Assessment of Electronic Health Literacy Among Filipino Americans.

Health literacy requires skills of reading, understanding, and analyzing text, numbers, graphs, and diagrams to make well-informed decisions. The increase advancement in technologies has made health information accessible in electronic format. Individuals must apply health literacy in navigating through health information resources on the Internet. Filipino Americans originating from a diverse background are often underreported and underrepresented in health research. The study aim was to examine electronic health literacy among Filipino Americans using the Electronic Health Literacy Scale survey. The descriptive study recruited 103 participants. Overall Filipino Americans are electronic health literate, with a mean of 32.4 ( SD = 4.6). Females ( P = .017), those with graduate or professional degrees ( P = .004) and working in healthcare ( P = .040) tend to have higher electronic health literacy. The study provided valuable insight on electronic health literacy on a population that is underrepresented in research. The descriptive data gained from the study lays foundational work to help decrease health inequities experienced by Filipino Americans.

Healthy Lifetime (HL): An Internet-Based Behavioral Health Coaching Protocol for Older Adults.

By 2060, the number of Americans 65 years and older will more than double, comprising nearly one-quarter of the population in the United States. While there are many advantages to living longer, a byproduct of aging is also a growing incidence of chronic illness and functional health limitations associated with a concurrent rise in chronic disease and disability that impair independent living in the community. We describe a personalized, behavioral health coaching protocol for early intervention that is delivered online to enhance a participant's independent functioning and to increase their self-care capacity with a goal to maintain independent living throughout aging. The electronic platform provides secure access to fillable surveys, health tracking, "just in time" communication with coaches and scheduling of two-way videos launched from the platform site. The 2-month protocol used two-way video conferencing which allowed high fidelity communication to sustain a complex behavioral intervention. Participants indicate high satisfaction with the intervention, the use of the platform, and the technology. While many health systems across the U.S. have ramped up virtual delivery of care in a proactive manner with now more than 70% of out-patient visits conducted through virtual delivery modes in some health systems, there remains much unevenness in this capability across the U.S. Our approach is to create a stable, interoperable, virtual outreach system for personalized professional health coaching that is complementary to medically oriented services that supports the health and functioning of participants as they age.

Prevalence and Components of Newborn Assessment Policies Related to Sudden Unexpected Postnatal Collapse.

OBJECTIVE: To describe, in a convenience sample, different hospitals' nursing care policies related to normal newborn assessment, to summarize common components of those policies related to sudden unexpected postnatal collapse (SUPC) of the newborn, and to correlate characteristics of the hospitals with the presence or absence of a normal newborn assessment policy. DESIGN: Descriptive evaluative design. SETTING: Hospital representatives were contacted to complete a questionnaire and provide a copy of their policies regarding normal newborn assessment. PARTICIPANTS: Representatives from 39 hospitals that provide maternal/newborn services within the United States completed the questionnaire and/or provided the investigator with a written nursing care policy for normal newborn assessment. INTERVENTION/MEASUREMENTS: Components of the hospitals' normal newborn assessment policies were evaluated according to the framework of recommended components outlined by the American Academy of Pediatrics in Feldman-Winter et al. (2016). RESULTS: The four components most often included in the policies submitted by 26 hospitals were maternal/newborn dyad assessments (n = 25, 96%), sequence of events postpartum (n = 15, 58%), monitoring (n = 9, 35%), and skin-to-skin contact procedures (n = 8, 30%). Differences were noted based on the size of the hospital as defined by the number of births and number of beds and also by the type of unit. CONCLUSION: Few policies in this study aligned with the recommended suggestions from the American Academy of Pediatrics outlined in Feldman-Winter et al. (2016). It is also important to note that these recommended suggestions relate to safe skin-to-skin contact and rooming-in practices, which may in turn affect the incidence of SUPC. There is much work to be done in terms of disseminating evidence and developing and implementing newborn assessment policies related to SUPC.

Prevalence of Cervical Cancer Overscreening: Review of a Wellness Registry.

Appropriately matching preventive health services and screenings with patient risk is an important quality indicator. Adherence by both providers and patients to cervical cancer screening guidelines has been inconsistent, resulting in overscreening and increased costs. This study examined the prevalence of cervical cancer overscreening following changes in screening guidelines in a wellness registry database. Cervical cancer overscreening after guideline implementation decreased for 18- to 20-year-old patients from 26.8% to 24.8% (P < .001) and increased for those aged 65 years and older from 11.1% to 12.5% (P = .0005). Black race, Hispanic ethnicity, Medicaid insurance, and the presence of a personal health record were associated with overscreening. Reliability and accuracy of data are a concern when data intended for one purpose, such as clinical care, are used for research. Correctly identifying screening tests in the electronic health record is important so that appropriate screening can be reliably assessed. In this study on the prevalence of cervical cancer overscreening, we used a focused chart review to identify whether screening Pap tests were accurately identified in the electronic medical record. Pap tests were correctly identified as screening in 85% of those aged 18 to 20, and in 74% of those aged 65 and older.

The transition of care from hospital to home for patients with hypertension.

Approximately 50% to 75% of hospital patients have hypertension. At the time of discharge, patients experience a transition of care as they move from the hospital to home. This article describes the transition of care from the hospital to home for patients with hypertension and discusses practice implications for NPs.

Getting to Normal: Women's Experiences Self-Managing Their Perceived Blood Pressure Changes.

BACKGROUND: In the United States, nearly 25% of all women older than 20 years have hypertension (HTN). Nearly 30% to 50% of persons with HTN experience symptoms attributed to high blood pressure (BP). Women with hypertensive symptoms may connect their symptoms to perceived BP changes and may be using their perceptions about BP changes to guide their HTN self-management. There is limited research about perceived BP changes or their use in self-management. OBJECTIVE: The purpose of this qualitative study is to describe the experiences of women with HTN self-managing their perceived BP changes. METHODS: van Manen's phenomenology methodology and method guided the inquiry. Women with HTN who believed they could tell when their BP changed based on their symptoms were recruited from community settings and were interviewed once with a semistructured guide. Interviews were digitally recorded and professionally transcribed. Textual data were analyzed using thematic analysis to identify major themes. RESULTS: Seven black and 6 white women comprised the study sample. Participants were middle aged (mean [SD], 50.5 [9.62] years), were experienced in living with HTN (mean [SD],10.76 [9.50] years), had at least a high school education, and had a limited annual income (93% <$24 000). One central theme ("getting to normal") and 4 subthemes (i.e., "I can tell," "tending to it," "the wake-up call," and "doing it right") were discovered in the data. The themes depict a process of episodic symptom-driven and day-to-day actions that the participants used to get their BP to normal. CONCLUSIONS: The study is significant as new knowledge was discovered about how women perceive their BP changes and use them to guide self-management. This study contributes to clinical practice through suggestions for improving patient assessments. Results serve as a foundation for further research of the self-management of BP changes and developing belief-based interventions with the potential to improve BP control.

Hypertensive symptom representations: a pilot study.

PURPOSE: Approximately 40% of African Americans have hypertension (HTN). Up to 50% of persons with HTN experience symptoms they attribute to HTN. The beliefs African Americans ascribe to their symptoms have not been substantively described in research. Therefore, the purpose of this study was to describe the "representations" (meaning and emotions associated with symptoms) ascribed to hypertensive symptoms. DATA SOURCES: Twenty-six community-dwelling African Americans with hypertensive symptoms were identified from among 51 participants enrolled in a larger HTN study. Participants completed the Symptom Representation Questionnaire for each reported hypertensive symptom. CONCLUSIONS: Twenty-six participants (51%) experienced at least one hypertensive symptom (e.g., headaches, dizziness, vision changes). Participants held neutral scores for the level of distress, and expected duration and consequences of their headaches, dizziness, and vision changes. Participants attributed HTN as a cause of their symptom(s) to a greater degree than HTN treatment. Strong symptom cure/control beliefs were reported among participants with headaches, dizziness, and vision changes. IMPLICATIONS FOR PRACTICE: The study results highlight areas that nurse practitioners should assess with hypertensive patients. Key assessment areas include (a) hypertensive symptom type and frequency; (b) HTN as a cause for symptoms; and (c) beliefs about cure/control of symptoms and patients' corresponding self-management actions.

Illness beliefs in African Americans with hypertension.

Guided by Leventhal's common sense model of illness representations, this study examined the relationship between hypertension beliefs and self-care behaviors necessary for blood pressure (BP) control in a sample of 111 community-dwelling African Americans with hypertension. Participants completed the revised Illness Perception Questionnaire, BP Self-Care Scale, and a demographic data sheet, and had BP measured. Analyses revealed that beliefs about the causes of hypertension differed by gender and educational level. Stress-related causal attributions accounted for 34.7% of the variance in hypertension beliefs. Participants who believed stress or external factors caused hypertension were less likely to engage in healthy self-care behaviors (e.g., keeping doctor visits, eating low-salt, low-fat diets). Results suggest that patients who are nonadherent with hypertension self-care recommendations may hold hypertension beliefs that are not consistent with the medically endorsed views of this disease. To more effectively treat and control BP, providers should assess patients' hypertension beliefs.

Using a two-step hydride transfer to achieve 1,4-reduction in the catalytic hydrogenation of an acyl pyridinium cation.

The stoichiometric reduction of N-carbophenoxypyridinium tetraphenylborate (6) by CpRu(P-P)H (Cp = eta(5)-cyclopentadienyl; P-P = dppe, 1,2-bis(diphenylphosphino)ethane, or dppf, 1,1'-bis(diphenylphosphino)ferrocene), and Cp*Ru(P-P)H (Cp* = eta(5)-pentamethylcyclopentadienyl; P-P = dppe) gives mixtures of 1,2- and 1,4-dihydropyridines. The stoichiometric reduction of 6 by Cp*Ru(dppf)H (5) gives only the 1,4-dihydropyridine, and 5 catalyzes the exclusive formation of the 1,4-dihydropyridine from 6, H(2), and 2,2,6,6-tetramethylpiperidine. In the stoichiometric reductions, the ratio of 1,4 to 1,2 product increases as the Ru hydrides become better one-electron reductants, suggesting that the 1,4 product arises from a two-step (e(-)/H(*)) hydride transfer. Calculations at the UB3LYP/6-311++G(3df,3pd)//UB3LYP/6-31G* level support this hypothesis, indicating that the spin density in the N-carbophenoxypyridinium radical (13) resides primarily at C4, while the positive charge in 6 resides primarily at C2 and C6. The isomeric dihydropyridines thus result from the operation of different mechanisms: the 1,2 product from a single-step H(-) transfer and the 1,4 product from a two-step (e(-)/H(*)) transfer.

Improving quality of care for acute myocardial infarction: The Guidelines Applied in Practice (GAP) Initiative.

CONTEXT: Quality of care of patients with acute myocardial infarction (AMI) has received intense attention. However, it is unknown if a structured initiative for improving care of patients with AMI can be effectively implemented at a wide variety of hospitals. OBJECTIVE: To measure the effects of a quality improvement project on adherence to evidence-based therapies for patients with AMI. DESIGN AND SETTING: The Guidelines Applied in Practice (GAP) quality improvement project, which consisted of baseline measurement, implementation of improvement strategies, and remeasurement, in 10 acute-care hospitals in southeast Michigan. PATIENTS: A random sample of Medicare and non-Medicare patients at baseline (July 1998--June 1999; n = 735) and following intervention (September 1--December 15, 2000; n = 914) admitted at the 10 study centers for treatment of confirmed AMI. A random sample of Medicare patients at baseline (January--December 1998; n = 513) and at remeasurement (March--August 2001; n = 388) admitted to 11 hospitals that volunteered, but were not selected, served as a control group. INTERVENTION: The GAP project consisted of a kickoff presentation; creation of customized, guideline-oriented tools designed to facilitate adherence to key quality indicators; identification and assignment of local physician and nurse opinion leaders; grand rounds site visits; and premeasurement and postmeasurement of quality indicators. MAIN OUTCOME MEASURES: Differences in adherence to quality indicators (use of aspirin, beta-blockers, and angiotensin-converting enzyme [ACE] inhibitors at discharge; time to reperfusion; smoking cessation and diet counseling; and cholesterol assessment and treatment) in ideal patients, compared between baseline and postintervention samples and among Medicare patients in GAP hospitals and the control group. RESULTS: Increases in adherence to key treatments were seen in the administration of aspirin (81% vs 87%; P =.02) and beta-blockers (65% vs 74%; P =.04) on admission and use of aspirin (84% vs 92%; P =.002) and smoking cessation counseling (53% vs 65%; P =.02) at discharge. For most of the other indicators, nonsignificant but favorable trends toward improvement in adherence to treatment goals were observed. Compared with the control group, Medicare patients in GAP hospitals showed a significant increase in the use of aspirin at discharge (5% vs 10%; P<.001). Use of aspirin on admission, ACE inhibitors at discharge, and documentation of smoking cessation also showed a trend for greater improvement among GAP hospitals compared with control hospitals, although none of these were statistically significant. Evidence of tool use noted during chart review was associated with a very high level of adherence to most quality indicators. CONCLUSIONS: Implementation of guideline-based tools for AMI may facilitate quality improvement among a variety of institutions, patients, and caregivers. This initial project provides a foundation for future initiatives aimed at quality improvement.