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Biomedical subjects

Lauren Clark

Publications and source records attributed to Lauren Clark.

15 recordsLinked to original sources
PubMed2026

Proinsulin regulators identified with CRISPR screen and in vivo mouse QTL mapping.

Altered proinsulin levels in β-cells and bloodstream are hallmarks of diabetes and other diseases, but our knowledge about the proinsulin regulators remains limited. Here we perform a genome-wide CRISPR screen to identify 84 proinsulin regulators that alter intracellular proinsulin/insulin ratio in a mouse β-cell line. The proinsulin regulators are distinct from the insulin regulators from a previous orthogonal CRISPR screen. Functional annotation of the proinsulin regulators highlights Golgi as the primary organelle for proinsulin storage and regulation. Trafficking towards the Golgi increases the intra-cellular proinsulin/insulin ratio, while trafficking away from the Golgi, including exocytosis and Golgi-to-ER retrograde transport, decreases the intracellular proinsulin levels. We also map mouse quantitative trait loci (QTLs) associated with plasma proinsulin levels and use the CRISPR screen results to pinpoint the causal genes within the QTL loci. Interestingly, protein disulfide isomerase Pdia6 is the strongest hit from both CRISPR screen and the in vivo QTL mapping. Knocking down Pdia6 significantly reduce proinsulin accumulation in Golgi and secretory granules. Intriguingly, Pdia6-depletion in both human and mouse β-cells does not affect the folding status of proinsulin but causes significantly impaired proinsulin production through a UPR-independent mechanism. Taken together, our genetic profiles provide mechanistic insights into the regulation of proinsulin/insulin homeostasis.

Animals↗
PubMed2006

Nursing home resident barriers to effective pain management: why nursing home residents may not seek pain medication.

OBJECTIVES: Multiple barriers to effective pain management are present in the nursing home setting. The purpose of this analysis was to determine the extent to which residents in pain declined to request pain medication from the staff, and the reasons provided by the residents to explain this behavior. DESIGN: Every 3 months, a 20% sample of residents in 12 nursing homes was administered a short pain interview, then observed for pain indicators. Medical records were reviewed at the same time for documentation about pain and its treatment. All residents were asked if they had pain (or a similar word) now or in the past 24 hours. They were also asked if they had pain but did not request pain medication. If affirmative, the resident was asked to provide up to three reasons for not requesting medication. SETTING: The study was conducted in 12 Colorado nursing homes, located in both urban and rural settings. PARTICIPANTS: A total of 2033 nursing home residents completed pain interviews and/or were observed for pain indicators by trained research assistants. These interviews took place before, during, and after implementation of an intervention to improve pain practices. MEASUREMENTS: A cognitive organizing structure was used to categorize resident responses into a coherent classification. Individual responses were assigned by team members to the appropriate category using a consensus process. The final classification scheme consisted of 10 categories of reasons why residents do not request pain medication. RESULTS: More than one-half of residents (59.5%) reporting pain in the past 24 hours did not request medication for that pain. Subjects in pain were most likely to state medication concerns or stoicism as the reasons for not requesting pain medication. Concerns about staff reactions to a request or perceptions that the staff was too busy were also mentioned frequently by the residents. Subgroup analyses suggested that residents in pain but not requesting pain medication were significantly more likely to be in rural rather than urban nursing homes (67.9% vs. 52.9%, P < or = .01), and white as compared to nonwhite ethnicity (60.6% vs. 52.1%, P < or = .05). They also tended to be older on average (80.4 +/- 12.1 years vs. 77.9 +/- 12.7 years, P < or = .01) than residents who did request pain medication. Finally, residents in pain but not requesting pain medication were significantly more likely to report having both continuous (c) and intermittent (i) pain (71.8% [c + i] vs. 61% [c] or 56.5% [i], P < or = 0.01). CONCLUSION: Interventions to reduce pain in nursing home residents need to be responsive to the concerns of the residents. It must be acknowledged that resident preferences and beliefs may lead to declined pain interventions regardless of the staff's motivation to make the resident more comfortable. Staff nurses also need to make a more concerted effort to systematically assess pain and offer pain medication to residents rather than rely on resident requests.

Journal Article↗
PubMed2006

Nurses' reflections on pain management in a nursing home setting.

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

Analgesia↗
PubMed2005

A model to identify direct costs of nursing education: the Colorado experience.

During spring 2003, national, state, and local economic factors converged in a manner that propelled us to better identify the costs of the educational programs offered within the University of Colorado Health Sciences Center School of Nursing (SON). Two factors prompted analysis of direct costs of the nursing education programs: a shrinking state appropriation and a 36.7% rescission of state funds during that academic year. The SON supports 618 students in four programs (baccalaureate, master of science, doctor of nursing, and doctor of philosophy). During summer 2003, the SON leadership team met numerous times in an iterative process to clarify assumptions and make recommendations in an attempt to cost out academic programs. Data were obtained from a variety of sources. The SON Office of Budget and Finance provided revenue and expense data. The Office of Academic Affairs provided course schedules, the course offering plan, and projected student enrollment in courses. The Division Chairs provided data concerning faculty workload and faculty areas of expertise. The data were compiled in Access tables and arrayed in a series of Excel spreadsheets that captured course data and faculty data. A "what-if" analysis was completed to determine cost of a pilot accelerated baccalaureate program. This method provides a dynamic analytic system shown to be prospectively and retrospectively effective. As a result of this analysis, the following metrics are available: direct cost per student per course/program; revenue per student per course/program; faculty teaching FTE; and faculty-to-student ratio.

Budgets↗
PubMed2004

Improving nursing home staff knowledge and attitudes about pain.

PURPOSE: Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain. DESIGN AND METHODS: Twelve nursing homes participated in this intervention study: six treatment homes and six control homes, divided evenly between urban and rural locations. Three hundred licensed and unlicensed nursing home staff members completed written knowledge and attitude surveys at baseline, and 378 staff members completed the surveys after intervention implementation. RESULTS: Baseline results revealed notable knowledge deficits in the areas of pharmacology, drug addiction and dependence, side effect management, and nonpharmacologic management-strategy effectiveness. Significant differences were noted by job title (registered nurse/licensed practical nurse/certified nursing assistant). Case studies displayed a knowledge application problem, with nurses often filtering resident pain reports through observed resident behaviors. The intervention led to significant improvement in knowledge scores in some, but not all, the treatment homes. Perceived barriers to effective pain management showed a significant decline across all study nursing homes. IMPLICATIONS: Knowledge deficits related to pain management persist in nursing homes. An interactive multifaceted educational program was only partially successful in improving knowledge across settings and job categories. Attitudes and beliefs appear more difficult to change, whereas environmental and contextual factors appeared to be reducing perceived barriers to effective pain management across all participating nursing homes.

Adult↗
PubMed2004

Translation research in long-term care: improving pain management in nursing homes.

BACKGROUND: Pain prevalence in nursing homes remains high, with multiple resident, staff, and physician barriers presenting serious challenges to its improvement. AIMS: The study aims were to (1) develop and test a multifaceted, culturally competent intervention to improve nursing home pain practices; (2) improve staff, resident, and physician knowledge and attitudes about pain and its management; (3) improve actual pain practices in nursing homes; and (4) improve nursing home policies and procedures related to pain. METHODS: A multifaceted, culturally competent intervention was developed and tested in six Colorado nursing homes, with another six nursing homes serving as control sites. Both educational and behavioral change strategies were employed. FINDINGS: The intervention was successful in improving the percentage of residents reporting constant pain in the treatment homes. Contextual factors (implementation of Medicare's Nursing Home Compare report card) appeared to exert a positive influence on pain documentation. There was no reduction in the percentage of residents reporting pain or reporting moderate/severe pain. DISCUSSION: Multiple challenges to quality improvement exist in nursing homes. Turnover of nursing staff reduced actual exposure to the intervention, and turnover of directors of nursing influenced constancy of message and overall facility stability. Residents often failed to report their pain, and physicians were reluctant to alter their prescribing practices. IMPLICATIONS: Any intervention to improve pain management in nursing homes must target explicitly the residents, nursing home staff, and primary care physicians. Implementation strategies need to accommodate the high turnover rates among staff, as well as the changes among the nursing home leadership. CONCLUSIONS: Pain is a complex problem in the nursing home setting. Multiple factors must be considered in both the design and implementation of interventions to improve pain practices and reduce pain prevalence in nursing homes.

Aged↗
PubMed2004

Pain assessment practices with nursing home residents.

The purpose of this research was to describe the kinds of pain assessments nursing home staff use with nursing home residents and the characteristics and behaviors of residents that staff consider as they assess pain. Twenty-one focus groups were held in 12 nursing homes. Nurses and other nursing home staff attended the focus groups. Coding techniques consistent with ethnographic methodology were used for data analysis. Four themes identified an underlying uncertainty in assessing residents' pain, the staff relationship-centered approach to pain assessment, the resident cues that alert staff to pain, and residents' characteristics important to the nursing assessment. Composition of focus groups made a difference in participation of certified nursing assistants in focus group discussion. Urban and rural differences were noted across the focus groups. Research is needed to further refine pain assessment techniques specifically for nursing home settings.

Aged↗
PubMed2004

Conceptualizing and critiquing culture in health research.

Given the growing diversity of U.S. society, the federal mandates for health research with multicultural populations, and persistent confusion about the concept of culture, the purpose of this article is to present various definitions and biases of culture as found in current nursing research. By addressing various definitions and biases, the debates can help investigators become more culturally sensitive, avoid serious pitfalls, and eventually ensure the provision of culturally competent health care. Authors familiar with concepts of culture in research recommend investigators use culture in their health research, including strengthening research designs, embedding culture into research models, using culture-sensitive instruments, employing emic perspectives, and replicating interventions across diverse and changing populations.

Anthropology, Cultural↗
PubMed2002

Mexican-origin mothers' experiences using children's health care services.

A focused ethnographic study in an urban Latino community in the western United States describes Mexican-origin mothers 'experiences obtaining and using health services for their children. Repeated interviews with mothers, participant observation, and children's medical records composed the data sources. Qualitative findings suggest access to health care begins in the household, where women negotiate a working diagnosis for the children's illness with family members and coalesce support for health care seeking. Immigrant mothers described more barriers to children's health care than more acculturated mothers. Quantitative analyses of medical records supported this finding, with children of the least acculturated mothers demonstrating fewer well-child visits, increased emergent visits, and lower levels of immunization completeness. The results suggest health care providers can better meet the needs of Latino families with children by offering better explanations about children's diagnoses and treatment plans and demonstrating personalismo, or a friendly, kind, and social approach to care.

Adult↗
PubMedDate not supplied

Nursing home resident barriers to effective pain management: why nursing home residents may not seek pain medication.

OBJECTIVES: Multiple barriers to effective pain management are present in the nursing home setting. The purpose of this analysis was to determine the extent to which residents in pain declined to request pain medication from the staff, and the reasons provided by the residents to explain this behavior. DESIGN: Every 3 months, a 20% sample of residents in 12 nursing homes was administered a short pain interview, then observed for pain indicators. Medical records were reviewed at the same time for documentation about pain and its treatment. All residents were asked if they had pain (or a similar word) now or in the past 24 hours. They were also asked if they had pain but did not request pain medication. If affirmative, the resident was asked to provide up to three reasons for not requesting medication. SETTING: The study was conducted in 12 Colorado nursing homes, located in both urban and rural settings. PARTICIPANTS: A total of 2033 nursing home residents completed pain interviews and/or were observed for pain indicators by trained research assistants. These interviews took place before, during, and after implementation of an intervention to improve pain practices. MEASUREMENTS: A cognitive organizing structure was used to categorize resident responses into a coherent classification. Individual responses were assigned by team members to the appropriate category using a consensus process. The final classification scheme consisted of 10 categories of reasons why residents do not request pain medication. RESULTS: More than one-half of residents (59.5%) reporting pain in the past 24 hours did not request medication for that pain. Subjects in pain were most likely to state medication concerns or stoicism as the reasons for not requesting pain medication. Concerns about staff reactions to a request or perceptions that the staff was too busy were also mentioned frequently by the residents. Subgroup analyses suggested that residents in pain but not requesting pain medication were significantly more likely to be in rural rather than urban nursing homes (67.9% vs. 52.9%, P < or = .01), and white as compared to nonwhite ethnicity (60.6% vs. 52.1%, P < or = .05). They also tended to be older on average (80.4 +/- 12.1 years vs. 77.9 +/- 12.7 years, P < or = .01) than residents who did request pain medication. Finally, residents in pain but not requesting pain medication were significantly more likely to report having both continuous (c) and intermittent (i) pain (71.8% [c + i] vs. 61% [c] or 56.5% [i], P < or = 0.01). CONCLUSION: Interventions to reduce pain in nursing home residents need to be responsive to the concerns of the residents. It must be acknowledged that resident preferences and beliefs may lead to declined pain interventions regardless of the staff's motivation to make the resident more comfortable. Staff nurses also need to make a more concerted effort to systematically assess pain and offer pain medication to residents rather than rely on resident requests.

Aged↗
PubMedDate not supplied

Assessment of community contamination: a critical approach.

The purpose of this paper is to review data from two Superfund sites and describe the latitude of interpretation of "environmental risk" by residents living in the area, governmental agencies, and the media. The first community was located within a 5-mi perimeter of the Rocky Flats Environmental Technology Site (RFETS) outside Denver, Colorado. The second community was located on the south side of Tucson, Arizona, adjacent to the Tucson International Airport area (TIAA) Superfund site. Critical theory was the perspective used in this analysis and proposal of public health actions to attain social justice. Differences between the two populations' experiences with risk and contamination coincided with divergent levels of trust in government. RFETS residents demanded monitoring, whereas the minority residents at TIAA were ambivalent about their trust in government cleanup activities. Unraveling the purpose of "facts" and the social force of "truth" can direct nurses to address environmental justice issues. By policing governmental and business activities in halting or cleaning up environmental contamination, nurses may become mouthpieces for the concerns underlying the fragile surface of "virtual trust" in contaminated communities. Cutting through competing rhetoric to police environmental safety, the core function of assurance becomes what nurses do, not what they say.

Arizona↗
PubMedDate not supplied

Using focus groups to develop a culturally competent diabetes self-management program for Mexican Americans.

PURPOSE: The purpose of this study was to describe factors that facilitate or hinder diabetes self-management and elicit participants' preferences and recommendations about the essential components of a culturally competent diabetes self-management program. METHODS: Latino patients with type 2 diabetes and their family caregivers were interviewed in focus groups. Four focus groups consisted of patients, and 2 groups consisted of family caregivers for a total of 40 participants. Participants were assigned to groups based on break characteristics of gender and preferred language. RESULTS: "Being in the dark" emerged as an important concern, and patient respondents wanted timely access to information that they deemed understandable about how to manage their diabetes. Family members' support and understanding were crucial in maintaining lifestyle changes. Patient and family caregiver participants wanted a self-management program to incorporate information on how to modify traditional foods, home remedies, and stress management. Preferences for information delivery included group didactic and interactive sessions, written information, and videotapes. Higher technology strategies using computers were not seen as useful. CONCLUSIONS: Culturally competent diabetes self-management for Latinos should incorporate the family and include techniques for stress management as well as diet modification. Information delivery should include a variety of techniques.

Diabetes Mellitus, Type 2↗