Signature Area: Responding to Recurring Health Issues
Acute and chronic illness researchers aim to improve the lives of individuals, caregivers, communities and health care systems
By Marissa Shapiro
There are key differences between acute and chronic illnesses—one is associated with conditions that occur suddenly but eventually dissipate, while the other’s symptoms are long lasting and worsen over time. But together they make up one of the School of Nursing’s signature areas of research, with faculty united around the idea of improving the lives of patients through creative thinking and problem solving. Among the new techniques developed by these researchers are innovative systems-based interventions, as well as programs aimed to improve the physical and mental health of patients suffering from disease. Meet four faculty members helping keep Vanderbilt on the leading edge of acute and chronic illness research.
Julie Barroso, PhD, Julia Eleanor Blair Chenault Professor of Nursing
Julie Barroso has been researching various aspects of living with HIV since the early days of the epidemic. While working as a medical/surgical nurse at a large public hospital in the 1980s, she saw firsthand how poorly patients with HIV infection were treated in hospitals.
“I saw someone open the door to the room of a patient with HIV infection and put a lunch tray on the floor and shove it into the room with his foot,” Barroso says. “Back in those pre-HIPAA days, we actually had signs on patient doors that indicated they had HIV infection, so people knew. I was incoherent with anger when I saw that.”
Barroso earned her PhD from the University of Texas at Austin, where she focused on issues related to long-term survivors of AIDS and conducted extensive research on HIV-related fatigue—the disease’s most problematic symptom. Stressful life events are the best predictor of increases in HIV-related fatigue, according to Barroso’s research. To improve the care of patients with HIV, she has collaborated on the development of an app that teaches cognitive behavioral stress management. The recent successful pilot study was funded by the National Institutes of Health and has given Barroso the insights she needed to pursue wider testing and the ultimate dissemination of the app.
Over the past year and a half, her research interests have also expanded to long COVID-19, as its most prominent symptom is fatigue. “Patients report over 250 symptoms in large studies, which is hard for anyone to get their arms around,” Barroso says. “My goal is to find clusters of symptoms related to long COVID. Cluster identification may make reported symptoms more manageable, and importantly, may help us find the cause(s) of those symptoms. Then, I would like to determine the impact of each cluster on the patients’ functional status – their ability to work, exercise and the activities of daily living. This will help us begin to develop interventions. So many people with long COVID are young and cannot take care of themselves. With the way this epidemic is progressing, there will be millions of people affected with long COVID, therefore it is most imperative to begin the research now.”
With former roles as an associate dean of the faculty and associate dean of doctoral programs at other universities over the past decade, Barroso came to Vanderbilt in August 2020 to pursue a more research-oriented path that would give her the necessary time to think creatively about research solutions to problems. She cites her time as a researcher at Vanderbilt as the happiest in her academic career.
Chorong Park, PhD, assistant professor
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During her time as a nurse in the cardiovascular disease unit, Chorong Park saw just how greatly patients struggled to modify their health behaviors, including their diet. Moving from South Korea to pursue her doctoral studies at Yale University, Park began her investigation into the interplay between physical activity, sedentary behavior and sleep, and how each contributes to the risk of cardiovascular disease.
Now at Vanderbilt, Park is developing simple interventions that encourage people at high risk of cardiovascular disease and diabetes to make slight yet impactful changes to their behaviors. Park’s current focus is on how to encourage people to replace sedentary behavior with light-to-moderate physical activities. “Those most at risk of acute heart attack sit for 10 to 14 hours each day. Simply standing or walking two to three minutes for every 30 minutes of sitting can reduce their total sitting time and increase their light levels of physical activity,” Park says. “We believe that these behavior changes have a direct influence on cardiovascular disease risk factors like glucose, insulin sensitivity and inflammation biomarkers, in addition to typical factors like blood pressure.”
With her early education and clinical work in South Korea, Park would like to work with the Asian American population on future research. Asian populations are understudied in all research areas, including cardiovascular disease research. “While Asian Americans are slim compared to the general U.S. population, most literature shows that particularly South Asian women are at high risk for cardiovascular disease,” Park says. “This group’s metabolism and genetic factors are different than studied populations, and their health patterns—amid the experience of adapting to American culture and habits—put their risk of developing Type 2 diabetes or heart disease higher than many researchers realize.”
Heading in this research direction, Park intends to investigate the relationship between stress, sleep and physical activity to consider new interventions. This work will include novel and objective measures of stress—including levels of the chronic stress level biomarker cortisol in two to three hairs of participants. This will give Park a precise measurement of three months of cortisol in individual participants, resulting in what she anticipates will be seminal research in the field.
Lori Schirle, PhD, assistant professor
Lori Schirle’s goal is to deliver effective pain management and minimize the risk of opioids. As a surgical intensive care nurse and nurse anesthetist for more than 30 years, Schirle has plenty of experience helping patients assess and manage their pain. During her doctoral studies at the University of Miami researching postoperative opioid prescribing recommendations, it became quickly apparent that there were no guidelines on prescribing opioids for any type of pain.
“Postoperative pain management relied on surgeons’ standard opioid-prescribing amounts, but no one really knew how much pain medication people actually took after surgery,” Schirle says. “This started my research path to investigate pain and opioid use, and safety after surgery.
“Currently, opioids remain the mainstay of postoperative pain management. Some patients require no opioids after surgery while others go on to become persistent users, which greatly increases the risk of opioid use disorders,” she added. “Persistent opioid use after surgery is considered one of the most common complications after surgery, major and minor.”
To address these and other risk factors that lead to persistent opioid use, Schirle collaborates with colleagues in the Vanderbilt Genetics Institute and Vanderbilt University Medical Center’s Department of Anesthesiology, as well as colleagues at the University of Maryland Pain and Translational Symptom Science Department. She is currently investigating the role that individual pain sensitivity and genetic makeup may play in the great variation seen in opioid use after similar surgeries. Her research has been funded by the American Association of Nurse Anesthetists Foundation and the Vanderbilt Institute for Clinical and Translational Research. She is also a member of a number of professional organizations related to the study of pain.
Schirle describes the current opioid epidemic as improving, with a long way to go. The COVID-19 pandemic may not be making things easier. As most public health efforts have centered on the SARS-CoV-2 virus since March 2020, emergency measures to cope with the pandemic have failed to include people suffering with addiction and chronic pain, leading to a disruption in access to treatment facilities and providers, Schirle says. These factors, in combination with social isolation and economic stress, resulted in an increase in overdose deaths by as much as 50 percent in the U.S., and 44 percent in Nashville, when compared to 2019 numbers.
Deonni Stolldorf, PhD, assistant professor
Sustainable health care interventions—the continuation and integration of a program in the context in which it was implemented—are how health care providers and systems can leverage programs to ensure patient well-being and positive outcomes. Deonni Stolldorf became interested in sustainable health care interventions during her work as a hospital-based nurse educator. When quality improvement or a new implementation was initiated in a health care setting, nurse educators provided the necessary education to support the project.
“I began to see a pattern of hospitals becoming enamored with the latest health care intervention or improvement process, and hurriedly adopting it. However, once the intervention was implemented, it was not used to its full extent or sustained use was not achieved,” Stolldorf says. “These projects became like dusty books on the shelf. My goal is to take the book off the shelf and make sure it is used and never again collects dust. We can achieve this by integrating interventions as part of routine care.”
Her latest work involves a study funded by the Patient-Centered Outcomes Research Institute to evaluate the implementation of GUIDED-HF, a self-care program designed to decrease the risk of cardiovascular-related death and readmissions in patients with acute heart failure discharged from the emergency department. Stolldorf, dual PI Sean Collins, MD, director of the Center for Emergency Care Research and Innovation at VUMC, and their research team will tailor the implementation of GUIDED-HF and evaluate its use and clinical outcomes in four emergency departments.
Stolldorf is also investigating the perspectives of patients, their caregivers and health care professionals regarding Hospital at Home programs, which enable eligible patients who need acute care to receive it at home rather than in a hospital setting. This study funded by the Vanderbilt Institute for Clinical and Translational Research will assist with the future development of interventions to enhance patient safety and care quality, support patients’ and caregivers, and develop and support nursing care delivery.
Stolldorf has worked on the sustainability of various health care interventions in nursing residency programs, rapid response teams, the VA’s Warrior to Soul Mate initiative and the MARQUIS Toolkit of medication reconciliation interventions.
“If we can achieve sustainability of the interventions we implement, we are likely to more achieve the long-term outcomes we want,” Stolldorf says. “These clinical outcomes ultimately affect population health.”
Photo: John Russell
Above, from left: Julie Barroso, Lori Schirle, Chorong Park and Deonni Stolldorf are four VUSN researchers working in the school’s signature acute and chronic illness research specialty.