Lauren Terhorst

Complementary and alternative medicine in the treatment of pain in fibromyalgia: a systematic review of randomized controlled trials.

OBJECTIVE The purpose of this study was to systematically review the literature for randomized trials of complementary and alternative medicine (CAM) interventions for fibromyalgia (FM). METHODS A comprehensive literature search was conducted. Databases included the Cochrane library, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, Natural Medicines Comprehensive Database Manual, Alternative and Natural Therapy Index System (MANTIS), Index for Chiropractic Literature, and Allied and Complementary Medicine (AMED). Inclusion criteria were (a) subjects were diagnosed with fibromyalgia and (b) the study design was a randomized controlled trial that compared a CAM therapy vs a control group. Studies were subgrouped by CAM treatment into 11 categories. Evidence tables and forest plots were organized to display quality ratings and effect sizes of each study. RESULTS The literature search yielded 1,722 results; 102 abstracts were selected as potential articles for inclusion. Sixty studies met criteria and were rated by 2 reviewers; 18 were rated as good quality; 20, moderate; 18, low; and 4, very low. Synthesis of information for CAM categories represented by more than 5 studies revealed that balneotherapy and mind-body therapies were effective in treating FM pain. This study analyzed recent studies and focused exclusively on randomized controlled trials. Despite common use of manual therapies such as massage and manipulation to treat patients with FM, there is a paucity of quality clinical trials investigating these particular CAM categories. CONCLUSION Most of these studies identified were preliminary or pilot studies, thus had small sample sizes and were likely underpowered. Two CAM categories showed the most promising findings, balneotherapy and mind-body therapies. Most of the other CAM categories showed a trend favoring the treatment group. It appears that several CAM therapies show some preliminary treatment effect for FM pain, but larger trials that are more adequately powered are needed.

Test of a conceptual model of uncertainty in children and adolescents with cancer

Despite recognition as a significant stressor in childhood cancer, illness-related uncertainty from the perspective of children remains under-studied. We tested a conceptual model of uncertainty, derived from Mishels uncertainty in illness theory, in 68 school-aged children and adolescents with cancer. As hypothesized, uncertainty was significantly related to psychological distress, but only one hypothesized antecedent (parental uncertainty) significantly predicted childrens uncertainty. An alternative model incorporating antecedent developmental factors (age and illness-specific expertise) explained 21% of the variance in child uncertainty; controlling for stage of treatment, uncertainty was higher in children with shorter time since diagnosis, older age, lower cancer knowledge, and higher parental uncertainty. These findings provide the foundation for further studies to understand childrens management of uncertainty and its contribution to psychological adjustment to illness.

Effects of Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education and Training on Nursing Students’ Attitudes Toward Working With Patients Who Use Alcohol and Drugs

ABSTRACT Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) can reduce alcohol use and negative health outcomes in patients with risky substance use. However, negative attitudes that some health care professionals have toward patients who use substances are a barrier to implementing SBIRT. Methods: The University of Pittsburgh School of Nursing, in partnership with the Institute for Research, Education, and Training in Addictions (IRETA), developed a curriculum to train baccalaureate student nurses to deliver SBIRT. Results: Following SBIRT education and training, students’ perceived attitudes toward patients who use alcohol became more positive. Less robust changes were found for attitudes related to patients who use drugs. Conclusions: Nurses composing the largest group of healthcare workers are in key positions to screen, intervene, and provide education about substance use.

Assessing mobile phone communication utility preferences in a social support network

While it is generally accepted that the mobile cell phone has become ubiquitous within society for communicating, the actual use of the utilities on a phone have not been reported. Understanding how communication patterns are changing in society as a result of the mobile cell phone will enable the development and/or modification of existing cell phone utilities, the concept of privacy, and a mobile literacy research domain. To explore mobile cell phone utility use, 99 people completed a mobile phone usage questionnaire. Key results from the questionnaire are physical location when using a mobile cell phone, the length of communication episodes, the usage of phone utilities and existing privacy concerns related to mobile cell phones.

Gene Expression in First Trimester Preeclampsia Placenta

Background. The goal of this study was to further validate eight candidate genes identified in a microarray analysis of first trimester placentas in preeclampsia. Material and method. Surplus chorionic villus sampling (CVS) specimens of 4 women subsequently diagnosed with preeclampsia (PE) and 8 control women (C) without preeclampsia analyzed previously by microarray and 24 independent additional control samples (AS) were submitted for confirmatory studies by quantitative real-time polymerase chain reaction (qRT-PCR). Results. Downregulation was significant in FSTL3 in PE as compared to C and AS (p = .04). PAEP was downregulated, but the difference was only significant between C and AS (p = .002) rather than between PE and either of the control groups. Expression levels for CFH, EPAS1, IGFBP1, MMP12, and SEMA3C were not statistically different among groups, but trends were consistent with microarray results; there was no anti-correlation. S100A8 was not measurable in all samples, probably because different probes and primers were needed. Conclusions. This study corroborates reduced FSTL3 expression in the first trimester of preeclampsia. Nonsignificant trends in the other genes may require follow-up in studies powered for medium or medium/large effect sizes. qRT-PCR verification of the prior microarray of CVS may support the placental origins of preeclampsia hypothesis. Replication is needed for the candidate genes as potential biomarkers of susceptibility, early detection, and/or individualized care of maternal—infant preeclampsia.

Psychometric evaluation of the Epworth Sleepiness Scale in an obstetric population

BACKGROUND The Epworth Sleepiness Scale (ESS) was initially developed to measure daytime sleep propensity in patients affected by a variety of sleep disorders. Obstetrical research has measured sleepiness in pregnant women with the ESS, although psychometric analyses and dimensionality evaluations have never been conducted with this population. OBJECTIVE The objective was to perform a psychometric evaluation of the ESS in an obstetric population. The design was a secondary data analysis of the subjects enrolled in the Prenatal Exposures and Preeclampsia Prevention III (PEPP) study. The setting for the subjects who received prenatal care was at Magee-Womens Hospital UPMC in Pittsburgh, Pennsylvania and included 337 pregnant women in their first trimester that completed the ESS. METHODS Principal components analysis and confirmatory factor analysis were performed using SPSS and M-Plus. Additionally, reliability was assessed and construct validity was measured using the Life Orientation Test (LOT). Lastly, a relationship between daytime sleepiness and snoring was investigated using item 5e from the Pittsburgh Sleep Quality Index (PSQI). RESULTS PCA with varimax rotation yielded two factors that explained approximately 50% of the variance and CFA results verified this two-factor solution. An overall Cronbachs alpha (0.751) revealed moderate reliability (Factor 1α=.754; Factor 2α=.524). Both convergent and discriminant validity were established. CONCLUSION The ESS is appropriate for use in an obstetric population to measure daytime sleepiness. Future work should include additional evaluations of the ESS in a diverse group of pregnant women.

Goal Attainment Scaling (GAS) in geriatric primary care: A feasibility study

OBJECTIVE Evaluate the feasibility of generating patient-centered goals using GAS with older adults who have multiple chronic conditions, recruited through primary care. METHOD Adults age 65+ (N=27) were recruited from a geriatric primary care center. Participants were asked to identify 2-4 activity-based goals and set attainment levels using GAS. At 8 weeks, participants were asked to rate current level of their goal performance. Physician surveys were used to evaluate if goals were realistic and feasible, and patient surveys were implemented to evaluate satisfaction. GAS T-scores were used to quantify change in goal achievement. RESULTS Ninety-three percent (n=25) of participants were able to establish a minimum of two goals using GAS. 100% of participants were able to rate goal performance at follow-up. Physician survey results identified 100% of goals realistic and 93% achievable and 100% of participants were either neutral or satisfied with the process. Significant improvement was reported in GAS change scores (t(24)=6.54, p<0.001). CONCLUSION Findings support the feasibility of GAS for older adults with multiple chronic conditions in geriatric primary care as a strategy to facilitate patient-centered care and suggest that the process of personalized goal-setting itself may facilitate goal attainment.

Psychometric Properties of the Screen for Child Anxiety Related Emotional Disorders in a Rural High School Population

PROBLEM   Evaluate psychometric properties of the 41-item SCARED (Screen for Child Anxiety Related Emotional Disorders) when used with a rural community-dwelling sample. METHODS   As part of a randomized controlled trial, SCARED was administered to 193 adolescents in a rural high-school setting. Internal consistency, test-retest reliability, and factor structure were assessed. FINDINGS   Adequate internal consistency (α= 0.93) and test-retest reliability (r= 0.703) were demonstrated. Five factors were identified with a differing composition than previously reported. CONCLUSIONS   The SCARED was found to be a reliable tool in the rural adolescent population. Differences in some factors suggest further research is needed.

Psychometric analysis of the Patient Assessment of Own Functioning Inventory in women with breast cancer.

Background and Purpose: The purpose of this secondary analysis was to examine the reliability and validity of the Patient Assessment of Own Functioning Inventory (PAOFI) in postmenopausal women with early-stage breast cancer before adjuvant therapy. Methods: Data from 259 postmenopausal women with early-stage breast cancer before adjuvant therapy were analyzed. Exploratory factor analysis was used to uncover the PAOFI’s underlying factor structure and reliability coefficients were computed for each subscale. Results: 5 factors measuring perceived cognitive functioning had eigenvalues >1 and accounted for 54% of the extracted variance. Subscale reliability coefficients ranged from .572 to .883. Conclusions: Psychometric evaluation of the PAOFI provided evidence of reliability and construct validity in this population. Additional studies are needed to confirm the 5-factor structure.

Variation in endoglin pathway genes is associated with preeclampsia: a case-control candidate gene association study.

BackgroundPreeclampsia is a hypertensive, multi-system pregnancy disorder whose pathophysiology remains unclear. Elevations in circulating soluble endoglin (sENG) and placental/blood ENG mRNA expression antedate the clinical onset of preeclampsia. This study investigated if endoglin (ENG) pathway genetic variation was also associated with the development of preeclampsia.MethodsWe used a case–control candidate gene association design. Data from 355 white (181 preeclampsia cases/174 controls) and 60 black (30 preeclampsia cases/30 controls) women matched on ancestry, age, and parity were analyzed. Tagging single nucleotide polymorphisms (tSNPs) and potentially functional SNPs in ENG, TGFβ1, TGFβR1, ALK1, and TGFβR2 were genotyped with iPLEX® and TaqMan®. Chi-square or Fisher’s exact tests were used to conduct allele/genotype/haplotype tests in white/black subgroups separately. Odds ratios were computed with binary logistic regression for tSNPs with significant genotype tests.ResultsOf the 49 SNPs evaluated, variation in two ENG tSNPs (rs11792480, rs10121110) and one TGFβR2 tSNP (rs6550005) was associated with preeclampsia in white women (P <0.05, each). In black women, variation in two TGFβ1 tSNPs (rs4803455, rs4803457), one TGFβR1 tSNP (rs10739778), and three TGFβR2 tSNPs (rs6550005, rs1346907, rs877572) was associated with preeclampsia (P <0.05, each). Further evaluation of ENG tSNP rs10121110 revealed that white women inheriting the AA genotype were 2.29 times more likely to develop preeclampsia compared to the GG genotype (P = 0.008, [99% CI: 1.02 to 5.13]). For black women, similar evaluation of TGFβ1 tSNP rs4803457 revealed women inheriting the CT genotype were 7.44 times more likely to develop preeclampsia than those with the CC genotype (P = 0.005, [99% CI: 1.19 to 46.41]).ConclusionsENG pathway genetic variation is associated with preeclampsia. Different ENG pathway genes may be involved in preeclampsia development among white and black women. Additional studies are needed to validate these findings and to determine if genetic variation in ENG pathway genes impacts ENG and sENG levels in preeclampsia.