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Funded Projects Meals at home for persons with late-stage dementia Dementia, an irreversible and progressive loss of memory and function, afflicts over 4 million Americans, is the 7th leading cause of death in those over age 65, and is a terminal illness with a survival time from diagnosis to death of 3.1 to 3.5 years. Late-stage care reflects palliative end-of-life strategies as persons lose all abilities. The last loss is the ability to self-feed; this responsibility must be assumed by a caregiver or the person with dementia would starve. However, the majority of persons with dementia receive care in the home (75%) from a caregiver who may not be prepared for this responsibility. Related to intrinsic and extrinsic changes seen as the disease progresses, an inability to adjust to either excessive or inadequate levels of stimuli at meals results in disruptive behaviors by the person with dementia that inhibit the caregiver's ability to assist and subsequently diminishes intake. Thus, the possibility of nutritional decline is very real with subsequent morbidity and premature mortality. Although description and testing of nutritional interventions occurred in nursing homes, no study could be found that described an intervention for in-home mealtime care. The proposed pilot study tests the efficacy and feasibility of a mealtime intervention - a training video with pamphlet - that can be used by in-home caregivers to accomplish two specific aims (outcomes): 1) decrease mealtime disruptive behaviors and 2) maintain or increase food intake. Mealtime behaviors will be measured using the EdFED-Q and nutritional status will be measured using BMI and a Three-Day Diet Recall. Using two groups of 20 dyads (caregivers and persons with late-stage dementia) For more information, contact Dr. Elaine Amella at amellaej@musc.edu. An Education, Screening, and Referral Program for Abuse Among Pregnant Women The purpose of this project, funded by the Duke Endowment, t is to institute a program of education, screening, and referral for domestic violence for all pregnant women who deliver at the Medical University hospital. Approximately 1,800 women deliver their infants each year at MUSC. Given the prevalence of abuse to pregnant women in the United States, between 100 to 550 of these women will experience some form of physical abuse during the pregnancy. Abuse includes slapping, choking, beating, kicking, shoving, or punching, most often directed to the maternal abdomen, head, or upper torso. To address these concerns, five program components are proposed. The program is targeted to all patients and health care workers affiliated with the prenatal care clinics and women's services department of the Medical University Hospital. The five program needs initiatives include:
For more information contact Dr. Gail Barbosa at: barbosag@musc.edu Greenwall Foundation The research project is the study of nurses’ participation in the medical experiment of the Nazi concentration camp. These atrocities led to the Nuremburg Code, including the principle if informed consent, which defines the ethics of experimentation on human subjects. Nurses obtained subjects, assisted with procedures, and cared for the prisoners afterward. Nurse-survivor of Auschwitz and Ravensbrück concentration camps will be interviewed and primary source archival documents form US and European archives will be analyzed to investigate the methodology will be used and the relationship among gender, political power, and class will be examined within the larger framework of ethical analysis. An awareness of the nurses’ roles in the experiment will heighten nurses’ understanding of the genesis of the Code and increase the Code’s relevance to nurses. A more thoughtful and comprehensive presentation of the elements of informed consent to patients is the application of this study to patient care. Teaching Gerontological Nursing Competencies Teaching Gerontological Nursing Competencies Program is to provide continuing education to individuals who provide geriatric care. Through a partnership among the College of Nursing, the South Carolina Geriatric Education Center (SC-GEC) and two health care institutions in South Carolina, nursing staff will develop knowledge of core geriatric content, identify resources to use in practice, and more effectively deliver individualized and culturally sensitive care to hospitalized older adults. The program also offering also will serve as a pathway for basic certification in gerontological nursing from the American Nurses Credentialing Center (ANCC). The need for this program is evident when considering the aging of the American population and its effects on health care centers and the lack of gerontology content in nursing school curricula to ensure best practices for older adults. For more information contact Dr. Barbara Edlund at edlundb@musc.edu Emergency Department Ise-African Amercians With Diabetes The overall goals of this study are to document and understand the factors related to ED use, the reasons for and persons influencing care-seeking by AA who have a primary ED discharge diagnosis of ambulatory sensitive or uncomplicated diabetes, and to develop an evidence-based explanatory model that will be used for future intervention research. To explore and document: Reach 2010: Charleston and Georgetown Diabetes Coalition REACH 2010: Charleston and Georgetown Diabetes Coalition is a The Charleston and Georgetown Diabetes Coalition is a broad-based, community-driven coalition focused on improving health for more than 12,000 African Americans (AfA) living with diabetes in the two county area. The Central Coordinating Organization, the Diabetes Initiative of South Carolina, is home-based at the Medical University of South Carolina (MUSC), and is composed of more than 40 agencies and organizational partners. Identified health disparities include increased mortality (especially cardiovascular related to diabetes), increased emergency department use, increased hospitalizations, increased renal failure, amputations, diabetes treatment and education differences, less satisfaction and trust with care, and increased difficulties accessing and continuing care. Charleston and Georgetown Diabetes Coalition Partners include health systems (MUSC, Franklin C. Fetter Family Health Care, Inc, St. James-Santee Health Center, Sea Island Medical Center, and VA Medical Center), SC Department of Health and Environmental Control, Commun-I-Care, Library, University of South Carolina School of Public Health, Tri-County Black Nurses Association, Alpha Kappa Alpha Sorority, Georgetown and Charleston Diabetes CORE Groups, Charleston's Enterprise Community, and Carolina Medical Review. The partners collaborate to plan, implement, and evaluate a community action plan (CAP)to reduce disparities in diabetes care and education. The organizing framework for the local community program is community-driven participatory action research. Racial disparities in diabetes care were identified qualitatively through focus groups and interviews and quantitatively through annual chart audits of care using MedQuest data abstraction and analysis system. Multiple approaches used to decrease the disparities include (1) health systems change related to improved access, care, education and outcomes using problem-based learning and continuous improvement (2) community development, empowerment, and education using lay Community Health Advisors and (3) Coalition power, expansion, advocacy, and sustainability. Program activities are conducted in communities where African Americans with diabetes and their families live, play, worship, work, and seek health care. Activities are delivered by community health advisors who live in the communities where they work. Following 24 months of implementation, disparities for AfA in A1c testing (initially at 21%), lipid profile (initially at 15%), kidney testing (initially at 28%), eye exams (initially at 22%), and blood pressure control (initially at 11%) have been eliminated, while no significant changes occurred for A1c control and aspirin therapy. Although significantly lower initially, after two years, overall testing compares favorably with percentages nationally for Medicare patients with diabetes and also for those enrolled in community plans. Current and future efforts are focused on further improvements in diabetes care and control, and identifying the contributions of each of the multifactorial interventions in eliminating disparities for diabetes care and control. South Carolina Rural Interdisciplinary Program of Training The South Carolina Rural Interdisciplinary Program of Training (SCRIPT) prepares health professions students to deliver culturally acceptable care in rural settings from an interdisciplinary, community-focused perspective. The program was initiated in 1994 with one course offering which served 12 students from one university with clinical placements in two counties. In 2004 five course offerings served 85 students from seven universities with clinical placements in 21 counties located in the Lowcountry, Mid-Carolina, Pee Dee, and Upstate regions of South Carolina. Through 2004 there have been 515 program completers from 13 health-related disciplines. This intensive 5-week residency course combines a 4-day rural health workshop with clinical training in rural settings, interdisciplinary team conferences, field trips to raise socioeconomic and cultural awareness, and community-driven health promotion activities. The curriculum model integrates experiential teaching/learning strategies with the rural, interdisciplinary, and transcultural context of care and two health care delivery models, community-focused health care, and continuous quality improvement. The populations in the service regions are rural, poor, and predominately African American. They suffer heart disease, diabetes, stroke, cancer and infant mortality at a greater rate than others in South Carolina. Their access to prenatal care and other primary care services continues to be severely limited. Pretest/posttest data show that students’ knowledge of rural, interdisciplinary, and cultural diversity increased due to the SCRIPT experience. The mean change in scores from pretest to posttest demonstrated that the greatest gains in knowledge occurred in an understanding of rural demographics, rural health problems, unique social and environmental conditions of rural residents, and barriers to health care delivery in rural settings. Two surveys indicate that SCRIPT alumni demonstrate an increased likelihood to practice in a rural area. In 2001 all program completers (N = 193) from the first 6 years (1994 to 1999) were surveyed to determine practice pattern outcomes. The survey was repeated in 2003 for those not surveyed in 2001 who were scheduled to graduate from their discipline by the time of the survey. Combining the results, a 54% (134/249) response rate was achieved. Eighty percent (107/134) of respondents had graduated, and 98% (105/107) of those graduated were employed. Of the 105 employed program alumni who responded to the surveys, 35% (37/105) were practicing in a rural area. Of those not now practicing in a rural area, 49% (27/68) had unsuccessfully sought practice in a rural area or would do so in the future. Thus cumulatively 61% (64/105) of the graduated working respondents were motivated to seek practice in a rural area. Project Export The EXPORT Center is a partnership for excellence between SCSU and MUSC. Project Export aims to reduce the incidence of the Metabolic Syndrome in an 11-county area of South Carolina by combining the research strengths of the two universities. Funded by the National Center on Minority Health and Health Disparities, this NIH Center grant focuses on adolescents and youth to prevent obesity, cardiovascular disease and diabetes later in life. The Center also builds research capacity for health disparities research in our two minority-serving institutions. Seven Cores direct the work of the Center. Dr. Marilyn Laken is Director of the Administrative Core. This Core coordinates all activities of the Center and evaluates its progress toward reaching its goals. A Shared Facilities Core builds a new Clinical Research Unit as SCSU, with a focus on nursing assessment and evaluation. The Research and Pilot Research Cores promote multi-disciplinary work on lifestyle change and the metabolic syndrome as well as the impact of behavioral, birthweight, and genetic factors on the expression of the syndrome. The Outreach Core develops grassroots efforts to educate at-risk populations in lifestyle changes. Training and Education Cores focus on African American youth in the catchment area and junior faculty at both institutions. For more information, contact Dr. Marilyn Laken at lakenm@musc.edu. Health-e-AME Faith-Based Physical Activity Program The Health-e-AME Faith-Based Physical Activity Program aims to promote positive attitudes toward exercise and increase the number of AME members who participate in organized physical activities. The AME church represents almost 23% of African Americans in South Carolina. A recent survey revealed that 87% of adult members have at least one risk factor for cardiovascular disease. Overweight/obesity and lack of moderate exercise are the most prevalent problems. This CDC-funded program is a joint effort with the Department of Exercise Science at the Arnold School of Public Health at USC. Focus group discussions with AME members across the state document barriers to exercising and provide suggestions for activities that members would like. The delayed-intervention design trains volunteers from churches in half the districts in Year One and the others in Year Two. Four physical activity programs are offered:
A random survey of adults will assess penetration of the program among the over 500 churches and change in attitude toward exercise and actual participation in one or more of the programs. Members from churches receiving training in Year One will be compared with members who do not receive training until Year Two. Additionally, this project monitors change in attitude and participation within individuals over the 3 years of the program. More information can be found on the AME/MUSC website: http://health-e-ame.com/. Physical Activity and Diet Behaviors of Middle Aged African American Women: Validation of Selected Instruments Testing a Model to Adjust Hospital Billling for Nursing Intensity This study will test two methods for adjusting inpatient billing for nursing intensity. The first will use the New York State Nursing Intensity Weights (NIW) and the second, the Medical University of South Carolina Nursing Intensity Database (NID) mean weights. Both the NIW and NIW will be applied to existing patient data from 8 states encompassing approximately 800 hospitals and 8.7 million discharges from the 2002 Heath Care Utilization Project (HCUP) State Inpatient Database (SID). The proposed study will be the first in a series of planned research activities to explicate and test methods to identify nursing specific inpatient costs and to use these expenditures as a basis for creating a separate inpatient billing mechanism to replace the outdated method of including nursing care in daily fixed accommodation or “room and board” charges. The ultimate aim of this line of research is to produce a national model to allow independent costing, billing, and reimbursement of inpatient nursing care that can be used at all U.S. hospitals. For more information contact John Welton at weltonj@musc Hispanic Health Initiative South Carolina has the fourth fastest growing Hispanic population in the nation. The increase in the number of Hispanic residents has been recent enough that the cultural norms and health beliefs of the Hispanic population are not well understood by health care providers. As the Hispanic community has grown, nursing efforts to optimally respond to their health care needs have been hampered by the lack of alternative learning resources, culturally sensitive curriculum, and appropriate communication skills. Language barriers, poverty, and cultural differences are associated with poorer utilization of preventive services, increased use of hospital emergency rooms, and less satisfaction with care among Hispanics. This growing Hispanic minority mandates creative approaches that address issues of access, quality, and satisfaction with health services. This proposal combines service delivery with building infrastructure, capacity, and personnel readiness to meet the United States Office of Minority Health’s National Standards for Culturally and Linguistically Appropriate Services in Health Care known as the CLAS standards (USDHHS, 2001).This proposal is congruent with the overarching goals of Healthy People 2010, Rural Healthy People 2010, and the Health Professions National Goals. For more information contact Dr. Deborah Williamson at willmsnd@musc.edu |
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