Faculty Bibliography

BACKGROUND: Symptom assessment and management are vital aspects of patient care through the entire illness trajectory. Patients often experience two or more symptoms concurrently. Building global assessment capacity on symptoms holds significant promise for advancing the science of nursing. The Symptom Experience Index is a reliable and valid patient-centered health outcome measure developed in the United States to assess multiple symptoms and distress. No Korean version is available for Korean healthcare professionals and patients to promote an accurate assessment of multiple symptoms. OBJECTIVE: To translate the Symptom Experience Index into Korean language and assess its psychometric properties in Korean patients and healthy adults. DESIGN: A psychometric study with a cross-sectional design. SETTING: Two hospitals and a large university in Seoul, Korea in 2009. PARTICIPANTS: A purposive sample of 230 adult participants, including medical-surgical and oncology patients, as well as healthy university students. METHODS: The English Symptom Experience Index was translated to Korean language using an integrative translation method to ensure its semantic equivalence and content validity. The Korean version was then pretested and tested using a contrast-group and test-retest method. RESULTS: Semantically, no modifications to items were needed in terms of comparability of language and similarity of interpretability. Feedback on the pretest of the Korean version by 15 Korean adult patients resulted in one item deletion and one item modification. The Korean version demonstrated high internal consistency with the Cronbach's alpha coefficient: total symptom experience of 0.92, occurrence of 0.91 and distress of 0.90. Intra-class correlation coefficients demonstrated strong stability over time: total symptom experience (ICC=0.82; 95% CI=0.73-0.88), occurrence (ICC=0.77; 95% CI=0.66-0.84), and distress (ICC=0.85; 95% CI=0.77-0.89). Construct validity was supported by (1) factor analysis; (2) differences in symptom experience scores between healthy university students and patient groups; and (3) positive correlations between symptom experience scores and functional impairment. CONCLUSIONS: Our study provided evidence to support psychometric properties of the Korean Symptom Experience Index. The use of the instrument can help patients who speak Korean language systematically report symptoms and assist healthcare professionals in assessing multiple symptom experience.

AIDS clinical trials (ACTs) are critical to the development of new treatments for HIV infection. However, people of color living with HIV/AIDS are involved in ACTs at disproportionally low rates, with African-Americans experiencing the greatest under-representation. In this article, we describe the core elements and key characteristics of a highly efficacious multi-component peer-driven intervention (PDI) designed to increase rates of screening for and enrollment into ACTs among African-American and Latino/Hispanic individuals, by addressing the main complex, multi-level barriers they experience to ACTs. We discuss the process of developing the intervention, the theoretical models guiding its delivery format and content, and provide an overview of the intervention's components. We then use brief case studies to illustrate a number of key issues that may arise during intervention implementation. Finally, we describe lessons learned and provide recommendations for the PDI's uptake in clinical and clinical trials settings.

PURPOSE: To describe perceived risk for sexually transmitted infections (STIs) and sexual risk behavior among sexually active female college students. DATA SOURCES: An online, anonymous survey was used to collect data from 458 sexually active female students between the ages of 18-24 enrolled at a private, suburban university in the mid-Atlantic region. CONCLUSION: Most women in this study did not consider themselves at risk for contracting an STI, despite low levels of condom use. Perceiving no risk and never using condoms were both more common among women with just one sex partner. Further investigation of factors contributing to individual risk perception is warranted in order to develop effective prevention programs. IMPLICATIONS FOR PRACTICE: Nurses and advanced practice nurses who work with women, particularly at-risk women, should be aware of low levels of risk perception for STIs, despite engaging in risk-taking behaviors. Education regarding strategies to reduce and prevent contracting STIs should be incorporated into encounters with women seeking health care, and in health promotion settings.

OBJECTIVE: African-American/Black and Latino/Hispanic persons living with HIV/AIDS (i.e., "PLHA of color") are under-represented in HIV/AIDS medical studies (HAMS). A crucial entry point into HAMS is screening, but PLHA of color face serious barriers to screening compared to Whites. Recently we evaluated a social/behavioral intervention that substantially increased rates of HAMS screening among PLHA of color. Yet very little is known about the actual screening experience for these under-represented subgroups. Thus, the objectives of the present study were to explore participants' motivations for and experiences of HAMS screening. METHODS: A total of 186 participants in the larger study's intervention arm were screened for HAMS, 35 of whom also participated in qualitative interviews. Participants engaged in a structured interview about the screening experience at 4- and 12- months post-baseline (14 items, Cronbach's alpha=0.72). Further, from a qualitative data set we purposively selected a set of three case studies to contextualize and enrich quantitative findings on screening experiences. RESULTS: The screening experience was overwhelmingly positive. Almost all participants reported being treated with dignity and respect, did not feel they were being treated like a "guinea pig," and experienced a high level of trust in the setting and the screener, with no gender or racial/ethnic differences, and no differences based on whether participants were found eligible for HAMS during screening. A number of areas where screening could be improved were also identified. CONCLUSIONS: Despite the complex barriers PLHA of color experience to screening for HAMS, the experience of screening was positive. Moreover, HAMS screening experiences were positive regardless of gender, race/ethnicity, or HAMS eligibility. HAMS screening can therefore be a productive learning experience that may reduce patient concerns about participating in HAMS. As such, fostering screening among PLHA of color can be an important component of reducing racial/ethnic disparities in HAMS.

Advances in bioelectrical impedance analysis (BIA) permit the assessment of lymphedema by directly measuring lymph fluid changes. The objective of the study was to examine the reliability, sensitivity, and specificity of cross-sectional assessment of BIA in detecting lymphedema in a large metropolitan clinical setting. BIA was used to measure lymph fluid changes. Limb volume by sequential circumferential tape measurement was used to validate the presence of lymphedema. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Reliability, sensitivity, specificity and area under the ROC curve were estimated. BIA ratio, as indicated by L-Dex ratio, was highly reliable among healthy women (ICC=0.99; 95% CI = 0.99 - 0.99), survivors at-risk for lymphedema (ICC=0.99; 95% CI = 0.99 - 0.99), and all women (ICC=0.85; 95% CI = 0.81 - 0.87); reliability was acceptable for survivors with lymphedema (ICC=0.69; 95% CI = 0.54 to 0.80). The L-Dex ratio with a diagnostic cutoff of >+7.1 discriminated between at-risk breast cancer survivors and those with lymphedema with 80% sensitivity and 90% specificity (AUC=0.86). BIA ratio was significantly correlated with limb volume by sequential circumferential tape measurement. Cross-sectional assessment of BIA may have a role in clinical practice by adding confidence in detecting lymphedema. It is important to note that using a cutoff of L-Dex ratio >+7.1 still misses 20% of true lymphedema cases, it is important for clinicians to integrate other assessment methods (such as self-report, clinical observation, or perometry) to ensure the accurate detection of lymphedema.

OBJECTIVE: The objective of the study is to determine whether Alcoholics Anonymous (AA) participation leads to reduced drinking and problems related to drinking within Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), an existing national alcoholism treatment data set. METHOD: The method used is structural equation modeling of panel data with cross-lagged partial regression coefficients. The main advantage of this technique for the analysis of AA outcomes is that potential reciprocal causation between AA participation and drinking behavior can be explicitly modeled through the specification of finite causal lags. RESULTS: For the outpatient subsample (n = 952), the results strongly support the hypothesis that AA attendance leads to increases in alcohol abstinence and reduces drinking/ problems, whereas a causal effect in the reverse direction is unsupported. For the aftercare subsample (n = 774), the results are not as clear but also suggest that AA attendance leads to better outcomes. CONCLUSIONS: Although randomized controlled trials are the surest means of establishing causal relations between interventions and outcomes, such trials are rare in AA research for practical reasons. The current study successfully exploited the multiple data waves in Project MATCH to examine evidence of causality between AA participation and drinking outcomes. The study obtained unique statistical results supporting the effectiveness of AA primarily in the context of primary outpatient treatment for alcoholism.

African-American and Latino/Hispanic persons living with HIV/AIDS are underrepresented in AIDS clinical trials (ACTs). The aim of this paper was to uncover factors, either unmodifiable or not directly targeted for change, that predicted screening for ACTs during an efficacious peer-driven intervention (N = 540 total; N = 351 in an intervention arm, N = 189 control). This paper focused on participants assigned to an intervention arm, 56 % of whom were screened for ACTs. We found a decreased odds of screening was associated with closer proximity to the screening site, gay/lesbian orientation, lower mental health symptoms, current injection drug use, more recent HIV diagnosis, lack of prior screening experience, and failure to attend all intervention sessions, but there were no gender or racial/ethnic differences. Efforts to reduce racial/ethnic disparities in ACTs can be enhanced by attending to these specific factors, which may interfere with programmatic efforts to increase African-American and Latino/Hispanic representation in ACTs.

Although experiencing childhood sexual abuse (CSA) puts youth at risk for involvement in relationship violence, research is limited on the potential pathways from CSA to subsequent dating aggression. The current study examined prospective pathways from externalizing behavior problems and stigmatization (abuse-specific shame and self-blame attributions) to anger and dating aggression. One hundred sixty youth (73% female, 69% ethnic/racial minorities) with confirmed CSA histories were interviewed at the time of abuse discovery (T1, when they were 8-15 years of age), and again 1 and 6 years later (T2 and T3). Externalizing behavior and abuse-specific stigmatization were assessed at T1 and T2. Anger and dating aggression were assessed at T3. The structural equation model findings supported the proposed relations from stigmatization following the abuse to subsequent dating aggression through anger. Only externalizing behavior at T1 was related to later dating aggression, and externalizing was not related to subsequent anger. This longitudinal research suggests that clinical interventions for victims of CSA be sensitive to the different pathways by which youth come to experience destructive conflict behavior in their romantic relationships.