Interview with Mildred Peterson

An interview with Mildred Peterson regarding her experiences in a one-room school house.https://scholars.fhsu.edu/ors/1142/thumbnail.jp

The Extent to which Patients follow their Low-Cholesterol Diets

This exploratory study was conducted to discover to what extent patients follow their low-cholesterol diets. If they did not, the reasons were investigated. It was hoped that the findings would aid in defining areas of instruction which need greater emphasis when patients receive instruction concerning a low-cholesterol diet. An interview guide was used as a data gathering tool. The dietitians at one private teaching hospital recorded all dietary prescriptions sent to them during the specified period and ten physicians were contacted for permission to include their patients in the study. The patients were then contacted by telephone and the interviews scheduled. However, half the patients lived more than fifty miles away from the hospital so questionnaires were mailed to them, making a total of twenty-one questionnaires returned. Each interview was conducted in a conversational style, with the majority of the data being obtained indirectly. The interviews varied from one to one and a half hours. Fourteen patients were interviewed, making a total of thirty-five patients included in the study. On the basis of data obtained, it was concluded that patients were following their diets and knew the reason why their physicians had prescribed the diet. Most of them were using unsaturated fats for cooking purposes, however, they did not know the difference between saturated and unsaturated fats. Over half the patients had been following the diet less than a month. Over half the patients sent questionnaires did not return them. Most of the patients felt that the diet was similar to their usual dietary pattern. The most frequent reasons given for having difficulty in adhering to the diet were having to give up ice-cream, hard cheese, baked goods and limitation on amount of meat. Restaurant eating was a problem, along with monotony and lack of palatability in the diet. Recommendations were made concerning the giving of instruction to patients, and concerning further studies to be made under varying conditions

Improving Lung Cancer Screening and Referral Rates of North Carolina Medicaid Enrollees

Low-dose chest tomography (LDCT) screening in high-risk patients (individuals age 55-74 with a 30-pack-year smoking history in a current smoker, or similar smoking history in a former smoker who quit within the past 15 years) has proven to reduce both lung cancer and all-cause mortality by 20% and 7%, respectively (Aberle et al., 2011). Despite endorsement by medical and nursing organizations and payers, as well as the strong evidence in support of LDCT screening (Aberle et al., 2011), lung cancer screening rates nationwide remain low at 1.9% (Pham et al., 2018). The goal of this Doctor of Nursing (DNP) quality improvement project was to improve lung cancer screening in eligible Medicaid recipients in a rural primary care practice. The process to improve screening included primary care provider (PCP) education and incorporating a lung cancer risk assessment tool into the practice EHR to assist the PCP to appropriately identify eligible patients for LDCT screening and to increase appropriate LDCT screening referrals. The patient sample included 34 participants who met the USPSTF lung cancer screening eligibility criteria (ages 55-80, documented pack-year smoking history and asymptomatic) from the total Medicaid practice population (N=184) seen during the study period. Data was gathered for three months before and after implementation of the lung cancer risk assessment tool. While our project found no significant improvement in the primary outcome of LDCT screening referral rates in the patient sample, it does provide data on current LDCT referral rates in a high-risk North Carolina Medicaid population. Future practice improvement projects should include educational interventions to increase PCP knowledge of lung cancer screening and process improvements in gathering accurate USPSTF lung cancer screening patient eligibility criteria of pack-years smoking history documentation in the EHR. Keywords: low-dose chest tomography, LDCT, lung cancer screeningDoctor of Nursing Practic

Laboratory Diagnosis of \u3cem\u3eClostridium difficile \u3c/em\u3eInfection: Can Molecular Amplification Methods Move Us Out of Uncertainty?

The laboratory diagnosis of Clostridium difficile infection (CDI) continues to be challenging. Recent guidelines from professional societies in the United States note that enzyme immunoassays for toxins A and B do not have adequate sensitivity to be used alone for detecting CDI, yet the optimal method for diagnosing this infection remains unclear. Nucleic acid amplification tests (NAATs) that target chromosomal toxin genes (usually the toxin B gene, tcdB) show high sensitivity and specificity, provide rapid results, and are amenable to both batch and on-demand testing, but these tests were not universally recommended for routine use in the recent guidelines. Rather, two-step algorithms that use glutamate dehydrogenase (GDH) assays to screen for C. difficile in stool specimens, followed by either direct cytotoxin testing or culture to identify toxin-producing C. difficile isolates, were recommended in one guideline and either GDH algorithms or NAATs were recommended in another guideline. Unfortunately, neither culture nor direct cytotoxin testing is widely available. In addition, this two-step approach requires 48 to 92 hours to complete, which may delay the initiation of therapy and critical infection control measures. Recent studies also show the sensitivity of several GDH assays to be \u3c90%. This review considers the role of NAATs for diagnosing CDI and explores their potential advantages over two-step algorithms, including shorter time to results, while providing comparable, if not superior, accuracy

CTRP3 and Serum Triglycerides in Children Aged 7-10 Years

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction The prevalence of obesity-related disorders has been steadily increasing over the past couple of decades. Diseases that were once only detected in adults are now prevalent in children, such as hyperlipidemia. The adipose tissue-derived hormonal factor C1q TNF Related Protein 3 (CTRP3) has been linked to triglyceride regulation especially in animal models. However, the relationship between circulating CTRP3 levels and obesity-related disorders in human subjects is controversial. CTRP3 can circulate in different oligomeric complexes: trimeric (kDa), middle molecular weight (100–300 kDa), and high molecular weight (HMW) oligomeric complexes (\u3e300 kDa). Previous work has identified that it is not the total amount of CTRP3 present in the serum, but the specific circulating oligomeric complexes that appear to be indicative of the relationship between CTRP3 and serum lipids levels. However, this work has not been examined in children. Therefore, the purpose of this study was to compare the levels of different oligomeric complexes of CTRP3 and circulating lipid levels among young children (aged 7–10 years). Methods Morphometric data and serum samples were collected and analyzed from a cross-sectional population of 62 children of self-identified Hispanic origin from a community health center, between 2015 and 2016. Serum analysis included adiponectin, insulin, leptin, ghrelin, glucagon, C-reactive peptide, triglyceride, cholesterol, IL-6, TNF, and CTRP3. Correlation analyses were conducted to explore the relationships between CTRP3 and other biomarkers. Results Total CTRP3 concentrations were significantly positively correlated with total cholesterol and HDL cholesterol. Whereas, HMW CTRP3 was not significantly associated with any variable measured. Conversely, the middle molecular weight (MMW) CTRP3 was negatively correlated with triglycerides levels, and very low-density lipoprotein (VLDL), insulin, and body mass index (BMI). The negative correlations between MMW CTRP3 and triglycerides and VLDLs were particularly strong (r2 = -0.826 and -0.827, respectively). Conclusion Overall, these data indicate that the circulating oligomeric state of CTRP3 and not just total CTRP3 level is important for understanding the association between CTRP3 and metabolic diseases. Further, this work indicates that MMW CTRP3 plays an important role in triglyceride and VLDL regulation which requires further study

Prevalence and Practice for Rare Diseases in Primary Care: A National Cross-Sectional Study in the USA

Objectives There are more than 7000 rare diseases in the USA, and they are prevalent in 8% of the population. Due to life-threatening risk and limited therapies, early detection and treatment are critical. The purpose of this study was to explore characteristics of visits for patients with rare diseases seen by primary care physicians (PCPs). Design The study used a cross sectional study using a national representative dataset, the National Ambulatory Medical Care Survey for the years 2012–2014. Setting Primary care setting. Participants Visits to PCPs (n=22 306 representing 354 507 772 office visits to PCPs). Primary outcome measures Prevalence of rare diseases in visits of PCPs was the primary outcome. Bivariate analyses and logistic regression analyses were used to compare patients with rare diseases and those without rare diseases and examined characteristics of PCP visits for rare diseases and practice pattern. Results Among outpatient visits to PCPs, rare diseases account for 1.6% of the visits. The majority of patients with rare diseases were established patients (93.0%) and almost half (49.0%) were enrolled in public insurance programmes. The time spent in visits for rare diseases (22.4 min) and visits for more common diseases (21.3 min) was not significantly different (p=0.09). In an adjusted model controlling for patient characteristics (age, sex, types of insurance, reason for this visit, total number of chronic disease, having a rare disease and established or new patient), patients with rare diseases were 52% more likely to be referred to another provider (OR 1.52, 95% CI, 1.01 to 2.28). Conclusions Visits for rare diseases are uncommon in primary care practice. Future research may help to explain whether this low level of management of rare diseases in primary care practice is consistent with a goal of a broad scope of care

Systemic inflammation, body composition, and physical performance in old community-dwellers

Background Chronic inflammation, changes in body composition, and declining physical function are hallmarks of the ageing process. The aim of the present study was to provide a preliminary characterisation of the relationship among these age-related phenomena via multivariate modelling. Methods Thirty-five old adults (OAs) and 17 young adults (YAs) were enrolled. The volume of skeletal muscle, subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) of the thigh was quantified by three-dimensional magnetic resonance imaging. Muscle strength was measured by knee extension strength testing. In OAs, physical performance was further assessed via the Short Physical Performance Battery (SPPB). Multi-block partial least squares-discriminant analysis (PLS-DA) was employed to explore the relationship among inflammatory profiles and functional and imaging parameters. Double cross-validation procedures were used to validate the predictive ability of the PLS-DA model. Results The optimal complexity of the PLS-DA model was found to be two latent variables. The proportion of correct classification was 92.3% in calibration (94.1% in YAs and 91.4% in OAs), 84.6% in internal validation (95.3% in YAs and 78.5% in OAs), and 82.6% in external validation (94% in YAs and 76.9% in OAs). Relative to YAs, OAs were characterised by smaller muscle volume, greater IMAT volume, lower muscle strength, and higher levels of myeloperoxidase, P-selectin, soluble intercellular adhesion molecule 1, and vascular cell adhesion molecule 1. Compared with OAs with SPPB >8, those scoring 8 were characterised by smaller muscle volume, greater SAT volume, lower muscle strength, and higher levels of interleukin 1 beta, 6, 10, 12, 13, tumour necrosis factor alpha, and granulocyte-macrophage colony-stimulating factor. Conclusions Multi-block PLS-DA identified distinct patterns of relationships among circulating cytokines and functional and imaging parameters in persons of different ages and varying levels of physical performance. The longitudinal implementation of such an innovative strategy could allow for the tracking of health status over time, the early detection of deviations in health trajectories, and the monitoring of response to treatments

Shared Governance in an Adult Education Doctoral Program: “Self-Directed Learning meets Democratic Process” – A Delicate Balance of Intent, Implementation, and Impact

This symposium explores the governance component offered within a doctoral program in which students were given the opportunity to engage in collective decision-making through democratic process. Panelists, most of whom were research participants for the dissertation upon which this exploration is based, represent cohort groups from 1996 through 2007

The Influence of Maternal Body Mass Index and Physical Activity on Select Cardiovascular Risk Factors of Preadolescent Hispanic Children

Background. Maternal obesity and physical inactivity have been identified as correlates of overweight and obesity and physical inactivity in older preadolescents; however, no study has explored this relationship in Hispanic preadolescents. Furthermore, the relation between maternal physical activity (PA) and blood pressure (BP) in Hispanic preadolescents has not been examined. Purpose. This study aimed to assess the associations between Hispanic mothers’ PA and body mass index (BMI) and their preadolescents’ PA, screen time, BP, and BMI. Methods. Data of 118 mother-child (aged 2–10 years) dyads enrolled in a crosssectional study of metabolic syndrome in Hispanic preadolescents at a community health center in Johnson City, TN were used. Parent and child questionnaires were used to ascertain mothers’ BMI and PA and preadolescents’ PA and screen time

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