bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Problems of Women with Severe Mental Illness
Authors: Perese Eris F. , Perese Kerry
Published: May 2005

Purpose

To provide a review of the health problems of women with severe mental illness (SMI) that are related to their psychiatric disorders and disabilities, prolonged use of psychotropic medications, and high‐risk lifestyle practices.

Data Sources

Review of current literature uncovered through MEDLINE, Cumulated Index to Nursing and Allied Health, and Psychological Abstracts as well as the authors' clinical experiences.

Conclusions

Women with SMI are at increased risk for obesity as well as cardiovascular, endocrine, and infectious disorders. They also experience psychotropic medication‐related disorders such as amenorrhea, galactorrhea, sexual dysfunction, breast cancer, and osteoporosis. High‐risk lifestyle practices, excessive weight gain, low physical activity, substance abuse and unprotected sexual activity increase risk for health problems. The mental illness, residual disabilities, sequelae of childhood abuse, poverty, limited social support and health knowledge deficits affect their ability to maintain optimum health.

Implications for Practice

Knowledge about women with SMI and their health problems will enable nurse practitioners to better meet the needs of this vulnerable population.
Case Study of a Young Man With Tremor
Authors: Hawkins‐Walsh Elizabeth
Published: May 2005

Purpose

To provide the clinician with an opportunity to review the most common causes of tremor in young adults.

Data Sources

Extensive review of international scientific literature on tremors and other movement disorders, supplemented by a recent case study.

Conclusions

Essential tremor (ET) is the most common tremor disorder in the world. In contrast to common expectations, the 2nd decade of life represents a period of peak incidence. The early presentation may be so mild that the tremor goes unnoticed by patients and clinicians for many years. The most important movement disorder to rule out in the workup of patients with tremors is Parkinson's disease.

Implications for Practice

The diagnosis of ET is generally made on clinical grounds. A comprehensive history and careful physical examination that rules out cerebellar or extrapyramidal disease is required. The clinician must distinguish between resting tremors and action tremors. If the appropriate diagnosis is unclear, a tremor recording (elec‐tromyogram) may assist in this distinction. Referral to a neurologist may be warranted.
Nutritional Health Promotion for Older Adults, Where Is the Content?
Authors: PhD Wanda Bonnel
Published: May 2005

Purpose

To describe nurse practitioners' (NPs') educational experiences related to older adult nutrition and eating abilities.

Data Sources

Descriptive research with written survey data collected from 80 gerontological NPs recruited from a national nursing conference.

Conclusions

Older adults' nutritional health has been related to acute illness, pressure sore development, prolonged hospital stays, and other health problems. Current literature suggests that although nutrition screening and intervention promote older adults' health, practitioners may not consistently receive education on this content. Participants indicated that gerontological‐nutrition content was important, that it was missing from their educational programs, and that it needed to be a part of the NP curriculum. Specific nutrition content concerns were organized by the categories (a) disease and functional issues, (b) psychosocial support and environmental impact, and (c) health care team and system considerations.

Implications for Practice

NP programs need to self‐evaluate for adequate and appropriate nutrition screening and intervention content. Frameworks such as those developed by the Nutrition Screening Initiative and others provide beginning guidance for further content development.
Nurse Practitioner Coding Practices in Primary Care: A Retrospective Chart Review
Authors: Allen Kymberly R. , Reinke Caroline B. , Pohl Joanne M. , Martyn Kristy K. , Mclntosh Elaine P.
Published: May 2005

Purpose

To describe the coding and documentation practices of nurse practitioners (NPs) when using evaluation and management (E & M) codes in an academic primary care center.

Data Sources

A randomized retrospective review of ten charts from a nurse‐managed primary care clinic affiliated with a midwestern research‐intensive university.

Conclusuion

The findings demonstrate that the documentation in the chart for six of the ten client encounters did not support the E & M codes assigned by the clinicis NPs. Four of these six client encounters were overcoded; the remaining two encounters were undercoded.

Implications for Practice

Findings of this study support the need for additional education of NPs in the areas of coding and documentation.
Diagnosis and Treatment of Idiopathic Thrombocytopenic Purpura
Authors: Blackwell James , Goolsby Mary Jo
Published: May 2005

This month's clinical practice guideline (CPG) review is on the diagnosis and treatment of idiopathic thrombocytopenic purpura (ITP). ITP is not a condition that would be seen in great numbers by nurse practitioners (NPs) in general practice. However, due to the current lack of consensus on how to diagnosis and treat ITP and the potential for patients to have serious adverse sequelae, NPs may want to have a copy of this CPG on file in their offices for future reference.
Balneo‐Phototherapy: A New Holistic Approach To Treating Psoriasis
Authors: Mikula Colleen
Published: May 2005

Purpose

To present and describe a new holistic therapy for the treatment of psoriasis and demonstrate its outcomes through a case study presentation.

Data Sources

Selected scientific literature and patient case study.

Conclusion

Balneo‐phototherapy, though new to the United States, has effective, safe outcomes as a new holistic treatment for psoriasis.

Implications for Practice

Nurse practitioners (NPs) and patients have an additional choice in psoriasis treatment that provides efficacious outcomes with fewer side effects compared to current therapies.
Optimal Management of Outpatients With Heart Failure Using Advanced Practice Nurses in a Hospital‐Based Heart Failure Center
Authors: Crowther Maryanne
Published: May 2005

Purpose

To examine the benefits of an advanced practice nurse (APN) driven, hospital‐based heart failure center.

Data Sources

Selected multidisciplinary studies, review articles, Heart Failure Society of America practice guidelines, and American College of Cardiology/American Heart Association clinical practice guidelines.

Conclusions

APN specialists in this hospital‐based heart failure center provide heart failure patients with high quality multidisciplinary health care in a single environment, which leads to optimal outcomes. Patients experience positive outcomes as evidenced by spared hospitalizations, improved scores on the Minnesota Living With Heart Failure Survey, and the 6‐min walk.

Implications for Practice

APNs with prescriptive authority can effectively direct heart failure care for outpatients by utilizing multidisciplinary resources of the hospital. Treatment strategies include titrating medication, frequent symptom monitoring, tracking medication and dietary compliance, telemonitoring, and providing aggressive multidisciplinary education. This approach is highly effective for reducing hospital readmissions as well as for improving quality of life and functional status for outpatients with left ventricular systolic dysfunction.
Policy on Acute Toxic Ingestion or Dermal or Inhalation Exposure
Authors: Goolsby Mary Jo
Published: May 2005

Many nurse practitioners (NPs) practice in emergency and urgent‐care settings, and far more practice in remote settings. NPs in each of these settings should be familiar with the assessment, stabilization, and treatment of patients who seek treatment for suspected intentional or accidental poisoning. This month's clinical practice guideline (CPG) column reviews the “Clinical Policy for the Initial Approach to Patients Presenting With Acute Toxic Ingestion or Dermal or Inhalation Exposure.”
What Nurse Practitioners Should Know About Direct‐to‐Consumer Advertising of Prescription Medications
Authors: Viale Pamela Hallquist
Published: May 2005

Purpose

To describe the marketing strategies of direct‐to‐consumer (DTC) advertising and the risks, benefits, and potential influence on the prescribing practices of nurse practitioners (NPs).

Data Sources

Journal articles, media sources, and clinical experience.

Conclusions

The effect of DTC advertising of prescription medications on NPs has not been well studied. Although there are studies that examine the effects of DTC advertising on physician prescribing as well as the effects of this practice on the consumer, opinions on the benefits of DTC advertising are varied.

Implications for Practice

NPs need to recognize the potential influence of DTC advertising and to be prepared to guide patients toward appropriate medication choices by participating in a partnership with patients. Health care providers, including NPs, need to work with the pharmaceutical industry to encourage accountability of DTC advertising, thus improving dissemination of correct information and promoting positive outcomes for health consumers and patients.
Simplified Regimens for Treating HIV Infection and AIDS
Authors: Piliero Peter J. , Colagreco Joseph P.
Published: May 2005

Purpose

To r eview the variables that greatly affect adherence to the complex treatment regimens used in HIV disease and to examine available options that could improve patient outcomes.

Data Sources

Comprehensive review of current medical and scientific literature, drug‐prescribing literature, and randomized clinical trials of drug treatments.

Conclusions

Effective treatment of HIV infection is dependent on consistent adherence to prescribed antiretroviral medications. A large pill burden, multiple daily doses, and adverse events are some of the complexities that negatively impact patient adherence. For example, lipodystrophy and hyperlipidemia are two serious side effects associated with some agents. Once‐daily antiretroviral agents offer many advantages over historical treatment options but are associated with possible drawbacks.

Implications for Practice

Currently, four single agents are available for once‐daily administration, and a few others are under investigation. In addition, combination therapy with either dual or boosted protease inhibitor regimens is becoming a popular way of overcoming the poor pharmacokinetic characteristics of individual protease inhibitors.
Optimizing Mental Health in an Academic Nurse‐Managed Clinic
Authors: Sousa Karen H. , Zunkel Gretchen M. , Holman Elizabeth Jordan
Published: May 2005

Purpose

To evaluate the initial results of tracking the health outcomes, specifically mental health outcomes, for clients at an academic nursing clinic and to describe an approach to mental health treatment in this setting.

Data Sources

Descriptive‐survey design with convenience sampling of patients from a nurse‐managed clinic (N = 151). As part of the routine documentation for clinic clients, the Medical Outcomes Study Short‐Form 36‐Item Health Survey (SF‐36) was selected to monitor client health outcomes.

Conclusions

This health status evaluation indicated that the mental health scores for clinic clients were lower than national normed data. This result could reflect unmet mental health needs in clinic clients. Mental health reasons for the visit were reported in only 3% of the sample. Most clients in this sample sought treatment in the clinic for physical health screening and episodic health problems.

Implications for Practice

Integration of mental health interventions in primary care settings may help providers to optimize the management of clients' overall health status.
Impact of the New National Cholesterol Education Program (NCEP) Guidelines on Patient Management
Authors: Harmel Anne Peters , Berra Kathy
Published: May 2005

Purpose

To update nurse practitioners (NPs) on the latest National Cholesterol Education Program (NCEP) guidelines for the management of high blood cholesterol in adults.

Data Sources

The 2001 NCEP Adult Treatment Panel (ATP) III guidelines and supporting scientific reviews and reports of clinical trials related to the evidence upon which the guidelines are based.

Conclusions

The many new features of the ATP III guidelines include an increased emphasis on the patient with multiple risk factors in order to identify appropriate candidates for primary prevention and on more stringent classifications of elevated lipid/lipoprotein levels. However, elevated levels of low‐density lipoprotein (LDL) cholesterol continue to be the focus for both primary and secondary prevention, and 3‐hydroxy‐3‐methylglu‐tarylcoenzyme A (HMG‐CoA) reductase inhibitors (statins) are clearly the drugs of choice for decreasing LDL cholesterol in most patients.

Implications for Practice

Because NPs play key roles in optimizing treatment management, it is important that they become familiar with, and be prepared to help implement, these latest guidelines. By embracing the global risk assessment approach of ATP III and aggressively treating all at‐risk patients, NPs can take a proactive role in helping to halt the progression of coronary heart disease and its consequences.
Nurse Practitioners' Knowledge, Practice and Attitudes About Tobacco Cessation & Lung Cancer Screening
Authors: Lawvere Silvana , Mahoney Martin C. , Englert Jessica J. , Murphy Jill M. , Hyland Andrew , Klein Susan B. , Loewen Greg M.
Published: May 2005

Purpose

To determine nurse practitioners' (NPs') knowledge, practice, and attitudes about tobacco cessation counseling and lung cancer early detection.

Data Source

A descriptive, cross‐sectional survey design was used to examine NPs' approaches to primary and secondary prevention of tobacco use among patients in western New York.

Conclusions

Among the 175 respondents, NPs appropriately counseled tobacco users on tobacco cessation. However, there was limited understanding of first‐line pharmacological agents used for tobacco cessation and of how to manage treatment for a patient at high risk for lung cancer.

Implications for Practice

These findings suggest the need to implement professional educational programs aimed at conveying not only the importance of tobacco cessation counseling but also information on the most effective first‐line pharmacological agents and appropriate management options for patients at increased risk of developing lung cancer.
Sickle Cell Disease: Health Promotion and Maintenance and the Role of Primary Care Nurse Practitioners
Authors: Tanyi Ruth A.
Published: May 2005

Purpose

To discuss the role of nurse practitioners (NPs) with regard to early identification of affected individuals, effective monitoring and screening, effective pain management and prophylaxis, and health education for patients with sickle cell disease (SCD).

Data Sources

Electronic database searches were performed using Medline, Cinahl, and PsycINFO. Data were obtained from medical textbooks, research, and review articles.

Conclusions

SCD is a chronic inherited disease belonging to a group of conditions called hemo‐globinopathies. Individuals with SCD often require close medical care from specialists. Nonetheless, NPs are in ideal positions to facilitate the health promotion and health maintenance necessary to decrease the high rate of morbidity and mortality associated with this disease.

Implications for Practice

NPs must understand the importance of early identification of affected individuals, effective monitoring and screening, effective pain treatment, and prophylaxis. The unpredictable trajectory of SCD can lead to frustration, fear, helplessness, hopelessness, and emotional distress. Ineffective pain management is a major problem for people with SCD. NPs can overcome this problem by initiating effective and prompt pain management in a nonjudgmental manner.
Recognizing And Treating Non‐Infectious Rhinitis
Authors: Mastin Terrye
Published: May 2005

Purpose

To increase clinicians' familiarity with nonallergic and mixed rhinitis and to differentiate these from allergic rhinitis, thus providing for an accurate diagnosis and facilitating a successful initial treatment program.

Data Sources

A Medline search of published journal articles was supplemented with known books and proceedings pertaining to rhinitis.

Conclusions

Although there is significant overlap of symptoms among the three types of rhinitis (i.e., allergic, nonallergic, and mixed), the patient history often contains clues that can aid in establishing a correct diagnosis. The new Patient Rhinitis Screen, a questionnaire developed for use in the primary care arena, facilitates the diagnostic process.

Implications for Practice

As the most common condition in the outpatient practice of medicine, rhinitis is frequently treated by primary care practitioners. Recent guidelines for the diagnosis and management of rhinitis suggest that a specific diagnosis of allergic, nonallergic, or mixed rhinitis leads to more effective treatment strategies. The result is successful and efficient care utilizing, as appropriate, broad‐based and symptom‐specific therapies.
The Regulation of Dietary Supplements
Authors: Larsen Larissa L. , Berry Judith A.
Published: May 2005

Purpose

To discuss the regulatory history of dietary supplements, define the term dietary supplement, clarify ingredient and nutrition information labeling, and discuss safety issues and implications for practice.

Data Sources

Review of primary and secondary sources, including both Internet sites and journal articles.

Conclusions

In the United States, 6 out of every 10 people use dietary supplements. For decades, the Food and Drug Administration (FDA) protected the public from mislabeled and unsafe products by regulating as foods those dietary supplements that included only essential nutrients. The Nutrition Labeling and Education Act of 1990 included herbs as dietary supplements. When the Dietary Supplement and Health and Education Act (DSHEA) of 1994 was passed, the FDA lost its regulatory power. The DSHEA expanded the definition of dietary supplements beyond essential nutrients. Dietary supplements are no longer considered food additives, which makes them exempt from prescreening or any safety and efficacy studies before they are released to the public. Under the DSHEA, the FDA may take action if a product poses a direct health threat and only after adverse health effects have already occurred.

Implications for Practice

A good understanding of the regulatory procedures for dietary supplements will aid nurse practitioners (NPs) in patient education regarding these products. Patients should be advised to choose supplements that are made by nationally known food and drug manufacturers that belong to trade groups. NPs and patients can contact the manufacturer directly and can access government Internet sites for more product information.
Integrating the Principles of Evidence‐Based Practice: Testing and Diagnosis
Authors: Goolsby Mary Jo , McNaughton Molly Ann , Klardie Kathleen , Meyers Wendy
Published: May 2005

The intention of the clinical practice guideline (CPG) column has included increasing readers’ familiarity with the range of available evidence‐based recommendations, while stimulating dialogue regarding application of those recommendations in practice. This column introduces the first article in a series of three written to describe a framework in which the principles of evidence‐based practice can be applied. This article uses a clinical scenario to illustrate considerations relevant to the selection and application of a CPG in practice.
Adherence to Oral Therapy for Type 2 Diabetes: Opportunities for Enhancing Glycemic Control
Authors: Bartels David
Published: May 2005

Purpose

Although diet and exercise are important parts of type 2 diabetes treatment, most patients require pharmacological intervention with multiple agents to maintain adequate glycemic control. This article addresses the numerous patient‐related, disease‐related, and demographic variables affecting medication adherence in this patient population.

Data Sources

Extensive review of scientific literature, clinical practice guidelines, and Internet sources.

Conclusions

Studies have demonstrated that treatments including multiple medications or frequent dosing had a negative impact on adherence. Practitioners have used several approaches in an effort to improve adherence to oral antidiabetic medical therapy, including increased communication between health care providers and patients, implementation of multidisciplinary programs, and use of treatment regimens with easier dosing (i.e., reduced number of drugs or doses taken per day).

Implications for Practice

Options for type 2 diabetes treatments that combine effective medications into a simpler oral‐dosage form may motivate and improve patient adherence. Ultimately, simplifying dosing may lead to better glycemic control, thereby reducing the risks associated with long‐term consequences of the disease.
Factors Influencing the Utilization of Lyme Disease‐Prevention Behaviors in a High‐Risk Population
Authors: McKenna Donna , Faustini Yolanda , Nowakowski John , Wormser Cary P.
Published: May 2005

Purpose

To evaluate factors motivating high‐risk individuals to implement Lyme disease—prevention behaviors.

Data Sources

Patients presenting to the Lyme Disease Diagnostic Center in New York State completed a voluntary, anonymous questionnaire.

Conclusions

Of the 219 persons completing the questionnaire, participants who reported having had Lyme disease in the past were significantly more likely to use preventive behaviors than those without a history of Lyme disease (p = .01). Additionally, persons who reported having a family member or close friend with Lyme disease were more likely to use preventive behaviors than those without such a relationship (p = .02). Increasing age was associated with increased use of preventive behaviors only for participants without a history of Lyme disease (p = .04).

Implications for Practice

These findings provide information that may be important in developing community prevention programs for Lyme disease. Younger persons without a history of Lyme disease should be targeted for programs that will educate them about Lyme disease. Table 1 Clinical Resources for Diagnosing and Treating Lyme disease
The Need to Bleed: Women's Attitudes and Beliefs About Menstrual Suppression
Authors: Andrist Linda C. , Hoyt Alex , Weinstein Dawn , McGibbon Chris
Published: May 2005

Purpose

To describe how women feel about monthly menstruation in general and menstrual suppression in particular.

Data Sources

This descriptive, exploratory study used a convenience sample of 221 women who completed a self‐administered questionnaire on attitudes toward monthly menstruation and menstrual suppression. Descriptive statistics and correlations were used to analyze the data.

Conclusions

Women not using oral contraceptives (OCs) had more menstrual symptoms than women using OCs. Negative feelings about menstruation were correlated with interest in menstrual suppression. Over two thirds expressed interest in reducing menstrual pain and the amount of menstrual discharge, particularly if not taking OCs. Women who were not interested in changing their menstrual pattern said they would be anxious about not having a menstrual flow and said it would not be normal.

Implications for Practice

Advanced practice nurses play an important role in educating women about menstrual health. Clinicians can use this information to assess women's attitudes and beliefs about menstrual symptoms and to educate them about misconceptions. The FDA approved Seasonale® in September 2003, the first dedicated OC created to reduce the number of menstrual cycles yearly. Women need to be educated about the pros and cons of suppression; some women will benefit from suppression, and others will consider it unnatural.
Tort Reform: An Issue for Nurse Practitioners
Authors: Klutz Diane L.
Published: May 2005

Purpose

To inform nurse practitioners (NPs) about the issues related to tort reform and its relationship to malpractice insurance costs.

Data Sources

Current journals, newspapers, professional newsletters, and Internet sites.

Conclusions

NPs are paying more for their malpractice premiums, and many are losing their places of employment as clinics close due to the increased cost of premiums. One method proposed for curbing the flow of monies spent on premiums and litigation is tort law reform. California serves as an example; its Medical Injury Compensation Reform Act (MICRA) tort reform law was passed 25 years ago, and has maintained stable malpractice premiums. Other states have proposed similar laws, but some have not had similar success. To curb litigation costs, not only should tort laws be reformed, but NPs and physicians should keep abreast of current practice standards in order to provide quality medical care.

Implications for Practice

Like physicians, NPs are affected directly by tort laws. These laws hold NPs accountable the same level as physicians. In addition, many states limit NPs’ practice to delegation of authority by a physician. Liability is therefore transferred from the NP to the physician and vice versa in cases of injury or wrongful act. In addition, many NPs are finding it increasingly difficult to locate insurers who will write policies for medical liability.
The Health Styles of Nurse Practitioners
Authors: Blackwell James
Published: May 2005

Purpose

To examine the formal and informal health care beliefs, behaviors, and practices of nurse practitioners (NPs).

Data Sources

A self‐administered questionnaire with a primarily closed‐ended format was distributed over a 3‐day period to a convenience sample of 321 NPs attending a national NP conference.

Conclusions

The overall health status and health practices of NPs were found to be fairly good, but there was room for improvement, particularly with regard to nutrition, health responsibility, physical activity, and stress management.

Implications for Practice

Respondents were more likely to self‐diagnose and self‐treat minor illnesses and largely received their primary health care from physicians. The majority of NPs indicated a willingness to receive health care from an NP; however, the nonavailability of NPs restricted this option.
Integrating the Principles of Evidence‐Based Practice Into Clinical Practice
Authors: Klardie Kathleen A. , Johnson Judith , McNaughton Molly Ann , Meyers Wendy , Goolsby Mary Jo
Published: May 2005

Column Editor Comment

This series of articles illustrates many considerations relevant to the application of clinical practice guidelines (CPGs). This particular column describes the actions of a nurse practitioner (NP) striving to understand the foundations of recommendations that are based largely on expert opinion. Although application of CPGs does not generally require this degree of investigation, it is essential that providers understand the processes used to interpret the basis of recommendations, including the application of the basic statistical concepts, when making decisions about how recommendations apply to individual patient scenarios.

Utilizing evidence‐based practice when providing patient care requires a range of skills that allows the NP to locate appropriate research evidence, to develop an understanding of the statistics used in interpreting and reporting research, and to evaluate the effects of interventions on patient outcomes. The application of the key concepts of evidenced‐based practice within the primary care setting is explored through a hypothetical patient scenario, which was created as the focal point for three articles that illustrate principles of evidence‐based practice. The goal of this series of articles is to provide a basic understanding of evidence‐based practice and its application in clinical practice.

This article explores the use of interventions selected from CPGs and investigates the potential effects of recommended interventions on patient outcomes. Commonly encountered statistical concepts are reviewed, and examples of their application in interpreting and reporting research are demonstrated. The principles of relative risk, relative risk reduction, absolute risk reduction, and numbers needed to treat are described. This review provides the NP with some basic skills to determine both the quality and usefulness of research.
The Role of Genetics in the Risk of Thromboembolism: Prothrombin 20210A and Oral Contraceptive Therapy
Authors: Welker Glade C. , Lookinland Sandra , Tiedeman Mary E. , Beckstrand Renea L
Published: May 2005

Purpose

To provide an overview of the prothrombin 20210A mutation, its effects on the incidence of venous thromboembolism (VTE) in users of oral contraceptive therapy (OCT), and screening recommendations for the primary care practice setting.

Data Sources

Several databases, including MEDLINE, EMBASE, BIOSIS, Cochrane Library, and SciSearch, were searched for articles published between 1996 and 2003. An integrative review of studies addressing prothrombin 20210A was done using available case‐series and case‐control studies. No randomized controlled trials on prothrombin 20210A were available in the literature from the years searched.

Conclusions

Prothrombin 20210A increases the risk of developing a VTE for those who carry the genetic mutation. The presence of either concomitant circumstantial factors (e.g., surgery or immobilization) or a combination of genetic factors (e.g., factor V Leiden and prothrombin 20210A) raises the frequency of VTEs to an even greater extent. The risk increases exponentially in users of OCT. Screening guidelines for the use of OCT in prothrombin 20210A carriers remain unclear due to the paucity of empirical evidence related to the topic.

Implications for Practice

Practitioners caring for a prothrombin 20210A carrier should maintain a high degree of suspicion with even vague signs or symptoms of a possible VTE. Practitioners should consider completing a full diagnostic workup for VTE on that patient, particularly if that patient is taking OCT. Until evidence becomes available as to the best anticoagulation practice after an initial or recurrent VTE in a prothrombin 20210A carrier, standard treatment guidelines for anticoagulation should be followed.
Educational Strategies to Enhance Placement and Retention of Nurse Practitioners in Rural Arkansas
Authors: Kippenbrock Thomas , Stacy Annette , Gilbert‐Palmer Deborah
Published: May 2005

Purpose

To examine the factors and incentives enhancing nurse practitioners’ (NPs’) long‐term employment in rural areas.

Data Source

The participants were 121 master's prepared or higher educated NPs located in rural Arkansas. A survey about role preparation and employment factors was mailed to the participants.

Conclusions

We found that 10% of all respondents were not currently employed in the role of an NP. The majority of rural‐employed NPs had didactic content focusing on rural‐practice opportunities and engaged in rural practicums while in graduate school. Rural NPs were much more likely to have graduated from research‐intensive universities. Nearly 90% of NPs reported they were somewhat very well prepared for practice in rural Arkansas.

Implications for Education

The shortage of health care providers remains one of the most irresolvable problems in the U.S. health care delivery system. Compounding the shortage is the unequal distribution of health care practitioners rural areas. Evidence indicates that NP students engaged in rural clinical practicums were more likely to practice in rural areas. light of this information, nurse educators should expand the NP educational process beyond rurally located practicums to deliver the entire educational process to the NP students’ rural homes.
Wolff‐Parkinson‐White Syndrome: Essentials for the Primary Care Nurse Practitioner
Authors: Valderrama Amy L.
Published: May 2005

Purpose

To provide nurse practitioners with a basic understanding of the pathophysiology, clinical characteristics, diagnostic methods, and management of Wolff‐Parkinson‐White (WPW) syndrome.

Data Sources

Selected research and clinical articles.

Conclusions

WPW syndrome is the most common form of ventricular preexcitation. The ventricular myocardium is activated earlier than expected by an accessory conduction pathway that allows a direct electrical connection between the atria and ventricles. Although many patients remain asymptomatic throughout their lives, approximately half of the patients with WPW syndrome experience symptoms secondary to tachyarrhythmias, such as paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, and, rarely, ventricular fibrillation and sudden death. Symptoms include palpitations, dizziness, syncope, and dyspnea. Diagnosis is usually made by electrocardiogram findings, but further testing may be warranted to confirm the diagnosis.

Implications for Practice

A thorough patient history and physical examination can aid the practitioner in identifying patients who may have WPW syndrome. With appropriate referral, treatment, and patient education, patients with WPW syndrome can expect to have a normal life expectancy and good quality of life.
Treatment of Hypertriglyceridemia With Omega‐3 Fatty Acids: A Systematic Review
Authors: Lewis Amanda , Lookinland Sandra , Beckstrand Renea L. , Tiedeman Mary E.
Published: May 2005

Purpose

To (a) critically appraise available randomized controlled trials (RCTs) addressing the efficacy of long‐chain omega‐3 fatty acids as secondary agents for prevention of hypertriglyceridemia and (b) make recommendations for clinical practice.

Data Sources

Two independent reviewers examined all RCTs from 1994 to 2003 identified in several databases, extracted data from each study, and used the previously tested Boyack and Lookinland Methodological Quality Index (MQI) to determine study quality.

Conclusions

Ten studies reported long‐chain omega‐3 fatty acids to be effective in the treatment of hypertriglyceridemia. The average decrease in triglycerides was 29%, total cholesterol 11.6%, very low density lipoprotein (VLDL) 30.2%, and low‐density lipoprotein (LDL) 32.5%. One study found LDLs to increase by 25%. The average increase in highdensity lipoprotein was 10%. The overall average MQI score was 36% (range = 26% to 54%). Many of the RCTs had serious shortcomings, including short duration, lack of a power analysis, no intention‐to‐treat analysis, no report of blind assessment of outcome, and lack of dietary control as a confounding variable.

Implications for Practice

Overall study methodology was weak. Although the evidence supporting use of long‐chain omega‐3 fatty acids in the secondary prevention of hypertriglyceridemia is reasonably strong, until there are larger RCTs of better methodological quality, it is not recommended that practitioners treat hypertriglyceridemia with omega‐3 fatty acid supplementation in lieu of lipid‐lowering medications.
Flu Vaccines and Patient Decision Making: What We Need to Know
Authors: Mayo Ann M. , Cobler Steffanie
Published: May 2005

Purpose

To describe and compare patient‐perceived barriers and motivators and decision‐making conflict between groups of hospitalized patients, those who received vaccines and those who did not.

Data Sources

Data collection included extracting data from databases and mailing two surveys to 436 discharged patients. One hundred eight patients participated in the study.

Conclusions

Top motivators for obtaining a flu vaccine included previous vaccination (93%) and provider recommendation (62%). Top barriers included fear of side effects the vaccine (35%) and fear of contracting the flu (30%). Motivators, barriers, and patient decisional conflict differed depending upon the patient's vaccination status.

Implications for Practice

Given the potential negative consequences of contracting the flu, prevention is the best strategy. Prevention contingent upon motivating patients to obtain an annual flu vaccine. Recommending flu vaccinations, offering vaccinations in convenient locations free of charge, discussing perceived barriers with patients may increase vaccinations among high‐risk patients. Helping to clarify the advantages and disadvantages from the patient's perspective may decrease decisional conflict and increase vaccination rates.
The Process of Changing Health Risk Behaviors: An Oregon Rural Clinic Experience
Authors: Bowden Jeanne M. , Shaul Muriel P. , Bennett Jill A.
Published: May 2005

Purpose

A counseling intervention was conducted by nurse practitioners (NPs) at a rural clinic in Oregon. The intervention was designed to help individuals change health risk behaviors. Three focus groups were conducted to aid in understanding the barriers to changing health behaviors and to identify resources that rural individuals needed to succeed in behavior change.

Data Sources

Quantitative data were collected using appraisal forms that were specific to five behaviors. Qualitative data were from written comments submitted by focus group participants in answer to questions sent prior to each meeting and from written summaries of focus group meetings submitted by the focus group leader.

Conclusions

Most participants were not successful in changing their health behaviors. The issues raised in the focus group discussions provide an overview of the barriers to health behavior change as perceived by a group of adults in a rural environment. Both individual lack of will and the rural community environment were barriers to adopting new health behaviors.

Implications for Practice

NPs in rural health care clinics could provide important support for individuals attempting to adopt new health behaviors. Specific suggestions from focus group participants included discussing risky behaviors more often, forming support groups that do not charge a fee, and developing a peer‐mentoring program.
Evaluation and Treatment of Hyperthyroidism and Hypothyroidism
Authors: Goolsby Mary Jo , Blackwell James
Published: May 2005

This month's clinical practice guideline (CPG) review is on the diagnosis and treatment of hyperthyroidism and hypothyroidism as provided by the American Association of Clinical Endocrinologists. An estimated 27 million Americans have thyroid disease, and about 13 million of them are undiagnosed. The risk of thyroid disease increases with age, and women are seven times more likely than men to develop thyroid problems. Unfortunately, thyroid symptoms are usually very nonspecific and should be kept in the differential diagnosis of many clinical complaints.

The format of this month's column is a little different because we received two independent manuscripts, each of which had merit. We made a decision to present both points of view and deleted repetitive material. This is an example of variable approaches one can take with reviewing and critiquing CPGs.
Critique of the Hyperthyroidism and Hypothyroidism CPG
Authors: Goolsby Mary Jo , Scatcherd Julie A.
Published: May 2005

The clinical practice guideline (CPG) for the evaluation and treatment of hyperthyroidism and hypothyroidism was developed in 2002 to update the original American Association of Clinical Endocrinologists (AACE) thyroid guidelines, which were published in 1995 (AACE Thyroid Task Force). The mission of this guideline as stated by the authors was to provide a framework for managing the diagnosis and treatment of patients with hyperthyroidism and hypothyroidism. The guidelines are intended to improve outcomes and reduce costs while stressing the importance of routine continual care provided by one physician. The guidelines are also intended to enhance physicians’ awareness of subclinical hyperthyroidism and subclinical hypothyroidism, which are frequently encountered in the clinical setting and often have detrimental health consequences when untreated.

The organization of the guideline is clear and easy to follow. Hyperthyroidism and hypothyroidism are described in two separate sections, each of which covers clinical features, diagnosis, laboratory evaluation, differential diagnosis, treatment, and management. (See previous article in this column.)
Challenges in the Assessment of Erectile Dysfunction and Treatment With Oral Therapies: Review With Case Examples
Authors: Lewis Jean H.
Published: May 2005

Purpose

To review the clinical dimensions, etiology, assessment, and treatment of erectile dysfunction (ED) and to increase awareness of oral therapies for this condition.

Data Sources

Scientific literature, consensus guidelines, and manu facturers' product information and guidelines.

Conclusions

A prevalent condition, particularly in middle‐aged and elderly men, ED is vastly underreported and undertreated. Oral therapies, including phosphodiesterase type 5 inhibitors, are effective and well tolerated in many patients and represent potential first‐line treatments for ED.

Implications for Practice

ED has been associated with both life‐threatening nesses and reduced quality of life.Improving recognition and treatment of this condition and counseling patients about ED represent important clinical opportunities. A broad and expanding array of ED treatments enable therapy to be individualized to the needs of patients and their partners.
Cardiac Resynchronization Therapy and Automatic Implantable Cardiac Defibrillators in the Treatment of Heart Failure: A Review Article
Authors: Vesty Jill , Rasmusson Kismet D. , Hall Jill , Schmitz Sandy , Brush Sally
Published: May 2005

Purpose

To review the use of cardiac resynchronization therapy (CRT)and automatic implantable cardiac defibrillators (AICDs)in heart failure (HF)patients.

Data Sources

Selected scientific literature.

Conclusions

New developments in device therapy for HF patients are helping to decrease morbidity and mortality in this challenging patient population. CRT improves left ventricular (LV) ejection fraction, quality of life, 6‐min walk distances, and New York Heart Association scores in select patients. AICDs can prevent sudden cardiac death in those who have LV dysfunction and are at risk for ventricular arrhythmias. Cardiac devices are now becoming a standard of care for those with HF who meet certain criteria.

Implications for Practice

Despite advances in medical therapy for treating LV dysfunction, newly diagnosed patients face a 50% mortality rate in 5 years. The natural history of HF leads to continual deterioration of function unless adverse cardiac remodeling is reversed. Until recently, the only means for improving symptoms and cardiac function has been through the optimization of standard medicines that are indicated for LV dysfunction, such as angiotensin‐converting enzyme inhibitors and beta‐blockers. However, not all patients benefit from medical management alone. Cardiac devices may now be considered when significant symptoms persist after standard medicines are optimized. When practitioners use a multiple‐modality approach, careful patient selection based on the inclusion criteria used in the trials outlined in this article will likely lead to improved management of those with LV dysfunction.
Do Nurse Practitioners Make a Difference in Provision of Health Counseling in Hospital Outpatient Departments?
Authors: Lin Susan X. , Gebbie Kristine M. , Fullilove Robert E. , Arons Raymond R.
Published: May 2005

Purpose

This study examined whether nurse practitioners (NPs) had any impact on the type and amount of health counseling provided during patient visits to hospital outpatient departments (OPDs).

Data Sources

This is a secondary data analysis of the National Hospital Ambulatory Medical Care Survey from 1997 to 2000. Only patient visits to hospital OPDs were included. Rates of health counseling provided at patient visits involving an NP were compared with those without an NP. Adjusted odds ratio was reported separately for each type of health counseling provided at patient visits for nonillness care, for chronic problems, and for acute

Conclusions

Health counseling for diet, exercise, human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention, tobacco use, and injury prevention are more likely to be provided at nonillness care visits involving an NP than at those not involving an NP. The presence of an NP is associated not only with higher rates of counseling for diet, exercise, and tobacco use provided at patient visits for chronic problems but also with higher rates of counseling for diet and HIV/STD prevention provided at patient visits for acute problems.

Implications for Practice

This study indicates an important role NPs can play in providing preventive services in outpatient hospital departments.The findings reflect the emphasis of the NP education on health counseling and patient education in clinical practice.
Assessing Ethnicity in Preconception Counseling: Genetics—What Nurse Practitioners Need to Know
Authors: Edwards Quannetta T. , Seibert Diane , Macri Charles , Covington Carolyn , Tilghman Joan
Published: May 2005

Purpose

To define and discuss five genetic disorders Tay‐Sachs, sickle cell anemia, Canavan's dis‐ease, thalassemia, and cystic fibrosis (CF)—and to explain the importance of the nurse practitioner's (NP's) assessment of clients' ethnicity during preconception counseling, which should address these genetic conditions.

Data Sources

Review of literature from professional journals, professional organizations' Web sites, guidelines from the American College of Obstetricians and Gynecologists, the National Institute of Health Consensus Statement, and the authors' professional clinical experience.

Conclusions

The goal of preconception counseling is to identify potential or actual medical, psychological, or social conditions that may affect the mother or fetus. NPs are often the health care providers that initiate preconception counseling to women in varied primary care settings. NPs must be familiar with ethnicity‐related inheritable conditions in order to provide appropriate client information and education and to implement testing and, when needed, referral for genetic counseling to individuals and families at risk for genetic disorders such as Tay‐Sachs, Canavan's disease, CF, sickle cell anemia, and thalassemia.

Implications for Practice

NPs providing health care to women of child‐bearing age should assess the client's use of contraception and intent for future pregnancy. Preconception counseling when indicated should be initiated to all women to increase their potential for healthy pregnancy outcomes. Although a comprehensive personal, family, medical, and psychoso‐cial history and initiation of folic acid are the mainstays of preconception counseling, assessment for risk of ethnicity‐related genetic conditions must also be included in prepregnancy health care.
Is There a Need for Screening for Type 2 Diabetes in Seventh Graders?
Authors: Whitaker Judy A. , Davis Kimberley L. , Lauer Chad
Published: May 2005

Purpose

To determine if a screening program for type 2 diabetes in a seventh‐grade population is war‐ranted as well as to increase health care providers' awareness of the need for this screening.

Data Sources

We sent a diabetes questionnaire to each par‐ticipant's parent or guardian. The question‐naire assessed for any family history of diabetes, any currently diagnosed participant with diabetes, and physical activity. Each participant was also assessed for age, ethnicity, gen‐der, and acanthosis nigricans and received a one‐time blood pressure reading. The researchers obtained height and weight by utilizing each school's weight/height scale and calculated each participant's body mass index (BMI).

Conclusions

Overall results determined that there is a need for screening for type 2 diabetes in a seventh‐grade population.

Implications for Practice

The role of the nurse practitioner (NP) is to increase health professionals' and the public's awareness of risk factors related to adolescents and type 2 diabetes by patient education both in areas of health promotion and disease pre‐vention. NP‐directed educational programs could include diabetic education in health classes in cooperation with the school nurse and/or health teacher and community‐based diabetic forums addressing this topic.