Int J Qual Health Care 2015; 27:396-404. [DOI: 10.1093/intqhc/mzv054] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2015] [Indexed: 12/11/2022] Open
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Ferguson S, Swan M, Smaldone A. Does Diabetes Self-management Education in Conjunction With Primary Care Improve Glycemic Control in Hispanic Patients? Diabetes Educ 2015; 41:472-84. [DOI: 10.1177/0145721715584404] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose The purpose of this systematic review and meta-analysis is to evaluate the effectiveness of diabetes self-management education (DSME) interventions delivered in conjunction with primary care among Hispanic adults with type 2 diabetes mellitus (T2DM). Methods A systematic search of PubMed, Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature identified randomized controlled trials (RCT) that tested the effect of DSME interventions in Hispanic adults with T2DM. Studies reporting hemoglobin A1C (A1C) pre and post intervention or change in A1C were eligible for inclusion in the meta-analysis. Results Of 625 studies identified, 13 RCTs met criteria for inclusion in the systematic review; of these, 11 studies were included in the meta-analysis. The 13 RCTs represent data from 2784 adult Hispanic subjects. DSME interventions (individual, group, telephone/electronic, and multimodal sessions) varied in intensity from 1-time DSME sessions with phone follow-up to contact every 4 to 6 weeks over 5 years. At ≥6 months following intervention, pooled A1C reduction was −0.25 (95% CI, −0.42 to −0.07), favoring the intervention group. Conclusions DSME in conjunction with primary care is effective in improving glycemic control in Hispanic adults with T2DM. Future comparative effectiveness research is needed to identify best delivery methods to optimize effectiveness of DSME delivered to the Hispanic population.
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Affiliation(s)
- Sacha Ferguson
- Columbia University School of Nursing, New York, New York (Ms Ferguson, Ms Swan, Dr Smaldone)
| | - Melanie Swan
- Columbia University School of Nursing, New York, New York (Ms Ferguson, Ms Swan, Dr Smaldone)
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, New York (Ms Ferguson, Ms Swan, Dr Smaldone)
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LaCross A, Groff M, Smaldone A. Obstetric Anal Sphincter Injury and Anal Incontinence Following Vaginal Birth: A Systematic Review and Meta-Analysis. J Midwifery Womens Health 2015; 60:37-47. [DOI: 10.1111/jmwh.12283] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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