Publications by authors named "Rita H Pickler"

98 Publications

Editor's Response to Letter to the Editor From Drs. Draughon Moret, Anderson, Burton, and Williams (NRES 20-00374).

Authors:
Rita H Pickler

Nurs Res 2021 Mar-Apr 01;70(2):84

Rita H. Pickler, PhD, RN, FAAN, is Editor, Nursing Research.

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http://dx.doi.org/10.1097/NNR.0000000000000491DOI Listing
March 2021

Innovative Lessons Learned From COVID-19.

Authors:
Rita H Pickler

Nurs Res 2021 Mar-Apr 01;70(2):81-82

Rita H. Pickler, PhD, RN, FAAN, is The FloAnn Sours Easton Professor of Child and Adolescent Health and Director, PhD & MS in Nursing Science Programs, The Ohio State University College of Nursing, Columbus.

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http://dx.doi.org/10.1097/NNR.0000000000000497DOI Listing
March 2021

Truth and Science.

Authors:
Rita H Pickler

Nurs Res 2021 Jan/Feb;70(1):1-2

Rita H. Pickler, PhD, RN, FAAN, is Editor of Nursing Research, and the Director of the PhD and MS in Nursing Science Programs, The Ohio State University College of Nursing, Columbus.

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http://dx.doi.org/10.1097/NNR.0000000000000481DOI Listing
February 2021

Prediction of Cognitive Ability With Social Determinants in Children of Low Birth Weight.

Nurs Res 2020 Nov/Dec;69(6):427-435

Lisa M. Blair, PhD, RNC-NIC, is Postdoctoral Scholar, Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington. Jodi L. Ford, PhD, RN, is Associate Professor, The Ohio State University College of Nursing, Columbus. P. Cristian Gugiu, PhD, was Assistant Professor, The Ohio State University College of Education and Human Ecology, Columbus, at the time of the study completion and is now in private practice. Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Endowed Professor of Child and Adolescent Health and Director of PhD and MS in Nursing Science Programs, The Ohio State University College of Nursing, Columbus. Cindy Munro, PhD, ANP-BC, FAAN, FAANP, FAAAS, is Dean and Professor, University of Miami School of Nursing and Health Studies, Coral Gables. Cindy M. Anderson, PhD, APRN-CNP, ANEF, FAHA, FNAP, FAAN, is Senior Associate Dean for Academic Affairs and Educational Innovation and Professor, The Ohio State University College of Nursing, Columbus.

Background: Despite strong prevention efforts and advances in neonatal care in recent decades, low birth weight remains a serious public health problem in the United States, and survivors remain at increased risk for lifelong problems including cognitive deficits. Current regional and local strategies for referral often rely on variable thresholds for birth weight and gestational age that may be poor analogues to cognitive risk. Improving early referral criteria offers many benefits, including improved cognitive outcomes for children and improved cost-effectiveness and resource utilization in resource-limited communities.

Objectives: We hypothesized that social determinants measurable at birth or at birth hospital discharge, when combined with birth weight and gestational age, would offer an improvement over birth weight and gestational age alone in predicting cognitive test scores in school-aged children with low birth weight.

Methods: We conducted a secondary analysis using a birth cohort of children from the Fragile Families and Child Wellbeing Study. We created a panel of maternal, familial, and community-level social determinant indicators from the data and examined associations with cognitive measures assessed at age of 9 years.

Results: The final social determinant model was statistically significant and explained 35% of the total variance in composite test scores. The "standard care" model (birth weight and gestational age) only explained 9% of the variance.

Discussion: Assessment of social determinants may offer improvement over traditional referral criteria to identify children most at risk of cognitive deficits after low birth weight.
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http://dx.doi.org/10.1097/NNR.0000000000000438DOI Listing
February 2021

The Year That Wasn't.

Authors:
Rita H Pickler

Nurs Res 2020 Nov/Dec;69(6):413

Rita H. Pickler, PhD, RN, FAAN, is Editor of Nursing Research, and The FloAnn Sours Easton Professor of Child and Adolescent Health and Director, PhD & MS in Nursing Science Programs, The Ohio State University College of Nursing, Columbus.

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http://dx.doi.org/10.1097/NNR.0000000000000467DOI Listing
February 2021

Hair sampling for cortisol analysis with mother-toddler dyads living in low-income homes.

Infant Behav Dev 2020 11 14;61:101499. Epub 2020 Oct 14.

The Crane Center for Early Childhood Research and Policy, College of Education and Human Ecology, The Ohio State University, 175 East 7th Ave, Columbus, OH 43201, United States.

Background: A first step to advance stress science research in young children is understanding the relationship between chronic stress in a mother and chronic stress in her child. One non-invasive measure of chronic stress is hair cortisol. However, little is known about strategies for hair sampling in mother-toddler dyads living in low-income homes in the U.S. To address prior limitations, the purpose of this study was to understand the feasibility of sampling hair for cortisol analysis in mother-toddler dyads living in low-income homes in the U.S. We examined feasibility related to participation, eligibility, and gathering an adequate hair sample weight.

Methods: We approached 142 low-income, racially diverse, urban-dwelling mothers who were participating in an ongoing longitudinal birth cohort study for informed consent to cut approximately 150 hairs from the posterior vertex of their scalp and their toddlers' (20-24 months) scalp. We demonstrated the process of sampling hair with a hairstyling doll during home visits to the mother and toddler using rounded-end thinning shears.

Results: Overall, 94 of 142 mother-toddler dyads (66 %) participated in hair sampling. The most common reason for participation refusal was related to hairstyle. All but three hair samples were of adequate weight for cortisol extraction.

Discussion: The findings from this study can help researchers address sampling feasibility concerns in hair for cortisol analysis research in mother-toddler dyads living in low-income homes in the U.S.
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http://dx.doi.org/10.1016/j.infbeh.2020.101499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7736194PMC
November 2020

Prevalence of ICU Delirium in Postoperative Pediatric Cardiac Surgery Patients.

Pediatr Crit Care Med 2021 Jan;22(1):68-78

University of California San Francisco, School of Nursing, San Francisco, CA.

Objectives: The objective of this study was to determine the prevalence of ICU delirium in children less than 18 years old that underwent cardiac surgery within the last 30 days. The secondary aim of the study was to identify risk factors associated with ICU delirium in postoperative pediatric cardiac surgical patients.

Design: A 1-day, multicenter point-prevalence study of delirium in pediatric postoperative cardiac surgery patients.

Setting: Twenty-seven pediatric cardiac and general critical care units caring for postoperative pediatric cardiac surgery patients in North America.

Patients: All children less than 18 years old hospitalized in the cardiac critical care units at 06:00 on a randomly selected, study day.

Interventions: Eligible children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the study team in collaboration with the bedside nurse.

Measurement And Main Results: Overall, 181 patients were enrolled and 40% (n = 73) screened positive for delirium. There were no statistically significant differences in patient demographic information, severity of defect or surgical procedure, past medical history, or postoperative day between patients screening positive or negative for delirium. Our bivariate analysis found those patients screening positive had a longer duration of mechanical ventilation (12.8 vs 5.1 d; p = 0.02); required more vasoactive support (55% vs 26%; p = 0.0009); and had a higher number of invasive catheters (4 vs 3 catheters; p = 0.001). Delirium-positive patients received more total opioid exposure (1.80 vs 0.36 mg/kg/d of morphine equivalents; p < 0.001), did not have an ambulation or physical therapy schedule (p = 0.02), had not been out of bed in the previous 24 hours (p < 0.0002), and parents were not at the bedside at time of data collection (p = 0.008). In the mixed-effects logistic regression analysis of modifiable risk factors, the following variables were associated with a positive delirium screen: 1) pain score, per point increase (odds ratio, 1.3; 1.06-1.60); 2) total opioid exposure, per mg/kg/d increase (odds ratio, 1.35; 1.06-1.73); 3) SBS less than 0 (odds ratio, 4.01; 1.21-13.27); 4) pain medication or sedative administered in the previous 4 hours (odds ratio, 3.49; 1.32-9.28); 5) no progressive physical therapy or ambulation schedule in their medical record (odds ratio, 4.40; 1.41-13.68); and 6) parents not at bedside at time of data collection (odds ratio, 2.31; 1.01-5.31).

Conclusions: We found delirium to be a common problem after cardiac surgery with several important modifiable risk factors.
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http://dx.doi.org/10.1097/PCC.0000000000002591DOI Listing
January 2021

Why We Care.

Nurs Res 2020 Sep/Oct;69(5S Suppl 1):S1-S2

Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, Martha S. Pitzer Center for Women, Children, and Youth, The Ohio State University College of Nursing, Columbus. Christine A. Fortney, PhD, RN, is Assistant Professor, Martha S. Pitzer Center for Women, Children, and Youth, The Ohio State University College of Nursing, Columbus. Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Endowed Professor of Child and Adolescent Health, Martha S. Pitzer Center for Women, Children, and Youth, The Ohio State University College of Nursing, Columbus.

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http://dx.doi.org/10.1097/NNR.0000000000000451DOI Listing
February 2021

Pandemic Science.

Authors:
Rita H Pickler

Nurs Res 2020 Sep/Oct;69(5):329-330

Rita H. Pickler, PhD, RN, FAAN, is Editor of Nursing Research and the FloAnn Sours Easton Professor of Child and Adolescent Health and Director, PhD and MS in Nursing Science Programs, The Ohio State University College of Nursing, Columbus.

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http://dx.doi.org/10.1097/NNR.0000000000000458DOI Listing
December 2020

Losing touch.

Nurs Inq 2020 07;27(3):e12368

The Ohio State University College of Nursing, Columbus, OH, USA.

The need for human touch is universal among critical care patients and is an important component of the nurse-patient relationship. However, multiple barriers to human touch exist in the critical care environment. With little research to guide practice, we argue for the importance of human touch in the provision of holistic nursing care.
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http://dx.doi.org/10.1111/nin.12368DOI Listing
July 2020

Measures of Stress Exposure for Hospitalized Preterm Infants.

Nurs Res 2020 Sep/Oct;69(5S Suppl 1):S3-S10

Marliese Dion Nist, PhD, RNC-NIC, is Postdoctoral Scholar, The Ohio State University College of Nursing, Columbus. Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, The Ohio State University College of Nursing, Columbus. Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Endowed Professor of Child and Adolescent Health, The Ohio State University College of Nursing, Columbus. Abigail B. Shoben, PhD, is Associate Professor, Division of Biostatistics, The Ohio State University College of Public Health, Columbus.

Background: Extended hospitalization in neonatal intensive care units subjects preterm infants to multiple stress exposures that affect long-term cognitive functioning, motor development, and stress reactivity. Measurement of stress exposure is challenging with multiple measures of stress exposure in use, including counts of skin-breaking or invasive procedures or counts of noxious sensory exposures.

Objectives: The purpose of this analysis was to compare measures of stress exposure commonly used by researchers and to determine the predictive validity of these measures for early neurobehavior. We accomplished this objective through the following specific aims: (a) describe the stress exposures of preterm infants in the first 2 weeks of life, (b) determine the correlations among measures of stress exposure, and (c) compare the predictive validity of measures of stress exposure for early neurobehavior.

Methods: Very preterm infants born between 28 and 31 weeks postmenstrual age were enrolled from four neonatal intensive care units in a large Midwest city. We measured stress exposure over the first 14 days of life for each infant as a count of skin-breaking procedures, a count of invasive procedures, and cumulative scores derived from the Neonatal Infant Stressor Scale. Neurobehavior was assessed at 35 weeks postmenstrual age using the motor development and vigor and alertness/orientation subscales from the Neurobehavioral Assessment of the Preterm Infant. We used Spearman's rho to determine correlations among the measures of stress exposure and multiple linear regression to determine the predictive validity of each stress exposure measure for neurobehavioral outcomes.

Results: Seventy-one preterm infants were included in the analysis. We found marked variance across individuals in all measures of stress exposure. There were moderate-high correlations among the measures of stress exposure. No measure of stress exposure was associated with early neurobehavior.

Discussion: The stress experiences of hospitalized preterm infants vary. This variance is reflected in all measures of stress exposure. Because measures of stress exposure are highly correlated, the most objective measure requiring the least interpretation should be used. However, the currently available measures of stress exposure used in this analysis may not reflect the infant's physiological stress responses and fail to associate with early neurobehavior.
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http://dx.doi.org/10.1097/NNR.0000000000000444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483888PMC
February 2021

Back to Science.

Authors:
Rita H Pickler

Nurs Res 2020 Jul/Aug;69(4):251

Rita H. Pickler, PhD, RN, FAAN, is Editor of Nursing Research and The FloAnn Sours Easton Professor of Child and Adolescent Health and Director, PhD & MS in Nursing Science Programs, The Ohio State University College of Nursing, Columbus.

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http://dx.doi.org/10.1097/NNR.0000000000000439DOI Listing
November 2020

Behavioral Observation of Infants With Life-Threatening or Life-Limiting Illness in the Neonatal Intensive Care Unit.

Nurs Res 2020 Sep/Oct;69(5S Suppl 1):S29-S35

Christine A. Fortney, PhD, RN, is Assistant Professor, Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University College of Nursing, Columbus. Stephanie Sealschott, MS, RN, is Doctoral Candidate, The Ohio State University College of Nursing, Columbus. Rita Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Professor of Child and Adolescent Health, The Ohio State University College of Nursing, Columbus.

Background: Infants in the neonatal intensive care unit experience aversive stimuli that cause pain and distress. Maintaining adequate relief from pain and distress is challenging because of infants' varying ages and stages of development and their nonverbal status. Thus, pain and distress must be interpreted by a healthcare provider or other proxy from their own observations or perceptions. There is no standard research or clinical measure for pain and distress in infants.

Objective: The purpose of this analysis was to evaluate the use of the COMFORT Behavior (COMFORT-B) Scale as a measure of pain and distress in infants diagnosed with life-threatening or life-limiting illnesses in the neonatal intensive care unit in comparison with the nurse-documented Neonatal Pain, Agitation and Sedation Scale; the infants' Technology Dependence Scale; and the mothers' report of total perceived symptom scores.

Methods: Infants diagnosed with life-threatening or life-limiting illnesses and hospitalized in a Level IV neonatal intensive care unit in the Midwestern United States and their parents were included. Measurement of pain and distress in infants was collected weekly from enrollment through 12 weeks or until discharge, whichever occurred first. Observations for the COMFORT-B Scale were conducted before and after standard caregiving activities. Pearson r correlations were used to compare means between pain and distress, technology dependence, and mothers' total perceived symptom scores over time.

Results: Data from 78 infants (46 male and 32 female infants) of ages 23-41 weeks of gestation at birth were analyzed. No correlations were found among the COMFORT-B Scale; the Neonatal Pain, Agitation and Sedation Scale; and mothers' total perceived symptom scores. Moderate correlations were found among the Technology Dependence Scale; mothers' total perceived symptom scores; and the Neonatal Pain, Agitation and Sedation Scale.

Discussion: Performing COMFORT-B observations can be challenging, and it is unclear whether the information obtained from the COMFORT-B Scale added to the assessment of the infant's pain and distress that is typically recorded in the health record or from parents. Further evaluation is needed to determine if it is more reliable to collect the Neonatal Pain, Agitation and Sedation Scale scores rather than conduct observations using the COMFORT-B Scale in studies of infants with life-threatening and life-limiting illnesses in the neonatal intensive care unit.
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http://dx.doi.org/10.1097/NNR.0000000000000456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709877PMC
February 2021

Effect of Tactile Experience During Preterm Infant Feeding on Clinical Outcomes.

Nurs Res 2020 Sep/Oct;69(5S Suppl 1):S21-S28

Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Professor of Child and Adolescent Health, College of Nursing, The Ohio State University, Columbus. Jareen Meinzen-Derr, PhD, MPH, is Professor, Department of Pediatrics, University of Cincinnati College of Medicine, and Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Ohio. Margo Moore, MS, RN, is Research Nurse III, Division of Infectious Disease, Cincinnati Children's Hospital Medical Center, Ohio. Stephanie Sealschott, MS, RN, is PhD Candidate, College of Nursing, The Ohio State University, Columbus. Karin Tepe, BS, RN, is Research Nurse in Neonatology, Cincinnati Children's Hospital Medical Center, Ohio.

Background: Although the survival rate of very preterm infants has improved, rates of subsequent neurobehavioral disabilities remain high. One factor implicated in poor neurobehavioral and developmental outcomes is hospitalization and inconsistent caregiving patterns in the neonatal intensive care unit. Although much underlying brain damage occurs in utero or shortly after birth, neuroprotective strategies may stop progression of damage, particularly when these strategies are used during the most sensitive periods of neural plasticity 2-3 months before term age.

Objective: The purpose of this analysis was to test the effect of a patterned feeding experience involving a tactile component (touch and/or holding) provided during feedings on preterm infants' clinical outcomes, measured by oral feeding progress, as an early indicator of neurodevelopment.

Methods: We used an experimental, longitudinal, two-group random assignment design. Preterm infants (n = 120) were enrolled within the first week of life and randomized to an experimental group receiving a patterned feeding experience or to a control group receiving usual feeding care.

Results: Analysis of data from 91 infants showed that infants receiving touch at more than 25% of early gavage feedings achieved full oral feeding more quickly; as touch exposure increased, time from first oral to full oral feeding decreased. There was no association between holding during early gavage feedings or touch during transition feedings and time to full oral feeding.

Discussion: Neurological expectation during critical periods of development is important for infants. However, a preterm infant's environment is not predictable: Caregivers change regularly, medical procedures dictate touch and holding, and care provision based on infant cues is limited. Current knowledge supports caregiving that occurs with a naturally occurring sensation (i.e., hunger), is provided in a manner that is congruent with the expectation of the neurological system, and occurs with enough regularity to enhance neuronal and synaptic development. In this study, we modeled an experience infants would "expect" if they were not in the neonatal intensive care unit and demonstrated a shorter time from first oral feeding to full oral feeding, an important clinical outcome with neurodevelopmental implications. We recommend further research to determine the effect of patterned caregiving experiences on other areas of neurodevelopment, particularly those that may occur later in life.
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http://dx.doi.org/10.1097/NNR.0000000000000453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483367PMC
February 2021

Integrative Review of Gut Microbiota and Expression of Symptoms Associated With Neonatal Abstinence Syndrome.

Nurs Res 2020 Sep/Oct;69(5S Suppl 1):S66-S78

Stephanie D. Sealschott, MS, RN, is PhD Candidate, College of Nursing, The Ohio State University, Columbus. Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Professor of Child and Adolescent Health, College of Nursing, The Ohio State University, Columbus. Christine A. Fortney, PhD, RN, is Assistant Professor, College of Nursing, The Ohio State University, Columbus. Michael T. Bailey, PhD, is Associate Professor of Pediatrics, The Ohio State University, and Principle Investigator, Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.

Background: Neonatal exposure and subsequent withdrawal from maternal substance use disorder are a growing problem and consequence of the current opioid epidemic. Neonatal abstinence syndrome (NAS) is defined by a specified cluster of symptoms with treatment guided by the expression and severity of these symptoms. The mechanisms or pathophysiology contributing to the development of NAS symptoms are not well known, but one factor that may influence NAS symptoms is the gut microbiota.

Objectives: The purpose of this integrative review was to examine evidence that might show if and how the gut microbiota influence expression and severity of symptoms similar to those seen in NAS.

Methods: Using published guidelines, a review of research studies that focused on the gut microbiome and symptoms similar to those seen in NAS was conducted, using the Cochrane, EMBASE, and Scopus databases, from 2009 through 2019.

Results: The review results included findings of aberrant microbial diversity, differences in microbial communities between study groups, and associations between specific taxa and symptoms. In studies involving interventions, there were reports of improved microbial diversity, community structure, and symptoms.

Discussion: The review findings provide evidence that the gut microbiota may play a role in modifying variability in the expression and severity of symptoms associated with NAS. Future research should focus on examining the gut microbiota in infants with and without the syndrome as well as exploring the relationship between symptom expression and aberrant gut microbiota colonization in infants with NAS.
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http://dx.doi.org/10.1097/NNR.0000000000000452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483611PMC
February 2021

Early Inflammatory Measures and Neurodevelopmental Outcomes in Preterm Infants.

Nurs Res 2020 Sep/Oct;69(5S Suppl 1):S11-S20

Marliese Dion Nist, PhD, RNC-NIC, is Postdoctoral Scholar, The Ohio State University College of Nursing, Columbus. Abigail B. Shoben, PhD, is Associate Professor, Division of Biostatistics, The Ohio State University College of Public Health, Columbus. Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Endowed Professor of Child and Adolescent Health, The Ohio State University College of Nursing, Columbus.

Background: Inflammation may be an important predictor of long-term neurodevelopment in preterm infants. The identification of specific inflammatory biomarkers that predict outcomes is an important research goal.

Objectives: The purpose of this analysis was to identify associations between an early measure of inflammation and neurodevelopment in very preterm infants and to identify differences in the relationship between inflammation and neurodevelopment based on infant gender and race.

Methods: We conducted a secondary analysis of data from a randomized controlled trial of a caregiving intervention for preterm infants born less than 33 weeks postmenstrual age. Plasma was collected with a clinically indicated laboratory draw by neonatal intensive care unit nurses and analyzed by multiplex assay for cytokines, chemokines, and growth factors. Neurobehavior was assessed by research nurses at the time of discharge from the neonatal intensive care unit using the motor development and vigor and alertness/orientation clusters from the Neurobehavioral Assessment of the Preterm Infant. Neurodevelopment was assessed at 6 months corrected age by the developmental specialist in the hospital's neonatal follow-up clinic using the Bayley Scales of Infant Development, Third Edition. We used linear regressions to estimate the effect of cytokine levels on neurodevelopment and allowed the effects to differ by infant gender and race.

Results: In a sample of 62 preterm infants with discharge neurobehavioral assessments and a sample of 40 preterm infants with 6-month neurodevelopmental assessments, we found inconsistent associations between single-time point inflammatory measures and neurobehavior or neurodevelopment in analyses of the total sample. However, regressions with interactions revealed effects for multiple inflammatory measures on early neurobehavior and neurodevelopment that differed by infant gender and race.

Discussion: Although early single-time point measures of inflammation may be insufficient to predict neurodevelopment for all preterm infants, the effect of inflammation appears to differ by infant gender and race. These demographic factors may be important considerations for future studies of inflammation and neurodevelopment as well was the development of future interventions to optimize outcomes.
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http://dx.doi.org/10.1097/NNR.0000000000000448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584341PMC
February 2021

Inflammatory predictors of neurobehavior in very preterm infants.

Early Hum Dev 2020 08 22;147:105078. Epub 2020 May 22.

The Ohio State University, College of Public Health, Division of Biostatistics, 1841 Neil Avenue, Columbus, OH 43210, USA. Electronic address:

Background: Preterm infants are at risk for impaired neurodevelopment. Inflammation may be an important modifiable mediator of preterm birth and neurodevelopmental impairment, but few studies have examined longitudinal measures of inflammation.

Objective: To determine the relationship between longitudinal measures of inflammation and neurobehavior in very preterm infants.

Study Design: Non-experimental, repeated measures cohort study.

Methods: Very preterm infants were enrolled between October 2017 and December 2018. Blood was collected weekly until 35 weeks post-menstrual age for the quantification of plasma cytokines. Neurobehavior was assessed at 35 weeks post-menstrual age using the cluster scores for motor development and vigor and alertness/orientation from the Neurobehavioral Assessment of the Preterm Infant. Multiple linear regression models with robust standard errors were used to analyze the data. Average levels of individual cytokines, cytokine trends, and composite scores were used as measures of inflammation.

Results: Seventy-three infants were enrolled in the study. Interleukin-1 receptor antagonist was associated with motor development and vigor scores. Interleukin-6 was associated with alertness/orientation scores. Tumor necrosis factor-alpha and composite scores of inflammation were associated with motor development and vigor and alertness/orientation scores. There were interactions with post-menstrual age at birth and infant sex.

Conclusion: Inflammation may be an important predictor of short-term neurobehavior in preterm infants. Interleukin-1 receptor antagonist, interleukin-6, and tumor necrosis factor-alpha are key cytokines for studies of preterm infants, but composite scores may be a better measure of inflammation than individual cytokines. Inflammation can be damaging to the immature brain and may be a specific target for future interventions to improve outcomes.
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http://dx.doi.org/10.1016/j.earlhumdev.2020.105078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363528PMC
August 2020

Happy Birthday, Florence Nightingale.

Authors:
Rita H Pickler

Nurs Res 2020 May/Jun;69(3):165-166

Rita H. Pickler, PhD, RN, FAAN, is Editor of Nursing Research and The FloAnn Sours Easton Professor of Child and Adolescent Health Director, PhD Program and MS in Nursing Science Program, The Ohio State University College of Nursing, Columbus.

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http://dx.doi.org/10.1097/NNR.0000000000000431DOI Listing
August 2020

Protocol to Measure Hair Cortisol in Low Mass Samples From Very Preterm Infants.

Nurs Res 2020 Jul/Aug;69(4):316-321

Marliese Dion Nist, PhD, RNC-NIC, is PhD Presidential Postdoctoral Scholar, The Ohio State University College of Nursing, Columbus. Brent A. Sullenbarger, MA, is Research Lab Manager, The Ohio State University College of Nursing, Columbus. Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, The Ohio State University College of Nursing, Columbus. Rita H. Pickler, PhD, RN, FAAN, is the FloAnn Sours Easton Endowed Professor of Child and Adolescent Health and Director of the PhD and MS in Nursing Science Programs, The Ohio State University College of Nursing, Columbus.

Background: Hair cortisol is a measure of chronic or repeated hypothalamic-pituitary-adrenal axis activation in response to physical or psychological stressors. Hair cortisol has been successfully used as a measure of chronic stress in adults and children; however, its use as a valid measure in preterm infants has been limited by challenges in measuring cortisol in the low mass samples collectable from these infants.

Objectives: The purpose of this report is to present a novel protocol for the measurement of hair cortisol in very low mass hair samples.

Methods: Small changes were made to previously published protocols. After washing and pulverizing the hair samples, a double methanol cortisol extraction was performed. Samples were spiked with a known quantity of cortisol and analyzed in duplicate using an enzyme-linked immunosorbent assay.

Results: Hair cortisol was detectable in samples weighing between 0.4 and 10.9 mg. The mean cortisol level was 23.74 pg/mg hair (SD = 26.38).

Discussion: With small changes to previously published laboratory protocols, cortisol is quantifiable in low mass hair samples from preterm infants. This technical advance is an important step toward quantifying the stress experiences of hospitalized preterm infants.
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http://dx.doi.org/10.1097/NNR.0000000000000436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610218PMC
November 2020

Opioid use disorder research and the Council for the Advancement of Nursing Science priority areas.

Nurs Outlook 2020 Jul - Aug;68(4):406-416. Epub 2020 Apr 9.

Yale School of Nursing, Orange, CT.

Background: Chronic diseases, such as opioid use disorder (OUD) require a multifaceted scientific approach to address their evolving complexity. The Council for the Advancement of Nursing Science's (Council) four nursing science priority areas (precision health; global health, determinants of health, and big data/data analytics) were established to provide a framework to address current complex health problems.

Purpose: To examine OUD research through the nursing science priority areas and evaluate the appropriateness of the priority areas as a framework for research on complex health conditions.

Method: OUD was used as an exemplar to explore the relevance of the nursing science priorities for future research.

Findings: Research in the four priority areas is advancing knowledge in OUD identification, prevention, and treatment. Intersection of OUD research population focus and methodological approach was identified among the priority areas.

Discussion: The Council priorities provide a relevant framework for nurse scientists to address complex health problems like OUD.
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http://dx.doi.org/10.1016/j.outlook.2020.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484386PMC
November 2020

Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period.

J Adv Nurs 2020 Jun 30;76(6):1394-1403. Epub 2020 Mar 30.

The Ohio State University, Colombus, Ohio, USA.

Aim: To describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge.

Design: Analysis of nursing documentation generated as part of a randomized controlled trial evaluating the effect of a nurse home visit on healthcare re-use.

Methods: We analysed home visit records of 651 children (age <18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial. Registered nurses documented concerns in structured fields and free-text notes in visit records. Descriptive statistics were used to summarize visit documentation. Free-text visit notes were reviewed and exemplars illustrative of quantitative findings were selected.

Results: Overall, nurses documented at least one concern in 56% (N = 367) of visits. Most commonly, they documented concerns about medication safety (15% or 91 visits). Specifically, in 11% (N = 58) of visits nurses were concerned that caregivers lacked a full understanding of medications and in 8% (N = 49) of visits families did not have prescribed discharge medications. Pain was documented as present in 9% of all visits (N = 56). Nurses completed referrals to other providers/services in 12% of visits (N = 78), most frequently to primary care providers. In 13% of visits (N = 85) nurses documented concerns considered beyond the immediate scope of the visit related to social needs such as housing and transportation.

Conclusion: Inpatient and community nurses and physicians should be prepared to reconcile and manage discharge medications, assess families' medication administration practices and anticipate social needs after paediatric discharge.

Impact: Little empirical data are available describing concerns manifesting immediately after paediatric hospital discharge. Concerns about medication safety were most frequent followed by concerns related to housing and general safety. The results are important for clinicians preparing children and families for discharge and for community clinicians caring for discharged children.
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http://dx.doi.org/10.1111/jan.14341DOI Listing
June 2020

Advances and Challenges in Symptom Science.

Authors:
Rita H Pickler

Nurs Res 2020 Mar/Apr;69(2):89-90

Rita H. Pickler, PhD, RN, FAAN, is Editor of Nursing Research.

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http://dx.doi.org/10.1097/NNR.0000000000000416DOI Listing
April 2020

Year of the Nurse: Take the Challenge.

Authors:
Rita H Pickler

Nurs Res 2020 Jan/Feb;69(1):1-2

Rita H. Pickler, PhD, RN, FAAN, is Editor of Nursing Research.

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http://dx.doi.org/10.1097/NNR.0000000000000394DOI Listing
April 2020

The Problem With p and Statistical Significance.

Authors:
Rita H Pickler

Nurs Res 2019 Nov/Dec;68(6):421-422

Rita H. Pickler, PhD, RN, FAAN, is Editor of Nursing Research.

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http://dx.doi.org/10.1097/NNR.0000000000000391DOI Listing
November 2019

Publishing Preprints.

Authors:
Rita H Pickler

Nurs Res 2019 Sep/Oct;68(5):337-338

Rita H. Pickler, PhD, RN, FAAN, is Editor of Nursing Research.

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http://dx.doi.org/10.1097/NNR.0000000000000378DOI Listing
November 2019

Genetic Risk Factors for Poor Cognitive Development in Children With Low Birth Weight.

Biol Res Nurs 2020 01 13;22(1):5-12. Epub 2019 Aug 13.

College of Nursing, The Ohio State University, Columbus, OH, USA.

Low birth weight is an ongoing public health problem with severe consequences for those affected, including early morbidity and mortality and elevated risk for lifelong deficits in cognitive function. These deficits can be ameliorated by early intervention in many cases. To contribute to criteria for earlier identification of at-risk children prior to the onset of delays or deficits, we examined relationships between three gene candidates-, , and cognitive outcomes at school age in a secondary analysis of existing data from a nationally representative cohort. Single nucleotide polymorphism rs4074134, a variant of , and a rare insertion/deletion in the intron region of were significant predictors of cognitive performance. Our final model predicted 17% of the variance in composite cognitive test scores among children with low birth weight at school age ( = 96.36, < .001, = .17). Specifically, children homozygous for cytosine at rs4074134 scored .62 standard deviations higher on a measure of global cognition than children with one or more thymine. Similarly, children with an extra-long copy number variant of scored .88 standard deviations higher than children who had one or more short forms of the gene. These findings support the potential for an approach to identifying children with low birth weights who are most at need of early intervention services. Future research should focus on validation of these findings in an independent sample and confirmation of the biological mechanisms through which these genes influence cognitive development.
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http://dx.doi.org/10.1177/1099800419869507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068752PMC
January 2020

The future of pediatric nursing science.

Nurs Outlook 2020 Jan - Feb;68(1):73-82. Epub 2019 Jun 27.

Martha S. Pitzer Center for Women, Children, and Youth, The Ohio State University College of Nursing, Columbus, OH.

The provision of safe and effective nursing care to children is dependent upon pediatric nurse scientists creating knowledge that guides and directs day-to-day nursing practice. Current trends demonstrating steady decreases of pediatric nurses and inadequate numbers of PhD-prepared pediatric nurse scientists put the health of our children at risk. The purposes of this paper are to (1) summarize current health care demands in pediatrics, (2) present our concern that the number of pediatric nurse scientists is inadequate to generate foundational knowledge to guide pediatric nursing practice, (3) present our perspectives on factors influencing the number of pediatric nurse scientists, and (4) recommend specific actions for nursing leaders, nursing faculty, and professional nursing organizations to increase the depth and breadth of pediatric nursing science to meet current and future pediatric care needs.
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http://dx.doi.org/10.1016/j.outlook.2019.06.020DOI Listing
May 2020

Oxidative Stress Levels Throughout Pregnancy, at Birth, and in the Neonate.

Biol Res Nurs 2019 10 8;21(5):485-494. Epub 2019 Jul 8.

7 Department of Cellular and Integrative Physiology, College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE, USA.

Background: Oxidative stress is associated with poor perinatal outcomes. Little is known regarding the longitudinal levels of oxidative stress in the perinatal period or the correlation between maternal and neonatal oxidative stress levels.

Objective: Describe and compare oxidative stress, specifically superoxide, superoxide dismutase, catalase, and glutathione levels, over the perinatal period.

Study Design: Longitudinal descriptive design using a convenience sample of medically high- and low-risk pregnant women ( = 140) from a maternal-fetal medicine and general obstetrics practice, respectively. Blood was obtained from women at 12-20 and 24-28 weeks' gestation and during labor, from the umbilical cord at birth, and from neonates at 24-72 hr after birth. Levels of superoxide were measured using electron paramagnetic resonance (EPR) spectroscopy; antioxidants (superoxide dismutase, catalase, and glutathione) were measured using commercial assay kits. Relationships between oxidative stress levels at different time points were examined using nonparametric methods. Pregnancy outcome was collected.

Results: Demographic variables, outcome variables, and oxidative stress levels in maternal blood, cord blood, and infants differed between medically high- and low-risk women. Descriptive patterns for oxidative stress measures varied over time and between risk groups. Significant correlations between time points were noted, suggesting intraindividual consistency may exist throughout the perinatal period. However, these correlations were not consistent across each medical risk group.

Conclusion: EPR spectroscopy is a feasible method for the perinatal population. Results provide new information on perinatal circulating superoxide levels and warrant further investigation into potential relationships between prenatal and neonatal physiologic dysregulation of oxidative stress.
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http://dx.doi.org/10.1177/1099800419858670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854430PMC
October 2019