Jason Brinkley

Pediatric peripheral intravenous access: does nursing experience and competence really make a difference?

Placement of peripheral pediatric intravenous (IV) catheters in infants and children is difficult, even in skilled hands. This large, 2-institution prospective study used real-time independent observations to describe the effect of nurse experience and competence on the length of time and the number of attempts to establish a successful IV placement in the hospitalized child. Data from a convenience sample of 592 evaluable patients and 1135 venipunctures showed that successful IV placements required an average of 2 venipunctures over 28 minutes. Although nurse experience and self-rated competence were correlated with attaining a successful IV placement, time of day, predicted difficulty of the venipuncture, and cooperativeness of the child appeared to be better predictors of success.

Pushing the Envelope Beyond a Centimeter in Rectal Cancer: Oncologic Implications of Close, But Negative Margins

BACKGROUND The treatment of rectal cancer has improved significantly over the last century. Advances in surgical and adjuvant therapy coupled with a better understanding of the natural history have allowed for acceptance of progressively diminished margins for distal neoplasms. In order to better define oncologically safe distal margins, we performed a meta-analysis of the existing worlds literature. STUDY DESIGN Studies were identified on Medline and ISI Web of Science using key words rectal cancer and margin. Studies were excluded if specific margins and local recurrence rates could not be extracted. All analyses were performed using Comprehensive Meta-Analysis Software (Biostat). RESULTS Twenty-one studies reported outcomes in relationship to distal margins. Seventeen studies, 4,885 patients, reported outcomes with margins of less than 1 cm. Analysis of all studies indicated a nonsignificant trend favoring greater margins. However, in order to understand distal margins in the context of current care standards, additional analyses were performed. Thirteen studies reported application of total mesorectal excision and/or radiation. There was no significant difference in local recurrence rates for margins less than 1 cm. In the 4 studies that reported neither total mesorectal excision nor radiation, a margin greater than 1 cm was favored. Increased recurrence rates and decreased survival were associated with positive final margins. CONCLUSIONS When total mesorectal excision is combined with radiotherapy, excellent local control can be expected with sphincter preservation for distal rectal cancers when margins are less than 1 cm, as long as final pathologic margins are negative.

A Generalized Estimator of the Attributable Benefit of an Optimal Treatment Regime

For many diseases where there are several treatment options often there is no consensus on the best treatment to give individual patients. In such cases, it may be necessary to define a strategy for treatment assignment; that is, an algorithm that dictates the treatment an individual should receive based on their measured characteristics. Such a strategy or algorithm is also referred to as a treatment regime. The optimal treatment regime is the strategy that would provide the most public health benefit by minimizing as many poor outcomes as possible. Using a measure that is a generalization of attributable risk (AR) and notions of potential outcomes, we derive an estimator for the proportion of events that could have been prevented had the optimal treatment regime been implemented. Traditional AR studies look at the added risk that can be attributed to exposure of some contaminant; here we will instead study the benefit that can be attributed to using the optimal treatment strategy. We will show how regression models can be used to estimate the optimal treatment strategy and the attributable benefit of that strategy. We also derive the large sample properties of this estimator. As a motivating example, we will apply our methods to an observational study of 3856 patients treated at the Duke University Medical Center with prior coronary artery bypass graft surgery and further heart-related problems requiring a catheterization. The patients may be treated with either medical therapy alone or a combination of medical therapy and percutaneous coronary intervention without a general consensus on which is the best treatment for individual patients.

Association of the built environment with physical activity and adiposity in rural and urban youth.

OBJECTIVE To determine if: (1) differences exist for body mass index (BMI) and moderate-to-vigorous physical activity (MVPA) between rural and urban youth, and (2) perceived and objective measures of environmental supports for physical activity differentially correlate with BMI and MVPA in middle school rural and urban youth. METHOD Cross-sectional analyses were performed in spring 2012 on data collected from December 2008 until May 2010 for 284 middle school youth from a rural county and an adjacent urbanized area. Multivariable linear models estimated associations between BMI/MVPA and perceived environmental barriers/supports for physical activity and objectively measured neighborhood spatial variables. RESULTS Mean MVPA was significantly lower for rural youth (15.9 min/day) compared to urban youth (19.2 min/day). No differences were observed between rural and urban youth for BMI or BMI percentile. Significant differences in both perceived and objective correlates for MVPA and BMI percentile were found in multivariable models between rural and urban youth. CONCLUSION Differences observed for correlates of MVPA and BMI across the settings suggest that rurality should be considered when identifying targets for intervention to promote MVPA and prevent adiposity in youth.

Associations between Neighborhood Amenity Density and Health Indicators among Rural and Urban Youth

Purpose. To examine associations between the built/social environment (neighborhood amenity density, crime) and health indicators (body mass index [BMI] percentile, cardiovascular fitness, and time spent in moderate to vigorous physical activity [MVPA]) among rural and urban youth. Design. Cross-sectional. Setting. Eastern North Carolina. Subjects. Youth (n = 296) were recruited from three middle schools. Measures. Neighborhood density was estimated using Walk Score. Crime was assessed using Regional Analysis and Information Sharing online. BMI percentiles were calculated from measured height and weight. Cardiovascular fitness was estimated using heart rate measured at the conclusion of a 3-minute step test. Time spent in MVPA was measured objectively via accelerometer. Analysis. Bivariate and multivariate statistics were used to examine associations between Walk Score, crime, BMI percentile, cardiovascular fitness (as measured via heart rate), and MVPA. Results. Walk Score was positively correlated with crime. There were positive, statistically significant associations between Walk Score and (1) BMI percentile (p = .0223) and (2) heart rate (p = .0044), and (3) inverse associations between Walk Score and MVPA (p = .0042), indicating that high neighborhood density was associated with greater BMI percentiles, lower fitness, and less MVPA among urban youth. Conclusion. These counterintuitive findings may be due to the negative effect of crime on health indicators, which may outweigh potential positive health impacts of high neighborhood amenity density.

Radiotherapy associated with improved survival for high-grade sarcoma of the extremity

The impact of radiotherapy on local control in limb‐preserving surgery for high‐risk sarcoma has been well studied. However, the impact of the use and timing of radiation therapy on survival is unclear.

The stigma surrounding intimate partner violence: a cluster analysis study

Existing research suggests that a significant stigma surrounds intimate partner violence, and this stigma can make it difficult for survivors to receive help. This article presents the results of a research study that used hierarchical cluster analysis to identify whether certain types of stigma are more likely to co-occur. Survey results revealed four clusters based on participants’ stigma-related experiences: low stigma, blamed and black sheep, shame and separation, and high stigma. Participants in the high stigma group reported the highest levels of verbal abuse. Implications for theory, research, and practice are discussed.

Sexual behaviour and interest in using a sexual health mobile app to help improve and manage college students' sexual health

Many US college students are reported to engage in risky sexual behaviour. Smartphone applications are a popular way to provide users with information in real time. We explored the potential for mobile technology to be used in promoting the sexual health of college students. Using findings from an online survey among a random sample of 5000 college students (15% response), we examined sexual behaviours and interest in a sexual health application in January 2012. The majority of students were female (73%) and owned a smartphone (74%). Twenty-nine per cent currently used health-related applications on their phone and 67% reported interest in using a free application that could improve/manage their sexual health. Interest in use varied based on gender, race/ethnicity, sexual orientation, having an unintended pregnancy, sexually transmitted infection (STI) testing, smartphone ownership and past application use. The top most useful features for women included a period tracker (46%), birth control reminder (43%) and STI and pregnancy symptom checker (30%). Women were more likely to be interested in using the application compared with men and those engaging in more sexual activity were more likely to be interested as compared with those engaging in less sexual activity. The evaluation of mobile technology to promote healthy sexuality among college students is warranted.

Distress in Caregivers of a Family Member With Serious Mental Illness

It is well documented that mental illness influences not only the person diagnosed but also the family. The following study explored distress in 169 caregivers of a family member with serious mental illness (SMI). Factors such as time spent caregiving, type of familial relationship, mental health treatment, and income were explored as they associated to caregiver depression and family discord. Regression models suggested that caregiving for a son or daughter or devoting 20 hr a week or less to caregiving was associated with lower distress levels. Higher numbers of difficult behaviors exhibited by the person diagnosed were associated with higher family discord. The Mental Illness Distress Scale demonstrated some capacity to measure distress related to having a family member with SMI.

Sexual Behaviors During the First Year of College: An Exploratory Comparison of First and Second Semester Freshmen

The transition from high school to college offers adolescents more freedom that may result in increased risky sexual behaviors. This exploratory study examines sexual behaviors of freshmen. Half of participants completed a questionnaire during the first week of college and the other half during the last week of their freshmen year. Significant differences in sexual behaviors between the semesters and subgroups of students who may be more likely to engage in high risk behaviors are identified. The results suggest that freshmen need more effective targeted educational programming about the importance of condom use in preventing sexually transmitted infections (STIs) and pregnancy.