College of Nursing and Health Science

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90-90-90-plus: Maintaining adherence to antiretroviral therapies
(Mary Ann Liebert, 2017-05-01) Corless, Inge; Hoyt, Alex; Tyer-Viola, Lynda; Sefcik, Elizabeth; Kemppainen, Jeanne; Holzemer, William; Sanzero Eller, Lucille; Nokes, Kathleen; Phillips, J. Craig; Dawson Rose, Carol; Rivero-Mendez, Marta; Iipinge, Scholastika Ndatinda; Chaiphibalsarisdi, Puangtip; Portillo, Carmen J.; Chen, Wei-Ti; Webel, Allison; Brion, John; Johnson, Mallory O.; Voss, Joachim; Hamilton, Mary Jane; Sullivan, Kathleen M.; Kirksey, Kenn; Nicholas, Patrice; Corless, Inge; Hoyt, Alex; Tyer-Viola, Lynda; Sefcik, Elizabeth; Kemppainen, Jeanne; Holzemer, William; Sanzero Eller, Lucille; Nokes, Kathleen; Phillips, J. Craig; Dawson Rose, Carol; Rivero-Mendez, Marta; Iipinge, Scholastika Ndatinda; Chaiphibalsarisdi, Puangtip; Portillo, Carmen J.; Chen, Wei-Ti; Webel, Allison; Brion, John; Johnson, Mallory O.; Voss, Joachim; Hamilton, Mary Jane; Sullivan, Kathleen M.; Kirksey, Kenn; Nicholas, Patrice
Medication adherence is the “Plus” in the global challenge to have 90% of HIV-infected individuals tested, 90% of those who are HIV positive treated, and 90% of those treated achieve an undetectable viral load. The latter indicates viral suppression, the goal for clinicians treating people living with HIV (PLWH). The comparative importance of different psychosocial scales in predicting the level of antiretroviral adherence, however, has been little studied. Using data from a cross-sectional study of medication adherence with an international convenience sample of 1811 PLWH, we categorized respondent medication adherence as None (0%), Low (1–60%), Moderate (61–94%), and High (95–100%) adherence based on self-report. The survey contained 13 psychosocial scales/indices, all of which were correlated with one another (p < 0.05 or less) and had differing degrees of association with the levels of adherence. Controlling for the influence of race, gender, education, and ability to pay for care, all scales/indices were associated with adherence, with the exception of Berger's perceived stigma scale. Using forward selection stepwise regression, we found that adherence self-efficacy, depression, stressful life events, and perceived stigma were significant predictors of medication adherence. Among the demographic variables entered into the model, nonwhite race was associated with double the odds of being in the None rather than in the High adherence category, suggesting these individuals may require additional support. In addition, asking about self-efficacy, depression, stigma, and stressful life events also will be beneficial in identifying patients requiring greater adherence support. This support is essential to medication adherence, the Plus to 90-90-90.
Anticholingeric burden screening and reduction for older adults in long-term care
(2019-08) Arredondo, Derek; Garcia, Theresa; Baldwin, Sara; DeGrande, Heather
Anticholinergic (ACH) medication use amongst older adults has been associated with cognitive decline, development of dementia, counteraction of cholinergic dementia treatments, numerous adverse effects and subsequent prescribing cascades. Older adults in long-term care facilities (LTCF) are exceptionally vulnerable to these adverse effects. This quality improvement project implemented an evidence-based ACH cognitive burden screening and reduction program for adults aged 60 and older (N=31) in a south Texas LTCF to maximize cognitive function. Based on ACH medication screenings, reduction recommendations were made to prescribers for 19 residents. A three-group comparative design was used. The 3 groups included: those without recommended ACH reductions (n=12), those with recommendations for reduction which were approved by their prescribers (n=11) and those with recommendations which were not approved (n=8). Cognitive function was measured with the Short-Blessed Test (SBT) and ACH use with the Anticholinergic Cognitive Burden (ACB) scale. The group with approved reduction recommendations had a decreased mean (M ) ACB score (0.73 points lower, p=0.233) and a lower M SBT score (1.82 points lower, p=0.051) at 60-days post-intervention when compared to pre-intervention. Overall, the 31 participants had a significant decrease in M SBT (by 1.06, p=0.026) and a decrease in M ACB (by 0.23, p=0.422) in the same period. Those without any ACH reduction recommendations (n=12), were found to have a significantly increased M ACB, from 0.42 to 1.08 at the conclusion (p=0.013). The application of an evidence-based ACB screening and reduction program decreased ACB and was associated with clinically improved cognitive function in the residents of this facility. These findings were clinically significant and may also provide useful clinical outcome data to support research into, and improvement of, prescribing practices in LTCFs.
Assessment of the impact of patient/family video visitation on depression severity scores at a hospital-based skilled nursing facility
(2021-08) Robison, April Lynn; Loika, Elizabeth
Background: The COVID-19 global pandemic resulted in regulations severely restricting patient visitation in Skilled Nursing Facilities (SNF). Lack of family visitation can have a negative impact on patients such as loneliness, social isolation, and feelings of depression. Therefore, prompting this facility act to reduce the barriers for this, often fragile, patient population, at high risk for depression. Purpose: The purpose of this quality improvement (QI) project was to improve the resources provided by a hospital based SNF to prevent or lessen depression in patients, related to restricted family visitation, through implementation of a patient family video visitation initiative. Methods: This QI project used a before and after design to implement a technology-based patient/family video visitation initiative aimed at preventing or decreasing depression severity in patients cared for in a hospital-based SNF during the COVID 19 pandemic. Video visitation was implemented using an I-pad and the Microsoft Teams platform to allow for face-to-face visitation. PHQ-9 scores and patient/family satisfaction with video visitation were measured before and after the intervention. Conclusion: The initiation of a technology-based, patient-family visitation resource by the SNF resulted in patients scoring in the minimal depression category before and after the intervention, supporting the use of video visitation to prevent depression or worsening depression due to prolonged isolation of patients. The initiative illuminated the organizational and feasibility factors to be considered and mitigated when introducing new technology and processes into an already strained health care setting. Lessons learned and similar positive outcomes, can be expanded to many health settings faced with long lengths of patient stays where family members have regulatory, organizational, or personal barriers to visitation
Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America
(BMC, 2013-08-08) Phillips, J. Craig; Webel, Allison; Dawson Rose, Carol; Corless, Inge; Sullivan, Kathleen M; Voss, Joachim; wantland, dean; Nokes, Kathleen; Brion, John; Chen, Wei-ti; Iipinge, Scholastika; Sanzero Eller, Lucille; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Johnson, Mallory O.; Maryland, Mary; Kemppainen, Jeanne; Portillo, Carmen; chaiphibalsarisdi, puangtip; Kirksey, Kenn; Sefcik, Elizabeth; Reid, Paula; Cuca, Yvette; Huang, Emily; Holzemer, William; Phillips, J. Craig; Webel, Allison; Dawson Rose, Carol; Corless, Inge; Sullivan, Kathleen M; Voss, Joachim; wantland, dean; Nokes, Kathleen; Brion, John; Chen, Wei-ti; Iipinge, Scholastika; Sanzero Eller, Lucille; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Johnson, Mallory O.; Maryland, Mary; Kemppainen, Jeanne; Portillo, Carmen; chaiphibalsarisdi, puangtip; Kirksey, Kenn; Sefcik, Elizabeth; Reid, Paula; Cuca, Yvette; Huang, Emily; Holzemer, William
Background Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one’s life chances and overcome life’s challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH. Methods We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations. Results Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence. Conclusions Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society’s most vulnerable populations.
BDPS: An efficient spark-based big data processing scheme for cloud Fog-IoT orchestration
(MDPI, 2021-12-10) Hossen, Rakib; Whaiduzzaman, Md; Uddin, Mohammed Nasir; Islam, Md. Jahidul; Faruqui, Nuruzzaman; Barros, Alistair; Sookhak, Mehdi; Mahi, Md. Julkar Nayeen
The Internet of Things (IoT) has seen a surge in mobile devices with the market and technical expansion. IoT networks provide end-to-end connectivity while keeping minimal latency. To reduce delays, efficient data delivery schemes are required for dispersed fog-IoT network orchestrations. We use a Spark-based big data processing scheme (BDPS) to accelerate the distributed database (RDD) delay efficient technique in the fogs for a decentralized heterogeneous network architecture to reinforce suitable data allocations via IoTs. We propose BDPS based on Spark-RDD in fog-IoT overlay architecture to address the performance issues across the network orchestration. We evaluate data processing delays from fog-IoT integrated parts using a depth-first-search-based shortest path node finding configuration, which outperforms the existing shortest path algorithms in terms of algorithmic (i.e., depth-first search) efficiency, including the Bellman–Ford (BF) algorithm, Floyd–Warshall (FW) algorithm, Dijkstra algorithm (DA), and Apache Hadoop (AH) algorithm. The BDPS exhibits low latency in packet deliveries as well as low network overhead uplink activity through a map-reduced resilient data distribution mechanism, better than in BF, DA, FW, and AH. The overall BDPS scheme supports efficient data delivery across the fog-IoT orchestration, outperforming faster node execution while proving effective results, compared to DA, BF, FW and AH, respectively.
Bioactive ingredients in K. pinnata extract and the effects of combined K. pinnata and metformin preparations on antioxidant activities in diabetic and non-diabetic skeletal muscle cells
(2023-03-25) Ramon, Pedro; Bergmann, Daniela; Abdulla, Hussain; Sparks, Jean; Omoruyi, Felix
With healthcare costs rising, many affected by ailments are turning to alternative medicine for treatment. More people are choosing to complement their pharmacological regimen with dietary supplements from natural products. In this study, the compound composition of Kalanchoe Pinnata (K. pinnata) and the effects of combined preparations of K. pinnata and metformin on antioxidant activity in human skeletal muscle myoblasts (HSMMs) and human diabetic skeletal muscle myoblasts (DHSMMs) were investigated. Ultraperformance liquid chromatography fusion orbitrap mass spectrometry (UPLC-OT-FTMS) identified biologically active flavanols in K. pinnata. The main compounds identified in locally grown K. pinnata were quercetin, kaempferol, apigenin, epigallocatechin gallate (EGCG), and avicularin. Antioxidant results indicated that a combinatorial preparation of K. pinnata with metformin may modulate antioxidant responses by increasing the enzymatic activity of superoxide dismutase and increasing levels of reduced glutathione. A combination of 50 µM and 150 µg/mL of metformin and K. pinnata, respectively, resulted in a significant increase in reduced glutathione levels in non-diabetic and diabetic human skeletal muscle myoblasts and H2O2-stress-induced human skeletal muscle myoblasts. Additionally, a K. pinnata treatment (400 µg/mL) alone significantly increased catalase (CAT) activity for non-diabetic and diabetic human skeletal muscle myoblasts and a H2O2-stress-induced human skeletal muscle myoblast cell line, while significantly lowering malondialdehyde (MDA) levels. However, the treatment options were more effective at promoting cell viability after 24 h versus 72 h and did not promote cell viability after 72 h in H2O2 -stress induced HSMM cells. These treatment options show promise for treating oxidative-stress-mediated pathophysiological complications associated with type II diabetes.
A change initiative to prevent critical care nurse burnout implementing a sacred pause following patient death
(2021-08) Volek, Nicole Brion; DeGrande, Heather; Keys, Yolanda
Background: Critical care nurses are increasingly challenged by the complex work environment of the critical care unit. The nature of a critical care nurse’s job can be especially stressful because of the high patient morbidity and mortality, challenging daily work routines, and regular encounters with traumatic and ethical issues. Burnout concerns are particularly important when critical care nurses serve patients who die under their care, which can exacerbate general burnout. Purpose: This evidence-based change initiative aims to prevent burnout and thereby promote resilience in the critical care nurse by using an intentional sacred pause following a patient death. Methods: This change initiative project is a pre-test/post-test design. Burnout was measured pre-and post-intervention (the sacred pause) with the intention to prevent critical care nurse burnout and thereby promote nurse resilience. The Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS-MP) was used to measure nurse burnout. Conclusion: The MBI-HSS-MP inventory scores were similar on both pre-and postintervention assessments indicating prevention of nurse burnout. This evidence-based practice change initiative was well received by the staff members in the hospital and demonstrated clinical significance. Participation in the intervention was documented. The use and progressive implementation of the sacred pause following patient death was naturally implemented by the nurses. Critical care nurses are a vulnerable population susceptible to burnout. Further research around multi-modal health-promoting interventions such as the sacred pause will be beneficial for this population. Supporting critical care nurses to adopt health-promoting behaviors may promote resilience and prevent the risk of burnout that often results in many nurses leaving the profession
A cross-sectional description of social capital in an international sample of persons living with HIV/AIDS (PLWH)
(BMC, 2012-03-13) Webel, Allison; Phillips, J. Craig; Dawson Rose, Carol; Holzemer, William; Chen, Wei-Ti; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Nokes, Kathleen; Kemppainen, Jeanne; Sefcik, Elizabeth; Brion, John; Eller, Lucille; Iipinge, Scholastika; Kirksey, Kenn; Wantland, Dean; Chaiphibalsarisdi, Puangtip; Johnson, Mallory O.; Portillo, Carmen; Corless, Inge; Voss, Joachim; Salata, Robert; Webel, Allison; Phillips, J. Craig; Dawson Rose, Carol; Holzemer, William; Chen, Wei-Ti; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Nokes, Kathleen; Kemppainen, Jeanne; Sefcik, Elizabeth; Brion, John; Eller, Lucille; Iipinge, Scholastika; Kirksey, Kenn; Wantland, Dean; Chaiphibalsarisdi, Puangtip; Johnson, Mallory O.; Portillo, Carmen; Corless, Inge; Voss, Joachim; Salata, Robert
Background Social capital refers to the resources linked to having a strong social network. This concept plays into health outcomes among People Living with HIV/AIDS because, globally, this is a highly marginalized population. Case studies show that modifying social capital can lead to improvements in HIV transmission and management; however, there remains a lack of description or definition of social capital in international settings. The purpose of our paper was to describe the degree of social capital in an international sample of adults living with HIV/AIDS. Methods We recruited PLWH at 16 sites from five countries including Canada, China, Namibia, Thailand, and the United States. Participants (n = 1,963) completed a cross-sectional survey and data were collected between August, 2009 and December, 2010. Data analyses included descriptive statistics, factor analysis, and correlational analysis. Results Participant's mean age was 45.2 years, most (69%) identified as male, African American/Black (39.9%), and unemployed (69.5%). Total mean social capital was 2.68 points, a higher than average total social capital score. Moderate correlations were observed between self-reported physical (r = 0.25) and psychological condition (r = 0.36), social support (r = 0.31), and total social capital. No relationships between mental health factors, including substance use, and social capital were detected. Conclusions This is the first report to describe levels of total social capital in an international sample of PLWH and to describe its relationship to self-reported health in this population.
A cross-sectional relationship between social capital, self-compassion, and perceived HIV symptoms
(Elsevier, 2015-02-04) Webel, Allison; wantland, dean; Dawson Rose, Carol; Kemppainen, Jeanne; Holzemer, William; Chen, Wei-ti; Johnson, Mallory O.; Nicholas, Patrice; Sanzero Eller, Lucille; chaiphibalsarisdi, puangtip; Sefcik, Elizabeth; Nokes, Kathleen; Corless, Inge; Tyer-Viola, Lynda; Kirksey, Kenn; Voss, Joachim; Sullivan, Kathy; Rivero-Mendez, Marta; Brion, John; Iipinge, Scholastika Ndatinda; Phillips, J. Craig; Portillo, Carmen
Context Individual resources of social capital and self-compassion are associated with health behaviors and perceived symptoms, suggesting that both are positive resources that can be modified to improve a person's symptom experience. Objectives The aim was to examine the relationship between self-compassion and social capital and its impact on current HIV symptom experience in adult people living with HIV (PLWH). We further explored the impact of age on this relationship. Methods We conducted a cross-sectional analysis of 2182 PLWH at 20 sites in five countries. Social capital, self-compassion, and HIV symptom experience were evaluated using valid and reliable scales. To account for inflated significance associated with a large sample size, we took a random sample of 28% of subjects (n = 615) and conducted correlation analyses and zero-inflated Poisson regression, controlling for known medical and demographic variables impacting HIV symptom experience. Results Controlling for age, sex at birth, year of HIV diagnosis, comorbid health conditions, employment, and income, our model significantly predicted HIV symptom experience (overall model z = 5.77, P < 0.001). Employment status and social capital were consistent, negative, and significant predictors of HIV symptom experience. Self-compassion did not significantly predict HIV symptom experience. For those reporting symptoms, an increase in age was significantly associated with an increase in symptoms. Conclusion Employment and social capital modestly predicted current HIV symptom experience. Social capital can be incorporated into symptom management interventions, possibly as a way to reframe a person's symptom appraisal. This may be increasingly important as PLWH age. The relationship between employment status and HIV symptom experience was significant and should be explored further.
Depressive symptoms, self-esteem, HIV symptom management self-efficacy and self-compassion in people living with HIV
(Taylor and Francis Online, 2013-10-04) Sanzero Eller, Lucille; Rivero-Mendez, Marta; Voss, Joachim; Chen, Wei-ti; chaiphibalsarisdi, puangtip; Iipinge, S.; Johnson, Mallory O.; Portillo, Carmen; Sullivan, K.; Tyer-Viola, Lynda; Kemppainen, Jeanne; Dawson Rose, Carol; Sefcik, Elizabeth; Nokes, Kathleen; Phillips, J. Craig; Nicholas, P.K.; Holzemer, William; Webel, A.R.; Brion, J.M.; Sanzero Eller, Lucille; Rivero-Mendez, Marta; Voss, Joachim; Chen, Wei-ti; chaiphibalsarisdi, puangtip; Iipinge, S.; Johnson, Mallory O.; Portillo, Carmen; Sullivan, K.; Tyer-Viola, Lynda; Kemppainen, Jeanne; Dawson Rose, Carol; Sefcik, Elizabeth; Nokes, Kathleen; Phillips, J. Craig; Nicholas, P.K.; Holzemer, William; Webel, A.R.; Brion, J.M.
The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Beck's cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = −0.154), education (r = −0.106), work status (r = −0.132), income adequacy (r = −0.204, self-esteem (r = −0.617), HIV symptom self-efficacy (r = − 0.408), and self-kindness (r = − 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p < 0.001) in depressive symptoms was predicted by the combination of age, education, work status, income adequacy, self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Beck's theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.
A discharge protocol initiative to decrease hospital readmission following amputaton in adults with type 2 diabetes
(2021-08) Vasquez, Jennifer; Zhao, Meng; Park, Gloria; Gobert, Melissa; Watson, Joshua
Introduction: In the United States, lower limb amputations are more common in patients, than in those without diabetes, and can result in infections and unplanned hospital readmissions, that cost the U.S. billions of dollars annually. However, very few hospitals focus on amputation discharge education to prevent such readmissions. The purpose of this quality improvement project is to improve the quality of diabetic amputee discharge education by implementing a Diabetes-Amputation Protocol, with the intent of reducing infection related hospital readmissions. Methods: A Quality Improvement (QI) project conducted in an acute care, nonprofit hospital. A one group, pre-and-post design was used to conduct this project. Inclusion criteria: Participants >21 years of age, with T2DM, with initial amputation received the Diabetes-Amputation Protocol. Paired sample t-tests were used to compare patient knowledge, pre-and-post education. Descriptive statistics were used to calculate monthly percentages of patients who were readmitted and received the protocol. Results: The total number of participants was 30, with a mean age of 59.7 years. Findings from the DWCK questionnaire scores showed a statistically significant positive change from pre-to-post knowledge scores, with t(29) and p <0.01. The readmission rate decreased significantly from 20% to 7%, and 100% of participants received the Diabetes-Amputation Protocol. Conclusion: Improved the discharge material and individualized discharge information based on patient needs can improve patient knowledge, increase independent self-care and reduce hospital readmissions.
The early response to the coronavirus-surveys in southern Texas
(Global Journal of Health Science, 9/8/2021) Zhao, Meng; Monahan, Laura; Monahan, Michael; Huang, Yuxia; Mathur, Sunil
To investigate if Southern Texas communities were prepared in their awareness and knowledge of the coronavirus disease 2019 (COVID-19) in timed snapshots as the pandemic unfolded, two assessment surveys were implemented utilizing the Coronavirus Awareness and Preparedness Scale (CAPS) in March and April 2020, respectively. A convenience sample of university faculty in Southern Texas was used. Responses to survey questions changed significantly in the one-month timeframe. Respondents' perception of the COVID-19 threat increased dramatically from March to April, while their perceived preparedness facing the COVID-19 also increased tremendously. The benefits of mask-wearing were limited recognized in both March and April. Male and older people aged 55 and above had significantly lower awareness of the COVID-19 in March (p< 0.05) and may need more attention at the early phase of a pandemic. The increased availability of COVID-19 information through public health agencies led to the increased awareness of COVID-19. When facing a pandemic, both healthcare education and health care policy approaches are essential in addressing the containment and the eradication of COVID-19.
Education and reminder initiative to decrease sexually transmitted infections and increase HPV vaccinations in primary care
(2020-08) Pompa, Stacey Crystal; Murphey, Christina; Lee, Kyoung; Martinez, Mario A.; Seidel, Steven
Sexually transmitted infections (STIs) continue to rise within the United States and within local communities. The adolescent and young adult population accounts for nearly half of the new STI prevalence. All STIs are preventable however only 2 have an available vaccine. Since 2006, HPV vaccinations have been available to prevent the incidence of HPV infections and yet the vaccination rates remain low within the United States. An initial chart review of 50 electronic medical records (EMRs) from patients within that age group revealed these patients had no updated HPV vaccination information on their profiles and were not up to date with the completed HPV vaccination series. A quality improvement project was initiated to improve the STD education and HPV prevalence by providing reminders and administering HPV vaccines and educating patients on each visit about STDs at a local clinic within South Texas. A total of 85 patients between the ages of 13-24 years met the criteria to participate in the project, however 33 were excluded due to decline to participant and/or unable to contact for telephone follow up visit, leaving a total of 52 participants (n=52). The study showed an increase of STI education by approximately 87% after implementing verbal and written education during routine visits in primary care. A total of 47 referrals were discussed with the patients in regards to contacting the health department when opens to receive and completion of the HPV vaccination series. Due to the COVID-19 pandemic, patients were also given the health department’s information in efforts for them to contact and follow up with their HPV vaccination administration and completion of series. The number of vaccinations administered and the completed vaccination series among the participants were unable to be obtained due to the inability of administration from COVID-19.
Educational text messaging to improve knowledge and self-care practices among adults with Type 2 Diabetes
(2022-08) Brown, Merlendi; Park, Gloria; Lee, Kyoung; Houlihan, Amy
Poor diabetes knowledge and self-care practices are correlated with impaired glycemic control and vascular complications among patients with type 2 diabetes. Diabetes education interventions are essential to improve diabetes self-management and reduce overall mortality; however, time pressures imposed upon healthcare providers limit the amount and quality of education provided in the primary care setting. The purpose of this project was to determine if an educational text messaging intervention would improve diabetes knowledge and self-care practices among patients with type 2 diabetes in a rural primary care clinic. A pretest-posttest, quasi-experimental design was utilized and twenty patients with type 2 diabetes were recruited for this project. Three distinct educational text messages were disseminated weekly for 12 weeks. Six educational domains were addressed: nutrition, physical activity, foot care, blood sugar management, behavioral support, and general diabetes knowledge. Pre- and post-intervention measures consisted of diabetes knowledge and self-care participation questionnaires. From pretest to posttest, considerable improvements were observed in diabetes knowledge scores (13.3% increase), the number of days per week participants engaged in healthy (general) eating habits (15.7% increase), and the number of days per week participants engaged in foot care practices (21.4% increase). The results of this project indicate that educational text messaging can improve diabetes knowledge, general eating habits, and foot care practices among patients with type 2 diabetes in a rural primary care clinic. Based on these findings, we recommend integrating educational text messaging into clinical practice.
Effect of aerobic exercise on mitochondrial DNA and aging
(Science Direct, 2013-05-16) Eluamai, Anusha; Brooks, Kelly
The aging process occurs at different rates among different tissues. The complication of the definition of aging is due to the occurrence of various diseases that modify body functions and tissue structure. Advances in medicine and public health have considerably increased life expectancy over the past 200 years. An enormous effort has recently been expended to understand how the aging process is regulated at the molecular and cellular levels with hopes to find a way to extend maximal life span. There are several determinants of life span, but one common thread that has emerged in a variety of species from yeast to rodents is regulation of life span by mitochondria. Mitochondria decay that occurs with age cannot be counteracted unless physical activity is enhanced. As the frontiers of understanding the senescence and life span increases, the countermeasures for reducing aging senescence has brought to light the effectiveness of enhanced physical activities in aging individuals. Regular aerobic exercise may increase healthy life expectance and prolong life through beneficial effects at the mitochondrial level.
Engagement with care, substance use, and adherence to therapy in HIV/AIDS
(Hindawi, 2014-04-03) Nicholas, Patrice; Willard, Suzanne; Thompson, Clinton J.; Dawson Rose, Carol; Corless, Inge; Wantland, Dean; Sefcik, Elizabeth; Nokes, Kathleen; Kirksey, Kenn; Hamilton, Mary Jane; Holzemer, William; Portillo, Carmen; Rivero-Mendez, Marta; Robinson, Linda M.; Rosa, Maria; Human, Sarie P.; Cuca, Yvette; Huang, Emily; Maryland, Mary; Arudo, John; Sanzero Eller, Lucille; Stanton, Mark A.; Driscoll, MaryKate; Voss, Joachim; Moezzi, Shahnaz; Nicholas, Patrice; Willard, Suzanne; Thompson, Clinton J.; Dawson Rose, Carol; Corless, Inge; Wantland, Dean; Sefcik, Elizabeth; Nokes, Kathleen; Kirksey, Kenn; Hamilton, Mary Jane; Holzemer, William; Portillo, Carmen; Rivero-Mendez, Marta; Robinson, Linda M.; Rosa, Maria; Human, Sarie P.; Cuca, Yvette; Huang, Emily; Maryland, Mary; Arudo, John; Sanzero Eller, Lucille; Stanton, Mark A.; Driscoll, MaryKate; Voss, Joachim; Moezzi, Shahnaz
Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial () that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care.
The experience of working nurses attending graduate school during COVID-19: A hermeneutic phenomenology study
(2023-07-05) DeGrande, PhD, Heather; Seifert, Madison; Painter, Elizabeth
Introduction: There has been unprecedented uncertainty involved in the COVID-19 pandemic, especially for working nurses. Nurses working while attending graduate school faced additional unique challenges including working extended hours while also home-schooling young children, managing a family life while also navigating pandemic-related changes affecting students’ educational paths. Objectives: The purpose of this study was to explore the lived experiences of working nurses attending graduate school during the COVID-19 pandemic. The central research question was: What is the lived experience of working nurses attending graduate school during COVID-19? Methods: The exploration of the lived experience of working nurses attending graduate school during a pandemic required a research methodology delving into the meaning of lived experience as it has been lived, temporally, and contextually (during a pandemic). Qualitative hermeneutic phenomenology was used to explore the meaning of lived experience from an interpretational stance. Results: The overall meaning of the experience was a paradigm shift of existence across the three realms of work, home, and school. The themes associated with the shift were rapid change, uncertainty, fear, and support persons. Stress was a resulting overarching theme. Conclusions: To support working nurses further their education during times of crisis, nurse leaders and educators should put processes in place to mitigate change and stress through strategic communication and supportive work environments.
Exploring the stability of communication network metrics in a dynamic nursing context
(Elsevier, 2020-01-23) Brewer, Barbara; Carley, Kathleen M.; Benham-Hutchins, Marge; Effken, Judith A.; Reminga, Jeffrey
Network stability is of increasing interest to researchers as they try to understand the dynamic processes by which social networks form and evolve. Because hospital patient care units (PCUs) need flexibility to adapt to environmental changes (Vardaman et al., 2012), their networks are unlikely to be uniformly stable and will evolve over time. This study aimed to identify a metric (or set of metrics) sufficiently stable to apply to PCU staff information sharing and advice seeking communication networks over time. Using Coefficient of Variation, we assessed both Across Time Stability (ATS) and Global Stability over four data collection times (Baseline and 1, 4, and 7 months later). When metrics were stable using both methods, we considered them “super stable.” Nine metrics met that criterion (Node Set Size, Average Distance, Clustering Coefficient, Density, Weighted Density, Diffusion, Total Degree Centrality, Betweenness Centrality, and Eigenvector Centrality). Unstable metrics included Hierarchy, Fragmentation, Isolate Count, and Clique Count. We also examined the effect of staff members’ confidence in the information obtained from other staff members. When confidence was high, the “super stable” metrics remained “super stable,” but when low, none of the “super stable” metrics persisted as “super stable.” Our results suggest that nursing units represent what Barker (1968) termed dynamic behavior settings in which, as is typical, multiple nursing staff must constantly adjust to various circumstances, primarily through communication (e.g., discussing patient care or requesting advice on providing patient care), to preserve the functional integrity (i.e., ability to meet patient care goals) of the units, thus producing the observed stability over time of nine network metrics. The observed metric stability provides support for using network analysis to study communication patterns in dynamic behavior settings such as PCUs.
A health policy education initiative to increase political self-efficacy in texas nurse practitioners
(2020-08) Aleman, Kristy; Aleman, Kristy; Garcia, Theresa; Garcia, Theresa
Texas ranks lowest in the nation for access to healthcare. Improvement could be facilitated by active engagement of nurses in political activities and health policy advocacy. Political Self Efficacy (PSE) is the belief or idea that one can influence policymakers and/or the political process. Historically, nurse practitioners (NPs) have had low PSE because political activity in nurses tends to be limited to voting. This health policy education initiative was a collaboration between the Texas Nurse Practitioners (TNP) organization and Texas A&M University-Corpus Christi (TAMU-CC) to provide an evidence-based educational resource for Texas NPs to improve their PSE and ability to advocate for high quality healthcare for Texas residents. Approximately 5,145 members of TNP, were invited to participate in this health policy education initiative. Participants completed the Efficacy Index (EI) survey before and after attending two live educational webinars addressing key NP policies, the legislative process and engagement in advocacy. Participants were predominantly White females, held a master’s degree in Nursing, were certified as Family Nurse Practitioners, aged 46-65 years of age, and had an income between $80,000-$120,000/year. Pre-education mean scores improved, but only slightly (Webinar 1: 48.3 to 50.0; Webinar 2: 49.3 to 50.5). Initial levels of PSE in this NP sample were higher than expected, likely due to higher education, experience, and membership in a professional organization. Targeted educational interventions can improve PSE levels in NPs resulting in increased engagement in the political process, making it imperative to educate all nurses, and to expand educational opportunities to NPs outside of professional organizations. Nurses constitute the largest group of healthcare providers and have the potential to positively impact legislative health policies. Through increased PSE, Texas NPs can become the needed change agents to advocate for the rights of their profession and their patients.
Identifying barriers to diabetic self-management education for adult Hispanic males
(2019-08) Lopez, Hugo; Keys, Yolanda; Garcia, Theresa; Peck, Jessica L
This quality improvement project explores diabetes self-management barriers for adult Hispanic males with type II diabetes mellitus at the Texas A&M Coastal Bend Health Education Center (CBHEC). Since diabetes is one of the leading causes of death for Hispanic persons, especially men with behavioral characteristics associated with machismo, information on barriers preventing adult, Hispanic male attendance at CBHEC would help to improve their program. The director of this quality improvement project administered a Masculine Behavior Scale (MBS) questionnaire, conducted individual interviews, and identified essential elements of the participants’ experience which can be used to improve the CBHEC program. Recommendations were formulated for stakeholders to improve program offerings and encourage attendance of adult Hispanic males with identified barriers and serve as a basis for future projects to improve patient outcomes for the target population.

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