bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating interventions to delay the progression of prediabetes to type-2 diabetes mellitus in an uninsured Hispanic population
Authors: Botah-Oduro Ophelia , Talley Michele H. 
Published: September 2020

ABSTRACT

Background:
Diabetes is a chronic progressive disease affecting 34 million Americans. The Centers for Disease Control and Prevention estimates that 12.5% of people aged 20 years or older diagnosed with diabetes are Hispanic. The American Diabetes Association further estimates that 84.1 million Americans aged 20 years and older have prediabetes based on fasting blood sugar and hemoglobin A1c (HbA1c) levels alone.

Local problem:
In Georgia, the overall rate of diagnosed diabetes is 9.7%, undiagnosed is 6.5%, and prediabetes is 1.1%. The prevalence of diabetes for the Hispanic population in Georgia is 9% and is 10% among Clayton County residents. The purpose of this quality improvement project (QIP) was to evaluate interventions implemented to delay the progressions of prediabetes to type-2 diabetes in an uninsured Hispanic population.

Methods:
Retrospective chart review was conducted comparing pre- and postmeasurements for HbA1c and body mass index (BMI) in Hispanic patients identified as having prediabetes.

Interventions:
Patients with HbA1c of 5.7–6.1% were provided with a diabetes tool kit, whereas patients with an HbA1c of 6.2–6.4% were given the diabetes tool kit plus metformin.

Results:
A decrease in mean HbA1c was noted in both groups of patients. However, a paired sample t-test indicated nonsignificant decrease in HbA1c for the diabetes tool kit group (p = .51) but significant decrease for the diabetes tool group kit plus metformin group (p < .01).

Conclusions:
Although this QIP did not reveal statistically significant changes in HbA1c and BMI for both groups, the results were clinically significant among this Hispanic population.
Quality of life among women veterans
Authors: Devine Debbie T. , McMillan Susan C. , Kip Kevin , Powell-Cope Gail 
Published: September 2020

ABSTRACT

Background:
Of 23 million US veterans, 2 million are women. Female veterans often have physical and mental health disorders, but only 6.5% use the Veterans Health Administration (VA) system. Health care for women veterans is challenging in a health care system unfamiliar with this population.

Purpose:
The purpose of this study was to investigate how receipt of treatment by female veterans at a VA women's health specialty clinic affected levels of distress, quality of life (QOL), and depression.

Methods:
A retrospective record review was completed on 51 female veterans between the ages of 40 and 60 years attending a VA clinic. The clinic provides comprehensive women's health services to female veterans. Multiple linear regression models were fit to explore QOL and depression levels with socioeconomic status, parity, years of service, and military sexual trauma (MST).

Results:
Female veterans had significantly lower baseline scores for QOL than did a comparison group. The only significant predictor associated with higher health-related symptom scores at baseline was a history of MST (β = 0.363; t = 2.44; p = .02). Means and standard deviations for total scores were significantly higher than those of the comparison group. Higher symptom scores indicated lower QOL among female veterans.

Implications for practice:
Study findings suggested that timely, comprehensive, gender-specific health care can significantly improve overall QOL and depression levels. Nurse practitioners play a leading role in providing primary care to this population with significant potential to impact QOL, depression levels, and overall health of female veterans.
Implementation of the chronic obstructive pulmonary disease Assessment Test in clinical practice
Authors: Abrams Meghan E. 
Published: September 2020

ABSTRACT

Background:
The chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) is a questionnaire used for COPD symptom assessment that is valid, reliable, and evidence based; yet, few specialty or primary care practices have formally implemented it in practice.

Local problem:
The University of Colorado's pulmonary division has consistently been rated the best in the country by US News and World Reports; however, the dedicated multidisciplinary COPD clinic at the University had yet to formally implement any COPD Assessment tools for COPD symptom management. This quality improvement project focused on the successful implementation of the CAT for management of COPD and whether its use impacts symptom management.

Methods:
Plan-Do-Study-Act cycles were used to implement the CAT questionnaire in the outpatient COPD clinic from April 16 to September 30, 2019. Weekly retrospective chart evaluation was completed to evaluate CAT completion, documentation, and associated medical intervention rates. Weekly patient phone surveys were completed on qualifying COPD patients to garner patient opinion on the utility of the CAT in symptom management.

Interventions:
The CAT was administered to all COPD patients in University of Colorado Hospital's COPD clinic. Cat-themed signs, decorations, and treats were provided to staff on COPD clinic days to increase staff buy-in.

Results:
The CAT was completed on 217 of 245 (89%) patients with COPD. Of patients surveyed, 81% (n = 53) noted that their symptoms were better managed after CAT implementation.

Conclusions:
Implementation and utilization of COPD assessment tools, like the CAT, are practical and sustainable in a specialty practice setting. Moreover, the CAT helps with COPD symptom management.
Exploring family nurse practitioner professional identity formation at rural health care facilities
Authors: Owens Rhoda A. 
Published: September 2020

Background:
Nurse practitioners (NPs) are being used to meet the increased demand for rural primary care.

Purpose:
The purpose of this study was to explore the perceptions and experiences of rural NPs while they transitioned from being registered nurses to family NPs (FNPs). In addition, the study examined if and how new FNPs experienced their professional identity formation in their first year of rural primary care practice.

Methodological orientation:
A qualitative phenomonological research design was used.

Sample:
A sample of 12 FNPs who graduated from one of three Midwestern university programs, worked, and provided primary care at a rural health care facility located in one of four full-practice states were used within the study.

Conclusions:
Participants experienced new nurse practitioner professional identity formation beginning in their education programs, which continued throughout their first year of practice. Four themes emerged from the data analysis: learning new knowledge, skills, roles, and responsibilities; interactions with patients, providers, and interprofessional team members; incentive to learn and practice in rural health care; and professional identity formation.

Implications for practice:
The emerging model, The Process of Professional Identity Formation for Rural Family NPs, shows potential for use as a framework to guide rural NP curriculum and professional development programs. Policy makers must also continue the push to increase the number of states allowing NPs full independent practice. These efforts could promote rural NP support, recruitment, and retention that will be key to meeting the primary care needs of rural and vulnerable populations.
Recent evidence of nurse practitioner outcomes in a variety of care settings
Authors: Geller Daniel E. , Swan Beth Ann 
Published: September 2020

ABSTRACT
When nurse practitioners (NPs) work to expand their scope of practice through state legislatures, the opposing lobbying groups are often physician-led organizations. The main argument against NP independence and limited scope of practice is that NP care is inherently inferior to that of physicians. However, more than three decades of research demonstrates quality and cost outcomes to be equal to or better than that of physicians. This article reviews a wide range of evidence documenting NP competency, satisfaction, and safety, as well as the challenges and consequences when limiting NP scope of practice. The evidence is clear and has not changed in over 30 years, NPs provide access to effective primary care in a variety of settings, equal in quality outcomes, safety, and cost-effectiveness compared with physicians.
Developing the advanced practice nursing role in Slovakia: Perception, education, and practice
Authors: Grešš Halász Beáta , Majerníková L'udmila , Obročníková Andrea , Hudáková Anna , Vojteková Marta 
Published: September 2020

ABSTRACT

Background:
Advanced practice nursing (APN) is a modern and effective nursing role that has a positive impact on health care systems around the world. Guiding principles are advanced education, expanded scope of practice, and policies supportive of the role.

Purpose:
The aim of this study was to find out the perception of APNs of their own practice in the context of the current legislative conditions in Slovakia and to identify related factors.

Methods:
A quantitative exploratory design was selected. From 5,067 APN, 584 were conveniently selected. The adapted and modified SCAPE study questionnaire was used for data collection. Data were processed using SPSS 25.

Results:
There were differences between newly introduced competencies for the APN role in Slovakia and the general concept of the role that could influence practice. The level of APNs' perception of their own practice is low. Years of practice was significantly and positively related to the perception. The results in each region were significantly different. Community nurses/outpatient nurses assessed their practice at a significantly higher level. The educational curriculum lacks the subject of APN. Competencies, remuneration, and satisfaction with the status are insufficient.

Implications for practice:
To understand, implement, and practice the concept of APN, it is essential to change policies related to competencies, education, remuneration, and status. Creation of an educational model that includes the subject area of advanced practice nursing in the postgraduate curriculum is essential. Education and practice conditions for advanced practice nurses should be uniform in all regions of the country.
Improving the rate of colorectal cancer screening with the “80% in every community” campaign
Authors: Morrow Linda , Greenwald Beverly 
Published: September 2020

ABSTRACT
Colorectal cancer (CRC) ranks third in both cancer diagnoses and cancer-related deaths in men and women in the United States. Fortunately, both incidence and deaths have declined due to the increased use of CRC screening to find and remove precancerous polyps and to diagnose CRC at earlier, more treatable stages. Deaths from CRC have shifted to a new demographic, with a recent increase in incidence of 2% per year in people younger than 55 years. The American Cancer Society has issued a qualified recommendation that screening start at the age of 45 years because of this increase in early-onset CRC. There are multiple CRC screening test options. Professional organizations vary in their screening guidelines, but regardless of these differences, screening has been shown to save lives. Currently, one out of every three adults aged 50–75 years are not screened as recommended. The National Colorectal Cancer Roundtable (NCRCRT) has placed a high priority on screening people who remain unscreened. Nurse practitioners can improve the screening rates in outpatient clinics and health systems by adopting the campaign, “80% in Every Community,” which has a goal to reduce disparities and improve screening rates in underserved and rural populations. The NCRCRT resources will help clinics and health systems reach the screening goal of 80% in every community.
Menstrual suppression in girls with disabilities
Authors: Hopkins Casey S. , Fasolino Tracy 
Published: September 2020

ABSTRACT

Background:
Girls with disabilities and their caregivers are challenged during pubertal transitions, particularly with menses onset. More than 50% of caregivers report concern and anxiety related to menarche, and they have sought health care providers to discuss options. Menstrual suppression planning and education from nurse practitioners (NP) is key to ensure quality of life for these girls and their caregivers.

Objective:
The purpose of this systematic review is to examine and evaluate the state of the science surrounding the use of medical modalities for menstrual suppression in adolescent girls with disabilities.

Data sources:
Articles were identified through systematic electronic search of the following databases: CINAHL, Medline, Health Sources: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection, PsycINFO, Cochrane Register of Controlled Trials, and Academic Search Complete.

Conclusions:
Results indicate that the most common medical modality used for menstrual suppression in girls with disabilities is the combined oral contraceptive pill, but depot medroxyprogesterone acetate and levonorgestrel-releasing intrauterine system have been recommended. Concerns related to menstrual suppression include expressed wishes of the girl and her caregivers, existing comorbid conditions, and risks associated with medical modalities used for suppression.

Implications for practice:
Meaningful conversations about concerns and expectations related to pubertal transitions are essential to ensure smooth transitions. NPs should provide counseling and discuss the variety of interventions available for menstrual suppression, being mindful of the need for comprehensive gynecological care. Additional studies using robust methods, including longitudinal and prospective strategies, are needed to better inform NPs of the goals and desirable outcomes for these girls and their caregivers.
Prescriptive practice differences between nurse practitioners and physicians in the treatment of uncomplicated urinary tract infections in the emergency department setting
Authors: O'Neill Daniel , Branham Steve , Reimer Andrew , Fitzpatrick Joyce 
Published: September 2020

ABSTRACT

Background:
Nurse practitioners (NPs) have increasingly broad prescribing authority, yet there is insufficient information available on the prescribing practices of NPs working in the emergency department setting.

Purpose:
The purpose of this study was to describe prescriptive practices between two provider groups, NPs and physicians, in an emergency department setting in the United Arab Emirates. This comparison focused on treatment of a common emergency department diagnosis of uncomplicated urinary tract infection (UTI).

Methods:
The investigators reviewed a sample of 690 UTI patients during the period of August 30, 2016 to June 30, 2018. Physician and NP provider groups were then assessed for treatment selection and associated patient outcomes. A Chi-square test was used to compare empiric antibiotic selection using variables of population type, gender, age, and provider type.

Results:
There were similar prescriptive practices for beta-lactam, nitrofurantoin, and trimethoprim prescriptions. The investigators noted a statistical difference for fluoroquinolone use, with the physician group selecting fluoroquinolones more often than the NP group. Also, fluoroquinolone use within the physician group varied significantly; however, the investigators did not see this within the NP group.

Implications for practice:
The findings support that there is comparable care quality in the treatment of uncomplicated UTIs between physician providers and NPs in this setting. Comparing outcome similarities and differences on a commonly occurring medical problem in the emergency department provides an early look at the value-added services that NPs provide.
Clinical practice guideline for primary care providers in the management of antidepressant-induced hyperhidrosis: A quality improvement project
Authors: Thompson Summer , Johnson Deborah , Lindgren Teri , Compton Laura , Chen Jyu-Lin 
Published: September 2020

ABSTRACT

Background:
Antidepressant-induced excessive sweating (ADIES) is a side effect that occurs in approximately 22% of patients taking antidepressant medications and can negatively affect patient medication adherence.

Local problem:
Primary care providers may not have adequate knowledge of ADIES management. The aims of this project were to increase primary care provider's overall perceived knowledge related to ADIES, improve confidence in the management of ADIES, and gather input on the perceived usefulness of the initial clinical practice guideline (CPG) for ADIES management.

Methods:
This quality improvement (QI) project consisted of two phases. Phase 1 included the development of a CPG for the pharmacologic management of ADIES based on processes recommended by the Institute of Medicine.

Interventions:
Phase 2 of the project consisted of a pretest–posttest design pilot of the guideline via a “Lunch and Learn” educational session at a Federally Qualified Health Care Center located in the Northern California.

Results:
The results indicated that after exposure to the CPG and participation in the educational program about the guideline, there was an overall significant improvement in provider knowledge and confidence about identification and management of ADIES in their practice.

Conclusions:
Although small in scope, this QI project provides important avenues for further implementation and dissemination of the guideline to manage ADIES. The potential for improved patient care and medication adherence support the usefulness of the implementation of this guideline in other locations.
How nurse practitioners can advocate for local, state, and federal policy to promote colorectal cancer prevention and screening
Authors: Morrow Linda , Greenwald Beverly 
Published: September 2020

ABSTRACT
Colorectal cancer (CRC) is the second most common cause of cancer deaths for men and women, combined, even though it is the most preventable, treatable, and beatable cancer. Polyp removal during colonoscopy is one major way to help prevent CRC, but it can also be prevented by modifiable risk factor reduction. The National Colorectal Cancer Roundtable's campaign “80% in Every Community” is an effort to address disparities in the less-screened populations and communities. The nurse practitioner (NP) can assist health care organizations to develop policies for high-quality screening programs and create system changes to promote CRC prevention and screening. Professional organizations provide an easy way to become involved in policy change at the health system, local, state, and federal levels. State and federal policies affect patient access to care and adherence to the CRC prevention and screening recommendations. Fourteen states have not yet elected to expand Medicaid. Every NP has the knowledge, skills, and ability to advocate for the expansion of Medicaid in these remaining states to reduce this access to care barrier for underserved patients and communities.
Nurse practitioners' experiences of polypharmacy in community-dwelling older adults
Authors: Pariseault Christine A. , Sharts-Hopko Nancy , Blunt Elizabeth 
Published: September 2020

ABSTRACT

Background:
Numerous studies have defined polypharmacy and its impact on health. The literature is also rich in studies documenting the benefits of care provided by nurse practitioners (NPs). A gap in research exists at the intersection of the value of NPs in caring for older adults and their management of polypharmacy.

Purpose:
Coinciding with growth in America's older adult population and the need for adequate care, the purpose of this study was to explore the experiences of NPs caring for community-dwelling older adults experiencing polypharmacy.

Methodological orientation:
A qualitative descriptive study was conducted. Interviews were conducted, and data were analyzed for themes.

Sample:
This study was conducted using a purposive sampling of NPs who care for older adults (n = 15).

Conclusions:
Four themes emerged: defining polypharmacy, communicating and collaborating, clinical judgement of NPs in relation to polypharmacy, and medication issues of older adults. The themes depict the complexity of medication management in older adults and the important role of NPs in providing care to older adults.

Implications for practice:
The significance of the study findings to future practice includes improving communication and collaboration between prescribing health care providers, better identification and management of polypharmacy, and improving the health care delivered to older adults. Safe and effective prescribing for older adults requires that NPs consider the unique needs of each older adult while using technology to support collaboration and decision making.
Initiation of HIV pre-exposure prophylaxis in adolescents and young adults: Barriers and opportunities
Authors: Mocorro Igor , Sandhu Prabjot Jodie , Rowniak Stefan , Leonard Adam 
Published: September 2020

ABSTRACT

Background:
Adolescents and young adults (AYA) ages 13 to 24 years comprise a quarter of the new HIV diagnoses in the United States. Lack of access to HIV-preventive biomedical tools such as pre-exposure prophylaxis (PrEP) reduces opportunities to prevent HIV infection in this population. Initiating PrEP in AYA significantly reduces the negative health outcomes of HIV, but many providers are still reluctant to initiate PrEP in their AYA patients based on perceived threats and barriers.

Objectives:
This review aims to highlight the barriers and opportunities for initiating PrEP services in AYA and provides recommendations for PrEP services in this population.

Data sources:
Ten scholarly articles rated levels IIA through IIIB were identified using the Johns Hopkins Evidence-Based Practice ratings. These included quasi-experimental and nonexperimental publications. Both quantitative and qualitative data contributed to identifying perceived barriers, opportunities, and recommendations for increased PrEP access and prescription in AYA.

Conclusions:
Pre-exposure prophylaxis is a vital component of a robust HIV prevention program. Themes that emerged hindering optimal PrEP utilization in AYA included provider-related barriers (e.g., knowledge deficit, lack of familiarity with PrEP guidelines, and protocols), patient-related barriers (e.g., lack of awareness, confidentiality issue, and HIV stigma), and structure-related barriers (e.g., lack of AYA-friendly clinics and insurance coverage).

Implications for practice:
Providers in any setting should be able identify at-risk AYA and prescribe PrEP accordingly. Nurse practitioners should make PrEP accessible to AYA by addressing the barriers to PrEP utilization, prescribing, and continuity of care. Nurse practitioner curriculum, training, and continuing education should include PrEP for AYA.