Approximately 20% of the annual 795,000 stroke occurrences in the United States are fatal, and survivors face high-risk of long-term disability. The purpose of this secondary analysis of a ...cross-sectional survey data was to explore the association between individuals’ family history of stroke and their stroke risk among Minnesota adults attending the State Fair. The primary study sample (n=207) completed a nine-part survey addressing medical history, stroke risk factor knowledge, and the American Stroke Association stroke risk score. Analysis used descriptive summaries and McNemar’s Chi-square test. McNemar’s test indicated a significant association between family history of stroke and an individual’s stroke risk score (χ2=38.09, p<.001, (n=194)). Of those with and without family history of stroke, 87.1% and 95.5% correctly identified at least one stroke risk factor, respectively. Implications of this secondary data analysis is for nurses to target high-risk populations using primary prevention strategies to reduce stroke occurrence.
Abstract Background Research has demonstrated a significant positive association between frequent family meals and children’s dietary intake; however, the promotion of healthful family meals has not ...been rigorously tested for key food environment and nutrition-related behavioral outcomes in a randomized trial. Objective To describe family home food environment and nutrition-related parent and child personal and behavioral outcomes of the Healthy Home Offerings via the Mealtime Environment Plus program, the first rigorously tested family meals intervention targeting childhood obesity prevention. Design Randomized controlled trial. Baseline, postintervention (12 months, 93% retention), and follow-up (21 months, 89% retention) data (surveys and dietary recalls) were collected. Participants/setting Children aged 8 to 12 years (N=160) and their parents were randomized to intervention (n=81) or control (n=79) groups. Intervention The intervention included five parent goal-setting calls and 10 monthly sessions delivered to families in community settings that focused on experiential nutrition activities and education, meal planning, cooking skill development, and reducing screen time. Main outcome measures Family home food environment outcomes and nutrition-related child and parent personal and behavioral outcomes. Statistical analyses performed Analyses used generalized linear mixed models. Primary comparisons were contrasts between intervention and control groups at postintervention and follow-up, with adjustments for child age and parent education. Results Compared with control parents, intervention parents showed greater improvement over time in scores of self-efficacy for identifying appropriate portion sizes, with significant differences in adjusted means at both post-intervention ( P =0.002) and follow-up ( P =0.01). Intervention children were less likely to consume at least one sugar-sweetened beverage daily at post-intervention than control children ( P =0.04). Conclusions The Healthy Home Offerings via the Mealtime Environment Plus program involved the entire family and targeted personal, behavioral, and environment factors important for healthful changes in the home food environment and children’s dietary intake. The intervention improved two nutrition-related behaviors and this may inform the design of future family meal interventions.
•Peer physical examination limits learning and threatens psychologically safety.•A wearable simulator system offers more realism while protecting privacy.•An SP wearing a simulator was rated ...satisfactory by student and faculty participants.
Peer physical examination is a clinical teaching-learning approach used for decades because of the convenient sample of peers for practicing. However, this approach has limitations when learning to assess abnormalities and threatens psychologically safe learning. A wearable simulator system was designed for learning physical examination skills to minimize ethical and learning challenges.
The sample consisted of fifty prelicensure nursing students and ten faculty in an upper Midwest university.
The wearable simulator was constructed into a vest with RFID tags and ribcage landmarks. An observational, evaluative design was used for participants to rate seven categories during a 1-hour evaluation session of the wearable simulator worn by a standardized patient trained to portray an individual with pneumonia.
Satisfaction was rated highly among participants. More than 80% of student participants indicated the wearable simulator promotes privacy and reduces embarrassment.
The wearable simulator system offers a promising teaching-learning alternative with scenario-specific auscultation and palpation feedback to provide a safe, repeatable, and consistent simulation experience.
Abstract Background Patients with progressive kidney disease experience increasing physiologic and psychosocial stressors and declining health-related quality of life (HRQOL). Methods We conducted a ...randomized, active-controlled, open-label trial to test whether a Mindfulness-based Stress Reduction (MBSR) program delivered in a novel workshop-teleconference format would reduce symptoms and improve HRQOL in patients awaiting kidney transplantation. Sixty-three transplant candidates were randomized to one of two arms: i) telephone-adapted MBSR (tMBSR, an 8-week program of meditation and yoga); or ii) a telephone-based support group (tSupport). Participants completed self-report questionnaires at baseline, post-intervention, and after 6-months. Anxiety, measured by the State-Trait Anxiety Inventory (STAI) post-intervention served as the primary outcome. Secondary outcomes included: depression, sleep quality, pain, fatigue, and HRQOL assessed by SF-12 Physical and Mental Component Summaries (PCS, MCS). Results 55 patients (age 54 ± 12 yrs) attended their assigned program (tMBSR, n = 27; tSupport, n = 28). 49% of patients had elevated anxiety at baseline. Changes in anxiety were small and did not differ by treatment group post-intervention or at follow-up. However, tMBSR significantly improved mental HRQOL at follow-up: + 6.2 points on the MCS - twice the minimum clinically important difference (95% CI: 1.66 to 10.8, P = 0.01). A large percentage of tMBSR participants (≥ 90%) practiced mindfulness and reported it helpful for stress management. Conclusions Neither mindfulness training nor a support group resulted in clinically meaningful reductions in anxiety. In contrast, finding that tMBSR was more effective than tSupport for bolstering mental HRQOL during the wait for a kidney transplant is encouraging and warrants further investigation. ClinicalTrials.gov NCT01254214.
Identification of HLA class I ligands from the tumor surface (ligandome or immunopeptidome) is essential for designing T-cell mediated cancer therapeutic approaches. However, the sensitivity of the ...process for isolating MHC-I restricted tumor-specific peptides has been the major limiting factor for reliable tumor antigen characterization, making clear the need for technical improvement. Here, we describe our work from the fabrication and development of a microfluidic-based chip (PeptiCHIP) and its use to identify and characterize tumor-specific ligands on clinically relevant human samples. Specifically, we assessed the potential of immobilizing a pan-HLA antibody on solid surfaces via well-characterized streptavidin–biotin chemistry, overcoming the limitations of the cross-linking chemistry used to prepare the affinity matrix with the desired antibodies in the immunopeptidomics workflow. Furthermore, to address the restrictions related to the handling and the limited availability of tumor samples, we further developed the concept toward the implementation of a microfluidic through-flow system. Thus, the biotinylated pan-HLA antibody was immobilized on streptavidin-functionalized surfaces, and immune-affinity purification (IP) was carried out on customized microfluidic pillar arrays made of thiol–ene polymer. Compared to the standard methods reported in the field, our methodology reduces the amount of antibody and the time required for peptide isolation. In this work, we carefully examined the specificity and robustness of our customized technology for immunopeptidomics workflows. We tested this platform by immunopurifying HLA-I complexes from 1 × 106 cells both in a widely studied B-cell line and in patients-derived ex vivo cell cultures, instead of 5 × 108 cells as required in the current technology. After the final elution in mild acid, HLA-I-presented peptides were identified by tandem mass spectrometry and further investigated by in vitro methods. These results highlight the potential to exploit microfluidics-based strategies in immunopeptidomics platforms and in personalized immunopeptidome analysis from cells isolated from individual tumor biopsies to design tailored cancer therapeutic vaccines. Moreover, the possibility to integrate multiple identical units on a single chip further improves the throughput and multiplexing of these assays with a view to clinical needs.
Aims
There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence ...occur. To determine the time to and predictors of dual incontinence in older nursing home residents.
Methods
Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home‐specific random effect was used.
Results
At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care.
Conclusions
The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents.
Gene expression plasticity is central for macrophages' timely responses to cues from the microenvironment permitting phenotypic adaptation from pro-inflammatory (M1) to wound healing and ...tissue-regenerative (M2, with several subclasses). Regulatory macrophages are a distinct macrophage type, possessing immunoregulatory, anti-inflammatory, and angiogenic properties. Due to these features, regulatory macrophages are considered as a potential cell therapy product to treat clinical conditions, e.g., non-healing diabetic foot ulcers. In this study we characterized two differently manufactured clinically relevant regulatory macrophages, programmable cells of monocytic origin and comparator macrophages (M1, M2a and M0) using flow-cytometry, RT-qPCR, phagocytosis and secretome measurements, and RNA-Seq. We demonstrate that conventional phenotyping had a limited potential to discriminate different types of macrophages which was ameliorated when global transcriptome characterization by RNA-Seq was employed. Using this approach we confirmed that macrophage manufacturing processes can result in a highly reproducible cell phenotype. At the same time, minor changes introduced in manufacturing resulted in phenotypically and functionally distinct regulatory macrophage types. Additionally, we have identified a novel constellation of process specific biomarkers, which will support further clinical product development.
Introduction
Self-management with clinician guidance is a cornerstone of successful conservative treatment for accidental bowel leakage (ABL). There are currently few resources to assist patients ...with that essential self-management. The purpose of this study was to describe self-management of ABL and explore interest in a mobile health application (m-Health app) for supporting ABL self-management among community-living women.
Methods
Using an observational/descriptive design, women (18+ years) previously seen in a urogynecology clinic for ABL were mailed a survey containing eight multiple-choice questions and an open-ended prompt for comments.
Results
Survey responses were received from 161 women (18% response rate). The highest percentage of participants was aged 61–70 years (39%). Nearly half of the participants (47%) “did not know anything” about ABL self-management before visiting a clinician. Only 4% “knew a lot.” Of those who have been trying to self-manage their ABL (
n
= 132), 37% reported that it was not effective, and only 5% thought their self-management was “very effective.” Half (50%) of the participants had “a lot of” interest in an m-Health app to support managing ABL, and 30% had “some” interest. The vast majority (89%) thought that it was “very important” to have ongoing guidance and support for self-managing ABL.
Conclusions
Before visiting a clinician, most women with ABL lacked knowledge about ABL self-management, and their self-management was not very effective. Women thought having guidance to self-manage ABL was important. There would be good interest among women in an m-Health app supporting self-management of ABL if one were created.
•Parous women had higher prenatal confidence for physiologic birth than nulliparous women.•Women report that their providers are their main source of labor and birth information.•Prenatal confidence ...for physiologic birth was not associated with mode of birth.
Pregnancy, labor, and birth are normal, physiologic processes. Women often seek information during pregnancy to enhance their confidence for physiologic birth. Little is known about confidence for physiologic birth and associated prenatal characteristics and birth outcomes such as provider type, source of labor and birth information, mode of birth, and use of pain medication in labor. The purpose of this study was to examine prenatal confidence for physiologic birth and associated prenatal characteristics and birth outcomes.
This study was completed as part of a multi-phased instrument development study, the Preparation for Labor and Birth (P-LAB) instrument. P-LAB confidence scores were examined for their relationship with variables including labor type, provider type, source of labor support, pain medication use, and birth mode.
Women (N = 192) from five prenatal clinics in the Midwestern United States who had completed the P-LAB instrument participated in postpartum telephone interviews.
Women with previous birth experience had higher confidence than nulliparous women. Prenatal care providers were reported as main source of labor and birth information. Confidence for birth was associated with intention to not use pain medication in labor. Women's overall intention to use or not use pain medication was consistent with use. Prenatal confidence was not associated with mode of birth.
Special emphasis should be paid to nulliparous women when developing interventions to enhance confidence for physiologic birth. Women rely on their care providers for information regarding labor and birth, therefore one area to strengthen confidence for physiologic birth is within the provider-patient relationship.
One in four American older adults fall every year, resulting in injuries, death, and significant financial burden. Although fall etiology is multifactorial, the medical problems and aging factors ...that lead to unsteady gait and imbalance represent one of the major fall risks among older adults. A growing number of research studies support the health benefits of regular Tai Chi (TC) practice including improved physical, cognitive, and psychological function. The purpose of this quality improvement project was to assess the feasibility of establishing a 12-week (45 min per session) Tai Chi (TC) program (Sun Style Tai Chi) in a 75 bed assisted living facility as well as to evaluate the potential of the TC program to improve the fear of falling and functional mobility (as proxy for fall risk) and quality of life (QoL). A nurse who was a certified TC instructor taught the program. Twenty-three participants, 96% female and 96% white, mean (SD) age 83 (±7) years, attended one or more TC classes. Class attendance, self-reported questionnaires (e.g., fear of falling, QoL), and objective measure Timed Up and Go (TUG) were used to collect data. Nine participants (39%) completed 9 out of 12 sessions. Eleven participants (48%) completed both pre- and post-intervention measurements and twelve (52%) provided feedback on a post-intervention satisfaction survey. Participants showed 20% improvement in fear of falling (mean relative change) and 21% decrease (mean relative change) in TUG test (
= 0.001) with no clinically important changes in QoL. This quality improvement project suggested that TC is a feasible exercise that might have the potential to reduce risk of falls in older adults, and the program was well accepted with no serious or other adverse events reported. Further research studies are needed to examine the potential effects of TC programs with an appropriately powered RCT and longer intervention period.
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