Students' Attitudes Towards Patient Smoking Status During Enrollment in a Pulmonary Rehabilitation Program

The harmful effects of nicotine products are well documented, especially cigarettes. Due to the addictive nature of nicotine, it is often difficult for people who smoke to quit. This study was performed to assess the attitudes of healthcare students regarding enrollment of patients who smoke into a pulmonary rehabilitation program. Public colleges and universities in Texas offering health professions programs were asked to participate if they offered a baccalaureate degree and student enrollment was >5,000. Results were obtained from 114 participants, the majority of whom were from the fields of respiratory therapy and physical therapy. The results revealed that older student participants, >37 yrs old, were less likely to agree to allow a patient who smokes to enroll in a pulmonary rehabilitation program when compared to younger student participants. Students who were more likely to allow patients who smoke to enroll in a pulmonary rehabilitation program were 18- to 22-yr-old women. Females were more likely to agree/strongly agree with allowing a patient who smokes to enroll in a pulmonary rehabilitation program. There was little difference in the attitudes of students who had any history vs no history of smoking.

Prospective Analyses of Cytokine Mediation of Sleep and Survival in the Context of Advanced Cancer

OBJECTIVE

The aims of this study were to examine the potential association between sleep problems, symptom burden, and survival in patients with advanced cancer.

METHODS

A prospective study of 294 patients with gastrointestinal cancer administered questionnaires assessing sleep, depression, anxiety, stress, pain, fatigue, and health-related quality of life. Serum levels of cytokines including interleukin (IL)-1α, IL-1β, tumor necrosis factor α, IL-10, IL-2, and interferon-γ were measured to assess biological mediation between sleep and survival. Survival was measured as time from diagnosis to death.

RESULTS

Fifty-nine percent of patients reported poor sleep quality, 53% reported poor sleep efficiency, 39% reported sleep latency greater than 30 minutes, and 45% reported sleeping less than 6 hours or greater than 10 hours. We found a significant association between sleep duration and symptom burden. Shorter sleep duration was significantly associated with higher levels of fatigue (r = -0.169, p = .01), pain (r = -0.302, p = .01), anxiety (r = -0.182, p = .01), depression (r = -0.172, p = .003), and lower levels of quality of life (r = 0.240, p = .01). After adjustment for demographic, psychological, and disease-specific factors, short sleep duration was associated with reduced survival (hazard ratio [HR] linear = 0.485, 95% confidence interval = 0.275-0.857) and there was also evidence for a quadratic pattern (HR quadrati = 1.064, 95% confidence interval = 1.015-1.115) suggesting a curvilinear relationship between sleep duration and survival. Interleukin 2 was the only cytokine significantly related to survival (HR = 1.01, p = .003) and sleep duration (β = -30.11, p = .027). When of IL-2 was added to the multivariable model, short and long sleep (β = -0.557, p = .097; β = 0.046, p = .114) were no longer significantly related to survival, suggesting mediation by IL-2.

CONCLUSION

Sleep duration was associated with symptom burden and poorer survival and IL-2 was found to mediate the association between sleep and survival. Screening and treatment of sleep problems in patients diagnosed with cancer are warranted.

Pediatric Patients Discharged from the Emergency Department with Abnormal Vital Signs

INTRODUCTION

Children often present to the emergency department (ED) with minor conditions such as fever and have persistently abnormal vital signs. We hypothesized that a significant portion of children discharged from the ED would have abnormal vital signs and that those discharged with abnormal vital signs would experience very few adverse events.

METHODS

We performed a retrospective chart review encompassing a 44-month period of all pediatric patients (aged two months to 17 years) who were discharged from the ED with an abnormal pulse rate, respiratory rate, temperature, or oxygen saturation. We used a local quality assurance database to identify pre-defined adverse events after discharge in this population. Our primary aim was to determine the proportion of children discharged with abnormal vital signs and the frequency and nature of adverse events. Additionally, we performed a sub-analysis comparing the rate of adverse events in children discharged with normal vs. abnormal vital signs, as well as a standardized review of the nature of each adverse event.

RESULTS

Of 33,185 children discharged during the study period, 5,540 (17%) of these patients had at least one abnormal vital sign. There were 24/5,540 (0.43%) adverse events in the children with at least one abnormal vital sign vs. 47/27,645 (0.17%) adverse events in the children with normal vital signs [relative risk = 2.5 (95% confidence interval, 1.6 to 2.4)].However, upon review of each adverse event we found only one case that was related to the index visit, was potentially preventable by a 23-hour hospital observation, and caused permanent disability.

CONCLUSION

In our study population, 17% of the children were discharged with at least one abnormal vital sign, and there were very few adverse (0.43%) events associated with this practice. Heart rate was the most common abnormal vital sign leading to an adverse event. Severe adverse events that were potentially related to the abnormal vital sign(s) were exceedingly rare. Additional research is needed in broader populations to better determine the rate of adverse events and possible methods of avoiding them.

Racial and ethnic disparities in parent-reported diagnosis of ADHD: National Survey of Children's Health (2003, 2007, and 2011)

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed mental disorder among children in the United States. While overall ADHD prevalence continues to rise, few have examined difference by race/ethnicity.

OBJECTIVE

To examine trends in parent-reported ADHD prevalence between 2003 and 2011 across racial/ethnic groups and the role of sociodemographic factors in observed differences in ADHD.

METHOD

Data were from 3 waves of the National Survey of Children's Health (2003, 2007, and 2011), including 190,408 children aged 5-17 years. Independent variables included race/ethnicity (white non-Hispanic, black non-Hispanic, Hispanic, other non-Hispanic), gender, age, poverty level, primary language, insurance status, parental marital status, and neighborhood safety. Sociodemographic factors and year were compared among those diagnosed with ADHD and between racial/ethnic groups using χ(2) tests. Adjusted logistic regression models, stratified by race/ethnicity, were fit to examine the association between identified risk factors and ADHD across racial/ethnic groups. Parental report of an ADD or ADHD diagnosis for a child aged 5-17 years was the dependent variable. If the household included more than 1 child aged 5-17 years, 1 was selected at random.

RESULTS

Increasing trends were observed over the past decade in the prevalence of parent-reported ADHD overall (43%, P < .001), among children aged 10-14 years (47%, P < .001), and adolescents aged 15-17 years (52%, P < .001). Although the ADHD prevalence was still highest among whites, increasing trends were observed for all racial/ethnic groups, most notably among Hispanics, increasing 83% from 2003 to 2011 (P < .001). A greater increase in ADHD was also observed among females (55%, P < .001) than among males (40%).

CONCLUSIONS

Economics, family status, non-English language in the home, and neighborhood safety factors differentially impacted diagnosed ADHD across racial/ethnic groups. Although new insights into the role of economic, family, and neighborhood factors on parent-reported ADHD diagnoses were noted, more research is needed to understand causes of the observed racial/ethnic disparities.

Teaching Health Care Students the Radial Arterial Puncture Procedure

The radial artery puncture is a frequently ordered medical procedure for patients requiring blood gas analysis. Deviating from the proper procedure increases the likelihood of error and jeopardizes patient safety. The teaching methodology for the radial artery puncture is rarely addressed in the medical literature. First-year respiratory care students enrolled in a clinical practice course participated in an expanded curriculum on arterial puncture technique. The new five-step curriculum included: 1) a face-to-face lecture, 2) radial artery localization, 3) blunt-tipped needle simulation, 4) manikin arm puncture, and 5) a peer assessment video. Students participated in an inter-rater reliability exercise for step five. The multi-step process for teaching the arterial puncture stressed process over outcome. Students were required to master each step with a satisfactory evaluation to successfully pass the unit. Students also demonstrated high inter-rater evaluation scores of a peer video of the arterial puncture. Additional research is needed to determine if widespread application of the curriculum across other respiratory care programs and other healthcare disciplines is possible. The detailed report of our new curriculum offers other academic researchers the ability to formally study its usefulness.

Managing Asthma on the College Campus: Findings of a Texas Pilot Study

BACKGROUND

Students attending institutions of higher education have the option of utilizing their student health center (SHC) for asthma management. However, a review of the available literature revealed no previous research as to how SHCs on college campuses in Texas manage students with asthma. This led to the following research questions; how are SHCs in Texas managing asthma for college students, and what are the SHC directors' attitudes and perceptions of the impact of asthma on their college campuses?

METHODS

This descriptive pilot study randomly selected 20 colleges in Texas; 17 institutions agreed to participate. The inclusion criteria consisted of 4-y colleges accredited by the Southern Association of Colleges and Schools with an undergraduate student population of greater than 1,000 full-time students, excluding online colleges. Once identified, the director of each institution's SHC was contacted by telephone and invited to complete the Managing Asthma on College Campuses Survey instrument via telephone interview (n = 14) or e-mail (n = 3). Descriptive statistics were used to analyze quantitative data and common themes were noted for the qualitative data.

RESULTS

Quantitative data obtained through the survey revealed 23.5% of SHCs provide individualized asthma action plans to students and 35% of SHCs stated they have an emergency action plan for asthma exacerbations. Respondents noted 2 major barriers for effective asthma management on campus: lack of understanding of chronic disease management and underuse of the SHC due to a lack of awareness of its existence. Perceived barriers to visiting the SHC included access issues, money, and students self-medicating with short-acting β2 agonist inhalers and/or over-the-counter medications.

CONCLUSIONS

The majority of directors were satisfied with asthma services provided to students; however, they felt more face-to-face asthma education was needed.

Complications of penile prostheses in the spinal cord injury population

A total of 63 spinal cord injury patients underwent penile implantation. Followup ranged from 6 months to 11 years (average 41 months). A semirigid device was used in 53 patients with complications dictating loss of the prosthesis in 17 (33 per cent). The most common complication was spontaneous erosion and most of these occurred after 6 months. Of the 17 patients 8 underwent reimplantation with loss of the prosthesis in 3. Ten patients received an inflatable penile prosthesis and 4 of these were lost. Of the 4 uninfected patients 2 underwent successful reimplantation. Overall, the complication rate in the 63 patients was 33 per cent. After reimplantation 52 of the 63 patients have a functional device, resulting in an ultimate success rate of 82 per cent. In conclusion, penile prostheses have greatly benefited spinal cord injury patients with problems such as sexual dysfunction, maintenance of external appliances and decreasing the rate of skin lacerations. However, these benefits must be weighed against a significant complication rate.

Social Security Disability Benefits Reform Act of 1984: legislative history and summary of provisions

This article describes the legislative history of the Social Security Disability Benefits Reform Act of 1984 (Public Law 98-460), and contains a summary of the provisions in the new law. Major provisions include: standards for continuing disability reviews (CDR's) of disability insurance (DI) beneficiaries and supplemental security income (SSI) recipients who get payments based on disability or blindness; the right of a DI beneficiary or an SSI recipient to have payments continued during appeal of a CDR decision to an administrative law judge that disability or blindness has ceased; and suspension of CDR's of mentally impaired persons until the evaluation criteria for mental impairments are revised. The new law was enacted in response to problems that arose as a result of the implementation by the Social Security Administration (SSA) of a provision in the 1980 disability amendments that required periodic CDR's. In enacting the new law, Congress intended to assure more accurate, consistent, and uniform disability decisions at all levels and equitable and humane treatment not only to beneficiaries who must undergo CDR's but also to new applicants for DI benefits or SSI payments based on disability or blindness.