Influence of Digital Health Literacy on Blood Pressure and Hemoglobin A1c in Patients With Comorbid Type 2 Diabetes and Hypertension.

Digital health literacy is emerging as an important element in chronic illness management, yet its relationship with clinical outcomes remains unclear. Utilizing data from the ongoing EXpanding Technology-Enabled, Nurse-Delivered Chronic Disease Care trial, this cross-sectional, correlational study explored the association between digital health literacy, health literacy, and patient outcomes, specifically blood pressure and hemoglobin A1c levels in 76 patients managing comorbid type 2 diabetes and hypertension. Results indicate patients had moderate digital health literacy, which was not significantly correlated with health literacy (r = 0.

EXpanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND): Protocol and Baseline Data for a Randomized Trial.

Background: Approximately 10-15 % of individuals with type 2 diabetes have persistently poorly-controlled diabetes mellitus (PPDM) despite receiving available care, and frequently have comorbid hypertension. Mobile monitoring-enabled telehealth has the potential to improve outcomes in treatment-resistant chronic disease by supporting self-management and facilitating patient-clinician contact but must be designed in a manner amenable to real-world use.

Methods: Expanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND) is an ongoing randomized trial comparing two 12-month interventions for comorbid PPDM and hypertension: 1) EXTEND, a mobile monitoring-enabled self-management intervention; and 2) EXTEND Plus, a comprehensive, nurse-delivered telehealth program incorporating mobile monitoring, self-management support, and pharmacist-supported medication management.

Using Failure Mode and Effects Analysis to Decrease Risk When Developing a Home Health Nurse Residency Program.

Background: New graduate nurses are traditionally not recruited for home health care (HHC).

Local Problem: Due to staffing shortages, a HHC agency was interested in hiring graduate nurses, but there was concern about associated risks.

Methods: The purpose of this quality improvement project was to develop a nurse residency program to safely transition graduate nurses to the HHC setting.

Desirability of Outcome Ranking and Response Adjusted for Antibiotic Risk (DOOR/RADAR) Post Hoc Analysis Supports Equipoise for Antibiotic Initiation Strategies in Intensive Care Unit-Acquired Pneumonia.

Pneumonia is the most common intensive care unit (ICU)-acquired infection and source of potential sepsis in ICU populations but can be difficult to diagnose in real-time. Despite limited data, rapid initiation of antibiotic agents is endorsed by society guidelines. We hypothesized that a post hoc analysis of a recent randomized pilot study would show no difference between two antibiotic initiation strategies.

Provider Perceptions of Antibiotic Initiation Strategies for Hospital-Acquired Pneumonia.

The practice of rapidly initiating antibiotic therapy for patients with suspected infection has recently been criticized yet remains commonplace. Provider comfort level has been an understudied aspect of this practice. We hypothesized that there would be no significant differences in provider comfort level between the two treatment groups.

Urgent Care Centers and What You Need to Know.

Interpretation of and adaption to the health care environment have become a daily activity in the practice of medicine. Patients need health care that is affordable, convenient, and timely. The evolution of urgent care centers has been based on their ability to adapt in the face of changes and respond to patient needs to become a viable entry point into the health care system.

Trial of antibiotic restraint in presumed pneumonia: A Surgical Infection Society multicenter pilot.

Background: Pneumonia is the most common intensive care unit-acquired infection in the trauma and emergency general surgery population. Despite guidelines urging rapid antibiotic use, data supporting immediate antibiotic initiation in cases of suspected infection are limited. Our hypothesis was that a protocol of specimen-initiated antibiotic initiation would have similar compliance and outcomes to an immediate initiation protocol.

The median preoptic nucleus: A major regulator of fluid, temperature, sleep, and cardiovascular homeostasis.

Located in the midline lamina terminalis of the anterior wall of the third ventricle, the median preoptic nucleus is a thin elongated nucleus stretching around the rostral border of the anterior commissure. Its neuronal elements, composed of various types of excitatory glutamatergic and inhibitory GABAergic neurons, receive afferent neural signals from (1) neighboring subfornical organ and organum vasculosum of the lamina terminalis related to plasma osmolality and hormone concentrations, e.g.

Clinical Nurse Specialist Collaboration With a Community-Based Palliative Care Program: An Evidence-Based Practice Project.

Purpose/objectives: The purpose of the project was to evaluate the impact of a clinical nurse specialist (CNS) collaborating with an established Midwestern community-based palliative care program on the following quality outcomes: care coordination, 30-day readmissions, and emergency department (ED) utilization.

Description Of Project: Palliative care services are evolving from the inpatient setting to community-based models to meet the needs of patients in their homes. As community-based programs develop, healthcare systems are examining the various models of care.

Improving Retention of Home Health Nurses: Fostering Outcome Sustainability Through an Innovative Orientation and Mentorship Program.

Home healthcare plays an increasingly vital role in contemporary postacute healthcare. Staffing instability and lack of perceived organizational support is a stimulus for nursing attrition from the organization with far-reaching impact on staff morale, patient care, agency budgets, and relationships with other healthcare settings. The purpose of this article is to describe a redesign of an agency's nursing orientation and the development of a mentorship program for newly hired home healthcare nurses within a large Midwestern integrated health system.

Integrating Competing Demands of Osmoregulatory and Thermoregulatory Homeostasis.

Mammals are characterized by a stable core body temperature. When maintenance of core temperature is challenged by ambient or internal heat loads, mammals increase blood flow to the skin, sweat and/or pant, or salivate. These thermoregulatory responses enable evaporative cooling at moist surfaces to dissipate body heat.

Necrotizing infection of the heart.

A case of necrotizing infection of the heart is presented. A 70-year-old woman presented with vague chest and abdominal pain. CT of the abdomen and pelvis was initially obtained, which demonstrated gas in the myocardium of the left ventricle.

Neural Substrate Essential for Suppression of Vasopressin Secretion and Excretion of a Water Load.

Suppression of vasopressin secretion to very low levels is essential for the excretion of excess water. To investigate a role for the preoptic brain region in the suppression of vasopressin secretion and the excretion of a water load, lesions were made in the vicinity of the lamina terminalis in ewes (LTX-sheep) and responses to water-loading or reduction of cerebrospinal fluid NaCl by i.c.

Interventional Magnetic Resonance Imaging Clinic: The Emory University Experience.

In this article, we share our experience in establishing a clinic-based practice for MR imaging-guided interventions. Clinic resources and operational logistics are described and our institutional cost analysis for supporting the clinic activity is provided. We highlight the overall value of the clinic model in transitioning the field of interventional MR imaging from the "proof-of-concept" to the "working model" era and engage in a detailed discussion of our experience with the positive impact of the clinic on streamlining the procedural workflow, increasing awareness of the technology, expanding referral bases, and boosting the satisfaction of both patients and referring services.

Characterization of genes responsible for the CO-linked hydrogen production pathway in Rubrivivax gelatinosus.

Upon exposure to carbon monoxide, the purple nonsulfur photosynthetic bacterium Rubrivivax gelatinosus produces hydrogen concomitantly with the oxidation of CO according to the equation CO + H(2)O <--> CO(2) + H(2). Yet little is known about the genetic elements encoding this reaction in this organism. In the present study, we use transposon mutagenesis and functional complementation to uncover three clustered genes, cooL, cooX, and cooH, in Rubrivivax gelatinosus putatively encoding part of a membrane-bound, multisubunit NiFe-hydrogenase.

Statistical process control for hospitals: methodology, user education, and challenges.

The health care industry is slowly embracing the use of statistical process control (SPC) to monitor and study causes of variation in health care processes. While the statistics and principles underlying the use of SPC are relatively straightforward, there is a need to be cognizant of the perils that await the user who is not well versed in the key concepts of SPC. This article introduces the theory behind SPC methodology, describes successful tactics for educating users, and discusses the challenges associated with encouraging adoption of SPC among health care professionals.

Reconstructing tumor phylogenies from heterogeneous single-cell data.

Studies of gene expression in cancerous tumors have revealed that tumors presenting indistinguishable symptoms in the clinic can be substantially different entities at the molecular level. The ability to distinguish between these genetically distinct cancers will make possible more accurate prognoses and more finely targeted therapeutics, provided we can characterize commonly occurring cancer sub-types and the specific molecular abnormalities that produce them. We develop a new method for identifying these common tumor progression pathways by applying phylogeny inference algorithms to single-cell assays, taking advantage of information on tumor heterogeneity lost to prior microarray-based approaches.

Terahertz current oscillations in single-walled zigzag carbon nanotubes.

We report time-dependent terahertz current oscillations on an n=10 single-walled zigzag carbon nanotube (CNT) that is 100 nm long. To obtain transport characteristics in this CNT, we developed an ensemble Monte Carlo (MC) simulator, which self-consistently calculates the electron transport and electrical potential. The ensemble MC simulations indicate that, under certain dc bias and doping conditions, the average electron velocity and concentration oscillate.

Expectation-maximization method for reconstructing tumor phylogenies from single-cell data.

Recent studies of gene expression in cancerous tumors have revealed that cancers presenting indistinguishable symptoms in the clinic can represent substantially different entities at the molecular level. The ability to distinguish between these different cancers makes possible more accurate prognoses and more finely targeted therapeutics. Making full use of this knowledge, however, requires characterizing commonly occurring cancer sub-types and the specific molecular abnormalities that produce them.

Sex differences in regret: all for love or some for lust?

Few sex differences in regret or counterfactual thinking are evident in past research. The authors discovered a sex difference in regret that is both domain-specific (i.e.