Patricia Newcomb

Barriers to Patient-Clinician Collaboration in Asthma Management: The Patient Experience

Objective. To describe what adult patients with asthma report about their experiences with their own self-management behavior and working with their clinicians to control asthma. Methods. The study sample consisted of 104 patients with persistent asthma participating in a clinical trial on asthma monitoring. All subjects were seen by primary care clinicians of a large, academic medical center. This qualitative post hoc analysis examined the views of adults with asthma about their asthma-related health care. Patients attended monthly visits as part of their study participation, during which data were derived from semistructured interviews. All patients included in this analysis participated in the study for 1 year. At the end of study participation, patients were asked to complete an evaluation of their clinicians communication behavior. All study clinicians were also asked to complete a self-evaluation of their own communication behavior. Results. Five major themes of barriers to successful self-management were identified, including personal constraints, social constraints, communication failures, medication issues, and health care system barriers to collaboration with their clinicians. Patients most frequently reported lack of communication surrounding issues relating to day-to-day management of asthma (31%) and home management of asthma (24%). Clinicians generally rated themselves well for consistency in showing nonverbal attentiveness (89%) and maintaining interactive conversations (93%). However, only 30% of clinicians reported consistency in helping patients make decisions about asthma management and only 33% of clinicians reported consistency in tailoring medication schedules to the patients routines. Conclusion. These findings emphasize the difficulties of establishing and maintaining a therapeutic partnership between patients and clinicians. The results underscore the need for system-wide interventions that promote the success of a therapeutic patient-clinician relationship in order to achieve long-term success in chronic disease management.

Using improvisational theater to teach genetics concepts.

For 40 years, nursing leaders have called for more genetics content in the undergraduate nursing curriculum, but incorporating the essentials of the growing body of genetics knowledge into crowded nursing curricula remains a struggle. This case report describes an innovative strategy for assessing genetics content in a curriculum while providing a stimulating learning opportunity for students. Results suggest that using improvisational theater for teaching genetic concepts is an effective strategy and is well accepted by students.

Acute Effects of Walking Environment and GSTM1 Variants in Children With Asthma

Background:Exercise in air polluted by traffic emissions may aggravate airway inflammation in children with asthma, particularly those who produce decreased glutathione-S transferase (GST) as a result of GSTM1 gene deletion. Objectives: This pilot crossover study investigated whether children with asthma experience more airway changes when exercising outdoors near roadways than when exercising indoors. It also examined differences in risk between children with and without GSTM1 deletion. Method: Children between the ages of 5 and 12 years were assigned to groups and walked daily for 1 week in each exercise condition. Airway inflammation indicated by exhaled nitric oxide (eNO) and pulmonary functions measured as forced expiratory volume in 1 s (FEV1) and mid-expiratory flow rate were measured at baseline and at three intervals during the walking program. Independent variables of interest included walking condition (place), time of walking, genotype, and particulate matter (PM) exposure. Results: A linear mixed models approach was used to investigate the contributions of targeted variables to respiratory outcomes. Results indicated that walking location and ambient level of ultrafine particulates during walking influenced function of small airways. Absence of one or both alleles for the GSTM1 gene did not influence airway function acutely. Discussion: Mid-expiratory flow (FEF25-75) may be more informative than FEV1 in studies of acute lung function changes in children with asthma. Further study of the effects of varied environmental conditions on lower airway function of children is needed to optimize exercise experiences for urban children with asthma.

Pilot Trial of an Electronic Family Medical History in US Faith-Based Communities

In spite of the acknowledged importance of collecting family health information, methods of collecting, organizing, and storage of pedigree data are not uniformly utilized in practice, though several electronic tools have been developed for the purpose. Using electronic tools to gather health information may empower individuals to take responsibility in managing their family health history. The purpose of this study was to describe the feasibility and outcomes of introducing small groups to the My Family Health Portrait tool in faith-based communities using faith community nurses (FCNs). This pilot project adopted a mixed methods approach to assess the potential of an educational intervention delivered by FCNs for increasing the use of electronic technologies for organizing and storing family health histories among the general public. Treatment and control groups were recruited from four faith-based communities in north Texas using a parallel-groups quasi-experimental design. Qualitative data were gleaned from field notes made by investigators interacting with FCNs and observing their teaching. A majority of respondents believed that knowing one’s health history and passing it on to family and medical personnel is important. Those receiving face-to-face instruction on the electronic tool were significantly more likely to have written down family health information than the control group who received only an informational handout (χ2 = 5.96, P = .015). Barriers to teaching about and using the electronic tool included FCNs’ lack of facility with computers in the educational context and FCN and respondent mistrust of electronic storage for family health information.

Tricyclic antidepressants and children.

Tricyclic antidepressants have been used in the treatment of certain childhood disorders for more than 20 years, and indications for their use in the pediatric population are increasing. Research supports the use of tricyclics for preadolescent children as adjunctive therapy for major depression, attention deficit hyperactivity disorder, enuresis, tic disorders, anxiety disorders and eating disorders. The range of indications and effects of tricyclics in the treatment of children, and issues related to management by health care providers are discussed in this article.

Teaching Nurses How to Infiltrate Lacerations in the Emergency Department

Unlabelled BoxContribution to Emergency Nursing Practice •The current state of scientific knowledge on infiltration of lacerations by registered nurses in emergency departments is unknown because no published studies of the practice exist in relevant research databases. •The main findings of this case observation are that the practice of RN infiltration of lacerations with local anesthesia is feasible, safe, and effective. •Key implications for emergency nursing practice include RN infiltration of lacerations in the ED allows nurses to be more involved in wound management, promotes top-of-license practice, and promotes more efficient patient throughput.

Conditions Associated with Childhood Asthma in North Texas

Introduction. The purpose of this study was to identify significant associations between asthma diagnosis, comorbid conditions, and social problems in children. Method. This study explored data collected in a unique, regional survey of childrens health in north Texas originally administered in 2009 to a random sample of 21,530 households with children from 0 to 14 years of age. Descriptive statistics were compiled for the subsample of children with asthma, associations of interest were identified, and strengths of relevant associations were calculated. Results. The prevalence of asthma in school-aged children in the target area is 19–25%, which exceeds both national and state values. Statistically significant associations were found between asthma and allergies, sleep problems, and tonsillectomy. Significant associations were identified between asthma and school absences, academic problems, and behavior problems in school. There was a significantly greater prevalence of obesity/overweight among children with asthma than without asthma. Discussion. Children with asthma are at high risk for impairment in multiple dimensions. Thorough assessment, including comprehensive medical, social, and environmental histories, is critical in management of pediatric asthma.