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Adeola MT, Fink AM, Shen Q, Souza-Talarico JN, Timm J, Anderson CM, Buckwalter K. Growing the Next Generation of Nurse Leaders: A Report of the Process and Outcomes of the Midwest Nursing Research Society Leadership Academy. West J Nurs Res 2024; 46:478-482. [PMID: 38577819 DOI: 10.1177/01939459241244922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Leadership development, career advancement, and collaboration among scholars are essential to nurturing nursing research excellence and sustainability. The Midwest Nursing Research Society (MNRS) has incorporated several strategies to advance nursing science and to increase the pool of future nurse leaders. In this article, we describe the process, activities, and outcomes of the Leadership Academy (LA), an innovative initiative from MNRS developed to identify, engage, and nurture future generations of leaders. METHODS For the LA 2022 to 2023 period, the MNRS leaders selected a cohort of 5 nurse scholars and engaged them in activities to develop, enhance, and advance their leadership skills. By following the LA purposes, the cohort participated in monthly meetings with MNRS leaders, received individual mentoring sessions, assessed strengths and areas for further development, attended seminars, participated in a book club, and implemented a cohort project that focused on the promotion and support of early career scholars. RESULTS Outcomes showed increased knowledge about organizational governance, direction, and resource development; leadership confidence culminating with leadership positions inside and outside MNRS; career development plans; engagement with board members, and enhanced networking. Moreover, the cohort members planned and executed a well-attended conference special session that engaged a large group of scholars to discuss challenges and opportunities for career development at the MNRS Annual Conference. CONCLUSION The MNRS LA is a thriving organizational initiative that promotes engagement and leadership skills development thereby increasing the pool of candidates confidently prepared to lead the nursing profession.
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Affiliation(s)
| | - Anne M Fink
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Qiuhua Shen
- School of Nursing, University of Kansas, Kansas City, KS, USA
| | | | - Jennifer Timm
- Department of Graduate Nursing, Winona State University, Winona, MN, USA
| | - Cindy M Anderson
- College of Nursing, The Ohio State University, Columbus, OH, USA
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2
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Lee S, Quinn L, Fritschi C, Fink AM, Park C, Reutrakul S, Collins EG. Physical Activity After Heart Surgery: Associations With Psychosocial and Sleep Factors. West J Nurs Res 2024; 46:333-343. [PMID: 38533821 DOI: 10.1177/01939459241240432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Heart surgery is an effective intervention for managing heart disease, the leading cause of death globally. After surgery, physical activity is key to improving patients' quality of life and decreasing mortality, but patients are frequently physically inactive after heart surgery. OBJECTIVE This cross-sectional pilot study aimed to examine how psychosocial and sleep factors influenced physical activity in patients after heart surgery. The mediating role of sleep factors between psychosocial factors and physical activity was also examined. METHODS Thirty-three patients who had undergone heart surgery were recruited. Psychosocial and sleep factors and physical activity were measured using an online survey and a wrist-worn ActiGraph for 7 days and nights. RESULTS The participants had heart surgery an average of about 7 years previously. They exceeded the recommended 150 minutes per week of moderate-intensity physical activity for Americans; however, 64% of them showed poor sleep quality (Pittsburgh Sleep Quality Index >5). Higher anxiety and depressive symptoms, lower self-efficacy, and greater sleep disturbances were associated with lower physical activity. Moreover, self-efficacy, sleep duration, sleep disturbance, sleep efficiency, and wake after sleep onset were predictors for physical activity. No mediating role of sleep factors was observed between psychosocial factors and physical activity. CONCLUSIONS Psychosocial and sleep factors should be considered when developing and implementing physical activity strategies for patients after heart surgery. Researchers should examine the relationships among the study variables with larger samples of postsurgical cardiac patients during different periods after heart surgery.
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Affiliation(s)
- Sueyeon Lee
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Lauretta Quinn
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Cynthia Fritschi
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Anne M Fink
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Chang Park
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Sirimon Reutrakul
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Eileen G Collins
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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Lee S, Quinn L, Fritschi C, Fink AM, Park C, Reutrakul S, Collins EG. Effects of daily sleep on physical activity after cardiac surgery. Heart Lung 2024; 65:47-53. [PMID: 38401358 DOI: 10.1016/j.hrtlng.2024.02.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/06/2024] [Accepted: 02/18/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Maintaining physical activity is challenging after cardiac surgery. Postsurgical cardiac patients often experience sleep problems showing a reciprocal interaction with physical activity. As sleep and physical activity show day-to-day variations, their daily relationships need to be assessed. However, no studies have examined daily sleep-physical activity relationships in postsurgical cardiac patients. OBJECTIVES This study aimed to examine the effects of daily sleep factors on daily physical activity after cardiac surgery. METHODS Among 33 patients who underwent cardiac surgery at least 10 weeks earlier, 5 sleep and 4 physical activity variables were measured using a wrist-worn ActiGraph for 7 days. Mixed-effects models were applied for data analyses. RESULTS Most participants were male (57.6 %), non-Hispanic whites (63.6 %) who had coronary artery bypass graft surgery (54.6 %). Participants averaged 60.8 ± 10.1 years of age and 85.7 ± 91.2 months since surgery. They slept for an average of 385.6 ± 74.6 min (6.4 ± 1.2 h). Among sleep factors, greater number of awakenings (NOA) predicted lower next-day sedentary time. Higher sleep efficiency (SE) was associated with lower next-day sedentary time when not controlling for covariates. Among the psychosocial, demographic, and clinical covariates, higher comorbidity index was associated with fewer kcals expended, less daily moderate-to-vigorous physical activity, and more daily sedentary time. CONCLUSIONS Daily SE and NOA and individual health status, including comorbidity, should be assessed over time to support improvement of daily physical activity after cardiac surgery. Researchers should examine the relationship between NOA and next-day sedentary time with larger samples. Such research should address multiple psychosocial, demographic, and clinical factors and the potential mediating role of sleep.
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Affiliation(s)
- Sueyeon Lee
- Loyola University Chicago, Marcella Niehoff School of Nursing, 2160 S. 1st Ave., Maywood, IL 60153, USA.
| | - Lauretta Quinn
- University of Illinois Chicago, College of Nursing, 845 S. Damen Ave., Chicago, IL 60612, USA
| | - Cynthia Fritschi
- University of Illinois Chicago, College of Nursing, 845 S. Damen Ave., Chicago, IL 60612, USA
| | - Anne M Fink
- University of Illinois Chicago, College of Nursing, 845 S. Damen Ave., Chicago, IL 60612, USA
| | - Chang Park
- University of Illinois Chicago, College of Nursing, 845 S. Damen Ave., Chicago, IL 60612, USA
| | - Sirimon Reutrakul
- University of Illinois Chicago, Department of Medicine, 835 S. Wolcott, Chicago, IL 60612, USA
| | - Eileen G Collins
- University of Illinois Chicago, College of Nursing, 845 S. Damen Ave., Chicago, IL 60612, USA
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Fink AM. Shift Work Sleep Disorder and Mental Health: An Integrative Review of Neurobiological, Sociological, and Psychological Perspectives With Public Policy Implications. Policy Polit Nurs Pract 2024; 25:94-102. [PMID: 38509807 DOI: 10.1177/15271544241238752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Shift workers support critical 24-hr operations; their health can be impaired by disrupted circadian rhythms and dysfunctional sleep. Shift work sleep disorder (SWSD) is a prevalent condition with significant psychological consequences. Nurse leaders have not yet implemented effective policies to prevent SWSD and optimize shift workers' mental health. The purpose of this integrative review was to examine research about SWSD within the context of neurobiological, sociological, and psychological perspectives that can inform policy changes. The Centers for Disease Control and Prevention Policy Analytic Framework was used to determine the priority recommendations. A search of three databases provided 19 research articles about SWSD and mental health, which illustrated how SWSD is common around the world in many occupations. Backward-rotating schedules and quick returns were risk factors for SWSD. In addition, SWSD was associated with circadian languidity, sleep reactivity, depressive symptoms, and anxiety. Collectively, the studies lacked objective measures of sleep and circadian rhythms, which has hindered the ability to devise interventions that will target the neurobiological causes of SWSD. The research also lacked attention to important sociological factors, such as workers' pay and benefits. Using these findings, nurse leaders can contribute to public policy reforms that increase funding for more rigorous SWSD research. Lawmakers should be advised by nurse leaders to enforce new regulations that provide incentives for employers to create healthier workplaces, such as prohibiting the overuse of schedules that make employees vulnerable to SWSD and providing funds for interventions to prevent SWSD and support mental health.
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Affiliation(s)
- Anne M Fink
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, USA
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5
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Matthews J, Soltis I, Villegas‐Downs M, Peters TA, Fink AM, Kim J, Zhou L, Romero L, McFarlin BL, Yeo W. Cloud-Integrated Smart Nanomembrane Wearables for Remote Wireless Continuous Health Monitoring of Postpartum Women. Adv Sci (Weinh) 2024; 11:e2307609. [PMID: 38279514 PMCID: PMC10987106 DOI: 10.1002/advs.202307609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Indexed: 01/28/2024]
Abstract
Noncommunicable diseases (NCD), such as obesity, diabetes, and cardiovascular disease, are defining healthcare challenges of the 21st century. Medical infrastructure, which for decades sought to reduce the incidence and severity of communicable diseases, has proven insufficient in meeting the intensive, long-term monitoring needs of many NCD disease patient groups. In addition, existing portable devices with rigid electronics are still limited in clinical use due to unreliable data, limited functionality, and lack of continuous measurement ability. Here, a wearable system for at-home cardiovascular monitoring of postpartum women-a group with urgently unmet NCD needs in the United States-using a cloud-integrated soft sternal device with conformal nanomembrane sensors is introduced. A supporting mobile application provides device data to a custom cloud architecture for real-time waveform analytics, including medical device-grade blood pressure prediction via deep learning, and shares the results with both patient and clinician to complete a robust and highly scalable remote monitoring ecosystem. Validated in a month-long clinical study with 20 postpartum Black women, the system demonstrates its ability to remotely monitor existing disease progression, stratify patient risk, and augment clinical decision-making by informing interventions for groups whose healthcare needs otherwise remain unmet in standard clinical practice.
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Affiliation(s)
- Jared Matthews
- IEN Center for Wearable Intelligent Systems and Healthcare at the Institute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
- George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Ira Soltis
- IEN Center for Wearable Intelligent Systems and Healthcare at the Institute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
- George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Michelle Villegas‐Downs
- Department of Human Development Nursing ScienceCollege of NursingUniversity of Illinois Chicago845 S. Damen Ave., MC 802ChicagoIL60612USA
| | - Tara A. Peters
- Department of Human Development Nursing ScienceCollege of NursingUniversity of Illinois Chicago845 S. Damen Ave., MC 802ChicagoIL60612USA
| | - Anne M. Fink
- Department of Biobehavioral Nursing ScienceCollege of NursingUniversity of Illinois Chicago845 S. Damen Ave., MC 802ChicagoIL60612USA
| | - Jihoon Kim
- IEN Center for Wearable Intelligent Systems and Healthcare at the Institute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
- George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Lauren Zhou
- IEN Center for Wearable Intelligent Systems and Healthcare at the Institute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
- George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Lissette Romero
- IEN Center for Wearable Intelligent Systems and Healthcare at the Institute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
- George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Barbara L. McFarlin
- Department of Human Development Nursing ScienceCollege of NursingUniversity of Illinois Chicago845 S. Damen Ave., MC 802ChicagoIL60612USA
| | - Woon‐Hong Yeo
- IEN Center for Wearable Intelligent Systems and Healthcare at the Institute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
- George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGA30332USA
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Tech and Emory University School of MedicineAtlantaGA30332USA
- Parker H. Petit Institute for Bioengineering and BiosciencesInstitute for MaterialsInstitute for Robotics and Intelligent MachinesGeorgia Institute of TechnologyAtlantaGA30332USA
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Prakot S, Fink AM, Culbert G, Visudtibhan PJ. An Analysis and Evaluation of the Information-Motivation-Behavioral Skills (IMB) Model for Antiretroviral Therapy. ANS Adv Nurs Sci 2024; 47:73-88. [PMID: 36477381 PMCID: PMC10833178 DOI: 10.1097/ans.0000000000000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We use Fawcett and DeSanto-Madeya's framework to critique Fisher and Fisher's information-motivation-behavioral skills model and determine its usefulness and applicability for nursing. Our analysis and evaluation show that the model is a parsimonious and useful situation-specific theory for guiding nursing research and practice because it shows good fit with the nursing context, has social and theoretical significance, and exhibits empirical and pragmatic adequacy. More consistency in using terms referring to each concept would help to improve the model's internal consistency. The model's testability could also be improved by measuring health outcomes (eg, viral load or CD4 count) in future research.
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Affiliation(s)
- Sirinan Prakot
- Departments of Population Health Nursing Science (Ms Prakot and Dr Culbert) and Biobehavioral Nursing Science (Dr Fink), College of Nursing, University of Illinois Chicago, Chicago; and Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (Ms Prakot and Dr Visudtibhan)
| | - Anne M. Fink
- Departments of Population Health Nursing Science (Ms Prakot and Dr Culbert) and Biobehavioral Nursing Science (Dr Fink), College of Nursing, University of Illinois Chicago, Chicago; and Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (Ms Prakot and Dr Visudtibhan)
| | - Gabriel Culbert
- Departments of Population Health Nursing Science (Ms Prakot and Dr Culbert) and Biobehavioral Nursing Science (Dr Fink), College of Nursing, University of Illinois Chicago, Chicago; and Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (Ms Prakot and Dr Visudtibhan)
| | - Poolsuk Janepanish Visudtibhan
- Departments of Population Health Nursing Science (Ms Prakot and Dr Culbert) and Biobehavioral Nursing Science (Dr Fink), College of Nursing, University of Illinois Chicago, Chicago; and Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (Ms Prakot and Dr Visudtibhan)
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7
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Jeamjitvibool T, Lockwood MB, Fink AM. Sleep Disturbances in Older Adults Receiving Dialysis. Nephrol Nurs J 2023; 50:467-478. [PMID: 38112674] [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: 12/21/2023]
Abstract
Sleep disturbances are serious issues in individuals with end stage kidney disease because they are associated with worsening kidney function and other negative health outcomes, especially in older adults. Our analysis aimed to provide clinicians with the conceptual clarity required for managing sleep disturbances in older patients who are receiving dialysis. A literature review revealed three attributes that define this population's sleep disturbances: sleep initiation and maintenance difficulties, restless sleep and short sleep, and abnormal breathing during sleep. Con sidering the serious consequences and correlates of sleep disturbances in older patients who are receiving dialysis, tailored interventions are needed to improve their sleep. Our literature review, concept analysis, and case studies provide key information for designing future mechanistic, clinical-translational, and interventional research.
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Affiliation(s)
- Thanakrit Jeamjitvibool
- Nursing Instructor, the Department of Adults and Geriatrics, Princess Agrarajakumari College of Nursing, Chulabhorn Royal Academy, Bangkok, Thailand
- PhD candidate at the College of Nursing, University of Illinois - Chicago, Chicago, IL
| | - Mark B Lockwood
- Associate Professor, Biobehavioral Nursing Science, the College of Nursing, University of Illinois - Chicago, Chicago, IL
| | - Anne M Fink
- Associate Professor, Biobehavioral Nursing Science, the College of Nursing, University of Illinois - Chicago, Chicago, IL
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8
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Duangjina T, Fink AM, Gruss V. Resilience in Family Caregivers of Asian Older Adults With Dementia: A Concept Analysis. ANS Adv Nurs Sci 2023; 46:E145-E160. [PMID: 36728751 DOI: 10.1097/ans.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Asian family caregivers of older adults with dementia have stressful caregiving situations over long periods; they must become resilient to recover from adversity. A conceptual definition of resilience specific to Asian family caregivers is important for understanding their caregiving phenomena and the relationships with mental health and psychological well-being. The purpose of this concept analysis was to define resilience in family caregivers of Asian older adults with dementia using Walker and Avant's method. The findings of the analysis will guide future research about the modifiable factors that will prevent negative health outcomes in this population of caregivers.
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Affiliation(s)
- Thitinan Duangjina
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand (Ms Duangjina); and Biobehavioral Nursing Science Department, College of Nursing, University of Illinois Chicago, Chicago (Ms Duangjina and Drs Fink and Gruss)
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9
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Fink AM, Martyn-Nemeth P. Socratic Inquiry, Syllogism, Schematic Cases, and Symbolism: Critical Thinking Strategies for Nursing Education. Nurse Educ 2023; 48:125-130. [PMID: 36730625 DOI: 10.1097/nne.0000000000001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Critical thinking is an essential nursing competency. Faculty can teach students how to think critically by emphasizing the connections between their philosophy and nursing curricula to ensure that students recognize the cognitive processes they use to make complex decisions. PURPOSE The purpose of this article is to examine the definitions, history, and utility of philosophical perspectives that inform critical thinking. We explain several approaches: Socratic inquiry, syllogism, schematic cases, and symbolism. METHODS We conducted a narrative review about educational approaches and their associated philosophies. RESULTS Philosophical awareness can enhance students' abilities to examine data, communicate ideas, evaluate diverse opinions, understand theories, and apply innovative solutions to problems they will encounter in clinical practice. CONCLUSIONS Clinical issue dialogues, dramatizations (that link philosophical and practical themes), self-reflection exercises, and case studies (that are less content-laden and more focused on nurses' theories and decision-making processes) represent important and innovative critical thinking skill-building exercises.
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Affiliation(s)
- Anne M Fink
- Assistant Professor (Dr Fink) and Associate Professor (Dr Martyn-Nemeth), Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago
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10
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Fink AM, Milbrath GR. A concept analysis of nurses in conflicts after World War II. J Adv Nurs 2023; 79:31-47. [PMID: 36218173 PMCID: PMC10092232 DOI: 10.1111/jan.15454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 12/15/2022]
Abstract
AIM We analysed nurses' experiences during military conflicts since World War II. BACKGROUND Nurses have successfully reduced morbidity and mortality in populations affected by wars; despite centuries of nurses' global involvement in wars, there is limited knowledge about their experiences. METHOD We used Rodger's evolutionary concept analysis methodology to understand the antecedents, attributes, consequences, context and implications of nurses' war-related experiences. We analysed data from quantitative and qualitative research, media reports, editorials, historical reviews and published accounts of nurses' experiences in many locations, including Afghanistan, Bosnia, Croatia, Korea, Kosovo, Iran, Iraq, Israel, Palestine, Russia, Somalia, Ukraine and Vietnam. FINDINGS Two antecedent conditions preceded nurses' war involvement: actively responding to human suffering and having resources for readiness. Nurses were defined by five attributes: sacrifice, resourcefulness, tunnel-vision, survival mindset and comradery. We also found evidence for seven consequences; nurses saved lives (reduced morbidity and mortality), however, some nurses faced professional burnout/disillusionment, restricted practice authority, isolation and post-traumatic stress after war. In addition, growth and pacifism were consequences for some nurses who were exposed to war. CONCLUSION The findings of our concept analysis illustrate how nurses have fulfilled critical life-saving roles, but some nurses' post-war experiences were debilitating, stigmatized and unsupported. We conclude that research about the resourcefulness, innovations and resiliency nurses have developed during wars is essential, and professional support mechanisms must be developed to prevent post-traumatic stress, burnout and attrition from the profession. Governments can use utilize the knowledge nurses developed during wars to expand emergency preparedness skillsets and promote nurses as the leaders of international efforts to promote peace. NO PATIENT OR PUBLIC CONTRIBUTION Patients, service users, caregivers and members of the public were not involved in conducting this concept analysis or preparing the manuscript. IMPACT STATEMENT By understanding nurses' involvement with post-WWII conflicts, we have demonstrated the significant public health contributions, challenges and personal and professional growth experienced by nurses. Nurses' war-related knowledge should be utilized to innovate healthcare practices during disasters and to advise policymakers in developing, implementing and evaluating peace-promoting operations.
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Affiliation(s)
- Anne M Fink
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Gwyneth R Milbrath
- Midwest Nursing History Research Center and Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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Chapagai S, Fink AM. Cardiovascular diseases and sleep disorders in South Asians: A scoping review. Sleep Med 2022; 100:139-149. [PMID: 36054942 DOI: 10.1016/j.sleep.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND South Asians comprise 20% of the world population. There is a high prevalence of cardiovascular diseases among South Asians, and sleep disorders may be a key risk factor. OBJECTIVE The review examined literature about cardiovascular and sleep disorders in South Asian countries and in the United States, United Kingdom, Canada, and the Netherlands. METHODS Methods from Arksey and O'Malley's framework and Peter et al. were used to synthesize findings from 23 research studies. RESULTS The studies addressed sleep disorders with hypertension, heart failure, diabetes, and obesity. Obstructive sleep apnea and short sleep duration were common and associated with cardiovascular morbidity and mortality at early ages in South Asians. Researchers analyzed polysomnography-derived sleep measures, vascular functions, polymorphisms, C-reactive protein levels, public knowledge about cardiovascular health, and sleep-related questionnaire scores. Most studies were conducted in major metropolitan areas; no data were available about people living in locations with limited health care resources. Among migrant South Asians, researchers did not explore the role of acculturation on sleep patterns and cardiovascular outcomes. CONCLUSIONS The review highlights important considerations for researchers who plan to investigate cardiovascular conditions in South Asian communities. There is a need for more knowledge about sleep-related risk factors, and researchers should also examine cultural, political, and socioeconomic factors that affect health care access. This knowledge will be imperative for designing effective and tailored disease prevention strategies for South Asian populations.
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Affiliation(s)
- Swaty Chapagai
- Department of Biobehavioral Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, IL, USA.
| | - Anne M Fink
- Department of Biobehavioral Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, IL, USA
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12
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Maki KA, Fink AM, Weaver TE. Sleep, Time, and Space—Fatigue and Performance Deficits in Pilots, Commercial Truck Drivers, and Astronauts. SLEEP Advances 2022; 3:zpac033. [PMID: 36299616 PMCID: PMC9583651 DOI: 10.1093/sleepadvances/zpac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/24/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Sleep is essential for preventing fatigue in occupations that require sustained vigilance. We conducted a scoping review to synthesize knowledge about sleep, fatigue, and performance in pilots, commercial truck drivers, and astronauts. We found 28 studies where researchers objectively or subjectively measured sleep, fatigue, and performance. The research included laboratory-based (simulator) and field-based studies (i.e., real-world missions and a variety of shift-work schedules). Most researchers used actigraphy to measure sleep, and they found that sleep ~6 hrs of sleep was common. The research also demonstrated how sleep duration and quality were negatively affected by schedule irregularity, early-morning start times, and high-risk missions (e.g., extravehicular activities in space). Collectively, the data demonstrated how shorter sleep durations, short off-duty time, and early-morning start times were associated with slower reaction times, more lapses in attention, and premature responses on psychomotor vigilance tests. Considering that few studies included polysomnography and circadian rhythm biomarkers, there remains limited knowledge about the effects of sleep microstructure and circadian rhythm alterations on performance abilities in these occupations. Future neurobiological and mechanistic discoveries will be important for enhancing vigilance, health, and safety for people working in the skies, on the roads, and in space.
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Affiliation(s)
- Katherine A Maki
- Translational Biobehavioral and Health Disparities Branch, Clinical Center, National Institutes of Health , Bethesda, MD, 20814, USA
| | - Anne M Fink
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois Chicago , Chicago, IL, 60612, USA
| | - Terri E Weaver
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois Chicago , Chicago, IL, 60612, USA
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania , Philadelphia, PA, 19104, USA
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Abstract
INTRODUCTION Current methods of sleep research in rodents involve invasive surgical procedures of EEG and EMG electrodes implantation. Recently, a new method of measuring sleep, PiezoSleep, has been validated against implanted electrodes in mice and rats. PiezoSleep uses a piezoelectric film transducer to detect the rodent's movements and respiration and employs an algorithm to automatically score sleep. Here, we validate PiezoSleep scoring versus EEG/EMG implanted electrodes sleep scoring in rats. METHODS Adult male Brown Norway and Wistar Kyoto rats were implanted with bilateral stainless-steel screws into the skull for EEG recording and bilateral wire electrodes into the nuchal muscles for EMG assessment. In Brown Norway rats, the EEG/EMG electrode leads were soldered to a miniature connector plug and fixed to the skull. In Wistar Kyoto rats, the EEG/EMG leads were tunneled subcutaneously to a telemetry transmitter implanted in the flank. Rats were allowed to recover from surgery for one week. Brown Norway rats were placed in PiezoSleep cages, and had their headsets connected to cable for recording EEG/EMG signals, which were then manually scored by a human scorer in 10-sec epochs. Wistar Kyoto rats were placed in PiezoSleep cages, and EEG/EMG signals were recorded using a telemetry system (DSI). Sleep was scored automatically in 4-sec epochs using NeuroScore software. PiezoSleep software recorded and scored sleep in the rats. RESULTS Rats implanted with corded EEG/EMG headsets had 85.6% concurrence of sleep-wake scoring with PiezoSleep. Rats implanted with EEG/EMG telemetry had 80.8% concurrence sleep-wake scoring with PiezoSleep. Sensitivity and specificity rates were similar between the EEG/EMG recording systems. Total sleep time and hourly sleep times did not differ in all three systems. However, automatic sleep detection by NeuroScore classified more sleep during the light period compared to the PiezoSleep. CONCLUSION We showed that PiezoSleep system can be a reliable alternative to both automatic and visual EEG/EMG- based sleep-wake scoring in rat.
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Affiliation(s)
- Irina Topchiy
- Center for Sleep and Health Research, University of Illinois Chicago, Chicago, IL, USA.,Department of Biobehavioral Nursing Science; University of Illinois Chicago, Chicago, IL, USA
| | - Anne M Fink
- Center for Sleep and Health Research, University of Illinois Chicago, Chicago, IL, USA.,Department of Biobehavioral Nursing Science; University of Illinois Chicago, Chicago, IL, USA
| | - Katherine A Maki
- Department of Biobehavioral Nursing Science; University of Illinois Chicago, Chicago, IL, USA.,Translational Biobehavioral and Health Disparities Branch, Clinical Center; National Institutes of Health, Bethesda, MD, USA
| | - Michael W Calik
- Center for Sleep and Health Research, University of Illinois Chicago, Chicago, IL, USA.,Department of Biobehavioral Nursing Science; University of Illinois Chicago, Chicago, IL, USA
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14
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Hallihan H, Kapella MC, Fink AM. Alcohol Disorders in Military Veterans: An Evaluation with the Roy Adaptation Model. Nurs Sci Q 2021; 34:392-397. [PMID: 34538168 DOI: 10.1177/08943184211031595] [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: 11/15/2022]
Abstract
The purpose of this paper was to evaluate a role for the Roy adaptation model (RAM) for the nursing care of military veterans with alcohol use disorder. Parse's criteria were used to critique the RAM. The RAM's humanistic philosophy emphasizes the ability to develop new coping skills and adapt to complex environments. The framework can define physical, emotional, and social responses to stressors faced by veterans. The RAM could guide new research and practice initiatives that optimize the health of military veterans.
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Affiliation(s)
- Hagar Hallihan
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Mary C Kapella
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Anne M Fink
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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15
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Abstract
TOPIC Sleep in the intensive care unit can be poorly consolidated and highly fragmented. This review examines the neurobiology of normal and abnormal sleep, with a focus on the changes that occur in the intensive care unit environment. CLINICAL RELEVANCE Patients in the intensive care unit demonstrate a lack of rapid-eye-movement sleep and an inability to effectively transition from light to deep stages of sleep. These abnormalities can adversely affect hemodynamic parameters and physiological and psychological outcomes. PURPOSE To describe the brain mechanisms and electroencephalographic characteristics of wakefulness and the different stages of sleep. This review also describes how sleep can be altered by hospitalization in the intensive care unit and how nurses can design interventions that improve sleep and outcomes. CONTENT COVERED The review examines sleep mechanisms, including brain electrical activity, regulatory centers in the brain, and circadian and diurnal patterns of sleep and hemodynamic function. Nursing interventions for specific patient risk factors in the intensive care unit are proposed.
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Affiliation(s)
- Anne M Fink
- Anne M. Fink is an assistant professor in the Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
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16
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Breen KM, Finnegan L, Vuckovic KM, Fink AM, Rosamond W, DeVon HA. Multimorbidity phenotypes in patients presenting to the emergency department with possible acute coronary syndrome. Heart Lung 2021; 50:648-653. [PMID: 34098234 DOI: 10.1016/j.hrtlng.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multimorbidity (> 2 conditions) increases the risk of adverse outcomes and challenges health care systems for patients with acute coronary syndrome (ACS). These complications may be partially attributed to ACS clinical care which is driven by single-disease-based practice guidelines; current guidelines do not consider multimorbidity. OBJECTIVES To identify multimorbidity phenotypes (combinations of conditions) with suspected ACS. We hypothesized that: 1) subgroups of patients with similar multimorbidity phenotypes could be identified, 2) classes would differ according to diagnosis, and 3) class membership would differ by sex, age, functional status, family history, and discharge diagnosis. METHODS This was a secondary analysis of data from a large multi-site clinical study of patients with suspected ACS. Conditions were determined by items on the Charlson Comorbidity Index and the ACS Patient Information Questionnaire. Latent class analysis was used to identify phenotypes. RESULTS The sample (n = 935) was predominantly male (68%) and middle-aged (mean= 59 years). Four multimorbidity phenotypes were identified: 1) high multimorbidity (Class 1) included hyperlipidemia, hypertension (HTN), obesity, diabetes, and respiratory disorders (COPD or asthma); 2) low multimorbidity (Class 2) included only obesity; 3) cardiovascular multimorbidity (Class 3) included HTN, hyperlipidemia, and coronary heart disease; and 4) cardio-oncology multimorbidity (Class 4) included HTN, hyperlipidemia, and cancer. Patients ruled-in for ACS primarily clustered in Classes 3 and 4 (OR 2.82, 95% CI 1.95-4.05, p = 0.001 and OR 1.76, 95% CI 1.13-2.74, p = 0.01). CONCLUSION Identifying and understanding multimorbidity phenotypes may assist with risk-stratification and better triage of high-risk patients in the emergency department.
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Affiliation(s)
- Katherine M Breen
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, United States.
| | - Lorna Finnegan
- Loyola University Chicago, Marcella Niehoff School of Nursing, Chicago, IL, United States
| | - Karen M Vuckovic
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, United States
| | - Anne M Fink
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, United States
| | - Wayne Rosamond
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, United States
| | - Holli A DeVon
- University of California Los Angeles School of Nursing, Los Angeles, CA, United States
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17
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Fink AM, Burke LA, Sharma K. Lesioning of the pedunculopontine nucleus reduces rapid eye movement sleep, but does not alter cardiorespiratory activities during sleep, under hypoxic conditions in rats. Respir Physiol Neurobiol 2021; 288:103653. [PMID: 33716095 PMCID: PMC8112452 DOI: 10.1016/j.resp.2021.103653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 12/21/2020] [Accepted: 03/09/2021] [Indexed: 11/17/2022]
Abstract
To determine how partial lesioning of the pedunculopontine nucleus (PPT) affects sleep, breathing, and blood pressure in rats, ibotenic acid (IBO) was injected bilaterally into the PPT. Sham-injected (saline) and IBO-lesioned rats were first studied under normoxic conditions (40 recordings were obtained from 15 rats, with each recording lasting for 6 daytime hours). Rats were then exposed to intermittent hypoxia for 4 ± 2 days (51 recordings from 12 rats, each lasting 6 daytime hours). The intermittent hypoxia protocol involved an oxygen decline lasting 35 s (to a nadir of 10 %) followed by a 50 s increase to normoxia. The IBO caused an estimated 53 % reduction in PPT neurons. When normoxic, IBO-lesioned rats had remarkedly normal sleep architecture, respiratory rates, and mean arterial pressure. The exposure to intermittent hypoxia evoked tachypnea in both the IBO-lesioned and sham-injected rats. When intermittently hypoxic, IBO-lesioned rats demonstrated a significant reduction in the duration of rapid eye movement (REM) sleep. We conclude that partial lesions of the PPT do not disrupt cardiorespiratory activities, but a reduction in PPT neurons impairs the ability to sustain REM sleep under hypoxic conditions.
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Affiliation(s)
- Anne M Fink
- Center for Sleep and Health Research, University of Illinois Chicago, 845 S. Damen Ave (MC 802), Room 750, Chicago, IL, 60612, United States.
| | - Larisa A Burke
- Office of Research Facilitation, University of Illinois Chicago, 845 S. Damen Ave (MC 802), Room 615, Chicago, IL, 60612, United States.
| | - Kamal Sharma
- Department of Anatomy and Cell Biology, University of Illinois Chicago, 808 S Wood St (MC 512), Room 666, Chicago, IL, United States.
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18
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Diallo AF, Lockwood MB, Maki KA, Franks AT, Roy A, Jaime-Lara R, Joseph PV, Henderson WA, Chung SY, McGrath J, Green SJ, Fink AM. Metabolic Profiling of Blood and Urine for Exploring the Functional Role of the Microbiota in Human Health. Biol Res Nurs 2020; 22:449-457. [PMID: 32723087 DOI: 10.1177/1099800420941080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The quantification of metabolites in blood and urine allows nurses to explore new hypotheses about the microbiome. This review summarizes findings from recent studies with a focus on how the state of the science can influence future nursing research initiatives. Metabolomics can advance nursing research by identifying physiologic/pathophysiologic processes underlying patients' symptoms and can be useful for testing the effects of nursing interventions. To date, metabolomics has been used to study cardiovascular, respiratory, endocrine, autoimmune, and infectious conditions, with research focused on understanding the microbial metabolism of substrates resulting in circulating/excreted biomarkers such as trimethylamine N-oxide. This review provides specific recommendations for the collection of specimens and goals for future studies.
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Affiliation(s)
- Ana F Diallo
- Institute of Inclusion, Inquiry & Innovation (iCubed), Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark B Lockwood
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Katherine A Maki
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexis T Franks
- Sensory Science & Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, 2511National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Abhrarup Roy
- Sensory Science & Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, 2511National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Rosario Jaime-Lara
- Sensory Science & Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, 2511National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Paule V Joseph
- Sensory Science & Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, 2511National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Wendy A Henderson
- Digestive Disorders Unit, Biobehavioral Branch, Division of Intramural Research, 2511National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Seon Yoon Chung
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Jacqueline McGrath
- School of Nursing, University of Texas Health Science Center, San Antonio, TX, USA
| | - Stefan J Green
- Sequencing Core, Research Resources Center, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Anne M Fink
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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19
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Maki KA, Burke LA, Calik MW, Watanabe-Chailland M, Sweeney D, Romick-Rosendale LE, Green SJ, Fink AM. Sleep fragmentation increases blood pressure and is associated with alterations in the gut microbiome and fecal metabolome in rats. Physiol Genomics 2020; 52:280-292. [PMID: 32567509 PMCID: PMC7468692 DOI: 10.1152/physiolgenomics.00039.2020] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022] Open
Abstract
The gut microbiota, via the production of metabolites entering the circulation, plays a role in blood pressure regulation. Blood pressure is also affected by the characteristics of sleep. To date, no studies have examined relationships among the gut microbiota/metabolites, blood pressure, and sleep. We hypothesized that fragmented sleep is associated with elevated mean arterial pressure, an altered and dysbiotic gut microbial community, and changes in fecal metabolites. In our model system, rats were randomized to 8 h of sleep fragmentation during the rest phase (light phase) or were undisturbed (controls) for 28 consecutive days. Rats underwent sleep and blood pressure recordings, and fecal samples were analyzed during: baseline (days -4 to -1), early sleep fragmentation (days 0-3), midsleep fragmentation (days 6-13), late sleep fragmentation (days 20-27), and recovery/rest (days 28-34). Less sleep per hour during the sleep fragmentation period was associated with increased mean arterial pressure. Analyses of gut microbial communities and metabolites revealed that putative short chain fatty acid-producing bacteria were differentially abundant between control and intervention animals during mid-/late sleep fragmentation and recovery. Midsleep fragmentation was also characterized by lower alpha diversity, lower Firmicutes:Bacteroidetes ratio, and higher Proteobacteria in intervention rats. Elevated putative succinate-producing bacteria and acetate-producing bacteria were associated with lower and higher mean arterial pressure, respectively, and untargeted metabolomics analysis demonstrates that certain fecal metabolites are significantly correlated with blood pressure. These data reveal associations between sleep fragmentation, mean arterial pressure, and the gut microbiome/fecal metabolome and provide insight to links between disrupted sleep and cardiovascular pathology.
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Affiliation(s)
- Katherine A Maki
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
- Nursing Department, Nursing Research and Translational Science, National Institutes of Health, Clinical Center, Bethesda, Maryland
| | - Larisa A Burke
- Office of Research Facilitation, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Michael W Calik
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Miki Watanabe-Chailland
- NMR-Based Metabolomics Core, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dagmar Sweeney
- Genome Research Core, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois
| | | | - Stefan J Green
- Genome Research Core, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois
| | - Anne M Fink
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
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20
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Fink AM. Measuring the effects of night-shift work on cardiac autonomic modulation: an appraisal of heart rate variability metrics. Int J Occup Med Environ Health 2020; 33:409-425. [PMID: 32427129 DOI: 10.13075/ijomeh.1896.01560] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Night-shift workers may develop poor cardiovascular health. Studies about heart rate variability (HRV) metrics could identify risk factors in this population and be used to examine the effectiveness of interventions for optimizing the health of night-shift workers. The purpose of this review was to examine the use of HRV methodologies in studies about night-shift work. Overall, 34 articles met the selection criteria and underwent a methodological critique. The main conclusion across these studies was that night-shift work could increase the sympathetic influences on the variability between heartbeats. In many cases, however, important methodological details were omitted (e.g., the number and duration of electrocardiogram recordings, sampling rates, R-R segment duration, wavelet transform methods). Recommendations include adding measures of disease outcomes, using ≥250 Hz sampling rates and 600-s R-R segments, and measuring sleep and circadian rhythms. With these approaches, researchers can design investigations that identify therapeutic targets for improving the health of night-shift workers. Int J Occup Med Environ Health. 2020;33(4):409-25.
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Affiliation(s)
- Anne M Fink
- University of Illinois at Chicago, Chicago, USA (Center for Sleep and Health Research, College of Nursing)
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21
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Pascoe HM, Yang JYM, Chen J, Fink AM, Kumbla S. Macrocerebellum in Achondroplasia: A Further CNS Manifestation of FGFR3 Mutations? AJNR Am J Neuroradiol 2020; 41:338-342. [PMID: 31857328 DOI: 10.3174/ajnr.a6369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/02/2019] [Indexed: 12/29/2022]
Abstract
Achondroplasia is the result of a mutation in the fibroblast growth factor receptor 3 gene (FGFR3). Appearances suggestive of macrocerebellum have not been described in this patient group. We retrospectively reviewed MR imaging studies of the brain in 23 children with achondroplasia. A constellation of imaging findings that are recognized in macrocerebellum was observed, including cerebellar hemisphere enlargement (inferior and superior extension, wrapping around the brainstem); an effaced retro- and infravermian cerebellar subarachnoid CSF space; a shortened midbrain; distortion of the tectal plate; and mass effect on the brainstem. All MR imaging studies exhibited some of these findings. Quantitative analysis confirmed an increased cerebellar volume compared with age- and sex-matched controls. We hypothesized that this may be due to direct effects of the FGFR3 mutation on cerebellar morphogenesis.
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Affiliation(s)
- H M Pascoe
- From the Departments of Medical Imaging (H.M.P., A.M.F., S.K.)
| | - J Y-M Yang
- Neurosurgery (J.Y.-M.Y.), The Royal Children's Hospital, Parkville, Victoria, Australia
- Neuroscience Research (J.Y.-M.Y.)
- Developmental Imaging (J.Y.-M.Y., J.C.), Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics (J.Y.-M.Y.), University of Melbourne, Parkville, Victoria, Australia
| | - J Chen
- Developmental Imaging (J.Y.-M.Y., J.C.), Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A M Fink
- From the Departments of Medical Imaging (H.M.P., A.M.F., S.K.)
- Department of Perinatal Medicine (A.M.F.), Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - S Kumbla
- From the Departments of Medical Imaging (H.M.P., A.M.F., S.K.)
- Department of Diagnostic Imaging (S.K.), Monash Health, Clayton, Victoria, Australia
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22
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Fürstenau M, Bahlo J, Fink AM, Lange E, Dreger P, Dreyling M, Hess G, Ritgen M, Kneba M, Döhner H, Stilgenbauer S, Wendtner CM, Goede V, Fischer K, Böttcher S, Hallek M, Eichhorst B. Residual abdominal lymphadenopathy after intensive frontline chemoimmunotherapy is associated with inferior outcome independently of minimal residual disease status in chronic lymphocytic leukemia. Leukemia 2019; 34:924-928. [PMID: 31611627 DOI: 10.1038/s41375-019-0597-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/30/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022]
Affiliation(s)
- M Fürstenau
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - J Bahlo
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - A M Fink
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - E Lange
- Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - P Dreger
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - M Dreyling
- Department of Internal Medicine III, University Hospital of the Ludwig Maximilians University Munich, Munich, Germany
| | - G Hess
- Department of Hematology, Medical Oncology and Pneumology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - M Ritgen
- Department II of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - M Kneba
- Department II of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - H Döhner
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - S Stilgenbauer
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.,Department of Hematology, Oncology and Rheumatology and José Carreras Center for Immuno and Gene Therapy, Saarland University Medical School, Homburg/Saar, Germany
| | - C M Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, München Klinik Schwabing, Munich, Germany
| | - V Goede
- Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany
| | - K Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S Böttcher
- Department II of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany.,Medical Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - M Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany.,Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Disease (CECAD), University of Cologne, Cologne, Germany
| | - B Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany.
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23
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Fink AM, Dean C. Quantifying Acute Changes in Renal Sympathetic Nerve Activity in Response to Central Nervous System Manipulations in Anesthetized Rats. J Vis Exp 2018. [PMID: 30272648 DOI: 10.3791/58205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Renal sympathetic nerve activity (RSNA) and mean arterial pressure are important parameters in cardiovascular and autonomic research; however, there are limited resources directing scientists in the techniques for measuring and analyzing these variables. This protocol describes the methods for measuring RSNA and mean arterial pressure in anesthetized rats. The protocol also includes the approaches for accessing the brain during RSNA recordings for central nervous system (CNS) manipulations. The RSNA recording technique is compatible with pharmacologic, optogenetic, or electrical stimulation of the CNS. The approach is useful when an investigator will measure short-term (min to h) autonomic responses in non-survival experiments to correlate anatomically with CNS nuclei. The approach is not intended to be used to obtain chronic (survival) recordings of RSNA in rats. Discharges in RSNA, averaged rectified RSNA, and mean arterial pressure can be quantified and analyzed further using parametric statistical tests. Methods for obtaining venous access, recording mean arterial pressure telemetrically, and brain fixation for future histological analysis are also described in the article.
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Affiliation(s)
- Anne M Fink
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago;
| | - Caron Dean
- Department of Anesthesiology, Medical College of Wisconsin and Zablocki VA Medical Center
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24
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Taylor-Piliae RE, Fink AM, Kitko L. Council on Cardiovascular and Stroke Nursing Liaison Report. J Cardiovasc Nurs 2018; 33:202-203. [DOI: 10.1097/jcn.0000000000000479] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Manikkam SA, Chetcuti K, Howell KB, Savarirayan R, Fink AM, Mandelstam SA. Temporal Lobe Malformations in Achondroplasia: Expanding the Brain Imaging Phenotype Associated with FGFR3-Related Skeletal Dysplasias. AJNR Am J Neuroradiol 2017; 39:380-384. [PMID: 29170271 DOI: 10.3174/ajnr.a5468] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 09/13/2017] [Indexed: 11/07/2022]
Abstract
Thanatophoric dysplasia, achondroplasia, and hypochondroplasia belong to the fibroblast growth factor receptor 3 (FGFR3) group of genetic skeletal disorders. Temporal lobe abnormalities have been documented in thanatophoric dysplasia and hypochondroplasia, and in 1 case of achondroplasia. We retrospectively identified 13 children with achondroplasia who underwent MR imaging of the brain between 2002 and 2015. All children demonstrated a deep transverse temporal sulcus on MR imaging. Further common neuroimaging findings were incomplete hippocampal rotation (12 children), oversulcation of the mesial temporal lobe (11 children), loss of gray-white matter differentiation of the mesial temporal lobe (5 children), and a triangular shape of the temporal horn (6 children). These appearances are very similar to those described in hypochondroplasia, strengthening the association of temporal lobe malformations in FGFR3-associated skeletal dysplasias.
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Affiliation(s)
- S A Manikkam
- From the Departments of Medical Imaging (S.A. Manikkam, A.M.F., S.A. Mandelstam)
| | - K Chetcuti
- Department of Radiology (K.C.), Alder Hey Children's Hospital, Liverpool, UK
| | - K B Howell
- Neurology (K.B.H.), Royal Children's Hospital, Melbourne, Australia.,Departments of Paediatrics (K.B.H., S.A. Mandelstam).,Murdoch Children's Research Institute (K.B.H., R.S., A.M.F., S.A. Mandelstam), Melbourne, Australia
| | - R Savarirayan
- Murdoch Children's Research Institute (K.B.H., R.S., A.M.F., S.A. Mandelstam), Melbourne, Australia.,Victorian Clinical Genetics Services (R.S.), Melbourne, Australia
| | - A M Fink
- From the Departments of Medical Imaging (S.A. Manikkam, A.M.F., S.A. Mandelstam).,Radiology (A.M.F., S.A. Mandelstam), University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute (K.B.H., R.S., A.M.F., S.A. Mandelstam), Melbourne, Australia
| | - S A Mandelstam
- From the Departments of Medical Imaging (S.A. Manikkam, A.M.F., S.A. Mandelstam).,Departments of Paediatrics (K.B.H., S.A. Mandelstam).,Radiology (A.M.F., S.A. Mandelstam), University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute (K.B.H., R.S., A.M.F., S.A. Mandelstam), Melbourne, Australia.,Florey Institute of Neuroscience and Mental Health (S.A. Mandelstam), Melbourne, Australia
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Fink AM, Dean C, Piano MR, Carley DW. The pedunculopontine tegmentum controls renal sympathetic nerve activity and cardiorespiratory activities in nembutal-anesthetized rats. PLoS One 2017; 12:e0187956. [PMID: 29121095 PMCID: PMC5679551 DOI: 10.1371/journal.pone.0187956] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 10/30/2017] [Indexed: 11/18/2022] Open
Abstract
Elevated renal sympathetic nerve activity (RSNA) accompanies a variety of complex disorders, including obstructive sleep apnea, heart failure, and chronic kidney disease. Understanding pathophysiologic renal mechanisms is important for determining why hypertension is both a common sequelae and a predisposing factor of these disorders. The role of the brainstem in regulating RSNA remains incompletely understood. The pedunculopontine tegmentum (PPT) is known for regulating behaviors including alertness, locomotion, and rapid eye movement sleep. Activation of PPT neurons in anesthetized rats was previously found to increase splanchnic sympathetic nerve activity and blood pressure, in addition to altering breathing. The present study is the first investigation of the PPT and its potential role in regulating RSNA. Microinjections of DL-homocysteic acid (DLH) were used to probe the PPT in 100-μm increments in Nembutal-anesthetized rats to identify effective sites, defined as locations where changes in RSNA could be evoked. A total of 239 DLH microinjections were made in 18 rats, which identified 20 effective sites (each confirmed by the ability to evoke a repeatable sympathoexcitatory response). Peak increases in RSNA occurred within 10–20 seconds of PPT activation, with RSNA increasing by 104.5 ± 68.4% (mean ± standard deviation) from baseline. Mean arterial pressure remained significantly elevated for 30 seconds, increasing from 101.6 ± 18.6 mmHg to 135.9 ± 36.4 mmHg. DLH microinjections also increased respiratory rate and minute ventilation. The effective sites were found throughout the rostal-caudal extent of the PPT with most located in the dorsal regions of the nucleus. The majority of PPT locations tested with DLH microinjections did not alter RSNA (179 sites), suggesting that the neurons that confer renal sympathoexcitatory functions comprise a small component of the PPT. The study also underscores the importance of further investigation to determine whether sympathoexcitatory PPT neurons contribute to adverse renal and cardiovascular consequences of diseases such as obstructive sleep apnea and heart failure.
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Affiliation(s)
- Anne M. Fink
- Center for Narcolepsy, Sleep, and Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Caron Dean
- Department of Anesthesiology, Medical College of Wisconsin and Zablocki VA Medical Center, Milwaukee, Wisconsin, United States of America
| | - Mariann R. Piano
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - David W. Carley
- Center for Narcolepsy, Sleep, and Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Maurer C, Langerbeins P, Bahlo J, Cramer P, Fink AM, Pflug N, Engelke A, von Tresckow J, Kovacs G, Stilgenbauer S, Wendtner CM, Müller L, Ritgen M, Seiler T, Fischer K, Hallek M, Eichhorst B. Effect of first-line treatment on second primary malignancies and Richter's transformation in patients with CLL. Leukemia 2016; 30:2019-2025. [PMID: 27133817 DOI: 10.1038/leu.2016.113] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/23/2016] [Accepted: 04/05/2016] [Indexed: 12/15/2022]
Abstract
This study aimed to assess the frequency of and the contributing factors for second primary malignancies (SPMs) and Richter's transformations (RTs) following first-line treatment of chronic lymphocytic leukemia within four phase II/III trials of the GCLLSG evaluating fludarabine (F) vs F+cyclophosphamide (FC), chlorambucil vs F, FC without or with rituximab, and bendamustine+R (BR). Among 1458 patients, 239 (16.4%) experienced either an SPM (N=191) or a RT (N=75). Solid tumors (N=115; 43.2% of all second neoplasias) appeared most frequently, followed by RTs (N=75; 28.2%). Patients showed a 1.23-fold increased risk of solid tumors in comparison to the age-matched general population from the German cancer registry. Age>65 (hazard ratio (HR) 2.1; P<0.001), male sex (HR 1.7; P=0.01), co-morbidities (HR 1.6; P=0.01) and number of subsequent treatments⩾1 (HR 12.1; P<0.001) showed an independent adverse prognostic impact on SPM-free survival. Serum thymidine kinase>10 U/l at trial enrollment (HR 3.9; P=0.02), non-response to first-line treatment (HR 3.6; P<0.001) and number of subsequent treatments⩾1 (HR 30.2; P<0.001) were independently associated with increased risk for RT.
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Affiliation(s)
- C Maurer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - P Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - J Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - P Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - A M Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - N Pflug
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - A Engelke
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - J von Tresckow
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - G Kovacs
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - S Stilgenbauer
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - C-M Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - L Müller
- Oncology Leer, Practice for Hematology and Oncology, Leer, Germany
| | - M Ritgen
- Second Department of Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T Seiler
- Department of Medicine III, University Hospital Großhadern/LMU München, Munich, Germany
| | - K Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - M Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany.,Cluster of Excellence in Cellular Stress Responses in Aging-associated Diseases, Univeristy of Cologne, Cologne, Germany
| | - B Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
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Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O'Gara P, Taubert KA. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435-86. [PMID: 26373316 DOI: 10.1161/cir.0000000000000296] [Citation(s) in RCA: 1815] [Impact Index Per Article: 201.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. METHODS AND RESULTS This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. CONCLUSIONS Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.
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Fink AM, Topchiy I, Ragozzino M, Amodeo DA, Waxman JA, Radulovacki MG, Carley DW. Brown Norway and Zucker Lean rats demonstrate circadian variation in ventilation and sleep apnea. Sleep 2014; 37:715-21. [PMID: 24899760 DOI: 10.5665/sleep.3576] [Citation(s) in RCA: 8] [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] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Circadian rhythms influence many biological systems, but there is limited information about circadian and diurnal variation in sleep related breathing disorder. We examined circadian and diurnal patterns in sleep apnea and ventilatory patterns in two rat strains, one with high sleep apnea propensity (Brown Norway [BN]) and the other with low sleep apnea propensity (Zucker Lean [ZL]). DESIGN/SETTING Chronically instrumented rats were randomized to breathe room air (control) or 100% oxygen (hyperoxia), and we performed 20-h polysomnography beginning at Zeitgeber time 4 (ZT 4; ZT 0 = lights on, ZT12 = lights off). We examined the effect of strain and inspired gas (twoway analysis of variance) and analyzed circadian and diurnal variability. MEASUREMENTS AND RESULTS Strain and inspired gas-dependent differences in apnea index (AI; apneas/h) were particularly prominent during the light phase. AI in BN rats (control, 16.9 ± 0.9; hyperoxia, 34.0 ± 5.8) was greater than in ZL rats (control, 8.5 ± 1.0; hyperoxia, 15.4 ± 1.1, [strain effect, P < 0.001; gas effect, P = 0.001]). Hyperoxia reduced respiratory frequency in both strains, and all respiratory pattern variables demonstrated circadian variability. BN rats exposed to hyperoxia demonstrated the largest circadian fluctuation in AI (amplitude = 17.9 ± 3.7 apneas/h [strain effect, P = 0.01; gas effect, P < 0.001; interaction, P = 0.02]; acrophase = 13.9 ± 0.7 h; r (2) = 0.8 ± 1.4). CONCLUSIONS Inherited, environmental, and circadian factors all are important elements of underlying sleep related breathing disorder. Our method to examine sleep related breathing disorder phenotypes in rats may have implications for understanding vulnerability for sleep related breathing disorder in humans.
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Affiliation(s)
- Anne M Fink
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL ; Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Irina Topchiy
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL ; Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL ; Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Michael Ragozzino
- Department of Psychology, University of Illinois at Chicago, Chicago, IL
| | - Dionisio A Amodeo
- Department of Psychology, University of Illinois at Chicago, Chicago, IL
| | - Jonathan A Waxman
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL ; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL
| | - Miodrag G Radulovacki
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL ; Department of Pharmacology, University of Illinois at Chicago, Chicago, IL
| | - David W Carley
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL ; Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL ; Department of Medicine, University of Illinois at Chicago, Chicago, IL
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Abstract
Obstructive sleep apnea (OSA) affects one in five adult males and is associated with significant comorbidity, cognitive impairment, excessive daytime sleepiness, and reduced quality of life. For over 25 years, the primary treatment has been continuous positive airway pressure, which introduces a column of air that serves as a pneumatic splint for the upper airway, preventing the airway collapse that is the physiologic definition of this syndrome. However, issues with patient tolerance and unacceptable levels of treatment adherence motivated the exploration of other potential treatments. With greater understanding of the physiologic mechanisms associated with OSA, novel interventions have emerged in the last 5 years. The purpose of this article is to describe new treatments for OSA and associated complex sleep apnea. New approaches to complex sleep apnea have included adaptive servoventilation. There is increased literature on the contribution of behavioral interventions to improve adherence with continuous positive airway pressure that have proven quite effective. New non-surgical treatments include oral pressure devices, improved mandibular advancement devices, nasal expiratory positive airway pressure, and newer approaches to positional therapy. Recent innovations in surgical interventions have included laser-assisted uvulopalatoplasty, radiofrequency ablation, palatal implants, and electrical stimulation of the upper airway muscles. No drugs have been approved to treat OSA, but potential drug therapies have centered on increasing ventilatory drive, altering the arousal threshold, modifying loop gain (a dimensionless value quantifying the stability of the ventilatory control system), or preventing airway collapse by affecting the surface tension. An emerging approach is the application of cannabinoids to increase upper airway tone.
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Affiliation(s)
- Terri E Weaver
- Biobehavioral Health Science Department, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA ; Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Michael W Calik
- Biobehavioral Health Science Department, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA ; Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Sarah S Farabi
- Biobehavioral Health Science Department, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA ; Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Anne M Fink
- Biobehavioral Health Science Department, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA ; Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Maria T Galang-Boquiren
- Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, Chicago, IL, USA ; Department of Orthodontics, University of Illinois at Chicago College of Dentistry, Chicago, IL, USA
| | - Mary C Kapella
- Biobehavioral Health Science Department, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA ; Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Bharati Prasad
- Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, Chicago, IL, USA ; Sleep Center, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - David W Carley
- Biobehavioral Health Science Department, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA ; Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
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Feldmann R, Fink AM, Jurecka W, Rappersberger K, Steiner A. Accuracy of the non-sentinel node risk score (N-SNORE) in patients with cutaneous melanoma and positive sentinel lymph nodes: a retrospective study. Eur J Surg Oncol 2013; 40:73-6. [PMID: 24075029 DOI: 10.1016/j.ejso.2013.08.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sentinel node (SLN) biopsy in patients with melanoma permits identification of those at risk for further metastases in non-sentinel lymph nodes (NSLN). However, a mere 20% of SLN-positive patients have metastases in NSLN. Therefore we need criteria to predict NSLN-positivity. A new score system known as the non-sentinel risk score, (N-SNORE) based on five clinical and pathological characteristics (gender, regression in primary melanoma, proportion of SNs containing melanoma, perinodal lymphatic invasion, and SN tumor burden), was first published in 2010. In this study, the accuracy of N-SNORE was validated in melanoma patients with positive SLN. METHODS A total of 106 melanoma patients with positive SLN, who had undergone complete lymph node dissection (CLND) subsequently, were included in the study. The N-SNORE was calculated in all patients, and the risk was compared to the frequency of NSLN metastases. Statistical analysis of the data was performed. RESULTS Thirteen patients were at very low risk for NSN metastasis (score 0), 63 patients at low risk (score 1-3), 19 at intermediate risk (score 4-5), 6 at high risk (score 6-7), and 5 at very high risk (score >8). NSLN positivity rates for these 5 risk groups were 7.7%, 18.2%, 21.1%, 33.3%, and 80%, respectively. According to Fisher's exact test, the contingency coefficient was .322; the p-value was .025. CONCLUSION An increasing N-SNORE was clearly correlated with a higher risk of NSLN positivity. Based on the p-value and the contingency coefficient, the overall accuracy of the N-SNORE was proven on statistical calculation.
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Affiliation(s)
- R Feldmann
- Department of Dermatology, Krankenhaus Hietzing, Wolkersbergenstrasse 1, 1130 Vienna, Austria.
| | - A M Fink
- Department of Dermatology, Wilhelminenspital, Montleartstraße 37, 1160 Vienna, Austria
| | - W Jurecka
- Department of Dermatology, Wilhelminenspital, Montleartstraße 37, 1160 Vienna, Austria
| | - K Rappersberger
- Department of Dermatology, Krankenhaus Rudolfstiftung, Juchgasse 25, 1030 Vienna, Austria
| | - A Steiner
- Department of Dermatology, Krankenhaus Hietzing, Wolkersbergenstrasse 1, 1130 Vienna, Austria
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Fink AM, Böttcher S, Ritgen M, Fischer K, Pflug N, Eichhorst B, Wendtner CM, Winkler D, Bühler A, Zenz T, Staib P, Mayer J, Hensel M, Hopfinger G, Wenger M, Fingerle-Rowson G, Döhner H, Kneba M, Stilgenbauer S, Busch R, Hallek M. Prediction of poor outcome in CLL patients following first-line treatment with fludarabine, cyclophosphamide and rituximab. Leukemia 2013; 27:1949-52. [PMID: 23787395 PMCID: PMC3768112 DOI: 10.1038/leu.2013.190] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Fink AM, Gonzalez RC, Lisowski T, Pini M, Fantuzzi G, Levy WC, Piano MR. Fatigue, inflammation, and projected mortality in heart failure. J Card Fail 2013; 18:711-6. [PMID: 22939040 DOI: 10.1016/j.cardfail.2012.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/28/2012] [Accepted: 07/11/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Fatigue is a prominent and poorly understood symptom of heart failure with reduced ejection fraction (HFrEF). The purpose of this study was to determine whether fatigue correlated with immune biomarkers and prognosis. METHODS/RESULTS In patients with HFrEF (N = 59) and healthy controls (N = 25), we prospectively measured fatigue (Profile of Mood States), depressive symptoms (Patient Health Questionnaire-8), sleep quality (Pittsburgh Sleep Quality Index), and immune biomarkers (plasma C-reactive protein [CRP], tumor necrosis factor-α [TNFα], and interleukins [IL-6 and IL-10]). Seattle Heart Failure Model (SHFM) mortality risk scores were determined. Patients with HFrEF had significantly greater fatigue and depressive symptoms and poorer sleep quality compared to control subjects. When controlling for depressive symptoms, however, fatigue did not differ significantly between patients with HFrEF and controls. Patients with HFrEF had significantly lower levels of IL-10 compared to controls. Cytokines did not correlate significantly with fatigue, but fatigue was significantly associated with higher SHFM scores. CONCLUSIONS Depressive symptoms were an important covariate of fatigue in patients with HFrEF. Our study findings were the first to show a positive association between fatigue and the SHFM score, indicating that fatigue was associated with poorer prognosis.
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Affiliation(s)
- Anne M Fink
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Gu L, Fink AM, Chowdhury SAK, Geenen DL, Piano MR. Cardiovascular responses and differential changes in mitogen-activated protein kinases following repeated episodes of binge drinking. Alcohol Alcohol 2012; 48:131-7. [PMID: 22878590 DOI: 10.1093/alcalc/ags090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
AIMS Excessive alcohol use in the form of binge drinking is associated with many adverse medical outcomes. Using an animal model, the primary objective of this study was to determine the effects of repeated episodes of binge drinking on myocardial structure, blood pressure (BP) and activation of mitogen-activated protein kinases (MAPKs). The effects of carvedilol, a beta-adrenergic blocker, were also examined in this animal model of binge drinking. METHODS Rats were randomized into three groups: control, binge and binge + carvedilol (20 mg/kg). Animals received intragastric administration of 5 g ethanol/kg in the morning × 4 days (Monday-Thursday) followed by no ethanol on Friday-Sunday. Animals were maintained on the protocol for 5 weeks. BP was measured using radiotelemetry methods. Animals underwent echocardiography at baseline, 2.5 and 5 weeks. Myocardial MAPKs were analyzed at 5 weeks using western blot techniques. RESULTS Over the course of 5 weeks, binge drinking was associated with significant transient increases in BP that were greater at 4 and 5 weeks compared with earlier time points. Carvedilol treatment significantly attenuated the binge-induced transient increases in BP at 4 and 5 weeks. No significant changes were found in echocardiographic parameters at any time period; however, binge drinking was associated with increased phosphorylation of p38 MAPK, which was blocked by carvedilol treatment. CONCLUSION Repeated episodes of binge drinking result in progressive and transient increases in BP, no change in myocardial structure and differential regulation of MAPK activation.
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Affiliation(s)
- Lianzhi Gu
- Department of Medicine, Section of Cardiology and Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, IL, USA
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Abstract
Patients with type 2 diabetes often experience fatigue, which impacts their self-care and quality of life. There are few data supporting a relationship between fatigue and glucose homeostasis, but fatigue in type 2 diabetes has been associated with higher body mass index (BMI), depression, physical inactivity, sleep disturbances, and chronic low-grade inflammation. Although links between fatigue and inflammation are documented in other disease populations, little is known about inflammatory mechanisms specific to type 2 diabetes and associated treatment modalities for type 2 diabetes-related fatigue. Herein we review existing knowledge about fatigue in type 2 diabetes and potential pharmacologic and behavioral therapies.
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Abstract
The 6-min walk (6MW) is a self-paced test for measuring functional capacity. Lower 6MW distances have been associated with adverse outcomes in patients with heart failure. The purpose of this article is to describe the history of the 6MW test and to evaluate its reliability, validity, and predictive value as well as the responsiveness of the test to therapies. In the literature we reviewed, reliability was affected by several factors including learning effects and protocol deviations. The 6MW distance was moderately correlated with peak oxygen consumption derived from cardiopulmonary exercise stress testing. In some studies the 6MW distance was predictive of hospitalization and mortality. In pharmacological and cardiac resynchronization trials the 6MW distance did not consistently detect clinical improvements. Despite limitations, the 6MW test is a viable alternative to stress testing for objectively evaluating functional capacity in some settings. We provide recommendations for using the 6MW test in future studies.
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Affiliation(s)
- Karen M Vuckovic
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Hallek M, Fischer K, Fingerle-Rowson G, Fink AM, Busch R, Mayer J, Hensel M, Hopfinger G, Hess G, von Grünhagen U, Bergmann M, Catalano J, Zinzani PL, Caligaris-Cappio F, Seymour JF, Berrebi A, Jäger U, Cazin B, Trneny M, Westermann A, Wendtner CM, Eichhorst BF, Staib P, Bühler A, Winkler D, Zenz T, Böttcher S, Ritgen M, Mendila M, Kneba M, Döhner H, Stilgenbauer S. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. Lancet 2010; 376:1164-74. [PMID: 20888994 DOI: 10.1016/s0140-6736(10)61381-5] [Citation(s) in RCA: 1269] [Impact Index Per Article: 90.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND On the basis of promising results that were reported in several phase 2 trials, we investigated whether the addition of the monoclonal antibody rituximab to first-line chemotherapy with fludarabine and cyclophosphamide would improve the outcome of patients with chronic lymphocytic leukaemia. METHODS Treatment-naive, physically fit patients (aged 30-81 years) with CD20-positive chronic lymphocytic leukaemia were randomly assigned in a one-to-one ratio to receive six courses of intravenous fludarabine (25 mg/m(2) per day) and cyclophosphamide (250 mg/m(2) per day) for the first 3 days of each 28-day treatment course with or without rituximab (375 mg/m(2) on day 0 of first course, and 500 mg/m(2) on day 1 of second to sixth courses) in 190 centres in 11 countries. Investigators and patients were not masked to the computer-generated treatment assignment. The primary endpoint was progression-free survival (PFS). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00281918. FINDINGS 408 patients were assigned to fludarabine, cyclophosphamide, and rituximab (chemoimmunotherapy group) and 409 to fludarabine and cyclophosphamide (chemotherapy group); all patients were analysed. At 3 years after randomisation, 65% of patients in the chemoimmunotherapy group were free of progression compared with 45% in the chemotherapy group (hazard ratio 0·56 [95% CI 0·46-0·69], p<0·0001); 87% were alive versus 83%, respectively (0·67 [0·48-0·92]; p=0·01). Chemoimmunotherapy was more frequently associated with grade 3 and 4 neutropenia (136 [34%] of 404 vs 83 [21%] of 396; p<0·0001) and leucocytopenia (97 [24%] vs 48 [12%]; p<0·0001). Other side-effects, including severe infections, were not increased. There were eight (2%) treatment-related deaths in the chemoimmunotherapy group compared with ten (3%) in the chemotherapy group. INTERPRETATION Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab improves progression-free survival and overall survival in patients with chronic lymphocytic leukaemia. Moreover, the results suggest that the choice of a specific first-line treatment changes the natural course of chronic lymphocytic leukaemia. FUNDING F Hoffmann-La Roche.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Disease Progression
- Disease-Free Survival
- Drug Administration Schedule
- Female
- Humans
- Immunologic Factors/administration & dosage
- Incidence
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukopenia/chemically induced
- Male
- Middle Aged
- Neutropenia/chemically induced
- Rituximab
- Severity of Illness Index
- Treatment Outcome
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
- M Hallek
- Department I of Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany.
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Fink AM, Eckhardt AL, Fennessy MM, Jones J, Kruse D, VanderZwan KJ, Ryan CJ, Zerwic JJ. Psychometric properties of three instruments to measure fatigue with myocardial infarction. West J Nurs Res 2010; 32:967-83. [PMID: 20685901 DOI: 10.1177/0193945910371320] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The purpose of this study was to evaluate the psychometric properties of three questionnaires to measure fatigue with myocardial infarction. The Fatigue Symptom Inventory Interference Scale, Profile of Moods States Fatigue subscale (POMS-F), and Short Form 36 (SF-36) Vitality Scale were completed during hospitalization (n = 116) and 30 days after hospital admission (n = 49). Moderate to strong correlations were found among each of these fatigue scales and between each fatigue scale and measures of other variables to include vigor, depressed mood, anxiety, and physical functioning. POMS-F scores decreased significantly at Time 2, but this decline in fatigue was not validated on the other fatigue scales. Patients' Time 1 scores reflected significantly more fatigue compared to published scores for healthy adults. The ability to discriminate between groups suggests that the instruments may be useful for identifying patients with cardiovascular risk factors who report clinically significant fatigue.
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Affiliation(s)
- Anne M Fink
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL 60612-7350, USA.
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Fritschi C, Fink AM. Fatigue in Adults with Type 2 Diabetes – An Overview of Current Understanding and Management Approaches. European Endocrinology 2010. [DOI: 10.17925/ee.2012.08.02.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patients with type 2 diabetes often experience fatigue, which impacts their self-care and quality of life. There are few data supporting a relationship between fatigue and glucose homeostasis, but fatigue in type 2 diabetes has been associated with higher body mass index (BMI), depression, physical inactivity, sleep disturbances and chronic low-grade inflammation. Although links between fatigue and inflammation are documented in other disease populations, little is known about inflammatory mechanisms specific to type 2 diabetes and associated treatment modalities for type 2 diabetes-related fatigue. Herein we review existing knowledge about fatigue in type 2 diabetes and potential pharmacological and behavioural therapies.
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Abstract
In response to federal requests for investigation into measures to eradicate health disparities, a concept analysis of the term health disparity was conducted. Health-related and multidisciplinary literature was reviewed. Multiple terms were explored alone and in combination with no limitations on search date parameters. Findings indicated several definitions of the concept,with the term health care disparity being used interchangeably with the term health disparity. New theoretical and operational definitions, antecedents, characteristics, and consequences of the concept are proffered. Model, borderline, and contrary cases are developed to illustrate the concept. Nursing implications and recommendations for future research are discussed.
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Fink AM, Filz D, Krajnik G, Jurecka W, Ludwig H, Steiner A. Seborrhoeic keratoses in patients with internal malignancies: a case-control study with prospective accrual of patients. J Eur Acad Dermatol Venereol 2009; 23:1316-9. [PMID: 19309432 DOI: 10.1111/j.1468-3083.2009.03163.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between the eruption of numerous seborrhoeic keratoses as a result of an underlying malignancy is controversially discussed. The aim of this case-control study with prospective accrual of patients was to determine whether a direct association exists between the number seborrhoeic keratoses and internal malignancies. METHODS The numbers and sites of seborrhoeic keratoses were counted in 150 oncological patients and 150 matched controls. Additionally, the presence or absence of pruritus, acanthosis nigricans, and the sudden appearance of seborrhoeic keratoses were assessed. RESULTS Seborrhoeic keratoses did not differ significantly between patients with internal malignancies and controls. Only two patients fulfilled the criteria of the Leser-Trélat sign, defined as the eruption of numerous seborrhoeic keratoses as a cutaneous marker of an underlying internal malignancy. CONCLUSION No association was found between seborrhoeic keratoses and cancer. Furthermore, our data did not provide support to the validity of the Leser-Trélat sign in patients with internal malignancies.
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Affiliation(s)
- A M Fink
- Department of Dermatology, Wilhelminenspital, Vienna, Austria.
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Affiliation(s)
- K S Sodhi
- Department of Medical Imaging, Royal Children's Hospital, Melbourne, Victoria, Australia
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Fink AM, Cauza E, Hassfeld W, Dunky A, Bayer PM, Jurecka W, Steiner A. Vascular endothelial growth factor in patients with psoriatic arthritis. Clin Exp Rheumatol 2007; 25:305-8. [PMID: 17543159] [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: 05/15/2023]
Abstract
OBJECTIVE To determine the levels of vascular endothelial growth factor (VEGF) in patients with active psoriatic arthritis, patients with inactive psoriatic arthritis, and healthy controls. Serum VEGF levels were correlated with clinical and laboratory features in patients with active psoriasis arthritis. METHODS Serum samples from 14 patients with active psoriatic arthritis, 14 patients with inactive psoriatic arthritis, and 9 healthy controls were investigated. VEGF levels in the serum were measured using a sensitive sandwich ELISA. RESULTS The mean serum VEGF concentration in patients with active PA was 394.4 pg/ml (394 +/- 171.8), in patients with inactive PA 200.4 pg/ml (200.4 +/- 115.7), and in healthy subjects 214.3 pg/ml (214.3 +/- 162.1). Patients with active psoriasis arthritis had significantly higher levels of VEGF compared to patients with inactive psoriasis arthritis and healthy individuals (p > 0.001). In contrast, VEGF levels were comparable in patients with inactive psoriatic arthritis and controls (p =0.659). Furthermore, in patients with psoriatic arthritis, VEGF levels were positively correlated with ESR, HAQ, PASI and VAS. CONCLUSION VEGF levels may be regarded as a good indicator of active psoriasis arthritis.
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Affiliation(s)
- A M Fink
- Department of Dermatology, Wilhelminenspital, Vienna, Austria.
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Fink AM, Maixner W. Enlarged parietal foramina: MR imaging features in the fetus and neonate. AJNR Am J Neuroradiol 2006; 27:1379-81. [PMID: 16775301 PMCID: PMC8133951] [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: 05/10/2023]
Abstract
Enlarged parietal foramina are believed to be benign and familial and due to a variable degree of defective intramembranous ossification of the parietal bones. We report 2 patients with this condition in whom fetal and neonatal MR imaging studies illustrate the antenatal and perinatal evolution of this condition and the associated persistence of a falcine sinus. We discuss its relationship to the spectrum of cephalocoeles.
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Affiliation(s)
- A M Fink
- Department of Medical Imaging, The Royal Children's Hospital, Flemington Road, Parkville, Melbourne 3052, Australia
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Abstract
The incidence of infective endocarditis, an inflammation of the heart valves, the endocardium, or both that's caused by bacterial, viral, or fungal agents, continues to rise despite advances in treatment. People with prosthetic valves are among those at highest risk, and mortality rates can be extremely high, especially in cases of early onset. Diagnosis is challenging, in part because signs and symptoms associated with systemic infections can mask signs of the underlying endocarditis. This article outlines the causes and effects of prosthetic valve-related endocarditis (PVE), describes its signs and symptoms, discusses the leading diagnostic tests and criteria, and addresses prevention and treatment, as well as nursing implications.
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Affiliation(s)
- Anne M Fink
- University of Illinois at Chicago College of Nursing, USA.
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Fink AM, Herzog N, Borst-Krafek B, Jurecka W, Steiner A. Long-term Mortality in Patients with Thrombosis of the Inferior Vena Cava, Iliac and Femoral Veins. Eur J Vasc Endovasc Surg 2006; 31:200-3. [PMID: 16125982 DOI: 10.1016/j.ejvs.2005.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 07/03/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess the long-term mortality in patients with thrombosis of the vena cava, iliac and femoral veins. DESIGN Registry study. MATERIALS Between 1992 and 2000, 212 consecutive patients with acute pelvic vein thrombosis diagnosed by duplex sonography were examined by magnetic resonance imaging (MRI) to determine the most proximal extent of the thrombus. MRI revealed a thrombosis in the inferior vena cava in 46 patients (22%), in the iliac vein in 142 patients (67%), and in the femoral vein in 24 patients (11%). METHODS The vital status of the patients was investigated in April 2004 using the Austrian National Registry and the Cause of Death Register. RESULTS A total of 211 patients of the original 212 patients were monitored over a mean follow-up period of 91 months. Seventy-two of 211 patients (34%) had died. There was no significant difference in the long-term mortality, the survival period or the occurrence of fatal pulmonary embolism (PE) between previously diagnosed vena cava, iliac vein, or femoral vein thrombosis. CONCLUSIONS Extension of a thrombus into the inferior caval vein in patients considered to have a pelvic vein thrombosis has no impact on long-term mortality or the development of fatal PE compared to those patients with thrombus limited to more distal veins.
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Affiliation(s)
- A M Fink
- Department of Dermatology, Wilhelminenspital, Montleartstr. 37, 1160 Vienna, Austria.
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Fink AM, Vidmar S, Kumbla S, Pedreira CC, Kanumakala S, Williams C, Carlin JB, Cameron FJ. Age-related pituitary volumes in prepubertal children with normal endocrine function: volumetric magnetic resonance data. J Clin Endocrinol Metab 2005; 90:3274-8. [PMID: 15784716 DOI: 10.1210/jc.2004-1558] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Evaluation of the size of the pituitary gland on magnetic resonance imaging (MRI) may be difficult, considering the wide variation in normal gland morphology. Given the paucity of age-related biometric data, our purpose was to obtain standard normal reference values for pituitary volumes in prepubertal children using three-dimensional MRI data. METHODS Children under the age of 10 yr undergoing brain MRI for seizures or idiopathic developmental delay and who had no endocrine abnormality were recruited prospectively over 2 yr. All MRI studies included a three-dimensional sequence. Only subjects with normal studies were included. One hundred thirty-nine children were eligible (mean age, 5.2 yr). Direct pituitary volumes were measured from contiguous 1-mm thick reconstructed coronal and sagittal images. Estimated pituitary volumes were calculated using pituitary height, width, and length. RESULTS Volumes obtained from reconstructions in either plane were essentially identical. There was a linear increase in log-transformed pituitary volume with age, but relatively weak correlations with height or body mass index. There was no gender difference and only weak correlations between pituitary height and pituitary volume and between estimated pituitary volume calculation and measured pituitary volume. We provide age-related reference ranges for pituitary volumes in graphical and tabular forms.
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Affiliation(s)
- A M Fink
- Department of Medical Imaging, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
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Fink AM, Kaltenegger I, Schneider B, Frühauf J, Jurecka W, Steiner A. Serum level of VEGF-D in patients with primary lymphedema. Lymphology 2004; 37:185-9. [PMID: 15693535] [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: 05/01/2023]
Abstract
Recent studies have indicated that vascular endothelial growth factor-D (VEGF-D) stimulates lymphangiogenesis in humans. Furthermore, mutations of vascular endothelial growth factor receptor 3 (VEGFR-3) have been observed in families with hereditary lymphedema. The lack of stimulation of lymphangiogenesis could lead to production of even more VEGF-D to obtain stimulation of lymphangiogenesis resulting in a high serum level of VEGF-D. The aim of the present study was to compare the serum level of VEGF-D in patients with primary lymphedema with healthy controls. In a prospective study, the serum level of VEGF-D was determined by a solid phase ELISA in patients with primary lymphedema and compared with healthy controls. In the group of patients with primary lymphedema the serum level of VEGF-D was significantly higher compared with controls (p=0.0047). The increased levels of VEGF-D observed in the present study suggest that primary lymphedema may be based on defective stimulation of VEGFR-3.
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Affiliation(s)
- A M Fink
- Department of Dermatology, Wilhelminenspital, Vienna, Austria.
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