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Bolin LP, Crane PB, Gunn LH. Exploring Cytokine Networks in Resistant Hypertension. Nurs Res 2024; 73:16-25. [PMID: 37878533 PMCID: PMC10841083 DOI: 10.1097/nnr.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Controlling high blood pressure (BP) continues to be a major concern because the associated complications can lead to an increased risk of heart, brain, and kidney disease. Those with hypertension, despite lifestyle and diet modifications and pharmacotherapy, defined as resistant hypertension, are at increased risk for further risk for morbidity and mortality. Understanding inflammation in this population may provide novel avenues for treatment. OBJECTIVES This study aimed to examine a broad range of cytokines in adults with cardiovascular disease and identify specific cytokines associated with resistant hypertension. METHODS A secondary data analysis was conducted. The parent study included 156 adults with a history of myocardial infarction within the past 3-7 years and with a multiplex plasma analysis yielding a cytokine panel. A network analysis with lasso penalization for sparsity was performed to explore associations between cytokines and BP. Associated network centrality measures by cytokine were produced, and a community graph was extracted. A sensitivity analysis BP was also performed. RESULTS Cytokines with larger node strength measures were sTNFR2 and CX3. The graphical network highlighted six cytokines strongly associated with resistant hypertension. Cytokines IL-29 and CCL3 were found to be negatively associated with resistant hypertension, whereas CXCL12, MMP3, sCD163, and sIL6Rb were positively associated with resistant hypertension. DISCUSSION Understanding the network of associations through exploring oxidative stress and vascular inflammation may provide insight into treatment approaches for resistant hypertension.
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Horne CE, Abel WM, Crane PB. Fatigue, Stress, and Blood Pressure Medication Adherence by Race After Myocardial Infarction. J Nurse Pract 2023; 19:104757. [PMID: 37810177 PMCID: PMC10552602 DOI: 10.1016/j.nurpra.2023.104757] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Fatigue and stress may affect medication adherence. This study explored fatigue, stress, and blood pressure (BP) medication adherence in Black and White adults (N= 152) who had experienced a myocardial infarction. Over half of the sample (55%) reported fatigue as moderate to severe. The regression model explained up to 40% of the variance (p < .001) with fatigue and race significantly predicting adherence. Black participants reported fatigue causing distress (r =.40), and White participants reported greater association of fatigue severity-related BP medication adherence (r =.49). Our findings support considering racial differences when evaluating fatigue associated with BP medication adherence.
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Affiliation(s)
- Carolyn E Horne
- School of Nursing, The University of North Carolina, Charlotte, NC
| | - Willie M Abel
- School of Nursing, The University of North Carolina, Charlotte, NC
| | - Patricia B Crane
- School of Nursing, The University of North Carolina, Charlotte, NC
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Abel WM, Efird JT, Crane PB, Ferdinand KC. Self-management program and Black women with hypertension: Randomized controlled trial substudy. Res Nurs Health 2023; 46:336-347. [PMID: 36789452 PMCID: PMC10148903 DOI: 10.1002/nur.22301] [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: 10/18/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 02/16/2023]
Abstract
The prevalence of hypertension (HTN) among Black women in the United States has increased over the past 10 years with a decline in levels of HTN awareness, treatment, and control. Higher death rates occur in Black women from HTN-related diseases when compared with women of other racial/ethnic groups. Although interventions aimed at self-care/self-management are vital to adults becoming the cornerstone of their own health and well-being, there is a paucity of research in Black women. This randomized controlled pilot trial substudy examined the influence of a Chronic Disease Self-Management Program (CDSMP) with tailored coaching versus the CDSMP alone on blood pressure (BP), weight, and scores on self-care questionnaires and medication adherence for Black women with HTN over 9 months. Eighty-three women who had completed the CDSMP were randomly assigned to coaching or no coaching. Median age was 54 years and the time since the HTN diagnosis was 9 years. Significant differences were noted in self-care maintenance and management over time with better self-care in the treatment group. Though not significant, both groups denoted a trend toward better medication adherence. Almost 60% of the participants in both groups showed improvements in their systolic and/or diastolic BP. However, there was no significant difference between the study groups' BP and weight variables. The CDSMP was effective in decreasing BP and improving medication adherence. Further research is needed to evaluate effective coaching strategies that motivate Black women with HTN toward self-care management.
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Affiliation(s)
- Willie M Abel
- School of Nursing, The University of North Carolina, Charlotte, North Carolina, USA
| | - Jimmy T Efird
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,VA Cooperative Studies Program Coordinating Center, Boston, Massachusetts, USA
| | - Patricia B Crane
- School of Nursing, The University of North Carolina, Charlotte, North Carolina, USA
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Abel WM, Efird JT, Crane PB, Ferdinand KC, Foy CG, DeHaven MJ. Use of coaching and technology to improve blood pressure control in Black women with hypertension: Pilot randomized controlled trial study. J Clin Hypertens (Greenwich) 2022; 25:95-105. [PMID: 36537265 PMCID: PMC9832234 DOI: 10.1111/jch.14617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
Hypertension is the main cause of cardiovascular disease, especially in women. Black women (58%) are affected by higher rates of hypertension than other racial/ethnic groups contributing to increased cardio-metabolic disorders. To decrease blood pressure (BP) in this population, a pilot randomized controlled trial was conducted to examine the effects of Interactive Technology Enhanced Coaching (ITEC) versus Interactive Technology (IT) alone in achieving BP control, adherence to antihypertensive medication, and adherence to lifestyle modifications among Black women diagnosed with and receiving medication for their hypertension. Participants completed a 6-week Chronic Disease Self-Management Program (CDSMP), and 83 participants were randomly assigned to ITEC versus IT. Participants were trained to use three wireless tools and five apps that were synchronized to smartphones to monitor BP, weight, physical activity (steps), diet (caloric and sodium intake), and medication adherence. Fitbit Plus, a cloud-based collaborative care platform was used to collect, track, and store data. Using a mixed-effects repeated measures model, the main effect of group means indicated no significant difference between the treatment and referent groups on study variables. The main effect of time indicated significant differences between repeated measures for systolic BP (p < .0001), weight (p < .0001), and steps (p = .018). An interaction effect revealed differences over time and was significant for study measures except diastolic BP. An important goal of this preliminary analysis is to help Black women prioritize self-care management in their everyday environment. Future research is warranted in a geographically broader population of hypertensive Black women.
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Affiliation(s)
- Willie M. Abel
- School of NursingThe University of North Carolina at CharlotteCharlotteNorth CarolinaUSA
| | - Jimmy T. Efird
- School of MedicineCase Western Reserve UniversityClevelandOhioUSA,VA Cooperative Studies Program Coordinating CenterBostonMassachusettsUSA
| | - Patricia B. Crane
- School of NursingThe University of North Carolina at CharlotteCharlotteNorth CarolinaUSA
| | | | - Capri G. Foy
- Division of Public Health Sciences, Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Mark J. DeHaven
- Department of Public Health SciencesThe University of North Carolina at CharlotteCharlotteNorth CarolinaUSA
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Abstract
BACKGROUND As recurrent myocardial infarctions (MIRs) constitute almost a third of the annual incidence of myocardial infarction, identifying the traditional and novel variables related to MIR is important. OBJECTIVE The aim of this study was to examine modifiable cardiac risks, adiposity, symptoms associated with inflammation (fatigue, depression, sleep) and inflammatory cytokines, and MIR by sex and race. METHODS Using a cross-sectional descriptive design, we recruited a convenience sample of adults (N = 156) discharged with first myocardial infarction or had MIR in the last 3 to 7 years. Surveys measured demographics, cardiac risk factors, depression, sleep, and fatigue. Anthropometric measures and cytokines tumor necrosis factor-α, interleukin-6, and high-sensitivity C-reactive protein (hsCRP) were obtained. A maximum likelihood regression was calculated to predict MIR. RESULTS The sample included 57% male and 30% Black participants, and the mean (SD) age was 65 (12) years. The hsCRP was the only cytokine related to symptoms: fatigue ( r = 0.309, P < .001) and depression ( r = 0.255, P = .002). An MIR was not associated with race despite White participants reporting better sleep ( t146 = -3.25, P = .002), lower body mass index ( t154 = -3.49, P = .001), and fewer modifiable risk factors ( t152 = -2.05, P = .04). An MIR was associated with being male, higher hsCRP and tumor necrosis factor-α levels ( P < .001), and higher inflammatory symptoms of fatigue ( P = .04), depression ( P = .01), and poor sleep ( P < .001). CONCLUSION Further examination of biomarkers to understand the mechanisms associated with inflammatory symptoms of fatigue, depression, and poor sleep and MIR is needed.
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Affiliation(s)
- Willie M. Abel
- School of Nursing, The University of North Carolina at
Charlotte
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Hirsch S, Stephens AR, Crane PB. Fatigue, Depression, Cardiovascular Risk, and Self-Rated Health: Comparing a Community Sample of Adults to Those With a History of Myocardial Infarction. Clin Nurs Res 2021; 31:174-182. [PMID: 34727779 DOI: 10.1177/10547738211055570] [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] [Indexed: 11/17/2022]
Abstract
This cross-sectional descriptive study was designed to compare fatigue, depression, cardiovascular risk, and self-rated health in community dwelling adults (CDA) without a history of myocardial infarction (MI) compared to adults who had experienced an MI 3 to 7 years ago. A convenience sample (n = 40) of CDA completed: demographic health form, Revised Piper Fatigue Scale, and CES-D. Age-matched controls (n = 40) were randomly selected from the Recurrence of Myocardial Infarction (ROMI) study. Most (N = 80) were White (66%) with a mean age of 58.3 (SD = 11.5; range 21-83). The ROMI group reported more diabetes, hypercholesterolemia, obesity, and hypertension, and had higher fatigue (t(61) = 4.51, p < .001). No differences were noted in depression scores (p = .952). Higher fatigue and depression scores were correlated with poorer self-rated health: r = .544 (p < .001) and r = .295 (p = .008).
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Davis SP, Crane PB, Bolin LP, Johnson LA. An integrative review of physical activity in adults with inflammatory bowel disease. Intest Res 2021; 20:43-52. [PMID: 33472342 PMCID: PMC8831770 DOI: 10.5217/ir.2020.00049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/12/2020] [Indexed: 11/17/2022] Open
Abstract
Adults with inflammatory bowel disease (IBD) search for self-management strategies to manage their symptoms and improve their quality of life (QOL). Physical activity (PA) is one of the self-management strategies widely adopted by adults with IBD. This integrative review aimed to synthesize the evidence on health outcomes of PA in adults with IBD as well as to identify the barriers to engaging in PA. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), published literature was searched to identify the articles that addressed PA in adults with IBD. Twenty-eight articles met the inclusion criteria. Many of the reviewed studies used the terms of PA and exercise interchangeably. Walking was the most common PA reported in the studies. The findings from the majority of the reviewed studies supported the benefits of moderate-intensity exercise/PA among adults with IBD. The reviewed studies noted the following positive health outcomes of PA: improvement in QOL, mental health, sleep quality, gastrointestinal symptoms, fatigue and cardiorespiratory fitness. More importantly, participation in PA reduced the risk for development of IBD and the risk for future active disease. The findings from the reviewed studies highlighted the following barriers to engage in PA: fatigue, joint pain, abdominal pain, bowel urgency, active disease and depression.
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Davis SP, Bolin LP, Crane PB, Crandell J. Non-pharmacological Interventions for Anxiety and Depression in Adults With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Front Psychol 2020; 11:538741. [PMID: 33250803 PMCID: PMC7676293 DOI: 10.3389/fpsyg.2020.538741] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 02/28/2020] [Accepted: 09/23/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives: To assess the published randomized controlled trials (RCT) of non-pharmacological interventions systematically and to synthesize the evidence of these interventions for the management of anxiety and depression in adults with inflammatory bowel disease (IBD). Background: Anxiety and depression are common symptoms in adults with IBD and can have many negative outcomes on their quality of life (QOL). Non-pharmacological interventions for anxiety and depression are important to improve the adaptive strategies of adults with IBD. Previously published reviews of non-pharmacological interventions to mitigate anxiety and depression in those with IBD have resulted in inconclusive evidence. This review is aimed to fill that gap. Design: Systematic review and meta-analysis. Method: Using a PRISMA diagram, English-language RCT published were searched using combined keywords of inflammatory bowel disease, Crohn's disease, ulcerative colitis, randomized controlled trial, anxiety, and depression. The Cochrane risk of bias tool is utilized to assess the methodological quality of each study. A meta-analysis of RCTs was conducted using Comprehensive Meta-Analysis (CMA) software. Results: The final review included 10 studies. The overall risk of bias of the selected studies varied from low risk in three studies, some concerns in four of the studies, and high risk of bias in three of the studies. Interventions included cognitive-behavioral therapy, mindfulness-based therapy, breath–body- mind –workshop, guided imagery with relaxation, solution-focused therapy, yoga, and multicomponent interventions. The pooled evidence from all non-pharmacological interventions showed that these interventions significantly helped to reduce anxiety, depression, and disease specific quality of life (QOL) in adults with IBD compared to control groups. However, the effect sizes are small. The pooled standardized mean difference (SMD) was −0.28 (95% CI [−0.47, −0.09], p = 0.004) for anxiety, −0.22 (95% CI [−0.41, −0.03], p = 0.025) for depression and 0.20 (95% CI [0.004, 0.39], p = 0.046) for disease specific QOL. Conclusion: The addressed non-pharmacological interventions were multifaceted and demonstrated positive effects on anxiety and depression, and QOL in those with IBD. Healthcare providers can facilitate a discussion with adults with IBD about the availability of these interventions to mitigate their anxiety and depression and to improve their QOL.
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Affiliation(s)
- Suja P Davis
- School of Nursing, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Linda P Bolin
- College of Nursing, East Carolina University, Greenville, SC, United States
| | - Patricia B Crane
- School of Nursing, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Jamie Crandell
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Davis SP, Bolin LP, Crane PB, Wei H, Crandell J. Non-pharmacological interventions to manage fatigue in adults with inflammatory bowel disease: A systematic review and meta-analysis. Complement Ther Clin Pract 2020; 41:101229. [PMID: 32836107 DOI: 10.1016/j.ctcp.2020.101229] [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] [Received: 03/19/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The prevalence of fatigue is higher in adults with inflammatory bowel disease (IBD). There is limited information on the effectiveness of non-pharmacological interventions to manage fatigue. The purposes of this review is to evaluate the effectiveness of these interventions to manage fatigue in adults with IBD. MATERIALS AND METHODS A systematic review was conducted based on the PRISMA guidelines. Comprehensive Meta-Analysis software was used to compute metaanalysis. RESULTS Eleven studies were included in the review. The interventions to manage fatigue included problem-solving therapy, solution-focused therapy, cognitive behavioral therapy, psychoeducational intervention, exercise advice with omega-3 supplements, electro-acupuncture, and AndoSan. The pooled evidence from the metaanalysis demonstrated that non-pharmacological interventions could decrease IBDFatigue (SMD = 0.33, 95% CI [0.10, 0.55], p = 0.005). CONCLUSION The pooled data indicate that non-pharmacological interventions are helpful in managing IBD-Fatigue. Additionally, the non-pharmacological interventions reviewed could be utilized to promote self-management in IBD.
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Affiliation(s)
- Suja P Davis
- School of Nursing, UNC-CH, CB#7460, Chapel Hill, NC, 27599, USA.
| | - Linda P Bolin
- Department of Nursing Science, College of Nursing, East Carolina University, 2205 W 5th St, Greenville, NC, 27889, USA.
| | - Patricia B Crane
- Carol Grotnes Belk Endowed Chair, 9201, University City Blvd, Charlotte, NC, USA.
| | - Holly Wei
- College of Nursing, East Carolina University, 2205 W 5th St, Greenville, NC, 27889, USA.
| | - Jamie Crandell
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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10
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Abstract
The insertable cardiac monitor (ICM) is technology for diagnosing cardiac arrhythmias. The perception of those living with the device and how this relates to self-care management is unknown. The aim of this study was to explore the experiences of those with undiagnosed cardiac symptoms living with an ICM. This study used a qualitative descriptive design. Analysis of data was by intraparticipant analysis, interparticipant analysis, and interrelationships. Three global categories emerged: (a) influences on self-care, (b) dealing and (c) monitoring. Self-care management after insertion of the ICM was determined by the participant's perception of health, what symptoms they were experiencing and whether there was a positive or negative experience with the clinician. Many indicated little to no regular communication regarding symptoms and ICM results. Increasing communication relevant to management of health and long-term findings may assist in enhancing physical and psychological health.
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Affiliation(s)
- Aprel F Ventura
- College of Nursing, East Carolina University, Greenville, NC, USA.,School of Nursing, Fayetteville State University, Fayetteville, North Carolina, USA
| | - Carolyn E Horne
- College of Nursing, East Carolina University, Greenville, NC, USA
| | - Patricia B Crane
- College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Samuel Sears
- Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
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Horne CE, Johnson S, Crane PB. Comparing comorbidity measures and fatigue post myocardial infarction. Appl Nurs Res 2019; 45:1-5. [PMID: 30683244 DOI: 10.1016/j.apnr.2018.11.004] [Citation(s) in RCA: 4] [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: 06/05/2018] [Revised: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE/AIMS The purpose of this study was to examine comorbidity measures that may relate to the symptom of fatigue post MI: self-reported comorbidities, medication-validated comorbidities, weighted comorbidities for fatigue, and number of comorbidities. DESIGN Using a cross sectional design, we interviewed a convenience sample of 98 adults, 65 and older, who were 6 to 8 months post myocardial infarction. METHODS Participants self-reported their comorbidities using a list of 23 comorbid conditions. All medications were visually inspected, and medications were reviewed by a geriatric pharmacist for a common side effect of fatigue. The Revised Piper Fatigue Scale was used to measure fatigue. RESULTS The mean age of the participants was 76 (SD = 6.3), and most of the sample were White (84%). Neither medication-validated comorbidities nor those medications with fatigue as a common side effect explained fatigue. When controlling for age, sex, and marital status, self-reported comorbidities explained 10% of the variance in fatigue (F (4, 93) = 2.65; p = 0.04). Having 5 or more self-reported comorbidities explained 7% of variance in fatigue scores (F (1, 96) = 7.53; p = 0.007). CONCLUSION Comorbidities are associated with fatigue post MI. Adults post MI with 5 or more comorbidities should be screened for fatigue.
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Affiliation(s)
- Carolyn E Horne
- College of Nursing, East Carolina University, Greenville, NC 27858, United States of America.
| | - Sharona Johnson
- Vidant Health, Greenville, NC 27858, United States of America.
| | - Patricia B Crane
- College of Nursing, East Carolina University, Greenville, NC 27858, United States of America.
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Johnson S, Crane PB, Neil J, Christiano C. Coping with Intradialytic Events and Stress Associated with Hemodialysis. Nephrol Nurs J 2019; 46:13-21. [PMID: 30835092] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intradialytic events (IDEs), such as cramping, loss of consciousness, bleeding, and allergic reactions, are major stressors for persons on hemodialysis (HD). This study examined the association between coping strategies and stress associated with HD in persons who have experienced an IDE. Using a cross-sectional correlation design, a convenience sample of patients (N=73) completed a Hemodialysis Demographic Form, Ways of Coping Questionnaire, and a Hemodialysis Stress Visual Analog Scale. Most participants were African American (95%), male (52%), with a mean age of 57 (SD=11.98) years, and an average of 41 (SD=31.55) months on HD. Coping strategies explained 34% of the variance in stress associated with HD (F [11, 61] = 2.89; p=0.004); positive reappraisal and planful problem solving were negatively correlated with stress. Emotion-focused coping strategies were used most during an IDE.
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Affiliation(s)
- Sharona Johnson
- Director of Advanced Clinical Practice, Vidant Medical Center, Greenville, NC
- member of ANNA's Tar River Chapter
| | - Patricia B Crane
- Associate Dean for Research and Scholarship and the Richard R. Eakin Distinguished Professor, East Carolina University College of Nursing, Greenville, NC
| | - Janice Neil
- Associate Professor, East Carolina University College of Nursing, Greenville, NC
| | - Cynthia Christiano
- Division Chief and an Associate Professor of Medicine, East Carolina University, Department of Internal Medicine, Division of Nephrology and Hypertension, Greenville, NC
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Horne CE, Engelke MK, Schreier A, Swanson M, Crane PB. Effects of Tactile Desensitization on Postoperative Pain After Amputation Surgery. J Perianesth Nurs 2018; 33:689-698. [PMID: 30236577 DOI: 10.1016/j.jopan.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Pain in the acute setting after amputation is complex with multiple types of pain experienced, including somatic and neuropathic. No studies have measured multiple pain control modalities while using self-management techniques for acute amputation pain. Desensitization could provide a means of pain control for somatic and neuropathic pain. The purpose of this study was to test the efficacious use and effects of tactile desensitization in managing acute postoperative pain after lower limb amputation. DESIGN This was a pre-experimental repeated measure study. METHODS Pain description, intensity, anxiety, depression, and medication usage were measured during repeated time periods. Pain intensity was measured before and after each intervention along with efficacy. FINDINGS Of the times the intervention was self-administered (n = 50) there was a statistically significant reduction in the pain level (P < .001) with large effect sizes for all paired comparisons. Participants found the intervention efficacious and feasible to use. CONCLUSIONS The findings support a reduction in pain intensity scores using pain medication coupled with tactile desensitization.
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14
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Bolin LP, Horne CE, Crane PB, Powell JR. Low-salt diet adherence in African Americans with hypertension. J Clin Nurs 2018; 27:3750-3757. [DOI: 10.1111/jocn.14551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Linda P Bolin
- East Carolina University - College of Nursing; Greenville North Carolina
| | - Carolyn E Horne
- East Carolina University - College of Nursing; Greenville North Carolina
| | - Patricia B Crane
- East Carolina University - College of Nursing; Greenville North Carolina
| | - James R Powell
- Department of Medicine; East Carolina University - Brody School of Medicine; Greenville North Carolina
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Bolin LP, Crane PB, Powell JR, Horne CE, Floegel TA. Factors associated with physical activity in African Americans with hypertension. Appl Nurs Res 2018; 41:62-67. [PMID: 29853217 DOI: 10.1016/j.apnr.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/21/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Pharmacological management only controls 58% of those with hypertension. Combining pharmacological therapy with physical activity is important in controlling hypertension. AIM To examine factors associated with physical activity (PA) adherence in African Americans (AAs) with hypertension and antihypertensive medication adherence. METHODS A cross-sectional descriptive correlational design was used to examine if systolic BP, co-morbidities, serum creatinine and potassium, education, depression, locus of control, and social support explained PA adherence in a convenience sample of AAs (N = 77) aged 55 to 84. All completed: demographic data, PA visual analog scale (VAS-PA); Multidimensional Health Locus of Control Scale; Patient Health Question-9 Depression Instrument. Physiological data and co-morbidities were also collected. RESULTS A third (n = 26) had systolic BP over 140 mm/Hg. The model explained 26% variance in adherence to PA (F = 3.378 [8, 68]; p = .003) with creatinine (p < .05), depression (p < .01), and social support (p < .05) as significant. Differences in VAS-PA scores between levels of depression were significant (F = 4.707 [269], p = .012; Eta2 = 0.12). Those with no depression had significantly higher PA adherence (M = 88.26, SD = 18.97) compared to mildly depressed (M = 70.24, SD 27.71) and moderately depressed (M = 66.83, SD = 23.31). CONCLUSIONS Clinicians should promote PA as an adjunct to medications for effective control of hypertension in AAs. Screening and intervening for depression are important when examining adherence to PA in AAs with hypertension.
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Affiliation(s)
- Linda P Bolin
- East Carolina University, College of Nursing, 2116 Health Science Building, Mailstop 162, Greenville, NC 27858, USA.
| | - Patricia B Crane
- East Carolina University, College of Nursing, 4210-C Health Science Building, Mailstop 162, Greenville, NC 27858, USA.
| | - James R Powell
- East Carolina University, Brody School of Medicine, Department of Medicine, 521 Moye Blvd., Greenville, NC 27858, USA.
| | - Carolyn E Horne
- East Carolina University, College of Nursing, 3118 Health Science Building, Mailstop 162, Greenville, NC 27858, USA.
| | - Theresa A Floegel
- East Carolina University, College of Nursing, 4165-E Health Science Building, Mailstop 162, Greenville, NC 27858, USA.
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Efird JT, Jindal C, Kiser AC, Akhter SA, Crane PB, Kypson AP, Sverdlov AL, Davies SW, Kindell LC, Anderson EJ. Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents. J Int Med Res 2018; 46:3183-3194. [PMID: 29808744 PMCID: PMC6134635 DOI: 10.1177/0300060518773934] [Citation(s) in RCA: 2] [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] [Indexed: 01/13/2023] Open
Abstract
Background Postoperative atrial fibrillation (POAF) is a frequent complication of coronary artery bypass graft (CABG) surgery. This arrhythmia occurs more frequently among patients who receive perioperative inotropic therapy (PINOT). Administration of nitrates with antiplatelet agents reduces the conversion rate of cyclic guanosine monophosphate to guanosine monophosphate. This process is associated with increased concentrations of free radicals, catecholamines, and blood plasma volume. We hypothesized that patients undergoing CABG surgery who receive PINOT may be more susceptible to POAF when nitrates are administered with antiplatelet agents. Methods Clinical records were examined from a prospectively maintained cohort of 4,124 patients undergoing primary isolated CABG surgery to identify POAF-associated factors. Results POAF risk was increased among patients receiving PINOT, and the greatest effect was observed when nitrates were administered with antiplatelet therapy. Adjustment for comorbidities did not substantively change the study results. Conclusions Administration of nitrates with certain antiplatelet agents was associated with an increased POAF risk among patients undergoing CABG surgery. Additional studies are needed to determine whether preventive strategies such as administration of antioxidants will reduce this risk.
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Affiliation(s)
- Jimmy T Efird
- 1 Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Charulata Jindal
- 1 Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Andy C Kiser
- 2 Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, NC, USA
| | - Shahab A Akhter
- 2 Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, NC, USA
| | - Patricia B Crane
- 3 Office of the Dean, College of Nursing, East Carolina University, Greenville, NC, USA
| | - Alan P Kypson
- 4 Cardiac Surgical Specialists, REX Health Care, University of North Carolina, Raleigh, NC, USA
| | - Aaron L Sverdlov
- 5 Priority Clinical Centre for Cardiovascular Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Stephen W Davies
- 6 Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Linda C Kindell
- 2 Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, NC, USA
| | - Ethan J Anderson
- 7 Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA
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Anderson EJ, Efird JT, Kiser AC, Crane PB, O'Neal WT, Ferguson TB, Alwair H, Carter K, Williams JM, Gehi AK, Kypson AP. Plasma Catecholamine Levels on the Morning of Surgery Predict Post-Operative Atrial Fibrillation. JACC Clin Electrophysiol 2017; 3:1456-1465. [PMID: 29430523 DOI: 10.1016/j.jacep.2017.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/19/2022]
Abstract
OBJECTIVES This study sought to determine whether plasma catecholamines and monoamine oxidase-B (MOA-B) are associated with post-operative atrial fibrillation (POAF) in patients undergoing elective cardiac surgery. BACKGROUND Although intra- and post-operative adrenergic tone has been demonstrated to be an causative factor for POAF, the role and association of pre-operative plasma catecholamines remains unclear. METHODS Prior to administration of anesthesia on the morning of surgery, blood samples were obtained from 324 patients undergoing nonemergent coronary artery bypass graft and/or aortic valve surgery with cardiopulmonary bypass at East Carolina Heart Institute. The concentrations of norepinephrine (NE), dopamine (DA), epinephrine (EPI), and enzyme MAO-B were assessed in platelet-rich plasma. A log-binomial regression model was used to determine the association between quartiles of these variables and POAF. RESULTS Levels of NE (p = 0.0006) and EPI (p = 0.047) in the 4th quartile [Formula: see text] were positively associated with POAF, whereas DA (p = 0.0034) levels in the 4th quartile [Formula: see text] were inversely associated with POAF. Adjusting for age, heart failure (HF), and history of atrial fibrillation, the composite pre-operative (adrenergic) plasma marker [Formula: see text] was associated with a 4-fold increased occurrence of POAF (adjusted p = 0.0001). No association between plasma MAO-B and POAF was observed. CONCLUSIONS Our results suggest that pre-operative adrenergic tone is an important factor underlying POAF. This information provides evidence that assessment of plasma catecholamines may be a low-cost method that is easy to implement for predicting which patients are likely to develop POAF. More investigation in a multicentric setting is needed to validate our results.
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Affiliation(s)
- Ethan J Anderson
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa.,Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Jimmy T Efird
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina.,Office of the Dean of Research, College of Nursing, East Carolina University, Greenville, North Carolina.,Center for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Andy C Kiser
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Patricia B Crane
- Office of the Dean of Research, College of Nursing, East Carolina University, Greenville, North Carolina
| | - Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia
| | - T Bruce Ferguson
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Hazaim Alwair
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Kendal Carter
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina
| | - J Mark Williams
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Anil K Gehi
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan P Kypson
- REX Cardiac Surgical Specialists, University of North Carolina Health Care, Raleigh, North Carolina
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Efird JT, Kiser AC, Crane PB, Landrine H, Kindell LC, Nelson MA, Jindal C, Sarpong DF, Griffin WF, Ferguson TB, Chitwood WR, Davies SW, Kypson AP, Gudimella P, Anderson EJ. Perioperative Inotrope Therapy and Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery: Evidence of a Racial Disparity. Pharmacotherapy 2017; 37:297-304. [PMID: 28052357 DOI: 10.1002/phar.1894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Following coronary artery bypass graft (CABG) surgery, mortality rates are significantly higher among black patients who experience postoperative atrial fibrillation (POAF). Perioperative inotropic therapy (PINOT) was associated with POAF in previous reports, but the extent to which race influences this association is unknown. In the present study, the relationship between PINOT, race, and POAF was examined in patients undergoing CABG surgery. METHODS AND SETTING Clinical records were examined from a prospectively maintained cohort of 11,855 patients (median age 64 yrs; 70% male; 16% black) undergoing primary isolated CABG at a large cardiovascular institute in the southeastern region of the United States. Relative risk (RR) and 95% confidence intervals (CIs) were computed using log-binomial regression. MAIN RESULTS The association between PINOT and POAF was significantly increased among black patients (adjusted RR 1.7, CI 1.4-2.0) compared with white patients (adjusted RR 1.3, CI 1.2-1.4) (pinteraction = 0.013). CONCLUSIONS These findings suggest that PINOT may be disproportionately associated with POAF among black patients undergoing CABG surgery. Additional studies are needed to examine further the potential underlying mechanisms of this association.
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Affiliation(s)
- Jimmy T Efird
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina.,Center for Health Disparities, Brody School of Medicine, Greenville, North Carolina.,Office of the Dean, College of Nursing, East Carolina University, Greenville, North Carolina.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andy C Kiser
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina
| | - Patricia B Crane
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Center for Health Disparities, Brody School of Medicine, Greenville, North Carolina.,Office of the Dean, College of Nursing, East Carolina University, Greenville, North Carolina
| | - Hope Landrine
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Center for Health Disparities, Brody School of Medicine, Greenville, North Carolina
| | - Linda C Kindell
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina
| | - Margaret-Ann Nelson
- Department of Pharmacology and Toxicology, Brody School of Medicine, Greenville, North Carolina
| | - Charulata Jindal
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Daniel F Sarpong
- Center for Minority Health and Health Disparities Research and Education, Xavier University of Louisiana, New Orleans, Louisiana
| | - William F Griffin
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - T Bruce Ferguson
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina
| | - W Randolph Chitwood
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina
| | - Stephen W Davies
- Department of General Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Alan P Kypson
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina
| | - Preeti Gudimella
- Department of Pharmacology and Toxicology, Brody School of Medicine, Greenville, North Carolina
| | - Ethan J Anderson
- Department of Pharmacology and Toxicology, Brody School of Medicine, Greenville, North Carolina.,Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa
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Crane PB. Fatigue 2 months after myocardial infarction may indicate risk for persistent fatigue. Evid Based Nurs 2016; 19:78. [PMID: 27125500 DOI: 10.1136/eb-2015-102231] [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: 06/05/2023]
Affiliation(s)
- Patricia B Crane
- East Carolina University College of Nursing, Greenville, North Carolina, USA
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Efird JT, Griffin W, O'Neal WT, Davies SW, Shiue KY, Grzybowski M, Kindell LC, Kypson AP, Bowling M, Ferguson TB, Alger L, Crane PB. Long-Term Survival after Cardiac Surgery in Patients with Chronic Obstructive Pulmonary Disease. Am J Crit Care 2016; 25:266-76. [PMID: 27134234 DOI: 10.4037/ajcc2016119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Although many patients with chronic obstructive pulmonary disease (COPD) require a prolonged length of stay (PLOS) following coronary artery bypass grafting (CABG), the impact of PLOS on long-term survival has not been examined in this population. OBJECTIVES To determine the association between PLOS and long-term survival among COPD and non-COPD patients after CABG and to examine consequent policy and practice-based implications. METHODS A retrospective cohort study of CABG patients was conducted between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by PLOS. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. RESULTS A total of 203 patients (4.2%) had PLOS after nonemergent CABG (N = 4801). PLOS was an important independent predictor of decreased long-term survival (no COPD, no PLOS: HR = 1.0; COPD, no PLOS: adjusted HR [95% CI], 1.8 [1.5-2.1]; no COPD, PLOS: 3.3 [2.5-4.4]; COPD, PLOS: 6.0 [4.4-8.2]; PTrend < .001). CONCLUSIONS COPD and PLOS are 2 of many factors that affect long-term mortality in postoperative CABG patients. Aggressive treatment strategies aimed at early weaning off of mechanical ventilation and prevention of reintubation among COPD patients must be considered carefully as a means to reduce length of stay after CABG. Our results also have important implications for the long-term management of these patients and strategies for containing costs over the life course of the patient.
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Affiliation(s)
- Jimmy T Efird
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
| | - William Griffin
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
| | - Wesley T O'Neal
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University.
| | - Stephen W Davies
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
| | - Kristin Y Shiue
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
| | - Marysia Grzybowski
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
| | - Linda C Kindell
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
| | - Alan P Kypson
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
| | - Mark Bowling
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
| | - T Bruce Ferguson
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
| | - Lada Alger
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
| | - Patricia B Crane
- Jimmy T. Efird is director, Center for Epidemiology and Outcomes Research at the East Carolina Heart Institute, East Carolina University, Greenville, North Carolina. William Griffin is an intern in the Department of Internal Medicine at the Medical University of South Carolina, Charleston, South Carolina. Wesley T. O'Neal is a resident in the Department of Internal Medicine at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Stephen W. Davies is a resident in the Department of General Surgery at the University of Virginia Health System, Charlottesville, Virginia. Kristin Y. Shiue is an external research consultant for the Office of Research and Creative Activities, College of Nursing, East Carolina University. Marysia Grzybowski is a cardiovascular epidemiologist and assistant professor in the Department of Public Health, East Carolina University. Linda C. Kindell is a nurse specialist and clinical database manager at the East Carolina Heart Institute, East Carolina University. Alan P. Kypson is chief of the Division of Cardiothoracic Surgery at the East Carolina Heart Institute, East Carolina University. Mark Bowling is associate chief of the Division of Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, North Carolina. T. Bruce Ferguson is a professor of cardiothoracic surgery in the Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University. Lada Alger is a clinical research coordinator at Eastern Virginia Medical School, Norfolk, Virginia. Patricia B. Crane is associate dean, Office for Research and Creative Activities, College of Nursing, East Carolina University
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Efird JT, Griffin WF, Davies SW, O'Neal WT, Crane PB, Kindell LC, O'Neal JB, Chitwood WR, Kypson AP. Seasonal Incidence of Emergent Coronary Artery Bypass Grafting Surgery. Heart Surg Forum 2016; 19:E048-53. [PMID: 27146229 DOI: 10.1532/hsf.1277] [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] [Received: 05/20/2015] [Revised: 08/28/2015] [Accepted: 01/28/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Emergent coronary artery bypass grafting (CABG) surgery is often required in the case of severe coronary artery disease, which is refractory to traditional management. The objective of our study was to test the hypothesis that there is seasonal variation in the incidence of emergent CABG. METHODS A sinusoidal logistic regression model was used to analyze operative data at our cardiovascular institute of 270 cases spanning 5939 calendar days. RESULTS A cyclic peak risk for emergent CABG was observed for late winter (calendar day 66; P = .036). The odds ratios for the 1-, 2- and 3-month window surrounding this peak were 1.8 (95% CI = 0.94-3.5, P = .072), 1.6 (95% CI = 1.06-2.5, P = .024) and 1.4 (95% CI = 0.9-1.8, P = .066), respectively. CONCLUSION Our results suggest that a seasonal variation may exist in the incidence of patients presenting with severe coronary artery disease requiring emergent CABG. This information is useful in the scheduling of hospital resources and staff. It also provides important etiology clues underlying coronary artery disease that may lead to future interventions or targeted therapies.
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Affiliation(s)
- Jimmy T Efird
- 1. East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC 2.Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 3. The College of Nursing, East Carolina University, Greenville, NC.
| | | | - Stephen W Davies
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA.
| | - Wesley T O'Neal
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
| | - Patricia B Crane
- The College of Nursing, East Carolina University, Greenville, NC.
| | - Linda C Kindell
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.
| | - Jason B O'Neal
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
| | - W Randolph Chitwood
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.
| | - Alan P Kypson
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.
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Efird JT, Griffin WF, Gudimella P, O'Neal WT, Davies SW, Crane PB, Anderson EJ, Kindell LC, Landrine H, O'Neal JB, Alwair H, Kypson AP, Nifong WL, Chitwood WR. Conditional long-term survival following minimally invasive robotic mitral valve repair: a health services perspective. Ann Cardiothorac Surg 2015; 4:433-42. [PMID: 26539348 DOI: 10.3978/j.issn.2225-319x.2015.08.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Conditional survival is defined as the probability of surviving an additional number of years beyond that already survived. The aim of this study was to compute conditional survival in patients who received a robotically assisted, minimally invasive mitral valve repair procedure (RMVP). METHODS Patients who received RMVP with annuloplasty band from May 2000 through April 2011 were included. A 5- and 10-year conditional survival model was computed using a multivariable product-limit method. RESULTS Non-smoking men (≤65 years) who presented in sinus rhythm had a 96% probability of surviving at least 10 years if they survived their first year following surgery. In contrast, recent female smokers (>65 years) with preoperative atrial fibrillation only had an 11% probability of surviving beyond 10 years if alive after one year post-surgery. CONCLUSIONS In the context of an increasingly managed healthcare environment, conditional survival provides useful information for patients needing to make important treatment decisions, physicians seeking to select patients most likely to benefit long-term following RMVP, and hospital administrators needing to comparatively assess the life-course economic value of high-tech surgical procedures.
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Affiliation(s)
- Jimmy T Efird
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - William F Griffin
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Preeti Gudimella
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Wesley T O'Neal
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen W Davies
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Patricia B Crane
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ethan J Anderson
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Linda C Kindell
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hope Landrine
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jason B O'Neal
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hazaim Alwair
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alan P Kypson
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Wiley L Nifong
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W Randolph Chitwood
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Efird JT, Griffin WF, Sarpong DF, Davies SW, Vann I, Koutlas NT, Anderson EJ, Crane PB, Landrine H, Kindell L, Iqbal ZJ, Ferguson TB, Chitwood WR, Kypson AP. Increased Long-Term Mortality among Black CABG Patients Receiving Preoperative Inotropic Agents. Int J Environ Res Public Health 2015; 12:7478-90. [PMID: 26154656 PMCID: PMC4515669 DOI: 10.3390/ijerph120707478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 01/02/2023]
Abstract
The aim of this study was to examine racial differences in long-term mortality after coronary artery bypass grafting (CABG), stratified by preoperative use of inotropic agents. Black and white patients who required preoperative inotropic support prior to undergoing CABG procedures between 1992 and 2011 were compared. Mortality probabilities were computed using the Kaplan-Meier product-limit method. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. A total of 15,765 patients underwent CABG, of whom 211 received preoperative inotropic agents within 48 hours of surgery. Long-term mortality differed by race (black versus white) among preoperative inotropic category (inotropes: adjusted HR = 1.6, 95% CI = 1.009–2.4; no inotropes: adjusted HR = 1.15, 95% CI = 1.08–1.2; Pinteraction < 0.0001). Our study identified an independent preoperative risk-factor for long-term mortality among blacks receiving CABG. This outcome provides information that may be useful for surgeons, primary care providers, and their patients.
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Affiliation(s)
- Jimmy T Efird
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - William F Griffin
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - Daniel F Sarpong
- Center for Minority Health and Health Disparities Research and Education, Xavier University of Louisiana, New Orleans, LA 70125, USA.
| | - Stephen W Davies
- Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
| | - Iulia Vann
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Nathaniel T Koutlas
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - Ethan J Anderson
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Patricia B Crane
- The College of Nursing, East Carolina University, Greenville, NC 27834, USA.
| | - Hope Landrine
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Linda Kindell
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - Zahra J Iqbal
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - T Bruce Ferguson
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - W Randolph Chitwood
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
| | - Alan P Kypson
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
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Abstract
BACKGROUND Fatigue is prevalent after myocardial infarction (MI) and is a barrier to physical activity (PA). Because PA is an important health behavior in preventing or delaying recurrent MIs, examining the influence of biophysical markers and fatigue on PA is important as a prerequisite to developing effective interventions. OBJECTIVE This study compared PA in 34 men and 38 women, aged 65 and older, 6-8 months post MI, and examined the influence of biophysiological measures and fatigue on PA in this sample. METHODS Using a cross-sectional descriptive correlational design, adults completed a demographic form that included documentation of blood pressure, heart rate, height and weight; the Revised Piper Fatigue Scale (RPFS), and the Community Healthy Activities Model Program for Seniors Physical Activity Questionnaire for Older Adults, and blood collection for measurement of hemoglobin (Hgb), interleukin-6, and B-natriuretic peptide. RESULTS There were no differences in frequency of PA between older men and older women; however, men reported a higher intensity of PA (p = .011). When controlling for sex, age, and biophysiological measures, the RPFS significantly explained 16% of the variance in the frequency of PA (p = .03), with no individual subscale serving as a significant predictor. The RPFS behavior/severity subscale explained 31% of the variance in energy expended on all PA (p < .001) and 40% of the variance in energy expended on moderate-intensity PA (p < .001). CONCLUSION The older adults participating in this study did not participate in the recommended levels of PA, and fatigue significantly influenced PA post MI.
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Affiliation(s)
- Patricia B Crane
- Adult Health Department, The University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Willie M Abel
- School of Nursing, The University of North Carolina at Charlotte, Greensboro, NC, USA
| | - Thomas P McCoy
- Community Practice Department, The University of North Carolina at Greensboro, Greensboro, NC, USA
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Abstract
Black women have the highest prevalence of hypertension in the world, and depression is associated with both hypertension and lack of health promoting behaviors. Thus, it is important to identify factors that may contribute to depression in hypertensive women. This cross-sectional study was conducted with a convenience sample of 80 black women ages 18-60 who were prescribed anti-hypertensive medication. Data were collected using self-report instruments. The study showed that lower income level, greater number of comorbidities, lower active coping scores, and poorer medication adherence were significantly associated with higher depression scores. These findings have important implications for the development of screening protocols and interventions for black women.
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Affiliation(s)
- Willie M Abel
- University of North Carolina at Charlotte, School of Nursing , Charlotte, North Carolina , USA
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Crane PB. Message from the President Advancing Nursing Science: Are You a Gift? Res Nurs Health 2013. [DOI: 10.1002/nur.21569] [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)
- Patricia B. Crane
- School of Nursing; University of North Carolina Greensboro; Greensboro NC
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Crane PB. Message from the President return on investment: Debunking a myth. Res Nurs Health 2013; 36:437. [DOI: 10.1002/nur.21559] [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: 11/06/2022]
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Crane PB. Message from the president talking about it: Engaging the public in advancing nursing research. Res Nurs Health 2013; 36:328-9. [DOI: 10.1002/nur.21547] [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] [Accepted: 08/13/2013] [Indexed: 11/09/2022]
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B. Crane P. Missing in Action: Physical Activity for Women with Heart Disease. Womens Health Issues 2012. [DOI: 10.4172/2325-9795.1000e101] [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: 11/09/2022]
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McSweeney JC, O'Sullivan P, Cleves MA, Lefler LL, Cody M, Moser DK, Dunn K, Kovacs M, Crane PB, Ramer L, Messmer PR, Garvin BJ, Zhao W. Racial differences in women's prodromal and acute symptoms of myocardial infarction. Am J Crit Care 2010; 19:63-73. [PMID: 20045850 DOI: 10.4037/ajcc2010372] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Minority women, especially black and Hispanic women, have higher rates of coronary heart disease and resulting disability and death than do white women. A lack of knowledge of minority women's symptoms of coronary heart disease may contribute to these disparities. OBJECTIVE To compare black, Hispanic, and white women's prodromal and acute symptoms of myocardial infarction. METHODS In total, 545 black, 539 white, and 186 Hispanic women without cognitive impairment at 15 sites were retrospectively surveyed by telephone after myocardial infarction. With general linear models and controls for cardiovascular risk factors, symptom severity and frequency were compared among racial groups. Logistic regression models were used to examine individual prodromal or acute symptoms by race, with adjustments for cardiovascular risk factors. RESULTS Among the women, 96% reported prodromal symptoms. Unusual fatigue (73%) and sleep disturbance (50%) were the most frequent. Eighteen symptoms differed significantly by race (P<.01); blacks reported higher frequencies of 10 symptoms than did Hispanics or whites. Thirty-six percent reported prodromal chest discomfort; Hispanics reported more pain/discomfort symptoms than did black or white women. Minority women reported more acute symptoms (P < .01). The most frequent symptom, regardless of race, was shortness of breath (63%); 22 symptoms differed by race (P <.01). In total, 28% of Hispanic, 38% of black, and 42% of white women reported no chest pain/discomfort. CONCLUSIONS Prodromal and acute symptoms of myocardial infarction differed significantly according to race. Racial descriptions of women's prodromal and acute symptoms should assist providers in interpreting women's symptoms.
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Affiliation(s)
- Jean C McSweeney
- University of Arkansas for Medical Sciences, Little Rock, 72205, USA.
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Kring DL, Crane PB. Factors affecting quality of life in persons on hemodialysis. Nephrol Nurs J 2009; 36:15-55. [PMID: 19271620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of this cross-sectional, correlational study was to describe the quality of life (QOL) in persons with end stage renal disease and explore factors that may affect QOL. Biologicalfunction, symptoms,function, general health perception, and characteristics of the individual and environment explained 61% of the variability in overall QOL. Only anxiety, depression, and general health perception significantly contributed to QOL QOL may be better predicted from psychological factors than physiological factors.
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Williams AG, Crane PB, Kring D. Fatigue in African American women on hemodialysis. Nephrol Nurs J 2007; 34:610-618. [PMID: 18203569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The purpose of this study was to examine factors associated with fatigue in African American women with end stage renal disease. Twenty-seven of 36 women in the sample were fatigued. Correlations were found with mood disorder and fatigue (p < .001), social support and uremic malnutrition (p = .003), and anemia and fatigue (p = .012) and mood disorder (p = .039). Anemia, uremic malnutrition, mood disorder, and social support explained 38% of variance in fatigue scores (F = 4.768 [4, 31]; p = .004). Future studies testing interventions that mitigate fatigue are warranted.
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Affiliation(s)
- Amy G Williams
- University of North Carolina at Greensboro, Greensboro, NC, USA
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Abstract
Cardiovascular disease rates are higher in African American women and they have more cardiovascular risk factors than other groups. Although one of the most important cardiovascular risk reduction behaviors is physical activity, few studies have focused on African American women's cardiovascular risk and physical activity. Therefore, the aims of this descriptive pilot study were to describe modifiable cardiovascular risks and to explore physical activity, as measured by pedometer steps, in younger (n = 22; aged 21-45 years) and older (n = 22; aged 46-75 years) community-dwelling African American women. The total number of pedometer steps recorded in 3 days ranged from 1,153 to 52,742. Day 1 steps were significantly different than day 2 and day 3 steps across the sample (F = 5.30, df = 1, P < .05). Risk factors were similar across the age groups. There was no relationship between the 3-day total or average number of daily steps and cardiovascular risks. Thus, interventions may be used in both age groups, with modifications for cohort effects of approach and health status. Given the disparities in cardiovascular disease and the Healthy People 2010 national health objectives, it is important to continue a variety of efforts to assist adult women of all ages to increase their physical activity and to decrease other CVD risks.
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Affiliation(s)
- Patricia B Crane
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC 27402, USA.
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Crane PB. Commentary on “Nursing Home Residents' Sense of Coherence and Functional Status”. J Holist Nurs 2007. [DOI: 10.1177/0898010107303269] [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: 11/15/2022]
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Abstract
PURPOSE The purpose of this study was to assess demographic characteristics of women prescribed beta-blocker (beta-blocker) medication and compare to those not using beta-blocker medication, and to determine if there are differences in depression and fatigue among women who used beta-blockers compared to nonusers 6-12 months after myocardial infarction (MI). DATA SOURCES This was a descriptive cross-sectional study of 84 women (61 using beta-blockers and 23 not using beta-blockers) aged 65 and older who were 6-12 months post-MI. Women had their height and weight measured and completed a Demographic Health Form, the Geriatric Depression Scale, and the Revised Piper Fatigue Scale (RPFS). CONCLUSIONS While most of the women were taking beta-blockers after MI (74%), significantly fewer Black women were taking beta-blockers (chi(2) = 5.086, p = 0.032). Most of the beta-blocker users were overweight or obese. There were no significant differences in age, t(82) = 0.7, p = 0.486; body mass index, t(82) = 0.76, p = 0.445; income, chi(2)(df = 2) = 3.219, p = 0.075; mean depression, t(82) = 1.648, p = 0.103; or fatigue scores, t(82) = 0.993, p = 0.324, between beta-blocker users and nonusers. More of those not taking beta-blockers reported fatigue with significantly higher fatigue in the affective meaning dimension of the RPFS, t(82) = 2.272, p = 0.03. IMPLICATIONS FOR PRACTICE beta-Blocker medication continues to be underutilized in older women. Because no difference was noted in fatigue and depression in the two groups, these may mean that these side effects are not barriers in prescribing this medication post-MI. Nurse practitioners are in pivotal positions to monitor the ongoing physiological and psychological sequelae post-MI and implement interventions to improve their outcomes.
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Affiliation(s)
- Patricia B Crane
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina 27402-6170, USA.
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Kennedy-Malone L, Penrod J, Kohlenberg EM, Letvak SA, Crane PB, Tesh A, Kolanowski A, Hupcey J, Milone-Nuzzo P. Integrating gerontology competencies into graduate nursing programs. J Prof Nurs 2006; 22:123-8. [PMID: 16564479 DOI: 10.1016/j.profnurs.2006.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Current demographic and health care utilization trends strongly indicate a rapidly increasing demand for nurses who are well qualified to care for older adults. Advanced practice nurses are positioned to assume leadership roles in geriatric nursing care; however, they must first acquire adequate preparatory education. This article describes two graduate nursing schools' curricular innovations that were funded by The John A. Hartford Foundation, in collaboration with the American Association of Colleges of Nursing (AACN), through the Geriatric Nursing Education Project: Enhancing Gerontological/Geriatric Nursing for Advanced Practice Nursing. These programs at University of North Carolina at Greensboro and Pennsylvania State University incorporated techniques to translate the Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care [American Association of Colleges of Nursing. (2004). Nurse practitioner and clinical nurse specialist competencies for older adult care. Washington, DC: AACN] into an advanced practice curriculum and developed strategies to sustain curricular innovations. Finally, lessons learned from these two projects are discussed and recommendations are made for integrating geriatric nursing competencies into graduate programs.
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Simpson JP, Crane PB. The effects of hyperglycemia on patient length of stay following myocardial infarction. Medsurg Nurs 2005; 14:233-9. [PMID: 16206893] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Jenny P Simpson
- Moses Cone Health System Diabetes Treatment Program, Greensboro, NC, USA
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Abstract
BACKGROUND Within 6 years of a myocardial infarction (MI) more women (35%) than men (18%) will have another MI. Participation in physical activity is one of the most effective methods to reduce cardiac risks; however, few older women participate. One of the most frequently reported barriers to physical activity is fatigue. OBJECTIVES The specific aims of this study were to (1) describe factors related to fatigue in older women after MI and (2) examine the relationship of fatigue to physical activity in older women after MI. METHODS This descriptive correlational study examined the effects of age, body mass index, comorbidities, sleep, beta-blocker medication, depression, and social support on fatigue and physical activity in women (N = 84), ages 65 to 88 years old, 6 to 12 months post-MI. All women had their height and weight measured and completed (1) a health form on comorbidities, physical activity, and medication history; (2) the Geriatric Depression Scale; (3) the Epworth Sleepiness Scale; (4) the Revised Piper Fatigue Scale; and (5) the Social Provisions Scale. RESULTS The majority (67%) of the women reported fatigue that they perceived as different from fatigue before their MI. Moderately strong correlations were noted among depression, sleep, and fatigue, and multivariate analysis indicated that depression and sleep significantly accounted for 32.7% of the variance in fatigue. Although only 61% of the women reported participating in physical activity for exercise, most were meeting minimal kilocalories per week for secondary prevention. Fatigue was not significantly associated with participation in physical activity. CONCLUSION Describing correlates to fatigue and older women's participation in physical activity after MI are important to develop interventions targeted at increasing women's participation in physical activity, thus decreasing their risk for recurrent MIs.
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Affiliation(s)
- Julia W Aucoin
- School of Nursing, University of North Carolina at Greensboro, NC 27402, USA.
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Abstract
BACKGROUND Although the inclusion of women in research has been examined in medical publications, little is known about how federal mandates have influenced the inclusion of women in research published in nursing journals. OBJECTIVE This study aimed to examine the inclusion of women in published nursing research from 1995 to 2001, with a focus on the leading causes of mortality. METHOD All the articles in each journal were reviewed, and all the research articles that focused on the top 10 causes of death were sampled to measure the inclusion of women, the characteristics of the women included, the funding source, and the topic. RESULTS Of the 1,149 studies reviewed, 139 met the inclusion criteria, and 117 of these studies included women. Only 15 of the studies reported the age of the women in their samples, and 10 of these included women between the ages of 35 and 64 years. The most frequently reported race was White (n = 21), followed by African American (n = 17), Hispanic (n = 6), and Asian (n = 2). There were no associations among year of publication (p =.62), federal funding (p =.30), and inclusion of women. Among the studies including women, heart disease was the most frequent topic (n = 52), followed by Alzheimer's disease (n = 21), cancer (n = 14), respiratory illness (n = 14), and diabetes (n = 8). DISCUSSION Although the majority of the research included women, continuing efforts must be made to include sufficient numbers of women.
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Affiliation(s)
- Patricia B Crane
- School of Nursing Research Office, University of North Carolina at Greensboro, Greensboro, NC, USA.
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Abstract
Trust is the foundation of the informed consent process. According to Kass et al., Yet only through vigilance and humility will we, as investigators, be able to live up to the trust that is placed in us; and only if that trust is deserved can the research enterprise survive (1996, p. 28). Therefore, further research should examine the effect of the informed consent process in limiting older adults' participation. Only by re-evaluating the first point of contact, implementing creative strategies to overcome barriers to the informed consent process, and validating these strategies through research will nurses facilitate the inclusion of older adults in research.
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Affiliation(s)
- Patricia B Crane
- The University of North Carolina, Greensboro, School of Nursing, 27402-6170, USA
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Abstract
BACKGROUND/OBJECTIVES Coronary heart disease (CHD) is the number one cause of death in women, yet, little is known about women's symptoms. Early symptom recognition of CHD in women is essential but most instruments do not assess both prodromal and acute CHD symptoms. Our aims were to develop an instrument validly describing women's prodromal and acute symptoms of myocardial infarction and to establish reliability of the instrument, the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS). METHODS Four studies contributed to the content validity and reliability of this instrument. Two qualitative studies provided the list of symptoms that were confirmed in study 3. The resulting instrument assesses 37 acute and 33 prodromal symptoms. In study 4, 90 women were retested 7 to 14 days after their initial survey. We used the kappa statistic to assess agreement across administrations. RESULTS The women added no new symptoms to the MAPMISS. The average kappa of acute symptoms was 0.52 and 0.49 for prodromal. Next we calculated a weighted score. The mean acute score for time 1 was 19.4 (SD = 14.43); time 2 was 12.4 (SD= 8.79) with Pearson correlation indicating stability (r = .84; P < .01). The mean prodromal score at time 1 was 23.80 (SD= 24.24); time 2 was 26.79 (SD = 30.52) with a Pearson correlation of r = .72; P < .01. CONCLUSIONS The tool is comprehensive, has high content validity, and acceptable test-retest reliability. Low kappas were related to few women having those symptoms. The symptom scores remained stable across administrations.
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Affiliation(s)
- Jean C McSweeney
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Ark 72205, USA.
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Lewallen LP, Crane PB, Letvak S, Jones E, Hu J. An innovative strategy to enhance new faculty success. Nurs Educ Perspect 2003; 24:257-60. [PMID: 14535147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Faculty stress is a factor in the current shortage of nursing faculty. New faculty members in schools of nursing are subject to stress from many sources. This article reports on an innovative strategy that decreases stress for new faculty while facilitating faculty tenure success.
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Crane PB, McSweeney JC. Exploring older women's lifestyle changes after myocardial infarction. Medsurg Nurs 2003; 12:170-6. [PMID: 12861754] [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] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The researchers explored the failure of older women to attend cardiac rehabilitation after myocardial infarction, and examined facilitating and inhibiting factors in making lifestyle changes. Three global categories emerged: physiological changes, health decisions and actions, and life outcomes of the change process.
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Affiliation(s)
- Patricia B Crane
- School of Nursing, the University of North Carolina, Greensboro, NC, USA
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Abstract
The purpose of this descriptive naturalistic study was to: (a) explore how older women not participating in outpatient cardiac rehabilitation (CR) acquire health knowledge regarding secondary prevention measures after a myocardial infarction (MI), and (b) describe women's perceived barriers to acquiring this knowledge. Women (N = 15), ages 66-88, participated in semi-structured in-depth interviews. Data analysis resulted in four global categories: (a) previous learning, (b) self knowledge, (c) actively seeking knowledge from others, and (d) information provided by others. Barriers to acquiring health knowledge after MI without the support of outpatient CR were also identified.
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Affiliation(s)
- P B Crane
- University of Arkansas for Medical Sciences, College of Nursing, Little Rock 72205, USA.
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Abstract
The purpose of this qualitative study was to describe the factors that affect women's attendance and adherence to a cardiac rehabilitation (CR) program after a myocardial infarction (MI). We used in-depth interviews and a health survey form to collect data. The purposive sample consisted of 40 women who had experienced a first MI within the previous 6 weeks to 12 months. Of those 40, 18 women were not offered the program, 8 declined it, and 14 attended. Using content analysis and constant comparison, we identified three distinct phases: "initial decision," "CR attendance," and "reevaluation." Four data clusters positively influenced the continuation of CR attendance: "Psychological Appraisal," "Program Components," "Staff Behaviors," and "Outcomes." When women encountered a fifth cluster--"Barriers"--they entered the reevaluation phase. Results of this study support specific interventions for each phase.
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Affiliation(s)
- J C McSweeney
- University of Arkansas for Medical Sciences, College of Nursing, 4301 W. Markham Street, Slot 784, Little Rock, AR 72205, USA.
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Abstract
This study described women's prodromal and acute symptoms associated with myocardial infarction (MI) based on interviews with 76 women who had experienced an MI in the previous year. Sixty-eight women experienced prodromal symptoms including unusual fatigue (70%), shortness of breath (53%), and pain in the shoulder blade/upper back (47%). All women experienced acute symptoms including chest pain/discomfort (90%), unusual fatigue (59%), shortness of breath (59%), and shoulder blade/upper back discomfort (42%). Although women in this study reported numerous prodromal symptoms, none had received a new diagnosis of coronary heart disease (CHD) prior to MI. Practitioners must develop an awareness of and a more comprehensive approach to treating women at risk for CHD. Further research to elucidate prodromal and acute symptom clusters is needed to assist practitioners in early diagnosis of CHD in women.
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Affiliation(s)
- J C McSweeney
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
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Abstract
In this qualitative study the researcher identified symptoms women experienced prior to and during an acute myocardial infarction (AMI). The purposive nonprobability sample for this descriptive naturalistic study consisted of 40 women. Using content analysis and constant comparison, the researcher identified specific symptoms and grouped them according to time of occurrence, prodromal and acute. Thirty-seven women experienced prodromal symptoms, beginning from a few weeks to 2 years prior to their AMI and ranging from 0 to 11 symptoms per woman. The most frequent prodromal symptoms were unusual fatigue (n = 27), discomfort in the shoulder blade area (n = 21), and chest sensations (n = 20), whereas the most frequent acute symptoms were chest sensations (n = 26), shortness of breath (n = 22), feeling hot and flushed (n = 21), and unusual fatigue (n = 18). Only 11 women experienced severe pain during their AMI. Conclusions of this study are threefold: (a) women identified classic and unique symptoms of AMI, which challenge the content of current educational literature; (b) women experienced a gradual progression of number and severity of AMI symptoms; and (c) women need sufficient time to recognize their prodromal symptoms of their AMI.
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Affiliation(s)
- J C McSweeney
- University of Arkansas for Medical Sciences, College of Nursing, Little Rock 72205, USA
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