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Biomedical subjects

Elaine Larson

Publications and source records attributed to Elaine Larson.

48 records · Page 3Linked to original sources
PubMed2003

Antibiotic use in Hispanic households, New York city.

Trained interviewers visited 631 inner city households to determine community prevalence and predictors of antibiotic use. Infectious disease symptoms were reported in 911 (33.2%) of 2,743 household members in the previous 30 days: medical attention was sought by 441 (48.4%) of 911 persons, and 354 (8.9%) of 911 took antibiotics for symptoms. Reported symptoms were respiratory (68.9%(, gastrointestinal (15.3%(, fever (12.8%(, and skin infection (2.8%(. Medical attention was sought significantly more often among those with chronic illness, those born in the United States, and those with fever, runny nose, or skin infections (all p<0.05). Antibiotics were taken significantly more often among those with poor health, those who spent more time at home, and those with fever and respiratory symptoms. Interventions to promote judicious use of antibiotics must include clinicians and the public, and for the Hispanic population such interventions must also be culturally relevant and provided in Spanish.

Adolescent↗
PubMed2003

Racial and ethnic disparities in immunizations: recommendations for clinicians.

There continue to be significant racial and ethnic disparities in rates of childhood and adult immunizations in the United States. The causes are multifactorial, including inequities in education, income, and socioeconomic status; structural and systemic barriers in the health care delivery system; and beliefs, preferences, and practice patterns of the recipients and providers of care. Elimination of these disparities is a targeted priority in Healthy People 2010. The individual clinician can contribute to the narrowing of this gap by being informed of and using available national and regional resources, implementing national standards for culturally and linguistically appropriate health care services, and using every clinical encounter to assure that vaccination is offered and provided. Specific action steps are suggested.

Adult↗
PubMed2002

The role of the home environment in the transmission of infectious diseases.

The purpose of this paper is to examine current health care literature (1980-2000) regarding the microbiology of the home environment, to summarize evidence of transmission within the home, and to assess effectiveness of cleaning practices and products. The home environment, particularly the kitchen and bathroom, serves as a reservoir of large numbers of microorganisms, particularly Enterobacteriacae, and infectious disease transmission has been demonstrated to occur in 6-60% of households in which one member is ill. Current food preparation and cleaning practices provide multiple opportunities for intra-household member spread. Routine cleaning is often sufficient, but in cases of household infection, may not adequately reduce environmental contamination. The effectiveness of disinfectants varies considerably and depends on how they are used as well as their intrinsic efficacy. The behavioral aspects of infection prevention in the home (e.g., foodhandling and cleaning practices) warrant increased public attention and education.

Communicable Diseases↗
PubMed2002

A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000.

BACKGROUND: Nosocomial infections (NIs) are a serious patient safety issue. Infection control personnel are responsible for implementing interventions to reduce this risk. The purpose of this systematic review was to audit the published economic evidence of the attributable cost of NIs and interventions conducted by infection control professionals and to evaluate the methods used. Economic evaluation methodology and recommendations for standardization are reviewed. METHODS: A search of MEDLINE and HealthSTAR with medical subject headings or text words "nosocomial infections," "infection control," or "hospital acquired infections" cross-referenced with "costs," "cost analysis," "economics," or "cost-effectiveness analysis" was conducted. Published review articles were also searched. Inclusion criteria included articles published between 1990 and 2000 that contained an abstract and original cost estimate and were written in English. Results were standardized into a common currency. RESULTS: Fifty-five studies were eligible. Approximately one quarter examined NIs in intensive care patients (n = 13). Most studies were conducted from the hospital perspective (n = 48). The costs attributable to bloodstream (mean = $38,703) and methicillin-resistant Staphylococcus aureus infections (mean = $35,367) were the largest. CONCLUSIONS: Increased standardization and rigor are needed. Clinicians should partner with economists and policy analysts to expand and improve the economic evidence available to reduce hospital complications such as NI and other adverse patient/staff outcomes.

Cost-Benefit Analysis↗
PubMed2002

Leadership research in business and health care.

PURPOSE: To summarize research on leadership in the health care and business literature and to identify the outcomes of leadership on individuals, groups, and organizations. METHODS: A computerized search and review of research studies was conducted in the health care and business literature from 1970-1999. Studies were categorized and analyzed according to participants, design, primary topic area, and effects or outcomes of leadership. FINDINGS: Most of the health care and business literature on leadership consisted of anecdotal or theoretical discussion. Only 4.4% (n = 290) of 6,628 articles reviewed were data-based. Further, the largest proportion of the research (120/290, 41.4%) was purely descriptive of the demographic characteristics or personality traits of leaders. Other studies showed the influence of leadership on subordinates (27.9%). Only 15 (5.2%) of 290 research articles include correlations of qualities or styles of leadership with measurable outcomes on the recipients of services or positive changes in organizations. CONCLUSIONS: Research on leadership in the health care and business literature to date has been primarily descriptive. Although work in the social sciences indicates that leadership styles can have a major influence on performance and outcomes, minimal transfer of this work to the health care system is evident. Limited research on leadership and health care outcomes exists, such as changes in patient care or improvements in organizational outputs. In this era of evidence-based practice, such research, although difficult to conduct, is urgently needed.

Commerce↗
PubMedDate not supplied

Focusing research priorities in schools of nursing.

Schools of nursing are facing the challenge of shrinking resources simultaneously with the public's cry for more nursing manpower. This challenge compounds the difficult decisions all schools must make regarding the allocation of precious resources. One element critical to the future of the profession is the growth of its knowledge base through research, but it is essential to ensure that the research programs developed and encouraged in the school reflect its culture and values and contribute to the mission of the sponsoring institution and the profession. The purpose of this article is to describe a process for articulating a school of nursing's research focus and its congruence with the school's culture. The process outlined includes a discussion of the role of the school's leadership, how faculty can become engaged, and criteria used to identify a school's research niche. Additionally, an example of one school's final articulation of research focus is provided. Schools of nursing that support research should examine that enterprise in light of their mission. The first step should be a formal articulation of how the research conducted in the school supports the school's mission.

Humans↗
PubMedDate not supplied

Effects of age and race on skin condition and bacterial counts on hands of neonatal ICU nurses.

OBJECTIVE: The purpose of this study was to assess the relationship between demographic factors such as age and race and skin condition and bacterial counts on hands of nurses. METHODS: Nurses (n = 111) working in 1 of 2 neonatal ICUs in New York City were surveyed regarding reported hand care practices and demographics, the condition of their hands was assessed by a trained observer and by themselves using validated instruments, and a hand culture was obtained. RESULTS: There were no significant differences in any skin care practices by race, but nurses who wore powder-free gloves were significantly younger than those who did not (P =.004). There were no significant differences in bacterial counts on hands of black or white nurses (mean log colony-forming units 3.49 and 3.61 respectively, P =.63) and no significant correlation between age and microbial counts (r = 0.04, P =.72). In a logistic regression analysis, race, but not age, was a significant predictor of skin health. By both observer (P =.02) and self-assessment (P =.004) black nurses had healthier skin. CONCLUSION: Physiochemical differences in skin associated with demographic factors such as age and race may be exacerbated among those in disciplines such as nursing, for whom the skin of the hands is continually stressed by occupational practices such as frequent hand hygiene. Such demographic factors need be considered when assessing skin condition and when advocating for appropriate strategies to maximize skin health. The recommendations of the new CDC Hand Hygiene Guideline for Healthcare Settings(23) regarding maintaining skin health and providing moisturizers and products that are milder to the skin are timely and should be followed.

Adult↗
PubMedDate not supplied

Length of normal labor in women of Hispanic origin.

Emanuel Friedman in the 1950s established means and statistical guidelines for normal lengths of labor. The childbearing population in the United States has changed considerably since Friedman's research was conducted. This study documented the duration of labor in a cohort of 240 Hispanic women who had normal vaginal births of singleton term infants from January 1995 through December 1998 and compared these results with the mean duration of the first and second stages of labor as established by Friedman. The mean duration of the active phase first stage labor duration for nulliparous Hispanic women was 6.2 hours, and for multiparous Hispanic women was 4.4 hours, both significantly longer than Friedman's group (P <.01). The mean duration of the second stage of labor in nulliparous Hispanic women was 54.2 minutes and for multiparous Hispanic women was 22.2 minutes, not significantly different from Friedman's group (P =.5 and P =.09, respectively).

Adolescent↗
PubMedDate not supplied

Prevalence and antimicrobial patterns of Acinetobacter baumannii on hands and nares of hospital personnel and patients: the iceberg phenomenon again.

OBJECTIVE: To determine the prevalence and antimicrobial susceptibility patterns of Acinetobacter baumannii on the hands and nares of health care workers and patients from intensive care and rehabilitation units at two hospitals in northern Manhattan, New York. DESIGN: Prevalence survey of Acinetobacter on the hands and anterior nares of staff (n = 184) and patients (n = 98) in rehabilitation and intensive care units of two hospitals. RESULTS: Twenty subjects (7.1%) had positive test results for A baumannii (6 staff [3.3%] and 14 patients [14.3%]). Five patients had positive test results at both sites, four in the nares only, and 11 on hands only. Among patients, four significant predictors of A baumannii were days on unit (P = .003), location (hospital A or B) (P = .01), surgery (P = .04), and receiving an antifungal agent (P = .02; OR, 5.6; 95% CI, 1.25-24.52). Among staff, predictors were skin damage (P = .02) and employment in hospital B (P = .03). Nine of the 20 subjects (45%) had positive test results for multiresistant strains, one from a staff member and eight from patients. CONCLUSION: Patients whose conditions are not clinically symptomatic for A baumannii, as well as staff, are often colonized. Staff with damaged skin are more likely to be colonized. Control of this organism will only be possible when the principle of the iceberg phenomenon--all patients (and staff) treated with standard, Universal Precautions--is strictly followed. Further, the endemic prevalence of multiresistant strains may be higher than previously appreciated.

Acinetobacter Infections↗
PubMedDate not supplied

Perceived nursing work environment of critical care nurses.

BACKGROUND: Different concepts and measures have been used to evaluate the work environment of nurses in hospital settings. There is increasing need for updated measurement tools that reflect the evolving nature of the work environment. OBJECTIVES: To report the psychometric properties of the Perceived Nursing Work Environment (PNWE) instrument, and to compare these results with those of other scales derived from the same background instrument: the Nursing Work Index-Revised. METHODS: The Nursing Work Index-Revised was used in a national survey of critical care nurses. Exploratory principal component analysis with orthogonal rotation was conducted. Psychometric properties were examined. Construct validity was evaluated by comparing the scores for a subsample of nurses in magnet and nonmagnet hospitals. RESULTS: Surveys obtained from 68 hospitals across the nation had a mean response rate of 41%, resulting in a sample of 2,324 participants. The PNWE, with its seven subscales and 42 items, explained 53% of the total variance of the Nursing Work Index-Revised. The subscales exhibited moderate to high reliabilities ranging from .70 to .91, except for one subscale (.56), and generally low intercorrelation. A similar version of the nurse-physician collaboration subscale was found in three of the other four scales compared. The positive scheduling climate subscale was a unique finding. Nurses employed at magnet hospitals had more positive perceived work environments than those employed at nonmagnet hospitals, and showed higher mean scores in four of the seven subscales (p < .05). CONCLUSIONS: The PNWE, a measure of the work environment as perceived by nurses, represents the latest version of the Nursing Work Index-Revised based on current practice. In this study, it exhibited sound psychometric properties. Further application and testing of the PNWE in various patient care settings is recommended.

Adult↗
PubMedDate not supplied

Chemotherapy-handling practices of outpatient and office-based oncology nurses.

PURPOSE/OBJECTIVES: To determine the current patterns of use of personal protective equipment among oncology nurses while handling antineoplastic chemotherapeutic agents in outpatient and office-based settings. DESIGN: Descriptive-correlational, mailed survey. SETTING: National survey of oncology nurses. SAMPLE: 500 randomly selected members of the Oncology Nursing Society who identified their work settings as office, clinic, or outpatient private practice; 263 responded for an overall response rate of 53%. METHODS: Mailed, self-report survey based on the current Occupational Safety and Health Administration's (OSHA's) guidelines for the handling of hazardous drugs. MAIN RESEARCH VARIABLE: Chemotherapy-handling practices. FINDINGS: More than 94% of participants reported usually wearing gloves during chemotherapy handling; 55% reported using laboratory coats as protective garments. Usual use of face and respiratory protection was less than 6%. Chemotherapy was reported to be prepared in laminar air flow hoods in 99% of work settings. Only 46% of sites reportedly provided any type of medical monitoring. CONCLUSION: Use and availability of personal protective equipment when handling chemotherapy have increased, but medical monitoring of exposed employees still is neither widely practiced nor consistent with OSHA guidelines. IMPLICATIONS FOR NURSING: Safety concerns and potential adverse health effects associated with the occupational handling of chemotherapeutic agents have been reported. Historically, nurses' adherence to chemotherapy-handling guidelines has been poor. Results suggest that adherence is increasing; however, research is lacking regarding nurses' level of knowledge of and specific barriers to safe handling of chemotherapy.

Ambulatory Care↗