Jeanne Salyer

Supportive relationships, self-care confidence, and heart failure self-care.

Background: The theory of heart failure (HF) self-care proposes that confidence mediates relationships between social support and self-care behaviors. Objective: This study aimed to examine the effects of supportive relationships on self-care behaviors and the mediating effects of self-care confidence in HF outpatients. Methods: Structural equation modeling (SAS version 9.1, SAS Institute Inc, Cary, North Carolina) was used to examine the influence of supportive relationships and self-care confidence on self-care management and maintenance in a cross-section of patients with HF (n = 97; age = 56 years; 57% men; 45% African American; 55% married). Models included 3 variables characterizing supportive relationships: marital status (1 = currently married, 0 = not currently married), social network size (number of persons available to provide support), and perceived social support (Medical Outcomes Study Social Support Scale). To account for the effects of severity of illness, 2 measures characterizing severity of HF were included: left ventricular ejection fraction and New York Heart Association functional classification of HF. The Self-Care of Heart Failure Index (version 4) was used to measure self-care confidence, management, and maintenance. A consensus of fit indices estimated overall model fit. Results: Initial models fit the data; however, to improve fit and identify the most parsimonious models, 3 nonsignificant paths were removed, and modified models, including only social support and social network size, were proposed and tested. Modified models fit the data well and accounted for 15% in the variance in self-care maintenance (&khgr; 2 P = .29) and 18% of the variance in self-care management (&khgr; 2 P = .631). The indirect effect of social support (&bgr; = 0.37; P = .0004) through self-care confidence (&bgr; = 0.35; P = .0002) on self-care management, in the absence of a significant direct effect, supports the hypothesis that self-care confidence mediates the relationship between social support and self-care management. Social network size had a negative effect on self-care confidence (&bgr; = −0.22; P = .029), but this effect was mediated by self-care confidence (&bgr; = 0.33; P = .0002), which reduced the total negative effects. Self-care confidence was the best predictor of self-care management. In the self-care maintenance model, direct (&bgr; = 0.27; P = .003) and indirect effects of social support (&bgr; = 0.37; P = .0002) on self-care maintenance through self-care confidence (&bgr; = 0.22; P = .001) attenuated negative effects of social network size (&bgr; = −0.22; P = .0145). Social support was the best predictor of self-care maintenance. Conclusions: Findings support the positive influence of social support on self-care behaviors. Self-care confidence mediated the relationship between social support and self-care behaviors and had direct influence on these behaviors as well. This suggests that self-care confidence and self-care behaviors can be enhanced by improving the quality of social support.

An Integrative Review of Skin Breakdown in the Preterm Infant Associated with Nasal Continuous Positive Airway Pressure

OBJECTIVE To identify factors associated with skin injury during nasal continuous positive airway pressure (NCPAP) and describe differences in frequency, severity, and type of skin injuries when comparing nasal interfaces used during NCPAP in the preterm infant. DATA SOURCES Scientific databases were searched using provided key terms and yielded 113 articles. STUDY SELECTION Forty-six articles were included in this integrative review: six case studies, 22 with identified aim of examining skin and nasal injury during NCPAP; 18 included skin care considerations during NCPAP. DATA EXTRACTION Studies were categorized into four themes: types of nasal injuries; associated risk factors that increase incidence of injury; differences between NCPAP devices and/or nasal interface and corresponding rate and severity of nasal injury; and recommended prevention strategies to reduce iatrogenic cutaneous injury. DATA SYNTHESIS Skin injury was a common theme during neonatal NCPAP with skin breakdown rates of 20% to 60%. Increased skin injury risk was associated with smaller infant size, gestational age, and duration of therapy. Nursing care strategies to improve skin integrity during NCPAP had little supportive evidence. Nursing practice is varied with reportedly little standardized care during NCPAP therapy. Recommendations for specific care strategies to reduce skin injury during NCPAP were supported by limited experimental studies. CONCLUSIONS Risk factors during NCPAP include nasal injury and trauma secondary to tight-fitting nasal interfaces necessary to provide continuous distending pressure for respiratory stability. Identifying strategies to reduce skin breakdown will support noninvasive treatment success, reduce reintubation rates, reduce sepsis, reduce patient discomfort, and improve developmental outcomes during NCPAP use.

Heart failure symptom relationships: a systematic review.

Background:Heart failure is a prevalent chronic health condition in the United States. Individuals who have heart failure experience as many as 2 to 9 symptoms. The examination of relationships among heart failure symptoms may benefit patients and clinicians who are charged with managing heart failure symptoms. Objective:The purpose of this systematic review was to summarize what is known about relationships among heart failure symptoms, a precursor to the identification of heart failure symptom clusters, as well as to examine studies specifically addressing symptom clusters described in this population. Methods:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in the conduct of this systematic review. PubMed, PsychINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Database were searched using the search term heart failure in combination with a pair of symptoms. Results:Of a total of 1316 studies identified from database searches, 34 were included in this systematic review. More than 1 investigator found a moderate level of correlation between depression and fatigue, depression and anxiety, depression and sleep, depression and pain, anxiety and fatigue, and dyspnea and fatigue. Conclusions:The findings of this systematic review provide support for the presence of heart failure symptom clusters. Depression was related to several of the symptoms, providing an indication to clinicians that individuals with heart failure who experience depression may have other concurrent symptoms. Some symptom relationships such as the relationships between fatigue and anxiety or sleep or pain were dependent on the symptom characteristics studied. Symptom prevalence in the sample and restricted sampling may influence the robustness of the symptom relationships. These findings suggest that studies defining the phenotype of individual heart failure symptoms may be a beneficial step in the study of heart failure symptom clusters.

A comparative effectiveness study of continuous positive airway pressure-related skin breakdown when using different nasal interfaces in the extremely low birth weight neonate

A three group prospective randomized experimental design was conducted to identify differences in frequency and severity of nasal injuries when comparing various interfaces used during continuous positive airway pressure (CPAP) and identified risk factors associated with injury. Seventy-eight neonates <1500 g were randomized into three groups: continuous nasal prongs; continuous nasal mask; or alternating mask/prongs. Repeated measures ANOVA with Bonferroni correction demonstrated that significantly less skin injury was detected in the rotation interface group when compared to both mask and prong groups. In the final stepwise regression model (F = 11.51; R(2) = 0.221; p = 0.006) significant predictors of skin injury included number of days on nasal CPAP (p < 0.001) and current mean post menstrual age (p = 0. 006). Reduced nasal injury was demonstrated using rotating mask/prong nasal interfaces. Future best practices must include precise selection of device size, developmental and CPAP device positioning with focused skin assessment including rapid intervention for skin injury.

Self-efficacy and barriers to healthy diet in cardiac rehabilitation participants and nonparticipants.

Background and Research Objective:Participation in cardiac rehabilitation (CR) can result in positive outcomes for patients, but this population comprises only up to 20% of the total cardiac population. Thus, it is also necessary to examine the determinants of lifestyle behaviors in cardiac patients who do not attend CR programs. Studies have focused largely on physical health and outcomes of exercise participation, with less attention to dietary habits and the psychological determinants of behavior change. The purpose of this descriptive comparative study was to examine the differences in self-efficacy for and barriers to healthy dietary intake between CR participants and nonparticipants at 6 and 12 weeks after hospital discharge. Participants and Methods:A prospective longitudinal design was used. The sample consisted of 51 adults who (1) were diagnosed with/recovering from an acute cardiac event, treatment, or intervention; (2) received phase I CR; and (3) were physically able to participate in phase II CR. Participants were primarily male, elderly, married, and white; had more than a high school education; and had incomes more than

Psychosocial assessment of candidates and risk classification of patients considered for durable mechanical circulatory support.

30 000. Analysis of covariance was used to determine differences over time in self-efficacy and barriers to healthy dietary intake between groups. Results and Conclusions:Although time 1 findings between groups were not significant, CR participants reported higher self-efficacy for healthy dietary intake than did nonparticipants. At time 2, CR participants also reported greater self-efficacy (F3,40 = 13.69, P ⩽ .0001), indicating more confidence they could commit to a healthy diet. A significant difference was found in barriers to healthy dietary intake (t = 2.13, P = .04) at time 1, with CR participants reporting fewer barriers. At time 2, CR participants reported fewer barriers to healthy dietary intake (F3,39 = 18.19, P < .0001), indicating a more positive perception. Findings improve understanding of factors influencing adoption of healthy diet behaviors and are useful for designing interventions to assist individuals in sustaining secondary preventive efforts over time.

Salivary Biomarkers of Chronic Psychosocial Stress and CVD Risks A Systematic Review

BACKGROUND The psychosocial assessment of candidates for transplantation (PACT), developed to assess candidates for heart transplant, has not been routinely used to assess left ventricular assist device (LVAD) candidacy. We examined the efficacy of the PACT to assess psychosocial outcomes in LVAD patients. METHODS We reviewed patients who received LVAD implants between June 2006 and April 2011 and retrospectively applied the PACT. We determined the accuracy of identifying social success with the PACT and revised domains to reflect criteria influencing social success for LVAD patients. RESULTS Forty-eight patients (72% men, 44% non-white, 50.4 years old) were divided into high-scoring and low-scoring groups. Nine patients with low PACT scores were falsely categorized as high-risk, whereas 4 with high scores had poor social outcomes. The score had a high positive-predictive value (0.86) but low negative-predictive value (0.31). The PACT was revised (modified [m]PACT) to measure indicators, such as social support and understanding of care requirements, identified to more closely affect LVAD outcome. The mPACT exhibited improved accuracy. A reclassification table was developed, and the net reclassification index was 0.32. The percentage of patients incorrectly classified for social risk decreased from 27% with the PACT to 8% with the mPACT. Patients with higher mPACT scores had decreased 30-day readmission rates (26% vs 67%, p = 0.045) after device implantation. CONCLUSIONS By emphasizing social support, psychologic health, lifestyle factors, and device understanding, the mPACT showed improved performance in risk-stratifying candidates for LVAD therapy. Prospective validation is warranted.

Psychological Strains, Salivary Biomarkers, and Risks for Coronary Heart Disease Among Hurricane Survivors

Background: The use of salivary biomarkers in stress research is increasing, and the precision and accuracy with which researchers are able to measure these biomarkers have dramatically improved. Chronic psychosocial stress is often linked to the pathogenesis of cardiovascular disease (CVD). Salivary biomarkers represent a noninvasive biological method of characterizing the stress phenomenon that may help to more fully describe the mechanism by which stress contributes to the pathogenesis and outcomes of CVD. Objectives: We conducted a systematic review of 40 research articles to identify the salivary biomarkers researchers have most commonly used to help describe the biological impact of chronic psychosocial stress and explore its associations with CVD risk. We address strengths and weaknesses of specimen collection and measurement. Methods: We used PubMed, CINAHL, EBSCOhost, Web of Science, BIOSIS Previews, Biological Sciences (ProQuest), and Dissertations/Theses (ProQuest) to retrieve 387 initial articles. Once we applied our inclusion/exclusion criteria to specifically target adult human studies dealing with chronic stress rather than acute/laboratory-induced stress, 40 studies remained, which we synthesized using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Results: Cortisol was the biomarker used most frequently. Sources of psychosocial stress included job strain, low socioeconomic status, and environmental factors. Overall, psychosocial stress was associated with CVD risks such as vascular pathology (hypertension, blood pressure fluctuation, and carotid artery plaque) as well as metabolic factors such as abnormal blood glucose, dyslipidemia, and elevated cardiac enzymes. Conclusion: Diverse salivary biomarkers have been useful in stress research, particularly when linked to CVD risks.

Text Messaging as Adjunct to Community-Based Weight Management Program

Objective: To examine the associations of psychological strains, salivary biomarkers, and coronary heart disease (CHD) risks in hurricane survivors 2 years after Hurricane Ike in the United States. Background: Hurricane survivors often suffer from long-lasting posttraumatic stress disorder (PTSD) and other forms of psychological strain related to surviving a natural disaster and dealing with its aftermath. Psychological strains may be associated with biomarkers, which, in turn, may be associated with a higher incidence of CHD risks. Methods: Structured interviews were conducted with 19 hurricane survivors to assess psychological strains (PTSD, perceived stress, depression, and anxiety) and measure CHD risks. Saliva samples were collected by the passive drool method and analyzed for inflammatory cytokine (interleukin [IL]-1β, IL-6, and IL-10) and chemokine (monocyte chemotactic protein [MCP]-1) biomarkers. Results: The salivary level of MCP-1 was significantly associated with PTSD symptoms, depression (both p < .01), and anxiety (p < .05). There were significant associations between anxiety and hypertension (p < .01), perceived stress and blood glucose level (p < .05), and perceived stress and obesity (p < .05). Conclusion: Our findings that long-lasting psychological strains are associated with major CHD risks and salivary MCP-1 levels suggest that the mechanism by which such strains play a role in the development of CHD involves recruitment of monocyte cells in response to chronic endothelial inflammation. Further studies are needed to advance our understanding of the underlying mechanisms by which the PTSD and other psychological strains contribute to the development of CHD.

Immunosuppressant-driven de novo malignant neoplasms after solid-organ transplant

Increasing obesity rates are still a public health priority. The primary aim of this study was to evaluate the effect of tailored text messages on body weight change in overweight and obese adults in a community-based weight management program. A secondary aim was to detect behavioral changes in the same population. The study design was quasi-experimental with pretest and posttest analysis, conducted over 12 weeks. A total of 28 participants were included in the analysis. Body weight, eating behaviors, exercise and nutrition self-efficacy, attitude toward mobile technology, social support, and physical activity were assessed at baseline and at 12 weeks. Text messages were sent biweekly to the intervention but not to the control group. At 12 weeks, the intervention group had lost significant weight as compared with the control group. There was a trend toward an improvement in eating behaviors, exercise, and nutrition self-efficacy in the intervention group, with no significant difference between groups. A total of 79% of participants stated that text messages helped in adopting healthy behaviors. Tailored text messages appear to enhance weight loss in a weight management program at a community setting. Large-scale and long-term intervention studies are needed to confirm these findings.