Latest Articles Rss

Intervened 2-Tier Poisson Distribution for Understanding Hospital Site Infectivity

Problem statement: Whether it is a surgical site or medical treatment at a hospital site, the nurses in particular and the entire medical team including surgeons/physicians in general undergo a risk of being infected ironically by the patients whom they intend to disinfect. There are 2-tiers of patients at the site. One type consists of patients who are internally and well pre-disinfected, not to be sourced for infecting the medical team. The second type consists of patients who are influx to the hospital site and are not well pre-disinfected enough. It is the second type which is a source of hospital site infection for the medical team in general and for the nurses in particular. In other words, the nurses who have to deal with the second type of patients get more exposed to the virus from the patients themselves. This is named the nurses� exposure exposure rate. Independently, there is an inactivity rate in general for anyone. To reduce such an infectivity, the hospital management makes an intervention with preventive efforts to reduce the infection rate and the impact of such preventive intervention efforts is captured by a parameter in our model. Using a maximum likelihood estimate of the intervention parameter with the data information, we assess the significance of the intervention efforts. Approach: For this concept to work, there is a need to develop an appropriate model as none exists in the literature to be suitable. The model is an abstraction of the reality in the hospital set up. Such a needed, new probability count model is introduced. It is named an Intervened 2-Tier Poisson (I2TP) distribution in this article. Several statistical properties of the I2TP distribution are derived and illustrated to explain the inactivity rate, θ>0 during the treatments of contagious patients in a hospital. Not all nurses are exposed to the virus, while 0 (π≤1 is their exposure rate towards infection. The physicians/surgeons, nurses and staffs undergo a risk of being infected during their treatment of infection or surgery on patients in spite of precautions to avoid infection. The hospital management intervenes with several precautions to minimize, if not eliminate the health care personnel�s risk of being infected. In this article, a statistical methodology is developed to estimate and test the significance of the management�s intervention effect, ρ≥0. Results: The methodology is illustrated using the number of exposed and infected nurses during their healthcare of SARS patients in a Toronto hospital as reported in http://wwwnc.cdc.gov/. There were 32 nurses in the Toronto hospital working with the Severe Acute Respiratory Syndrome (SARS) patients. The sixteen activities of the nurses included in our analysis are administration of medication, intubation, bathing, manipulation of bipap mask, radiology procedures among others. In all these activities, the nurses are well trained to use disinfected gloves, nasal masks. As part of the preventive measures to avoid infection from the SARS patients. The exposure rates for the nurses in these activities to SARS patients varied from 0.13 to 0,81. The infectivity ranged from 1.26 to 8 in these activities. The impact of the intervention efforts ranged from 0.25 to 206.3 in all these sixteen activities. The impact of the intervention efforts was insignificant in the activities: endotracheal aspirate, integration of a peripheral,, intravenous catheter Intubation, manipulation of bipap mask, Manipulation of bipap mask, manipulation of commodes or bedpans, Nebulizer treatment and Suctioning before intubation. The impact of the intervention was significant in the activities: administration of medication, assessment of patient, bathing or patient transfer, manipulation of oxygen mask, mouth or dental care, performing an electrocardiogram, radiology procedures, suctioning after intubation and venipuncture. Conclusion/Recommendations: It is interesting to notice that the preventive intervention efforts by the hospital management for the nurses to be disinfected from the SARS patients worked in some activities but not in others. This distinction could be made because of the intervened 2-tier Poisson distribution which is introduced in this article. Clues for successful intervention in some but not in other activities perhaps hid in covariates. Currently, the author is not able to access such data on covariates. The future research work would proceed in this direction using regression concepts.

Evaluation of an Emerging Research Center: Lessons Learned

Problem statement: Rigorous evaluation assures that research endeavors meet their purpose and achieve stated goals. This is especially true for federally funded exploratory research centers, which tend to be more complex due to the involvement of multiple, interdisciplinary investigators. This study provides an overview of the approach used to develop an evaluation strategy and reports the lessons learned during the initial development of the Center for Ohana Self-Management of Chronic Illness (COSMCI) at the University of Hawai�i at Mānoa School of Nursing and Dental Hygiene. The COSMCI is composed of an interdisciplinary team of researchers and practitioners and aims to advance knowledge in the field of self management of chronic disease in the community setting. Approach: A systematic approach was utilized that included formative and summative strategies for ongoing evaluation. The problem was solved by addressing five key concerns: (1) development of research structure, (2) observing the process of the research pilot projects, (3) scholarly activity of COSMCI faculty, (4) dissemination and translation and (5) sustainability prospects. The method of research included formulating process strategies and determine if the plans for developing the Center were followed and whether these plans were effective. Interviews were also conducted at year one and at mid-point though the project. Results: Themes that emerged from our evaluation included inclusion, timelines, realistic expectations, ongoing evaluation and preparing for changes in the team. This provided timely recognition of successes and challenges and facilitated a rapid response for interventions especially during the early development stage of the center. Conclusion/Recommendations: Effective development of a successful Center is highly dependent upon having a strong evaluation process in place that can inform ongoing development. An exploratory research center requires ongoing evaluation that allows for celebration of successes, as well as early identification of problems and rapid response.

Feasibility Study: Colorectal Cancer Related Educational Program for Korean Americans

Problem statement: The purpose of this study was to assess feasibility and acceptability of Colorectal Cancer (CRC) related educational program, specifically designed to promote Fecal Occult Blood Test (FOBT) completion for Korean Americans aged 50 years and older. Approach: Focus group discussion (N = 9) guided by semi-structured questions was conducted to understand the demand for CRC education and to obtain feedback on overall content, language and delivery media for a preliminary version of the educational program. A single group pilot study (N = 85) was conducted to assess the acceptability of animated PowerPoint slides with culturally appropriate pictures, graphics and words to convey CRC and early screening practice and to review the Korean-language version questionnaire items for its clarity, understandability, readability and burden of over survey completion. Results: Focus group participants postulated several themes and expressed strong desire to learn more about CRC through the face-to-face educational program. The educational program was feasible with 100% response rate for study participation. Acceptability was established by process questions related to the educational program in terms of cultural appropriateness of the content, participants' responses to the content and intent to change health behavior. The mean acceptability score was 3.5 (SD = 0.41); range was 2.75-4, indicating that participants found the education highly acceptable. The Korean-language version questionnaire items were clearly written, easy to read and understand and it took about 25 min to complete. There were no additional comments on the questionnaire items. Conclusion: The focus group discussion enabled us to add culturally appropriate language and content to the education, underscoring the importance of formative work prior to intervention testing. The educational program is feasible and acceptable as evidenced by ease of recruitment (100%), attendance (100%) and high acceptability score of the educational contents.

Let's Talk about Sex: An Evolving Research Program in Perinatal Sexuality

This article presents the definition of a research program and how to develop one. The author offers her own experience as an example. Problem statement: There was a dearth of literature on how-to articles on �how to� establish a research program. Approach: This article presents the author�s evolving research program in perinatal sexuality which focuses on the couple�s intimacy in the transition to parenthood. The theoretical and clinical background leading up to the development of the research program was presented as well as preliminary findings from the first group of studies. Results: The current research program with its various research studies were featured next. Lastly, the author shares the lessons that she had learned about establishing a research program. Conclusion: More articles are needed in which researchers present their own personal experiences of how they developed their research programs.

A Study of Clinical Behavior in Intensive Care Unit

Problem statement: In order to support the needs of the staff working in discrete areas of nursing, the attitudes, behaviors and needs of the group must first be articulated. Unfortunately, there has been little research conducted to understand the culture of what it is that health care workers think and feel and why they make the choices they do in their working environment and also why they chose to leave the environment. Specifically, what do intensive care clinicians think about the work they do when managing end-of-life care in this technical, highly skilled environment. The focus of an ethnographic study conducted in an Australian hospital in 2007 was to describe the attitudes, behaviors and social conscience of this group whilst they provided end-of-life care. Conclusion: Staff were unable to control many factors that impact on the capacity of professional practice within the intensive care environment. In response to this limited control, staff developed tactics for managing the varying levels of expected clinical service delivery associated with varying possible outcome for each individual patient admission. This research garnered three discrete groups of coping strategies: physical, social and psychological. Future research may demonstrate capacity to engage in such coping strategies has a direct link to clinical longevity.

Assessment of Predicting Risk Factors for Cesarean Complication Development in Tikrit City Hospitals

Problem statement: A cesarean birth happens through an incision in the abdominal wall and uterus In November of 2005, the Centers for Disease Control and prevention (CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience a cesarean delivery. With any major surgical procedure, there are risks involved. It is important to know and understand your risks before a cesarean procedure, Approach: Descriptive study was carried from 1st March to end of October 2009, 200 cases attending Tikrit teaching hospital and 2 private hospitals in Tikrit city that were developing complications after cesarean section during time of the study were enrolled in this study. Results: The study reviled that half of study population from age group 20-34 years, 36.5% were developed complications after C/S. it was founded that 36.5% developed wound infections, 31.5% complained from post partum hemorrhage 17.5% of them of secondary type and 14% of primary type. And 6, 7.5 and 1% developed paralytic illus, DVT, death respectively and 34% occurred within first week after C/S and 8%within operation. Conclusion: wound infection and hemorrhage are the most frequent complications that happened after cesarean section and about third of patients with complication had previous complication.

Cardiovascular Disease Risk Factors among Adult Australian-Lebanese in Melbourne

This study reported on a descriptive exploratory study of the prevalence of Cardiovascular Disease (CVD) risk factors among adult Australian-Lebanese migrants living in Melbourne. This study fills a gap in extant research regarding CVD risk factors within this ethnic community in Melbourne. Problem statement: Australia�s multicultural society consists of more than 200 ethnic groups. Nearly a quarter of the populations are born overseas. Thus, the national health profile is significantly affected by the health status of immigrants. The prevalence of CVD risk factors has been researched in several ethnic communities in Melbourne, however, specific CVD risk factors among Australian-Lebanese migrants living in Melbourne has never been studied. Approach: A convenience sample of 200 adult Australian-Lebanese (88 men and 112 women) residing permanently in Melbourne completed a structured questionnaire based on the 1989 National Heart Foundation Risk Factor Prevalence Study. Physical measurements of height, weight, Body Mass Index (BMI), waist and hip circumferences, blood pressure and reported cholesterol levels were also obtained. Results: Subjects were aged between 20-69 years and manifested many risk factors for CVD. Lack of physical activity and increased weight was prevalent across all age groups. Hypertension increased with age and smoking was more prevalent among the Australian-Lebanese than the general Australian population. Multivariate forward logistic regression analysis found that the strongest predictors of CVD risk factors were age, gender, level of education and length of residence in Australia. The most vulnerable were older men with a lower level of education who had resided in Australia for more than 10 years. Conclusion: The CVD risk factors among the Australian-Lebanese included overweight and obesity, lack of physical activity and high levels of smoking. The findings warrant further research among other Arabic speaking groups who have similar social and cultural practices. The findings demonstrate the need for culturally tailored health promotion programs aimed at reducing CVD risk behaviors among this ethnic group.

Predictors of Home Health Care Service Use by Anglo American, Mexican American and South Korean Elders

Problem statement: This study was designed to identify predictors of the use of home health care services by elders in different ethnic groups. Approach: A cross-sectional study was conducted with convenient sample of Anglo elders (N = 57), Mexican American elders (N = 56) and elders in South Korea (N = 83). Hierarchical multiple regression analysis was conducted. Results: The need for home health care services was the significant predictor of home care service use for Anglo (Adjusted R² = 0.164; R² change = 0.176; F-change (1,56) = 11.93; p = 0.001); service awareness and low education were significant predictors for Mexican American (Adjusted R² = 0.332; R² change = 0.068; F-change (1,48) = 5.22; p = 0.027). Service awareness and elders living alone were significant predictors for South Korean elders (Adjusted R² = 0.112; R² change = 0.050; F-change (1,80) = 4.58; p = 0.035). Conclusion: The results of the study suggested that effective interventions for home health care services should focus on elders� service awareness, low income and education and elders living alone to maximize the use of home health care services.

The Relationship between Demographic Factors and Low Birth Weight Infants

Problem statement: To identify demography factor relation that is study, education storey; level, mother age and also social economics status to occurrence of LBW in RSCM Jakarta. Approach: Type this studied is analytic survey with cross sectional design. Population in this studied is all noted mothers bear during year 2006 counted 2.755 with sample equal to 125 mothers. This studied is started in January with intake of sample by random sampling. The data were collected in this studied are secondary data, that is seen data and noted from medical record of RSCM Jakarta Year 2006. Appliance used at this studied is sheet of check list. Data analysis conducted by univariat and bivariate. Results: Statistical test from variable studied that is, study, education, mother age and social economics status, known by that there is relation having a meaning among study of mother, mother age and social economics status with occurrence of heavy baby born to lower in RSCM Jakarta. Conclusion: LBW in RSCM Year equal to 4.54% from 125 mother sample bear.