Publications by authors named "Haley Hoy"

14 Publications

  • Page 1 of 1

Psychosocial Implications for Transplant Patients During the Global Pandemic.

Prog Transplant 2020 09 29;30(3):295-296. Epub 2020 Jun 29.

Vanderbilt Transplant Center, 5718Vanderbilt University Medical Center, Nashville, TN, USA.

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http://dx.doi.org/10.1177/1526924820935400DOI Listing
September 2020

Choosing the right inhaler for the right patient: Considerations for effective management of patients with chronic obstructive pulmonary disease or asthma.

J Am Assoc Nurse Pract 2020 Jan;32(1):89-99

College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama, Huntsville, Alabama.

Background And Purpose: Effective management of chronic respiratory disorders such as chronic obstructive pulmonary disease and asthma necessitates that patients inhale their medication. However, lack of detailed guidelines on the technological and mechanical functions of inhalers limits the ability of health care providers (HCPs) to personalize inhaler choice for patients. Numerous types of inhalers are currently available which offer their own distinct advantages and disadvantages. Independent of the drug class, the choice of inhaler may be influenced by many factors (e.g., inhaler attributes and the efficiency with which it delivers the medication, patient characteristics and preferences, dosing regimen, clinical setting, and support available for both patients and HCPs). This article attempts to summarize the inhalation technology and factors influencing inhaler choice and use and to provide an approach for matching the right inhaler to the right patient.

Conclusions: Identifying factors related to inhaler choice is critical to ensuring adherence to treatment and patients' ability to use their inhaler correctly.

Implications For Practice: This review will help HCPs engage their patients in decision-making for inhaler choice and facilitate selection of the correct inhaler for each patient (i.e., one that they will use).
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http://dx.doi.org/10.1097/JXX.0000000000000366DOI Listing
January 2020

Surgical Treatment of Lung Cancer.

Crit Care Nurs Clin North Am 2019 Sep 5;31(3):303-313. Epub 2019 Jul 5.

University of Alabama in Huntsville, 301 Sparkman Drive, Huntsville, Al 35899, USA.

Lung cancer is the leading cause of cancer-related death and the second most diagnosed cancer in the United States. Surgical intervention is most applicable to early-stage lung cancer diagnoses and considered the best curative option. Multiple surgical techniques are now available, including wedge resection, segmentectomy, lobectomy, and pneumonectomy. Robotics and video-assistance are commonly used in wedge resection and sometimes used for segmentectomy. Regardless of the technique, focused clinical management of the patient following lung cancer surgery by nurses and nurse practitioners remains a priority. Future innovations affecting the surgical treatment of lung cancer include immunotherapy and oncogenomics.
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http://dx.doi.org/10.1016/j.cnc.2019.05.002DOI Listing
September 2019

Long-Term Physical HRQOL Decreases After Single Lung as Compared With Double Lung Transplantation.

Ann Thorac Surg 2018 12 16;106(6):1633-1639. Epub 2018 Aug 16.

Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee.

Background: Single lung transplantation (SLT) and double lung transplantation (DLT) are associated with differences in morbidity and mortality, although the effects of transplant type on patient-reported outcomes are not widely reported and conclusions have differed. Previous studies compared mean health-related quality of life (HRQOL) scores but did not evaluate potentially different temporal trajectories in the context of longitudinal follow-up. To address this uncertainty, this study was designed to evaluate longitudinal HRQOL after SLT and DLT with the hypothesis that temporal trajectories differ between SLT and DLT.

Methods: Patients transplanted at a single institution were eligible to be surveyed at 1 month, 3 months, 6 months, and then annually after transplant using the Short Form 36 Health Survey, with longitudinal physical component summary (PCS) and mental component summary (MCS) scores as the primary outcomes. Multivariable mixed-effects models were used to evaluate the effects of transplant type and time posttransplant on longitudinal PCS and MCS after adjusting age, diagnosis, rejection, Lung Allocation Score quartile, and intubation duration. Time by transplant type interaction effects were used to test whether the temporal trajectories of HRQOL differ between SLT and DLT recipients. HRQOL scores were referenced to general population norms (range, 40 to 60; mean, 50 ± 10) using accepted standards for a minimally important difference (½ SD, 5 points).

Results: Postoperative surveys (n = 345) were analyzed for 136 patients (52% male, 23% SLT, age 52 ± 13 years, LAS 42 ± 12, follow-up 37 ± 29 months [range, 0.6 to 133]) who underwent lung transplantation between 2005 and 2016. After adjusting for model covariates, overall posttransplant PCS scores have a significant downward trajectory (p = 0.015) whereas MCS scores remain stable (p = 0.593), with both averaging within general population norms. The time by transplant type interaction effect (p = 0.002), however, indicate that posttransplant PCS scores of SLT recipients decline at a rate of 2.4 points per year over the total observation period compared to DLT. At approximately 60 months, the PCS scores of SLT recipients, but not DLT recipients, fall below general population norms.

Conclusions: The trajectory of physical HRQOL in patients receiving SLT declines over time compared with DLT, indicating that, in the longer term, SLT recipients are more likely to have physical HRQOL scores that fall substantively below general population norms. Physical HRQOL after 5 years may be a consideration for lung allocation and patient counseling regarding expectations when recommending SLT or DLT.
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http://dx.doi.org/10.1016/j.athoracsur.2018.06.072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240480PMC
December 2018

The Effect of Transplant Education on Nurses Attitudes Toward Organ Donation and Advocacy for Transplantation.

Prog Transplant 2017 06 11;27(2):175-179. Epub 2017 Apr 11.

2 College of Nursing, University of Alabama in Huntsville, Huntsville, AL, USA.

Nurses are the largest group of health-care professionals, yet they are not uniformly educated regarding transplantation and organ donation. The future of transplantation hinges on education of this group. Before meaningful studies can be conducted, an instrument to measure attitudes and commitment to organ transplantation is needed. The purpose of this study was to examine content and construct validity as well as establish internal reliability of an investigator-developed online instrument to measure nurses' attitudes and commitment to organ transplantation by registered nurses. The online instrument was administered to registered nurses enrolled in transplantation electives at the University of Alabama in Huntsville and Vanderbilt University. Exploratory factor analysis revealed 4 components with eigenvalues over 1.0. The components were as follows: (1) desire to work in transplantation, (2) confidence in transplantation advocacy, (3) organ donation advocacy, and (4) procurement. Internal consistency of the revised instrument was established (α = .94). The Transplant-Registered Nurse (TXP-RN) instrument is a new instrument with excellent reliability and validity that can be used to measure attitudes and knowledge of American nurses about organ donation and transplantation. This important step is necessary before educational interventions can be accurately assessed.
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http://dx.doi.org/10.1177/1526924817699961DOI Listing
June 2017

Implementation of a Screening Program for Patients at Risk for Posttraumatic Stress Disorder.

Clin Med Insights Cardiol 2016 8;10:129-37. Epub 2016 Aug 8.

Washington University School of Medicine Associate Professor, Medicine Division of Cardiovascular Diseases, Section Head, Cardiac Electrophysiology, USA.

Introduction: Implantable cardioverter defibrillator (ICD) recipients who suffer from posttraumatic stress disorder (PTSD) are known to be associated with significant cardiac-specific mortality. Clinical observations suggest that PTSD is frequently undetected in ICD recipients followed up at electrophysiology (EP) outpatient clinics. Early recognition of PTSD is important to reduce the risk of serious manifestations on patient outcomes.

Methods: All ICD recipients aged 19 years or older at the Washington University School of Medicine (WASHU) EP clinic, a large urban EP clinic, were invited to participate in the project. An informed consent letter with an attached primary care: posttraumatic stress disorder (PC: PTSD) survey was offered to the participants who met the inclusion criteria. Those who completed the survey were included in the project. Individuals with positive survey result were offered a referral to mental health services. Comparisons between PTSD and non-PTSD patients were done using a two-sample t-test for continuous variables. Using Fisher's exact test, PTSD prevalence was compared to the study by Ladwig et al in which prevalence was determined as the proportion of patients with positive findings of PTSD (n = 38/147). All analyses were conducted using SAS v9.4. The proportion of patients having PTSD was determined and an exact 95% confidence interval was evaluated based on the binomial distribution.

Results: Using a convenience sample, 50 ICD recipients (33 males and 17 females) were enrolled. The project had a 30-day outcome period. Nine (18%) of the 50 participants had positive PC: PTSD findings and all these nine participants were referred to a mental health specialist. The current project demonstrated an 18% (9/50) PTSD prevalence rate when compared to a 26% (38/147) prevalence rate in the study by Ladwig et al (P = 0.34). Although this project did not demonstrate 20% PTSD prevalence rate, as hypothesized, the 18% PTSD prevalence rate is consistent with previous research.

Conclusion: The prevalence of PTSD noted in the current project is consistent with previous research and validates underrecognition of PTSD in ICD patients. Offering a referral to all ICD recipients at EP clinic visits with a positive PC: PTSD screening to a mental health specialist is an important step in reducing the risk of serious manifestations on patient outcomes.
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http://dx.doi.org/10.4137/CMC.S39957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978196PMC
August 2016

Practical guidance on the recognition of uncontrolled asthma and its management.

J Am Assoc Nurse Pract 2015 Aug 25;27(8):466-75. Epub 2015 Jun 25.

College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama.

Purpose: To highlight the significance of asthma in primary care and offer a practitioner-friendly interpretation of the asthma guidelines for the busy provider, while introducing new treatment options currently in clinical trials, such as the once-daily long-acting anticholinergic bronchodilator tiotropium Respimat.

Data Sources: Articles with relevant adult data published between 2004 and 2015 were identified via PubMed. Additional references were obtained by reviewing bibliographies from selected articles.

Conclusions: In the United States, uncontrolled or symptomatic asthma is common, with rates of 46%-78% in primary care. Uncontrolled asthma has a substantial impact on patients' quality of life and represents a significant healthcare burden. Nurse practitioners can improve patients' asthma control through education, monitoring, assessment, and treatment. Although asthma management guidelines are readily available, the authors recognize that nurse practitioners see patients with multiple comorbidities, all of which have treatment guidelines of their own.

Implications For Practice: Nurse practitioners have a compelling opportunity as frontline caregivers and patient educators to recognize and assess uncontrolled asthma, along with determining the steps necessary to help patients gain and maintain symptom control.
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http://dx.doi.org/10.1002/2327-6924.12284DOI Listing
August 2015

Powering transplant professional collaborations with Web and mobile apps.

Comput Inform Nurs 2013 Aug;31(8):351-5

Information Technology and Systems Center, University of Alabama in Huntsville, AL, USA.

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http://dx.doi.org/10.1097/CIN.0000000000000001DOI Listing
August 2013

Initiating collaboration among organ transplant professionals through Web portals and mobile applications.

Online J Issues Nurs 2013 May 13;18(2). Epub 2013 May 13.

College of Nursing at the University of Alabama in Huntsville, AL, USA.

The knowledge base for healthcare providers working in the field of organ transplantation has grown exponentially. However, the field has no centralized 'space' dedicated to efficient access and sharing of information. The ease of use and portability of mobile applications (apps) make them ideal for subspecialists working in complex healthcare environments. In this article, the authors review the literature related to healthcare technology; describe the development of health-related technology; present their mobile app pilot project assessing the effects of a collaborative, mobile app based on a freely available content manage framework; and report their findings. They conclude by sharing both lessons learned while completing this project and future directions.
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May 2013

Evaluation of living kidney donors: variables that affect donation.

Prog Transplant 2012 Dec;22(4):385-92

Vanderbilt University Medical Center, Nashville, TN, USA.

Approximately 10000 deceased donor organs are available yearly for 85 000 US patients awaiting kidney transplant. Living kidney donation is essential to close this gap and offers better survival rates. However, nationally, 80% of potential donors evaluated fail to donate. Nurse coordinators who perform predonation screening and education need additional insight into the large number of potential donors who fail to complete the donation process. Reasons for nondonation in donor candidates undergoing medical evaluation, and variables affecting nondonation at Vanderbilt University Medical Center between 2004 and 2009 are examined. Multivariable logistic regression models are used to test the effects of age and race on donation status and reasons for nondonation. Summary data are frequencies, percentages, and means (SD). The sample included 706 candidates (63% female, 80% white; mean age, 40 [SD, 12] years). Almost half (46%) received clearance to donate. Undiagnosed hypertension (14%), abnormal glucose tolerance (10%), and protein-urea (9%) were the most prevalent medical reasons for nondonation. About 13% of candidates changed their minds during evaluation. Analyses demonstrated an increased likelihood of older candidates (P < .001) and a decreased likelihood of white candidates (P = .007) being excluded from donation. Within the nondonation group, increased age was associated with undiagnosed hypertension and abnormal glucose tolerance (both race-adjusted, P = .01). Younger candidates (race-adjusted, P = .003) and African Americans (age-adjusted, P = .04) were more likely to decide against donation. The most prevalent medical reasons for nondonation could be identified through enhanced prescreening, and improved preevaluation education could decrease nondonation rates.
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http://dx.doi.org/10.7182/pit2012570DOI Listing
December 2012

Negative effects of pretransplant body mass index on physical health-related quality of life after lung transplant.

Prog Transplant 2012 Dec;22(4):363-8

Vanderbilt Transplant Center, Nashville, TN, USA.

Background: Although current national data show improved graft and patient survival following lung transplant, the effects of several modifiable preexisting comorbid conditions on health-related quality of life after transplant have not been evaluated. This study examines the effects of 3 comorbid conditions present before lung transplant (reduced bone density, diabetes mellitus, and elevated body mass index) on health-related quality of life after lung transplant.

Methods: The Short Form 36 Health Survey was completed by 92 adult recipients at various times after lung transplant (mean, 41 months; range, 1-127 months). Multiple linear regression models that controlled for underlying disease, chronic rejection, and time after transplant tested the independent effects of the 3 pretransplant conditions on posttransplant health-related quality of life.

Results: The effects of pretransplant reduced bone density and diabetes mellitus were not statistically significant in these models. However, pretransplant body mass index had a significant negative effect (β = -.29, P = .007) on posttransplant physical health-related quality of life. Additionally, overweight status and obesity exerted comparable independent negative effects (P = .01 and P = .03, respectively) on the physical function scale of the Short-Form 36 Health Survey compared with persons who were underweight or normal weight before transplant.

Conclusions: Reevaluation of elevated body mass index before transplant as a risk for reduced physical quality of life after lung transplant should be considered.
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http://dx.doi.org/10.7182/pit2012582DOI Listing
December 2012

Effect of transplant education on nurses' attitudes toward organ donation and plans to work with transplant patients.

Prog Transplant 2011 Dec;21(4):317-21

University of Alabama, Huntsville Vanderbilt University Transplant Center, Nashville, Tennessee, USA.

Context: Despite the increase in rates of solid organ transplantation in the past 2 decades, nurses are inconsistently educated regarding issues of organ donation and posttransplant care.

Objective: To characterize the attitudes of registered nurses before and after a graduate-level elective on issues in transplantation.

Design: Pre-experimental, pretest and posttest interventional study.

Participants: 30 graduate students, who are registered nurses, who enrolled in a transplant elective at a university in the Southeastern United States.

Main Outcome Measure: Investigator-designed survey tool consisting of 18 questions delivered in an electronic format.

Results: Statistically significant results were seen in nurses' attitudes toward encouraging others to become organ donors (P = .04), preparation to discuss transplantation with others (P< .001), advocacy to discuss transplantation among colleagues (P = .003), confidence in working with transplant patients (P = .005), confidence in speaking to communities about organ donation (P = .001), and plans to encourage others to get involved in transplantation (P = .03).

Conclusion: These results support the need for providing focused education on transplantation issues to registered nurses, particularly in the academic setting.
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http://dx.doi.org/10.7182/prtr.21.4.x5q2378623281h61DOI Listing
December 2011

The role of advanced practice nurses in transplant center staffing.

Prog Transplant 2011 Dec;21(4):294-8

University of Alabama in Huntsville, Alabama, USA.

Context: Despite increased rates of solid organ transplantation and frequent use of advanced practice nurses (APNs) to manage patients, no established staffing model including APNs and their roles exists.

Objective: To characterize the role and integration of APNs in the staffing models of existing transplant centers.

Design: Descriptive research using a researcher-designed survey of transplant APN professionals.

Participants: 53 attendees of a national APN transplant clinical management symposium.

Main Outcome Measure: Investigator-designed survey tool consisting of 21 questions delivered in a paper format with 1 open-ended question about adequacy of current staffing and ideas for improvement.

Results: 53 responses from staff members of 21 different transplant centers were collected. In addition to APNs, members of existing transplant staffing models were identified as licensed practical nurses, registered nurses, social workers, administrative assistants, and data managers. The primary responsibilities of APNs were both inpatient and outpatient, before and after transplant, and consisted primarily of collecting patients' medical histories, doing physical examinations, handling clinic visits, and education. Licensed practical and registered nurses handled pre-transplant referral management and phone triage duties. Social workers, administrative assistants, and data managers were responsible for social support, medical record management, and regulatory documentation, respectively. Most respondents (57%) found current staffing to be inadequate in their centers and suggested areas for improvement.

Conclusion: APNs play a vital role in management of transplant patients. Transplant centers use APNs in different capacities, depending on the individual needs of the institution. Across institutions, support staff is crucial in the perception of adequate staffing. Additional research is needed to determine the most efficient use of APNs in transplant centers.
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http://dx.doi.org/10.7182/prtr.21.4.dj5270173k020772DOI Listing
December 2011

Progress in transplantation.

Prog Transplant 2011 Dec;21(4):273

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http://dx.doi.org/10.7182/prtr.21.4.b114650660326238DOI Listing
December 2011