bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wait Time and Satisfaction with Care and Service at a Nurse Practitioner Managed Clinic
Authors: Cole Frank L. , Mackey Thomas A. , Lindenberg Julie 
Published: August 2010

PurposeTo examine the relationships among the various times patients wait for health care and patient satisfaction with nurse practitioner (NP) care and the service component of care in a NP developed and managed clinic.Data SourcesFortyseven patients (78% response rate) responded anonymously to a 15‐item questionnaire that measured satisfaction with NP care and an additional 15 items that measured satisfaction with the service component of care. Actual clock times were recorded on a flow sheet that corresponded to the system of care at this clinic.ConclusionsUsing Pearson Product‐Moment Correlation, there were no statistically significant relationships among various wait times and the measures of satisfaction.Implications for PracticePatient satisfaction with NP care is an important indicator of quality of care. Although satisfaction was not related to wait times, NPs must be respectful of the amount of time that patients wait for health care.
AACE Hyperandrogenism Guidelines
Authors: Goolsby Mary Jo 
Published: August 2010

The problems associated with hyperandrogenism are not uncommon in primary care settings. In fact, polycystic ovary syndrome, a common cause of androgen excess, exists in 5% to 10% of women during their reproductive years, with onset typically in adolescence. The subject of this column is the AACE's Hyperandrogenism Guidelines, which review the evaluation and treatment of the disorders causing androgenic excess.Readers are encouraged to submit ideas and manuscripts for future CPG columns. The column editor can be contacted at: mjgoolsby@home.com or mgoolsby@uh.org.
Assessing Diagnostic Accuracy and Tympanocentesis Skills by Nurse Practitioners in Management of Otitis Media
Authors: Sorrento Ann , Pichichero Michael E. 
Published: August 2010

PurposeTo assess healthcare provider accuracy in rec‐ognizing the physical examination findings of acute otitis media (AOM) and otitis media with effusion (OME) and technical compe‐tence in performing tympanocentesis using a simulation model.Data SourcesA descriptive study of 1,271 pediatricians and 206 nurse practitioners (NPs) who viewed 9 dif‐ferent video‐recorded pneumatic otoscopic examinations of tympanic membranes (TMs) during a continuing medical education (CME) course. Diagnostic differentiation of AOM, OME and normal was ascertained. A mannequin model of a one‐two year old child was used to assess technical proficiency of performing tympa‐nocentesis on artificial tympanic membranes.ConclusionsOverall, the average correct diagnosis by all healthcare providers was 46% (range=25% to 71%); by pediatricians it was 50% (25% to 71%) and by NPs 42% (25% to 68%). Pediatricians and NPs correctly recognized the absence of normality 86% to 99% and 68% to 99% of the time; they over‐diagnosed AOM in 7% to 58% (average 27%) and 10% to 65% of examinations (average 31%), respectively. Performance of tympanocentesis was optimal‐ly performed by 73% of NPs.Implications for PracticeThe distinction between AOM and OME is important for antibiotic management deci‐sions; tympanocentesis may be useful in diag‐nosis of AOM in selected patients. Healthcare providers may misdiagnose AOM and OME with some frequency. Nurse pactitioners and pediatricians have the skills to be trained in the tympanocentesis procedure. Interactive CME courses with simulation technology may enhance skills and lead to a willingness to change and improve diagnostic accuracy and treatment paradigms.
Individualizing Care of Hepatitis B in Older Adults and Asians
Authors: Fu Helen N. C. 
Published: August 2010

PurposeTo review the pathophysiology of hepatitis B virus (HBV) as it relates to special groups such as older adults and Asian populations and to stratify preventive services relative to these particular populations.Data SourcesSelected scientific literature and practice guidelines.ConclusionsThe HBV is one of the most common causes of viral hepatitis. Acute infection is mostly self‐limiting with nonspecific symptoms. Chronic infection is characterized by persistent serum levels of Hepatitis B surface antigen (HBsAg) for more than six months.Implications for PracticeChronic HBV is a major risk factor for hepa‐tocellular carcinoma. Special populations, such as older adults with decreased immune response and Asians from places with high endemic HBV infection, are at particularly high risk for progression of HBV infection to chronic states and serious liver damage.
Lyme Disease
Authors: Schumann Lorna , Wright Donna 
Published: August 2010

PurposeTo review the presentation, treatment, and prevention of Lyme disease in primary care.Data SourcesSelected articles from the scientific literature and the Centers for Disease Control.ConclusionsLyme disease is a tick‐borne, multisystem inflammatory disease with worldwide distribution caused by the spirochete Borrelia burgdor‐feri. Lyme disease is initially characterized by a spreading, annular erythema migrans skin rash and can disseminate to the musculoskeletal, neurologic, or cardiovascular system. Stages of the disease present with varying clinical mani‐festations.Implications for PracticeTreatment of Lyme disease with appropriate antimicrobial therapy should be prompt in order to avoid debilitating outcomes. Awareness of the many presentations of Lyme disease in endemic areas may facilitate a timely diagnosis and appropriate treatment.
Primary Care Providers' Views of Precepting Nurse Practitioner Students
Authors: Lyon Debra E. , Peach JoAnne 
Published: August 2010

PurposeTo explore perceived barriers to and facilitators of precepting as viewed by experienced community‐based preceptors.Data SourcesTwenty‐four nurse practitioner and physician preceptors participated in a 20‐minute telephone interview, using a semi‐structured format. The interviews were audio‐taped and transcribed. Constant comparative analysis was used to organize the preceptors' responses into thematic categories.ConclusionsOverall, most preceptors were satisfied with the precepting experience; however, many preceptors cited increasing difficulty with teaching students in primary care sites due various organizational constraints such as the imperative to increase productivity. Good communication with school of nursing faculty was cited as the key factor to continued willingness to precept.Implications for PracticeUnderstanding factors that are important for preceptors continuing in their clinical teaching role is important for schools of nursing, especially given the increasing time‐limitations that many providers face due to social and economic changes in health‐care delivery.
Congestive Heart Failure: Understanding the Pathophysiology and Management
Authors: Fletcher Lynn , Thomas Debera 
Published: August 2010

PurposeTo explain key concepts involved in the development and management of congestive heart failure (CHF). An overview of medications commonly used in the treatment of CHF is also presented.Data SourcesSelected clinical articles, major research studies, and clinical guidelines.ConclusionsThe prevalence of CHF continues to increase and in the United States alone accounts for more than two million outpatient clinic visits per year at a cost of more than $10 billion annually. With the growing number of people over age 65, coupled with the advances in medical technology, primary care providers are treating many more patients with CHF.Implications for PracticeA thorough understanding of the pathophysiology, especially the compensatory neurohormonal systems and ventricular remodeling that are the hallmarks of CHF, is essential for consistent application of the principles of management of this complex condition. Multidisciplinary approaches led by advanced practice nurses have excellent outcomes and improve the quality of life of patients with CHF.
Peyronie's Disease: Assessment and Treatment
Authors: Schumann Lorna , Reesor Linda E. 
Published: August 2010

PurposeTo describe the assessment, diagnosis, appropriate testing, and available treatment options for Peyronie's disease.Data sourcesSelected articles from the medical literature, standard textbooks and online resources.ConclusionsClinical hallmarks of the disease include palpable, fibrotic plaques, temporary painful, penile curvature during erection and decreased rigidity of the penis.Implications for practiceTreatment options range from watchful waiting to surgery. Several promising medications, including vitamin E, are being investigated.
Urinary Tract Infection
Authors: Goolsby Mary Jo 
Published: August 2010

Clinical Practice Guidelines (CPG) are widely available and published by many sources. CPGs hold great potential for application in practice. The best summarize a large amount of clinical and scientific evidence on a particular topic, in a format that informs practice. This series provides a monthly review of one of the many available CPGs. The CPG reviewed in this month's column provides recommendations for a very common problem: urinary tract infection in women. It is expected that this CPG will have broad application.Readers are encouraged to suggest specific CPGs for future columns or to request that the editor search for and summarize a CPG addressing a common health problem. Readers are also invited to submit a manuscript reviewing CPGs that they find helpful in their area of practice.
Primary Care Assessment and Management of Sleep Disorders
Authors: Schumann Lorna , Elliott Ann Christy 
Published: August 2010

PurposeTo review the functions of sleep and describe an appropriate sleep assessment for the identification of sleep disorders for nurse practitioners (NP) in primary care. Guidelines for management and referral are included.Data SourcesSelected scientific literature, national consensus guidelines, and the author's experience.ConclusionsThe incidence of sleep deprivation in the United States is generally unacknowledged by the public as well as health care professionals. Unfortunately, the catastrophic and debilitating consequences that result from alterations in sleep are usually noted after significant physical and emotional damage have occurred.Implications for PracticeAn assessment of sleep hygiene and the physical, emotional, or lifestyle changes that alter sleep patterns should be a part of the NP's routine encounter with patients. Referral is indicated for suspicion of obstructive sleep apnea, narcolepsy, restless leg syndrome, complex motor activity, or if the condition fails to respond to therapeutic management.
A Review of Current Weight Management: Research and Recommendations
Authors: Davis Robert B. , Turner Lori W. 
Published: August 2010

PURPOSETo review current research and recommendations on weight loss and weight control and provide suggestions for health care providers who furnish weight management counseling.DATA SOURCESScientific publications, clinical guidelines, and government sourcesCONCLUSIONSResearch reaffirms the long‐held understanding that weight loss can be accomplished only through a reduction in the number of calories consumed and an increase in exercise. Weight maintenance requires life‐long behavioral change combining moderate exercise, lower fat intake, increased fruit and vegetable consumption, as well as social support. Fad diets and medications are not the answer to long‐term weight maintenance.IMPLICATIONS FOR PRACTICEThe essential components of a weight loss or weight management program include: calorie reduction of 300–500 calories per day, appropriate exercise, variety in food choices, increased consumption of grains, fruits, and vegetables, and reduction of fat to no more than 30% of daily calories. Clients should be referred to dietitian and exercise consultants as needed.
Polycystic Ovary Syndrome: Implications for the Advanced Practice Nurse in Primary Care
Authors: Markle Mary Elizabeth 
Published: August 2010

PURPOSETo discuss the diagnosis and management of polycystic ovary syndrome (PCOS) by the advanced practice nurse in primary care.DATA SOURCESSelected research and clinical articles.CONCLUSIONSThe disorder is an endocrinopathy characterized by chronic anovulation, resulting in multiple ovarian cysts. Recent research suggests a genetic etiology and a close association with obesity. Patients often present with hyperan‐drogenism, irregular menses, and infertility. Management is directed at the alleviation of individual symptoms.IMPLICATIONS FOR PRACTICEIf left untreated, cardiovascular disease, abnormal insulin metabolism, and ovarian and endometrial cancers may develop.
Smoking Cessation Interventions for Pregnant Women to Prevent Low Birth Weight: What Does the Evidence Show?
Authors: Messecar Deborah C. 
Published: August 2010

PURPOSETo review the epidemiology of smoking cessation and low birth weight (LBW), the use of meta‐analysis and cost‐benefit analysis in analyzing this problem, and the financial considerations of institutionalizing smoking cessation interventions. Recommendations for clinicians caring for smoking pregnant women and suggestions for implementing the recommended strategies for smoking cessation programs are included.DATA SOURCESComprehensive review of smoking and low birth weight (LBW) outcomes, cost‐effective‐ness, and tobacco use and dependence literature; clinical practice guidelines, and a widely cited meta‐analysis on smoking cessation.CONCLUSIONSResearch has shown that smoking is a significant factor in LBW outcomes and that cessation is especially critical for pregnant women.IMPLICATIONS FOR PRACTICECareful evaluation of the intervention research is required before designing local interventions to ensure the most effective measures are utilized.
A Community Needs Assessment for a SANE Program Using Neuman's Model
Authors: Melton Linda , Secrest Janet , Chien Anne , Andersen Barbara 
Published: August 2010

PURPOSETo present guidelines for a community needs assessment for a Sexual Assault Nurse Examiner (SANE) program using Neuman's Systems Model. The guidelines provide advanced practice nurses with a holistic, systematic means to conduct an assessment prior to the implementation of a SANE program and facilitate collaborative work with other disciplines and agencies.DATA SOURCESSelected research‐based articles on sexual assault, classic texts and writings on Neuman's Systems Model, and community assessment models and programs.CONCLUSIONSSexual assault is a problem faced by almost every community. A thorough community assessment is an important first step in establishing programs that adequately meet a com‐munity's needs. Guidelines for conducting such an assessment related to implementation of a SANE program are rare, and guidelines using a nursing model were not found in the literature.IMPLICATIONS FOR PRACTICEOne program that has been successful in meeting community needs is the SANE program. A concise and organized assessment guide can reduce the necessary time and money allocated for a community assessment and can provide a basis for evaluation and research.
Addressing nutritional issues in the college‐aged client: Strategies for the nurse practitioner
Authors: Gores Sarah E. 
Published: August 2010

AbstractPurpose: To educate nurse practitioners (NPs) on the nutritional risks specific to the college‐aged client and provide recommendations for interventions for this group.Data sources: Information was gathered through a literature search as well as the author’s own experience.Conclusions: As young adults move into an independent living situation, there is a high risk for unhealthy eating habits. While this may not translate into the weight gain known as the “Freshman 15,” this is the time period when young adults begin to cement their eating habits. Current research has found that students who gain weight during this period tend to continue a slow, steady gain in weight.Implications for practice: NPs must take every opportunity to provide guidance toward healthy eating habits. Most clients of this age group are seen infrequently by a primary care practitioner. Thus, each visit should be used to explore the topic with clients to minimize adverse outcomes in the future.
Clinical practice characteristics of gerontological nurse practitioners: A national study
Authors: Kennedy‐Malone Laurie , Penny Judith , Fleming Mary Elizabeth 
Published: August 2010

AbstractPurpose:  To determine the clinical practice characteristics of gerontological nurse practitioners (GNPs) in the United States and ascertain whether length of employment, geographic region of practice, work setting, and educational preparation influence GNPs’ delivery of advanced clinical services and clinical procedures.Data sources:  The Gerontological Nurse Practitioner Practice Profile was mailed to a stratified random sample of 1000 GNPs certified by the American Nurses Credentialing Center.Conclusions:  Despite the growing demands for GNPs, of the 472 GNPs who responded to the survey, only half were working full‐time as a GNP. Although the role was established over 30 years ago, 56% of the respondents indicated that they were the first GNP in the position. There was a statistically significant positive relationship between being the first GNP in his or her practice and the percent of primarily medical advanced clinical services performed. GNPs who worked in multiple clinical setting performed more advanced clinical services and medical procedures than GNPs who only worked in one setting.Implications for practice:  This study provides insight into the complex practice characteristics of GNPs. GNPs are combining the nursing skills so necessary to care for older adults with advanced clinical services and clinical procedures deemed medical acts. Various factors influence how GNPs practice, including geographic location, type of practice, and whether the GNP was the first person to be employed as a nurse practitioner at the practice.
Prescribing patterns of gerontological nurse practitioners in the United States
Authors: Kennedy‐Malone Laurie , Fleming Mary Elizabeth , Penny Judith 
Published: August 2010

AbstractPurpose: To identify the prescribing patterns of gerontological nurse practitioners (GNPs) as reported on the Gerontological Nurse Practitioner Practice Profile. Specifically, the study examined (a) GNPs’ frequency of prescribing certain categories of medications for older adults; (b) the influence of practice, education, and experience variables on prescribing practices of GNPs; and (c) the rate of prescribing inappropriate medications for older adults based on the list of medications on the modified Beers Criteria.Data sources: The study was part of a larger descriptive survey that examined the practice characteristics of GNPs using the Gerontological Nurse Practitioner Practice Profile. A stratified random sample of 1000 GNPs certified by American Nurses Credentialing Center was sent surveys; 472 usable surveys were returned. Only the 234 GNPs who indicated that they were currently practicing full time as a GNP were included in this analysis.Conclusions: Ninety‐three percent of the respondents indicated that they had prescriptive privileges. The most commonly prescribed types of medications were analgesics, antihypertensives, cardiovascular drugs, and diabetic medications. The prescribing patterns of these GNPs were not influenced by education, years of practice, or selected practice characteristics. There was a significant difference in the prescribing of inappropriate medication among office‐based GNPs and those who worked in long‐term care settings. The GNPs in the ambulatory care setting had a tendency to prescribe inappropriate medications more frequently than those in long‐term care facilities. Overall, self‐reported prescribing of inappropriate medications among the GNPs participating in this study, however, was low.Implications for practice: The findings of this study indicate that GNPs are prescribing medications for complex medical conditions.
Hyponatremia as a complication of selective serotonin reuptake inhibitors
Authors: Wright Stephanie K. , Schroeter Stefanie 
Published: August 2010

AbstractPurpose: To review the literature on hyponatremia as a complication of selective serotonin reuptake inhibitors (SSRIs) in the elderly; to summarize the prevalence, clinical findings, treatment modalities, and likely pathophysiological mechanisms related to the problem.Data sources: All published articles that could be located since Food and Drug Administration approval of this class of medications in 1987, using MEDLINE, CINAHL, and PsychInfo databases and a case study.Conclusions: Hyponatremia is a potentially serious complication of the use of SSRIs and is statistically more prevalent in the elderly and in females. Few clinical guidelines exist for managing this potential reaction. No evidence‐based guidelines could be located.Implications for practice: Since articles describing this phenomenon have been primarily case studies, many healthcare providers may not be aware of this potentially serious complication. Monitoring of serum sodium in elderly female patients starting SSRI therapy seems prudent.
Experiences of women in obtaining human immunodeficiency virus testing and healthcare services
Authors: Blake Barbara J. , Jones Taylor Gloria A. , Reid Paula , Kosowski Margaret 
Published: August 2010

AbstractPurpose: Over a decade ago, the U.S. Public Health Service recommended routine human immunodeficiency virus (HIV) testing for pregnant women. Despite this recommendation, nearly 30% of pregnant women report not being tested. The purpose of this qualitative study was to describe personal experiences of women in obtaining HIV testing and healthcare services in east Texas.Data sources: A secondary data analysis was conducted using audiotapes and transcriptions from structured group interview data obtained from HIV‐positive and high‐risk negative women residing in east Texas (n = 64).Conclusions: Content analysis revealed three patterns: living with stigma; struggling to be healthy; and getting along, day by day. Additional findings indicated that women are more likely to access HIV testing if they are assured of confidentiality and women living with HIV are more likely to remain in the healthcare system if healthcare professionals are supportive, knowledgeable, and nonjudgmental.Implications for practice: Healthcare professionals must engage in self‐reflection to conscientiously uncover their true feelings related to caring for women with or at risk for HIV disease. Once providers acknowledge that their beliefs and values differ from their clients, they will be able to minimize personal biases that interfere with HIV testing and healthcare services.