Category Archives: Research & Analysis

Apr 15 2014
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Media Exposure and Acute Stress Following the Boston Marathon Bombings

E. Alison Holman, PhD, FNP, is an associate professor in nursing science at the University of California, Irvine and a Robert Wood Johnson Foundation Nurse Faculty Scholar.

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A year ago today, on April 15, 2013, in the first major terror attack on U.S. soil since September 11, 2001, Dzhokhar and Tamerlan Tsarnaev planted two pressure cooker bombs near the finish line of the Boston Marathon. Three people died and more than 260 were injured. For a week authorities searched for the perpetrators, shootouts occurred, and Boston was locked down. As reporters and spectators filmed the mayhem, graphic images were shown repeatedly in both traditional and social media around the world. Like the September 11, 2001 (9/11) terrorist attacks, the population of the United States was the terrorists’ intended psychological target. Yet most research on reactions to such events focuses on individuals directly affected, leaving the public health consequences for populations living outside the immediate community largely unexplored.

Tens of thousands of individuals directly witnessed 9/11, but millions more viewed the attacks and their aftermath via the media. In our three-year study following 9/11, my colleagues and I found that people who watched more than one hour of daily 9/11-related TV in the week following the attacks experienced increases in post-traumatic stress (PTS) symptoms (e.g., flashbacks, feeling on edge and hyper vigilant, and avoidance of trauma reminders) and physical ailments over the next three years (Silver, Holman et al., 2013).

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Apr 14 2014
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Improvements to Dermatology Curriculum and Residency Training Could Improve Patient Safety, Study Finds

Modifications to curricula, systems, and teacher development may be needed to bring down medical error rates among dermatology residents, according to a study published online by JAMA Dermatology.

The survey of 142 dermatology residents from 44 residency programs in the United States and Canada draws attention to several areas of concern. According to the survey:

  • Just over 45 percent of the residents failed to report needle-stick injuries incurred during procedures;
  • Nearly 83 percent reported cutting and pasting a previous author’s patient history information into a medical record without confirming its validity;
  • Nearly 97 percent reported right-left body part mislabeling during examination or biopsy; and
  • More than 29 percent reported not incorporating clinical photographs of lesions sampled for biopsy in the medical records at their institutions. 

Also, nearly three in five residents reported working with at least one attending physician who intimidates them, reducing the likelihood of reporting safety issues. More than three-quarters of residents (78 percent) have witnessed attending physicians ignoring required safety steps.

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Apr 10 2014
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RWJF Scholars in the News: Electronic health records, nurse mentoring, ‘longevity gaps,’ and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

The California Action Coalition has developed a mentorship program that is helping prepare the next generation of nurses to serve as leaders on health care reform. The state’s mentorship program dovetails with the 2014 leadership focus of the Future of Nursing: Campaign for Action, a national effort backed by RWJF and AARP that is working to transform health care through nursing. “Mentoring is key to strengthening any leader,” Mary Dickow, MPA, tells Nurse Zone. “Having strong mentors in my life helped me think differently and advance. I wouldn’t be where I am today without them.” Dickow is statewide director of the California Action Coalition.

A recent interview in the Atlantic with David Blumenthal, MD, MPP, has generated numerous comments from readers weighing in on the merits of electronic health records (EHRs). Blumenthal is former national coordinator for health information technology at the U.S. Department of Health and Human Services and a recipient of an RWJF Investigator Award in Health Policy Research. He points out in the interview that EHRs offer “substantial” benefits for patients, but notes that in the short-term, providers incur significant costs and that it will take time to make the transition to EHRs. The Atlantic has now published several articles highlighting reader comments, which can be found here, here, and here. FierceEMR published a story about the give-and-take, which notes that many of the commenters who are skeptical about the value of EHRs are physicians.

RWJF Health & Society Scholars program University of Wisconsin-Madison Site Director David Kindig, MD, PhD, appeared on the Kojo Nnamdi Show on Washington, D.C.’s WAMU radio to discuss the “longevity gap,”—the growing gap in life expectancy between the rich and the poor. Kindig and other guests explore how health care reform and policies to address income inequality might affect the gap.

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Apr 3 2014
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RWJF Scholars in the News: Medical debt disparities, nurses providing primary care, technologies that maximize time with patients, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

In a study of women diagnosed with breast cancer, RWJF Physician Faculty Scholars alumna Reshma Jagsi, MD, PhD, found that Black and Latina patients were more than twice as likely as White patients to have medical debt and to skip treatments due to concerns about costs. Jagsi tells Reuters that “our findings suggest that racial and ethnic minority patients appear to be more vulnerable, as are those who are too young to qualify for Medicare, those who lack prescription drug coverage, those who reduce their work hours after diagnosis, and those with lower household income at the time of diagnosis.”

Expanding nurse practitioners’ role in primary care could help meet new demands on California’s health care system, as millions of previously uninsured residents gain coverage under the Affordable Care Act, according to Susan Reinhard, RN, PhD, senior vice president of the AARP Public Policy Institute. “We should make sure that the nurse practitioners can use every ounce of their talent for what is needed,” she tells the AARP Bulletin. “Consumers should have a choice of different clinicians who will suit their preferences and their needs.” Reinhard is chief strategist for the Center to Champion Nursing in America, a partnership of AARP, AARP Foundation, and RWJF and co-director of the Future of Nursing: Campaign for Action.

At a recent information technology summit, Ann O’Brien, MSN, RN, an RWJF Executive Nurse Fellow, discussed her work with Kaiser Permanente to leverage new health care technology to maximize nurses’ valuable time providing patient care. O’Brien explains that “you have to look at what can enable small amounts of change,” because saving seconds with each repeated use of rapid sign-on technology, for example, can mean gaining extra minutes in a day for a nurse to provide direct care, FierceHealthIT reports.

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Mar 27 2014
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One in Five Health Care Facilities Falling Short on Hand Sanitizer

In a time of progress against hospital-acquired infections, a new nurse-led study offers a reminder of the work that remains to be done. The study finds that approximately one in five U.S. health care facilities fails to place alcohol-based hand sanitizer at every point of care, missing an opportunity to prevent the spread of infectious diseases.

A research team jointly led by Laurie Conway, RN, MS, CIC, a PhD student at the Columbia University School of Nursing, and Benedetta Allegranzi, MD, of the World Health Organization (WHO), surveyed compliance with WHO hand-hygiene guidelines at 168 facilities in 42 states and Puerto Rico. Just over 77 percent reported that alcohol-based sanitizer was continuously available at every point of care. They also found that only about half of the hospitals, ambulatory care, and long-term care facilities had allocated funds for hand-hygiene training.

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Mar 27 2014
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RWJF Scholars in the News: Cultural barriers to care, medical conspiracies, parenting, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

In a Talking Points Memo opinion piece, Harold Amos Medical Faculty Development Program alumna Paloma Toledo, MD, MPH, writes that while the Affordable Care Act holds the promise of greatly increasing access to care, language and cultural barriers could still stand between Hispanic Americans and quality care. Toledo’s research into why greater numbers of Hispanic women decline epidurals during childbirth revealed that many made the choice due to unfounded worries that it would leave them with chronic back pain or paralysis, or that it would harm their babies. “As physicians, we should ensure that patients understand their pain management choices,” she writes.

More than one in three patients with bloodstream infections receives incorrect antibiotic therapy in community hospitals, according to research conducted by Deverick J. Anderson, MD, an RWJF Physician Faculty Scholars alumnus. Anderson says “it’s a challenge to identify bloodstream infections and treat them quickly and appropriately, but this study shows that there is room for improvement,” reports MedPage Today. Infection Control Today, FierceHealthcare, and HealthDay News also covered Anderson’s findings.

People’s health and wellness can be linked to their zip codes as much as to their genetic codes, according to an essay in Social Science and Medicine co-authored by Helena Hansen, MD, PhD. As a result, Hansen argues, physicians should be trained to understand and identify the social factors that can make their patients sick, HealthLeaders Media reports. Hansen is an RWJF Health & Society Scholars alumna.

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Mar 20 2014
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RWJF Scholars in the News: ADHD medication, reconstruction after mastectomy, care for returning veterans, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

NBC News reports on a surge in the number of young adult women taking ADHD medication. An RWJF Investigator Award in Health Policy Research recipient, Stephen Hinshaw, PhD, explains that the rise in diagnoses among women in that age group may be evidence of failure to recognize the problem when the women were children. They may not have manifested symptoms as visibly as their male classmates with ADHD did, turning their distress inward rather than misbehaving in class, for example.

“How people with mental disorders are viewed by treatment providers and the general public can have a significant impact on treatment outcomes and the quality of life of clients,” Jennifer Stuber, PhD, and colleagues write in a study reported by Health Canal. The researchers presented vignettes about people with mental health problems to mental health providers and the general public, and compared their reactions. Providers had more positive attitudes, but some held views about the danger such patients might pose in the workplace that the researchers called “concerning.” Stuber is an RWJF Health & Society Scholars alumna.

More women are having breast reconstruction after mastectomies, USA Today reports. As a result of a 1998 federal law, most group insurance plans that cover mastectomies also cover breast reconstruction. Researchers found that the share of women who received reconstruction after mastectomy rose from 46 percent to 63 percent between 1998 and 2007. Author Reshma Jagsi, MD, DPhil, an RWJF Physician Faculty Scholars alumna, says the law could be contributing to the increase. The study was also covered by 9 News (Denver) and WKYC.com (Cleveland), among other outlets.

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Mar 13 2014
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RWJF Scholars in the News: Military suicides, easing the path to a BSN, early clues to lung cancer, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

Amid growing attention to suicide rates among members of the military, a new series of studies explores the contributing factors, the New York Times reports. One of the studies, on suicides and accidental deaths, was led by RWJF Scholars in Health Policy Research alumnus Michael Schoenbaum, PhD. He identified a host of risk factors, including demotions, low rank, and previous deployment. However, Schoenbaum did not find evidence to support the contention that relaxed recruitment standards had led to the induction of soldiers more likely to commit suicide. The study was also covered in USA Today, the Wall Street Journal, and the Guardian, among other outlets.

The North Carolina Medical Journal features an article by Polly Johnson, RN, MSN, RN, FAAN, on the Regionally Increasing Baccalaureate Nurses (RIBN) initiative. It provides an economically feasible educational pathway between community colleges and universities so that more North Carolina nursing students can achieve a baccalaureate degree at the start of their careers. RIBN is supported by RWJF’s Academic Progression in Nursing initiative.

In her work as a nurse practitioner in a pediatric ICU, Karin Reuter-Rice, PhD, CPNC-AC, has observed that some children with traumatic brain injuries improve rapidly, while others suffer grave and permanent damage, reports Duke Nursing. As a result, Reuter-Rice, an RWJF Nurse Faculty Scholar, is using her RWJF grant for a multi-year research project to determine what neurological differences account for those dramatically different outcomes. She is exploring whether vasospasm, the sudden contraction of blood vessels in the brain, might play a role.

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Mar 6 2014
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An Unhealthy Sign for Health Care Workers? Survey Says They’re the Most Stressed

Health care may have some of the nation’s most promising career opportunities. But it also promises a lot of stress to go along with those jobs, according to a survey from CareerBuilder and its health-care-focused website.

Health care workers topped the list of most stressed workers in the United States, with 69 percent reporting that they feel stress in their current jobs. Next are workers in professional and business services, retail, financial services, information technology, leisure and hospitality, and manufacturing. Health care also had the highest percentage (17) of workers reporting that they are “highly stressed.”

“Stress is part of the environment in many health care settings, but high levels sustained over a long period of time can be a major detriment to employee health and ultimately stand in the way of providing quality care to patients,” CareerBuilder Healthcare President Jason Lovelace said in a news release.

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Mar 6 2014
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RWJF Scholars in the News: Nurse staffing and patient mortality, communicating about vaccines, specialized HIV training for NPs, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

A study led by Linda H. Aiken, PhD, FAAN, FRCN, RN, and covered by CNN.com, finds that hospital nurse-patient ratios and the share of nurses with bachelor’s degrees both have an important impact on patient mortality. Aiken, a research manager supporting the Future of Nursing: Campaign for Action and a member of the RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) National Advisory Committee, found that increasing a hospital nurse’s workload by one patient increased by 7 percent the likelihood of an inpatient death within 30 days of admission. The same research revealed that a 10-percent increase in the number of nurses with bachelor’s degrees at a given hospital reduces the likelihood of a patient death by 7 percent. Aiken’s study has also been covered by the Guardian, Philly.com, and FierceHealthcare, among other outlets.

Public health messages aimed at boosting childhood vaccination rates may be backfiring, according to a new study led by RWJF Scholars in Health Policy Research alumnus Brendan Nyhan, PhD. Campaigns that use studies, facts, and images of ill children increased fears about vaccine side-effects among some parents, NBC News reports. In fact, messaging that debunked myths about links between vaccines and autism actually made parents less inclined to have their children inoculated. Time magazine online also covered the study.

The Johns Hopkins University School of Nursing has developed a new curriculum that provides specialized HIV training to nurse practitioners, with funding from the Health Resources and Services Administration, Medical Xpress reports. “The design of our program starts with the recognition that HIV care cannot be provided in a silo, that it needs to be integrated holistically into primary care," RWJF Nurse Faculty Scholar Jason Farley, PhD, MPH, said in a statement. Farley is the developer of the curriculum.

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