Allen Prettyman - Academia.edu (original) (raw)

Papers by Allen Prettyman

Research paper thumbnail of Central hemodynamic responses to an acute sodium load in black and white subjects

The FASEB Journal, Mar 1, 2006

Research paper thumbnail of Muscle Sympathetic Nerve Activity During a Sodium and Volume Load

The FASEB Journal, Mar 1, 2006

Research paper thumbnail of Development of Professional Education Curriculum for Early Childhood Educators: Supporting Partnerships with Families

ProQuest LLC eBooks, 2011

Research paper thumbnail of Lack of association between body mass index and acute hypertonic saline induced increases in blood pressure

The FASEB Journal, Mar 1, 2006

Objective The association between body-mass index and ambulatory blood pressure variables is not ... more Objective The association between body-mass index and ambulatory blood pressure variables is not straightforward. Specifically, there are contradicting data regarding the correlation between obesity and white-coat hypertension. The aim of this report was to study the relationship between body-mass index and the white-coat effect, defined by ambulatory monitoring. Methods A retrospective analysis of a prospectively collected ambulatory blood pressure monitoring laboratory database was performed. We analyzed 3928 unselected ambulatory monitoring sessions of nontreated (n = 1654) and treated (n = 2274) patients, for statistical associations between body-mass index and blood pressure variables. Body-mass index was categorized according to National Institutes of Health classification or quartiles. Results Office and ambulatory blood pressure variables correlated with body-mass index in untreated patients. Unadjusted, the systolic white-coat effect did not differ by body-mass index category, whereas the diastolic effect was higher in obese patients. Adjustment for age, sex and office blood pressure revealed inverse associations of body-mass index category with the systolic white-coat effect, in both untreated and treated patients. When determined categorically, neither overweight/obese untreated or treated patients had increased prevalence of white-coat hypertension. Multivariate linear regression models confirmed the negative correlation between body-mass index and the systolic white-coat effect in untreated (b =-0.24, P < 0.0001) and treated (b =-0.14, P < 0.05) patients. Conclusion In patients referred for ambulatory blood pressure monitoring there was no association between body-mass index and white-coat hypertension. Blood Press Monit 12:95-99 c 2007 Lippincott Williams & Wilkins.

Research paper thumbnail of Implementation of an Integrative Holistic Healthcare Model for People Living with Parkinson’s Disease

Gerontologist, Jun 1, 2015

Center (NMHC) developed a novel PD Telehealth Clinic serving individuals with PD and their caregi... more Center (NMHC) developed a novel PD Telehealth Clinic serving individuals with PD and their caregivers throughout Delaware. Design and Methods: The PD clinic is based on a collaborative framework that uses synchronous videoconferencing telehealth technology to bring together out-of-state clinicians and scientists with expertise in PD to help deliver specialized care to PD patients and their caregivers. The team includes a movement disorder specialist, psychologists, nurse practitioners, researchers, physical and speech therapists, exercise physiologists, nutritionists, and graduate students. The PD Clinic delivery model seamlessly blends telehealth provider and onsite provider interactions, enabling the diagnosis, treatment, and ongoing management of PD. Results: In the first 6 months of the Parkinson's clinic opening, the nurse practitioners along with the movement disorder specialist evaluated 36 PD patients. Several patients have received recommendations to change their medication regimen by the movement disorder specialist. About 20 patients were referred to physical therapy, 7 to speech therapy, 9 to mental health services, 1 to occupational therapy, and 12 to local support groups. The location of the NMHC-PD clinic has reduced travel time and distance by as much as 1.5 hr or 80 miles, each way, and wait time for a new patient appointment is less than 3 months. Implications: The NMHC-PD Telehealth Clinic provides access to specialized multidisciplinary and advanced care and was successfully implemented. This model can be replicated in other nurse managed health centers across the United States.

Research paper thumbnail of Blood pressure and hemodynamic responses to an acute sodium load in humans

Journal of Applied Physiology, Oct 1, 2005

Research paper thumbnail of Sympathetic neural responses to increased osmolality in humans

American Journal of Physiology-heart and Circulatory Physiology, Nov 1, 2006

The purpose of this study was to examine the relationship between osmolality and efferent sympath... more The purpose of this study was to examine the relationship between osmolality and efferent sympathetic outflow in humans. We hypothesized that increased plasma osmolality would be associated with increases in directly measured sympathetic outflow. Muscle sympathetic outflow was successfully recorded in eight healthy subjects during a 60-min intravenous hypertonic saline infusion (HSI; 3% NaCl) on one day and during a 60-min intravenous isotonic saline (ISO) infusion (0.9% NaCl) on a different day. The HSI provides an osmotic and volume stimulus, whereas the ISO infusion provides a volume-only stimulus. Muscle sympathetic nerve activity was quantified using the technique of peroneal microneurography. Plasma osmolality increased during the HSI but not during the ISO infusion (ANOVA, P Ͻ 0.05). Sympathetic outflow differed between the trials (ANOVA, P Ͻ 0.05); during the HSI burst, frequency initially increased from 14.6 Ϯ 2.5 to 18.1 Ϯ 1.9 bursts/min; during the ISO infusion, burst frequency initially declined from 14.7 Ϯ 2.5 to 12.0 Ϯ 2.1 bursts/min. Plasma norepinephrine concentration was greater at the end of the HSI compared with the end of the ISO infusion (HSI: 297 Ϯ 64 vs. ISO: 202 Ϯ 49 pg/ml; ANOVA, P Ͻ 0.05). We conclude that HSI-induced increases in plasma osmolality are associated with increases in sympathetic activity in humans.

Research paper thumbnail of Adherence to outpatient program postoperative appointments after bariatric surgery

Surgery for Obesity and Related Diseases, Jul 1, 2008

Surgery is the only treatment that has been proved to have beneficial long-term effects for the m... more Surgery is the only treatment that has been proved to have beneficial long-term effects for the morbidly obese (body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;40 kg/m(2)). One of the requirements for the Centers for Excellence program instituted by American Society for Bariatric Surgery is to have a system in place to provide comprehensive follow-up care. A recent study showed that the complication rate after bariatric surgery is 39.6% during the 180 days after discharge. Inadequate adherence to follow-up care has been recognized as contributory to the development of complications after bariatric surgery. The purpose of this study was to examine the variables that relate to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; adherence to scheduled appointments after bariatric surgery. A block entry logistic regression analysis was done from a database of an outpatient bariatric program that contained cross-sectional data collected for 1 year. Patient adherence to follow-up was defined as having 1 postoperative follow-up appointment within 90 days of undergoing surgery. A total of 375 subjects completed the preoperative program and underwent either laparoscopic Roux-en-Y gastric bypass (84.3%) or gastric banding (15.7%). Of the 14 variables used in the analysis, 5 were statistically significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05) predictors of adherence: age, body mass index, marital status, employment status, and insurance coverage. Incorporation of the identified predictors into preoperative screening tools to flag patients at risk of nonadherence might improve follow-up care. Additional research is needed on possible interventions to decrease complications after bariatric surgery.

Research paper thumbnail of Preserved autonomic function in amenorrheic athletes

Journal of Applied Physiology, Aug 1, 2006

Reproductive hormones such as estradiol and progesterone are known to influence autonomic cardiov... more Reproductive hormones such as estradiol and progesterone are known to influence autonomic cardiovascular regulation. The purpose of this study was to determine whether amenorrheic athletes (AA) have impaired autonomic cardiovascular regulation compared with eumenorrheic athletes (EA). Thirty-five athletes were tested: 13 AA (19 Ϯ 1 yr), 13 EA (21 Ϯ 1 yr), and 9 EA (23 Ϯ 1 yr) on oral contraceptives (EA-OC). Multiple indexes of autonomic cardiovascular regulation were assessed: respiratory sinus arrhythmia (RSA), cardiovagal baroreflex sensitivity (BRS) via phase IV and phase II of the Valsalva maneuver, a spontaneous index of BRS, and the heart rate and blood pressure responses to orthostatic stress (20-min 60°head-up tilt). RSA was not different among the groups. There were no group differences in the spontaneous index of BRS (AA ϭ 30 Ϯ 6, EA ϭ 24 Ϯ 3, EA-OC ϭ 29 Ϯ 5 ms/mmHg) or in phase II (AA ϭ 8 Ϯ 2, EA ϭ 7 Ϯ 1, EA-OC ϭ 8 Ϯ 1 ms/mmHg) of the Valsalva. There was a difference in BRS during phase IV (AA ϭ 21 Ϯ 3, EA ϭ 15 Ϯ 1, EA-OC ϭ 26 Ϯ 6 ms/mmHg; ANOVA P ϭ 0.04). Tukey's post hoc test indicated that BRS was greater in the EA-OC group compared with the EA group (P ϭ 0.04). There were no differences in cardiovascular responses to orthostatic stress among the groups. In conclusion, AA do not display signs of impaired autonomic function and orthostatic responses compared with EA or EA-OC during the follicular phase of the menstrual cycle.

Research paper thumbnail of Influence of increased plasma osmolality on sympathetic outflow during apnea

American Journal of Physiology-regulatory Integrative and Comparative Physiology, Oct 1, 2010

Animal models have shown that peripheral chemoreceptors alter their firing patterns in response t... more Animal models have shown that peripheral chemoreceptors alter their firing patterns in response to changes in plasma osmolality, which, in turn, may modulate sympathetic outflow. The purpose of this study was to test the hypothesis that increases in plasma osmolality augment muscle sympathetic nerve activity (MSNA) responses to chemoreceptor activation. MSNA was recorded from the peroneal nerve (microneurography) during a 23-min intravenous hypertonic saline infusion (3% NaCl; HSI). Chemoreceptor activation was elicited by voluntary end-expiratory apnea. MSNA responses to end-expiratory apnea were calculated as the absolute increase from the preceding baseline period. Plasma osmolality significantly increased from pre-to post-HSI (284 Ϯ 1 to 290 Ϯ 1 mOsm/kg H 2O; P Ͻ 0.01). There was a significant overall effect of osmolality on sympathetic activity (P Ͻ 0.01). Duration of the voluntary end-expiratory apnea was not different after HSI (pre ϭ 40 Ϯ 5 s; post ϭ 41 Ϯ 4 s). MSNA responses to end-expiratory apnea were not different after HSI, expressed as an absolute change in burst frequency (n ϭ 11; pre ϭ 8 Ϯ 2; post ϭ 11 Ϯ 1 burst/min) and as a percent increase in total activity (pre ϭ 51 Ϯ 4% AU; post ϭ 53 Ϯ 4% AU). A second group of subjects (n ϭ 8) participated in 23-min volume/time-control intravenous isotonic saline infusions (0.9% NaCl). Isotonic saline volume-control infusions yielded no change in plasma osmolality or MSNA at rest. Furthermore, MSNA responses to apnea following isotonic saline infusion were not different. In summary, elevated plasma osmolality increased MSNA at rest and during apnea, but contrary to the hypothesis, MSNA responsiveness to apnea was not augmented. Therefore, this study does not support a neural interaction between plasma osmolality and chemoreceptor stimulation.

Research paper thumbnail of Baroreflex Control of Sympathetic Activity

Medicine and Science in Sports and Exercise, May 1, 2007

Research paper thumbnail of Autonomic Function in Amenorrheic Athletes

Medicine and Science in Sports and Exercise, May 1, 2005

Research paper thumbnail of Rural Telehealth Team Education for Baccalaureate and Nurse Practitioner Students

Journal of Nursing Education, May 1, 2020

Background: Rural areas face health care workforce shortages. Nursing students seeking rural empl... more Background: Rural areas face health care workforce shortages. Nursing students seeking rural employment require instruction and clinical experience in using telehealth to work in health care teams. Method: An innovative telehealth consultation simulation paired nurse practitioner (NP) students with prelicensure baccalaureate nursing degree (BSN) students. The simulation aimed to enhance NP student proficiency and confidence in telehealth consultation skills and to foster professional role development through exposure to telehealth nursing roles for RNs and NPs. On-campus BSN students assumed the role of the RN in a rural clinic and consulted with off-campus NP students using telehealth technology in the care of a standardized patient. Results: Participants demonstrated level-appropriate proficiency and reported confidence in telehealth consultation and favorable attitudes toward intraprofessional communication. Conclusion: An intraprofessional educational model allowing BSN and NP students to develop telehealth consultation skills successfully addressed a gap in preparing nursing students to meet rural health care workforce needs. [ J Nurs Educ . 2020;59(5):274–277.]

Research paper thumbnail of Bad Ad

American Journal of Nursing, Nov 1, 2001

Research paper thumbnail of Objective Structured Clinical Examination From Virtually Anywhere!

The Journal for Nurse Practitioners, Sep 1, 2018

The Objective Structured Clinical Examination (OSCE) is used in nurse practitioner (NP) education... more The Objective Structured Clinical Examination (OSCE) is used in nurse practitioner (NP) education programs to evaluate students' clinical competency. The OSCE was developed to be done with students on campus in a simulation laboratory, but for online NP programs, an on-campus environment is a barrier to the use of OSCEs. The virtual OSCE eliminates this barrier and provides an effective method of implementing OSCEs and evaluating student competencies in online NP education.

Research paper thumbnail of Utilizing Academic–Service Partnerships to Advance the Care of Veterans

The Journal for Nurse Practitioners, 2021

Abstract Challenges encountered in both advanced practice registered nursing (APRN) education and... more Abstract Challenges encountered in both advanced practice registered nursing (APRN) education and veteran health care include an aging workforce, limited resources, and faculty/staff shortages, which ultimately affect patient outcomes. Academic–service partnerships (ASP) address these challenges by increasing workforce capacity and engagement, promoting interprofessional collaboration and evidence-based practice, creating educational opportunities for nursing students to work with underserved populations, and offering a mechanism for recruitment and retention. This article outlines the systematic approach a large doctor of nursing practice (DNP) program in the southwestern United States used to develop and deploy an ASP program with 2 sizeable veteran-serving community partners.

Research paper thumbnail of Development of professional education curriculum for early childhood educators: Supporting partnerships with families

Research paper thumbnail of Implementation of an Integrative Holistic Healthcare Model for People Living with Parkinson’s Disease

The Gerontologist, 2015

Center (NMHC) developed a novel PD Telehealth Clinic serving individuals with PD and their caregi... more Center (NMHC) developed a novel PD Telehealth Clinic serving individuals with PD and their caregivers throughout Delaware. Design and Methods: The PD clinic is based on a collaborative framework that uses synchronous videoconferencing telehealth technology to bring together out-of-state clinicians and scientists with expertise in PD to help deliver specialized care to PD patients and their caregivers. The team includes a movement disorder specialist, psychologists, nurse practitioners, researchers, physical and speech therapists, exercise physiologists, nutritionists, and graduate students. The PD Clinic delivery model seamlessly blends telehealth provider and onsite provider interactions, enabling the diagnosis, treatment, and ongoing management of PD. Results: In the first 6 months of the Parkinson's clinic opening, the nurse practitioners along with the movement disorder specialist evaluated 36 PD patients. Several patients have received recommendations to change their medication regimen by the movement disorder specialist. About 20 patients were referred to physical therapy, 7 to speech therapy, 9 to mental health services, 1 to occupational therapy, and 12 to local support groups. The location of the NMHC-PD clinic has reduced travel time and distance by as much as 1.5 hr or 80 miles, each way, and wait time for a new patient appointment is less than 3 months. Implications: The NMHC-PD Telehealth Clinic provides access to specialized multidisciplinary and advanced care and was successfully implemented. This model can be replicated in other nurse managed health centers across the United States.

Research paper thumbnail of Should NP Student Programs Continue to Require a Set Number of Direct Clinical Hours?

The Journal for Nurse Practitioners, 2009

Allen Prettyman, MSN, FNP-BC, earned his BSN and MSN from Wilmington University. He is the progra... more Allen Prettyman, MSN, FNP-BC, earned his BSN and MSN from Wilmington University. He is the program coordinator for the nurse practitioner programs at the University of Delaware, where he has been full time faculty for 5 years. He is currently a doctoral student in the University of Delaware Human Development and Family Studies Department and his research focus is obesity. He maintains a part-time clinical practice in the Christiana Care Occupational Medicine Office.

Research paper thumbnail of Bad Ad

American Journal of Nursing, 2001

Research paper thumbnail of Central hemodynamic responses to an acute sodium load in black and white subjects

The FASEB Journal, Mar 1, 2006

Research paper thumbnail of Muscle Sympathetic Nerve Activity During a Sodium and Volume Load

The FASEB Journal, Mar 1, 2006

Research paper thumbnail of Development of Professional Education Curriculum for Early Childhood Educators: Supporting Partnerships with Families

ProQuest LLC eBooks, 2011

Research paper thumbnail of Lack of association between body mass index and acute hypertonic saline induced increases in blood pressure

The FASEB Journal, Mar 1, 2006

Objective The association between body-mass index and ambulatory blood pressure variables is not ... more Objective The association between body-mass index and ambulatory blood pressure variables is not straightforward. Specifically, there are contradicting data regarding the correlation between obesity and white-coat hypertension. The aim of this report was to study the relationship between body-mass index and the white-coat effect, defined by ambulatory monitoring. Methods A retrospective analysis of a prospectively collected ambulatory blood pressure monitoring laboratory database was performed. We analyzed 3928 unselected ambulatory monitoring sessions of nontreated (n = 1654) and treated (n = 2274) patients, for statistical associations between body-mass index and blood pressure variables. Body-mass index was categorized according to National Institutes of Health classification or quartiles. Results Office and ambulatory blood pressure variables correlated with body-mass index in untreated patients. Unadjusted, the systolic white-coat effect did not differ by body-mass index category, whereas the diastolic effect was higher in obese patients. Adjustment for age, sex and office blood pressure revealed inverse associations of body-mass index category with the systolic white-coat effect, in both untreated and treated patients. When determined categorically, neither overweight/obese untreated or treated patients had increased prevalence of white-coat hypertension. Multivariate linear regression models confirmed the negative correlation between body-mass index and the systolic white-coat effect in untreated (b =-0.24, P < 0.0001) and treated (b =-0.14, P < 0.05) patients. Conclusion In patients referred for ambulatory blood pressure monitoring there was no association between body-mass index and white-coat hypertension. Blood Press Monit 12:95-99 c 2007 Lippincott Williams & Wilkins.

Research paper thumbnail of Implementation of an Integrative Holistic Healthcare Model for People Living with Parkinson’s Disease

Gerontologist, Jun 1, 2015

Center (NMHC) developed a novel PD Telehealth Clinic serving individuals with PD and their caregi... more Center (NMHC) developed a novel PD Telehealth Clinic serving individuals with PD and their caregivers throughout Delaware. Design and Methods: The PD clinic is based on a collaborative framework that uses synchronous videoconferencing telehealth technology to bring together out-of-state clinicians and scientists with expertise in PD to help deliver specialized care to PD patients and their caregivers. The team includes a movement disorder specialist, psychologists, nurse practitioners, researchers, physical and speech therapists, exercise physiologists, nutritionists, and graduate students. The PD Clinic delivery model seamlessly blends telehealth provider and onsite provider interactions, enabling the diagnosis, treatment, and ongoing management of PD. Results: In the first 6 months of the Parkinson's clinic opening, the nurse practitioners along with the movement disorder specialist evaluated 36 PD patients. Several patients have received recommendations to change their medication regimen by the movement disorder specialist. About 20 patients were referred to physical therapy, 7 to speech therapy, 9 to mental health services, 1 to occupational therapy, and 12 to local support groups. The location of the NMHC-PD clinic has reduced travel time and distance by as much as 1.5 hr or 80 miles, each way, and wait time for a new patient appointment is less than 3 months. Implications: The NMHC-PD Telehealth Clinic provides access to specialized multidisciplinary and advanced care and was successfully implemented. This model can be replicated in other nurse managed health centers across the United States.

Research paper thumbnail of Blood pressure and hemodynamic responses to an acute sodium load in humans

Journal of Applied Physiology, Oct 1, 2005

Research paper thumbnail of Sympathetic neural responses to increased osmolality in humans

American Journal of Physiology-heart and Circulatory Physiology, Nov 1, 2006

The purpose of this study was to examine the relationship between osmolality and efferent sympath... more The purpose of this study was to examine the relationship between osmolality and efferent sympathetic outflow in humans. We hypothesized that increased plasma osmolality would be associated with increases in directly measured sympathetic outflow. Muscle sympathetic outflow was successfully recorded in eight healthy subjects during a 60-min intravenous hypertonic saline infusion (HSI; 3% NaCl) on one day and during a 60-min intravenous isotonic saline (ISO) infusion (0.9% NaCl) on a different day. The HSI provides an osmotic and volume stimulus, whereas the ISO infusion provides a volume-only stimulus. Muscle sympathetic nerve activity was quantified using the technique of peroneal microneurography. Plasma osmolality increased during the HSI but not during the ISO infusion (ANOVA, P Ͻ 0.05). Sympathetic outflow differed between the trials (ANOVA, P Ͻ 0.05); during the HSI burst, frequency initially increased from 14.6 Ϯ 2.5 to 18.1 Ϯ 1.9 bursts/min; during the ISO infusion, burst frequency initially declined from 14.7 Ϯ 2.5 to 12.0 Ϯ 2.1 bursts/min. Plasma norepinephrine concentration was greater at the end of the HSI compared with the end of the ISO infusion (HSI: 297 Ϯ 64 vs. ISO: 202 Ϯ 49 pg/ml; ANOVA, P Ͻ 0.05). We conclude that HSI-induced increases in plasma osmolality are associated with increases in sympathetic activity in humans.

Research paper thumbnail of Adherence to outpatient program postoperative appointments after bariatric surgery

Surgery for Obesity and Related Diseases, Jul 1, 2008

Surgery is the only treatment that has been proved to have beneficial long-term effects for the m... more Surgery is the only treatment that has been proved to have beneficial long-term effects for the morbidly obese (body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;40 kg/m(2)). One of the requirements for the Centers for Excellence program instituted by American Society for Bariatric Surgery is to have a system in place to provide comprehensive follow-up care. A recent study showed that the complication rate after bariatric surgery is 39.6% during the 180 days after discharge. Inadequate adherence to follow-up care has been recognized as contributory to the development of complications after bariatric surgery. The purpose of this study was to examine the variables that relate to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; adherence to scheduled appointments after bariatric surgery. A block entry logistic regression analysis was done from a database of an outpatient bariatric program that contained cross-sectional data collected for 1 year. Patient adherence to follow-up was defined as having 1 postoperative follow-up appointment within 90 days of undergoing surgery. A total of 375 subjects completed the preoperative program and underwent either laparoscopic Roux-en-Y gastric bypass (84.3%) or gastric banding (15.7%). Of the 14 variables used in the analysis, 5 were statistically significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05) predictors of adherence: age, body mass index, marital status, employment status, and insurance coverage. Incorporation of the identified predictors into preoperative screening tools to flag patients at risk of nonadherence might improve follow-up care. Additional research is needed on possible interventions to decrease complications after bariatric surgery.

Research paper thumbnail of Preserved autonomic function in amenorrheic athletes

Journal of Applied Physiology, Aug 1, 2006

Reproductive hormones such as estradiol and progesterone are known to influence autonomic cardiov... more Reproductive hormones such as estradiol and progesterone are known to influence autonomic cardiovascular regulation. The purpose of this study was to determine whether amenorrheic athletes (AA) have impaired autonomic cardiovascular regulation compared with eumenorrheic athletes (EA). Thirty-five athletes were tested: 13 AA (19 Ϯ 1 yr), 13 EA (21 Ϯ 1 yr), and 9 EA (23 Ϯ 1 yr) on oral contraceptives (EA-OC). Multiple indexes of autonomic cardiovascular regulation were assessed: respiratory sinus arrhythmia (RSA), cardiovagal baroreflex sensitivity (BRS) via phase IV and phase II of the Valsalva maneuver, a spontaneous index of BRS, and the heart rate and blood pressure responses to orthostatic stress (20-min 60°head-up tilt). RSA was not different among the groups. There were no group differences in the spontaneous index of BRS (AA ϭ 30 Ϯ 6, EA ϭ 24 Ϯ 3, EA-OC ϭ 29 Ϯ 5 ms/mmHg) or in phase II (AA ϭ 8 Ϯ 2, EA ϭ 7 Ϯ 1, EA-OC ϭ 8 Ϯ 1 ms/mmHg) of the Valsalva. There was a difference in BRS during phase IV (AA ϭ 21 Ϯ 3, EA ϭ 15 Ϯ 1, EA-OC ϭ 26 Ϯ 6 ms/mmHg; ANOVA P ϭ 0.04). Tukey's post hoc test indicated that BRS was greater in the EA-OC group compared with the EA group (P ϭ 0.04). There were no differences in cardiovascular responses to orthostatic stress among the groups. In conclusion, AA do not display signs of impaired autonomic function and orthostatic responses compared with EA or EA-OC during the follicular phase of the menstrual cycle.

Research paper thumbnail of Influence of increased plasma osmolality on sympathetic outflow during apnea

American Journal of Physiology-regulatory Integrative and Comparative Physiology, Oct 1, 2010

Animal models have shown that peripheral chemoreceptors alter their firing patterns in response t... more Animal models have shown that peripheral chemoreceptors alter their firing patterns in response to changes in plasma osmolality, which, in turn, may modulate sympathetic outflow. The purpose of this study was to test the hypothesis that increases in plasma osmolality augment muscle sympathetic nerve activity (MSNA) responses to chemoreceptor activation. MSNA was recorded from the peroneal nerve (microneurography) during a 23-min intravenous hypertonic saline infusion (3% NaCl; HSI). Chemoreceptor activation was elicited by voluntary end-expiratory apnea. MSNA responses to end-expiratory apnea were calculated as the absolute increase from the preceding baseline period. Plasma osmolality significantly increased from pre-to post-HSI (284 Ϯ 1 to 290 Ϯ 1 mOsm/kg H 2O; P Ͻ 0.01). There was a significant overall effect of osmolality on sympathetic activity (P Ͻ 0.01). Duration of the voluntary end-expiratory apnea was not different after HSI (pre ϭ 40 Ϯ 5 s; post ϭ 41 Ϯ 4 s). MSNA responses to end-expiratory apnea were not different after HSI, expressed as an absolute change in burst frequency (n ϭ 11; pre ϭ 8 Ϯ 2; post ϭ 11 Ϯ 1 burst/min) and as a percent increase in total activity (pre ϭ 51 Ϯ 4% AU; post ϭ 53 Ϯ 4% AU). A second group of subjects (n ϭ 8) participated in 23-min volume/time-control intravenous isotonic saline infusions (0.9% NaCl). Isotonic saline volume-control infusions yielded no change in plasma osmolality or MSNA at rest. Furthermore, MSNA responses to apnea following isotonic saline infusion were not different. In summary, elevated plasma osmolality increased MSNA at rest and during apnea, but contrary to the hypothesis, MSNA responsiveness to apnea was not augmented. Therefore, this study does not support a neural interaction between plasma osmolality and chemoreceptor stimulation.

Research paper thumbnail of Baroreflex Control of Sympathetic Activity

Medicine and Science in Sports and Exercise, May 1, 2007

Research paper thumbnail of Autonomic Function in Amenorrheic Athletes

Medicine and Science in Sports and Exercise, May 1, 2005

Research paper thumbnail of Rural Telehealth Team Education for Baccalaureate and Nurse Practitioner Students

Journal of Nursing Education, May 1, 2020

Background: Rural areas face health care workforce shortages. Nursing students seeking rural empl... more Background: Rural areas face health care workforce shortages. Nursing students seeking rural employment require instruction and clinical experience in using telehealth to work in health care teams. Method: An innovative telehealth consultation simulation paired nurse practitioner (NP) students with prelicensure baccalaureate nursing degree (BSN) students. The simulation aimed to enhance NP student proficiency and confidence in telehealth consultation skills and to foster professional role development through exposure to telehealth nursing roles for RNs and NPs. On-campus BSN students assumed the role of the RN in a rural clinic and consulted with off-campus NP students using telehealth technology in the care of a standardized patient. Results: Participants demonstrated level-appropriate proficiency and reported confidence in telehealth consultation and favorable attitudes toward intraprofessional communication. Conclusion: An intraprofessional educational model allowing BSN and NP students to develop telehealth consultation skills successfully addressed a gap in preparing nursing students to meet rural health care workforce needs. [ J Nurs Educ . 2020;59(5):274–277.]

Research paper thumbnail of Bad Ad

American Journal of Nursing, Nov 1, 2001

Research paper thumbnail of Objective Structured Clinical Examination From Virtually Anywhere!

The Journal for Nurse Practitioners, Sep 1, 2018

The Objective Structured Clinical Examination (OSCE) is used in nurse practitioner (NP) education... more The Objective Structured Clinical Examination (OSCE) is used in nurse practitioner (NP) education programs to evaluate students' clinical competency. The OSCE was developed to be done with students on campus in a simulation laboratory, but for online NP programs, an on-campus environment is a barrier to the use of OSCEs. The virtual OSCE eliminates this barrier and provides an effective method of implementing OSCEs and evaluating student competencies in online NP education.

Research paper thumbnail of Utilizing Academic–Service Partnerships to Advance the Care of Veterans

The Journal for Nurse Practitioners, 2021

Abstract Challenges encountered in both advanced practice registered nursing (APRN) education and... more Abstract Challenges encountered in both advanced practice registered nursing (APRN) education and veteran health care include an aging workforce, limited resources, and faculty/staff shortages, which ultimately affect patient outcomes. Academic–service partnerships (ASP) address these challenges by increasing workforce capacity and engagement, promoting interprofessional collaboration and evidence-based practice, creating educational opportunities for nursing students to work with underserved populations, and offering a mechanism for recruitment and retention. This article outlines the systematic approach a large doctor of nursing practice (DNP) program in the southwestern United States used to develop and deploy an ASP program with 2 sizeable veteran-serving community partners.

Research paper thumbnail of Development of professional education curriculum for early childhood educators: Supporting partnerships with families

Research paper thumbnail of Implementation of an Integrative Holistic Healthcare Model for People Living with Parkinson’s Disease

The Gerontologist, 2015

Center (NMHC) developed a novel PD Telehealth Clinic serving individuals with PD and their caregi... more Center (NMHC) developed a novel PD Telehealth Clinic serving individuals with PD and their caregivers throughout Delaware. Design and Methods: The PD clinic is based on a collaborative framework that uses synchronous videoconferencing telehealth technology to bring together out-of-state clinicians and scientists with expertise in PD to help deliver specialized care to PD patients and their caregivers. The team includes a movement disorder specialist, psychologists, nurse practitioners, researchers, physical and speech therapists, exercise physiologists, nutritionists, and graduate students. The PD Clinic delivery model seamlessly blends telehealth provider and onsite provider interactions, enabling the diagnosis, treatment, and ongoing management of PD. Results: In the first 6 months of the Parkinson's clinic opening, the nurse practitioners along with the movement disorder specialist evaluated 36 PD patients. Several patients have received recommendations to change their medication regimen by the movement disorder specialist. About 20 patients were referred to physical therapy, 7 to speech therapy, 9 to mental health services, 1 to occupational therapy, and 12 to local support groups. The location of the NMHC-PD clinic has reduced travel time and distance by as much as 1.5 hr or 80 miles, each way, and wait time for a new patient appointment is less than 3 months. Implications: The NMHC-PD Telehealth Clinic provides access to specialized multidisciplinary and advanced care and was successfully implemented. This model can be replicated in other nurse managed health centers across the United States.

Research paper thumbnail of Should NP Student Programs Continue to Require a Set Number of Direct Clinical Hours?

The Journal for Nurse Practitioners, 2009

Allen Prettyman, MSN, FNP-BC, earned his BSN and MSN from Wilmington University. He is the progra... more Allen Prettyman, MSN, FNP-BC, earned his BSN and MSN from Wilmington University. He is the program coordinator for the nurse practitioner programs at the University of Delaware, where he has been full time faculty for 5 years. He is currently a doctoral student in the University of Delaware Human Development and Family Studies Department and his research focus is obesity. He maintains a part-time clinical practice in the Christiana Care Occupational Medicine Office.

Research paper thumbnail of Bad Ad

American Journal of Nursing, 2001