Category Archives: Research
Ayotunde Dokun, MD, PHD, is an assistant professor of medicine at the University of Virginia Health System in Charlottesville, VA. He is also an alumnus of the Harold Amos Medical Faculty Development program (2009-2013), an initiative funded by the Robert Wood Johnson Foundation (RWJF) that supports faculty in academic medicine and dentistry who are from historically disadvantaged backgrounds.
Human Capital Blog: Congratulations on your recent award from the American Heart Association! What does it mean for your work and for your career?
Ayotunde Dokun: It is a great honor to be recognized by the Peripheral Vascular Council of the American Heart Association with an early stage investigator award. For my work, it means the society recognizes the significance of what I have contributed to the field thus far. For my career, it’s a stepping stone hopefully to a brighter future as physician scientist.
HCB: The award recognizes the research and background of outstanding early-career researchers in the field of peripheral vascular disease. Can you describe your current work in this area?
Dokun: Part of my work in this area has been focused on trying to understand why individuals with peripheral arterial disease (PAD) show different levels of disease severity even when their risk factors and extent of vessel occlusions are similar. Some individuals tend to present with mild symptoms, described as “intermittent claudication,” while others present with a severe form of the disease called “critical limb ischemia.” Individuals with intermittent claudication typically have pain in the affected limb when walking, but this pain is usually relieved when they stop walking. Individuals with critical limb ischemia, on the other hand, tend to have pain even when they are not walking and may have associated ulcer or gangrene in the affected limb.
Such individuals are at a several-fold higher risk of limb amputation and death compared to their counterparts who present with intermittent claudication. Interestingly, similar to what is seen in humans, different strains of mice show different levels of injury when PAD is induced experimentally. We therefore hypothesized that the underlying genetic differences might be contributing to this difference in disease severity.
We explored this possibility using experimentally induced PAD in mice, and our work was the first to identify a region on the mouse chromosome that contained genetic information that, when present, allowed the mice to adapt well to experimentally induced PAD. When absent, it was associated with poor adaption, poor recovery, and a tendency to lose the affected limb. More recently, we have now, for the first time, indentified a specific gene in both mice and humans that modifies the severity of PAD.
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.
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).
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.
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
ICU Staffing’s Impact on Patient Outcomes
A nurse-led study from the United Kingdom has found that higher numbers of doctors and nurses in intensive care units (ICUs) have a positive effect on survival rates for high-risk patients.
A research team led by Elizabeth West, PhD, MSc, RN, Director of Research in the School of Health and Social Care at the University of Greenwich, used data on 38,000 patients in 65 ICUs in the United Kingdom, correlating patient outcomes with staffing levels for doctors, nurses, and support staff. They found that “higher numbers of nurses per bed ... and higher numbers of ‘consultants’ [senior hospital-based physicians or surgeons] were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death.”
“It seems reasonable to argue,” the researchers conclude, “that skilled nurses, who have the time to observe patients closely, to intervene or mobilise the team if they begin to deteriorate, would be most important to patients who are at the greatest risk. This study is the first to produce evidence that this is the case.” Their findings are published in the May 2014 issue of the International Journal of Nursing Studies.
Susan B. Hassmiller, PhD, RN, FAAN, is co-director of the Future of Nursing Scholars Program and senior adviser for nursing for the Robert Wood Johnson Foundation (RWJF). The Future of Nursing Scholars program’s call for proposals will close on April 15. It is open to schools of nursing with research-focused PhD programs. The schools that receive awards will select the scholars to support.
I started my nursing career at a community college. It was a terrific experience that left me as prepared as I could be for my beginning staff nurse role. I quickly discovered that I wanted and needed to know more, however, so I returned to school. Over the next several years, I earned a PhD in nursing administration and health policy. It was difficult but incredibly rewarding and has led to a career I could never have imagined when I started out, including serving as a faculty member at the University of Nebraska and George Mason University. That experience has made me want to “pay it forward”—to pay homage to the nurses who mentored and encouraged me on my journey.
Serving as co-director of the Future of Nursing Scholars program is part of my personal mission to help other nurses who want to follow the same path. It also is a big part of RWJF’s extraordinary, long-term support for the nursing profession, which advances the Foundation’s mission to improve health and health care, and build a culture of health in this country.
Supporting nurses seeking PhD degrees is tremendously important. Because nurses have vast experience working directly with patients and families, we are positioned to help make care safer, more accessible, and higher quality. In particular, PhD-prepared nurse scientists and researchers are in a unique position to identify solutions that make a real difference to patients and families. But, as the Institute of Medicine (IOM) noted in its landmark report, The Future of Nursing: Leading Change, Advancing Health, the country will need many more PhD-prepared nurses in coming years.
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.
Robin Knobel, PhD, RN, is an associate professor at the Duke University School of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2010-2013). The University of Carolina at Chapel Hill (UNC-CH) School of Nursing recently recognized her with its Distinguished Alumna award.
Human Capital Blog: Congratulations on the award! What does it mean for you and for your research?
Robin Knobel: I was truly honored to receive this award from UNC-CH because it recognizes my achievement thus far in my career in my area of research around improving thermal stability with premature infants. I was given great support as a doctoral student at UNC-CH through mentorship in research from faculty who are leaders as nurse scientists. To be recognized by alumni and faculty of the UNC-CH School of Nursing is a tremendous honor.
HCB: You received the award for your research into physiologic processes related to thermoregulation and perfusion in extremely premature infants. Can you explain what this means in lay terms?
Knobel: Yes. Premature infants are born too early to be able to keep themselves warm through the normal methods of heat production. Normally, infants up to one year of age do this through a metabolic production of heat, instead of shivering. Premature infants lack necessary components to accomplish efficient production of heat and consequently can become very cold if exposed to cold air after birth and through stabilization in the neonatal unit. They often experience hypothermic body temperatures during the early weeks after birth, which can lead to instability and possible lasting insults such as brain hemorrhage, infection, or even death. My research is studying the mechanisms around thermal stability in premature infants and ways to prevent bad outcomes from hypothermia.
This is part of the March 2014 issue of Sharing Nursing’s Knowledge.
Comparing Nurse and Physician Performance on Colonoscopies
A new study finds that colonoscopies performed by nurse and physician endoscopy trainees are comparable in terms of quality and safety.
Researchers in The Netherlands studied 15 endoscopy trainees—seven nurses and eight physicians—at two medical centers over the course of three-and-a-half years. At the beginning of the study, none had experience in endoscopy. All were trained according to the applicable regulations of the Dutch Society of Gastroenterology, performing a minimum of 100 colonoscopies. After completing their training, each performed 135 consecutive colonoscopies under the supervision of a gastroenterologist, with their work evaluated for safety and quality.
The nurse group and the physician group had comparable results on both measures, with the nurse group producing marginally better scores in some areas. Each group detected the same percentage of adenomas (benign polyps), and had the same low rate of complications. The nurses had slightly higher rates of cecal intubation (successfully passing the colonoscope to a key part of the colon), and slightly higher rates of completing the procedure without assistance.
The Robert Wood Johnson Foundation (RWJF) Investigator Awards in Health Policy Research program has selected projects and Investigators as a result of its 2013 application process. The program provides funding to highly qualified individuals undertaking broad studies of the most challenging health, health care, and health policy issues facing the country. Grants of up to $335,000 are awarded to investigators from a wide range of disciplines.
Eleven individuals have been selected to join the program. Their eight projects address race, ethnicity, and class in pharmaceutical marketing; mood and behavior disorders in children and adolescents; ethical and policy issues raised by living donor transplantation; resilience and recovery from disasters; and more. Grants to their institutions will be awarded on a rolling basis throughout 2014.
Shreya Kangovi, MD, is an assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine, executive director of the Penn Center for Community Health Workers, and a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholars program alumna.
“What do you think will help you stay healthy after discharge?”
Mr. Manzi, a soft-spoken man in his early 60s, paused to consider. No one had asked him this question before. He had come to the hospital because of blurry vision and thirst too severe to ignore. The doctors told him that he had severe diabetes and hypertension, and that he needed to adhere to a long list of new medications, tests, and appointments.
“Not just medical stuff,” Anthony, the community health worker, continued. “Talk to me about anything. Dealing with shut-off notices, housing issues, whatever you think you need to stay healthy.”
Mr. Manzi opened up. He explained that he was originally from Ghana but had been living and working odd jobs in Philadelphia for 20 years as an undocumented immigrant. He had not had a job in six months and twice, his home had gone into foreclosure. Mr. Manzi was uninsured and had not been able to get outpatient care before coming to the hospital.
“I’m willing to do whatever it takes to stay healthy,” he concluded. “But I need to make sure I can pay for all of these medications and a doctor. And I need some help with the foreclosure—I can’t take care of myself if I lose my home.”
Mr. Manzi’s answers became the basis for his tailored intervention. IMPaCT (Individualized Management for Patient-Centered Targets) is an innovative model of care in which community health workers (CHWs) provide tailored support to help patients achieve individualized goals. Anthony, an IMPaCT CHW, shares socioeconomic background with patients like Mr. Manzi. He and other IMPaCT CHWs are selected for traits such as empathy, active listening, and reliability.