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Teshome R, Yang I, Woldetsadik E, Girma E, Higgins M, Wells J. Pre- and Post-Treatment Quality of Life Among Patients with Advanced Stage Cervical Cancer at Tikur Anbessa Specialized Hospital, Ethiopia. Cancer Manag Res 2024; 16:311-323. [PMID: 38646146 PMCID: PMC11032665 DOI: 10.2147/cmar.s451124] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/28/2024] [Indexed: 04/23/2024] Open
Abstract
Background The development of health concepts beyond traditional markers of illness and death has made the evaluation of quality of life (QoL) crucial to patient care. Yet, there is little research evaluating the pre- and post-treatment QoL of cervical cancer survivors in Ethiopia. Objective This study aimed to assess the pre- and post-treatment QoL of women diagnosed with advanced-stage cervical cancer. Methods and Materials A cohort design was conducted at the Tikur Anbessa Specialized Hospital Oncology Center. A total of 166 cervical cancer patients were recruited consecutively. Data was collected through interviews with standardized questionnaires before and after treatment. The Wilcoxon rank test was used to assess the significant differences in pre-treatment and post-treatment quality of life. Additionally, the Mann-Whitney U-test was also employed. Statistical significance was determined with p-values <0.05 and a 95% confidence interval. Results Women who were in stages IVA and IVB were 24.7% and 10.2%, respectively. Both the global health scale (66.67 [47.92-75] to 83.33 [66.67-83.33]) and the functional domain QoL (66.67 [40-80] to 70 [46.67-86.66]) showed statistically significant improvements from pre-treatment to post-treatment QoL. Women under the age of 45 were found to have higher global health QOL (P < 0.001) and functional domain QOL (P = 0.029). Women presented in stages II and III had comparatively higher global health QoL (P = 0.008) and functional domain QoL (P = 0.021). Conclusion Global health QOL and the majority of functional quality of life significantly improved following six months of cancer treatment. But there was no discernible change in terms of sexual enjoyment, sexual function, or activity. Age, marital status, the duration since diagnosis, the stage of the cancer, and the presence of comorbidities were the factors that affected the improvement of post-treatment quality of life.
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Affiliation(s)
- Roza Teshome
- Department of Midwifery, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Irene Yang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Edom Woldetsadik
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Teshome R, Yang I, Woldetsadik E, Girma E, Higgins M, Wells J. Survival Status and Predictors Among Women with Advanced Stage of Cervical Cancer. Int J Womens Health 2024; 16:605-617. [PMID: 38645983 PMCID: PMC11027928 DOI: 10.2147/ijwh.s455235] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Background Cervical cancer is one of the leading causes of cancer death in women, even though it is a preventable disease. Most deaths occur in low- and middle-income countries. In addition to early detection and receipt of standard treatments, survivorship is an important component of high quality of care across the cancer continuum. Objective To assess the survival status of advanced-stage cervical cancer patients after cancer treatment has started. Methods and Materials A one-year prospective cohort study was employed to assess the survival status of women with advanced stages of cervical cancer. A total of 180 cervical cancer patients were recruited, and the study was conducted from January 10, 2022, to September 20, 2023. Data entry and analysis were done in the SPSS 29 version. Descriptive statistics were used to examine participant characteristics. The Kaplan-Meier procedure and log rank test were used to estimate the duration of survival. Bivariate and multivariate Cox regression analyses were computed for predictor variables with survival status. Results Patients receiving cancer treatment at FIGO stages IVA and IVB had survived by 56% and 24%, respectively, whereas patients receiving treatment at stages IIB and IIIA had survived by 100%. The estimated mean survival time at one-year follow-up was 5.706 months (95% CI: 3.785-7.627) for patients with FIGO stage IVB, but 11.537 months (95% CI: 11.199-11.887) for those with stages II and III (P < 0.001). Women over 60 years old had a 1.5-fold higher risk of death than those under 60 (HR: 1.482, P = 0.040). Conclusion The one-year cumulative survival rate among advanced-stage cervical cancer patients was 77%. Major factors associated with survival were age, cancer stage, the presence of anemia, and waiting time for treatment.
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Affiliation(s)
- Roza Teshome
- Department of Midwifery, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Irene Yang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Edom Woldetsadik
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Zaccari B, Sherman ADF, Higgins M, Ann Kelly U. Trauma Center Trauma-Sensitive Yoga Versus Cognitive Processing Therapy for Women Veterans With PTSD Who Experienced Military Sexual Trauma: A Feasibility Study. J Am Psychiatr Nurses Assoc 2024; 30:343-354. [PMID: 35833676 PMCID: PMC9839891 DOI: 10.1177/10783903221108765] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a common sequela to military sexual trauma (MST) among women veterans. Yoga has shown promise in research examining its benefit for symptoms and sequela of PTSD. AIMS The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of Trauma Center Trauma-Sensitive Yoga (TCTSY) for women veterans with PTSD related to MST. METHOD In this feasibility study, the final sample included women veterans (n = 41) with PTSD related to MST accessing health care in a Veterans Affairs Health Care System in the southeast United States; the majority were African American (n = 33; 80.5%). Interventions used established protocols of 10 weekly sessions of group TCTSY versus 12 weekly sessions of group Cognitive Processing Therapy (CPT). PTSD was assessed via clinical interview and participant report. Additional data collection included multiple participant-reported outcomes commonly associated with PTSD and psychophysiological measures. We also collected data regarding participant satisfaction and feasibility-related feedback from participants and providers. RESULTS Feasibility and acceptability were evaluated via demand, practicality, fidelity, and acceptability. This was measured by expressed interest, attendance, program completion, barriers to care and satisfaction with treatment, and satisfaction with interventions and data collection. CONCLUSIONS Results indicate the RCT design and TCTSY implementation were feasible; a full-scale RCT was subsequently conducted to determine efficacy of the experimental intervention. Recommendations for successful research strategies are provided.
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Affiliation(s)
- Belle Zaccari
- Belle Zaccari, PsyD, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Belle Zaccari, PsyD, Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Athena D F Sherman
- Athena D. F. Sherman, PhD, PHN, RN, CNE, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Melinda Higgins
- Melinda Higgins, PhD, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Ursula Ann Kelly
- Ursula Ann Kelly, PhD, APRN, ANP-BC, PMHNP-BC, FAANP, FAAN, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- Ursula Ann Kelly, PhD, APRN, ANP-BC, PMHNP-BC, FAANP, FAAN, Atlanta VA Health Care System, Atlanta, GA, USA
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Kolwaite AR, Edwards JA, Higgins M, Kandaswamy S, Orenstein E, Boughton D, Zinyandu T, Brasher S, Shashidharan S, Thompson LM, Chanani NK. Associations between Child Opportunity Index and Pediatric Cardiac Surgical Outcomes. J Pediatr 2024; 270:114000. [PMID: 38432295 DOI: 10.1016/j.jpeds.2024.114000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To assess the relationship between the Child Opportunity Index (COI), a comprehensive measurement of social determinants of health, and specific COI domains on patient-specific outcomes following congenital cardiac surgery in the metropolitan region of Atlanta, Georgia. STUDY DESIGN In this retrospective chart review, we included patients who underwent an index operation for congenital heart disease between 2010 and 2020 in a single pediatric health care system. Patients' addresses were geocoded and mapped to census tracts. Descriptive statistics, univariable analysis, and multivariable regression models were employed to assess associations between variables and outcomes. RESULTS Of the 7460 index surgeries, 3798 (51%) met eligibility criteria. Presence of an adverse outcome, defined as either mortality or 1 of several other major postoperative morbidities, was significantly associated with COI in the univariable model (P = .008), but not the multivariable regression model (P = .39). Postoperative hospital length of stay was significantly associated with COI (P < .001) in univariable and multivariable regression models. There was no significant association between COI and readmission within 30 days of hospital discharge in univariable (P < .094) and multivariable (P = .49) models. CONCLUSION COI is associated with postoperative hospital length of stay but not all outcomes in patients after congenital heart surgery. By understanding the role of COI in outcomes related to cardiac surgery, targeted interventions can be developed to improve health equity.
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Affiliation(s)
- Amy R Kolwaite
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
| | - Johnathan A Edwards
- Rollins School of Public Health, Emory University, Atlanta, GA; University of Lincoln, School of Health and Social Care, Lincolnshire, UK
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Evan Orenstein
- Rollins School of Public Health, Emory University, Atlanta, GA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, GA; Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Dawn Boughton
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Tawanda Zinyandu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Susan Brasher
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - Nikhil K Chanani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Alexander K, Cave N, Oliver S, Bennett S, Higgins M, Hepburn K, Clevenger C, Epps F. Caregiving While Black: A novel, online culturally tailored psychoeducation course for Black dementia caregivers. Gerontologist 2024:gnae009. [PMID: 38330399 DOI: 10.1093/geront/gnae009] [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] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Psychoeducation interventions using distance learning modalities to engage caregivers in active learning environments have demonstrated benefits in enhancing caregiving mastery. However, few of these programs have been specifically adapted to develop mastery in Black caregivers. RESEARCH DESIGN AND METHODS A multi-method approach was carried out to assess Caregiving While Black (CWB), including pre-post surveys and in-depth interviews. This psychoeducation course addresses the cultural realities of caring for a person living with dementia as a Black American. Caregivers engaged in online asynchronous education related to healthcare navigation, home life management, and self-care. Primary (caregiving mastery) and secondary outcomes (anxiety, depression, perceived stress, burden, perceived ability to manage behavioral & psychological symptoms) were assessed at baseline and post-course (10 weeks). RESULTS Thirty-two Black caregivers from across the United States completed the course within the allotted timeframe. Paired sample t-test analyses revealed significant reductions in caregiver burden and role strain. Caregiver mastery from baseline to completion increased by 0.45 points with an effect size of 0.26 (Cohen's d). Twenty-nine caregivers participated in an optional post-course interview, and thematic analysis led to the construction of 5 overarching themes: Comfortability with a Culturally Tailored Course; Experiences Navigating the Course Platform; Utility of Course Resources; Time as a Barrier and Facilitator; Familial and Community Engagement. DISCUSSION AND IMPLICATIONS Pilot findings convey a need to continue creating and receiving feedback on culturally tailored psychoeducation programs for dementia caregivers. The next steps include applying results to fuel the success of the next iteration of CWB.
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Affiliation(s)
- Karah Alexander
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Nkosi Cave
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Sloan Oliver
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Stephanie Bennett
- Patient Experience and Service Excellence, Emory Healthcare, Atlanta, Georgia, USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Ken Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Carolyn Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Bonds Johnson K, Higgins M, Epps F, Brewster GS, Alexander K, Hepburn K. Tele-Savvy Outcomes of Non-Hispanic Black American and White Caregivers. Gerontologist 2024; 64:gnad044. [PMID: 37067896 PMCID: PMC10733122 DOI: 10.1093/geront/gnad044] [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] [Received: 01/17/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Tele-Savvy is a synchronous/asynchronous psychoeducation program for caregivers of community-dwelling persons living with Alzheimer's disease and related dementias (ADRD) designed to increase caregivers' competence and confidence (mastery) in caregiving. Its overall efficacy was tested in a randomized controlled trial. RESEARCH DESIGN AND METHODS This secondary data analysis examined the caregiver mastery and psychological health (i.e., perceived stress, depressive symptoms, and burden) outcome of 153 non-Hispanic Black American and White caregivers (31 non-Hispanic Black American and 122 White caregivers) from baseline to 6 months postintervention. Given the difference in the sample sizes of Black and White caregivers, a descriptive post hoc subgroup analysis was conducted of 21 non-Hispanic Black American and 20 White adult children and grandchildren caregivers. RESULTS In the overall sample, Black American caregivers demonstrated higher levels of mastery and lower levels of distress than White caregivers at baseline and across all time points. Over time, White caregivers, but not Black American caregivers, experienced significantly improved levels of mastery and significantly lowered levels of depression. Within the subgroup analysis, except for a moderate effect size in the management of situation scores over time among Black American adult children caregivers, similar results were obtained. DISCUSSION AND IMPLICATIONS The findings highlight the strengths and shortcomings of the Tele-Savvy program in improving caregiver mastery and reducing negative psychological health outcomes. Intentionally tailoring the Tele-Savvy program to certain racial and caregiving groups may hold promise in meeting the needs of more ADRD caregivers. CLINICAL TRIAL REGISTRATION NCT03033875.
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Affiliation(s)
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Karah Alexander
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Brewster GS, Higgins M, McPhillips MV, Bonds Johnson K, Epps F, Yeager KA, Bliwise DL, Hepburn K. The Effect of Tele-Savvy on Sleep Quality and Insomnia in Caregivers of Persons Living with Dementia. Clin Interv Aging 2023; 18:2117-2127. [PMID: 38111602 PMCID: PMC10726954 DOI: 10.2147/cia.s425741] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Sleep disturbance is prevalent in caregivers of persons living with dementia (PLwD). Tele-Savvy, a 7-week virtual psychoeducational intervention, enhances caregivers' competence and self-care, and reduces depression. While not explicitly designed to do so, Tele-Savvy can potentially improve caregivers' disturbed sleep. The present study aimed to examine the longitudinal effects of Tele-Savvy on caregivers' sleep quality and insomnia. Methods This was a secondary data analysis of a 3-arm randomized control trial [Tele-Savvy (active treatment), Healthy Living (attention control), and usual care (waitlist control)]. Multilevel mixed modeling with intent-to-treat principles tested for group, time, and group-by-time effects. Effect sizes were estimated for all changes from baseline to the initial 6-month post-intervention point. Following completion of the 6-month post-randomization delay, we examined combined outcomes for Tele-Savvy. Results Participants (n=137; mean age 64.7 years) were predominantly female (68.6%) and White (68.6%). We found no initial group-by-time effects for the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). For the combined Tele-Savvy group, there was a statistically significant improvement in ISI scores across time (p=0.050). The combined Tele-Savvy effect size for PSQI was d=0.126 and ISI was d=0.310. Discussion Tele-Savvy resulted in a significant long-term reduction in insomnia symptoms in this sample of caregivers of PLwD and demonstrated a positive trend for improvement in their sleep quality. Since sleep disturbance is so prevalent among caregivers of PLwD, the inclusion of sleep health education into psychoeducation caregiver interventions may yield even better outcomes for caregivers.
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Affiliation(s)
- Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Donald L Bliwise
- Division of Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Kassa R, Irene Y, Woldetsadik E, Kidane E, Higgins M, Dejene T, Wells J. Survival of women with cervical cancer in East Africa: a systematic review and meta-analysis. J OBSTET GYNAECOL 2023; 43:2253308. [PMID: 37776893 DOI: 10.1080/01443615.2023.2253308] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/21/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The prognosis for cervical cancer varies greatly between nations. The disparity in cancer survival rates within nations is largely a result of disparities in public knowledge, the accessibility of cancer services, diagnosis and treatment. The purpose of this systematic review and meta-analysis is to assess the survival rate and associated factors among cervical cancer patients in East Africa. METHODS Literature search was carried out using Google scholar, PubMed/Medline, Embase and CINHAL. Covidence, a web-based program, was used to import studies for review process. PRISMA guidelines were followed. A total of 110 abstracts were identified from electronic sources. There were five duplicate articles removed. We looked at 105 papers' abstracts and titles, and we excluded 78 of them because they did not fit our inclusion criteria. We conducted a full-text analysis of the remaining 27 papers, leaving out 14 researches that did not fit our inclusion requirements. For final review, 13 studies were included. Using the Joanna Briggs Institute (JBI) assessment checklist, methodological quality was evaluated. RESULTS The included articles were cohort studies. They were conducted in Ethiopia, Uganda, Zimbabwe, Kenya, Sudan, Tanzania and Rwanda. One-year, two-year, three-year, four-year and five-year overall survival rates ranged from 67% to 92%, 55% to 84%, 44% to 53%, 32% to 47%, and 26% to 43%, respectively. CONCLUSIONS The pooled one-year, two-year, three-year, four-year and five-year survival rates of cervical cancer patients in East Africa were 84%, 71%, 50%, 39% and 36%, respectively. HIV status, late presentation, treatment modalities, older age and presence of comorbidities were the most commonly mentioned prognostic factors for survival. PROSPERO REGISTRATION NUMBER CRD42023402551.
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Affiliation(s)
- Roza Kassa
- Department of Midwifery, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yang Irene
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Edom Woldetsadik
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Kidane
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Tariku Dejene
- College of Developmental Study, Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Zaccari B, Higgins M, Haywood TN, Patel M, Emerson D, Hubbard K, Loftis JM, Kelly UA. Yoga vs Cognitive Processing Therapy for Military Sexual Trauma-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2344862. [PMID: 38064219 PMCID: PMC10709771 DOI: 10.1001/jamanetworkopen.2023.44862] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/14/2023] [Indexed: 12/18/2023] Open
Abstract
Importance First-line treatment for posttraumatic stress disorder (PTSD) in the US Department of Veterans Affairs (VA), ie, trauma-focused therapy, while effective, is limited by low treatment initiation, high dropout, and high treatment refraction. Objective To evaluate the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) vs first-line cognitive processing therapy (CPT) in women veterans with PTSD related to military sexual trauma (MST) and the hypothesis that PTSD outcomes would differ between the interventions. Design, Setting, and Participants This multisite randomized clinical trial was conducted from December 1, 2015, to April 30, 2022, within 2 VA health care systems located in the southeast and northwest. Women veterans aged 22 to 71 years with MST-related PTSD were enrolled and randomized to TCTSY or CPT. Interventions The TCTSY intervention (Hatha-style yoga focusing on interoception and empowerment) consisted of 10 weekly, 60-minute group sessions, and the CPT intervention (cognitive-based therapy targeting modification of negative posttraumatic thoughts) consisted of 12 weekly, 90-minute group sessions. Main Outcome and Measures Sociodemographic data were collected via self-report survey. The primary outcome, PTSD symptom severity, was assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5). Assessments were conducted at baseline, midintervention, 2 weeks post intervention, and 3 months post intervention. Results Of 200 women veterans who consented to participate, the intent-to-treat sample comprised 131 participants (mean [SD] age, 48.2 [11.2] years), with 72 randomized to TCTSY and 59 randomized to CPT. Treatment was completed by 47 participants (65.3%) in the TCTSY group and 27 (45.8%) in the CPT group, a 42.6% higher treatment completion rate in the TCTSY group (P = .03). Both treatment groups improved over time on the CAPS-5 (mean [SD] scores at baseline: 36.73 [8.79] for TCTSY and 35.52 [7.49] for CPT; mean [SD] scores at 3 months: 24.03 [11.55] for TCTSY and 22.15 [13.56]) and the PCL-5 (mean [SD] scores at baseline: 49.62 [12.19] for TCTSY and 48.69 [13.62] for CPT; mean [SD] scores at 3 months: 36.97 [17.74] for TCTSY and 31.76 [12.47]) (P < .001 for time effects). None of the group effects or group-by-time effects were significant. Equivalence analyses of change scores were not significantly different between the TCTSY and CPT groups, and the two one-sided test intervals fell within the equivalence bounds of plus or minus 10 for CAPS-5 for all follow-up time points. Conclusions and Relevance In this comparative effectiveness randomized clinical trial, TCTSY was equivalent to CPT in reducing PTSD symptom severity, with both groups improving significantly. The higher treatment completion rate for TCTSY indicates its higher acceptability as an effective and acceptable PTSD treatment for women veterans with PTSD related to MST that could address current VA PTSD treatment limitations. Trial Registration ClinicalTrials.gov Identifier: NCT02640690.
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Affiliation(s)
- Belle Zaccari
- Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Mental Health and Clinical Neurosciences, Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Psychiatry, Oregon Health & Science University, Portland
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | | - Meghna Patel
- Mental Health Service Line, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David Emerson
- The Center for Trauma and Embodiment at Justice Resource Institute, Needham, Massachusetts
| | - Kimberly Hubbard
- Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Jennifer M. Loftis
- Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Psychiatry, Oregon Health & Science University, Portland
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland
| | - Ursula A. Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Nursing and Patient Care Services, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia
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Abstract
BACKGROUND Little is known about where young adults with chronic illness die in the United States and factors associated with place of death. OBJECTIVES This study aimed to examine place of death and factors associated with place of death for young adults with chronic illness using the most recent national data. METHODS Our sample ( N = 405,535) from the National Center for Health Statistics Division of Vital Statistics death certificate data (2003-2018) included young adults (age 18-39 years) who died from chronic conditions common in childhood or young adulthood. Conditions were grouped by underlying pathophysiology (oncological, cardiovascular, neuromuscular, metabolic, hematological/immunological, renal, chromosomal/congenital, gastrointestinal, and respiratory). Place of death was dichotomized into acute care (inpatient, outpatient/emergency room, and dead on arrival) or nonacute care (home, hospice, nursing home/long-term care, other, and unknown). Examined factors were gender, year of death, age, race (White, Black, Asian/Pacific Islander, American Indian/Alaskan Native), cause of death, and city of residence population (100,000 or greater and under 100,000). Descriptive statistics and logistic regression were used to examine factors related to place of death. RESULTS Over half of young adults died in acute care settings. Young adults who were Asian/Pacific Islander or Black or who died from a respiratory or renal cause of death were most likely to die in an acute care setting. Rates of acute care death decreased over the studied years. DISCUSSION Many young adults died in an acute care setting. Race and cause of death were the most influential factors associated with place of death. Young adults with an oncological cause of death were less likely to die in an acute care setting than patients with other underlying causes. This may indicate that specific care needs or preferences at the end of life may differ in certain disease populations and may affect place of death. Previous research has shown similar results in other developmental populations; however, given the complex psychosocial concerns that often arise during young adulthood, further research is needed to describe how the young adult status may specifically affect place of death.
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11
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Angwin C, Zschocke J, Kammin T, Björck E, Bowen J, Brady AF, Burns H, Cummings C, Gardner R, Ghali N, Gröbner R, Harris J, Higgins M, Johnson D, Lepperdinger U, Milnes D, Pope FM, Sehra R, Kapferer-Seebacher I, Sobey G, Van Dijk FS. Non-oral manifestations in adults with a clinical and molecularly confirmed diagnosis of periodontal Ehlers-Danlos syndrome. Front Genet 2023; 14:1136339. [PMID: 37323685 PMCID: PMC10264792 DOI: 10.3389/fgene.2023.1136339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/03/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: Periodontal Ehlers-Danlos Syndrome (pEDS) is a rare autosomal dominant type of EDS characterised by severe early-onset periodontitis, lack of attached gingiva, pretibial plaques, joint hypermobility and skin hyperextensibility as per the 2017 International EDS Classification. In 2016, deleterious pathogenic heterozygous variants were identified in C1R and C1S, which encode components of the complement system. Materials and Methods: Individuals with a clinical suspicion of pEDS were clinically and molecularly assessed through the National EDS Service in London and Sheffield and in genetic services in Austria, Sweden and Australia. Transmission electron microscopy and fibroblast studies were performed in a small subset of patients. Results: A total of 21 adults from 12 families were clinically and molecularly diagnosed with pEDS, with C1R variants in all families. The age at molecular diagnosis ranged from 21-73 years (mean 45 years), male: female ratio 5:16. Features of easy bruising (90%), pretibial plaques (81%), skin fragility (71%), joint hypermobility (24%) and vocal changes (38%) were identified as well as leukodystrophy in 89% of those imaged. Discussion: This cohort highlights the clinical features of pEDS in adults and contributes several important additional clinical features as well as novel deleterious variants to current knowledge. Hypothetical pathogenic mechanisms which may help to progress understanding and management of pEDS are also discussed.
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Affiliation(s)
- C. Angwin
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - J. Zschocke
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - T. Kammin
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - E. Björck
- Clinical Genetics, Karolinska University Hospital, Solna, Sweden
| | - J. Bowen
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - A. F. Brady
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - H. Burns
- Department Otolaryngology Head and Neck Surgery, Children’s Health QLD, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - C. Cummings
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - R. Gardner
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - N. Ghali
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - R. Gröbner
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - J. Harris
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - M. Higgins
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - D. Johnson
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - U. Lepperdinger
- Department of Operative and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - D. Milnes
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - F. M. Pope
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - R. Sehra
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - I. Kapferer-Seebacher
- Department of Operative and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - G. Sobey
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - F. S. Van Dijk
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
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12
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Carlson NS, Carlson MS, Erickson EN, Higgins M, Britt AJ, Amore AD. Disparities by race/ethnicity in unplanned cesarean birth among healthy nulliparas: a secondary analysis of the nuMoM2b dataset. BMC Pregnancy Childbirth 2023; 23:342. [PMID: 37173616 PMCID: PMC10176719 DOI: 10.1186/s12884-023-05667-6] [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] [Received: 12/10/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Racial disparities exist in maternal morbidity and mortality, with most of these events occurring in healthy pregnant people. A known driver of these outcomes is unplanned cesarean birth. Less understood is to what extent maternal presenting race/ethnicity is associated with unplanned cesarean birth in healthy laboring people, and if there are differences by race/ethnicity in intrapartum decision-making prior to cesarean birth. METHODS This secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset involved nulliparas with no significant health complications at pregnancy onset who had a trial of labor at ≥ 37 weeks with a singleton, non-anomalous fetus in cephalic presentation (N = 5,095). Logistic regression models were used to examine associations between participant-identified presenting race/ethnicity and unplanned cesarean birth. Participant-identified presenting race/ethnicity was used to capture the influence of racism on participant's healthcare experiences. RESULTS Unplanned cesarean birth occurred in 19.6% of labors. Rates were significantly higher among Black- (24.1%) and Hispanic- (24.7%) compared to white-presenting participants (17.4%). In adjusted models, white participants had 0.57 (97.5% CI [0.45-0.73], p < 0.001) lower odds of unplanned cesarean birth compared to Black-presenting participants, while Hispanic-presenting had similar odds as Black-presenting people. The primary indication for cesarean birth among Black- and Hispanic- compared to white-presenting people was non-reassuring fetal heart rate in the setting of spontaneous labor onset. CONCLUSIONS Among healthy nulliparas with a trial of labor, white-presenting compared to Black or Hispanic-presenting race/ethnicity was associated with decreased odds of unplanned cesarean birth, even after adjustment for pertinent clinical factors. Future research and interventions should consider how healthcare providers' perception of maternal race/ethnicity may bias care decisions, leading to increased use of surgical birth in low-risk laboring people and racial disparities in birth outcomes.
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Affiliation(s)
- Nicole S Carlson
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Madelyn S Carlson
- CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | | | - Melinda Higgins
- Biostatistics and Data Core in the Office of Nursing Research, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Abby J Britt
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Alexis Dunn Amore
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road NE, Atlanta, GA, 30322, USA
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13
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Davis E, Dunbar S, Higgins M, Wood K, Ferranti E, Morris A, Butts B. Heart failure symptom burden, dietary intake, and inflammation: An integrative review of the literature. J Integr Nurs 2023; 5:81-92. [PMID: 37727310 PMCID: PMC10508190 DOI: 10.4103/jin.jin_26_23] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Heart failure (HF) is characterized by high symptom burden including, but not limited to fatigue, dyspnea, and edema. Up to 21.5% of HF patients experience significant depressive symptoms, much higher than 7.1% in adults without HF. Diet, metabolites, and other inflammatory mechanisms have gained notable attention in recent studies for contributions to symptoms in HF. Symptoms for black adults (B/As) with HF are often influenced by lifestyle factors, which may influence their higher mortality rates; few studies address these factors. Distinguishing the links between key elements with diet, inflammation, and symptoms may bring clarity for new dietary strategies in HF clinical care. The purpose of this integrative review is to examine the existing literature regarding relationships among physiologic pathways in HF along with physical and emotional symptoms in the context of inflammation, dietary intake, tumor necrosis factor-alpha (TNF-α), a biomarker of inflammation, and trimethylamine-N-Oxide (TMAO). Based on available evidence, inflammation may be a key link between physical symptoms, diet, depression, TMAO, and TNF-α in persons with HF and warrants further examination to clarify pathological links to solidify evidence for better guidance with dietary modifications. The literature reviewed in this study demonstrates that more work is needed to examine dietary planning, social support, and differences between men and women in the B/A community. Results of this literature review call attention to the essential, personalized care needs related to symptom monitoring and dietary planning which is expected to decrease symptom burden in the HF population.
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Affiliation(s)
- Erica Davis
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States of America
| | - Sandra Dunbar
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States of America
| | - Melinda Higgins
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States of America
| | - Kathryn Wood
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States of America
| | - Erin Ferranti
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States of America
| | - Alanna Morris
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States of America
| | - Brittany Butts
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States of America
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14
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Phillips V, Quest TE, Higgins M, Marconi VC, Balthazar MS, Holstad M. A Cost-Effective Analysis of Motivational Interviewing with Palliative Care Versus Usual Care: Results from the Living Well Project. AIDS Behav 2023; 27:1259-1268. [PMID: 36334215 PMCID: PMC10832615 DOI: 10.1007/s10461-022-03862-8] [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] [Accepted: 09/12/2022] [Indexed: 11/08/2022]
Abstract
Little is known about the impact of early palliative care (EPC) combined with motivational interviewing (MI) for persons living with AIDS (PWA). We compared the cost and quality-adjusted life-years (QALYs) of EPC + MI (n = 61) versus usual care (UC) (n = 60) for patients with AIDS, not on antiretroviral medications, enrolled into the Living Well Project trial. Data on clinic, emergency department, and hospital visits were collected through self-report and billing records. Risk-adjusted average annual health care costs were estimated using a generalized linear model with a gamma log-link function. QALYs were calculated using the SF-12v2. Cost-effectiveness was defined as cost per QALY gained. Estimated intervention costs were $165 per participant. EPC + MI reduced costs by 33% (AOR = 0.67; CI 95%: 0.15, 0.93). QALYs did not differ between groups. Results suggest EPC + MI for PWA is cost-saving and maintains quality of life compared to UC due to reduced hospital and ED costs.
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Affiliation(s)
- Victoria Phillips
- Department of Health Policy and Management, Rollins School of Public Health of Emory University, Atlanta, Georgia.
- Rollins School of Public Health of Emory University, 1518 Clifton Road, Room 614, 30322, Atlanta, GA, USA.
| | - Tammie E Quest
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Melinda Higgins
- Office of Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Vincent C Marconi
- Department of Infectious Disease, Emory University School of Medicine, Atlanta, Georgia
| | - Monique S Balthazar
- Georgia State University Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, Georgia
| | - Marcia Holstad
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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15
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Kovacs-Balint ZA, Raper J, Richardson R, Gopakumar A, Kettimuthu KP, Higgins M, Feczko E, Earl E, Ethun KF, Li L, Styner M, Fair D, Bachevalier J, Sanchez MM. The role of puberty on physical and brain development: A longitudinal study in male Rhesus Macaques. Dev Cogn Neurosci 2023; 60:101237. [PMID: 37031512 PMCID: PMC10114189 DOI: 10.1016/j.dcn.2023.101237] [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] [Received: 07/04/2022] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
This study examined the role of male pubertal maturation on physical growth and development of neurocircuits that regulate stress, emotional and cognitive control using a translational nonhuman primate model. We collected longitudinal data from male macaques between pre- and peri-puberty, including measures of physical growth, pubertal maturation (testicular volume, blood testosterone -T- concentrations) and brain structural and resting-state functional MRI scans to examine developmental changes in amygdala (AMY), hippocampus (HIPPO), prefrontal cortex (PFC), as well as functional connectivity (FC) between those regions. Physical growth and pubertal measures increased from pre- to peri-puberty. The indexes of pubertal maturation -testicular size and T- were correlated at peri-puberty, but not at pre-puberty (23 months). Our findings also showed ICV, AMY, HIPPO and total PFC volumetric growth, but with region-specific changes in PFC. Surprisingly, FC in these neural circuits only showed developmental changes from pre- to peri-puberty for HIPPO-orbitofrontal FC. Finally, testicular size was a better predictor of brain structural maturation than T levels -suggesting gonadal hormones-independent mechanisms-, whereas T was a strong predictor of functional connectivity development. We expect that these neural circuits will show more drastic pubertal-dependent maturation, including stronger associations with pubertal measures later, during and after male puberty.
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Affiliation(s)
- Z A Kovacs-Balint
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA.
| | - J Raper
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA; Dept. of Pediatrics, Emory University, Atlanta, GA 30322, USA
| | - R Richardson
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - A Gopakumar
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - K P Kettimuthu
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - M Higgins
- Office of Nursing Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | - E Feczko
- Dept. of Pediatrics, University of Minnesota, Minneapolis, MN 55414, USA; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, USA
| | - E Earl
- Dept. of Behavioral Neuroscience, Oregon Health & Sciences University, Portland, OR 97239, USA
| | - K F Ethun
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - L Li
- Dept. of Pediatrics, Emory University, Atlanta, GA 30322, USA; Marcus Autism Center; Children's Healthcare of Atlanta, GA, USA
| | - M Styner
- Dept. of Psychiatry, University of North Carolina, Chapel Hill, NC 27514, USA
| | - D Fair
- Dept. of Pediatrics, University of Minnesota, Minneapolis, MN 55414, USA; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, USA
| | - J Bachevalier
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - M M Sanchez
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA; Dept. of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA 30322, USA
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16
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Hepburn K, Waldrop D, Song M, Clevenger CK, Aflatoony L, Higgins M, Glover CM, Lindauer A, Perkins M. Letters of Intent for Pilot Projects Affirm the Heterogeneity of Dementia Family Caregiving. Alzheimers Dement 2022. [DOI: 10.1002/alz.065582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kenneth Hepburn
- Emory University Nell Hodgson Woodruff School of Nursing Atlanta GA USA
| | - Drenna Waldrop
- Emory University Nell Hodgson Woodruff School of Nursing Atlanta GA USA
| | - Mi‐Kyung Song
- Emory University Nell Hodgson Woodruff School of Nursing Atlanta GA USA
| | | | | | - Melinda Higgins
- Emory University Nell Hodgson Woodruff School of Nursing Atlanta GA USA
| | | | - Allison Lindauer
- NIA‐Layton Aging and Alzheimer’s Disease Research Center Portland OR USA
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17
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McCormack KM, Howell BR, Higgins M, Bramlett S, Guzman D, Morin EL, Villongco C, Liu Y, Meyer J, Sanchez MM. The developmental consequences of early adverse care on infant macaques: A cross-fostering study. Psychoneuroendocrinology 2022; 146:105947. [PMID: 36242820 DOI: 10.1016/j.psyneuen.2022.105947] [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: 04/27/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Abstract
Early life adversity/stress (ELA/ELS), particularly adverse caregiving experiences such as child maltreatment (MALT), is a main risk factor for psychopathology, including psychiatric disorders such as anxiety, depression, ADHD, and substance abuse. Yet how these alterations unfold during development and the underlying mechanisms remain poorly understood, as it is difficult to prospectively and longitudinally study early developmental phases in humans, and nearly impossible to disentangle postnatal caregiving effects from heritable traits. This study examined the specific effects of "nurture" (maternal care) versus "nature" (heritable, biological maternal factors) on nonhuman primate infant socioemotional, stress neuroendocrine, and physical development. For this we used a translational and naturalistic macaque model of infant maltreatment by the mother with randomized assignment at birth to either mothers with a history of maltreating their infants (MALT group, n = 22) or to competent mothers (Control group, n = 20). Over the first 6 months of life (roughly equivalent to 2 years in humans), we examined the development of the mother-infant relationship, as well as infants' social behavior and emotional reactivity. In parallel, we assessed hypothalamic-pituitary-adrenal (HPA) axis function longitudinally, using measures of hair cortisol accumulation, and basal morning plasma cortisol. We identified broad impairments in maternal care exhibited by MALT foster mothers, beyond maltreatment (physical abuse, rejection) events, suggesting that MALT foster mothers provide an overall lower quality of care to their infants compared to Controls. MALT infants exhibited alterations in their initiations and breaks of proximity towards their mothers, as well as heightened emotional reactivity in comparison to Controls. Most striking are the HPA axis findings, with MALT infants showing higher levels of plasma cortisol across the first 6 postnatal months as well as higher hair cortisol accumulation from birth through month 6 (a signature of chronic stress) than Controls. No caregiving effects were detected on physical growth, which ruled out confounding effects of maternal nutrition, metabolism, etc. Taken together, these results suggest that the developmental trajectory of MALT and Control infants is different, marked by heightened levels of emotional reactivity, increased HPA activity and alterations in mother-infant interactions in MALT animals. These findings appear to be due to specific effects of postnatal maternal care, and not to biological/ behavioral traits inherited from the mother, or due to prenatal programming caused by prenatal stress, as the cross-fostering design controlled for these potential factors. However, we also detected a couple of interesting biological effects suggesting heritable transmission of some phenotypes. The prolonged HPA axis activation during the first 6 postnatal months of life is expected to have long-term consequences for brain, physiological, and behavioral development in MALT offspring.
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Affiliation(s)
- K M McCormack
- Department of Psychology, Spelman College, Atlanta, GA, USA; Emory National Primate Research Center, Emory University, Atlanta, GA, USA.
| | - B R Howell
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA; Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA, USA
| | - M Higgins
- School of Nursing, Emory University, Atlanta, GA, USA
| | - S Bramlett
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - D Guzman
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - E L Morin
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - C Villongco
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Y Liu
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - J Meyer
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - M M Sanchez
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
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18
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Zaccari B, Sherman ADF, Febres-Cordero S, Higgins M, Kelly U. Findings from a pilot study of Trauma Center Trauma-Sensitive Yoga versus cognitive processing therapy for PTSD related to military sexual trauma among women Veterans. Complement Ther Med 2022; 70:102850. [PMID: 35820575 PMCID: PMC9704511 DOI: 10.1016/j.ctim.2022.102850] [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] [Received: 04/19/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study objective was to explore the preliminary efficacy of trauma-sensitive yoga compared to cognitive processing therapy (CPT) for women Veterans with posttraumatic stress disorder (PTSD) related to military sexual trauma (MST) in a pilot randomized control trial (RCT). We then compared these results to published interim results for the subsequent full-scale RCT. METHOD The analytic sample included women Veterans (N = 41) with PTSD related to MST accessing healthcare in a southeastern Veterans Affairs Health Care System. The majority were African American, non-Hispanic (80.5 %). The protocol-driven group interventions, Trauma Center Trauma-Sensitive Yoga (TCTSY; n = 17) and the evidence-based control condition, CPT (n = 24), were delivered weekly for 10 and 12 sessions, respectively. Multilevel linear models (MLM) were used to compare changes over time between the two groups. RESULTS The primary outcomes presented here are PTSD symptom severity and diagnosis, assessed using the Clinician Administered PTSD Scale (CAPS) and the PTSD Symptom Checklist (PCL) total scores. PTSD symptom severity on both clinician-administered (CAPS) and self-reported (PCL) measures, improved significantly (p < .005) over time, with large within group effect sizes (0.90-0.99) consistent with the subsequent RCT. Participants in the TCTSY group showed clinically meaningful improvements earlier than the CPT group participants from baseline on the CAPS and PCL Total scores. CONCLUSIONS Results support published findings of the effectiveness of TCTSY in the treatment for PTSD related to MST among women Veterans, particularly African American women. TCTSY warrants consideration as an adjunctive, precursor, or concurrent treatment to evidence-based psychotherapies. Future research should include patient preference, men with sexual trauma, and civilian populations.
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Affiliation(s)
- Belle Zaccari
- Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Athena D F Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA; Atlanta VA Health Care System, Decatur, GA, USA.
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19
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Higgins M, Healy A, Eakins S, Brennan A, Cregg K. 161 CLEAR DISCHARGE PRESCRIBING IN STROKE PATIENTS: A RETROSPECTIVE AUDIT OF DUAL ANTIPLATELET DURATION AT FIRST FOLLOW-UP APPOINTMENT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The risk of further ischaemic events post stroke and TIA is high in the following weeks. Short term treatment with Dual Anti-Platelet Therapy (DAPT) in appropriate patients has been shown to decrease the incidence of recurrent ischaemic events. However continuing DAPT longer than six weeks increases the risk of haemorrhagic complications.
Methods
Retrospective analysis of patients admitted to the Acute Stroke Unit over 4 months in a tertiary referral centre, reviewing discharge summaries and follow-up Outpatient Department (OPD) clinic letters on the online hospital computer system.
Results
We analysed data from 205 patients. 57 patients were discharged on DAPT. Of those, 18(31.6%) did not have a recommended duration of DAPT documented in their discharge summary. 40 patients returned to OPD for review, 16 patients had no documented follow-up, 11 were repatriated to a referring hospital for follow-up locally. The average time of OPD review was 4 months post discharge. Of those 40 patients who attended OPD follow up appointment, 33(82.5%) had documented evidence of a medication review in clinic. 9 of those patients (27.3%) were still inappropriately on DAPT, 5 of whom (55.6%) had no DAPT duration instructions documented in the discharge summary.
Conclusion
Treatment with DAPT puts patients at risk of haemorrhagic complications with longer term use. Clear documentation of treatment duration and communication with the patient and the patient’s GP is vital to ensure medication errors and unnecessary complications for the patient are avoided. Intervention: Following these results, we organised an education session for the Stroke Department staff and re-designed the stroke discharge summary template to highlight instructions on DAPT duration. We also emphasised the importance of communication with the patient’s GP and medication counselling with patients.
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Affiliation(s)
| | - A Healy
- Beaumont Hospital , Dublin, Ireland
| | - S Eakins
- Beaumont Hospital , Dublin, Ireland
| | | | - K Cregg
- Beaumont Hospital , Dublin, Ireland
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20
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Higgins M, McGuirk C, Devitt L, Ludgate S, Doyle R, O'Donoghue C, O'Dwyer C, O'Hanlon S. 313 STREAMLINING A ZOLEDRONIC ACID SERVICE TO A LEVEL TWO HOSPITAL. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Approximately, 350-400 patients are admitted to a level 4 hospital for hip-fractures yearly (2019). According to the Irish Hip Fracture Database (2020) the average age for a hip-fracture is 81 years old. Patients post-hip fractures are commenced on Zoledronic acid; a bisphosphonate which is given intravenously 10 days post-surgery and then annually in year two and three. Zoledronic acid is a first line choice of bisphosphonate for the ≥65 population with a fragility fracture.
Methods
274 patients were transferred from the level 4 Hospital waiting list to a level 2 hospital waiting list to streamline the service. Meetings occurred to establish a pathway for the transition of services. A rapid improvement of the level 2 Day Hospital (DH) was commenced. Essential resources, training and information leaflets were developed in order to begin the service. A policy review, procedure guidelines and referral pathway were implemented. An excel database of patient information was transferred between organisations. The 274 patients were triaged by the DH. Pre-assessment phone calls were conducted determining if patients were still eligible for Zoledronic acid.
Results
Of the 274 referrals; 24 had died; 30 refused; 37 were on other bone treatments and another 7 patients haven’t made creatinine clearance, leaving 176. All 176 patients were allocated an appointment for 2022. Of the 176 patients; currently 57 patients have received their Zoledronic acid infusion in the DH. 69 of these referrals had an indicative date for their next Zoledronic acid infusion for dates after April 2022. There are 50 patients yet to receive their treatment which is overdue.
Conclusion
With the prospect of service demands increasing due to Irelands aging population inevitably placing extra pressures on infusion suites in a level 4 hospital. The level 2 hospital has effectively managed to focus on tackling the backlog, streamlining referrals to the bone health service and thus reducing the risk of subsequent hip fractures.
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Affiliation(s)
- M Higgins
- St. Columcille's Hospital , Dublin, Ireland
| | - C McGuirk
- St. Columcille's Hospital , Dublin, Ireland
| | - L Devitt
- St. Columcille's Hospital , Dublin, Ireland
| | - S Ludgate
- St. Vincent's University Hospital , Dublin, Ireland
| | - R Doyle
- St. Columcille's Hospital , Dublin, Ireland
| | | | - C O'Dwyer
- St. Vincent's University Hospital , Dublin, Ireland
| | - S O'Hanlon
- St. Columcille's Hospital , Dublin, Ireland
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21
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Higgins M, Brewer L. 354 PROMOTING THE BENEFITS OF COGNITIVE STIMULATION AMONGST OLDER PATIENTS: A BRIEF SURVEY AND QUALITY IMPROVEMENT PROJECT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cognitive Stimulation (CS) enhances cognitive function in patients with Cognitive Impairment (CI), including those with mild/moderate dementia. It has positive effects on various cognitive and non-cognitive symptoms. Engaging in CS can reduce the risk developing dementia and allows proactive improvement in wellbeing. Physical exercise and promotion of independence are also beneficial. Patients and staff are often poorly informed regarding such benefits.
Methods
We developed a 9-question survey, administered to a sample of representative doctors involved in the care of patients with CI to gauge their understanding of CS and its benefits. We envisaged this data may support the development of a patient-friendly information leaflet to educate about CS.
Results
Of 45 respondents, 68.89% could readily provide three examples of CS. 55.56% reported that CS “definitely” benefits patients with CI, 44.44% reported it “probably” does. All reported it was the joint responsibility of the doctor, memory nurse and occupational therapist to provide advice on CS. 44.44% regularly or sometimes discuss CS with patients/families, compared with 55.55% who rarely or never do. 55.56% were “not confident” giving advice on CS, only 8.89% were “quite confident”. 80% reported that exercise reduces the risk of CI. 37.78% could give an appropriate example of a compensatory strategy. All reported an information leaflet available for patients and their families, would be beneficial. We designed a patient information leaflet explaining cognitive domains, examples of impairments and measures patients can embrace to promote and maintain cognitive function. We highlighted physical and cognitive activities, social engagement and compensatory techniques to promote independence. We provided everyday examples of each including local clubs/classes to ensure accessibility and relatability.
Conclusion
Gaps in knowledge and confidence were identified amongst doctors rotating through the Geriatric Medicine Service. Recognising this, we designed an information leaflet ensuring we can readily impart accurate education and lifestyle advice to patients.
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Affiliation(s)
| | - L Brewer
- Beaumont Hospital , Dublin, Ireland
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22
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Brennan F, Higgins M, Russell S, Sands H, Keogh C, Curran C. 259 AN AUDIT OF DNACPR FORM USAGE IN A LEVEL 4 HOSPITAL FOLLOWING RE-DESIGN AND IMPLICATIONS FOR ITS FUTURE USE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In 2020 during the Covid-19 pandemic our hospital introduced a new green DNACPR form with 2 significant changes. It now specifies if the patient is or is not for resuscitation (as a yes/no choice) and a Treatment Escalation Plan (TEP) has moved to the front of the page from the back. A subsequent audit found that 19% of inpatients had forms completed, of which 68% stated DNACPR and 29% for CPR. 76% of forms had a TEP (versus 56% on the old forms). We repeated the hospital wide audit in 2022 to assess if the improvement in TEP documentation was sustained, and if it was used on all patients or primarily to document DNACPR decisions.
Methods
The hospital-wide audit was performed on the 25.05.2022. Charts were reviewed on medical and surgical wards. ICU patients were excluded. The following data were recorded: Resuscitation status, form completion, presence of a TEP, if the date of admission and form completion were recorded, if the name of doctor and nature of discussion with patient and family were documented, and if the TEP was consistent with the most recent clinical notes. The data was compared to the 2020 audit and against the Hospital’s DNAR & TEP policy.
Results
634 inpatients were identified. 15.7% (100) had a form completed of which 92% stated DNAR. One of these did not have a TEP. The doctor’s name and grade were clearly documented on all forms.
Conclusion
99% of patients who were not for CPR had a TEP indicating sustained improvement since the introduction of the new form. Given 83.3% of patients did not have any documented resuscitation status the approach of documenting yes or no for resuscitation is not being utilised. A return to a dedicated form that indicates someone should not undergo attempts at resuscitation may offer more clarity.
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Affiliation(s)
| | | | | | - H Sands
- Beaumont Hospital , Dublin, Ireland
| | - C Keogh
- Beaumont Hospital , Dublin, Ireland
| | - C Curran
- Beaumont Hospital , Dublin, Ireland
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23
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Nugent K, O'Neill B, Brennan V, Lynch J, Higgins M, Dunne M, Skourou C. Quantification of organ motion in male and female patients undergoing long course radiotherapy for rectal cancer in the supine position. Adv Radiat Oncol 2022; 8:101109. [DOI: 10.1016/j.adro.2022.101109] [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: 03/12/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
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24
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Higgins M, Farietta T, Volkova N, Liu M, Ostrenga J, Elbert A. WS08.04 Real-world data demonstrate clinical response in people with cystic fibrosis (pwCF) who have select residual function (RF) mutations and are treated with ivacaftor (IVA). J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00198-9] [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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25
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Friefeld A, Higgins M, Branch-Elliman W, Sturgeon D, Bart N, Hederstedt K, Foster M, Seren A, Lamkin R, Sullivan B, Mull H. Abstract No. 605 An algorithm to flag totally implantable venous access port infections for the administration of chemotherapy using unstructured and structured data in the Veterans Health Administration’s electronic medical record. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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26
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Kovaleva M, Nocera JR, Hepburn K, Higgins M, Nash R, Epps F, Brewster G, Bilsborough E, Blumling AA, Griffiths PC. Attention control in a trial of an online psychoeducational intervention for caregivers. Res Nurs Health 2022; 45:337-349. [DOI: 10.1002/nur.22208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Mariya Kovaleva
- Niedfelt Nursing Research Center University of Nebraska (UNMC) College of Nursing ‐ Omaha Division, 985330 Nebraska Medical Center Omaha Nebraska USA
| | - Joe R. Nocera
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation Decatur Georgia USA
- Department of Neurology Emory University School of Medicine, Emory University Atlanta Georgia USA
- Department of Physical Rehabilitation Emory University School of Medicine, Emory University Atlanta Georgia USA
| | - Kenneth Hepburn
- Department of Medicine Emory University School of Medicine Atlanta Georgia USA
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | - Rachel Nash
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | - Glenna Brewster
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | | | - Amy A. Blumling
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
- Division of Human Genetics Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
| | - Patricia C. Griffiths
- Department of Medicine Emory University School of Medicine Atlanta Georgia USA
- Georgia Institute of Technology Center for Assistive Technology Atlanta Georgia USA
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27
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Harris A, Lane R, Higgins M. Improving perceptions of communication, collaboration, and teamwork using structured nurse-surgeon bedside rounds. Nursing 2022; 52:56-59. [PMID: 35085199 DOI: 10.1097/01.nurse.0000806180.71822.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Adrienne Harris
- At Emory Johns Creek Hospital in Johns Creek, Ga., Adrienne Harris is the director of the surgical unit and Rosemary Lane is a unit charge nurse. Melinda Higgins is a biostatistician in the Office of Nursing Research at Emory University's School of Nursing
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28
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Kovaleva MA, Higgins M, Dietrich MS, Jennings BM, Song MK, Clevenger CK, Griffiths PC, Hepburn K. Characteristics associated with neuropsychiatric symptoms in persons living with dementia and caregiver distress and diminished well-being. J Am Assoc Nurse Pract 2022; 34:656-665. [PMID: 35025838 DOI: 10.1097/jxx.0000000000000681] [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] [Received: 08/18/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The population of persons living with dementia (PLWDs) is increasing, although mainstream dementia care quality is suboptimal. PURPOSE To identify characteristics associated with: (1) PLWDs' neuropsychiatric symptoms and quality of life; and (2) distress from neuropsychiatric symptoms and well-being among their family caregivers (N = 49). METHODOLOGY Cross-sectional single-group examination of PLWD and caregivers when they enrolled into a nurse-led dementia-centered primary care clinic. Pearson correlations were run between characteristics of PLWD and caregiver and variables representing PLWD's neuropsychiatric symptoms and quality of life and their caregivers' well-being. Statistically significant correlations were reported via Cohen d statistics. RESULTS Caregivers' characteristics associated with higher distress from neuropsychiatric symptoms and diminished well-being included Black race, female gender, younger age, caring for a parent with dementia, and being employed. Characteristics of PLWD associated with caregivers' higher distress and diminished well-being included longer time since dementia onset, higher Charlson Comorbidity Index, and non-Alzheimer dementia. Caregivers' characteristics associated with higher neuropsychiatric symptom burden included Black race, female gender, younger age, caring for parent PLWD, and being employed. Characteristics of PLWDs associated with higher neuropsychiatric symptom burden included non-Alzheimer dementia, longer time since dementia onset, more comorbidities, and higher Charlson Comorbidity Index. Finally, a longer time since dementia onset was associated with PLWDs' lower quality of life. CONCLUSIONS Black race, caring for caring for a parent with dementia, younger age, and being employed were characteristics linked to PLWDs' higher neuropsychiatric symptom burden and caregivers' diminished well-being. IMPLICATIONS Clinicians must assess and intervene with unpaid caregivers who may not appear obviously distressed.
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Affiliation(s)
- Mariya A Kovaleva
- University of Nebraska Medical Center College of Nursing, Omaha, Nebraska
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Mi-Kyung Song
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Carolyn K Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Integrated Memory Care Clinic, Emory Healthcare, Atlanta, Georgia
| | - Patricia C Griffiths
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Center for Assistive Technology and Environmental Access, Georgia Institute of Technology, Atlanta, Georgia
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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29
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Ko YA, Chen Z, Liu C, Hu Y, Quyyumi AA, Waller LA, Higgins M, Ziegler TR, Brigham KL, Martin GS. Developing a synthetic control group using electronic health records: Application to a single-arm lifestyle intervention study. Prev Med Rep 2021; 24:101572. [PMID: 34976636 PMCID: PMC8683890 DOI: 10.1016/j.pmedr.2021.101572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022] Open
Abstract
The electronic health records (EHR) infrastructure offers a tremendous resource for identifying controls who match the characteristics of study participants in a single-arm trial. The objectives are to (1) demonstrate the feasibility of curating a synthetic control group for an existing study cohort through EHR data extraction and (2) evaluate the effect of a lifestyle intervention on selected cardiovascular health metrics. A total of 711 university employees were recruited between 2008 and 2012 to participate in a health partner intervention to improve cardiovascular health and were followed for five years. Data of nearly 8000 eligible subjects were extracted from the EHR to create a synthetic control cohort during the same study period. To minimize confounding, crude comparison, exact matching, propensity score matching, and doubly robust estimation were used to compare the selected cardiovascular health metrics at 1 and 5 years of follow-up. Blood pressure and body mass index improved in the intervention group compared to the EHR synthetic controls. The findings of changes in lipid measurements were somewhat unexpected. When analyzing the subgroup without lipid-lowering medications, the intervention group exhibited better control of cholesterol levels over time than did our synthetic controls. Some measurements in the EHR system may be more robust for synthetic selection than others. EHR synthetic controls can provide an alternative to estimate intervention effects appropriately in single-arm studies for these measurements.
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30
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Killeen E, Doherty R, Higgins M, O'Reilly A, Brewer L. 254 OPTIMISING COMMUNICATION WITH FAMILIES OF PATIENTS ON ACUTE STROKE AND GERIATRIC MEDICINE WARDS IN A LARGE TERTIARY HOSPITAL. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Good communication with patients and families is important for older adults admitted to acute stroke or geriatric medicine wards, particularly with COVID19-related restricted visiting. These patients often have communication difficulties including aphasia, delirium, cognitive or hearing impairment, limiting their own communication with relatives. Using the Plan, Do, Study, Act (PDSA) approach we undertook a quality improvement project to optimise communication with families of patients on above wards in a large tertiary hospital.
Methods
PDSA cycle 1: Staff were surveyed to identify satisfaction level with communication and ways to optimise communication. Inpatients on study wards were identified, we recorded demographic and clinical details and prevalence of communication difficulties. We created a designated folder with individual ‘communication sheets’ in conjunction with ward doctors and the nurse manager. PDSA cycle 2: We performed a rapid interval audit of the communication folder use. ‘Outlier’ patients were excluded as their teams did not receive education about folder use.
Results
PDSA cycle 1: A total of 90 inpatients on three wards were included, mean age 78y (SD ±14.4y), 47% were male. Three-quarters (73%) had a communication difficulty noted, reported by nursing staff. Two patients were intubated and six had stroke-related aphasia. Half of surveyed staff reported communication with families was suboptimal. Most (86%) suggested a centrally-located communication logbook would be helpful. PDSA cycle 2: Over two weeks, communication sheets were reviewed for all included patients. Median frequency of calls to families was 4 days (range 0–14). Most (79%) had the name of the primary contact clearly documented. Many (52%) included no contact number. Only 9% had secondary contact information documented.
Conclusion
Communication with families of patients on acute stroke and geriatric medicine wards was suboptimal. Over a short interval this improved with regular phone calls using specific centrally-located communication folders. Further optimisation of their use is needed.
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Affiliation(s)
| | | | | | | | - L Brewer
- Beaumont Hospital , Dublin, Ireland
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31
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Killeen E, Higgins M, Keogh C, Russell S, Curran C. 154 SAFEGUARDING ADULTS AT RISK OF ABUSE—IDENTIFYING KNOWLEDGE GAPS AMONGST HOSPITAL STAFF TO GUIDE POLICY IMPLEMENTATION AND TRAINING. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Safeguarding is the protection of health, wellbeing and life free from abuse. Abuse is a a violation of a person’s human and civil rights; forms include psychological, financial, physical, sexual, neglect and self-neglect. Health Service Executive (HSE) drafted the 2019 ‘Adult Safeguarding Policy’ for adults at risk of abuse to replace the 2014 version. In preparation for implementation a tertiary hospital founded a Safeguarding Committee in 2021. A core objective was establishing staff understanding, experience of safeguarding and education needs to guide future training.
Methods
10-question survey of 223 staff; included doctors, nurses, allied health professionals, medical social workers, healthcare assistants, porters, psychologists.
Results
91% response rate.
184 (91%) staff were familiar with the term ‘safeguarding’; only 44% were aware of the HSE 2019 policy. 129 (64%) had experience with a case of suspected abuse. Most common forms were financial, psychological and self-neglect (n = 60, 47, 39 respectively). Sexual abuse was least common (n = 10).
47% felt ‘somewhat’ confident recognising possible abuse compared to 42% who felt ‘extremely’ or ‘very’ confident.
61% were ‘somewhat’ or ‘not so’ confident about the next steps for suspected abuse; only 11% were ‘extremely’ confident.
49% felt ‘extremely’ or ‘very’ confident in reporting a suspected abuse case; 50% felt ‘somewhat’ or ‘not so’ confident.
Most common reasons for lack of confidence were lack of training, unclear reporting process and lack of experience with cases of abuse. Medical social workers were most confident; doctors were the least.
170 (84%) wanted more safeguarding training—the most popular options were online or in-person training.
Conclusion
Gaps in knowledge and confidence were identified amongst staff for cases of suspected abuse. This will guide future training in the hospital in line with the HSE Adult Safeguarding policy.
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Affiliation(s)
| | | | - C Keogh
- Beaumont Hospital , Dublin, Ireland
| | | | - C Curran
- Beaumont Hospital , Dublin, Ireland
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32
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Henry CJ, Higgins M, Carlson N, Song MK. Racial Disparities in Stillbirth Risk Factors among non-Hispanic Black Women and non-Hispanic White Women in the United States. MCN Am J Matern Child Nurs 2021; 46:352-359. [PMID: 34653033 PMCID: PMC9026592 DOI: 10.1097/nmc.0000000000000772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/26/2022]
Abstract
INTRODUCTION Historically, stillbirth risk factors are more prevalent among non-Hispanic Black women than non-Hispanic White women, including age < 20, lower formal educational attainment, prepregnancy obesity, smoking, hypertension, diabetes, short interpregnancy interval, small for gestational age newborn, late prenatal care, and previous cesarean birth. We examined whether these disparities have changed since 2011 and identified a group of risk factors that differed between Black women and White women when accounting for correlations among variables. METHODS In a random sample of 315 stillbirths from the National Center for Health Statistics' 2016 fetal death data, Black women and White women were compared for each risk factor using t-tests or chi-square tests. Variables with p ≤ .20 were analyzed using multivariate analysis of variance. RESULTS In this sample, Black women experiencing stillbirth were less likely to have a Bachelor's degree (12.94% vs. 28.49%, p = .04), and more likely to be obese (44.5% vs. 29.1%, p = .01) than White women. Multivariate analysis accounting for correlations among variables showed a group of risk factors that differed between Black women and White women: age < 20, lower education, prepregnancy obesity, hypertension (chronic and pregnancy-associated), nulliparity before stillbirth, and earlier gestation. CLINICAL IMPLICATIONS Less formal education, obesity, age <20, hypertension, chronic and pregnancy-associated, nulliparity, and earlier gestation are important to consider in multilevel stillbirth prevention interventions to decrease racial disparity in stillbirth. Respectfully listening to women and taking their concerns seriously is one way nurses and other health care providers can promote equity in health outcomes for childbearing women.
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Higgins M, O’Keeffe S, Quinn M, Harper D, Thirion P, Armstrong J. PO-1620 Quantification of Incidental Clinical Target Volume Coverage in Linear Accelerator Based Lung SABR. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08071-3] [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: 12/01/2022]
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Mosley EA, Pratt M, Besera G, Clarke LS, Miller H, Noland T, Whaley B, Cochran J, Mack A, Higgins M. Evaluating Birth Outcomes From a Community-Based Pregnancy Support Program for Refugee Women in Georgia. Front Glob Womens Health 2021; 2:655409. [PMID: 34816209 PMCID: PMC8593936 DOI: 10.3389/fgwh.2021.655409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022] Open
Abstract
Refugee women face numerous and unique barriers to sexual and reproductive healthcare and can experience worse pregnancy-related outcomes compared with U.S.-born and other immigrant women. Community-based, culturally tailored programs like Embrace Refugee Birth Support may improve refugee access to healthcare and health outcomes, but empirical study is needed to evaluate programmatic benefits. This community-engaged research study is led by the Georgia Doula Access Working Group, including a partnership between academic researchers, Emory Decatur Hospital nurses, and Embrace. We analyzed hospital clinical records (N = 9,136) from 2016 to 2018 to assess pregnancy-related outcomes of Embrace participants (n = 113) and a comparison group of women from the same community and racial/ethnic backgrounds (n = 9,023). We controlled for race, language, maternal age, parity, insurance status, preeclampsia, and diabetes. Embrace participation was significantly associated with 48% lower odds of labor induction (OR = 0.52, p = 0.025) and 65% higher odds of exclusive breastfeeding intentions (OR = 1.65, p = 0.028). Embrace showed positive but non-significant trends for reduced cesarean delivery (OR = 0.83, p = 0.411), higher full-term gestational age (OR = 1.49, p = 0.329), and reduced low birthweight (OR = 0.77, p = 0.55). We conclude that community-based, culturally tailored pregnancy support programs like Embrace can meet the complex needs of refugee women. Additionally, community-engaged, cross-sector research approaches could ensure the inclusion of both community and clinical perspectives in research design, implementation, and dissemination.
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Affiliation(s)
- Elizabeth A. Mosley
- Georgia State University School of Public Health, Atlanta, GA, United States,Emory University Rollins School of Public Health, Atlanta, GA, United States,*Correspondence: Elizabeth A. Mosley
| | | | - Ghenet Besera
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Lasha S. Clarke
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Heidi Miller
- Embrace Refugee Birth Support, Clarkston, GA, United States
| | - Tracy Noland
- Embrace Refugee Birth Support, Clarkston, GA, United States
| | - Bridget Whaley
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | | | - Amber Mack
- Healthy Mothers, Healthy Babies Coalition of Georgia, Atlanta, GA, United States
| | - Melinda Higgins
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, United States
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McCormick PA, Higgins M, McCormick CA, Nolan N, Docherty JR. Hepatic infarction, hematoma, and rupture in HELLP syndrome: support for a vasospastic hypothesis. J Matern Fetal Neonatal Med 2021; 35:7942-7947. [PMID: 34130599 DOI: 10.1080/14767058.2021.1939299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: HELLP syndrome is a relatively uncommon pregnancy-related condition characterized by hemolysis, elevated liver function tests, and low platelets. It can be accompanied by life-threatening hepatic complications including hepatic infarction, hematoma formation, and hepatic rupture. HELLP syndrome occurs in approximately 0.2% of pregnancies. Major hepatic complications occur in less than 1% of HELLP patients suggesting an incidence of 1/50,000. The pathogenesis is incompletely understood and in particular, it is difficult to understand a disorder with both major thrombotic and bleeding manifestations.Methods: Literature review.Results: On the basis of reports in the published literature, and our own clinical experience, we suggest that vasospasm is one of the principal drivers with hepatic ischemia, infarction, and hemorrhage as secondary events. It is known that vasoactive substances are released by the failing placenta. We suggest these cause severe vasospasm, most likely affecting the small post-sinusoidal hepatic venules. This leads to patchy or confluent hepatic ischemia and/or necrosis with a resultant increase in circulating liver enzymes. Reperfusion is associated with a fall in platelet count and microvascular hemorrhage if the microvasculature is infarcted. Blood tracks to the subcapsular space causing hematoma formation. If the hematoma ruptures the patient presents with severe abdominal pain, intra-abdominal hemorrhage, and shock.Conclusions: We suggest that hepatic and other complications associated with HELLP syndrome including placental abruption, acute renal failure, and posterior reversible encephalopathy syndrome (PRES) may also be due to regional vasospasm.
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Affiliation(s)
- P A McCormick
- Liver Unit, St Vincent's University Hospital, Dublin, Ireland
| | - M Higgins
- University College Dublin Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - C A McCormick
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia
| | - N Nolan
- Histopathology Department, St Vincent's University Hospital, Dublin, Ireland
| | - J R Docherty
- Physiology Department, Royal College of Surgeons in Ireland, Dublin, Ireland
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Kelly U, Haywood T, Segell E, Higgins M. Trauma-Sensitive Yoga for Post-Traumatic Stress Disorder in Women Veterans who Experienced Military Sexual Trauma: Interim Results from a Randomized Controlled Trial. J Altern Complement Med 2021; 27:S45-S59. [PMID: 33788599 DOI: 10.1089/acm.2020.0417] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To conduct an interim analysis of data collected from an ongoing multisite randomized clinical trial (RCT) assessing the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) for post-traumatic stress disorder (PTSD) among women veterans with PTSD related to military sexual trauma (MST). The purpose of the interim analysis was to assess outcomes from the primary site, which is geographically, demographically, culturally, and procedurally distinct from the second site. Design: RCT was conducted within a Veterans Administration Health Care System. Data collection included preintervention through 3 months postintervention. Participants: Enrollment for the main site was 152 women. The sample size for the intent-to-treat analysis was 104. The majority were African American (91.3%) with a mean age of 48.46 years. Intervention: The TCTSY intervention (n = 58) was conducted by TCTSY-certified yoga facilitators and consisted of 10 weekly 60-min group sessions. The control intervention, cognitive processing therapy (CPT; n = 46), consisted of 12 90-min weekly group sessions conducted per Veterans Administration protocol by clinicians in the PTSD Clinic. Outcome measures: The Clinician Administered PTSD Scale for DSM-5 (CAPS-5) was used to assess current PTSD diagnosis and symptom severity, including overall PTSD and four symptom clusters. The PTSD checklist for DSM-5 (PCL-5) was used to obtain self-report of PTSD symptom severity, including total score and four symptom clusters. Results: The findings reported here are interim results from one clinical site. For both the CAPS-5 and PCL-5, total scores and all four criterion scores decreased significantly (p < 0.01) over time in all five multilevel linear models within both TCTSY and CPT groups, without significant differences between groups. There were clinically meaningful improvements seen for both TCTSY and CPT with 51.1%-64.3% of TCTSY subjects and 43.5%-73.7% of CPT decreasing their CAPS-5 scores by 10 points or more. Effect sizes for total symptom severity were large for TCTSY (Cohen's d = 1.10-1.18) and CPT (Cohen's d = 0.90-1.40). Intervention completion was higher in TCTSY (60.3%) than in CPT (34.8%). Symptom improvement occurred earlier for TCTSY (midintervention) than for CPT (2 weeks postintervention). Safety: There were no unanticipated adverse events in this study. Conclusion: The results of this study demonstrate that TCTSY may be an effective treatment for PTSD that yields symptom improvement more quickly, has higher retention than CPT, and has a sustained effect. TCTSY may be an effective alternative to trauma-focused therapy for women veterans with PTSD related to MST. The study is registered in ClinicalTrials.gov (CTR no.: NCT02640690).
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Affiliation(s)
- Ursula Kelly
- Atlanta VA Health Care System, Decatur, GA, USA.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Eliza Segell
- Atlanta VA Health Care System, Decatur, GA, USA.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Hepburn K, Nocera J, Higgins M, Epps F, Brewster GS, Lindauer A, Morhardt D, Shah R, Bonds K, Nash R, Griffiths PC. Results of a Randomized Trial Testing the Efficacy of Tele-Savvy, an Online Synchronous/Asynchronous Psychoeducation Program for Family Caregivers of Persons Living with Dementia. Gerontologist 2021; 62:616-628. [PMID: 33640979 PMCID: PMC7989248 DOI: 10.1093/geront/gnab029] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Family caregivers will grow in number as dementia prevalence increases, underscoring the continued importance of equipping these individuals for their new roles and ameliorating the adverse effects of caregiving. RESEARCH DESIGN AND METHODS A three-armed, waitlist, randomized trial design tested Tele-Savvy, an online adaptation of a successful in-person psychoeducation program, the Savvy Caregiver. Tele-Savvy is delivered over 43 days to groups of 6-8 caregivers in 7 weekly synchronous sessions accompanied by 36 brief asynchronous video lessons. We enrolled 23 cohorts of 15 eligible caregivers (N = 261), randomized 2:2:1 to active, attention control, and usual care arms. We assessed caregiver psychological well-being and caregiving mastery at baseline and 3, 6, 9, and 12 months. Multilevel linear models assessed outcomes over the 3 time points examined. The trial was slightly truncated, with Data and Safety Monitoring Board approval, because of the apparent confounding psychological effects of coronavirus disease 2019 restrictions. RESULTS Study findings indicate statistically and clinically significant benefits to Tele-Savvy arm caregivers (with moderate to large effect sizes) in the areas of depression, perceived stress, reaction to care recipients' behaviors, and enhancement of caregiver mastery. Expected benefits for caregiver burden and anxiety were not found. DISCUSSION AND IMPLICATIONS Findings attest to program efficacy and the viability of employing distance means to improve family caregivers' emotional well-being and sense of mastery in the caregiving role over a 6-month period. Next steps entail finding alternate ways to deliver the program to those with connectivity and/or time constraint problems.
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Affiliation(s)
- Kenneth Hepburn
- Address correspondence to: Kenneth Hepburn, PhD, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA. E-mail:
| | - Joe Nocera
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Allison Lindauer
- Alzheimer’s Disease Research Center, Oregon Health and Sciences University, Portland, USA
| | - Darby Morhardt
- Alzheimer’s Disease Research Center, Northwestern University, Chicago, Illinois, USA
| | - Raj Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Kalisha Bonds
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Rachel Nash
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Abstract
INTRODUCTION The weekend effect has been defined as a real or perceived decline in patient care provided on weekends and that provided on weekdays. The primary aim of this study was to investigate the association between day of surgery and length of stay for patients receiving elective lower limb joint arthroplasty in a large NHS teaching hospital. MATERIALS AND METHODS Data were obtained from a prospectively collected database of consecutive patients undergoing elective primary total knee and hip arthroplasty. Patient and clinical variables were collected alongside length of hospital stay. Data were anonymised and analysed using a multiple linear regression model. RESULTS A total of 3,544 knee and 3,277 hip replacements were included. No association was found between length of stay and day of surgery for either procedure. A significant association was noted between longer length of stay and increasing age, higher American Society of Anesthesiologists grade and male compared with female gender. DISCUSSION No evidence of a weekend effect was identified. Certain patient factors predicted longer hospital stay and focussing additional resources on these patient groups may prove a useful strategy in reducing overall length of stay. CONCLUSIONS Length of stay reduced across the time period included in this review while maintaining equality between the days of the week, which represents the successful management of weekend services.
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Affiliation(s)
- M Higgins
- Trauma and Orthopaedics, Nottingham City Hospitals NHS Trust, Nottingham, UK
| | - J Nightingale
- Trauma and Orthopaedics, Nottingham City Hospitals NHS Trust, Nottingham, UK
| | - K Sehat
- Trauma and Orthopaedics, Nottingham City Hospitals NHS Trust, Nottingham, UK
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Kaplow R, Cosper P, Snider R, Boudreau M, Kim JD, Riescher E, Higgins M. Impact of CPR Quality and Adherence to Advanced Cardiac Life Support Guidelines on Patient Outcomes in In-Hospital Cardiac Arrest. AACN Adv Crit Care 2020; 31:401-409. [PMID: 33313710 DOI: 10.4037/aacnacc2020297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Sudden cardiac arrest is a major cause of death worldwide. Performance of prompt, high-quality cardiopulmonary resuscitation improves patient outcomes. OBJECTIVES To evaluate the association between patient survival of in-hospital cardiac arrest and 2 independent variables: adherence to resuscitation guidelines and patient severity of illness, as indicated by the number of organ supportive therapies in use before cardiac arrest. METHODS An observational study was conducted using prospectively collected data from a convenience sample. Cardiopulmonary arrest forms and medical records were evaluated at an academic medical center. Adherence to resuscitation guidelines was measured with the ZOLL R Series monitor/defibrillator using RescueNet Code Review software. The primary outcome was patient survival. RESULTS Of 200 cases, 37% of compressions were in the recommended range for rate (100-120/min) and 63.9% were in range for depth. The average rate was above target 55.7% of the time. The average depth was above and below target 1.4% and 34.7% of the time, respectively. Of the 200 patients, 125 (62.5%) attained return of spontaneous circulation. Of those, 94 (47%) were alive 24 hours after resuscitation. Fifty patients (25%) were discharged from the intensive care unit alive and 47 (23.5%) were discharged from the hospital alive. CONCLUSIONS These exploratory data reveal overall survival rates similar to those found in previous studies. The number of pauses greater than 10 seconds during resuscitation was the one consistent factor that impacted survival. Despite availability of an audiovisual feedback system, rescuers continue to perform compressions that are not at optimal rate and depth.
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Affiliation(s)
- Roberta Kaplow
- Roberta Kaplow is Critical Care Clinical Nurse Specialist, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322
| | - Pam Cosper
- Pam Cosper is Executive Director for Professional Practice, Center for Nursing Excellence and Wellstar Development Center, Wellstar Health System, Atlanta, Georgia
| | - Ray Snider
- Ray Snider is Unit Director of the Medical ICU and Co-chair of the Resuscitation Committee, Emory University Hospital, Atlanta, Georgia
| | - Martha Boudreau
- Martha Boudreau is Unit Nurse Educator, Coronary Care Unit, Emory University Hospital, Atlanta, Georgia
| | - John D Kim
- John D. Kim is Hospitalist, Emory St Joseph Hospital, and Assistant Professor, Emory School of Medicine, Atlanta, Georgia
| | - Elizabeth Riescher
- Elizabeth Riescher is Nurse Scholar, Cardiovascular ICU, Emory University Hospital, Atlanta, Georgia
| | - Melinda Higgins
- Melinda Higgins is Biostatistician and Research Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Brewster GS, Higgins M, Yeager K, Bliwise D, Hepburn K. Examining the preliminary effect of a randomized control trial of Tele‐Savvy, an online psychoeducation program, on insomnia and sleep quality. Alzheimers Dement 2020. [DOI: 10.1002/alz.044631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Glenna S Brewster
- Emory University Nell Hodgson Woodruff School of Nursing Atlanta GA USA
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Bonds K, Griffiths P, Higgins M, Nocera JR, Epps F, Brewster GS, Hepburn K. Comparison of baseline characteristics of African‐American/black and non‐Hispanic white family caregivers in Tele‐Savvy: An online psychoeducation program. Alzheimers Dement 2020. [DOI: 10.1002/alz.044228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nocera JR, Hepburn K, Griffiths P, Higgins M, Epps F, Brewster GS, Bonds K, Nash R. Design and support of an online ‘control’ condition for the Tele‐Savvy randomized control trial. Alzheimers Dement 2020. [DOI: 10.1002/alz.044201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hepburn K, Griffiths P, Nocera JR, Higgins M, Lindauer A, Morhardt D, Shah RC, Epps F, Brewster GS, Bonds K, Nash R. Intermediate outcomes of a randomized trial of Tele‐Savvy: An online psychoeducation program. Alzheimers Dement 2020. [DOI: 10.1002/alz.039562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | - Raj C Shah
- Rush Alzheimer's Disease Center Chicago IL USA
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Davis EN, Dunbar S, Higgins M. Influences of Race and Sex on Self-Care for Persons with Heart Failure and Diabetes. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.270] [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: 11/28/2022]
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Kovaleva MA, Higgins M, Jennings BM, Song MK, Clevenger CK, Griffiths PC, Hepburn K. Patient and caregiver outcomes at the integrated memory care clinic. Geriatr Nurs 2020; 41:761-768. [PMID: 32513481 DOI: 10.1016/j.gerinurse.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/24/2019] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Abstract
The purpose of this longitudinal cohort study was to explore the outcomes of persons living with dementia (PLWD) and their caregivers during their first 9 months at the Integrated Memory Care Clinic (IMCC). IMCC advanced practice registered nurses provide dementia care and primary care simultaneously and continuously to PLWD until institutionalization. Changes were examined in caregivers' psychological well-being (perceived stress, depressive symptoms, caregiver burden, and anxiety) and health status and in PLWDs' quality of life and neuropsychiatric symptoms. Data were collected at baseline, then 3 and 6 months post-baseline. Forty-two caregivers completed all 3 assessments. Most variables remained unchanged. Statistically significant improvements in 5 sub-scales of the Neuropsychiatric Inventory were observed: caregivers' distress regarding their PLWDs' delusions and anxiety, and PLWDs' severity of delusions, depression, and total symptom severity. Further testing of the IMCC is required, including in quasi-experimental studies, to determine its efficacy.
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Affiliation(s)
- Mariya A Kovaleva
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States.
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States.
| | | | - Mi-Kyung Song
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States.
| | - Carolyn K Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States; Integrated Memory Care Clinic, Emory Healthcare, Atlanta, GA 30329, United States; Emory University Goizueta Alzheimer's Disease Research Center, Atlanta, GA 30329, United States.
| | - Patricia C Griffiths
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States; Birmingham/Atlanta Geriatric Research Education and Clinical Center, Decatur, GA 3033, United States.
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States; Emory University Goizueta Alzheimer's Disease Research Center, Atlanta, GA 30329, United States; Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States.
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Alsendi M, Lucas M, Darwish W, Higgins M, Kelly C. 94P Integration of clinicopathological and genomic data and adjuvant treatment decisions in premenopausal women with recurrence scores between 16 and 25. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Matthie N, Jenerette C, Gibson A, Paul S, Higgins M, Krishnamurti L. Prevalence and predictors of chronic pain intensity and disability among adults with sickle cell disease. Health Psychol Open 2020; 7:2055102920917250. [PMID: 32426150 PMCID: PMC7218472 DOI: 10.1177/2055102920917250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Among 170 adults with sickle cell disease, we evaluated chronic pain impact and disability prevalence, assessed age and gender differences, and identified psychosocial predictors of chronic pain intensity and disability. Most participants had a high level of disability. Chronic pain intensity and disability were significantly associated with pain catastrophizing and chronic pain self-efficacy, and worsened with age. Further research is needed to confirm study findings and develop interventions, including palliative care approaches that address catastrophizing and disability, particularly for young women and middle-aged adults with sickle cell disease. Moreover, consistent clinical assessment of chronic pain and psychosocial health should be implemented.
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Mapp C, Hostetler D, Sable J, Parker C, Gouge E, Masterson M, Willis-Styles M, Fortner C, Higgins M. Peppermint Oil: Evaluating Efficacy on Nausea in Patients Receiving Chemotherapy in the Ambulatory Setting. Clin J Oncol Nurs 2020; 24:160-164. [DOI: 10.1188/20.cjon.160-164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Grabbe L, Higgins M, Jordan D, Noxsel L, Gibson B, Murphy J. The Community Resiliency Model®: a Pilot of an Interoception Intervention to Increase the Emotional Self-Regulation of Women in Addiction Treatment. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00189-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Kovaleva MA, Higgins M, Jennings BM, Song MK, Clevenger CK, Griffiths PC, Hepburn KW. THE INTEGRATED MEMORY CARE CLINIC AS A HEALTHCARE NETWORK. Innov Aging 2019. [PMCID: PMC6841499 DOI: 10.1093/geroni/igz038.2067] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide dementia and primary care. This presentation describes the experiences of persons living with dementia and their caregivers during their first year at the IMCC, through the lens of the IMCC as a healthcare network. Forty-two caregivers were evaluated in three survey-based assessments over nine months. Twelve caregivers completed qualitative interviews about their experience at the IMCC. Severity of depression and delusions and total symptom severity improved significantly for persons living with dementia. Caregivers described their sense of belonging to the IMCC healthcare team and valued direct telephone access to APRNs. By enhancing care access and engaging clients in their care, the IMCC serves as a reliable and professional healthcare network for patient-caregiver dyads who often receive suboptimal dementia care in mainstream healthcare.
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Affiliation(s)
- Mariya A Kovaleva
- Vanderbilt University School of Nursing, Nashville, Tennessee, United States
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing Emory University, Atlanta, Georgia, United States
| | | | - Mi-Kyung Song
- Nell Hodgson Woodruff School of Nursing Emory University, Atlanta, Georgia, United States
| | - Carolyn K Clevenger
- Nell Hodgson Woodruff School of Nursing Emory University, Atlanta, Georgia, United States
| | - Patricia C Griffiths
- Atlanta VA Medical Center, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia, United States
| | - Kenneth W Hepburn
- Nell Hodgson Woodruff School of Nursing Emory University, Atlanta, Georgia, United States
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