National Institute of Nursing Research
National Institute of Nursing Research
News Article | October 31, 2016
PHILADELPHIA, PA (October 31, 2016) - A new study from the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research (CHOPR) shows that older black adults are not only more likely to be readmitted following an elective hip/knee replacement, than otherwise similar white patients - they may also be more adversely affected by insufficient hospital nurse staffing. The results are set for publication in a future issue of the Journal of the American Geriatric Society, but are available now online here. The cross-sectional study analyzed data of nearly 107,000 Medicare patients in 483 US hospitals and points to improving nurse-to-patient staffing ratios as a strategy for reducing racial disparities in postoperative readmissions. After accounting for patient factors such as patient acuity, age, and socioeconomic status, as well as characteristics of the hospital where patients receive care, older black adults have a 30 percent increased likelihood of readmission compared with their white counterparts. "Patients have multiple risk factors, such as older age or comorbidity, which predispose them to re-hospitalization. Our findings suggest that an individual's race is one such risk factor for poorer health outcomes," says the study's lead investigator Karen Lasater PhD, RN, and a Postdoctoral Fellow at CHOPR. Racial disparities in readmission outcomes are widely recognized and remain unabated despite numerous efforts in the public and private sectors. The study points to hospital nurse staffing as a likely mechanism for reducing readmissions in this postsurgical group and further demonstrates the added value for older minority adults. Every additional patient in a nurse's workload was associated with eight percent increased odds of readmission among older white patients and 15 percent increased odds among older black patients. "What is striking about these findings is that we find this relationship even in a cohort of relatively healthy adults undergoing an elective surgery. The protective benefit of higher nurse-to-patient staffing for minorities may be related to gaps in health care access, financial flexibility, and social support systems. If individuals lack resources to mobilize ongoing support following discharge, the quality and intensity of care received during the hospitalization may help to address such gaps," says Lasater. Since 2010, hospitals have been financially penalized for high readmission rates under the Centers for Medicare and Medicaid Services Hospital Readmission Reduction Program. Safety-net hospitals, those serving a disproportionate share of low-income and under-served patients, are more likely to experience financial penalties and have demonstrated slower improvements in curbing readmission rates overtime, compared to better resourced hospitals. These study findings provide insight into one potential mechanism that may help alleviate readmission disparities observed across various patient populations. This study shows nurse staffing is important for the health outcomes of all patients, but may have a more protective effect for black patients. While the study does not demonstrate causation, it suggests a focus on supporting front line providers can improve readmissions for high-risk groups. Matthew McHugh, PhD, JD, MPH, RN, Associate Director of CHOPR, served as co-lead investigator for this research. This study was supported by grants from the National Institute of Nursing Research (R01-NR04513, T32-NR0714 and R01-AG041099-01), and from the Robert Wood Johnson Foundation Nurse Faculty Scholars Program. The University of Pennsylvania School of Nursing is one of the world's leading schools of nursing, is consistently ranked as one of the top graduate nursing schools in the United States, and is among the nation's top recipients of nursing research funding from the National Institutes of Health. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through research, education, and practice. Follow Penn Nursing on: Facebook, Twitter, LinkedIn, Instagram & YouTube.
News Article | November 16, 2016
(PHILADELPHIA) November 16, 2016 - Hospitals that employ more nurse assistants relative to the number of professionally qualified nurses have higher mortality rates, lower patient satisfaction, and poorer quality and safety of care, according to a new European study published today in the leading scientific journal BMJ Quality and Safety. This study highlights the risks to patient safety and quality in hospitals that employ a greater proportion of lower skilled caregivers, say the lead study authors from the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing (Penn Nursing). The article, 'Nursing Skill Mix in European Hospitals: Cross-sectional Study of the Association with Mortality, Patient Ratings, and Quality of Care,' is available here through open access. The authors note that the study's findings in Europe closely mirror those from the United States and Canada where research has consistently shown that patients' lives and money could be saved by moving to a hospital nursing skill mix with a higher proportion of registered nurses (RNs). Costs are lower because good professional nurse staffing is associated with fewer costs incurred by patient complications. This is the largest study to date of the outcomes of variations in nursing skill mix in European hospitals and finds: A total of 242 representative hospitals were studied in Belgium, England, Finland, Ireland, Spain, and Switzerland. These countries are a subset of the 12 countries included in the large EU-funded RN4CAST study on the impact of nursing on quality of care in European hospitals selected because of the availability of independent data on mortality and patient satisfaction among hospitalized patients. The outcomes of 275,519 patients undergoing general surgery were reviewed. Some 18,828 patients rated their hospital care experience and 13,077 nurses practicing in the study hospitals reported on staffing levels and quality and safety of care. "The contention of some leaders in health care that fewer highly skilled professional nurses in hospitals supported by lower skilled, lower waged workers is safe and cost effective is not supported by this study," says lead author Linda Aiken, PhD, RN, Director of Penn Nursing's Center for Health Outcomes and Policy Research. "This research is consistent with a growing body of research showing that sufficient numbers of professional nurses providing direct care to hospitalized patients produces the best outcomes and avoids costly adverse care outcomes." "This is a very timely study because the NHS in England has announced its intention to train a new category of worker called 'nursing associates' who have limited qualifications and to use a measure that ignores the distinctions between registered nurses and untrained assistants when comparing staffing levels between hospitals and wards," added co-author, Peter Griffiths, Chair of Health Services Research at the University of Southampton. "England has one of the lowest percentages among European countries of professional nurses at the bedside already. Our study suggests that the NHS needs to focus on achieving safe registered nurse staffing levels as a means to achieve better outcomes including improving patients' satisfaction with their care." Co-author, Anne Marie Rafferty, DPhil (Oxon) RN, from the Florence Nightingale Faculty of Nursing and Midwifery, King's College London adds, "Our study finds that high professional nurse burnout and job dissatisfaction in hospital nursing practice is not alleviated by adding lower skilled workers. This fuels staff turnover and poses a significant threat to the sustainability of the NHS. Our results suggest that achieving safe professional nurse staffing is a more efficient and productive way to retain more nurses at the hospital bedside." "The findings are highly relevant to Europe with its difficulties in recovering from the economic crisis and facing continuous austerity measures in health care," said Walter Sermeus, co-author at KU Leuven and European coordinator of the RN4CAST study. The RN4CAST study was funded by European Union's Seventh Framework Program (223468) and the National Institute of Nursing Research, National Institutes of Health (NR014855). Editor's Notes: The researchers report no conflicts of interest. About the University of Pennsylvania School of Nursing The University of Pennsylvania School of Nursing is one of the world's leading schools of nursing, is consistently ranked as one of the top graduate nursing schools in the United States, and is among the nation's top recipients of nursing research funding from the National Institutes of Health. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through research, education, and practice. Follow Penn Nursing on: Facebook, Twitter, LinkedIn, Instagram & YouTube. About the University of Southampton Through world-leading research and enterprise activities, the University of Southampton connects with businesses to create real-world solutions to global issues. Through its educational offering, it works with partners around the world to offer relevant, flexible education, which trains students for jobs not even thought of. This connectivity is what sets Southampton apart from the rest; we make connections and change the world. http://www. About the Florence Nightingale School of Nursing and Midwifery at King's College London The Florence Nightingale Faculty of Nursing & Midwifery is the direct descendant of the Nightingale Training School established at St Thomas' Hospital in 1860. We are the world's first school of nursing. We develop leading-edge nurses and midwives of tomorrow - practitioners, partners, and leaders in their field. The Faculty is ranked as the number one faculty for nursing in the UK (QS For further information, please visit the website: http://www. About KU Leuven Institute for Healthcare Policy, University of Leuven, Belgium The KU Leuven Institute for Healthcare Policy is a world-leading research and education institute for healthcare management and policy. It is recently designated as a WHO Collaborating Center for Human Resources Research and Policy. http://www. .
News Article | November 22, 2016
PITTSBURGH, Nov. 22, 2016 - People living with serious illness who receive palliative care have better quality of life and fewer symptoms than those who don't receive palliative care, according to a new study by researchers at the University of Pittsburgh School of Medicine. Published today in the Journal of the American Medical Association (JAMA), the study is the first meta-analysis of the effect of palliative care as it relates to patients' quality of life, symptom burden and survival. Palliative care is health care for people living with serious illness and focuses on providing patients with relief from their symptoms, pain and stress of a serious illness, whatever the diagnosis. Palliative care can either refer to a specific service that is provided by physicians and nurses who have received specialized training in this type of care, or an overall approach to care for patients with serious illness, which would include palliative care when provided by a specialist or by a non-palliative care specialist (like an oncologist or a primary care physician). This study took a broad approach and looked at the philosophy of palliative care. The researchers conducted a systematic review of 43 trials of palliative care interventions, including 12,731 adults with serious illness and 2,479 of their family caregivers. Researchers also performed a meta-analysis to investigate the overall association between palliative care and three outcomes often linked with palliative care--patients' quality of life, symptom burden and survival. A meta-analysis is the statistical process of combining the results of multiple trials, which gives researchers an overall effect for interventions. "Taken all together, this is a very compelling message," said Dio Kavalieratos, Ph.D., assistant professor of medicine in the Section of Palliative Care and Medical Ethics in Pitt's Division of General Internal Medicine and lead author of the study. "People's quality of life and symptoms improved; their satisfaction with their health care improved--all during what is likely one of the most difficult periods of their lives." Researchers also determined that palliative care was associated with improvements in advance care planning, patient and caregiver satisfaction with care, and lower health care utilization. There was mixed evidence of improvement with site of death, patient mood, health care expenditures, and caregiver quality of life, mood or burden. "Historically, palliative care has overwhelmingly focused on individuals with cancer, but anyone with a serious illness, be it cancer, heart failure, multiple sclerosis or cystic fibrosis, deserves high-quality, individualized care that focuses on reducing their suffering and improving their quality of life," Kavalieratos said. "We need to find ways of integrating palliative care concepts in patients' usual care experiences so it isn't a luxury, but a standard part of health care for those living with serious illness." Over the past five years, much attention has been paid to the idea that palliative care improves patients' survival, Kavalieratos added. Although some individual studies had shown that, the association didn't play out when multiple studies were pooled together in the meta-analysis. "As a field, we need to develop new methods of studying how palliative care impacts people with serious illness and their caregivers," Kavalieratos added. "These methods should not burden patients and caregivers who participate in this research, but also need to be rigorous enough to capture what's going on at this critical point in people's lives." The researchers received funding support from several agencies, including the Agency for Healthcare Research and Quality (K12HS022989); National Heart, Lung, and Blood Institute (K01HL13346); National Institutes of Health (KL2TR000146); and National Institute of Nursing Research (K99NR015903). Those involved in the study included 10 staff members from Pitt, as well as others from the University of North Carolina at Chapel Hill, University of Alabama at Birmingham, University of Toronto and Virginia Tech. About the University of Pittsburgh School of Medicine As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support. Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www. .
News Article | November 2, 2016
WINSTON-SALEM, N.C. - Nov. 2, 2016 - Women experience a notable decline in sexual function approximately 20 months before and one year after their last menstrual period, and that decrease continues, though at a somewhat slower rate, over the following five years, according to a study led by a researcher at Wake Forest Baptist Medical Center. The study, published ahead of print in the online issue of Menopause: The Journal of the North American Menopause Society, also found that various factors that frequently co-occur with menopause have less direct influence on declining sexual function than menopause itself. "Sexual functioning in women declines with age, and there has been much debate about how much this is due to menopause, aging or other physical, psychological or social factors," said the study's lead author, Nancy Avis, Ph.D., professor of public health sciences at Wake Forest School of Medicine, part of Wake Forest Baptist. "Our findings support that menopause has a negative effect on sexual functioning in many women." Additionally, the study found that women who have a hysterectomy before the onset of menopause do not experience a marked decline in sexual function immediately before undergoing the procedure but do so afterward, for as long as five years. The researchers based their findings on information collected from 1,390 participants in the federally funded Study of Women's Health Across the Nation (SWAN), which began in 1996. These women, who were between the ages of 42 and 52 at the time of enrollment in the study and who had a known date of final menstrual period during their participation, responded to questionnaires dealing with various aspects of sexual function - including desire, arousal, satisfaction and pain - between one and seven times over the course of the study. The researchers analyzed 5,798 of these self-assessments (4,932 from the 1,164 women in the natural menopause group and 866 from the 226 women in the hysterectomy group) and tracked the changes in the respondents' scores on the sexual-function questionnaires relative to either their final menstrual period among women who experienced a natural menopause or the hysterectomy. Of note, in the natural menopause group the researchers found that race/ethnicity played a major role in the decline of sexual function, with African-American women experiencing a significantly smaller decline and women of Japanese descent experiencing a much greater decline when compared with white women. "Sexual functioning is an important component of women's lives. More than 75 percent of the middle-aged women in the SWAN study reported that sex was moderately to extremely important to them when the study began," Avis said. "It is important for women and their health care providers to understand all the factors that may impact women's experience of sex in relation to both the natural menopausal transition and hysterectomy, and we hope our findings will contribute to better understanding in this area." The SWAN project received funding from the National Institutes of Health through the National Institute on Aging, National Institute of Nursing Research and NIH Office on Women's Health in grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554 and U01AG012495. Co-authors of the study are Alicia Colvin, Ph.D., Maria Brooks, Ph.D., and Ping D. Tepper, Ph.D., University of Pittsburgh School of Public Health; Arun S. Karlamangla, M.D., Ph.D., and Gail A. Greendale, M.D., David Geffen School of Medicine at UCLA; Sybil Crawford, Ph.D., University of Massachusetts Medical Center, Worcester; Rachel Hess, M.D., University of Utah School of Health Sciences; and L. Elaine Waetjen, UC Davis School of Medicine.
News Article | November 26, 2015
You’re lingering outside your date’s dorm room and he’s fumbling with his keys. A calculated combination of dialogue options led you to this moment. Moving inside, as you’re shedding your clothes, you look at your date’s pixelated body and wonder: How do I ask his HIV status? Will he be persuaded to use a condom? A box pops up on the right corner of your screen. It feeds you lines like “Hey, I was just wondering, when was your last STD test?” or “Do you have any condoms?” You choose neither. Pressing forward, you move to the bed. A buzz resonates and the screen freezes: AT-RISK BEHAVIOR, it reads. You are promptly redirected to a 3D tutorial. TRY AGAIN. Once your turn is over, you remove the Oculus Rift virtual reality headset and pass it to your classmate. She places it on her head and the simulation kicks in outside her date’s dorm room. Is this the future of sex-ed—an immersive, VR driving test for teenaged love? Two researchers at Emory University, in collaboration with technologists at Georgia Tech, are working to realize their vision of 3D, high-engagement sex education for college-age women of color in the US. Spurred by the high rate of STIs, HIV infections and unintended pregnancies among African-American woman, Emory nursing professor Rasheeta Chandler and nursing program director Henry Ross are laying the groundwork for a VR application that, they argue, could better educate college women of color about safe and problematic sexual behaviors. Comprehensive sex-ed is proven to thwart unintended pregnancies and prevent the contraction of STIs. But more effective than properly pronouncing Latin anatomical terms is the actual practice of safe sexual behaviors before they’re really necessary. In this sense, sex ed may be a prime candidate for the VR treatment. VR sex ed certainly isn’t a great leap in logic; the Oculus is already on its way to becoming a high-cost porn screening device, with first-person viewpoints and choose-your-own-adventure plotlines already drawing at least a half dozen porn companies to VR. And this is months away from the Oculus Rift’s commercial release date. The stakes are high for teenagers. If unfurling a dummy digital condom could prevent even a few sexual mishaps, could VR be the answer to poor sex education we’ve been looking for? Using Oculus technology, users would enter dozens of lifelike scenarios to role-play consent, proper contraception use and other components of safe sex from a first-person perspective. “We’re trying to make it like interactive gaming,” Chandler told me. “We want to model the virtual environment on descriptions of what happens on college campuses.” Chandler described a potential VR scenario where a user and her avatar partner are sitting in a dorm room, poised to do the deed, when she’s prompted to decide whether to use a condom. If she opts for contraception, she would have to demonstrate on cyber-genitals how to use it; and, if she fails, she would be rerouted to an educational component in the VR program. There, she reviews step-by-step instructions. Then she’d have a second shot. Another potential scenario, Chandler explained, would evoke a club setting. A stranger approaches and offers a drink, soon beckoning the user to leave with him. The user would be educated about how to give consent or say “no,” and if it came to it, what resources are available for reporting sexual violence. Ideally, internalizing good judgment through immersive technology would empower victims to report their assault or prevent the contraction of HIV. In Chandler and Ross’s view, VR is the ultimate frontier for HIV prevention. Innovations in sex-ed couldn’t be more welcome to the sexual health community. Teen pregnancies are more common in states with government-funded abstinence-only programs, although one in two states requires schools to stress abstinence. Only 22 states mandate sex-ed at all. Perhaps this is why, according to data from the National Campaign to Prevent Teen and Unplanned Pregnancy, 41 percent of teenagers report knowing nothing, or very little, about condoms by the time they graduate high school (with 75 percent knowing nothing about the pill). That’s a year after the average teen loses their virginity. Of the around 750,000 teen pregnancies that occur yearly in the US, only two in ten are intended. For women of color, Chandler and Ross’s target audience, the stats on sexual health are even bleaker: African-American women account for 64 percent of all new HIV infections among all women in the US. Of any demographic in America, they also have the highest rate of unintended pregnancy. Before turning to VR, Chandler received an award from the National Institute of Nursing Research to study how to tailor HIV prevention for college-age black women. “Not all [African-American woman] received extensive sexual health education and training during their teenage years unless it involved direct experience,” Ross told me. “We hope that this program will provide the type of intervention that this population has imagined for some time.” But given that 30 years of public sexual health research remain essentially ignored by many American school systems, would a cutting-edge sex-ed program even be able to find footing in more conservative states where it’s most needed? Advocates for Youth Director of Sexuality Education and Training Nora Gelperin is optimistic about virtual reality as a venue for sex education. “We know that programs that are able to personalize the risk for young people, to help them understand that they are susceptible if they engage in specific behaviors, are beneficial,” she explained. Gelperin stressed the effectiveness of sex-ed programs that are not only based on sound health theories, but help students explore their values in a safe environment. An Oculus program, in which users are alone and insulated from reproach from peers or partners, could be an ideal venue, she said. On top of the safe and apparently private atmosphere inside an Oculus headset, its capacity for emotional immersion could be one of VR sex ed’s greatest assets. Ela Darling, VR cam girl and co-owner of VRtube, one of the earliest VR porn companies, says that instructive porn (videos that teach the ins and outs of various sex acts) is already immensely popular on traditional viewing platforms. Adding a third dimension to educational pornography could also add more dimensions to the sex-ed experience. “One of the benefits of VR sex is the level of empathy you can evoke in someone,” she said, “by showing them a first-person scenario of how to put on a condom or putting them in the position of someone who has been in a non-consensual sexual situation.” Darling noted that, with traditional sex ed in classrooms, there’s often a wall separating students from the material they’re engaging with. With VR, she told me, “you’re immersed in the world so much that you don’t feel like there’s anyone around you to judge or gawk at you. It’s just you and this world.” Darling has already taught her VR cam audience how to use KinkLab’s Neon Wand, a fetish sex toy, and how to find the elusive G-spot. She plans on providing lessons in ropework and bondage rigging, which she admits is difficult to learn from 2D images. (A representative from Virtual Real Porn, another VR porn company, confirmed that they have also discussed facilitating educational content.) Chandler and Ross submitted their proposal to the National Institute of Health last month. If their project receives funding, the future of sex ed could very well resemble something like a VR driving test, complete with a 3D checklist of proper sexual behavior. But for potential funders it might be difficult to invest in a world where students spend most of class waiting in line for their turn with the Oculus, especially when the average school only provides one computer per five students. (For Chandler and Ross’s college-age audience, the ratio is higher). For now, it’s unclear how the researchers would circulate and scale up the technology should they receive NIH funding. “We're really thinking about the implications on public health,” Chandler said. “We haven't thought about it from a marketing standpoint.” In VR’s endless capacity to position itself as a blanket solution to all societal inadequacies, the current state of sex ed could be a prime candidate for the “3D immersion” treatment. Intoxicated by the apparently infinite social possibilities for VR technology, however, it’s easy to forget that the American public’s understanding of sexuality is still stuck in an era where slide-flipping View-Masters would be a better technological fit. We live in a time where an Oculus in every classroom seems more viable than a basket of condoms. Perhaps today’s technology is decades ahead of our social thought. Or, perhaps, if teenagers were given the option to practice safe sex before the need actually arose a decrease in STIs and unintended pregnancies would follow. Once our public health knowledge catches up to our zeal for cutting-edge gadgets, the two forces could in parallel stamp out our harshest epidemics. Or, if school systems ever fully dismiss abstinence-only sex education, it will be against the backdrop of a terraformed Mars. Ross, however, is confident that his vision for VR sex ed will be disseminated nationally once it gains some momentum. His previous research on African American women’s opinions of virtual reality has convinced him that his target audience will embrace the technology, and more crucially, the opportunity to be more in touch with sexual health. “Maybe the last thing you want to do is sit for an hour-and-a-half in a classroom,” Ross said. “We hope that this program will provide the type of intervention that this population has imagined for some time.”
News Article | November 24, 2016
People with serious illness who are provided palliative care enjoy better quality of life, improved survival rates and fewer symptoms, says a new study published in the Journal of the American Medical Association. Carried out by researchers from the University of Pittsburgh School of Medicine, it's the first meta-analysis to focus on palliative care and how it relates to patient quality life, survival and symptom burden. As health care for people with serious illness, palliative care is geared toward providing relief from symptoms, stress and pain brought about by a health condition, regardless of the diagnosis. It differs then from hospice care that is aimed at providing specialized care for patients at the advanced stages of their diseases where the primary goal may be to be as comfortable as possible as final days are lived out. Palliative care may also be provide by specialists or non-specialists, like primary care doctors. After reviewing 43 trials involving palliative interventions, which included 12,731 adults diagnosed with serious illness as well as 2,479 family caregivers, the researchers found that patients were satisfied with their overall health, at what could be considered one of the hardest times in their life, after receiving palliative care. They also saw that palliative care was connected to better planning for advanced care, lower utilization of health care and satisfaction for the level of care provided from both caregiver and patient, although evidence was mixed in terms of the patient's mood, the caregiver's quality of life and health care expenses. "Taken all together, this is a very compelling message," said Dio Kavalieratos, Ph.D., the study's lead author. Traditionally, palliative care was offered to cancer patients but anyone seriously sick will benefit from high-quality specialized care designed to ease suffering and improve quality of life, pointed out the researchers. Kavalieratos added that it is crucial to figure out how palliative care can be integrated into a patient's usual care experiences so it is not treated as a luxury but rather as a health care standard for those who are seriously ill. Over the last five years, palliative care has received a lot of attention as a means of improving patient survival rates. Some studies have shown proof of this, but the researchers say there remains a need to develop ways of examining how palliative care affects not just the people who are seriously sick but also those who care for them. The current study was provided with funding support by the National Institute of Nursing Research, the National Institutes of Health, the National Heart, Lung, and Blood Institute and the Agency for Healthcare Research and Quality. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.
News Article | November 21, 2016
GW researcher Victoria Shanmugam, M.D., published a study looking at the relationship between opioid treatment and the rate of healing in chronic wounds WASHINGTON (Nov. 21, 2016) -- Patients with chronic wounds who never receive opioids heal faster than those who do receive the drugs, according to a new study by George Washington University (GW) researcher Victoria Shanmugam, M.D. Published in Wound Repair and Regeneration, the data suggests that opioid exposure is associated with reduced likelihood of healing in patients with chronic wounds. While there is a strong correlation, whether this is a causal relationship will require further research. "Opioid analgestics are commonly prescribed to patients with chronic wounds, but until now, little to no research had been done to determine the relationship between opioid treatment and wound healing," said Shanmugam, associate professor of medicine at the GW School of Medicine and Health Sciences. "It seems that exposing patients to opioids may impact ultimate wound outcome. More work needs to be done to understand this finding and the possible mechanisms driving it. We look forward to continuing this research, which may lead to faster healing and improved patient outcomes." Shanmugam and her research team studied 450 subjects enrolled in the WE-HEAL biorepository. Data was collected using baseline characteristics, such as pain score, longitudinal opioid exposure, and total wound surface area. Opioid dose was found to be significantly associated with total wound surface area. Chronic wounds are those that have failed to heal after three months of appropriate wound care. Approximately 6.5 million people in the U.S. experience chronic wounds. They cause considerable pain, affecting patient well-being and quality of life, and significantly impact their mortality. Additionally, costs associated with chronic wounds are estimated at $25 billion per year. "Finding ways to improve healing of chronic wounds will have an enormous effect on patients and the healthcare system," said Shanmugam. GW researchers Kara S. Couch, M.S., CRNP, CWS; Sean McNish, M.S., CRA; and Richard L. Amdur, Ph.D., are co-authors for this study. The study was primarily funded by the National Institute of Nursing Research, the National Center for Advancing Translational Sciences, and the National Institutes of Health through the Clinical and Translational Science Awards Program. For the full study published in Wound Repair and Regeneration, "Relationship between Opioid Treatment and Rate of Healing in Chronic Wounds," please visit https:/ . Media: To interview Dr. Shanmugam, please contact Lisa Anderson at email@example.com or 202-994-3121. About the GW School of Medicine and Health Sciences: Founded in 1824, the GW School of Medicine and Health Sciences (SMHS) was the first medical school in the nation's capital and is the 11th oldest in the country. Working together in our nation's capital, with integrity and resolve, the GW SMHS is committed to improving the health and well-being of our local, national and global communities. smhs.gwu.edu
News Article | November 18, 2016
Long-term services and supports are provided to disabled persons who live in nursing homes, in assisted living facilities, and in their own homes to help maintain quality of life and independence. In the United States (US), long-term services and supports are provided to 12 million people. With the aging of the US population, the number of persons needing long-term services and supports will increase substantially over the next several decades. Many of the older persons receiving long-term services and supports live with multiple chronic conditions. These persons are at risk for hospitalizations that can have serious consequences, such as falls and decline in function. A recent study published in Nursing Research journal by New York University Rory Meyers College of Nursing (NYU Meyers) Assistant Professor Janet H. Van Cleave, PhD, RN and her study team examines the association between combinations of multiple chronic conditions and hospitalization by older adults who receive long-term services and supports. To conduct this study, Dr. Van Cleave and her team used existing data from a National Institute on Aging and National Institute of Nursing Research funded study entitled "Health - Related Quality of Life: Elders in Long-Term Care (HrQoL), R01AG025524. The researchers also used a sophisticated analysis, Latent Class Analysis, to identify subgroups of persons with specific combinations of multiple chronic conditions that likely occurred together within individuals. The identified subgroups were combinations of cardiopulmonary conditions (i.e. cardiopulmonary class), cerebrovascular/paralysis conditions (i.e. cerebrovascular class), and all other conditions (i.e. all other conditions class). In analyzing the data, the researchers found that persons with a high probability of being in the "cardiopulmonary" class had statistically greater number of hospitalizations compared to persons with high probability of being in the "all other conditions" class. The researchers also found that persons most likely to be in the "cardiopulmonary class" or "cerebrovascular/paralysis class" were more likely to be male, Black/Other race, and reside in a nursing home. Medicaid patients were overrepresented in the "cardiopulmonary class" compared to the "cerebrovascular disease/paralysis class" or the "all other conditions class" Dr. Van Cleave and her study team concluded that effective care management strategies are needed for early identification and intervention to prevent hospitalizations in chronically ill older adults, especially those with multiple cardiopulmonary conditions. These strategies include the use of sophisticated analyses, such as latent class analysis, for early identification and intervention in populations at risk for hospitalization. Interventions that need further exploration include prevention and management of polypharmacy and transitional care from hospital to residence within services provided by medical homes. "Ultimately, new care management strategies are needed to meet the desires and needs of persons living with multiple chronic conditions that limit their capacity for self-care," said Dr. Van Cleave. 1. Assistant Professor, NYU Rory Meyers College of Nursing, New York, NY. 2. Associate Research Professor, Biostatistics Facility, Fox Chase Cancer Center, Philadelphia, PA 3. Assistant Professor of Gerontology, Miami University, Oxford, OH. 4. NewCourtland Term Chair in Health Transitions Research and Research Associate Professor of Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA. 5. Director of Nursing Practice, Hospital of the University of Pennsylvania, Philadelphia, PA. 6. Marian S. Ware Professor in Gerontology Director, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA. Acknowledgements: The authors acknowledge the following funding sources: Health Related Quality of Life: Elders in Long Term Care, R01AG025524, National Institute on Aging and National Institute of Nursing Research, Mary D. Naylor, Principal Investigator; Individualized Care for At-Risk Older Adults, T32-NR009356, National Institute of Nursing Research, Postdoctoral Research Fellowship; University of Pennsylvania, NewCourtland Center for Transitions and Health (Pilot Study), Comorbidity Patterns of Elders with Cancer Receiving Long Term Services and Supports, Janet H. Van Cleave, Principal Investigator. NYU Rory Meyers College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science with a major in Nursing, a Master of Science and Post-Master's Certificate Programs, a Doctor of Nursing Practice degree and a Doctor of Philosophy in nursing research and theory development.
News Article | December 12, 2016
Family members of the more than 10 million adults with bipolar disorder in the United States often see their own heath suffer from the demands of taking care of them. With a four-year, $2 million National Institutes of Health (NIH) grant, nurse scientists at Case Western Reserve University will conduct one of the first studies to test ways family members can maintain and improve their health while caring for relatives with bipolar disorder. "Often, family caregivers experience the unpredictable ups and downs of their relatives living with bipolar disorder," said Jaclene A. Zauszniewski, principal investigator on the NIH grant. "At the same time, caregivers may also be raising their own families, holding down jobs and leading their own lives." Bipolar disorder is a chronic mental illness leading to extreme mood swings and disruptive symptoms that challenge a person's ability to function normally, according to the National Institute of Mental Health. Previous studies have shown that caregivers of people with bipolar disorder have higher levels of distress than those with diabetes, hypertension, asthma or dementia. They also suffer from significantly more mental and physical health problems than the general population, which leads to greater use of mental health and primary care services. "Stress on caregivers can become so intense that it affects their health, which may make them unable to care for the diagnosed family member and may worsen the condition of the relative with bipolar disorder," said Zauszniewski, the Kate Hanna Harvey Professor in Community Health Nursing at Case Western Reserve's Frances Payne Bolton School of Nursing. Based on clinical and written tests, researchers will match caregivers with ways to self-manage their health that best fits their mental and physical needs. For example, caregivers with low variability in their heart rates--a sign of stress--will be taught breathing techniques designed to have calming effects. Researchers may also prescribe training in specific self-help and help-seeking skills to aid caregivers in coping with the ups and downs of their family member's bipolar disorder. Such techniques break from the traditional one-size-fits-all approach of providing education about bipolar disorder to family members before assessing their needs or preferences. "Existing strategies for these caregivers have had little effect on improving their health," said Zauszniewski. "If we can get to a place where these family members can manage their distress and remain healthy, then they'll be able to provide better care for their relatives." Researchers believe the study's results could also be applied to caregivers of people with other chronic mental or physical conditions, Zauszniewski said. The NIH's National Institute of Nursing Research awarded the grant.
News Article | December 1, 2016
The Gerontological Society of America (GSA) and Senior Service America, Inc., have named Sarah Szanton, PhD, ANP, FAAN, of the Johns Hopkins University School of Nursing as the 2016 recipient of the Senior Service America Senior Scholar Award for Research Related to Disadvantaged Older Adults. This honor acknowledges presentations at the GSA Annual Scientific Meeting that represent exemplary basic or applied research related to the capabilities, contributions, challenges and concerns of disadvantaged older adults, especially those who are low-income and minority group members. The Senior Scholar Award recipient must have five or more years of professional experience after receiving his/her terminal graduate degree. Szanton was selected for the paper "Food Assistance Reduces Nursing Home Admissions for Maryland's Dually Eligible Older Adults." Her study showed that -- all else equal -- older low-income recipients of Supplemental Nutrition Assistance Program (SNAP) benefits are significantly less likely to enter a nursing home. And if they do, their stay is substantially shorter than those who are not SNAP recipients. The award presentation took place at GSA's 2016 Annual Scientific Meeting, which was held November 16 to 20 in New Orleans, LA. This conference fosters interdisciplinary collaboration among researchers, educators, and practitioners who specialize in the study of aging. Visit http://www. for further details. Szanton is an associate professor at the Johns Hopkins University School of Nursing. She has developed a program of research on the role of the environment and stressors in health disparities in older adults, particularly those trying to "age in place" or stay out of a nursing home. The result is a program called CAPABLE, which combines handyman services with nursing and occupational therapy to improve mobility, reduce disability, and decrease healthcare costs. She is currently examining the program's effectiveness through grants from the National Institutes of Health and the Innovations Office at the Center on Medicaid and Medicare Services. She is also conducting a study, funded by the Robert Wood Johnson Foundation, of whether food and energy assistance improve health outcomes for low-income older adults. A former health policy advocate, Szanton aims her research and publications toward changing policy for older adults and their families. Szanton completed undergraduate work in African-American Studies at Harvard University. She holds a MSN degree from the University of Maryland and a PhD from Johns Hopkins University. She has had funding from the National Institute of Nursing Research and the John A. Hartford Foundation. Szanton also is a GSA fellow, which represents the Society's highest class of membership. The Gerontological Society of America (GSA) is the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society -- and its 5,500+ members -- is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA's structure also includes a policy institute, the National Academy on an Aging Society, and an educational branch, the Association for Gerontology in Higher Education. Senior Service America, Inc. (SSAI) is committed to making it possible for low-income and other disadvantaged older adults to participate fully in determining their own future and the future of their communities. For more than 40 years, the organization has operated the federal Senior Community Service Employment Program (SCSEP) through a network of local subgrantee organizations. For more information, please visit http://www. .