Teaching Nurse Practitioner Students Advanced Health Assessment Skills During COVID-19.

The purpose of this project was to evaluate student outcomes before and during the coronavirus disease 2019 (COVID-19) pandemic in an advanced health assessment course that was offered in the summer semesters to nurse practitioner (NP) students as a hybrid course with online didactic and in-person lab components. Due to COVID-19, the summer 2020 course offering transitioned to being 100% online and innovative strategies replaced the in-person labs. Student outcomes from summer 2019, when the course was hybrid, were compared to summer 2020, when the course was changed to being 100% online. The findings of this project showed somewhat similar learning outcomes on both knowledge and skill acquisition in the 100% online course despite the change to 100% online during COVID-19. In teaching advanced health assessment to NP students, use of videography for skills demonstration, the virtual classroom, and unfolding case studies provided a robust and flexible pedagogy approach for 100% online teaching during a pandemic. [J Contin Educ Nurs. 2022;53(2):83-89.].

Design of a Community-Based Lung Cancer Education, Prevention, and Screening Program.

Uptake of low-dose computed tomography (LDCT) for lung cancer screening is extremely low. Efforts to promote screening are warranted, especially among disparate groups such as racial/ethnic minorities and those of lower socioeconomic status. This article describes the design and implementation strategies of the ongoing cancer-Community Awareness Access Research and Education (c-CARE) program. The purpose of c-CARE is to increase community awareness of lung cancer screening through education. Community health workers were trained to implement the intervention in 12 community sites. The Health Belief Model guided the evaluation and intervention development methods. Aims include changing participants' knowledge, attitude, and beliefs related to lung cancer and increasing lung cancer early detection and prevention behaviors by identifying and connecting high-risk and/or nicotine-dependent individuals to LDCT screening and/or tobacco cessation services. If effective, these methods could model increased dissemination to other high-risk communities.

Cost-effectiveness of a faith-based lifestyle intervention for diabetes prevention among African Americans: A within-trial analysis.

AIMS: We assessed costs and cost-effectiveness of implementing Fit Body and Soul (FBAS), a church-based 18-session lifestyle education intervention for African Americans. METHODS: We calculated incremental cost-effectiveness ratios (ICER) using data from a cluster randomized controlled trial comparing FBAS with health education (HE) among 604 overweight participants in 20 churches. The ICER was the adjusted difference in costs to deliver FBAS versus HE over the difference in weight change (kilograms [kg]) at one-year follow-up. Costs included those incurred for participant identification and program implementation. We fitted linear mixed-effects regression models, accounting for clustering of participants within churches and for age, sex, and educational attainment. We repeated these analyses for secondary outcomes (waist circumference [cm], physical activity [MET], glucose, blood pressure, and quality of life). RESULTS: Per-person intervention cost of FBAS was $50.39 more than HE ($442.22 vs. $391.83 per-person), and adjusted differences in weight change (1.9 kg [95% CI: 1.0 to 2.8]) and waist circumference (2.4 cm [95% CI: 1.3 to 3.4]) were both significant. FBAS did not result in statistically significant differences in physical activity, glucose, blood pressures, or quality of life. We estimated that compared to HE, FBAS costs an additional $26.52 per kg weight lost and $21.00 per cm reduction in waist circumference. CONCLUSIONS: For a modest increase in cost, FBAS led to greater weight and waist reductions among African Americans in a church setting. ClinicalTrials.gov Identifier NCT01730196.

Percent weight reduction required to achieve minimal clinically important improvements in health-related quality of life among African Americans: A secondary analysis of the fit body and soul study.

OBJECTIVE: To calculate the percent weight reduction required to achieve minimal clinically important improvement (MCII) in health-related quality of life (HRQOL). DESIGN: Secondary data analysis from the longitudinal cohort of a single-blinded, cluster-randomized community trial to test the efficacy of the faith-based adaptation of the Diabetes Prevention Program. SETTING: African-American churches. PARTICIPANTS: This study included 472 congregants with a body mass index of ≥25 and fasting plasma glucose<126mg/dl. MAIN OUTCOME MEASURE: Percent weight reduction required to achieve the MCII in HRQOL measured by two instruments, SF-12 and EQ-5D, one year following baseline. ANALYSIS: The percent weight reduction required to achieve established MCII in SF-12 Physical Component Summary (PCS), SF-12 Mental Component Summary (MCS), and EQ-5D Health Status (HS) at one-year follow-up were calculated using fitted linear regression models. In addition to models for the total sample, we generated models, stratified by baseline BMI, PCS, and HS, to calculate the percent weight reduction required to achieve MCII in HRQOL for those most in need of weight reduction and those in need of improved HRQOL. RESULTS: The percent weight reduction was a significant predictor of improvement in the SF-12PCS and the EQ-5DHS but not SF-12MCS. To achieve a MCII in SF-12PCS and EQ-5DHS, 18% and 30% weight reductions were required, respectively. A smaller percent weight reduction was required when the baseline BMI was ≥40. CONCLUSIONS AND IMPLICATIONS: Improvements in HRQOL among African-American congregants seeking weight reduction required more than the 3-5% weight reduction associated with improvements in physical health.

Community Trial of a Faith-Based Lifestyle Intervention to Prevent Diabetes Among African-Americans.

About 75% of African-Americans (AAs) ages 20 or older are overweight and nearly 50% are obese, but community-based programs to reduce diabetes risk in AAs are rare. Our objective was to reduce weight and fasting plasma glucose (FPG) and increase physical activity (PA) from baseline to week-12 and to month-12 among overweight AA parishioners through a faith-based adaptation of the Diabetes Prevention Program called Fit Body and Soul (FBAS). We conducted a single-blinded, cluster randomized, community trial in 20 AA churches enrolling 604 AAs, aged 20-64 years with BMI ≥ 25 kg/m(2) and without diabetes. The church (and their parishioners) was randomized to FBAS or health education (HE). FBAS participants had a significant difference in adjusted weight loss compared with those in HE (2.62 vs. 0.50 kg, p = 0.001) at 12-weeks and (2.39 vs. -0.465 kg, p = 0.005) at 12-months and were more likely (13%) than HE participants (3%) to achieve a 7% weight loss (p < 0.001) at 12-weeks and a 7% weight loss (19 vs. 8%, p < 0.001) at 12-months. There were no significant differences in FPG and PA between arms. Of the 15.2% of participants with baseline pre-diabetes, those in FBAS had, however, a significant decline in FPG (10.93 mg/dl) at 12-weeks compared with the 4.22 mg/dl increase in HE (p = 0.017), and these differences became larger at 12-months (FBAS, 12.38 mg/dl decrease; HE, 4.44 mg/dl increase) (p = 0.021). Our faith-based adaptation of the DPP led to a significant reduction in weight overall and in FPG among pre-diabetes participants. CLINICALTRIALS. GOV IDENTIFIER: NCT01730196.

Comparison of central line-associated bloodstream infection rates when changing to a zero fluid displacement intravenous needleless connector in acute care settings.

This was a multicenter, quasiexperimental, 140-month, acute care study comparing central line-associated bloodstream infection rates associated with positive or negative intravenous connectors to a zero fluid displacement connector. A decrease in central line-associated bloodstream infections was found after changing from either negative or positive intravenous connectors to the zero fluid displacement connector (P = .004) with total cost savings of over $3 million.

Patients satisfaction with warfarin and willingness to switch to dabigatran: a patient survey.

Warfarin is an anticoagulant medication that is challenging to manage. Dabigatran has been approved by the FDA for stroke and systemic embolism prevention in non-valvular atrial fibrillation as an alternative to warfarin. Dabigatran does not require routine monitoring, has an established dose, and lacks many of the drug, herbal, and food interactions that afflict warfarin. To evaluate patients' satisfaction with their current warfarin treatment and their opinion on switching to a newly marketed medication (dabigatran) through a brief survey. Two separate surveys were administered to (1) evaluate the patients' opinion of their warfarin therapy and (2) evaluate their thoughts on switching to a newer anticoagulant. Responses were recorded on a rating scale of 1-5; 1 being the least and 5 being the highest. Study was conducted at the Georgia Regents Health System (GRHS) pharmacy-based anticoagulation clinic. Two hundred sixty patients on warfarin treatment were enrolled. Patients expressed high satisfaction with warfarin treatment (4.7 ± 0.78). However, a vast majority of the patients were willing to switch to an agent that: requires less frequent follow-up visits (3.9 ± 1.35); lacks interaction with food and/or beverage (4.1 ± 1.25); is as efficacious as warfarin (3.7 ± 1.38). Patients expressed that out-of-pocket cost would be a major barrier to switch to this new medication (1.3 ± 0.58). Patients are satisfied with their warfarin treatment but willing to consider a new anticoagulant. Cost was highlighted as the most significant barrier. Efficacy, dietary freedom and less frequent visits are the major factors affecting the patients' decision.

The impact of the Georgia Health Sciences University nursing faculty practice on tobacco cessation rates.

Nursing faculty practice groups can play a vital role in tobacco cessation in academic medical centers. Outcomes from the Georgia Health Sciences University Nursing Faculty Practice Group Tobacco Cessation Program revealed 64% abstinence outcomes at the end of treatment (N = 160) over a 2-year period from the campus-wide tobacco-free policy initiation. A nurse-led, evidence-based, interdisciplinary approach can be an effective strategy to make a difference in the lives of tobacco-dependent individuals, while at the same time integrating practice with education and research.

Online tobacco cessation education to optimize standards of practice for psychiatric mental health nurses.

This article presents an overview of an online education offering to improve standards of practice for nurses intervening with tobacco-dependent mentally ill populations. Designed as a pilot study and guided by the theory of reasoned action framework, the pretest-posttest educational program was conducted to examine attitudes and beliefs, knowledge, and intentions to integrate tobacco cessation interventions into practice. Although positive attitudes and beliefs were demonstrated, knowledge gaps continued to exist after the online program. Strengths and challenges of the online education offering are presented with recommendations for future research.

Access to hematopoietic stem cell transplantation: effect of race and sex.

BACKGROUND: The purpose of the current study was to determine whether the use of hematopoietic stem cell transplantation (HCT) to treat leukemia, lymphoma, or multiple myeloma (MM) differs by race and sex. METHODS: The annual incidence of leukemia, lymphoma, and MM was estimated in the United States in people aged <70 years by race and sex using the Surveillance, Epidemiology, and End Results (SEER) cancer registry between 1997 and 2002 and US census reports for the year 2000. The annual incidence of autologous, human leukocyte antigen (HLA) identical sibling, and unrelated HCT performed in these groups was estimated using Center for International Blood and Marrow Transplant Research data from 1997 through 2002. Logistic regression analysis was used to calculate the age-adjusted odds ratio (OR) of receiving HCT for Caucasians versus African Americans and for men versus women. RESULTS: The likelihood of undergoing HCT was found to be higher for Caucasians than for African Americans (OR, 1.40; 95% confidence interval [95% CI], 1.34-1.46). This difference existed for each type of HCT: autologous (OR, 1.24; 95% CI, 1.19-1.30), HLA identical sibling (OR, 1.59; 95% CI, 1.46-1.74), and unrelated donor (OR, 2.02; 95% CI, 1.75-2.33). Overall, men were more likely than women to receive HCT (OR, 1.07; 95% CI, 1.05-1.1 [P<.0001]); however, this difference was found to be significant only for autologous HCT (OR, 1.10; 95% CI, 1.07-1.13 [P<.0001]). CONCLUSIONS: HCT is more frequently used to treat leukemia, lymphoma, and MM in Caucasians than in African American individuals. African Americans have lower rates of both autologous and allogeneic HCT, indicating that donor availability cannot fully explain the differences. Women are less likely than men to receive autologous HCT for reasons unexplained by age or disease status.