Browsing by Author "Carpenter, Janet"
Now showing 1 - 9 of 9
Results Per Page
Sort Options
Item CONTINUOUS MONITORING OF THE GALVANIC SKIN RESPONSE(Office of the Vice Chancellor for Research, 2012-04-13) Teach, Heather; Igega, Christele; Schild, John; Carpenter, JanetGalvanic Skin Response (GSR) is an objective measurement of the electrical conductance of the skin. GSR is tightly correlated with peripheral sweat rate, which in turn is associated with many clinical conditions. These conditions include, but are not limited to, menopausal “hot flashes”, diabetic hypoglycemic and hyperglycemic episodes, and various cancers. The objective quantification of GSR can be a valuable clinical tool in evaluating the effectiveness of clinical interventions for these and other conditions. Current methods of monitoring GSR are not well suited to implementation outside of the clinical setting. The goal of this research is to develop a reliable portable device for real-time ambulatory monitoring of GSR. In order to get accurate and consistent readings, electrodes must be attached to the patient with a lasting and non-irritating electrically conductive gel with suitable impedance characteristics. Development of such a device requires consideration of many physiological factors. The distribution and density of sweat glands must be considered to determine a location for the device on the body that will yield measurable GSR without interfering with the patient’s daily activities. We are in the process of evaluating the electrical impedance of electrode and gel combinations presently used in the Carpenter lab. Quantification of the frequency dependent loading profile of the electrode-gel interface will improve the measurement accuracy of the GSR. The ionic composition of sweat and the sweat rate must be evaluated to ensure that the integrity of the interface between the body and the device is maintained throughout the monitoring period. 1Department of Biomedical Engineering, Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, IN 46204 2Center for Enhancing Quality of Life, Indiana University School of Nursing, IUPUI, Indianapolis, IN 46204Item Developing a Rodent Model of Adverse Menopausal Symptoms(Office of the Vice Chancellor for Research, 2011-04-08) Snow, Winter; Federi, Lauren; Fitz, Stephanie; Janasik, Stephen; Penno, Daniel; Samuels, Brian; Carpenter, Janet; Skaar, Todd C.; Shekhar, Anantha; Johnson, Philip L.Menopause is a condition where severe depletion of estrogen levels leads to a cluster of adverse symptoms such as anxiety, cutaneous vasodilation/sudomotor "hot flashes", sleep disturbances, and appetite change (Freeman et al., 2005; Seritan et al., 2010). Previously, estrogen replacement therapy was the first line treatment for menopausal symptoms. However, it is no longer acceptable due to increased risk of cancer (Rossouw et al., 2002). Therefore there is a need for creating non-hormonal therapies to reduce the incidence of adverse menopausal-related symptoms. This is hindered by the limited understanding of menopausal symptoms and a lack of animal models of "hot flashes" (Nelson et al., 2006). Currently, the most accepted model of hot flashes is addicting female rats to morphine then inducing morphine withdrawal using naloxone (a ?-opioid receptor competitive antagonist) to provoke increases in tail temp (an indicator of cutaneous vasodilation). Yet, there is no evidence that the opioid system is disrupted in women with menopause [e.g., naloxone does not provoke "hot flashes" clinically (DeFazio et al., 1984)]. Here we induced a menopausal state by surgically removing the ovaries (OVEX) to deplete estrogen which induces a cluster of adverse menopause-like symptoms that include: 1) increased anxiety; 2) weight gain; and 3) disrupted diurnal skin and core body tempature changes. Additionally, we have developed an alternative model of "hot flashes" where administering yohimbine (an alpha2-adrenergic autoreceptor antagonist that provokes "hot flashes in menopausal women) resulted in "hot flash"-related increases in skin temp in OVEX, but not sham-OVEX, female rats.Item Faculty Talent Development Effort: Mentoring Academy(Office of the Executive Vice Chancellor, IUPUI., 2014-04-24) Williamson, Gail; Lavitt, Melissa; Welch, Julie; Grove, Kathy; Lees, N. Douglas; Upton, Thomas; Carpenter, JanetIUPUI’s Strategic Plan, “Our Commitment to Indiana and Beyond,” places faculty and staff talent development among its highest priorities. The goal is to position IUPUI as an “employer of choice” through a number of actions, including improved workplace culture and communication and more robust developmental opportunities across all categories of faculty and staff. Based on feedback received during the strategic planning process, the completed implementation plan will articulate career paths for staff and faculty, identify and inventory a variety of campus resources, and provide relevant professional development opportunities. In addition, policies and procedures will be created to foster work/life balance and flexibility for IUPUI’s entire workforce. In order for IUPUI to reach the level of excellence expected in the plan, we must be assured that our investment in faculty will lead to greater success and productivity. The Mentoring Academy goals and objectives outlined below provide a means to engage faculty within each school and create a pathway for achievement of successful mentoring.Item Group-Based Trajectory Modeling of Nursing Home Resident Pain Scores(Oxford University Press, 2022-12-20) Cole, Connie; Hickman, Susan; Blackburn, Justin; Carpenter, Janet; Chen, Chen; School of NursingUp to 80% of older adults living in a nursing home (NH) experience pain and up to 32% have substantial pain. Pain in NH residents is associated with poor quality of life, higher likelihood of depression, and decreased life satisfaction. Pain in NH residents has often been studied using a cross-sectional approach, which fails to consider the temporal nature of pain. Therefore, the purpose of this analysis was to identify and characterize clinically meaningful, dynamic pain trajectories in NH residents using data from the Minimum Data Set. A retrospective longitudinal analysis was conducted using group-based trajectory modeling with pain scores from admission to discharge or a maximum of 28 assessments. We identified four distinct trajectories: 1) consistent pain absence (48.9%), 2) decreasing-increasing pain presence (21.8%), 3) increasing-decreasing pain presence (15.3%), and 4) persistent pain presence (14.0%). Relative to residents’ in the consistent pain absence trajectory, the likelihood of being in the persistent pain presence trajectory was more than twice as high for those living in a rural versus (AOR 2.7, CI 2.2-3.4, p<.001), over 4 times higher for those with hip fracture (AOR 4.3 CI 2.6-7.0, p<.001), nearly 3 times higher for those with a fracture other than hip (AOR 2.9, CI 2.0-4.1, p<.001), and almost twice as high for those with contracture (AOR 1.7, CI 1.4-2.1, p<.001). Using residents’ characteristics associated with persistent pain such as hip fracture or contracture may improve care planning based on early identification or risk stratification and can improve mitigation of persistent pain.Item A NOVEL APPROACH TO MODELING MENOPAUSAL SYMPTOMS AND THE ROLE OF THE OREXIN SYSTEM(Office of the Vice Chancellor for Research, 2012-04-13) Federici, Lauren; Fitz, Stephanie D.; Snow, Winter; Skaar, Todd C.; Carpenter, Janet; Shekhar, Anantha; Johnson, Philip L.Menopausal symptoms become prevalent in conditions associated with depletion of estrogens [e.g., ovariectomy surgery or with breast cancer treatments that block estrogen activity (e.g., tamoxifen or aromatase inhibition therapy)]. The primary menopause associated symptom is cutaneous vasodilation “hot flashes”, but also includes sleep and mood disruption (Freeman et al., 2005; Seritan et al., 2010). Although the cause of menopausal symptoms is poorly understood, it is well-established that the hypothalamus: 1) plays a critical role in thermoregulation, sleep wake activity and emotional responses; and 2) has high and fairly exclusive expression of both estrogen α and β receptors (Laflamme et al., 1998). A recently discovered neuropeptide called Orexin (ORX) is exclusively synthesized in the perifornical hypothalamus (PeF). This neuropeptide plays a critical role in arousal, anxiety (Johnson et al., 2010), and body temperature regulation (Rusyniak et al., 2011), but is also severely elevated in the brain of postmenopausal women (El-Sedeek et al., 2010) and reduced in control subjects following estrogen replacement. Therefore, loss of normal inhibitory control by estrogens of the ORX system may lead to menopausal-related symptoms, and ORX antagonists could constitute a potential novel treatment strategy for adverse menopausal symptoms. In support of this hypothesis, ovariectomized (OVEX), female rats, compared to sham controls, had significantly greater anxiety at baseline which was blocked by administration of an ORX1 receptor (ORX1R) antagonist (SB334867, 25mg/kg ip) or estrogen replacement. Administration of a sub-threshold dose of FG-7142 (a partial inverse GABAA receptor agonist, 3mg/kg ip) caused higher (~6°C) and longer tail skin flushes in OVEX rats, which was attenuated with similar pretreatment with an ORX1R antagonist or with estrogen replacement. These results indicate a novel role for both the GABA and ORX systems in menopausal symptoms and further research aims to elucidate the mechanisms of dysfunction of these systems in the menopausal state.Item Nurse to Family Communication in Intensive Care Units(2024-05) Dees, Mandy Lynn; Carpenter, Janet; Levoy, Kristin; Longtin, Krista; Reising, Deanna; Wocial, LuciaNurse to family communication is a crucial aspect of high-quality care delivery in adult intensive care units (ICU). Adult ICU nurses hold a unique position to engage in meaningful communication with families, often being the most accessible healthcare team members to family. However, these nurses frequently express a sense of ineptitude in their nurse to family communication skills. Simultaneously, families often find themselves unprepared for these adult ICU interactions yet are regularly tasked with the responsibility of surrogate decision-making when patients are incapacitated. Despite the successful utilization of the COMFORT (Connect, Options, Making meaning, Family caregivers, Openings, Relating, and Team) communication intervention in other settings, its implementation in the adult ICU has not been realized. Exploring the perspectives of adult nurses and nurse leaders on the COMFORT intervention topics could enhance the success of its implementation and sustainability in clinical practice. The overall goal of this three-paper dissertation was to advance scientific knowledge about nurse to family communication in the adult ICU setting. An integrative review was conducted to systematically assess available research evidence on enhancing communication between adult ICU patients/families and nurses. Using qualitative focus group approach, the aims of the next two studies were to gather participants’ perspectives of the practicability, appeal, and relevance of each COMFORT communication intervention topics and strategies for its implementation among adult ICU nurse leaders (second paper) and ICU nurses (third paper). Results of these studies indicate the importance of nurse to family communication in adult ICU environments and nurse leaders’ and nurses’ enthusiasm for the implementation of the COMFORT intervention in the ICU setting. Recommendations emerging from the focus group interviews include providing adult ICU nurses dedicated time to complete training during work hours, allowing early adopters to use the COMFORT app before expanding it to the entire unit staff nurse population, making the app accessible on unit computers, providing training suitable for nurses at all experience levels (from early career to seasoned staff), adopting a phased approach to implementation, and offering education on the COMFORT topics in quick, digestible learning tools suitable for a fast-paced nursing unit.Item Operationalizing the Measurement of Socioeconomic Position in Our Urogynecology Study Populations: An Illustrative Review(Wolters Kluwer, 2017-05) Heit, Michael; Guirguis, Nayera; Kassis, Nadine; Takase-Sanchez, Michelle; Carpenter, Janet; Obstetrics and Gynecology, School of MedicineObjectives The purpose of this illustrative review is to provide guidance for the measurement of socioeconomic position when conducting health disparities research in urogynecology study populations. Methods Deidentified data were extracted from existing investigational review board–approved research databases for illustrative purposes. Attributes collected included the study participant's marital status, level of educational attainment (in number of years of school completed) and occupation as well as the study participant's last/only spouses' level of education and occupation. Average household and female socioeconomic position scores were calculated using two established composite indices: (1) Hollingshead Four Factor Index of Social Position, (2) Green's Socioeconomic Status scores, and 2 single-item indices: (1) Hauser-Warren Socioeconomic Index of Occupation, (2) level of educational attainment. Results The Hollingshead Four Factor Index of Social Position more than the Hauser-Warren Socioeconomic Index of Occupation provides researchers with a continuous score that is normally distributed with the least skew from the dataset. Their greater standard deviations and low kurtotic values increase the probability that statistically significant differences in health outcomes predicted by socioeconomic position will be detected compared with Green's socioeconomic status scores. Conclusions Collection of socioeconomic data is an important first step in gaining a better understanding of health disparities through elimination of confounding bias, and for the development of behavioral, educational, and legislative strategies to eliminate them. We favor average household socioeconomic position scores over female socioeconomic position scores because average household socioeconomic position scores are more reflective of overall resources and opportunities available to each family member.Item Patient-reported symptoms and discontinuation of adjuvant aromatase inhibitor therapy(Wiley, 2014-08-15) Kidwell, Kelley M.; Harte, Steven E.; Hayes, Daniel F.; Storniolo, Anna Maria; Carpenter, Janet; Flockhart, David A.; Stearns, Vered; Clauw, Daniel J.; Williams, David A.; Henry, N. Lynn; Department of Medicine, IU School of MedicineBACKGROUND: Aromatase inhibitor (AI) therapy results in substantial survival benefits for patients with hormone receptor-positive breast cancer. The rates of poor adherence and discontinuation of AI therapy are high, primarily because of treatment-related toxicities like musculoskeletal pain. Although pain-related symptoms may worsen during AI therapy, the authors hypothesized that nonpersistence with AI therapy was associated with symptoms that were present before treatment initiation. METHODS: Postmenopausal women initiating AI therapy who were enrolled in a prospective clinical trial completed questionnaires at baseline to assess sleep, fatigue, mood, and pain. Reasons for treatment discontinuation during the first year of treatment were recorded. Associations between baseline patient-reported symptoms and treatment discontinuation because of toxicity were identified using logistic regression. RESULTS: Four hundred forty-nine patients were evaluable. The odds of treatment discontinuation were higher in patients who reported a greater number of symptoms before AI initiation. Baseline poor sleep quality was associated with early treatment discontinuation, with an odds ratio (OR) of 1.91 (95% confidence interval [CI], 1.26-2.89; P = .002). Baseline presence of tired feeling and forgetfulness had similar ORs for discontinuation (tired feeling: OR, 1.76; 95% CI, 1.15-2.67; P = .009; forgetfulness: OR, 1.66; 95% CI, 1.11-2.48; P = .015). An increasing total number of baseline symptoms was associated with an increased likelihood of treatment discontinuation, with an OR of 1.89 (95% CI, 1.20-2.96; P = .006) for 3 to 5 symptoms versus 0 to 2 symptoms. CONCLUSIONS: Symptom clusters in breast cancer survivors that are present before the initiation of adjuvant AI therapy may have a negative impact on a patient's persistence with therapy. Interventions to manage these symptoms may improve breast cancer outcomes and quality of life.Item Post-Craniotomy Pain in the Brain Tumor Patient: An Integrative Review(Wiley, 2016-06) Guilkey, Rebecca Elizabeth Foust; Von Ah, Diane; Carpenter, Janet; Stone, Cynthia; Draucker, Claire B.; Department of Nursing, IU School of NursingAim To conduct an integrative review to examine evidence of pain and associated symptoms in adult (≥21 years of age), postcraniotomy, brain tumour patients hospitalized on intensive care units. Background Healthcare providers believe craniotomies are less painful than other surgical procedures. Understanding how postcraniotomy pain unfolds over time will help inform patient care and aid in future research and policy development. Design Systematic literature search to identify relevant literature. Information abstracted using the Theory of Unpleasant Symptoms’ concepts of influencing factors, symptom clusters and patient performance. Inclusion criteria were indexed, peer-reviewed, full-length, English-language articles. Keywords were ‘traumatic brain injury’, ‘pain, post-operative’, ‘brain injuries’, ‘postoperative pain’, ‘craniotomy’, ‘decompressive craniectomy’ and ‘trephining’. Data sources Medline, OVID, PubMed and CINAHL databases from 2000–2014. Review method Cooper's five-stage integrative review method was used to assess and synthesize literature. Results The search yielded 115 manuscripts, with 26 meeting inclusion criteria. Most studies were randomized, controlled trials conducted outside of the United States. All tested pharmacological pain interventions. Postcraniotomy brain tumour pain was well-documented and associated with nausea, vomiting and changes in blood pressure, and it impacted the patient's length of hospital stay, but there was no consensus for how best to treat such pain. Conclusion The Theory of Unpleasant Symptoms provided structure to the search. Postcraniotomy pain is experienced by patients, but associated symptoms and impact on patient performance remain poorly understood. Further research is needed to improve understanding and management of postcraniotomy pain in this population.