Utilizing the AHRQ care coordination atlas as a framework: an integrative review of transitional care models : [poster]

PosterReferences and poster presented at the 2020 Midwest Nursing Research Society Annual Research Conferenc

Recommendations for Counselor Education and Supervision Programs to Improve Gatekeeping Processes Developed from Doctoral Student Experiences

The purpose of this qualitative study was to explore the experiences of eleven doctoral students at three CACREP accredited programs to address issues in counselor education and supervision programs and faculty face regarding gatekeeping. The information was used to develop and provide recommendations for gatekeeping procedures that can be implemented at the departmental and classroom levels. Ways programs can improve the training of doctoral students for gatekeeping roles and responsibilities, steps faculty can take to create an environment which supports gatekeeping at their institution, as well as support doctoral students as they grow into future gatekeepers of the profession are discussed

Hospital discharge destination decisions : exploring congruence in frail elders, their family members, and health care teams' decisions

The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file.Vita."August 2007"Thesis (Ph. D.) University of Missouri-Columbia 2007.This study used a mixed method design to explore congruence about the discharge destination decision of hospitalized frail older adults, their family members, and health care team members (HCTM). There was no common pattern of preferred level of participation (LOP) in discharge destination decisions, either among individuals, or in the triad. Congruence in the discharge destination occurred in the triad regardless of whether or not individual participants obtained their preferred LOP. There was more congruence with discharge destination decisions (a) in those triads that demonstrated ongoing communication with one another, (b) in which there was not a perceived safety issue for the older adult, (c) when post hospital care was not medically complex, and (d) when the older adults were returning to an environment of their choice.Includes bibliographical reference

Comfort care needs of cancer family caregivers (FCG) in outpatient palliative care : [poster]

PosterReferences and poster presented at the 2021 Midwest Nursing Research Society Annual Research Conference, March 24-27, 2021 (virtual)

Evaluating the implementation fidelity to a successful nurse-led model (INTERCARE) which reduced nursing home unplanned hospitalisations

Implementation fidelity assesses the degree to which an intervention is delivered as it should be. Fidelity helps to determine if the outcome(s) of an intervention are attributed to the intervention itself or to a failure of its implementation. Little is known about how fidelity impacts the intended outcome(s) and what elements or moderators can affect the fidelity trajectory over time. We exemplify the meaning of implementation fidelity with INTERCARE, a nurse-led care model that was implemented in eleven Swiss nursing homes (NHs) and showed effectiveness in reducing unplanned hospital transfers. INTERCARE comprises six core elements, including advance care planning and tools to support inter- and interprofessional communication, which were introduced with carefully developed implementation strategies.; A mixed-methods convergent/triangulation design was used to investigate the influence of implementation fidelity on unplanned transfers. A fidelity questionnaire measuring the degree of fidelity to INTERCARE's core components was fielded at four time points in the participating NHs. Two-monthly meetings were conducted with NHs (September 2018-January 2020) and structured notes were used to determine moderators affecting fidelity (e.g., participant responsiveness). We used the fidelity scores and generalized linear mixed models to analyze the quantitative data. The Framework method was used for the qualitative analysis. The quantitative and qualitative findings were integrated using triangulation.; A higher overall fidelity score showed a decreasing rate of unplanned hospital transfers post-intervention (OR: 0.65 (CI = 0.43-0.99), p = 0.047). A higher fidelity score to advance care planning was associated with lower unplanned transfers (OR = 0.24 (CI 0.13-0.44), p = < 0.001) and a lower fidelity score for communication tools (e.g., ISBAR) to higher rates in unplanned transfers (OR = 1.69 (CI 1.30-2.19), p = < 0.003). In-house physicians with a collaborative approach and staff's perceived need for nurses working in extended roles, were important moderators to achieve and sustain high fidelity.; Implementation fidelity is challenging to measure and report, especially in complex interventions, yet is crucial to better understand how such interventions may be tailored for scale-up. This study provides both a detailed description of how fidelity can be measured and which ingredients highly contributed to reducing unplanned NH transfers.; The INTERCARE study was registered at clinicaltrials.gov Protocol Record NCT03590470

Estimating relationships between phenotypes and subjects drawn from admixed families.

Background: Estimating relationships among subjects in a sample, within family structures or caused by population substructure, is complicated in admixed populations. Inaccurate allele frequencies can bias both kinship estimates and tests for association between subjects and a phenotype. We analyzed the simulated and real family data from Genetic Analysis Workshop 19, and were aware of the simulation model. Results: We found that kinship estimation is more accurate when marker data include common variants whose frequencies are less variable across populations. Estimates of heritability and association vary with age for longitudinally measured traits. Accounting for local ancestry identified different true associations than those identified by a traditional approach. Principal components aid kinship estimation and tests for association, but their utility is influenced by the frequency of the markers used to generate them. Conclusions: Admixed families can provide a powerful resource for detecting disease loci, as well as analytical challenges. Allele frequencies, although difficult to adequately estimate in admixed populations, have a strong impact on the estimation of kinship, ancestry, and association with phenotypes. Approaches that acknowledge population structure in admixed families outperform those which ignore it

Genome-wide Association Studies in Ancestrally Diverse Populations: Opportunities, Methods, Pitfalls, and Recommendations

Genome-wide association studies (GWASs) have focused primarily on populations of European descent, but it is essential that diverse populations become better represented. Increasing diversity among study participants will advance our understanding of genetic architecture in all populations and ensure that genetic research is broadly applicable. To facilitate and promote research in multi-ancestry and admixed cohorts, we outline key methodological considerations and highlight opportunities, challenges, solutions, and areas in need of development. Despite the perception that analyzing genetic data from diverse populations is difficult, it is scientifically and ethically imperative, and there is an expanding analytical toolbox to do it well