bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Care Provider Communicator Style and Patient Comprehension of Oral Contraceptive Use
Authors: Schrader Elizabeth L. , Schrader David C.
Published: May 2005

Purpose

To explore reasons for the incorrect usage of oral contraceptive pills (OCPs) by examining the relationship between patients' abilities to comprehend and/or recall information presented to them by nurse practitioners (NPs) and the communicator style of their NP.

Data Sources

A convenience sample of 46 OCP users completed an instrument designed to test their comprehension of OCP use and an instrument designed to measure the communicator style of their NP.

Conclusions

A multiple stepwise regression revealed that attentive and friendly communicator styles were positive predictors and the communicator image and dramatic styles were negative predictors of comprehension.

Practice Implications

Unwanted pregnancies that result from non‐compliance with OCP regimens can have significant social and financial effects. A lack of understanding of proper OCP use may depend on the style of communication a NP uses to convey crucial information regarding the regimen.
Brucellosis (Mediterranean Fever, Gibralter fever, Malta Fever, Cyprus Fever, Undulant Fever, Typhomalarial Fever)
Authors: Roberts Amy , Kemp Charles
Published: May 2005

This series is based on the Infectious Diseases section of the web site Refugee Health ∼ Immigrant Health, available on the World Wide Web at http://www.baylor.edu/~Charles_Kemp/Refugee_Health.htm. The site was developed through a contract with the Texas Department of Health as part of an ongoing effort to improve the health of refugees and immigrants.
Developing an Economic IQ in Primary Care
Authors: Abel Elizabeth , Longworth Judith C.D.
Published: May 2005

Purpose

To describe elements of an economic intelligence quotient (IQ) that can be used to enhance the nurse practitioner's (NP) fiscal viability in a primary care setting.

Data Sources

Anecdotal data from providers and administrators; clinical experiences of the authors; scientific and government publications and guidelines.

Conclusions

In the United States, managed care cost‐containment initiatives have led to competition among physicians and NPs for patients and jobs. An understanding of the economic base of a practice is essential to fiscal viability in this market.

Practice Implications

When turf and job competition are the norm, it is essential that the NP develop an economic IQ. Knowledge of coding, billing, reimbursement, and documentation are critical to identifying the NP's value to the practice and promoting job retention. The challenge is for the NP to give high‐quality, cost‐effective, and safe patient care and to be a productive provider.
Managing Oral Anticoagulant Therapy
Authors: Goolsby Mary Jo
Published: May 2005

Clinical practice guidelines (CPG) provide recommendations based on the summary of large volumes of literature and expert opinion. They are not absolute care directives, but are intended to facilitate individualized decision making related to patient care situations. Each month this column reviews a CPG of direct relevance to clinical practice. Readers are urged to contact the author, Mary Jo Goolsby (mjgoolsby@aanp.org) with requests for reviews of specific clinical guidelines or submissions of manuscripts addressing major guidelines that readers have found helpful in their practice.

The Clinical Practice Guideline column is designed to inform practitioners of the wide range of accessible and current recommendations on a myriad of clinical topics. The guideline reviewed this month is actually one part of a large report stemming from the Sixth American College of Chest Physicians (ACCP) Consensus Conference on Antithrombotic Therapy. The management of oral anticoagulant therapy is but one portion of the overall report, complemented and supported by other components, including a preceding chapter that summarizes the mechanisms of action, clinical effectiveness, and therapeutic range of oral agents.

This CPG focuses on following issues: (a) initiating and maintaining dosage, (b) managing non‐therapeutic dosages, (c) managing the agents during invasive procedures, and (d) recognizing and responding to adverse events. Special situations are discussed, including management of patients who are elderly or pregnant, and comparisons of the management in different models of care. There is in‐depth discussion of the literature, accompanied by a summary of recommendations.
Mutual Timing: An Essential Component of Provider/Patient Communication
Authors: Summers Linda C.
Published: May 2005

Purpose

To present a concept clarification in an effort to give a name to a commonly experienced but poorly understood communication process: mutual timing.

Data Sources

Extensive literature review of scientific and nursing literature; relevant theories; standardized process for concept clarification as delineated in the literature.

Conclusions

Good communication involves many familiar concepts, including good eye contact, attentive listening and the use of silence and touch. Mutual timing is the difference‐making moment, creating common ground in the midst of engagement. Concept clarification is a critical step to understanding important practice concepts. Wedding the concept to everyday practice provides the beginning for development of guidelines, which can be used by nurse practitioners (NPs) for making decisions while caring for patients.

Implications for Practice

Nursing has claimed to be privy to a special relationship with patients that differs from other health care professions. When asked to differentiate their care from that of physicians, NPs are often quoted as valuing the psychosocial aspect of care and stressing the importance of their relationship with patients. Many NPs define themselves in terms of relationship, emphasizing strong moral obligations and mutual commitments with their patients. One of the core processes of the effective patient/provider relationship is good communication.
Literacy in the Health Care System: A Study On Open Heart Surgery Patients
Authors: Kenyon Conlin Kathy , Schumann Lorna
Published: May 2005

Purpose

To determine if patients recovering from open heart surgery were able to read and understand written discharge instructions and further to analyze the level of difficulty of standard discharge instructions and consent forms for open heart surgery.

Data Sources

After screening for visual acuity and efficiency, literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine test (REALM) and comprehension was tested by a post‐test of five questions based on the discharge instructions. Flesch‐Kincaid scores were calculated on four sets of standard written discharge instructions and consent forms.

Conclusions

Results from the study indicated that the REALM test was more accurate than the reported grade level and that reading skills are needed to understand and comprehend information needed for post‐operative care. The study further substantiated that health care facilities are not providing wrien instructional material that is within the reading level of the patient.

Implications for Practice

Illiteracy can have a major impact in the health care system. Low reading skills can disempower and can prove to be costly for patients who are requiring health care services. Further investigation is needed on the impact of patients’ reading skills on the health care system.
Guidelines for the Management of Rheumatoid Arthritis 2002 Update
Authors: Goolsby Mary Jo , Newsome Grace
Published: May 2005

Rheumatoid arthritis (RA) is a progressive polyarthritis that is responsible for over nine million office visits annually. It is likely that most nurse practitioners will care for one or more patients with RA because approximately 1% of the adult population is affected by this disabling disorder. The guideline reviewed in this month's column describes the recommended care of patients who have been previously diagnosed with RA.
Parameters for the Treatment of Urticaria and Angioedema
Authors: Goolsby Mary Jo , Yates Christy
Published: May 2005

This month's CPG column reviews “The Diagnosis and Management of Urticaria: a Practice Parameter Part I: Acute Urticaria/Angioedema and Part II: Chronic Urticaria/Angioedema.” As many as 15%‐24% of the U.S. population may experience at least one episode of urticaria and/or angioedema in their lifetime. Evaluation and treatment is dependent on whether the urticaria/angioedema is acute or chronic because they are fundamentally different disorders. Acute urticaria is frequently self‐limited and usually caused by an allergic reaction to an identifiable agent. Chronic urticaria is usually due to an endogenous cause, one that is difficult to identify and to treat. Due to the magnitude, potential seriousness and chronicity of urticaria and angioedema, this CPG should be quite useful to nurse practitioners in a variety of settings.
Evaluating Intimate Partner Violence
Authors: Schumann Lorna , Valente Sharon M.
Published: May 2005

Purpose

To describe the incidence, assessment, and management of intimate partner violence (IPV) from a cultural perspective emphasizing the values, strengths, and health care needs of African‐American women.

Data Sources

Review of the published scientific literature, U.S. Bureau of Justice Statistics and the National Crime Victimization Survey (NCVS) supplemented with hypothetical cases.

Conclusions

Violence is a social and public health emergency affecting over 10% of the population during their lives and 22% of women who are physically assaulted by an intimate. Roughly 3 million to 4.4 million women report being battered annually, although this is a low estimate. Neither gender nor age nor sexual orientation protects one from IPV. Violent crime causes 2.2 million known injuries with a huge cost in hospital days and other expenses.

Implications for Practice

Women often hesitate to report violence; health care professionals detect as few as 5% of battered women. Women suffer for months and years before accurate diagnosis. Clinicians need to be vigilant in case finding, education, prevention, and treatment. Cultural differences in values and beliefs, and behavioral norms influence evaluation, treatment, and referral.
Screening Strategies for Group B Streptococcus in the Third Trimester of Pregnancy
Authors: Schumann Lorna , Gerner Woltjen Mary
Published: May 2005

Purpose

To identify the best screening protocol to prevent neonatal group B streptococcal (GBS) sepsis through literature review.

Data Sources

Selected research articles, texts, and Internet sources.

Conclusions

Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and American College of Nurse Midwives (ACNM) have issued guidelines describing methods to identify pregnant women at risk of intrapartum transmission of GBS to their babies. Studies have been conducted to discover the superiority of one prevention method over the other but no consensus has been reached.

Implications for Practice

Before widely used prevention methods, approximately 8,000 babies each year became infected with GBS; of those, 400 died and many survivors suffered life‐long sequelae. Adoption of an appropriate protocol can prevent transmission of GBS from a colonized mother to her infant. Clinicians should implement either universal culture‐based or risk factor‐based screening guidelines for prenatal diagnosis and intrapartum prophylaxis of GBS disease.
Pathogenesis and Treatment of Rhabdomyolysis
Authors: Rupert Stacy A.
Published: May 2005

PURPOSE

To provide clinicians in primary and acute care settings with information on the evaluation, diagnosis, and treatment of rhabdomyolysis.

DATA SOURCES

Selected review articles from print and electronic sources, and a case study.

CONCLUSIONS

Rhabdomyolysis is a common disorder, which may result from a large variety of diseases, trauma, or toxic insults to skeletal muscle. It is caused by skeletal muscle injury and results in the release of muscle contents (i.e., myoglobin) into the plasma. Muscular, urinary, and general internal disturbances are the three areas where signs and symptoms occur.

IMPLICATIONS FOR PRACTICE

Clinical signs and symptoms vary widely. Associated life‐threatening complications include acute renal failure, cardiac arrhythmias and arrest, disseminated intravascular coagulation, and compartment syndrome. Early recognition and treatment in the acute phase of rhabdomyolysis are keys to successful outcomes and an excellent recovery.
Factors Influencing the Access to Prenatal Care by Hispanic Pregnant Women
Authors: Shaffer Cynthia F.
Published: May 2005

Purpose

To explore factors influencing the access to prenatal care among Hispanic pregnant women living in the United States.

Data Sources

A convenience sample of 46 Hispanic migrant pregnant women was interviewed over a 12‐month period using a set of five open‐ended questions.

Conclusions

The ability of the health care providers to communicate in Spanish, as well as the availability of culturally sensitive prenatal care were the main factors influencing the willingness of Hispanic women to access to prenatal care.

Implications For Practice

With the Hispanic population increasing in the United States, there is a need to provide culturally appropriate health care for that population; prenatal care is one of the areas of health care in demand. This study supports the findings in the literature and provides nurse practitioners a deeper understanding of the needs of Hispanic women needing prenatal care.
USPSTF Recommendations
Authors: Goolsby Mary Jo
Published: May 2005

The United States Preventive Services Task Force (USPSTF) is convened by the U.S. Public Health Service. The set of recommendations published by the USPSTF addresses over 200 health topics on preventive measures, counseling, immunizations, and chemoprophylaxis. The 3rd edition of the recommendations is currently being released, with each statement published as it is prepared. This column reviews three of the six recommendations currently available as part of the 3rd edition on: aspirin therapy for the prevention of heart disease, screening for chlamydia, and screening for skin cancer.

The April column will review a comprehensive guideline on adult obesity. Readers are encouraged to submit ideas or manuscripts for this column to column editor Mary Jo Goolsby, EdD, MSN, APRN, ANP‐C, by e‐mail at mjgoolsby@aanp.org.
The Relationship of Actual Height Loss with Health‐Seeking Behaviors and Risk Factors in Perimenopausal and Menopausal Women
Authors: Twiss Janice J. , Dillon Annette L. , Konfrst Jill M. , Stauffer Jenda , Paulman Audrey
Published: May 2005

Purpose

To explore whether there is a difference in the perceived height and actual height in the perimenopausal or menopausal woman and discover the difference's effect on osteoporosis health‐seeking preventive behaviors and risk factor awareness.

Data Sources

Sixty‐three perimenopausal and menopausal women, aged 45–70 years, who presented three Midwestern clinics for their annual physical exam. Data were collected with The Osteoporosis Questionnaire, which included the Osteoporosis Risk Questionnaire, Health‐ O‐Meter height measuring stick, tape measure with inch‐rule for arm span measurements, and balance scale for weight.

Conclusions

There were a significant relationship between actual height loss and osteoporosis risk factors (r= 0.41595, p=0.0007) and a trend for a relationship between adjusted height loss and osteoporosis risk factors (r=0.2407, p=0.0574).

Implications For Practice

Due to the great expense of current testing for bone mass density loss, the results of this study may help clinicians more readily identify markers for increased risk of osteoporosis through simple height measurements and osteoporosis risk factor assessments during annual visits.
Identification, Evaluation, and Treatment of Overweight and Obese Adults
Authors: Goolsby Mary Jo , Blackwell James
Published: May 2005

This month's CPG review is on overweight and obese adults. With an estimated 97 million or more adults in the United States who are overweight or obese and as the second leading cause of preventable death in the United States, this guideline is expected to be of wide interest to nurse practitioners.
Trends in Mental Health: Implications for Advanced Practice Nurses
Authors: Puskar Kathryn R. , Bernardo Lisa
Published: May 2005

Purpose

To examine current trends in mental health care for vulnerable populations and suggest how advanced practice nurses (APNs) can incorporate mental health care into primary care practice.

Data Sources

Original research and evidence‐based clinical articles, government publications, and professional practice guidelines.

Conclusions

Vulnerable populations, such as racial and ethnic minorities, adults with chronic mental illness, the elderly, the incarcerated, and those living in rural areas have long been ignored as recipients of quality, integrated health care services. There is a compelling need for APNs to participate in the integrated delivery of physical and mental health care to all Americans, especially to vulnerable populations.

Implications for Practice

Under the umbrella of advanced practice nursing, a variety of nurse practitioners (NPs) and clinical nurse specialists (CNSs) can offer a holistic approach to the provision of evidencebased health care in a wide variety of settings to an array of vulnerable and underserved people. By serving on provider panels, partnering with consumer groups, and advocating for the unmet health needs of vulnerable populations, APNs can have a positive impact on the health care delivery system.
Increasing Awareness of Asthma and Asthma Resources in Communities on the Southwest Border
Authors: Ochsner Anita K. , Alexander Jackie L. , Davis Adelina
Published: May 2005

Purpose

To provide outpatient asthma education for children and families along the southwest border of the U.S. and to study the effectiveness of a southwest border hospital's in‐house asthma educational program.

Data Sources

(1). “Increasing the Knowledge Base of Asthmatics and Their Families through Asthma Clubs along the Southwest Border.” (2). American Lung Association. (3) National Institutes of Health, National Heart, Lung and Blood Institute. (4) Referrals from a southwest border hospital.

Conclusions

Only two of 23 patients referred for asthma follow‐up were readmitted to hospital and/or emergency care during the following year. Large group teaching pretest‐posttest score means for 3,429 fourth and fifth grade students revealed a 23% increase in asthma knowledge. Small follow‐up groups of students received in‐depth asthma education.

Implications for Practice

Effectiveness of hospital inpatient asthma education combined with outpatient family follow‐up was supported. An additional finding was that southwest border families are more receptive to visits arranged with a school nurse in their children's school than to home visits from primary care clinic nurses.
National Kidney Foundation Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification
Authors: Goolsby Mary Jo
Published: May 2005

Chronic kidney disease is becoming more prevalent in the United States. The National Kidney Foundation has recently published a new set of guidelines to assist clinicians in providing earlier detection and treatment of kidney disease to minimize the progression to end‐stage renal disease. As approximately 11% of the adult population has some degree of kidney disease, this new CPG should be applicable in many settings.
Implementing a Smoking Cessation Program for Pregnant Women Based on Current Clinical Practice Guidelines
Authors: Buchanan Lynne
Published: May 2005

Purpose

To describe the U.S. Department of Health and Human Services clinical practice guideline for treating tobacco use and dependence and demonstrate how the guideline was utilized in a pilot program for a small sample of pregnant women (n=20) to help them decrease smoking.

Data Sources

A convenience sample of 20 pregnant women was recruited from a health maintenance organization at their initial prenatal contact either by telephone or in person. A comparison group of pregnant women (n=28) was used for analysis of outcomes.

Conclusions

Clinical results showed better outcomes for women in the pilot program when compared to a similar group who did not participate in the program. There was a statistically significant difference between the two groups in average number of cigarettes smoked per day at delivery and two weeks after delivery with pilot program participants reporting less smoking (p<.05). Women in both groups showed a pattern of returning to smoking after delivery of the baby.

Implications for Practice

Although a few tobacco users achieve permanent abstinence in first or second attempts, the majority continue to use tobacco for many years and typically cycle through many lapse and relapses before permanent abstinence. Ambulatory care systems need to be developed and funded to treat tobacco use and dependence over the life span. Recognition of the chronic nature of the problem and development of long term care delivery systems are needed to assist clients to achieve goals of permanent abstinence and better personal and family health. This cycle of lapse and relapse before permanent abstinence is typical and demonstrates the chronic nature of tobacco use and dependence and the need for long term follow‐up.
Bulimia Nervosa: Knowledge, Awareness, and Skill Levels Among Advanced Practice Nurses
Authors: Dichter Jacquelin R. , Cohen Jayne , Connolly Phyllis M.
Published: May 2005

Purpose

To examine the knowledge, awareness, and self‐perceived skill levels regarding bulimia nervosa (BN) among advance practice nurses (APNs) caring for young female patients.

Data Sources

Two hundred APNs of various nurse practitioner (NP) specialties were surveyed with a mailed questionnaire. One hundred and twenty‐ one (61%) surveys were returned and analyzed.

Conclusions

Results demonstrated that APNs are knowledgeable and aware about BN. There were several statistically significant relationships among awareness and self‐perceived skill levels. Pediatric NPs were found to be the most aware of BN in their young female patients.

Implications for Practice

The incidence of eating disorders is on the rise. Bulimia nervosa, a common secretive illness, poses a significant challenge for APNs potentially leading to missed diagnosis. There is a paucity of research exploring this issue. Study findings provide evidence to enhance curricula on eating disorders in academic and continuing education programs and guidance for future research.
Lassa Fever
Authors: Roberts Amy , Kemp Charles
Published: May 2005

This series is based on the Infectious Diseases section of the web site Refugee Health ∼ Immigrant Health, available on the World Wide Web at http://www.baylor.edu/~Charles_Kemp/Refugees.htm. The site was developed through a contract with the Texas Department of Health as part of an ongoing effort to improve the health of refugees and immigrants.
Herpes Zoster Ophthalmicus: How Is It Identified and Treated?
Authors: Schumann Lorna , Temple Jeffery J.
Published: May 2005

Purpose

To describe herpes zoster ophthalmicus in relation to the anatomy, pathophysiology, course, diagnostic considerations, and management for the primary care provider.

Data Sources

Actual case study supplemented with an extensive review of current scientific and psychosocial literature.

Conclusions

Herpes zoster ophthalmicus (HZO) is an extension of a herpes zoster (HZ) infection involving the fifth cranial (trigeminal) nerve, which results from the reactivation of a latent varicella virus among individuals who had contracted a varicella infection sometime within their lifespan.

Implications for Practice

Due to the vague presenting symptomology of HZO, many patients may be misdiagnosed lessening the chance for prompt diagnosis and therapeutic intervention. Educational awareness, listening to psychosocial concerns of the patients, and immediate referral can decrease potential chronic side effects of the disorder.
Listening to Women: Culturally Tailoring the Violence Prevention Guidelines from the Put Prevention Into Practice Program
Authors: Shoultz Jan , Phillion Nancy , Noone Joanne , Tanner Barbara
Published: May 2005

Purpose

To develop five reliable and valid (culturally tailored) guidelines focused on the prevention of violence as presented in the violence prevention guideline of the Put Prevention into Practice Clinician's Handbook on Preventative Services (PPIP).

Data Sources

The data collection for this qualitative, descriptive design of naturalistic inquiry was focus group interviews with five different ethnic groups of women (Caucasian, Filipino, Hawaiian, Japanese and Hispanic) using a semi‐structured interview guide.

Conclusions

The women interviewed provided a variety of suggestions for adaptations to the guideline. Cultural similarities and differences are presented. Development of a nonjudgmental and trusting relationship is key to disclosure.

Implications for Practice

Violence against women is recognized as a major public health problem. Little is known about the effectiveness of standardized interventions such as those contained in the PPIP Handbook. Even less is known about the efficacy of such protocols within culturally diverse populations. Providers should consider adaptation of the guideline based on the individual relationship with the client. The next phase of this research is to implement the culturally tailored adaptations of these guidelines and test their effectiveness.
Alzheimer's Disease Management
Authors: Goolsby Mary Jo , Blackwell James
Published: May 2005

This month's CPG review is on Alzheimer's disease management. Currently, four million people in the United States have been diagnosed with Alzheimer's disease and this incidence is expected to become greater as the population ages. This guideline should therefore be of great interest to nurse practitioners who either treat this population or may be personally affected in some way by this condition.

James Blackwell, MS, APRN, BC, is the Disease Management Coordinator of Blue Cross/Blue Shield of South Carolina.

The views expressed in this article are those of the author and do not necessarily reflect the views of Blue Cross and Blue Shield of South Carolina or any of its subsidiaries.
Contraceptive Efficacy and Patient Acceptance of Lunelle
Authors: Freeman Sarah
Published: May 2005

Purpose

To review the efficacy, safety, and patient acceptance of the LunelleTMmonthly contraceptive injection and to raise awareness of this new contraceptive in the United States.

Data Sources

Worldwide scientific literature, reports of clinical trials, and manufacturers’ product information and guidelines.

Conclusions

LunelleTM is a combined hormonal method with a safety/tolerability profile comparable to that of oral contraceptives (OC) and a high efficacy rate and provides a rapid return of fertility after discontinuation. Moreover, LunelleTM was well accepted in a large clinical trial, with satisfaction levels similar to those of new‐start OC users.

Implications for Practice

Oral contraceptives are the most popular hormonal birth control method in the United States; however, typical use is associated with higher failure rates than those observed with perfect use because of poor compliance. Poor compliance has been attributed in part to the need for daily administration. A new contraceptive method that does not require daily administration and is readily reversible may be suitable for many women, resulting in better overall efficacy.
Migraine and Its Treatment with 5‐HT1B/1D Agonists (Triptans)
Authors: Schumann Lorna , Moriarty‐Sheehan Maureen
Published: May 2005

Purpose

To review the epidemiology and clinical features of migraine and to discuss the use of the 5‐HT1B/1D agonists (triptans) in the treatment of moderate to severe migraine.

Data Sources

A Medline search was conducted for relevant recent articles on migraine and the efficacy and safety of the triptans.

Conclusions

With the advent of a standardized classification system for headache to simplify migraine diagnosis, new approaches to treatment, and effective new therapies, such as the triptans, many patients have obtained significant relief from the pain and disability associated with migraine.

Implications for Practice

The key to successful migraine management is to provide the most effective treatment at the earliest possible time. Under the step‐care approach to migraine management, the mildest and most conservative treatment was recommended as a first step, without regard for the degree of the patient's pain or disability. This approach has been replaced by stratified care, in which migraine management is based on the severity of the patient's pain and disability. Under the stratified approach, patients with moderate or severe migraine would be prescribed effective migraine‐specific drugs, such as the triptans, as first‐line therapy.
Decision‐Making in Children with Asthma and their Parents
Authors: Meng Anne , McConnell Susan
Published: May 2005

Purpose

To learn how children with asthma and their parents make treatment‐related decisions.

Data Sources

Verbatim transcripts of focus group interviews of 28 school age children with asthma and their parents. Children had attended an educationally based asthma camp program. Questions related to choices parents and children made regarding implementation of their asthma treatment plans both, at home and at school.

Conclusions

Parents and children made many non‐adherence decisions especially with respect to preventive aspects of the treatment plan. Symptoms were the driving force for children's decisions. Parents and children had concerns about implementing the management plan school. Parents and children may not perceive asthma treatment options as true choices, thus affecting motivation for adherence.

Implications

Practitioners need to form partnerships with parents and children in developing treatmentgoals. Goals should focus on achievement of normal daily activities. Asthma education needs to be concrete and include school personnel. Practitioners need to give families positive, informational feedback.
Acquired Long QT Syndrome: Risk Assessment, Prudent Prescribing and Monitoring, and Patient Education
Authors: Kunkler Kathleen
Published: May 2005

Purpose

To inform nurse practitioners (NPs) about risk factors that precipitate the potentially fatal cardiac arrhythmia torsade de pointe (TdP) in patients with long QT syndrome (LQTS), and to recommend preventative strategies and prudent prescribing advice to use in clinical practice.

Data Sources

A review of the current literature is used to explain factors that cause prolonged repolarization during phase 2 and phase 3 of the cardiac action potential and relate these to the development of LQTS and TdP. The major risk factors reviewed are drugs, drug‐drug interactions, electrolyte disturbances, and populations at risk for LQTS.

Conclusions

The LQTS is an increasingly recognized cardiovascular problem. Nurse practitioners should be cognizant of the risk factors and be able to apply them in clinical practice.

Implications For Practice

Recognition of patients at risk for acquired LQTS is imperative in primary care practice. Currently, there are no practice guidelines that address acquired LQTS. In lieu of practice guidelines, the prudent NP uses physiology to guide treatment decisions, especially those decisions related to the use of drugs.
Domestic Violence: What Do Nurse Practitioners Think?
Authors: Bryant Sharon A. , Spencer Gale A.
Published: May 2005

Purpose

To examine factors that influence nurse practitioners’ (NPs) ability to incorporate universal domestic violence screening practices (e.g., asking, identifying, referring and reporting) into their practices.

Data Sources

A stratified random survey of certified NPs New York state was conducted in 1999. There were 118 family, women's health, OB/GYN, and adult NPs in the survey. Chi‐square and ANOVA were used to analyze the data.

Conclusions

There were significant differences in the domestic violence screening practices among women's health, OB/GYN, adult, and family NPs. Women's health and OB/GYN NPs were more likely to ask screening questions and identify victims of domestic violence than their other NP counterparts.

Implications for Practice

There is a need to identify strategies that encourage all NPs to incorporate universal domestic violence screening behaviors into their practices.
Considerations in the Management of the Patient with Comorbid Depression and Anxiety
Authors: Sekula L. Kathleen , DeSantis Joe , Gianetti Vincent
Published: May 2005

Purpose

To provide clinicians with guidelines for the assessment, evaluation, diagnosis, and manage‐ment of comorbid depression and anxiety in the primary care setting.

Data Sources

Research‐based articles in the medical and psy‐chiatric literature, literature reviews by experts in the field, and DSM‐IV‐TR.

Conclusions

Comorbid anxiety and depression occurs at a high rate in primary care, and is costly to both the individual and to society. These patients most often present in primary care settings, have more severe symptoms, and require more health care resources. The presentation of depression and anxiety together pose complicated diagnostic and treatment challenges, leading to inadequate diagnosis and treatment resulting in unnecessary patient distress and increased utilization of health care services.

Implications for Practice

This article is a review of comorbid depression and anxiety with a focus upon societal and patientsignificance and impact, under recog‐nition and under treatment, diagnostic chal‐lenges, medical comorbidity, treatment consid‐erations, and educational strategies. Effective assessment, evaluation, diagnosis and treat‐ment can lead to better treatment outcomes and improved quality of life inprimary care patients.
Procedures Taught in Family Nurse Practitioner Programs in the United States
Authors: Cole Frank L. , Ramirez Elda
Published: May 2005

Purpose

To determine the most frequently taught procedures and how important it is to teach these procedures in Family Nurse Practitioner (FNP) programs in the United States according to FNP program directors.

Data Sources

Each of the 178 directors of FNP programs in the United States was mailed a survey to complete anonymously. The survey, designed for this study, listed 78 procedures. Directors were asked to indicate whether or not the procedure is taught in their FNP program and how important they think itis that FNP programs in the United States should teach that procedure. A total of 114 (64%) responded.

Conclusions

A total of 10 of the 78 procedures were taught in 50% or more of the FNP programs. These procedures were; obtaining Papanicolau smears, testing visual acuity, audiometry, tym‐panometry, splinting of extremities, interpret‐ing 12‐Lead electrocardiograms, interpreting blood gases, local infiltration of anesthetics, single layer wound closure, and fluorescein staining of the eyes. The directors believed that six of these were very important to teach in FNP programs.

Implications for Practice

The findings of this study can be used to plan course content related to procedures in new FNPprograms or to revise course content in existing programs. The study results are helpful to individuals who develop continuing education courses to target skills that NPs may find valuable or may need for their current employment setting but were not taught in their educational programs.
Guidelines for the Diagnosis and Management of Asthma: Update on Selected Topics 2002
Authors: Goolsby Mary Jo , Judd Deborah M.
Published: May 2005

Asthma is an extremely common disorder, affecting more than 17 million people in the United States. Asthma is the most frequently treated chronic disease in primary care settings and affects patients of all ages. The recently published update to the NHLBI asthma diagnosis and management guidelines, a valuable resource for NPs in all specialties, is summarized in this column.
Primary Care Management of Sexually Transmitted Urethritis in Adolescent Males
Authors: Lindberg Claire E.
Published: May 2005

Purpose

To describe current knowledge about diagnosis, screening, and treatment of sexually transmitted urethritis among adolescent and young adult males.

Data Sources

Current research, systematic reviews, consensus guidelines and the author's clinical experience.

Conclusions

Urethritis, the most common sexually transmitted syndrome in young males, is most frequently caused by Chlamydia trachomatis and/or Neisseria gonorrhea. Symptoms include dysuria and penile discharge, although up to 50% of males are asymptomatic. Risky sexual behaviors and lack of access to healthcare increase incidence of this infection. Transmission to female partners can lead to pelvic inflammatory disease, infertility, and neonatal infection.

Implications for Practice

Young males with urethritis must be treated as soon as diagnosis is established. Consensus guidelines exist for diagnosis and treatment of gonococcal and non‐gonococcal urethritis. Careful patient education is necessary to ensure successful treatment. Prevention of repeat infections requires partner treatment and detailed education about safer sexual practices. Improved access to preventive services for young males should be a healthcare priority.
Recognizing and Managing Celiac Disease in Primary Care
Authors: Michael Melanie
Published: May 2005

Purpose

To heighten the awareness of primary care clinicians regarding the prevalence, clinical manifestations, diagnosis, and treatment of celiac disease (CD) in the primary care setting.

Data Sources

Selected research, clinical guidelines, research and clinically based articles from current scien‐tific literature, and current medical textbooks.

Conclusions

Celiac disease is commonly under diagnosed or misdiagnosed. Until recently, it was considered rare in the United States. New data indicate that 1:150 Americans are affected and demonstrate the protective effects of early diagnosis and treatment.

Implications for Practice

Delays in the diagnosis and treatment of CD increase the risk of early mortality, associated autoimmune disease, neurologic complica‐tions, gastrointestinal malignancy, and fetal growth retardation, where pregnancy precedes diagnosis. Primary care clinicians must culti‐vate a high index of suspicion for CD in the primary care setting and bear it in mind as a differential diagnosis in many clinical situations.
A Systematic Review of the Effectiveness of Garlic as an Anti‐Hyperlipidemic Agent
Authors: Alder Ryan , Lookinland Sandra , Berry Judith A. , Williams Mary
Published: May 2005

Purpose

To 1) conduct a thorough search of the literature for randomized controlled trials (RCTs) addressing the efficacy of garlic as an antihy‐perlipidemic agent, 2) critically appraise those studies, and 3) make a recommendation for practicing health care professionals.

Data Sources

Two independent reviewers extracted data from the articles identified from several data bases, using the previously tested Boyack and Lookinland Methodological Quality Index (MQI) as the standard.

Results

Six of ten studies found garlic to be effective. The average drop in total cholesterol was 24.8 mg/dL (9.9%), LDL 15.3 mg/dL (11.4%), and triglycerides 38 mg/dL (9.9%). The over‐all average MQI score was 39.6% (18%‐70%). Major shortcomings of many of the RCTs included short duration, lack of power analysis and intention to treat analysis, as well as lack of control of diet as a confoundingvariable.

Conclusion/Implications

The low methodological quality of the studies make it difficult to recommend garlic as an antihyperlipidemic agent. Until larger RCTs of longer duration, which correct the existing methodological flaws, are designed and carried out, it is best not to recommend garlic be used to treat mild to moderate hyperlipidemia.
An Analysis of Expert Nurse Practitioners’ Diagnostic Reasoning
Authors: Ritter Barbara J.
Published: May 2005

Purpose

To examine whether the Information Processing Model or the Hermeneutical Model or a combination ofthe two models best describes expert nurse practitioners (NPs) diagnostic reasoning.

Data Sources

Content analysis of “think‐aloud” verbaliza‐tions elicited while diagnosing a patient were used todescribe diagnostic reasoning behaviors. Post‐session interviews were also used to identify diagnostic reasoning behaviors in NPs’ practice.

Conclusion

Results indicate that NPs use the information processing Model 55% of the time and the Hermeneutical Model 45% of the time. Reasoning behaviors do not strictly exemplify individual components of either model.

Implications for Practice

Educators may need to devise additional methods to develop novice NPs’ clinical reasoning. This may require changes in the NP curriculum. Students need to identify significant clinical data, determine the meaning of data, and reason about patient problems in ways aligned to those of expert practitioners.
All in the Family: Resources and Referrals for Alcoholism
Authors: Barnett Mary Ann
Published: May 2005

Purpose

To emphasize the family as the unit of treatment when one member has alcoholism, discuss the impact of alcoholism on families, and identify resources and referrals available for primary care nurse practitioners (NPs) to assist the patient and family in improving recovery outcomes and family function.

Data Sources

Extensive review of current research, literature, and Internet‐based resources, supplemented and illustrated with a case study.

Conclusions

Alcohol dependency flourishes within the social context of the family system and is one of the leading causes of family dysfunction. Understanding the impact that alcoholism has on the family system and being familiar with resources and referrals are critical facets of the overall management of treatment for the patient and family.

Implications for Practice

Patients often seek health care in a primary care clinic for treatment of medical problems related to alcohol use or abuse, and the primary care NP is frequently the initial point of contact. It is imperative that the family be recognized as the unit of treatment and be included in the treatment plan. As the first line of defense, primary care NPs play a critical role in making appropriate referrals for management of family alcoholism. Helping families make changes leads to improved functioning and recovery outcomes for patients with alcoholism as well as to improved family function.
Diagnosis and Treatment of Heel Pain
Authors: Goolsby Mary Jo
Published: May 2005

The American College of Foot and Ankle Surgeons (ACFAC) clinical practice guideline (CPG) summarizes the literature on the assessment and diagnosis of heel pain. The framework classifies heel pain depending on whether the cause is mechanical, neurological, arthritic, traumatic, or from another origin. Treatment strategies are included for the most common form of heel pain that are caused by mechanical problems.
The Discovery of Unique Nurse Practitioner Theory in the Literature: Seeking Evidence Using an Integrative Review Approach
Authors: Nicoteri Jo Ann , Andrews Caryn
Published: May 2005

Purpose

To determine if theory unique to nurse practitioners (NPs) exists and to describe the attributes of such theory.

Data Sources

An integrative review of the literature was used. CINAHL and MEDLINE were searched using key terms such as nurse practitioners, theory, or research. Forty‐five articles contributed to the final analysis.

Conclusions

The NP role evolved from nursing yet is heavily influenced by medicine. This integration may affect both the use of theory in NP literature and the types of theories that are used to guide NP literature generation and research. Evidence was found of emerging theory unique to NPs with theoretical origins grounded in nursing, medicine, and social science.

Implications for Practice

NPs are beginning to develop theories of “nurse practitionering.” This development is imperative for NP education, practice, and research to further the knowledge of the discipline and to help articulate the unique body of knowledge possessed by NPs.
Knowledge of AIDS, Perceived Risk of AIDS, and At–Risk Sexual Behaviors Among Older Adults
Authors: Maes Cheryl A. , Louis Margaret
Published: May 2005

Purpose

To identify older adults' knowledge of acquired immune deficiency syndrome (AIDS), perceptions of their risk of AIDS, and at‐risk behaviors by using a questionnaire derived from the health belief model.

Data Sources

A descriptive correlation design was used to survey persons 50 years of age and older who participate in university‐based senior programs. The sample of 166 persons (55% return rate) had a mean age of 71 years and included 33% males. The sample is representative of the participants in these programs.

Conclusions

Five hypotheses based on the health belief model were tested. Statistical analyses showed significant predictors of the likelihood of using recommended safe sexual practices were gender, knowledge of AIDS, perceived susceptibility to AIDS, and perceived threat of AIDS. The results indicated the respondents were knowledgeable about human immunodeficiency virus (HIV) transmission through casual contact and medical aspects of AIDS. Although the respondents recognized the seri‐ousness of AIDS, they generally did not believe that they were susceptible to this disease, even though about 10% indicated sexual activity outside of a long‐term relationship.

Implications for Practice

The study findings support the need for nurse practitioners to assess sexual behaviors in and provide information about safe sex practices to older clients because of the documented rising incidence of AIDS in persons over 50 years of age.
An Approach to Postmenopausal Osteoporosis Treatment: A Case Study Review
Authors: Kessenich Cathy
Published: May 2005

Purpose

To review and discuss the clinical evaluation and therapeutic options for a postmenopausal woman with osteoporosis.

Data Sources

Review of scientific literature, practice guidelines, and a case study.

Conclusions

To prevent and treat postmenopausal osteoporosis, women should be encouraged to per‐form weight‐bearing exercise, to not smoke, and to optimize calcium and vitamin D intake through diet and supplements. Drug regimens are effective and well tolerated in post‐menopausal women with osteoporosis.

Implications for Practice

Drugs currently approved by the U.S. Food and Drug Administration for the treatment of postmenopausal osteoporosis include the bisphosphonates risedronate and alendronate; the selective estrogen receptor modulator, raloxifene; and intranasal calcitonin‐salmon spray. Bisphosphonates have demonstrated the most impressive fracture risk reduction in prospective clinical trials of women with post‐menopausal osteoporosis. Risedronate has consistently demonstrated significant reductions in vertebral fracture risk at 1 year and in vertebral and nonvertebral fracture risk at 3 years. Alendronate has demonstrated significant reductions in vertebral and nonvertebral fracture risk after 3 years.