bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integrating the Principles of Evidence‐Based Practice Into Clinical Practice
Authors: Klardie Kathleen A. , Johnson Judith , McNaughton Molly Ann , Meyers Wendy , Goolsby Mary Jo 
Published: May 2005

AbstractColumn Editor CommentThis series of articles illustrates many considerations relevant to the application of clinical practice guidelines (CPGs). This particular column describes the actions of a nurse practitioner (NP) striving to understand the foundations of recommendations that are based largely on expert opinion. Although application of CPGs does not generally require this degree of investigation, it is essential that providers understand the processes used to interpret the basis of recommendations, including the application of the basic statistical concepts, when making decisions about how recommendations apply to individual patient scenarios.Utilizing evidence‐based practice when providing patient care requires a range of skills that allows the NP to locate appropriate research evidence, to develop an understanding of the statistics used in interpreting and reporting research, and to evaluate the effects of interventions on patient outcomes. The application of the key concepts of evidenced‐based practice within the primary care setting is explored through a hypothetical patient scenario, which was created as the focal point for three articles that illustrate principles of evidence‐based practice. The goal of this series of articles is to provide a basic understanding of evidence‐based practice and its application in clinical practice.This article explores the use of interventions selected from CPGs and investigates the potential effects of recommended interventions on patient outcomes. Commonly encountered statistical concepts are reviewed, and examples of their application in interpreting and reporting research are demonstrated. The principles of relative risk, relative risk reduction, absolute risk reduction, and numbers needed to treat are described. This review provides the NP with some basic skills to determine both the quality and usefulness of research.
The Role of Genetics in the Risk of Thromboembolism: Prothrombin 20210A and Oral Contraceptive Therapy
Authors: Welker Glade C. , Lookinland Sandra , Tiedeman Mary E. , Beckstrand Renea L 
Published: May 2005

PurposeTo provide an overview of the prothrombin 20210A mutation, its effects on the incidence of venous thromboembolism (VTE) in users of oral contraceptive therapy (OCT), and screening recommendations for the primary care practice setting.Data SourcesSeveral databases, including MEDLINE, EMBASE, BIOSIS, Cochrane Library, and SciSearch, were searched for articles published between 1996 and 2003. An integrative review of studies addressing prothrombin 20210A was done using available case‐series and case‐control studies. No randomized controlled trials on prothrombin 20210A were available in the literature from the years searched.ConclusionsProthrombin 20210A increases the risk of developing a VTE for those who carry the genetic mutation. The presence of either concomitant circumstantial factors (e.g., surgery or immobilization) or a combination of genetic factors (e.g., factor V Leiden and prothrombin 20210A) raises the frequency of VTEs to an even greater extent. The risk increases exponentially in users of OCT. Screening guidelines for the use of OCT in prothrombin 20210A carriers remain unclear due to the paucity of empirical evidence related to the topic.Implications for PracticePractitioners caring for a prothrombin 20210A carrier should maintain a high degree of suspicion with even vague signs or symptoms of a possible VTE. Practitioners should consider completing a full diagnostic workup for VTE on that patient, particularly if that patient is taking OCT. Until evidence becomes available as to the best anticoagulation practice after an initial or recurrent VTE in a prothrombin 20210A carrier, standard treatment guidelines for anticoagulation should be followed.
Educational Strategies to Enhance Placement and Retention of Nurse Practitioners in Rural Arkansas
Authors: Kippenbrock Thomas , Stacy Annette , Gilbert‐Palmer Deborah 
Published: May 2005

PurposeTo examine the factors and incentives enhancing nurse practitioners’ (NPs’) long‐term employment in rural areas.Data SourceThe participants were 121 master's prepared or higher educated NPs located in rural Arkansas. A survey about role preparation and employment factors was mailed to the participants.ConclusionsWe found that 10% of all respondents were not currently employed in the role of an NP. The majority of rural‐employed NPs had didactic content focusing on rural‐practice opportunities and engaged in rural practicums while in graduate school. Rural NPs were much more likely to have graduated from research‐intensive universities. Nearly 90% of NPs reported they were somewhat very well prepared for practice in rural Arkansas.Implications for EducationThe shortage of health care providers remains one of the most irresolvable problems in the U.S. health care delivery system. Compounding the shortage is the unequal distribution of health care practitioners rural areas. Evidence indicates that NP students engaged in rural clinical practicums were more likely to practice in rural areas. light of this information, nurse educators should expand the NP educational process beyond rurally located practicums to deliver the entire educational process to the NP students’ rural homes.
Wolff‐Parkinson‐White Syndrome: Essentials for the Primary Care Nurse Practitioner
Authors: Valderrama Amy L. 
Published: May 2005

PurposeTo provide nurse practitioners with a basic understanding of the pathophysiology, clinical characteristics, diagnostic methods, and management of Wolff‐Parkinson‐White (WPW) syndrome.Data SourcesSelected research and clinical articles.ConclusionsWPW syndrome is the most common form of ventricular preexcitation. The ventricular myocardium is activated earlier than expected by an accessory conduction pathway that allows a direct electrical connection between the atria and ventricles. Although many patients remain asymptomatic throughout their lives, approximately half of the patients with WPW syndrome experience symptoms secondary to tachyarrhythmias, such as paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, and, rarely, ventricular fibrillation and sudden death. Symptoms include palpitations, dizziness, syncope, and dyspnea. Diagnosis is usually made by electrocardiogram findings, but further testing may be warranted to confirm the diagnosis.Implications for PracticeA thorough patient history and physical examination can aid the practitioner in identifying patients who may have WPW syndrome. With appropriate referral, treatment, and patient education, patients with WPW syndrome can expect to have a normal life expectancy and good quality of life.
Treatment of Hypertriglyceridemia With Omega‐3 Fatty Acids: A Systematic Review
Authors: Lewis Amanda , Lookinland Sandra , Beckstrand Renea L. , Tiedeman Mary E. 
Published: May 2005

PurposeTo (a) critically appraise available randomized controlled trials (RCTs) addressing the efficacy of long‐chain omega‐3 fatty acids as secondary agents for prevention of hypertriglyceridemia and (b) make recommendations for clinical practice.Data SourcesTwo independent reviewers examined all RCTs from 1994 to 2003 identified in several databases, extracted data from each study, and used the previously tested Boyack and Lookinland Methodological Quality Index (MQI) to determine study quality.ConclusionsTen studies reported long‐chain omega‐3 fatty acids to be effective in the treatment of hypertriglyceridemia. The average decrease in triglycerides was 29%, total cholesterol 11.6%, very low density lipoprotein (VLDL) 30.2%, and low‐density lipoprotein (LDL) 32.5%. One study found LDLs to increase by 25%. The average increase in highdensity lipoprotein was 10%. The overall average MQI score was 36% (range = 26% to 54%). Many of the RCTs had serious shortcomings, including short duration, lack of a power analysis, no intention‐to‐treat analysis, no report of blind assessment of outcome, and lack of dietary control as a confounding variable.Implications for PracticeOverall study methodology was weak. Although the evidence supporting use of long‐chain omega‐3 fatty acids in the secondary prevention of hypertriglyceridemia is reasonably strong, until there are larger RCTs of better methodological quality, it is not recommended that practitioners treat hypertriglyceridemia with omega‐3 fatty acid supplementation in lieu of lipid‐lowering medications.
Flu Vaccines and Patient Decision Making: What We Need to Know
Authors: Mayo Ann M. , Cobler Steffanie 
Published: May 2005

PurposeTo describe and compare patient‐perceived barriers and motivators and decision‐making conflict between groups of hospitalized patients, those who received vaccines and those who did not.Data SourcesData collection included extracting data from databases and mailing two surveys to 436 discharged patients. One hundred eight patients participated in the study.ConclusionsTop motivators for obtaining a flu vaccine included previous vaccination (93%) and provider recommendation (62%). Top barriers included fear of side effects the vaccine (35%) and fear of contracting the flu (30%). Motivators, barriers, and patient decisional conflict differed depending upon the patient's vaccination status.Implications for PracticeGiven the potential negative consequences of contracting the flu, prevention is the best strategy. Prevention contingent upon motivating patients to obtain an annual flu vaccine. Recommending flu vaccinations, offering vaccinations in convenient locations free of charge, discussing perceived barriers with patients may increase vaccinations among high‐risk patients. Helping to clarify the advantages and disadvantages from the patient's perspective may decrease decisional conflict and increase vaccination rates.
The Process of Changing Health Risk Behaviors: An Oregon Rural Clinic Experience
Authors: Bowden Jeanne M. , Shaul Muriel P. , Bennett Jill A. 
Published: May 2005

PurposeA counseling intervention was conducted by nurse practitioners (NPs) at a rural clinic in Oregon. The intervention was designed to help individuals change health risk behaviors. Three focus groups were conducted to aid in understanding the barriers to changing health behaviors and to identify resources that rural individuals needed to succeed in behavior change.Data SourcesQuantitative data were collected using appraisal forms that were specific to five behaviors. Qualitative data were from written comments submitted by focus group participants in answer to questions sent prior to each meeting and from written summaries of focus group meetings submitted by the focus group leader.ConclusionsMost participants were not successful in changing their health behaviors. The issues raised in the focus group discussions provide an overview of the barriers to health behavior change as perceived by a group of adults in a rural environment. Both individual lack of will and the rural community environment were barriers to adopting new health behaviors.Implications for PracticeNPs in rural health care clinics could provide important support for individuals attempting to adopt new health behaviors. Specific suggestions from focus group participants included discussing risky behaviors more often, forming support groups that do not charge a fee, and developing a peer‐mentoring program.
Evaluation and Treatment of Hyperthyroidism and Hypothyroidism
Authors: Goolsby Mary Jo , Blackwell James 
Published: May 2005

ABSTRACTThis month's clinical practice guideline (CPG) review is on the diagnosis and treatment of hyperthyroidism and hypothyroidism as provided by the American Association of Clinical Endocrinologists. An estimated 27 million Americans have thyroid disease, and about 13 million of them are undiagnosed. The risk of thyroid disease increases with age, and women are seven times more likely than men to develop thyroid problems. Unfortunately, thyroid symptoms are usually very nonspecific and should be kept in the differential diagnosis of many clinical complaints.The format of this month's column is a little different because we received two independent manuscripts, each of which had merit. We made a decision to present both points of view and deleted repetitive material. This is an example of variable approaches one can take with reviewing and critiquing CPGs.
Critique of the Hyperthyroidism and Hypothyroidism CPG
Authors: Goolsby Mary Jo , Scatcherd Julie A. 
Published: May 2005

ABSTRACTThe clinical practice guideline (CPG) for the evaluation and treatment of hyperthyroidism and hypothyroidism was developed in 2002 to update the original American Association of Clinical Endocrinologists (AACE) thyroid guidelines, which were published in 1995 (AACE Thyroid Task Force). The mission of this guideline as stated by the authors was to provide a framework for managing the diagnosis and treatment of patients with hyperthyroidism and hypothyroidism. The guidelines are intended to improve outcomes and reduce costs while stressing the importance of routine continual care provided by one physician. The guidelines are also intended to enhance physicians’ awareness of subclinical hyperthyroidism and subclinical hypothyroidism, which are frequently encountered in the clinical setting and often have detrimental health consequences when untreated.The organization of the guideline is clear and easy to follow. Hyperthyroidism and hypothyroidism are described in two separate sections, each of which covers clinical features, diagnosis, laboratory evaluation, differential diagnosis, treatment, and management. (See previous article in this column.)
Challenges in the Assessment of Erectile Dysfunction and Treatment With Oral Therapies: Review With Case Examples
Authors: Lewis Jean H. 
Published: May 2005

PurposeTo review the clinical dimensions, etiology, assessment, and treatment of erectile dysfunction (ED) and to increase awareness of oral therapies for this condition.Data SourcesScientific literature, consensus guidelines, and manu facturers' product information and guidelines.ConclusionsA prevalent condition, particularly in middle‐aged and elderly men, ED is vastly underreported and undertreated. Oral therapies, including phosphodiesterase type 5 inhibitors, are effective and well tolerated in many patients and represent potential first‐line treatments for ED.Implications for PracticeED has been associated with both life‐threatening nesses and reduced quality of life.Improving recognition and treatment of this condition and counseling patients about ED represent important clinical opportunities. A broad and expanding array of ED treatments enable therapy to be individualized to the needs of patients and their partners.
Cardiac Resynchronization Therapy and Automatic Implantable Cardiac Defibrillators in the Treatment of Heart Failure: A Review Article
Authors: Vesty Jill , Rasmusson Kismet D. , Hall Jill , Schmitz Sandy , Brush Sally 
Published: May 2005

PurposeTo review the use of cardiac resynchronization therapy (CRT)and automatic implantable cardiac defibrillators (AICDs)in heart failure (HF)patients.Data SourcesSelected scientific literature.ConclusionsNew developments in device therapy for HF patients are helping to decrease morbidity and mortality in this challenging patient population. CRT improves left ventricular (LV) ejection fraction, quality of life, 6‐min walk distances, and New York Heart Association scores in select patients. AICDs can prevent sudden cardiac death in those who have LV dysfunction and are at risk for ventricular arrhythmias. Cardiac devices are now becoming a standard of care for those with HF who meet certain criteria.Implications for PracticeDespite advances in medical therapy for treating LV dysfunction, newly diagnosed patients face a 50% mortality rate in 5 years. The natural history of HF leads to continual deterioration of function unless adverse cardiac remodeling is reversed. Until recently, the only means for improving symptoms and cardiac function has been through the optimization of standard medicines that are indicated for LV dysfunction, such as angiotensin‐converting enzyme inhibitors and beta‐blockers. However, not all patients benefit from medical management alone. Cardiac devices may now be considered when significant symptoms persist after standard medicines are optimized. When practitioners use a multiple‐modality approach, careful patient selection based on the inclusion criteria used in the trials outlined in this article will likely lead to improved management of those with LV dysfunction.
Do Nurse Practitioners Make a Difference in Provision of Health Counseling in Hospital Outpatient Departments?
Authors: Lin Susan X. , Gebbie Kristine M. , Fullilove Robert E. , Arons Raymond R. 
Published: May 2005

PurposeThis study examined whether nurse practitioners (NPs) had any impact on the type and amount of health counseling provided during patient visits to hospital outpatient departments (OPDs).Data SourcesThis is a secondary data analysis of the National Hospital Ambulatory Medical Care Survey from 1997 to 2000. Only patient visits to hospital OPDs were included. Rates of health counseling provided at patient visits involving an NP were compared with those without an NP. Adjusted odds ratio was reported separately for each type of health counseling provided at patient visits for nonillness care, for chronic problems, and for acuteConclusionsHealth counseling for diet, exercise, human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention, tobacco use, and injury prevention are more likely to be provided at nonillness care visits involving an NP than at those not involving an NP. The presence of an NP is associated not only with higher rates of counseling for diet, exercise, and tobacco use provided at patient visits for chronic problems but also with higher rates of counseling for diet and HIV/STD prevention provided at patient visits for acute problems.Implications for PracticeThis study indicates an important role NPs can play in providing preventive services in outpatient hospital departments.The findings reflect the emphasis of the NP education on health counseling and patient education in clinical practice.
Assessing Ethnicity in Preconception Counseling: Genetics—What Nurse Practitioners Need to Know
Authors: Edwards Quannetta T. , Seibert Diane , Macri Charles , Covington Carolyn , Tilghman Joan 
Published: May 2005

PurposeTo define and discuss five genetic disorders Tay‐Sachs, sickle cell anemia, Canavan's dis‐ease, thalassemia, and cystic fibrosis (CF)—and to explain the importance of the nurse practitioner's (NP's) assessment of clients' ethnicity during preconception counseling, which should address these genetic conditions.Data SourcesReview of literature from professional journals, professional organizations' Web sites, guidelines from the American College of Obstetricians and Gynecologists, the National Institute of Health Consensus Statement, and the authors' professional clinical experience.ConclusionsThe goal of preconception counseling is to identify potential or actual medical, psychological, or social conditions that may affect the mother or fetus. NPs are often the health care providers that initiate preconception counseling to women in varied primary care settings. NPs must be familiar with ethnicity‐related inheritable conditions in order to provide appropriate client information and education and to implement testing and, when needed, referral for genetic counseling to individuals and families at risk for genetic disorders such as Tay‐Sachs, Canavan's disease, CF, sickle cell anemia, and thalassemia.Implications for PracticeNPs providing health care to women of child‐bearing age should assess the client's use of contraception and intent for future pregnancy. Preconception counseling when indicated should be initiated to all women to increase their potential for healthy pregnancy outcomes. Although a comprehensive personal, family, medical, and psychoso‐cial history and initiation of folic acid are the mainstays of preconception counseling, assessment for risk of ethnicity‐related genetic conditions must also be included in prepregnancy health care.
Is There a Need for Screening for Type 2 Diabetes in Seventh Graders?
Authors: Whitaker Judy A. , Davis Kimberley L. , Lauer Chad 
Published: May 2005

PurposeTo determine if a screening program for type 2 diabetes in a seventh‐grade population is war‐ranted as well as to increase health care providers' awareness of the need for this screening.Data SourcesWe sent a diabetes questionnaire to each par‐ticipant's parent or guardian. The question‐naire assessed for any family history of diabetes, any currently diagnosed participant with diabetes, and physical activity. Each participant was also assessed for age, ethnicity, gen‐der, and acanthosis nigricans and received a one‐time blood pressure reading. The researchers obtained height and weight by utilizing each school's weight/height scale and calculated each participant's body mass index (BMI).ConclusionsOverall results determined that there is a need for screening for type 2 diabetes in a seventh‐grade population.Implications for PracticeThe role of the nurse practitioner (NP) is to increase health professionals' and the public's awareness of risk factors related to adolescents and type 2 diabetes by patient education both in areas of health promotion and disease pre‐vention. NP‐directed educational programs could include diabetic education in health classes in cooperation with the school nurse and/or health teacher and community‐based diabetic forums addressing this topic.
Intimate‐Partner Violence: A Retrospective Review of Records in Primary Care Settings
Authors: Magnussen Lois , Shoultz Janice , Oneha Mary Frances , Hla Mya Moe , Brees‐Saunders Zavi , Akamine May , Talisayan Bryan , Wong Eddie 
Published: May 2005

PurposeThe goals of this study were (a) to gather data regarding the documentation of disclosure of battering in primary care settings and (b) to collect demographic data, including ethnicity, of women who disclose intimate partner violence (IPV) in primary care settings in Hawaii.Data SourcesWe conducted a retrospective chart review focusing on documentation of IPV in four community health centers on Oahu. The review included 337 charts. The data were ana‐lyzed using descriptive statistics.ConclusionsOf the 337 records reviewed, IPV was reported in 31 (9.1%). Documentation of reported IPV differed among members of the various ethnic groups seen in the clinics.Implications for PracticePractitioners should develop a common area for documenting reports of IPV. The level and depth of resources available within the setting and the community may affect providers' will‐ingness to screen for IPV.
Integrating Evidence‐Based Practice in Nurse Practitioner Education
Authors: Goolsby Mary Jo , Taylor‐Seehafer Margaret A. , Abel PhD Elizabeth , Tyler Diane O. , Sonstein Frances C. 
Published: May 2005

ABSTRACTThis column normally focuses on a specific clinical practice guideline (CPG). This month's column deviates from that practice to demonstrate how evidence‐based practice (EBP) was integrated into the nurse practitioner (NP) curriculum at the University of Texas at Austin School of Nursing. Processes of EBP were linked to student clinical assignments across core NP clinical courses, culminating in a student‐published CPG. When students research and analyze available scientific evidence for a CPG, they learn to critically evaluate and logically organize knowledge for use in clinical practice, and those critical‐thinking skills can lead to improved clinical reasoning and decision making.