Serum BDNF is Positively Associated with Negative Symptoms in Older Adults with Schizophrenia

Objectives: Older adults with chronic schizophrenia are at greater risk for functional disability and poorer health outcomes than those without serious mental illness. This population makes up 0.6% to 1% of the elderly population in the US and is projected to number approximately 15 million by 2030. The symptoms of schizophrenia can be disabling for individuals, significantly reducing their quality of life. Often, the negative symptoms are the most resistant to treatment and are considered a marker of illness severity, although challenging to measure objectively. Biomarkers can provide an objective indicator of health status. Brain Derived Neurotrophic Factor (BDNF) is a potential biomarker for schizophrenia and may serve as an indicator of illness severity. Materials and methods: A cross-sectional study with 30 older adults with chronic schizophrenia. Participants were assessed on serum levels of BDNF and psychiatric symptoms (Positive and Negative Syndrome Scale; PANSS). Pearson’s bivariate correlations (two-tailed) and linear regression models were used. Results: Average serum levels of BDNF were 24.4 ng/mL (SD = 6.0). A significant positive association (p < .05) was found between higher serum levels of BDNF and greater severity for the negative symptom items that included passive, apathetic, social withdrawal, and emotional withdrawal. In multivariate analyses, the association remained significant. Conclusions: Although the association between BDNF and negative symptoms was not in the expected direction, the data corroborate findings from previous work in patients with schizophrenia. It is possible that higher serum levels of BDNF reflect compensatory mechanisms resulting from neurodevelopmental dysfunction

Personalizing Care for the Caregivers: An Exploration of Factors Contributing to the Experiences and Outcomes of Family Caregivers of Persons with Dementia

Family caregivers of persons with dementia are at increased risk for adverse health outcomes than their peers not in a caregiving role. Persistent heterogeneity in the literature focused on outcomes in this population complicates efforts at identifying who is at greatest risk and for what outcomes as well as avenues for personalizing their care. The purpose of this dissertation was to explore factors contributing to the experiences and health outcomes of family caregivers (FCG) of persons with dementia (PWD). The overarching goal of this dissertation was to move the science as well as clinical practice forward in providing individualized care to our family caregivers of persons with dementia. This dissertation sought to achieve this goal through triangulating data from both quantitative and qualitative sources. A systematic review of the literature was conducted with a meta-analysis of the included studies’ findings related to assessing personality traits (PT) as predictors of outcomes in the FCG of PWD. A quantitative secondary analysis was then conducted based on a self-report measure of PT in a sample of FCG of PWD. A novel approach using latent profile analysis was employed in this study for purposes of exploring how group membership into classes of PT profiles was associated with health outcomes in this population of FCG. The qualitative aspect explored theory development around a sub-group of FCG using a grounded theory approach to guide interviews and participant observations with 15 spouses of persons with an early-age of onset dementia (EOD) syndrome. The systematic review with meta-analysis evaluated the strength of the current evidence supporting the assessment of PT (as defined by the Five Factor Model of Personality) of the FCG of PWD as significant predictors of these caregivers’ health outcomes, explaining some of the persistent heterogeneity observed. Only the dimensions of Neuroticism and Extraversion showed the greatest utility as reliable predictors through this review process, however. The meta-analyses of these data from the systematic review revealed statistically significant associations between Neuroticism and burden (pooled-r = .304), Neuroticism and depression (pooled-r = .593), and Extraversion and burden (pooled-r = −.233). The quantitative study revealed a statistically significant difference between class membership and life satisfaction. Two classes (i.e., profiles) were identified through methods of latent class analysis that best fit the data. Membership in the “Higher Resilience” (HR) class was associated with higher self-reported measures of “global cognitive judgement” of personal satisfaction with life than membership in the “Lower Resilience” (LR) class. Membership in the HR class was also associated with higher self-reported measures of bodily pain and role limitation due to emotional problems as assessed by the SF-36 health-related quality of life (HRQoL) instrument. No significant differences between the HR and LR classes were identified in participant or patient characteristics or in the FCG outcomes of perceived burden, distress, depression, anxiety level, or the HRQoL subscales of physical role limitations. The qualitative data revealed an underlying psychosocial process of a step-wise progression in role identity in spouses of persons with an EOD syndrome. A shift was described in how the well-spouse self-identified in the situation from that of “spouse” to that of “caregiver”. These “step-downs” in the transition were interpreted as representing “moments of significance” in the PWEOD’s continuous decline that held special meaning to the respective well-spouse and challenged them to take action in order to resolve resulting incongruencies to what it meant to them to be a spouse. The conditions of the situation (i.e., changes in the marital partnership and the interpersonal relationship between the dyads) carried unique aspects for this sub-group of FCG primarily due to the relatively young life stage at which this has occurred and the repercussions on their family and social life as well as financially. Inter-individual factors (i.e., personality traits) as well as understandings of the unique situations of sub-groups of caregivers (i.e., spouses of PWEOD) are factors which contribute significantly to the experiences as well as to health outcomes of FCG of PWD. They are critical factors to consider in the development of tailored interventions aimed at improving the health outcomes of this population of FCG

Personalizing Care for the Caregivers: An Exploration of Factors Contributing to the Experiences and Outcomes of Family Caregivers of Persons with Dementia

Family caregivers of persons with dementia are at increased risk for adverse health outcomes than their peers not in a caregiving role. Persistent heterogeneity in the literature focused on outcomes in this population complicates efforts at identifying who is at greatest risk and for what outcomes as well as avenues for personalizing their care. The purpose of this dissertation was to explore factors contributing to the experiences and health outcomes of family caregivers (FCG) of persons with dementia (PWD). The overarching goal of this dissertation was to move the science as well as clinical practice forward in providing individualized care to our family caregivers of persons with dementia. This dissertation sought to achieve this goal through triangulating data from both quantitative and qualitative sources. A systematic review of the literature was conducted with a meta-analysis of the included studies’ findings related to assessing personality traits (PT) as predictors of outcomes in the FCG of PWD. A quantitative secondary analysis was then conducted based on a self-report measure of PT in a sample of FCG of PWD. A novel approach using latent profile analysis was employed in this study for purposes of exploring how group membership into classes of PT profiles was associated with health outcomes in this population of FCG. The qualitative aspect explored theory development around a sub-group of FCG using a grounded theory approach to guide interviews and participant observations with 15 spouses of persons with an early-age of onset dementia (EOD) syndrome. The systematic review with meta-analysis evaluated the strength of the current evidence supporting the assessment of PT (as defined by the Five Factor Model of Personality) of the FCG of PWD as significant predictors of these caregivers’ health outcomes, explaining some of the persistent heterogeneity observed. Only the dimensions of Neuroticism and Extraversion showed the greatest utility as reliable predictors through this review process, however. The meta-analyses of these data from the systematic review revealed statistically significant associations between Neuroticism and burden (pooled-r = .304), Neuroticism and depression (pooled-r = .593), and Extraversion and burden (pooled-r = -.233).The quantitative study revealed a statistically significant difference between class membership and life satisfaction. Two classes (i.e., profiles) were identified through methods of latent class analysis that best fit the data. Membership in the “Higher Resilience” (HR) class was associated with higher self-reported measures of “global cognitive judgement” of personal satisfaction with life than membership in the “Lower Resilience” (LR) class. Membership in the HR class was also associated with higher self-reported measures of bodily pain and role limitation due to emotional problems as assessed by the SF-36 health-related quality of life (HRQoL) instrument. No significant differences between the HR and LR classes were identified in participant or patient characteristics or in the FCG outcomes of perceived burden, distress, depression, anxiety level, or the HRQoL subscales of physical role limitations. The qualitative data revealed an underlying psychosocial process of a step-wise progression in role identity in spouses of persons with an EOD syndrome. A shift was described in how the well-spouse self-identified in the situation from that of “spouse” to that of “caregiver”. These “step-downs” in the transition were interpreted as representing “moments of significance” in the PWEOD’s continuous decline that held special meaning to the respective well-spouse and challenged them to take action in order to resolve resulting incongruencies to what it meant to them to be a spouse. The conditions of the situation (i.e., changes in the marital partnership and the interpersonal relationship between the dyads) carried unique aspects for this sub-group of FCG primarily due to the relatively young life stage at which this has occurred and the repercussions on their family and social life as well as financially. Inter-individual factors (i.e., personality traits) as well as understandings of the unique situations of sub-groups of caregivers (i.e., spouses of PWEOD) are factors which contribute significantly to the experiences as well as to health outcomes of FCG of PWD. They are critical factors to consider in the development of tailored interventions aimed at improving the health outcomes of this population of FCG

Pairing pedagogical and genomic advances to prepare advanced practice nurses for the era of precision health

Abstract Background Broadly accessible curriculum that equips Advanced Practice Nurses (APNs) with knowledge and skills to apply genomics in practice in the era of precision health is needed. Increased accessibility of genomics courses and updated curriculum will prepare APNs to be leaders in the precision health initiative. Methods Courses on genomics were redesigned using contemporary pedagogical approaches to online teaching. Content was based on the Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees. Results The number of students enrolled (n = 10) was comparable to previous years with greater breadth of representation across nursing practice specialty areas (53% vs. 20%). Prior to the first course, students reported agreement with meeting 8% (3/38) of the competencies. By completion of the 3rd course, students reported 100% (38/38) agreement with meeting the competencies. Conclusions Content on genomics sufficient to obtain self-perceived attainment of genomics competencies can be successfully delivered using contemporary pedagogical teaching approaches

Development and evaluation of a concise nurse-driven non-pharmacological delirium reduction workflow for hospitalized patients: An interrupted time series study.

We created a concise nurse-driven delirium reduction workflow with the aim of reducing delirium rates and length of stay for hospitalized adults. Our nurse-driven workflow included five evidence-based daytime sunrise interventions (patient room lights on, blinds up, mobilization/out-of-bed, water within patients reach and patient awake) and five nighttime turndown interventions (patient room lights off, blinds down, television off, noise reduction and pre-set bedtime). Interventions were also chosen because fidelity could be quickly monitored twice daily without patient interruption from outside the room. To evaluate the workflow, we used an interrupted time series study design between 06/01/17 and 05/30/22 to determine if the workflow significantly reduced the units delirium rate and average length of stay. Our workflow is feasible to implement and monitor and initially significantly reduced delirium rates but not length of stay. However, the reduction in delirium rates were not sustained following the emergence of the COVID-19 pandemic