This report provides evidence from a number of different approaches (i.e., comparison of cell shape in 1-microm sections of photodamaged versus healthy skin at the light microscopic level; comparison of cell shape and apposition to collagen fibrils in ultrathin sections of the same tissues examined by transmission electron microscopy, and fluorescence staining for adhesion site protein expression and actin filament architecture in frozen tissue sections) that dermal cells in healthy skin are attached to collagen fibrils over a large part of the cell border, have a flattened/spread (two-dimensional) appearance and have abundant actin in their cytoplasm. In contrast, cells in photodamaged skin are often in contact with fragmented collagen or amorphous debris rather than intact collagen, have a collapsed/elongated shape, and have a lower amount of actin. Collagen synthesis is reduced in severely photodamaged skin relative to collagen synthesis in corresponding sun-protected skin (N Engl J Med 329:530, 1993). We hypothesize that fibroblasts in severely damaged skin have less interaction with intact collagen and as a result experience a reduction in mechanical tension. Decreased collagen synthesis is (presumed to be) the result.

In order to assess patterns of usage of complementary and alternative medicine (CAM) in families of children with cerebral palsy (CP), 213 families with a child (0 to 18 years) with CP were recruited at the university medical center in Ann Arbor, MI, USA as part of a descriptive survey. Two hundred and thirty-five surveys were distributed. Mean age of the child was 8 years 6 months (SD 4y : 9mo) and 56% of the sample was male with 35% full-time independent ambulators, while the rest used an assistive device or a wheelchair. Fifty-four percent were in special education classrooms. Families were given a survey on functional status of the child with CP, CAM usage of the child and the parent, factors influencing the decision to use CAM, demographics, and clinical information. Of the families, 56%, used one or more CAM techniques. Massage therapy (25%) and aquatherapy (25%) were the most common. Children of families that used CAM were significantly younger (7y : 9mo, SD 4y : 7mo) than non-users (9y : 6mo, SD 4y : 6mo: t-test p < 0.01 two-tailed). Children with quadriplegic CP, with spasticity, and those who could not walk independently were more commonly exposed to CAM (Pearson's chi2 [P(chi)2] p = 0.01 two-tailed; for mobility, odds ratio [OR] of 2.5 with regression). Mothers with a college degree had a greater tendency to use CAM for their child than those without (P(chi)2 p = 0.01 two-tailed). Fathers of children who used CAM were older than fathers of those who did not (37y : 9mo versus 33y : 2mo, p = 0.04 two-tailed). There was no significant difference between groups for mother's age, father's education, income, or for population of home town. Parents who used CAM for themselves were more likely to try CAM for their child (70% versus 47%, OR 2.1), and were much more likely to be pleased with the outcome (71% versus 42%, OR 3.5). Child's age (younger), lack of independent mobility, and parental use of CAM were the most significant predictive factors identified via logistic regression.

No abstract

In order to assess patterns of usage of complementary and alternative medicine (CAM) in families of children with cerebral palsy (CP), 213 families with a child (0 to 18 years) with CP were recruited at the university medical center in Ann Arbor, MI, USA as part of a descriptive survey. Two hundred and thirty-five surveys were distributed. Mean age of the child was 8 years 6 months (SD 4y:9mo) and 56% of the sample was male with 35% full-time independent ambulators, while the rest used an assistive device or a wheelchair. Fifty-four percent were in special education classrooms. Families were given a survey on functional status of the child with CP, CAM usage of the child and the parent, factors influencing the decision to use CAM, demographics, and clinical information. Of the families, 56%, used one or more CAM techniques. Massage therapy (25%) and aquatherapy (25%) were the most common. Children of families that used CAM were significantly younger (7y:9mo, SD 4y:7mo) than non-users (9y:6mo, SD 4y:6mo: t-test p<0.01 two-tailed). Children with quadriplegic CP, with spasticity, and those who could not walk independently were more commonly exposed to CAM (Pearson's χ 2 [Pχ 2 ] p=0.01 two-tailed; for mobility, odds ratio [OR] of 2.5 with regression). Mothers with a college degree had a greater tendency to use CAM for their child than those without (Pχ 2 p=0.01 twotailed). Fathers of children who used CAM were older than fathers of those who did not (37y:9mo versus 33y:2mo, p=0.04 two-tailed). There was no significant difference between groups for mother's age, father's education, income, or for population of home town. Parents who used CAM for themselves were more likely to try CAM for their child (70% versus 47%, OR 2.1), and were much more likely to be pleased with the outcome (71% versus 42%, OR 3.5). Child's age (younger), lack of independent mobility, and parental use of CAM were the most significant predictive factors identified via logistic regression.

The purpose of this educational brief is to describe an innovative learning experience focused on teaching students empathy for chronic illness, using patient voices. Panel members of individuals who had experienced acute and chronic illness from either the perspective of the patient or caregiver participated in a one-time session for undergraduate baccalaureate nursing students. Panel members presented their narrative to the students, engaging them in a question-and-answer session about the impact of nursing care on their experience. Both the panelists and the students found the experience meaningful. Over time the panel has varied in format, but has consistently humanized the patient experience, highlighted the importance of empathy, and conveyed the impact that nurses have on their patients and families. This innovative strategy proved to be very beneficial for students transitioning into their first clinical experience.

The purpose of this article is to describe a service learning opportunity where interprofessional teams of students worked together to address patients' social determinants of health through home visits. This article describes this process, known as "hotspotting," and presents the development of this project, including collaboration with a local home health agency, recruiting of students, and weekly team meetings for debriefing. Evaluation data, barriers with implementation, and next steps for sustainability are also discussed.

This article describes a quality improvement (QI) project implemented in a home health setting among a population of patients with heart failure (HF). It was discovered there was a lack of nurse-led recommendations and ineffective use of the situation, background, assessment, and recommendations (SBAR) tool among home health nurse when communicating with providers about HF patients. Therefore, the QI project focused on creating and implementing a focused HF SBAR tool and a self-care patient checklist to be utilized by all home health nurses for all visits with HF patients. The focused HF tool was created and laminated and became part of home health nurse’s identification badges. The implementation phase took place over a 60-day time period. Following implementation, outcomes were measured and demonstrated an increased use of SBAR, and an increase in nurse-led recommendations documented. In addition, there was a decrease in acute hospitalizations for HF among home health patients. Furthermore, there was an increase in nurse-led interventions implemented in the home along with an increase of referrals to physical therapy (PT) and occupational therapy (OT). The educational session was well-received and prompted a practice change in the delivery of future continuing education content. Finally, organizational leadership reported increased confidence and improved interprofessional communication among home health nurses and providers.

The goal of this interprofessional quality initiative project was to decrease emergency department (ED) visits for nonemergency health problems by referring superutilizers to home healthcare or connecting them with existing community resources. An interprofessional team of students from schools of nursing, public health, and occupational therapy collaborated on a community assessment, investigated and gathered community resources, and interviewed key stakeholders at a rural ED to identify the root causes of high utilization. Using these data, we designed an algorithm for ED clinicians that provided an organized community resource collection and electronic resources for ED staff. We focused on encouraging an increase in the evaluation of patients for eligibility to receive home healthcare services.