NINR Research Highlights

NINR-supported researchers explore and address some of the most important challenges affecting the health of the American people.

Here are highlights of recent research accomplishments from the community of NINR-supported scientists across the U.S.

Featured Highlight

High compliance with “central line bundle” preventive practices can decrease infection rates in the ICU

• Patients hospitalized in an intensive care unit (ICU) frequently need a central line – a special type of intravenous catheter surgically implanted into a major vein – for the delivery of fluids, nutrition, and medications.
• However, central lines are associated with a high risk of bloodstream infections (BSIs), which are very expensive to treat and can lead to disability or death. The Institute for Healthcare Improvement has promoted use of a “central line bundle” of clinical practices to reduce the incidence of BSIs associated with central lines.

• A survey of 415 ICUs in 250 hospitals across the U.S. found that about half had a written central line bundle policy in place. However, only 45% of these units monitored compliance with this policy. Of these, 38% reported a high (> 95%) compliance rate.
• Among the 312 ICUs that reported BSI rates, lower rates were achieved only for those that had a bundle policy in place, monitored compliance, and reported high compliance with at least one of the three central line bundle elements studied.
• The researchers estimate that an ICU moving from non-compliance to high compliance with at least one of these central line bundle elements could achieve a 38% reduction in BSIs. This result has the promise to reduce the risks associated with central lines, thereby lowering health care costs and improving health outcomes.

Featured Highlights Archive

Additional Highlights

• Individuals with human immunodeficiency virus (HIV) infection commonly report symptoms that include muscle aches, tingling or numbness to the hands or feet (neuropathy), and fatigue. Some medications used to treat HIV can also induce or exacerbate these symptoms.
• The presence of these symptoms can impair quality of life, and may decrease compliance to medication regimens.
• Researchers surveyed 240 HIV-positive patients at four times over a six-month period about their symptom experience. Most of the study participants were male, and almost three quarters were black. All were on HIV medications.
• From the survey responses, the researchers examined the relationships between the timing and occurrence of different symptoms.
• The findings suggested time-dependent relationships between the symptoms. Individuals who reported both muscles aches and neuropathy at one time point were more likely to report fatigue at a later time point. Similarly, those reporting fatigue at one time were more likely to later report muscle aches and neuropathy.
• These results indicate that HIV-positive individuals may experience the symptoms of muscle aches, neuropathy, and fatigue in a synergistic fashion, and suggest that timely intervention on one symptom could enhance the management of multiple symptoms over time.

• Postpartum depression (PPD) affects over one in ten mothers in the first year after delivery. Symptoms often include feelings of anxiety or guilt, decreased energy, sleep difficulties, and a sense of worthlessness. Some mothers may even have thoughts of hurting themselves or their baby.
• As the first phase of a larger maternal mental health intervention, a PPD screening program was tested with over 5,000 recently-delivered mothers (average age 32 years, 48% first-time mothers). Roughly four weeks after giving birth, the mothers responded to a standardized PPD questionnaire (the Edinburgh Postnatal Depression Scale), either over the phone or through the mail.
• Overall, 13% of the respondents had screening scores indicating a possible risk for PPD. Hispanic and Asian American women had the highest positive score rates (18% and 17%, respectively), while white women had the lowest (11%).
• Among mothers with a positive screening score, 39% agreed to partake in follow-up diagnostic interviews. Of these, 78% were diagnosed with either minor or major depression. Having a history of depression was an important risk factor for PPD.
• For every participant who had a moderate or higher screening score or indicated a risk of self-harm, a research nurse followed up to determine current mental health treatment status or encourage the mother to seek a further evaluation.
• These findings indicate that new mothers are receptive to PPD screening, and the freely accessible EPDS provides a simple and effective screening method. Consistent screening may lead to earlier identification and treatment of depressed mothers, with the promise of improving their mental health and emotional well-being.

• In the U.S., there are over 4 million households in which grandparents are living with grandchildren, often with the grandmother serving as the primary caregiver. Grandmothers involved in raising their grandchildren tend to experience a wide range of stresses, while transitions in caregiving status may disrupt caring relationships.
• Researchers surveyed 485 grandmothers at three times over a two year period to examine the patterns of caregiving and the effect of transitions on the caregiving role.
• Compared to grandmothers not directly involved in childcare, those raising their grandchildren reported higher stress and family strain and more depressive symptoms, along with poorer family functioning, support, sense of reward, and physical health.
• While most of the grandmothers remained in a stable caregiving role, 22% reported a transition over the course of the study with 70% having a decrease in responsibility, and 30% an increase. Those who increased their caregiving responsibility also experienced a worsening of strain, stress, family problems, and physical health.
• These findings indicate that grandmothers involved in child caregiving experience high levels of strain and a wide range of concerns about family functioning, and increases in caregiving responsibilities tend to exacerbate these stresses.

Additional Highlights Archive