Continuous glucose monitors: use of waveform versus glycemic values in the improvements of glucose control, quality of life, and fear of hypoglycemia.

How patients are benefitting from continuous glucose monitoring (CGM) remains poorly understood. The focus on numerical glucose values persists, even though access to the glucose waveform and rate of change may contribute more to improved control. This pilot study compared outcomes of patients using CGMs with or without access to the numerical values on their CGM. Ten persons with type 1 diabetes, naïve to CGM use, enrolled in a 12-week study. Subjects were randomly assigned to either unmodified CGM receivers, or to CGM receivers that had their numerical values obscured but otherwise functioned normally. HbA1c, quality of life (QLI-D), and fear of hypoglycemia (HFS) were assessed, at baseline and at week 12. Baseline HbA1c for the entire group was 7.46 ± 1.27%. At week 12 the experimental group HbA1c reduction was 1.5 ± 0.9% (p < .05), the control group's reduction was 0.06 ± 0.61% (p > .05). Repeated measures testing revealed no significant difference in HbA1c reduction between groups. Both groups had reductions in HFS; these reductions were statistically significant within groups (p < .05), but not between groups. QLI-D indices demonstrated improvements (p < .05) in QLI-D total and the health and family subscales, but not between groups. The results of this pilot study suggest that benefits of CGM extend beyond reductions in HbA1c to reductions in fear of hypoglycemia and improvements in quality of life. The display of a numerical glucose value did not improve control when compared to numerically blinded units.

An advanced practice nursing program for foreign medical doctors: a practical approach.

AIM: This article articulates lessons learned about an accelerated family nurse practitioner course offered to foreign medical doctors who also held baccalaureate nursing degrees (BSN). BACKGROUND: In the last decade, many physicians in the Philippines returned to school to obtain BSN degrees and licensure as registered nurses (referred to as nurse-medics) to emigrate to the United States in the hope of a better life. Once in the United States, many remain in nursing even though they prefer the practice of medicine. METHOD: This fast-track master's degree program began in fall 2006 at a university in the southwestern United States in collaboration with St. Jude College in the Philippines. By the end of this program (2010), 76 students had graduated. All who sat for the FNP national certification exam passed on the first attempt. RESULTS: Due to a decrease in qualified applicants, the program eventually closed, but a number of important lessons were learned. CONCLUSION: Nursing programs planning to undertake accelerated programs to transition medical doctors to nurse practitioners should consider they retake courses such as physical assessment, pharmacology and pathophysiology.

Biofeedback-assisted relaxation training to decrease test anxiety in nursing students.

BACKGROUND: Nursing students experiencing debilitating test anxiety may be unable to demonstrate their knowledge and have potential for poor academic performance. METHOD: A biofeedback-assisted relaxation training program was created to reduce test anxiety. Anxiety was measured using Spielberger's Test Anxiety Inventory and monitoring peripheral skin temperature, pulse, and respiration rates during the training. Participants were introduced to diaphragmatic breathing, progressive muscle relaxation, and autogenic training. RESULTS: Statistically significant changes occurred in respiratory rates and skin temperatures during the diaphragmatic breathing session; respiratory rates and peripheral skin temperatures during progressive muscle relaxation session; respiratory and pulse rates, and peripheral skin temperatures during the autogenic sessions. No statistically significant difference was noted between the first and second TAI. Subjective test anxiety scores of the students did not decrease by the end of training. CONCLUSION: Autogenic training session was most effective in showing a statistically significant change in decreased respiratory and pulse rates and increased peripheral skin temperature.

Research support in doctoral-granting schools of nursing: a decade later.

Many nursing schools invest resources in offices to support research efforts and to strengthen research programs for external funding. This article will describe the resources available for research support in schools of nursing with doctoral degree-granting programs. Using a descriptive survey design, invitations and links to the online survey were sent to deans of nursing schools offering doctoral degrees as identified by the American Association of Colleges of Nursing. Response rate was 70.6% (120/170 eligible institutions), and 75% had a research office. Presence of a research office was associated with being in an academic health sciences center, being located in a public institution, and offering a doctor of philosophy (PhD) program. In 2009-2010, the average budget for the research offices was $390,000. Research offices were staffed by a director (88.6%), a grant administrator (78%), a statistician (74%), and a clerical staff (58.6%) and provided an array of services including grant support, scholarly support, and faculty development services. Nursing schools provided various support services for research productivity. Of those schools reporting that they had a research office, 59% had received National Institutes of Health (NIH) funding in the past year. Greater NIH funding was associated with those research offices employing more staff and offices existing for longer periods.

Methodological quality and scientific impact of quantitative nursing education research over 18 months.

The methodological quality of nursing education research has not been rigorously studied. The purpose of this study was to evaluate the methodological quality and scientific impact of nursing education research reports. The methodological quality of 133 quantitative nursing education research articles published between July 2006 and December 2007 was evaluated using the Medical Education Research Study Quality Instrument (MERSQI).The mean (+/- SD) MERSQI score was 9.8 +/- 2.2. It correlated (p < .05) with several scientific impact indicators: citation counts from Scopus (r = .223), Google Scholar (r = .224), and journal impact factor (r = .216); it was not associated with Web of Science citation count, funding, or h Index. The similarities between this study's MERSQI ratings for nursing literature and those reported for the medical literature, coupled with the association with citation counts, suggest that the MERSQI is an appropriate instrument to evaluate the quality of nursing education research.

Student stress and academic performance: home hospital program.

The purpose of this study was to evaluate whether nursing students assigned to a home hospital experience less stress and improved academic performance. Students were assigned to a home hospital clinical placement (n = 78) or a control clinical placement (n = 79). Stress was measured using the Student Nurse Stress Index (SNSI) and Spielberger's State Anxiety Inventory. Academic performance included score on the RN CAT, a standardized mock NCLEX-RN(®)-type test; nursing grade point average; and first attempt pass-fail on the NCLEX-RN. There were no statistically significant differences between the two groups for age, gender, marital status, ethnicity, or score on the nurse entrance examination. There were significant changes in SNSI over time but not between groups. Academic load and state anxiety showed an interaction of time by group, with the home hospital group showing reductions over time, compared with the control group.

Leveraging higher salaries for nursing faculty.

The nursing faculty pay scale at the University of Nevada, Las Vegas, has increased significantly over the past 5 years. This increase was driven by a number of factors: (a) the rapidly expanding population in Nevada, (b) the nursing shortage and the Nevada legislative mandate to double nursing enrollment in state schools, (c) the national nursing faculty shortage, and (d) the opening of private nursing schools in Nevada. This article describes how, given these factors, the faculty members were able to leverage a pay scale that is finally competitive with clinical appointments.

Altered beta-2 adrenergic receptor gene expression in human clinical hypertension.

OBJECTIVES: The beta-2 adrenergic receptor is involved in mediating vasodilatation via neurohumoral and sympathetic nervous system pathways. Alterations in beta-2 adrenergic receptor gene expression (mRNA transcription) may contribute to the hypertensive phenotype. Human gene expression in clinical phenotypes remains largely unexplored due to ethical constraints involved in obtaining human tissue. We devised a method to obtain normally discarded internal mammary artery tissue from coronary artery bypass graft patients. We then investigated differences in hypertensive and normotensive participants' beta-2 adrenergic receptor gene expression in this tissue. METHODS: We collected arterial tissue samples from 46 coronary artery bypass patients in a surgical setting. Using 41 of the samples, we performed TaqMan real-time polymerase chain reaction (RT-PCR) and used the delta delta cycle threshold (DeltaDeltaCt) relative quantitation method for determination of fold-differences in gene expression between normotensive and hypertensive participants. The beta-2 adrenergic receptor target was normalized to glyceraldehyde-phosphate dehydrogenase. RESULTS: Participants with hypertension had significantly less-expressed beta-2 adrenoceptor gene (2.76-fold, p<.05) compared to normotensive participants. After Bonferroni correction, gene expression did not differ by race, gender, type/dose of beta-blocker prescribed, positive family history of hypertension, or diagnosis of diabetes mellitus type 2. CONCLUSIONS: These data support the possibility of a molecular basis for impaired adrenoceptor-mediated vascular tone in hypertension. Modification and extension of this research is required.

Using rare diseases as models for biobehavioral research: allergic bronchopulmonary aspergillosis.

Biobehavioral science explores links between biological, psychosocial, and behavioral factors and health. Maintaining positive health outcomes over time and across a variety of populations and settings requires understanding interactions among biological, behavioral, and social risk factors as well as other variables that influence behavior. Some barriers to biobehavioral research are related to performing biobehavioral research along the natural history of an illness, limitations in existing methodologies to assess the biological impact of behavior, the unknowns relating to impact of behavior on biology, and lack of valid and reliable biobehavioral methods to assess outcomes. A rare disease, such as allergic bronchopulmonary aspergillosis (ABPA) can be used as a model of biobehavioral research. ABPA complicates asthma and cystic fibrosis. It is a hypersensitivity reaction to Aspergillus fumigatus in most cases. ABPA can be classified into five stages: acute, remission, exacerbation, steroid-dependent asthma, and fibrotic or end stage. Because of its rarity, there can be delays in diagnosis. Treatment has used oral corticosteroids and antifungal agents in addition to management of asthma or cystic fibrosis. The National Institute of Nursing Research held an invitational 2-day working group meeting on July 15-16, 2004 with biobehavioral, biological, and immunologic science experts to examine current knowledge of biobehavioral research and to provide recommendations for additional research. The focus was on biobehavioral methods of measurement and analysis with interdisciplinary/biobehavioral approaches. This article is an outcome of this meeting.

Psychosocial and physiological stress among women leaving welfare.

Women receiving Temporary Assistance for Needy Families (TANF) report more stress and have poorer health than women in the general population. Studies suggest chronic stress may contribute to poor health via physiological mechanisms, yet little is known about these mechanisms in this population. This study examined psychosocial stress, salivary cortisol, 24-hr ambulatory blood pressure and heart rate, and health among 40 single mothers before and after exiting TANF. As a group, perceived stress decreased after leaving TANF (p = .02), with other measures of psychosocial and physiological stress remaining unchanged. Within participants, changes in psychosocial stress predicted depression and general health over time (adjusted R(2) = .30 and .22; p = .006 and .004, respectively). These findings indicate psychosocial stress is positively associated with depression and negatively associated with general health as women exit welfare. Psychosocial stress was not associated with changes in physiologic indicators of stress.

Physiological wet laboratory facilities in colleges of nursing.

The purpose of this study was to describe physiological wet laboratories as they exist within colleges of nursing with doctoral programs. Surveys were sent to the current deans and directors of all 96 nursing colleges/schools with doctoral programs as of January 2004, obtained from the American Association of Colleges of Nursing Web site. Only 26 (37%) of 71 responding schools operate their own wet laboratory, either singly or with another college. The most common analyses done are hormone levels, immune proteins, and cell counts, followed by catecholamines, chemistries, and bacterial cultures. Approximate annual costs of running wet laboratories range from 1,500 dollars to 320,000 dollars per school. Schools based in an academic health center were more likely to operate a wet laboratory ( chi2 = .003). There were no differences based on source of university funding (public vs. private) or Carnegie classification.

Biofeedback-assisted relaxation training for essential hypertension: who is most likely to benefit?

The main purpose of this study was to develop a way to predict which persons with essential hypertension would benefit most from biofeedback-assisted relaxation (BFAR) training. Second, the authors evaluated the effect of BFAR on blood pressure (BP) reduction, which was measured in the clinic and outside the clinic using an ambulatory BP monitor. Fifty-four adults with stage 1 or 2 hypertension (78% taking BP medications) received 8 weeks of relaxation training coupled with thermal, electromyographic, and respiratory sinus arrhythmia biofeedback. Blood pressure was measured in the clinic and over 24 hours using an ambulatory BP monitor pretraining and posttraining. Systolic BP dropped from 135.0 +/- 9.8 mmHg pretraining to 132.2 +/- 10.5 mmHg posttraining (F = 6.139, P = .017). Diastolic BP dropped from 80.4 +/- 8.1 mmHg pretraining to 78.5 +/- 10.0 mmHg posttraining (F = 4.441, P = .041). Data from 37 participants with baseline BP of 130/85 mmHg or greater were used to develop a prediction model. Regression showed that those who were able to lower their SBP 5 mm Hg or more were (1) not taking antihypertensive medication, (2) had lowest starting finger temperature, (3) had the smallest standard deviation in daytime mean arterial pressure, and (4) the lowest score on the Multidimensional Health Locus of Control-internal scale. Since these types of persons are most likely to benefit from BFAR, they should be offered BFAR prior to starting hypertensive medications.

Obesity-related cardiovascular risk factors: intervention recommendations to decrease adolescent obesity.

The incidence of adolescent obesity is increasing dramatically in the United States with associated risks of hypertension, adverse lipid profiles, and Type II diabetes. Unless reversed, this trend predicts an epidemic of adult cardiovascular disease. Interventions at home, at school, and in the community are required to empower teens to increase physical activity and to modify eating habits. This article describes assessment for obesity-related health problems as well as scientific guidelines and research-based intervention strategies to decrease obesity in adolescents.