Permanent URI for this collection
ABOUT THIS COLLECTION
The mission of the Tan Chingfen Graduate School of Nursing at UMass Chan Medical School is to prepare nurses who embrace diversity and promote health equity to improve the quality of life and human health in the Commonwealth and beyond by leading and innovating in education, research, health care delivery and public service. This collection showcases journal articles, posters, and other publications and presentations written by faculty, staff, and students of the Tan Graduate School of Nursing.
QUESTIONS?
Contact escholarship@umassmed.edu with your questions.
Browse
Recent Publications
Publication Neighborhood Socioeconomic Status and Breastfeeding Initiation and Duration Among Primiparous Black Women(2025-01-21) Griswold, Michele K; Crawford, Sybil L; Person, Sharina D; Rosenberg, Lynn; Palmer, Julie R; Cozier, Yvette C; Biostatistics and Health Services Research; Population and Quantitative Health Sciences; Tan Chingfen Graduate School of NursingSocial determinants of health account for racial inequities in breastfeeding rates in the United States. There is a gap in the role of neighborhood socioeconomic status (NSES) as it relates to breastfeeding disparities. Using longitudinal data from the Black Women's Health Study, we assessed associations of NSES with breastfeeding initiation and duration in a cohort of primiparous U.S. Black women. We also explored associations within strata of important economic indicators, including education, occupation, and marital status. Breastfeeding initiation ( = 2,705) increased with NSES quartile, from 75.2% in the lowest quartile to 88.3% in the highest quartile ( < 0.0001). Compared with women living in the highest NSES quartile, those in the lowest quartile had a 41% (odds ratio: 0.59 [95% confidence interval: 0.43, 0.81]) decreased odds of initiating breastfeeding. For breastfeeding duration ( = 2,172), women residing in NSES quartiles 1-3 were significantly less likely ( < 0.0001) to breastfeed (44.4%) for 6+ months compared with those living in the highest quartile (62.8%). Adjusted relative risks for those in quartiles 1-3 compared with 4 (highest) were 0.63 (0.45, 0.87), 0.50 (0.37, 0.68), and 0.64 (0.47, 0.86), respectively ( = 0.0001). There was no statistically significant evidence of effect modification by education, occupation, marital status, and region ( = >0.05). Living in a lower NSES environment was associated with reduced breastfeeding initiation and duration compared with a higher NSES environment. Research is needed to understand the mechanisms by which neighborhood-level factors influence breastfeeding initiation and duration for Black women in the United States.Publication Physical activity and quality of life among breast cancer survivors: Pink SWAN(2025-01-16) Leitzelar, Brianna N; Crawford, Sybil L; Levine, Beverly; Ylitalo, Kelly R; Colvin, Alicia B; Gabriel, Kelley Pettee; Greendale, Gail A; Avis, Nancy E; Tan Chingfen Graduate School of NursingPurpose: To describe physical activity (PA) trajectories across 10 years post-breast cancer diagnosis and examine their association with quality of life (QoL). Methods: Participants from the longitudinal Study of Women's Health Across the Nation who developed incident breast cancer completed the Quality of Life in Adult Cancer Survivors scale (QLACS) which has 12 domains. Breast cancer survivors (BCS) with at least one post-diagnosis measure of the Kaiser Physical Activity Survey (PA) were included (n = 96). We estimated metabolic equivalents of task minutes per week (MET-min/week) for the two most frequent sport/exercise activities. Group-based trajectory modeling determined PA trajectories over 10 years post-diagnosis. Analysis of covariance assessed associations between PA trajectory group and the three QLACS domains with the worst scores (fatigue, pain, and recurrence-related distress), adjusted for PA and other relevant covariates. Results: There were four post-diagnosis PA trajectories: consistently very low/no PA ("inactive," 11.5%); consistently some, but below aerobic PA guideline ("below guideline," 48.9%); generally met aerobic PA guideline with a slight decline ("met guideline," 22.2%); and exceeded aerobic PA guideline ("exceeded guideline," 18.8%). In adjusted models, the below guideline group reported more fatigue than the met or exceeded groups and more pain than the met guideline group, but there were no group differences in recurrence-related distress. Conclusion: The majority of BCS did not meet the aerobic PA guideline over 10 years post diagnosis. BCS who met the aerobic PA guideline reported less fatigue and pain compared to those who did not meet the guideline in adjusted analyses, suggesting a negative association between PA and QoL.Publication Family Management of Hypertension in Brazil: A Cross-Sectional Study(2024-09-30) Sales, Paloma Cesar de; McCarthy, Margaret M; Dickson, Victoria Vaughan; Sullivan-Bolyai, Susan; Melkus, Gail D'Eramo; Chyun, Deborah; Tan Chingfen Graduate School of NursingIn Brazil, research indicates that primary family members are the main source of support for individuals with chronic conditions such as hypertension (HTN). The burden of caregiving not only hinders effective HTN management but can also cause stress and anxiety, potentially leading to HTN in caregivers. Despite this, few studies have explored the impact of caregiving on these family members. Aims of the study were to: (1) Describe the prevalence of blood pressure (BP) control in family members of individuals with HTN; (2) identify family member perspectives on facilitators and barriers to HTN management; and (3) identify influences that help or interfere with family member functioning (levels of stress, quality of life [QOL], and caregiver burden). This descriptive, cross-sectional study included 213 family members randomly selected from 3 Family Health Strategy units. Family members were largely female ( = 143; 67.1%); the mean age was 60.1 years ( ± 17.02) and 42.6% ( = 96) had less than a high school education. The three most important facilitators and barriers were related to medication, medical visits, healthy eating, physical activity, and stress. The mean systolic BP was 132.7 ( ± 21.9) mmHg and a diastolic BP of 85.9 ( ± 18.1) mmHg with 120 (56.3%) of family members classified as having normal BP. In regard to family member contributions to the self-care of the individual with HTN, family members displayed low levels of self-care maintenance ( = 148; 69.4%) and management ( = 47; 71.2%) support, while a slight majority ( = 114; 53.5%) had adequate levels of self-care confidence in supporting the individual with HTN. Family members ( = 189; 88.8%) showed moderate-to-high levels of perceived stress, but good physical ( = 189; 88.7%) and mental QOL ( = 196; 92%) and low levels of caregiver burden ( = 113; 53.1%). A variety of contextual sociocultural influences were associated with the outcomes under study. Family-based interventions are urgently needed to address the inadequate management of HTN.Publication An innovative Doctor of Nursing Practice scholarly project curriculum model: Strategies for supporting learners at various entry levels(2024-08-22) Feeney, Adele Susan; White, Patricia; Menard, Alexander; Peterson, Kenneth; Terrien, Jill M; Boucher, Jean; Tan Chingfen Graduate School of NursingThe Doctor of Nursing Practice (DNP) Program curriculum must address the challenge of developing Competency Based Education (CBE) curriculum for DNP Scholarly Projects tailored to meet variations in nursing learner preparation and practice, from novice bachelor's entry level and master's advanced nurse practice expert entry level pathways. The recent Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report by the National Academy of Medicine advocates that competency-based education (CBE) approaches in nursing schools should focus upon the advanced practice nursing population within collaborative academic practice partnerships. This article describes an innovative DNP Scholarly Project Curriculum model at an academic health science center that integrates academic partnerships and CBE strategies that have been developed for second degree Bachelor's direct entry to nursing (direct entry), post BS in nursing to DNP (BS to DNP), Post Master's to DNP (PM DNP) entry levels of preparation. The DNP Scholarly Project Curriculum utilizes an innovative, scaffolded approach to fostering CBE for the assessment of learning activities at the doctoral level. The DNP Scholarly Project Curriculum includes domains of quality improvement, critical appraisal of the literature, evidence-based practice models, implementation practice models, policy analysis, and process/outcome evaluations. Preliminary alumni and stakeholder feedback suggests that these projects are not only impacting practice but improving learner competency in quality improvement science. Implementation of this model has led to enhanced CBE-driven curriculum teaching and learning strategies, and sustainable collaborative academic partnerships.Publication A dynamic customized electronic health record rule based clinical decision support tool for standardized adult intensive care metrics(2024-12-11) Cucchi, Eric W; Burzynski, Joseph; Marshall, Nicholas; Greenberg, Bruce; Medicine; Tan Chingfen Graduate School of NursingObjectives: Many routine patient care items should be reviewed at least daily for intensive care unit (ICU) patients. These items are often incompletely performed, and dynamic clinical decision support tools (CDSTs) may improve attention to these daily items. We sought to evaluate the accuracy of institutionalized electronic health record (EHR) based custom dynamic CDST to support 22 ICU rounding quality metrics across 7 categories (hypoglycemia, venothromboembolism prophylaxis, stress ulcer prophylaxis, mechanical ventilation, sedation, nutrition, and catheter removal). Design: The dynamic CDST evaluates patient characteristics and patient orders, then identifies gaps between active interventions and conditions with recommendations of evidence based clinical practice guidelines across 22 areas of care for each patient. The results of the tool prompt clinicians to address any identified care gaps. We completed a confusion matrix to assess the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the dynamic CDST and the individual metrics. Setting: Tertiary academic medical center and community hospital ICUs. Subject: Customized Clinical Decision Support Tool. Measurements and main results: The metrics were evaluated 1421 times over 484 patients. The overall accuracy of the entire dynamic CDST is 0.979 with a sensitivity of 0.979, specificity of 0.978, PPV 0.969, and NPV 0.986. Conclusions: A customized, EHR based dynamic CDST can be highly accurate. Integrating a comprehensive dynamic CDST into existing workflows could improve attention and actions related to routine ICU quality metrics.Publication Assessment of adherence to American Diabetes Association guidelines and evaluation of social determinants of health and interventions in patients with type 2 diabetes mellitus in a nurse practitioner-owned clinic(2024-12-12) Murumba, Rachel G; Naman, Rachel O; Tuohy, Christine A; White, Patricia A; Wright, Wendy; Tan Chingfen Graduate School of NursingBackground: This was an ongoing quality-improvement (QI) project that aimed to assess the quality of nurse practitioner (NP)-driven diabetes care based on the 2023 American Diabetes Association (ADA) Standards of Care (SOC) at a NP-owned primary care practice. In addition, a more recent focus was the assessment of and intervention on social determinants of health (SDOH). Nationally, 47.4% of people with diabetes mellitus (DM) have an HbA1C of >7.0%. Adherence to ADA SOC for DM management minimizes the risk of diabetes-associated complications. Local problem: At a NP-owned clinic, within one year, the average A1Cs improved in all patients except those with positive SDOH despite receiving similar care. SDOH predicts DM prevalence and severity of progression, yet screening is not consistently performed or documented. Methods: An ongoing retrospective chart review since 2013 has assessed adherence to ADA SOC among adult patients with type 2 DM at an NP-owned practice. Multiple Plan-Do-Study-Act (PDSA) cycles have resulted in new recommendations that have promoted adherence to diabetes metrics and improvement in overall mean A1C. Interventions: The current PDSA cycle emphasizes the creation and implementation of evidence-based interventions to assist NPs in addressing social needs at a NP-owned practice. Results: Recent data collection has included frequency of SDOH screening, identifying social needs, gaps in SDOH documentation, and has found overall higher A1Cs in patients with positive screens. Conclusions: Project intervention of social workers collaboration with NPs resulted in improvement in addressing social needs in patients with type 2 diabetes mellitus.Publication Inclusivity: Educational Experiences of Registered Nurses With Physical Disabilities(2024-11-20) Mantlow, Kimberly D; Sullivan-Bolyai, Susan; McGuire, Anthony W; Morris, Nancy S; Tan Chingfen Graduate School of NursingAim: The aim of the study was to describe registered nurses' prelicensure educational experience as nursing students with physical disabilities. Background: Social and academic support help establish connections with the educational environment, but efforts to engage students with disabilities are inconsistent. Faculty support beyond required accommodations facilitates a sense of empowerment. Communities in academic settings for minority groups significantly increase the likelihood of academic success due to information-related social capital and social support. Method: A qualitative descriptive design with semistructured interviews of 16 individuals with 14 different physical disabilities was used for this study. Data were analyzed using thematic analysis. Results: Four themes emerged: 1) I saved my energy for learning; 2) I was determined; 3) wanting to find my people; and 4) secrets, living a double life, with subtheme fear of judgment. Conclusion: Identification of factors related to inclusion within the academic environment provides insight for improving the experiences of prelicensure nursing students with physical disabilities.Publication High-Risk Medications in Persons Living With Dementia: A Randomized Clinical Trial(2024-12-01) Singh, Sonal; Li, Xiaojuan; Cocoros, Noelle M; Antonelli, Mary T; Avula, Ramya; Crawford, Sybil L; Dashevsky, Inna; Fouayzi, Hassan; Harkins, Thomas P; Mazor, Kathleen M; Michnick, Ashley I; Parlett, Lauren; Paullin, Mark; Platt, Richard; Rochon, Paula A; Saphirak, Cassandra; Si, Mia; Zhou, Yunping; Gurwitz, Jerry H; Tan Chingfen Graduate School of Nursing; Family Medicine and Community HealthImportance: Individuals with Alzheimer disease (AD) and Alzheimer disease-related dementias (ADRD) may be at increased risk for adverse outcomes relating to inappropriate prescribing of certain high-risk medications, including antipsychotics, sedative-hypnotics, and strong anticholinergic agents. Objective: To evaluate the effect of a patient/caregiver and prescriber-mailed educational intervention on potentially inappropriate prescribing to patients with AD or ADRD. Design, setting, and participants: This prospective, open-label, pragmatic randomized clinical trial, embedded in 2 large national health plans, was conducted from April 2022 to June 2023. The trial included patients with AD or ADRD and use of any of 3 drug classes targeted for deprescribing (antipsychotics, sedative-hypnotics, or strong anticholinergics). Interventions: Patients were randomized to 1 of 3 arms: (1) a mailing of educational materials specific to the medication targeted for deprescribing to both the patient and their prescribing clinician; (2) a mailing to the prescribing clinician only; or (3) a usual care arm. Main outcomes and measures: Analysis was performed using a modified intention-to-treat approach. The primary study outcome was the dispensing of the medication targeted for deprescribing during a 6-month study observation period. Secondary outcomes included changes in medication-specific mean daily dose and health service utilization. Results: Among 12 787 patients included in the modified intention-to-treat analysis, 8742 (68.4%) were female, and the mean (SD) age was 77.3 (9.4) years. The cumulative incidence of being dispensed a medication targeted for deprescribing was 76.7% (95% CI, 75.4-78.0) in the patient and prescriber mailing group, 77.9% (95% CI, 76.5-79.1) in the prescriber mailing only group, and 77.5% (95% CI, 76.2-78.8) in the usual care group. Hazard ratios were 0.99 (95% CI, 0.94-1.04) for the patient and prescriber group and 1.00 (95% CI, 0.96-1.06) for the prescriber only group compared with the usual care group. There were no differences between the groups for secondary outcomes. Conclusions and relevance: These findings suggest medication-specific educational mailings targeting patients with AD or ADRD and their clinicians are not effective in reducing the use of high-risk medications. Trial registration: ClinicalTrials.gov Identifier: NCT05147428.Publication Actigraphy-derived multidimensional sleep health among breast cancer survivors and controls: Pink SWAN(2024-11-30) Price, Sarah N; Crawford, Sybil L; Swanson, Leslie M; Hood, Michelle M; Avis, Nancy E; Tan Chingfen Graduate School of NursingPurpose: To compare breast cancer survivors (BCS) to women without breast cancer (controls) on sleep health risk factors and actigraphy-derived dimensions of sleep (duration, maintenance, timing, and regularity) and examine whether the effect of breast cancer on sleep differs by time since diagnosis. Methods: Analyses included data from 68 BCS and 1042 controls who participated in actigraphy and Pink SWAN sub-studies within the Study of Women's Health Across the Nation. BCS and control characteristics were compared using chi-square, Fisher's exact, and Wilcoxon rank sum tests. Sleep measures were regressed onto breast cancer status using binomial logistic and linear regression. The interaction between BCS status and years since diagnosis (< 5; ≥ 5) was tested in these models before and after covariate adjustment. Results: There were no overall sleep differences between BCS and controls; both groups experienced poor sleep health on average across multiple dimensions. Physical inactivity, sleep apnea, and vasomotor and depressive symptoms were associated with worse sleep in both groups. Total sleep time was lower among BCS than controls within 5 years of diagnosis (6.13 vs. 6.57 h; p = .03) but did not differ at > 5 years post-diagnosis (6.59 vs. 6.45 h; p = .32). BCS reported greater use of exogenous hormones (p < .0001) and were twice as likely to have initiated anxiolytic use post-diagnosis (p = .03). Conclusions: BCS within 5 years of diagnosis experienced shorter sleep duration than controls but did not differ on other sleep parameters. Both groups experienced poor sleep health. Implications for cancer survivors: BCS and similarly-aged women experience poor sleep health requiring assessment and treatment.Publication Acute and Critical Care Nurses' Roles in Mass Shootings: An Integrative Review(2024-10-01) Carpenter, Dawn; Menard, Alexander; Isenberger, Johnny L.; Stevens, Gregg A; LaRock, Lisa; Lamar Soutter Library; Tan Chingfen Graduate School of NursingBackground: From 2018 to 2022, mass shooting incidents in the United States increased by 67.7%. Health care-associated shootings also increased. The role of acute and critical care nurses during shootings is not well defined in the literature. Objective: To identify roles of acute and critical care nurses during mass shooting incidents and provide best-practice recommendations for shooting incidents within a hospital. Methods: The methods of Whittemore, Knafl, and Torraco informed this integrative review. Ovid MEDLINE, CINAHL, and Scopus databases were searched for publications related to acute and critical care nurses, mass shooting incidents, and hospital setting. Results: Of 13 589 articles retrieved, 27 were included; 63% were narrative reviews. The highest level of evidence was an expert consensus panel; next highest was a quasi-experimental study that simulated experiences to test mass casualty incident response. Third highest was a qualitative study that analyzed nurses' experiences during a mass casualty experience. Discussion: The evidence revealed 3 themes: prevention and preparedness, response to incident, and recovery phase. Education and training for acute and critical care nurses about mass shooting incidents are central to defining nurses' roles and best practices for these incidents. Nurses must know Stop the Bleed techniques and run-hide-fight protocols. Additionally, acute and critical care nurses need representation on hospital committees to develop and implement policies and procedures. Conclusions: Hospitals are not immune to mass shooting incidents. Acute and critical care nurses require education including simulations and drills on mass shooting incidents to ensure safety of nurses and patients.Publication A pediatric primary care practice-based obesity intervention to support families: a cluster-randomized clinical trial(2024-07-30) Pbert, Lori; Druker, Sue; Crawford, Sybil; Frisard, Christine; Bram, Jennifer; Olendzki, Barbara; Andersen, Victoria; Hazelton, Jennifer; Simone, Dante; Trivedi, Michelle; Ryan, Grace W; Schneider, Kristin; Geller, Alan C; Pediatrics; Population and Quantitative Health Sciences; Prevention Research Center; Tan Chingfen Graduate School of NursingObjective: The American Academy of Pediatrics recommends that pediatric practices help families make lifestyle changes to improve BMI, but provider time and access to treatment are limited. This study compared the effectiveness of two pediatric practice-based referral interventions in reducing BMI. Methods: In this cluster-randomized clinical trial, 20 pediatric primary care practices were randomized to telephonic coaching (Fitline Coaching) or mailed workbook (Fitline Workbook). Parents and their 8- to 12-year-old children with BMI ≥ 85th percentile completed assessments at baseline and at 6 and 12 months post baseline. Primary outcomes were 12-month BMI percentile and z score. Results: A total of 501 children and their parents received Fitline Coaching (n = 243) or Fitline Workbook (n = 258); 26.8% had overweight, 55.4% had obesity, and 17.8% had severe obesity. Mean (SD) age was 10.5 (1.4), and 47.5% were female. BMI percentile improved in both groups; 12-month decline in continuous BMI z score was not statistically significant in either group. However, 20.8% of telephonic coaching participants and 12.4% of workbook participants achieved a clinically significant reduction of at least 0.25 in BMI z score, a significant between-group difference (p = 0.0415). Conclusions: Both low-intensity interventions were acceptable and produced modest improvements in BMI percentile. One in five children in the telephonic coaching condition achieved clinically meaningful BMI z score improvements. However, more research is needed before such a program could be recommended for pediatric primary care practice.Publication PhD nursing programs: Where are we headed?(2024-08-29) Fain, James A; Sullivan-Bolyai, Susan L; Bova, Carol A; Tan Chingfen Graduate School of NursingThank you for your timely editorial, The PhD in Nursing - Questions about a Credential at a Crossroads. We agree that the future of PhD education in nursing is in peril and needs rapid solutions. Low enrollment and threats of PhD program closures are on the rise. As three former Directors of PhD Programs, we feel it is essential that we do not walk away from PhD education. Here are some of our thoughts.Publication Application of Machine Learning Models to Biomedical and Information System Signals From Critically Ill Adults(2023-11-01) Lilly, Craig M; Kirk, David; Pessach, Itai M; Lotun, Gurudev; Chen, Ofer; Lipsky, Ari; Lieder, Iris; Celniker, Gershon; Cucchi, Eric W; Blum, James M; Anesthesiology and Perioperative Medicine; Medicine; SurgeryBackground: Machine learning (ML)-derived notifications for impending episodes of hemodynamic instability and respiratory failure events are interesting because they can alert physicians in time to intervene before these complications occur. Research question: Do ML alerts, telemedicine system (TS)-generated alerts, or biomedical monitors (BMs) have superior performance for predicting episodes of intubation or administration of vasopressors? Study design and methods: An ML algorithm was trained to predict intubation and vasopressor initiation events among critically ill adults. Its performance was compared with BM alarms and TS alerts. Results: ML notifications were substantially more accurate and precise, with 50-fold lower alarm burden than TS alerts for predicting vasopressor initiation and intubation events. ML notifications of internal validation cohorts demonstrated similar performance for independent academic medical center external validation and COVID-19 cohorts. Characteristics were also measured for a control group of recent patients that validated event detection methods and compared TS alert and BM alarm performance. The TS test characteristics were substantially better, with 10-fold less alarm burden than BM alarms. The accuracy of ML alerts (0.87-0.94) was in the range of other clinically actionable tests; the accuracy of TS (0.28-0.53) and BM (0.019-0.028) alerts were not. Overall test performance (F scores) for ML notifications were more than fivefold higher than for TS alerts, which were higher than those of BM alarms. Interpretation: ML-derived notifications for clinically actioned hemodynamic instability and respiratory failure events represent an advance because the magnitude of the differences of accuracy, precision, misclassification rate, and pre-event lead time is large enough to allow more proactive care and has markedly lower frequency and interruption of bedside physician work flows.Publication Burnout Among Young Adults With Type 1 Diabetes(2024-05-30) Perez, Danielle; Sullivan-Bolyai, Susan L; Bova, Carol A; Fain, James A; Tan Chingfen Graduate School of NursingPurpose: The purpose of this qualitative descriptive study was to describe the experience of diabetes burnout in young adults with type 1 diabetes (T1DM). In addition, aims included participant perspectives of risk and protective factors associated with burnout and ways to balance everyday life with diabetes self-management (DSM). Methods: Young adults with T1DM (N = 11) were recruited through social media platforms and modified snowball sampling and interviewed. Informational redundancy was achieved. Qualitative thematic coding and analysis were conducted within and across transcripts. Results: Diabetes burnout was described as the willingness to put diabetes and DSM on the "back burner" and let things slide due to exhaustion, frustration, apathy, and the desire to be like everyone else for a while. Risk and protective factors were identified along with strategies to achieve balance of DSM in everyday life. Conclusions: This study identified a clear definition of diabetes burnout and acknowledges this concept as distinct and separate from other psychosocial conditions. Health care providers can utilize this information to identify individuals at risk for diabetes burnout and offer more effective support to lessen the overall burden associated with T1DM.Publication Sexual functioning among breast cancer survivors and non-cancer controls over 5 years post diagnosis: Pink SWAN(2022-11-28) Avis, Nancy E; Crawford, Sybil L; Gold, Ellen B; Greendale, Gail A; Tan Chingfen Graduate School of NursingPurpose: To compare sexual functioning from diagnosis to 5 years post diagnosis among breast cancer survivors (BCS) and women without cancer (controls). Patients and methods: Analyses included 118 BCS and 1765 controls from 20 years of the longitudinal Study of Women's Health Across the Nation (SWAN), a multiracial/ethnic cohort of mid-life women assessed approximately annually from 1995 to 2015. Pink SWAN participants reported no cancer at SWAN enrollment and developed (BCS) or did not develop (controls) incident breast cancer after enrollment. Outcomes included: being sexually active or not, intercourse frequency, sexual desire, vaginal dryness, and pain with intercourse. Using longitudinal logistic regression, we compared BCS and controls on prevalence of sexual functioning outcomes with respect to years since diagnosis. In addition, we examined whether menopause transition stage, depressive symptoms, relationship satisfaction, vaginal dryness, or pain with intercourse modified the relation between breast cancer and sexual functioning outcomes. Results: Adjusting for partner status, both BCS and controls reported similar declines over time in being sexually active, sexual intercourse frequency, and sexual desire. Among sexually active women, more BCS than controls consistently reported vaginal dryness with significant differences between 2 and 4 years post-diagnosis, and pain with intercourse, with statistically significant differences between 0.5 years post-diagnosis to 2 years post-diagnosis. Being post-menopausal and reporting depressive symptoms were significant effect modifiers for pain with intercourse with both variables having positive and stronger associations with pain among the controls than among BCS. Conclusion: Except for more reporting of vaginal dryness and pain with intercourse among BCS, negative changes in sexual function during mid-life were similar in those with and without breast cancer.Publication Experiences Using Family or Peer Support for Smoking Cessation and Considerations for Support Interventions: A Qualitative Study in Persons With Mental Health Conditions(2022-12-28) Nagawa, Catherine S; Lane, Ian A; Davis, Maryann; Wang, Bo; Pbert, Lori; Lemon, Stephenie C; Sadasivam, Rajani S; Biostatistics and Health Services Research; Population and Quantitative Health Sciences; Prevention Research Center; Psychiatry; Tan Chingfen Graduate School of Nursing; Ian A LaneBackground: The current study aimed to understand how people with mental health conditions who currently smoke or recently quit engaged with family members or peers when quitting and assessed interest in involving family or peers in cessation interventions. Methods: Adults with mental health conditions who smoke or had quit within the past 5 years were recruited from publicly funded mental health programs (N = 24). We conducted virtual qualitative interviews between November 2020 and August 2021 and analyzed the data using the rapid thematic analytic approach. Results: Most participants were men (62%), and 71% were current smokers. We found that: having family/peers who were interested in quitting presented communal quitting opportunities, communication that facilitated quitting tended to be encouraging, and strong relationships with family members increased willingness to involve them in cessation interventions. But family or peer support was less helpful for individuals who were not ready to quit. Conclusion: Training family and peers to engage in supportive behaviors may promote cessation in this population. Cessation interventions may benefit from recruiting support partners who share a strong relationship with the smoker.Publication Preoperative walking intervention did not appear to improve patient-reported postoperative recovery in older adults with frailty traits: Randomized trial(2022-09-23) Sadiq, Hammad; Rampam, Sanjeev; Patel, Jay; Crawford, Sybil; Walz, Matthias; Kapoor, Alok; Anesthesiology and Perioperative Medicine; Medicine; T.H. Chan School of Medicine; Tan Chingfen Graduate School of Nursing; Jay PatelObjectives: To assess the impact of a preoperative walking intervention on improving postoperative recovery in at-risk frail older adult patients. Study type: Unblinded, randomized controlled trial which assigned patients to intervention versus control. Population: Patients aged 60+ scheduled for surgery 3-8 weeks from randomization scoring 4+ on the Edmonton Frail Scale. Intervention: Preoperative walking enhanced by goal setting with an activity monitor and telephonic coaching. Main outcomes: Quality of Recovery 9-item instrument total score and a modified version of the Abdominal Surgery Impact Scale total score. Results: A total of 83 patients were analyzed. Postoperative recovery scores were similar in intervention vs control - Quality of Recovery-9 item instrument total score 14.1 vs. 14.1 (P = .94) and modified Abdominal and Surgery Impact Scale total score 82.8 vs. 79.2 (P = .93). Few intervention patients met their daily step count goals. Despite this, intervention patients improved average daily step counts significantly. Conclusions: Preoperative walking bolstered with activity monitor and remote coaching did not appear to lead to improved postoperative recovery in older adults with frailty traits. Further research is necessary to see if a similar intervention in specific surgery types or a more intense version of the intervention can improve recovery.Publication Acute Care Advanced Practice Providers' Use of Telehealth During the COVID-19 Pandemic(2023-12-15) Winterbottom, Fiona; Katz, Adam W; Skinner, Sarah; Carpenter, Dawn; Williams, Lisa-Mae; Kleinpell, Ruth; Tan Chingfen Graduate School of NursingAdvanced practice registered nurses and physician assistants, collectively termed advanced practice providers (APPs), have been part of telehealth for many years. During the COVID-19 pandemic, APPs experienced the growth in roles, responsibilities, and tools used for telehealth care delivery. This article uses examples from 3 health systems to highlight the ways in which telehealth use was expanded due to the pandemic, how APP roles were altered across the United States during and after the pandemic, and implications for future practice.Publication Self- and staff-reported pain in relation to contextual isolation in long-term nursing home residents with Alzheimer's disease and related dementias(2023-11-23) Jesdale, Bill M; Bova, Carol A; Mbrah, Attah K; Lapane, Kate L; Population and Quantitative Health Sciences; Tan Chingfen Graduate School of NursingWe evaluated the degree to which contextual isolation in nursing home residents with Alzheimer's disease and related dementias is associated with documented pain using the Minimum Data Set 3.0, a comprehensive resident assessment required of all nursing home residents in the United States. Contextual isolation was defined as having a socially salient characteristic (demographics, habits and interests, and clinical and care dimensions) shared by fewer than 20% of other residents in the same nursing home. Thirteen percent were contextually isolated on multiple characteristics. Among residents self-reporting pain, residents contextually isolated with respect to multiple characteristics were 8% more likely (95% confidence interval: 7% to 9%) to have pain relative to residents who were not contextually isolated on any characteristics. Long-stay nursing home residents with ADRD who live in settings where they were contextually isolated were more likely to have pain relative to those without contextually isolation on any characteristic.Publication Pediatric healthcare professionals' attitudes and beliefs about weight stigma: A descriptive study(2023-12-15) Turner, Samantha L; Tan Chingfen Graduate School of Nursing; Samantha L TurnerPurpose: Children face weight-based stigma from their healthcare providers at a disconcerting rate, and efforts to mitigate this have been scant. This study aimed to quantify pediatric healthcare professionals' attitudes and beliefs about weight stigma and to determine stigma reduction interventions that are most supported by pediatric healthcare providers. Design and methods: Participants completed two validated instruments which measured implicit and explicit weight bias, respectively. They then completed a researcher-designed questionnaire to assess their attitudes and beliefs about weight stigma, and demographic questions. ANOVA models were used to examine associations between bias measures and participant characteristics, chi-square analyses were used to examine associations between questionnaire responses and participant characteristics, and Spearman's rank was used to determine correlations between weight bias and questionnaire responses. Results: Participants exhibited moderate-to-high levels of implicit and explicit weight bias (mean Implicit Association Test score = 0.59, mean Crandall Anti-Fat Attitudes Score = 38.95). Associations were noted between implicit bias and years in practice (p < 0.05), and implicit bias and occupation (p < 0.05). There was a significant correlation between explicit bias and multiple questionnaire items, suggesting that healthcare providers with greater weight bias are aware of those biases and are ready to take action to address them. Conclusion: Though pediatric healthcare exhibit weight-based biases, they are invested in taking steps to mitigate these biases and their impact on patients. Practice implications: The results of this study can inform the design of future interventions that aim to reduce healthcare-based weight bias, thus improving the quality of pediatric healthcare.