MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Journal of the American Academy of Nurse Practitioners' source. Wed, 08 Feb 2012 21:55:01 +0100 http://www.medworm.com/index.php?rid=5650364&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00686.x Conclusions: Actinic keratosis is a common skin lesion seen in primary care that results from exposure to ultraviolet light. Accurate and timely diagnosis is essential to prevent progression to squamous cell carcinoma.Implications for practice: Nurse practitioners can make a positive impact on patients' health by promoting treatment adherence and follow‐up in primary care. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5650364 Tue, 31 Jan 2012 05:00:00 +0100 5650364 http://www.medworm.com/index.php?rid=5650363&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00688.x Conclusions: No statistical significance was noted in regards to patient satisfaction for the demographic factors age, gender, country of upbringing, or education level. Presence of health insurance was a significant factor, with uninsured patients rating higher levels of satisfaction. However, based on patients' responses to role clarity for this survey, it is evident that there continues to be insufficient public understanding of the role of NPs.Implications for practice: The future of the NP relies on patient approval as well as acceptance of the role. This study joins the pioneering efforts towards describing what patient satisfaction is and supports NPs serving as providers in rural, nonprimary care venues. By identifying influential factors of satisfaction, NPs can bridge the gap bet... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5650363 Tue, 31 Jan 2012 05:00:00 +0100 5650363 http://www.medworm.com/index.php?rid=5650367&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00685.x Conclusions: The survey and the focus group findings indicate that there is a strong need for (a) access to a set of nationally recognized competencies for A‐GNPs; (b) teaching/learning resources to support faculty in implementation of A‐GNP programs; and (c) formal faculty development opportunities to facilitate faculty efforts to engage in curricular redesign and innovations and assure that NP students acquire strong competence in gerontology content.Implications for practice: The transition to A‐GNP has implications not only for NP faculty but also for practicing NPs. Almost all NPs care for older adults in a variety of settings. However, most of these NPs are not specialists in geriatrics. This article provides a context for self‐assessment by these NPs of their own needs relat... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5650367 Mon, 30 Jan 2012 05:00:00 +0100 5650367 http://www.medworm.com/index.php?rid=5650366&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00694.x Conclusions: Although the American Heart Association guidelines do not include ECG testing for preparticipation screenings, the implementation of routine ECG testing for preparticipation sports physicals is effective in preventing SCD in athletes.Implications for practice: Primary care providers should be aware of current guidelines for screening patients for heart diseases that predispose them to SCD and their legal obligations to be sure these athletes are safe. The implementation of ECG testing will assist in the decision whether to disqualify an athlete from participation as a result of preexisting cardiac conditions, and ultimately preventing the untimely death of a young athlete. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5650366 Mon, 30 Jan 2012 05:00:00 +0100 5650366 http://www.medworm.com/index.php?rid=5650365&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00695.x Conclusions: The overwhelming majority of participants were (a) willing to undergo screening; (b) take suppressive antiviral medication if necessary; (c) share their results with sexual partners; and (d) consider safer sexual practices as a consequence of screening. Older patients were less willing to consider daily antiviral medication. Men who have sex with men (MSM) had lower perceived susceptibility to HSV‐2 but were more likely to undergo and report screening.Implications for practice: Future research should include predictive models for determining the most appropriate patients to screen for HSV‐2 and best practices for those who test positive. Shared decision making between patients and advanced practice nurses regarding the risks and benefits of screening for HSV‐2 should be ... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5650365 Mon, 30 Jan 2012 05:00:00 +0100 5650365 http://www.medworm.com/index.php?rid=5650362&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00689.x Conclusions: The popularity of energy drinks and the rapid growth of their excessive consumption among adolescents and young adults have brought about great concern in regards to overall health and well‐being. Caffeine, which is readily available to minors, is the most commonly used psychoactive substance in the world and imposes a potentially harmful influence on health, academic performance, and personal adjustments. Teens and young adults account for nearly $2.3 billion of energy drink sales. Adolescents and young adults are often unaware that various products, such as energy drinks, herbal medications, and various other medications that promote alertness, contain caffeine. When these products are taken together, caffeine toxicity and severe adverse effects can occur.Implications for ... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5650362 Sun, 01 Jan 2012 05:00:00 +0100 5650362 http://www.medworm.com/index.php?rid=5630694&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00687.x Conclusion: The document "Curriculum Guidelines and Regulatory Criteria for Family Nurse Practitioners Seeking Prescriptive Authority to Manage Pharmacotherapeutics in Primary Care" should be examined for relevance to current prescribing practice, scope, and influences that emerged since publication.Implications for practice: In order to prepare NPs of the future it is important to acknowledge the implications of increased autonomy, scope, and depth of practice that explicitly includes broad prescriptive authority. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5630694 Sun, 01 Jan 2012 05:00:00 +0100 5630694 http://www.medworm.com/index.php?rid=5599621&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00664.x Conclusions: The results of this project demonstrate that patients with a life‐limiting illness who receive their primary care and palliative care in an NP‐founded and ‐directed Primary Palliative Care Clinic have decreased utilization of the emergency department, and some experience improvement in symptom assessment scores.Implications for practice: Palliative care providers and administrators should explore opportunities to expand outpatient palliative care clinics with an emphasis on primary care and continuity of care. NPs by experience and education are ideally suited to manage both primary and palliative care needs for people at the end of life. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5599621 Sun, 01 Jan 2012 05:00:00 +0100 5599621 http://www.medworm.com/index.php?rid=5599620&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00678.x Conclusions: Education is needed to raise awareness of risks of prepregnancy weight and excessive weight gain for mother and infant. The need for prenatal nutritional counseling to reduce the intake of calories, fats, sweets, and snacks; increase intake of vegetables, fruits, foods with iron, folate, and fiber. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5599620 Sun, 01 Jan 2012 05:00:00 +0100 5599620 http://www.medworm.com/index.php?rid=5599619&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00677.x Conclusions: The financial challenges facing NMHCs are significant; it will take an enormous push from organized fronts of the NMHC movement to give individual NMHCs a fighting chance to survive within the competitive healthcare climate.Implications for practice: Policy changes are essential to assure that NMHCs are an integral part of the primary healthcare safety net for America's vulnerable populations, and that advance practice nurses are at the forefront of policy initiatives. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5599619 Sun, 01 Jan 2012 05:00:00 +0100 5599619 http://www.medworm.com/index.php?rid=5599618&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00691.x Conclusions: EIB is a common and well‐described occurrence in patients with asthma, as well as in patients with no overt respiratory condition. Treatment with a short‐acting beta‐agonist before starting exercise is effective, yet this treatment approach is underutilized in the majority of patients with asthma.Implications for practice: This case highlights the implications of undermanaged EIB and the disconnect between healthcare provider recommendations and the beliefs and behaviors in patients with EIB. Inhaled short‐acting beta‐agonists can attenuate EIB in 80%–95% of patients and are effective during 2–3 h of exercise. Patients with a compromised level of physical activity because of EIB who do not respond to conventional treatment strategies should be referred to a respi... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5599618 Sun, 01 Jan 2012 05:00:00 +0100 5599618 http://www.medworm.com/index.php?rid=5599617&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00683.x Conclusions: Scope of practice is a legal term used by states to define what activities an individual professional can undertake. The Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation outlines that licensure and scope of practice are based on graduate education within a defined patient population for the APRN role. The APRN Consensus Model further identifies that the services provided by APRNs are not defined or limited by setting but rather by patient care needs. For the acute care NP, this is especially significant, as patient acuity and care requirements can vary across settings. When implemented, the Consensus Model will help to standardize regulation for APRNs as well as ensure congruence between licensure, accreditation, certification, and education.Implication... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5599617 Sun, 01 Jan 2012 05:00:00 +0100 5599617 http://www.medworm.com/index.php?rid=5599616&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00684.x Conclusions: Approximately 70 million individuals have been recognized as prehypertensive in the United States, placing them at increased risk for hypertension and cardiovascular disease. Identifying and managing prehypertension has been recognized in national health policy as a priority to improve public health. Prehypertension is managed primarily by eliminating risk factors and implementing lifestyle modification.Implications for practice: Health promotion and disease prevention form the cornerstone of the NP role. The designation of prehypertension serves as an opportunity for NPs to assist in decreasing the burden on the health system from chronic disease and improve patient quality of life. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5599616 Sun, 01 Jan 2012 05:00:00 +0100 5599616 http://www.medworm.com/index.php?rid=5599615&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00693.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5599615 Sun, 01 Jan 2012 05:00:00 +0100 5599615 http://www.medworm.com/index.php?rid=5527249&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00676.x Conclusions: OA may be under‐diagnosed, under‐reported, or overshadowed by co‐morbid medical conditions. Older adults with persistent OA pain are at increased risk for adverse events from prescribed NSAIDs. Safe and effective multimodal pain treatments need to be prescribed for older adults with persistent OA pain.Implications for practice: Referral to a rheumatologist or pain management specialist should be considered when pain intensity and/or pain interference with daily activities remains moderate or greater. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5527249 Mon, 19 Dec 2011 05:00:00 +0100 5527249 http://www.medworm.com/index.php?rid=5527248&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00679.x Conclusions: At UWMC and VA, 69% and 89% of MPI studies, respectively, were classified as appropriate, 16% and 3% as inappropriate, and 15% and 8% as uncertain. All differences were significant, p < .001. At UWMC, 11% of appropriate studies and 10% of inappropriate or uncertain studies were abnormal (demonstrating myocardial ischemia or myocardial infarction), p= .93; these analyses were not performed on VA studies.Implications for practice: Most studies at both sites were classified as appropriate. At UWMC, the likelihood of a study classified as appropriate demonstrating an abnormality was not significantly different from a study classified as uncertain or inappropriate. AUC are imperfect tools but are increasingly created and referenced; as such, it is vital that practicing nurse pra... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5527248 Mon, 19 Dec 2011 05:00:00 +0100 5527248 http://www.medworm.com/index.php?rid=5527247&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00680.x Conclusions: Transfusions of packed red blood cells save lives. There are many hematologic conditions for which packed red blood cell transfusions are required as a result of bone marrow suppression. However, extended exposure to red blood cell transfusions places the patient at an additional risk of iron overload. Iron overload is a real concern for patients who become transfusion dependent, with increased risks of liver cirrhosis and cardiac arrhythmias.Implications for practice: NPs in all areas of practice can increase awareness of the dangers of transfusional iron overload, and become familiar with the treatment options available. Additionally, NPs can institute a monitoring program based on the protocol suggested here within their own practices to prevent poor outcomes for patients w... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5527247 Mon, 19 Dec 2011 05:00:00 +0100 5527247 http://www.medworm.com/index.php?rid=5527246&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00681.x Conclusions: Pharmacologic treatment of COPD patients comprises mainly inhaled medications. Incorrect use of inhalers is very common in these individuals. Some of the consequences of poor inhaler technique include reduced therapeutic dosing, medication adherence, and disease stability, which can lead to increased morbidity, decreased quality of life, and a high burden on the healthcare system. Knowledgeable evaluation and frequent reassessment of inhaler use coupled with education of patients, caregivers, and healthcare professionals can significantly improve the benefits COPD patients derive from inhaled therapy.Implications for practice: Patient education is vital for correct use of inhalers and to ensure the effectiveness of inhaled medications. The NP has a critical role in assessing p... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5527246 Mon, 19 Dec 2011 05:00:00 +0100 5527246 http://www.medworm.com/index.php?rid=5527245&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00692.x This article provides a brief overview of a new program from the Agency for Healthcare Research and Quality (AHRQ) called the Effective Healthcare Program. This program has supported more than 70 research projects since its inception and published more than 50 products, including guides for clinicians and patients that provide a comprehensive analysis of treatment options for common, chronic illnesses. Research summaries are also available for mobile devices. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5527245 Thu, 01 Dec 2011 05:00:00 +0100 5527245 http://www.medworm.com/index.php?rid=5478174&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00682.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5478174 Thu, 01 Dec 2011 05:00:00 +0100 5478174 http://www.medworm.com/index.php?rid=5450378&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00673.x Conclusions: NPs in the sample believed that pediatric overweight and obesity are problems in need of treatment, but also reported not assessing and diagnosing the condition per current guidelines. Initiation of treatment was reported at very low rates. Rural NPs reported having fewer referral resources than urban NPs.Implications for practice: NPs are in an ideal position to properly assess, diagnose, and treat pediatric overweight and obesity. The findings suggest that more education on these topics is necessary for NPs. Rural NPs reported fewer referral services, and may need to have more knowledge about how to provide obesity treatment services in their own practice settings due to this disparity. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5450378 Sun, 27 Nov 2011 05:00:00 +0100 5450378 http://www.medworm.com/index.php?rid=5450377&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00674.x Conclusions: Results of the study suggested that higher levels of exercise self‐efficacy, family social support for exercise, and a decrease in physical environmental barriers may serve to increase physical activity levels in this population. No significant relationships were observed between the other study variables and physical activity levels.Implications for practice: Nurse practitioners working with African American females with type 2 diabetes need to assess family social support, exercise self‐efficacy, and physical environmental barriers and plan interventions that incorporate family support and the principles of self‐efficacy while minimizing environmental barriers. Further exploration is warranted to examine the relationship between body image discrepancy and physical acti... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5450377 Sun, 27 Nov 2011 05:00:00 +0100 5450377 http://www.medworm.com/index.php?rid=5450376&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00675.x Conclusions: Lupus is a multigenic autoimmune disease, which requires the clinician to be hypervigilant by collecting a thorough family history and performing a complete physical assessment of the patient. There is an array of treatment modalities, both experimental and proven therapies, which improve signs and symptoms associated with SLE. Numerous medications are available for symptom management: anti‐inflammatory agents for patients with musculoskeletal presentation, and steroids or antimalarials for those with more extensive organ involvement.Implications for practice: In SLE, the overall aim of management is to determine the extent of disease and prevent extensive organ involvement. Therefore, when diagnosed in a timely manner, most patients will survive and are able to manage their... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5450376 Sun, 27 Nov 2011 05:00:00 +0100 5450376 http://www.medworm.com/index.php?rid=5401753&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00669.x Conclusions: There is demonstrated efficacy educating NPs in proper documentation/early detection of skin cancer among young adults in a college health, primary care setting. Findings revealed a 223.4% increase in proper documentation of skin cancer screening and skin cancer patient education.Implications for practice: Educating NPs in skin cancer identification, screening and use of a skin cancer screening tool is an effective way to improve quality of services provided to patients and quality of NP documentation. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5401753 Fri, 11 Nov 2011 05:00:00 +0100 5401753 http://www.medworm.com/index.php?rid=5401752&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00670.x Conclusions: Electronic health policy information is generated by a wide variety of public and private organizations and disseminated in hundreds of journals and Web pages. Specialty search tools are needed to retrieve the unindexed gray literature, which includes government documents, agency reports, fact sheets, standards, and statistics not produced by commercial publishers. Further, Internet users need to examine search results with a critical eye for information quality.Implications for practice: Expertise in searching electronic health policy information is a prerequisite for developing APRNs' leadership in political arenas to influence health policy and the delivery of healthcare services. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5401752 Fri, 11 Nov 2011 05:00:00 +0100 5401752 http://www.medworm.com/index.php?rid=5450375&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00672.x Conclusions: Five themes and 13 subthemes emerged from the NPs’ accounts. The main themes included: (1) why they do what they do; (2) a unique population with unique needs; (3) NP characteristics; (4) how the relationship develops; and (5) lessons learned: a relationship of reciprocity.Implications for practice: Study findings will assist healthcare providers to gain insight into the experience of providing health care to the homeless and learn what it takes to become successful in such an important and much needed role. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5450375 Tue, 01 Nov 2011 04:00:00 +0100 5450375 http://www.medworm.com/index.php?rid=5401751&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00671.x Conclusions: Fibromyalgia is a complex muscular rheumatism that is not fully understood and often misdiagnosed. Signs and symptoms may overlap with many other conditions that must be properly ruled out to prevent diagnosis based upon arbitrary clinical judgment. Treatment is most beneficial when tailored to individual patient presentation, and further research is warranted, particularly in the domains of pathophysiology and efficacy of treatment options.Implications for practice: An accurate knowledge of current research will aid the nurse practitioner in effectively prescribing evidence‐based clinical interventions. Optimal fibromyalgia management can be achieved through a multifaceted treatment approach and is enhanced with early identification of the disease process. (Source: Journal ... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5401751 Tue, 01 Nov 2011 04:00:00 +0100 5401751 http://www.medworm.com/index.php?rid=5349908&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00668.x Conclusions: Cognitive impairment is prevalent among individuals with heart failure. Impairment frequently involves one or more domains, including attention, memory, and executive function. No gold standard screening measure was identified from the reviewed literature.Implications for practice: It is imperative that clinicians are aware of cognitive impairment and its implications for their patients with heart failure. Cognitive impairment likely contributes to multiple clinical implications, including a decreased ability to attend to and comprehend patient education materials and an inability to appropriately assess and self‐manage symptoms. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5349908 Thu, 27 Oct 2011 02:10:57 +0100 5349908 http://www.medworm.com/index.php?rid=5349907&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00667.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5349907 Thu, 27 Oct 2011 02:10:55 +0100 5349907 http://www.medworm.com/index.php?rid=5198077&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00663.x Conclusions: Three themes emerged from the NPs’ narratives: realities of practice, ambiguous role identity, and bridging models. Time constraints, financial considerations, and bridging the nursing and medical models while adapting to practice environments were barriers identified as components of the NP experience caring for patients with prehypertension.Implications for practice: This study revealed that caring for prehypertensive patients is a complex and multilayered experience. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5198077 Sat, 03 Sep 2011 23:00:00 +0100 5198077 http://www.medworm.com/index.php?rid=5198076&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00664.x Conclusions: The results of this project demonstrate that patients with a life‐limiting illness who receive their primary care and palliative care in an NP‐founded and ‐directed Primary Palliative Care Clinic have decreased utilization of the emergency department, and some experience improvement in symptom assessment scores.Implications for practice: Palliative care providers and administrators should explore opportunities to expand outpatient palliative care clinics with an emphasis on primary care and continuity of care. NPs by experience and education are ideally suited to manage both primary and palliative care needs for people at the end of life. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5198076 Sat, 03 Sep 2011 23:00:00 +0100 5198076 http://www.medworm.com/index.php?rid=5212010&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00665.x Conclusions: The role of rheumatology healthcare providers has evolved to include numerous vital functions, such as expanding communication between specialists and primary care providers, patient education and counseling, assistance with coping strategies, monitoring response to therapy, and administration of therapy. Education regarding clinical trial design, rationale, and discussion of endpoints has not been strongly emphasized for rheumatology healthcare providers who are increasingly introduced to novel agents and need to assimilate findings from clinical trials into daily practice.Implications for practice: Familiarity with the basics of clinical trial design and efficacy endpoints of new rheumatoid arthritis therapeutics, translation and application of that knowledge into daily prac... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5212010 Thu, 01 Sep 2011 04:00:00 +0100 5212010 http://www.medworm.com/index.php?rid=5099235&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00654.x Conclusions: NPs should be aware of the clinical features of TSP to improve diagnostic accuracy of symptomatic patients, reduce transmission rates, and provide appropriate patient counseling. The ability to accurately diagnose TSP early in the disease process and differentiate it from other neurological diseases will lead to improved patient outcomes. Timely diagnosis is important to maximize patient response to pharmacological interventions that are used to treat the clinical manifestations of TSP.Implications for practice: In this globalized society, NPs will need to be prepared to care for patients who have immigrated to the United States from parts of the world where the HTLV‐I virus is endemic. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5099235 Thu, 04 Aug 2011 23:00:00 +0100 5099235 http://www.medworm.com/index.php?rid=5099234&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00655.x Conclusions: As surgical management of obesity becomes more prevalent in an attempt to improve health‐related quality of life, reduce mortality, and address the comorbidities that are prevalent in this population, nurse practitioners (NPs) need to understand what long‐term management these patients will require.Implications for practice: NPs are primary care providers for patients with chronic diseases. It is likely that they will make referrals for this surgery and follow the patient after the procedure at some point. Knowledge of what the procedures involve, what changes to expect in the comorbid conditions, and what long‐term monitoring and treatment should take place in the care of these patients will provide these patients with optimal care. (Source: Journal of the American Acad... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5099234 Thu, 04 Aug 2011 23:00:00 +0100 5099234 http://www.medworm.com/index.php?rid=5099233&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00656.x Conclusions: Abuse of prescription opioid medications is a significant economic and public health burden. Buprenorphine is a highly effective medication that is used in the outpatient treatment of opioid‐dependent patients. However, the DATA 2000 permits only physicians to prescribe this medication, substantially reducing patient access to potentially life‐sustaining treatment.Implications for practice: Like diabetes and cardiovascular disease, addiction is a chronic condition that can be treated with lifestyle modifications, patient education, and appropriate medication. NPs are highly effective caregivers to patients with chronic disease. Granting NPs prescriptive authority for buprenorphine will improve access to treatment and patient outcomes. It will also enhance NP autonomy and a... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5099233 Thu, 04 Aug 2011 23:00:00 +0100 5099233 http://www.medworm.com/index.php?rid=5099232&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00657.x Conclusions: Findings suggest that TNCCH met or exceeded national HEDIS benchmark standards of care and targets set by OMPP. This study offers further evidence that NMCs provide a high quality of care.Implications for practice: Benefits of addressing the research question in this study include the preservation of the nurse‐managed healthcare safety net, increased access to health care for the medically underserved population resulting in improved health outcomes, and evidence to suggest that NMCs can assist private practice physicians to support this population of patients. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5099232 Thu, 04 Aug 2011 23:00:00 +0100 5099232 http://www.medworm.com/index.php?rid=5099231&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00658.x Conclusions: There are lessons to learn from the civilian and military care of mild traumatic brain injuries. As acute injury management improves and more patients survive their trauma to live in the chronic‐care community setting, primary care clinicians will be responsible for providing and coordinating total care. A team approach is required to meet the unique clinical and personal challenges these patients face.Implications for practice: These patients are at risk of receiving suboptimal care once released to the community, in part due to an incomplete understanding of the condition by primary care providers. Other difficulties in recommending care for these patients include nonuniform clinical terminology, the lack of a uniform set of diagnostic criteria, and the lack of endorsed pr... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5099231 Thu, 04 Aug 2011 23:00:00 +0100 5099231 http://www.medworm.com/index.php?rid=5099230&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00659.x Conclusions: Barriers to skin examination by APNs have been infrequently and inconsistently measured. Limited time to conduct skin examination is the most consistent barrier. APNs’ ability to recognize and refer suspicious and benign lesions is inconsistent, but shows improvement after training. Few skin cancer training programs are available for APNs.Implications: Larger and more rigorously designed studies are needed to better determine APNs’ barriers and facilitators to skin cancer assessment and their ability to recognize and appropriately refer potentially malignant skin lesions with a high level of sensitivity and specificity. Training to increase these skills needs to be targeted to APNs and occur at a much higher volume than current efforts. (Source: Journal of the American Aca... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5099230 Thu, 04 Aug 2011 23:00:00 +0100 5099230 http://www.medworm.com/index.php?rid=5198075&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00666.x Conclusions: Many NPs lack formal pain management education and preceptorships, thus leaving them at risk for incomplete assessments, poor documentation, and failing to implement necessary safeguards that can lead to regulatory complaint investigations and discipline against their license.Implications for practice: NPs often lack awareness of national pain management standards and the risks of chronic opioid prescribing. When adverse events occur, the NP can become the focus of a regulatory investigation that results in formal discipline against their license to practice. Using standard assessment tools, pain management contracts, and implementing safeguards to protect the patient and the public evidence safe practice and, help avoid regulatory discipline against the NP license. (Source: J... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5198075 Sun, 31 Jul 2011 23:00:00 +0100 5198075 http://www.medworm.com/index.php?rid=5099229&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00660.x Conclusions: Descriptive analysis showed a significant increase in exercise time with a mean increase of 86 min per week at post‐SMA (p= .002, 95% confidence interval [CI]). Each participant identified a measurable goal, and 97% of participants reported achieving or almost achieving their goals. Males reported a significantly (p= .002, 95% CI) larger increase in exercise time than women. Variance of self‐managing behaviors among the English, Spanish, and bilingual SMAs was statistically not significant.Implications for practice: Though much evidence exists demonstrating that SMAs provide effective quality care, literature is lacking in examining patients' self‐managing behaviors after participation in language‐specific SMAs. Understanding patients' response to programs that address... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5099229 Sun, 31 Jul 2011 23:00:00 +0100 5099229 http://www.medworm.com/index.php?rid=5065194&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00661.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5065194 Wed, 27 Jul 2011 04:16:44 +0100 5065194 http://www.medworm.com/index.php?rid=5065193&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00662.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5065193 Wed, 27 Jul 2011 04:16:42 +0100 5065193 http://www.medworm.com/index.php?rid=5065191&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00647.x Conclusion: Evidence indicated avoiding dichotomous thinking, eating to regulate mood, and disinhibited eating were associated with weight loss maintenance. Increased dietary restraint, perceived benefits outweighing costs, lower/stable levels of depression, and more positive body image were also associated with weight loss maintenance. Results were inconclusive on unrealistic weight loss expectations and failure to achieve weight loss goals.Implications for practice: Practitioners can play a pivotal role in screening clients for these factors and recommending treatment to increase the likelihood of successful weight loss maintenance. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5065191 Wed, 27 Jul 2011 04:16:21 +0100 5065191 http://www.medworm.com/index.php?rid=5065192&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00640.x Conclusions: We present a case in which the ascertainment of multiple CYP450 isoenzyme deficiencies resulted in a dramatic change in psychotropic treatment approach. Shortly after making these adjustments, the patient saw a significant improvement in most of her debilitating psychiatric symptoms.Implications for practice: In complex cases, CYP450 DNA testing can guide pharmacotherapy by exposing innate hepatic metabolic deficiencies as a result of DNA polymorphism. In such cases, clinicians can favor treatments that target functional isoenzyme pathways rather than deficient or null pathways thus leading to decreased risk of ADRs and improved patient response. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5065192 Sun, 24 Jul 2011 23:00:00 +0100 5065192 http://www.medworm.com/index.php?rid=5054276&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00644.x Conclusions: There is a disconnect between what patients have expressed as their wishes regarding end‐of‐life care (EOLC) and what occurs. Spiritual beliefs and values impact patients' and families' decisions regarding EOLC, but if not discussed in advance, most wishes, especially dying at home, do not occur.Implications for practice: Incorporating spiritual assessment in a holistic assessment, it is possible to assist patients and families prior to crisis in sorting out patients' wishes with respect to EOLC during clinic visits. With the use of a simple mnemonic to guide spiritual assessment, the APN can bridge the gap between what the patient wants and what care is received at end of life. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5054276 Thu, 21 Jul 2011 23:00:00 +0100 5054276 http://www.medworm.com/index.php?rid=5054275&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00645.x Conclusion: It is now well established that the development of type 2 diabetes results from the interaction between the individuals’ biological and genetic makeup and their environment. Even though some genetic variants have been found, the full genetic landscape of type 2 diabetes, especially among African‐Americans, is not yet discovered. Further researches or studies on pathophysiology and genetic susceptibility to diabetes may suggest new therapeutic targets for the treatment and prevention of insulin resistance.Implications for practice: Considering genetics as a potential cause of type 2 diabetes may suggest new therapeutic targets for the treatment and prevention, and new detecting tools for the undiagnosed patients. Nurse practitioners may gain a better understanding of the par... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5054275 Thu, 21 Jul 2011 23:00:00 +0100 5054275 http://www.medworm.com/index.php?rid=5054274&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00646.x Conclusions: This phenomenological study gave voice to the women's experience with and concerns about having diabetes in pregnancy. Three primary themes emerged and were identified: (a) feeling concern for the infant related to diabetes, (b) feeling concern for self related to diabetes, and (c) sensing a loss of personal control over their health. Subthemes for each of the primary themes were also identified.Implications for practice: The experiences shared by these women may serve to inform the development of interventions aimed at meeting the needs of women with diabetes in pregnancy. By learning from the themes of the phenomenological study, advance practice nurses may anticipate the needs of the women diagnosed with diabetes in pregnancy to augment their care, education, and promotion ... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5054274 Thu, 21 Jul 2011 23:00:00 +0100 5054274 http://www.medworm.com/index.php?rid=5054273&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00648.x Conclusions: The majority of the women were resilient with over half the sample scoring in the high resilience range. Only nine participants had resilience scores that were considered low. Interestingly, HbA1c levels and resilience scores had a significant negative correlation, as individuals scored high on the resilience scale, HbA1c levels went down, suggesting that resilience may influence glycemic control in this sample.Implications for practice: Nurse practitioners (NPs) have an opportunity to consider resilience in the care of minority populations with a chronic illness such as type 2 diabetes. High levels of resilience were significantly related to lower HbA1c levels indicating better glycemic control. Clinical implications based on the findings of this study included preventing com... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5054273 Thu, 21 Jul 2011 23:00:00 +0100 5054273 http://www.medworm.com/index.php?rid=5054272&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00649.x Conclusions: Respondents reported inserting liquids and foreign objects into the urethra. Inserted liquids included water, hot candle wax, baby oil, after‐shave lotions, and dental gel. Foreign objects frequently mentioned were the insertion of smooth stainless steel surgical dilators often used in surgical urological procedures; the respondents and the websites call this “urethral sounding.” These practices were used to “aid erections and sexual experimentation, enlarge the urethra, and stimulate their partner.” Other respondents discussed catheter insertion. Other objects such as cotton‐tipped swabs, spoons, and pencils, were also inserted. UTIs have been reported as a result of UP.Implications for practice: Nurse practitioners' knowledge of these seemingly unconventional ure... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5054272 Thu, 21 Jul 2011 23:00:00 +0100 5054272 http://www.medworm.com/index.php?rid=5054271&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00650.x Conclusions: Recurrent stroke is a major health concern. A first ischemic cerebrovascular event or transient ischemic attack (TIA) is a risk factor for future strokes.Implications for practice: The risk of recurring stroke has been demonstrated in multiple studies, yet only approximately 5% of stroke patients receive appropriate therapy in a timely manner. The stroke or TIA workup should be completed quickly so that the appropriate treatments and interventions can be initiated to reduce the risk of an additional event. The etiology of the stroke and identification of personal risk factors are important because treatment depends on the specific stroke mechanism. A variety of antiplatelet trials have specific implications for stroke and recurrent stroke. Present treatments include aspirin, a... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5054271 Thu, 21 Jul 2011 23:00:00 +0100 5054271 http://www.medworm.com/index.php?rid=5054270&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00651.x Conclusion: Evidence supports the use of metformin as an appropriate first‐line therapy for ovulation induction of infertile PCOS females and also for the treatment of menstrual irregularity. Current data suggest that metformin taken during pregnancy may reduce miscarriage rate, gestational diabetes mellitus complications, and fetal growth problems.Implications for practice: Metformin, as a single agent, is useful for multiple purposes in the treatment of PCOS: decreasing intestinal glucose uptake and both basal and postprandial glucose levels; inducing ovulation; and improving pregnancy outcomes. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5054270 Thu, 21 Jul 2011 23:00:00 +0100 5054270 http://www.medworm.com/index.php?rid=5054269&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00652.x Conclusions: CGMS data before and 3 months after pramlintide initiation supported the changes felt by the patient. Diurnal and postprandial glucose excursions decreased with a resultant decrease in A1C from 9% to 7.4%. Additionally, body weight decreased by 8 lbs and hypoglycemic events declined markedly. No nocturnal hypoglycemic events occurred during the observation period.Implications for practice: Given the serious and chronic nature of diabetes, it is paramount for the patient and healthcare provider to develop and modify as needed treatment regimens that help the patient achieve and maintain glycemic control over time—a difficult task even in the motivated patient. In patients with type 1 diabetes, pramlintide can further improve glycemic control and CGMS can be a beneficial tool ... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5054269 Thu, 21 Jul 2011 23:00:00 +0100 5054269 http://www.medworm.com/index.php?rid=5054268&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00653.x Conclusions: Results confirmed that breast cancer may have a profound impact on the couple relationship from diagnosis through survivorship. Relationships with healthcare providers disclosed significant disparities in identification and response to couple distress.Implications for practice: Healthcare providers need to be sensitive to the “silent suffering” that exists for some breast cancer patients and incorporate consistent methods to identify and respond to couple distress. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=5054268 Thu, 30 Jun 2011 23:00:00 +0100 5054268 http://www.medworm.com/index.php?rid=4940061&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00622.x Conclusions: Over 290 articles were found, although only 19 peer‐reviewed articles met the inclusion criteria of research conducted with both postdivorce coparents. Researchers’ priorities centered on quality and conflict in the postdivorce coparenting relationships.Implications for practice: This review may help improve the understanding of postdivorce families and the dynamics involved in their care. Based upon this review, areas of assessment and intervention for nurse practitioners are identified. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4940061 Mon, 13 Jun 2011 23:00:00 +0100 4940061 http://www.medworm.com/index.php?rid=4940060&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00623.x Conclusions: An exhaustive review of the literature revealed evidence that regularly practiced pursed lip breathing is an effective self‐management strategy for individuals with COPD to improve their dyspnea.Implications for practice: It is expected that implementation of this non‐pharmacological self‐management intervention will improve perception of dyspnea, functional performance, and self‐efficacy in individuals with COPD. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4940060 Mon, 13 Jun 2011 23:00:00 +0100 4940060 http://www.medworm.com/index.php?rid=4940059&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00627.x Conclusions: By listening carefully to their concerns, responding honestly, and providing clear information about the risks and benefits, NPs may be able to build trust and to convince once hesitant parents to have their children immunized. For those parents who refuse, NPs may feel uncertain on how to respond. By considering the ethical principles to which they are bound, autonomy, beneficence, and non‐maleficence, NPs can work with the parents to decide what treatment is best for the child.Implications for practice: Providing truthful information to parents and utilizing public awareness through recent discussions in the media and on the Internet may be able to obviate many of the concerns of parents, which may be getting in the way of universal immunization. (Source: Journal of the Am... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4940059 Mon, 13 Jun 2011 23:00:00 +0100 4940059 http://www.medworm.com/index.php?rid=4924816&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00631.x Conclusions: Twenty‐nine providers returned history and physical forms, which revealed 24% showed no item related to tobacco use. Others included questions related to smoking, but only 7% mentioned any sort of smokeless tobacco use.Implications for practice: Although a few studies have suggested the use of smokeless tobacco to be less harmful than smoking, all forms of smokeless tobacco are recognized carcinogens and dangerous for health. It is not sufficient to simply ask patients about smoking behaviors. Primary care providers, especially nurse practitioners, have the unique opportunity to assess use of smokeless tobacco and to offer treatment and counsel to help patients to stop the behavior. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924816 Sun, 12 Jun 2011 23:00:00 +0100 4924816 http://www.medworm.com/index.php?rid=4924814&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00632.x Conclusions: Latino mothers’ perception of immunizations and knowledge of up‐to‐date status greatly influenced their children's immunization status. In addition, Latino children had lower immunization rates and encountered more barriers to immunizations than children in other population groups despite government efforts to provide vaccines to healthcare providers at no cost to assist low‐income children. Most mothers (92%) believed their children were up‐to‐date on immunizations; however, immunization records documented that 42% of the children were current based on age. The most common barriers reported were that the child was sick at the time of the visit (51%) and/or transportation problems (39%).Implications for practice: When working with low‐income, uninsured Latinos, n... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924814 Sun, 12 Jun 2011 23:00:00 +0100 4924814 http://www.medworm.com/index.php?rid=4924813&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00633.x Conclusions: The results demonstrated that as the NP–patient relationship develops, the opportunity is often present for the NP to explore the adult's spiritual system. The NP and adult may develop an interspiritual relationship with the potential to use the adult's spirituality as a support resource.Implications for practice: The nursing model reflects a spiritual‐relational view. As the NP and older adult grow in relationship, they can grow into knowledge and use of spirit. The NP can use the adult's spirituality as a resource for helping the adult cope with ongoing and emerging problems. The model provides spiritual care guidance for NPs through evidence‐based concepts. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924813 Sun, 12 Jun 2011 23:00:00 +0100 4924813 http://www.medworm.com/index.php?rid=4924812&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00634.x Conclusions: Scoliosis is classified depending on the magnitude, location, direction, and cause of the curve, and can lead to a variety of health effects if not treated. The greater the scoliosis curve and the earlier it presents, the more likely it may affect thoracic growth, inhibit cardiopulmonary function, and cause psychosocial distress.Implications for practice: Routine scoliosis screening should be incorporated into each healthcare maintenance visit beginning in infancy and continue into adolescence until the child reaches skeletal maturity. Curves with a scoliometer reading greater than 5° should be referred, and conservative treatment should be considered for curves that surpass 20°. If scoliosis is detected early, it may be possible to stabilize the curve from progressing and e... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924812 Sun, 12 Jun 2011 23:00:00 +0100 4924812 http://www.medworm.com/index.php?rid=4924811&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00635.x Conclusions: No significant associations or correlations were found between age, maternal parenting style, decision self‐esteem, decision coping (vigilant and maladaptive), and contraceptive use. There were significant positive correlations (p < .05) between maternal parenting style, age, and decision coping‐complacency, suggesting that maternal parenting styles are more controlling and that decision coping‐complacency increases as the adolescent ages, leading the adolescents to take a less active role in decision making. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924811 Sun, 12 Jun 2011 23:00:00 +0100 4924811 http://www.medworm.com/index.php?rid=4924809&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00636.x Conclusion: Hypertension screening in the ED is feasible. Individuals with elevated blood pressure (BP) in the ED should be referred for follow‐up. Further study is needed to develop an ED screening tool that is predictive of persistently elevated BP in undiagnosed individuals.Implications for practice: Nurse practitioners in the ED should identify patients with elevated BP, provide hypertension education, and ensure appropriate intervention and referral. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924809 Sun, 12 Jun 2011 23:00:00 +0100 4924809 http://www.medworm.com/index.php?rid=4924808&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00637.x Conclusions: Commitment strength was significantly correlated with SOC, and SOC was significantly correlated with physical activity behavior. However, commitment strength did not predict physical activity. Further research is needed to determine if commitment strength predicts subsequent physical activity.Implications for practice: Understanding the role of the strength of a commitment statement made during an initial MI session could assist the APN in directing follow‐up MI sessions. This information could be useful in improving the cost effectiveness and efficiency of conducting MI. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924808 Sun, 12 Jun 2011 23:00:00 +0100 4924808 http://www.medworm.com/index.php?rid=4924807&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00639.x AbstractPurpose: To compare the effectiveness of an algorithm created for use in a nurse‐managed outpatient anticoagulation clinic with the use of clinical judgment without formalized guidelines.Data source: A search of the databases in Pub Med and the Cumulative Index to Nursing of articles published through November 2009 yielded 19 articles concerning warfarin, practice guidelines, and use of algorithms.Methods: A retrospective study was conducted comparing 179 consecutive patient visits in September 2007 with 206 consecutive patient visits in 2009 at the Johns Hopkins Outpatient Anticoagulation Clinic. An algorithm was created that incorporated “removeable causes” to aid nurses in decision making when, for example, additions and deletions of new medications are added that interact... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924807 Sun, 12 Jun 2011 23:00:00 +0100 4924807 http://www.medworm.com/index.php?rid=4924806&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00629.x Conclusions: Of the 18 subjects deemed osteopenic by DEXA scan and previously started on an antiresorptive agent, nine would not have been initiated had the FRAX tool been available at the time.Implications for practice: The FRAX tool was easy to use and applicable in day‐to‐day care of patients and significantly increases the clinician's ability to make evidence‐based decisions. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924806 Sun, 12 Jun 2011 23:00:00 +0100 4924806 http://www.medworm.com/index.php?rid=4924805&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00630.x Conclusions: While on a small scale, this project was deemed successful by increasing patient asthma treatment awareness, improving patient quality of life, and reducing emergency department visits for the patients at Access Carroll.Implications for practice: Using specific tools to assess asthma treatment knowledge and current self‐perception of asthma control can help healthcare professionals quantify patients' symptoms and specify areas of augmentation in asthma understanding. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924805 Sun, 12 Jun 2011 23:00:00 +0100 4924805 http://www.medworm.com/index.php?rid=4915754&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00619.x Conclusions: Establishing a partnership relationship with patients, families and other healthcare providers gave patients a greater voice in their care. Patients disclosed information to the practitioner that would otherwise have not been shared and practitioners' care management was more effective because it was based upon input from the patient and family as well as the practitioner's expertise. The interdisciplinary staff have learned to value one another's expertise and to call upon each other as the need arises.Implications for practice: Fostering patient‐provider partnering increases the effectiveness of care as well as patient and family satisfaction with the care received. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4915754 Wed, 08 Jun 2011 23:00:00 +0100 4915754 http://www.medworm.com/index.php?rid=4915753&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00620.x Conclusions: A content analysis of 590 goal statements listed by respondents resulted in the generation of seven basic level instrumental goals (global/general health care issues; diagnostic/assessment issues; treatment/plan of care issues; information‐gathering; information‐giving; information‐verifying; and resource management); four basic level relational goals (relationship‐building; compliance‐gaining; anxiety management; and identity management); and three basic level self‐presentational goals (establishing expertise; demonstrating professionalism; and demonstrating compassion).Implications for practice: Primary care medical interviews are recurring events that can produce automatic or habitual communication that may not be optimal for patient care. Training sessions that... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4915753 Wed, 08 Jun 2011 23:00:00 +0100 4915753 http://www.medworm.com/index.php?rid=4915752&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00621.x Conclusions: Nurse‐managed clinics (NMCs) have become important in the U.S. healthcare system with well documented positive impact. However, financial issues have placed may NMCs at risk for closure. Achieving FQHC status is seen as a viable option to increase revenue and therefore financial stability.Implications for practice: This discussion of the benefits of FQHC status, an overview of some common compliance issues with FQHC requirements, and the report of lessons learned along the way in meeting FQHC standards that we encountered can provide support and guidance for other NMCs in similar situations. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4915752 Wed, 08 Jun 2011 23:00:00 +0100 4915752 http://www.medworm.com/index.php?rid=4915751&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00624.x Conclusions: Acute myocardial infarction was diagnosed in 82% of the sample, and 18% experienced unstable angina. Subjects’ mean age was 44.7 years (SD± 7.6; range 29–60) and most were enlisted and reservists. Risk factors included a family history of premature coronary artery disease (41%) and smoking (47%) as well as a history of hyperlipidemia (48%), hypertension (28%), and glucose abnormalities (6%). The group was overweight (BMI 27.77 kg/m2± 3.2) and low risk for CV events (Framingham risk score 7.8%[± 4.4]).Implications for practice: Young military men are regarded as the epitome of health and fitness; however, findings from this study suggest that this generally low‐risk group do indeed have multiple CV risk factors and experience ACS. Early risk factor assessment and modif... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4915751 Wed, 08 Jun 2011 23:00:00 +0100 4915751 http://www.medworm.com/index.php?rid=4915750&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00625.x Conclusion: Few NPs (39%) reported “comfortable” in identifying red flags “suspect” for Lynch syndrome. Percentage of NPs who responded correctly on each of the pretest items ranged from 17.0% to 57.1% (M= 26.2%; SD= 13.5%; 95% confidence intervals [CI] 14.9%, −37.5%). NPs who responded correctly to the same items after the educational program (posttest) ranged from 53.8% to 95% (M= 80.5%; SD= 15.3%; 95% CI 67.8%, −93.4%).Implications for practice: Genetic testing is widely available for Lynch syndrome. It is important that NPs are cognizant of the syndrome and identify patients at risk for hereditary cancer syndromes so appropriate referral and management can be instituted. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4915750 Wed, 08 Jun 2011 23:00:00 +0100 4915750 http://www.medworm.com/index.php?rid=4940058&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00628.x Conclusion: Management of patients with ALS by the NP requires anticipation of needed referrals based on symptom assessment and knowledge of the common timeline of ALS progression. Close collaboration with specialists such as neurologists, pulmonologists, and a palliative care team provides patients and families with much needed support and improves outcomes.Implications for practice: Anticipating and initiating appropriate and timely referrals for patients with ALS may improve quality of life for patients with this devastating condition. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4940058 Tue, 31 May 2011 23:00:00 +0100 4940058 http://www.medworm.com/index.php?rid=4924803&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00641.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4924803 Tue, 31 May 2011 23:00:00 +0100 4924803 http://www.medworm.com/index.php?rid=4915749&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00626.x Conclusions: There is limited existing research on graduate student selection to assist faculty in selecting students. One university's process is described in detail for possible replication by others to improve the process.Implications for practice: The process highlighted in this article may be useful to other faculty as a model for improvement of student selection processes. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4915749 Tue, 31 May 2011 23:00:00 +0100 4915749 http://www.medworm.com/index.php?rid=4906187&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00638.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4906187 Tue, 31 May 2011 23:00:00 +0100 4906187 http://www.medworm.com/index.php?rid=4906186&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00642.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4906186 Tue, 31 May 2011 23:00:00 +0100 4906186 http://www.medworm.com/index.php?rid=4906185&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00643.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4906185 Tue, 31 May 2011 23:00:00 +0100 4906185 http://www.medworm.com/index.php?rid=4777011&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00615.x Conclusions: Black‐spot poison ivy is a rare phenomenon and usually poses a diagnostic challenge. It usually presents after exposure to a higher concentration of uroshiol on Toxicodendron plants. Patients present with black‐spot deposits on the epidermis with underlying poison ivy dermatitis. The black deposits cannot be washed off the skin and are followed by itchy blisters. They eventually peel off and the skin heals without scarring.Implications for practice: An understanding of the pathophysiology, clinical presentation, treatment, and management of this rare phenomenon is important for the nurse practitioner (NP) to be able to make an accurate diagnosis and initiate appropriate treatment without delay. The NP's recognition and differentiation of it from other skin disorders includ... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4777011 Sat, 30 Apr 2011 23:00:00 +0100 4777011 http://www.medworm.com/index.php?rid=4760019&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00618.x Conclusions: Women's health nurse practitioners have evolved to fill an important role in healthcare delivery, caring for women across generations often within the same families.Implications for practice: Women's health nurse practitioners, as do all nurse practitioners, offer a unique approach to care. To paraphrase the words of one participant, I think we address a major healthcare need because if women are educated about themselves and what they need to do to take care of themselves, the result is a better community (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4760019 Thu, 28 Apr 2011 18:34:43 +0100 4760019 http://www.medworm.com/index.php?rid=4760023&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00613.x Conclusions: The NP faced several challenges, including remembering emotional events recounted during focus groups differently than participants. This necessitated debriefing and a recommendation to carefully form policies and procedures before collecting data to anticipate such events. By far, the benefit of the NP's involvement was her ability to identify key members for focus groups, to assist in tribal council meetings, and to schedule meetings.Implications for practice: CBPR research partnerships are enhanced by NPs that are members of the community. CBPR partnerships present opportunities for NPs and university faculty to work on relevant community problems together. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4760023 Tue, 26 Apr 2011 23:00:00 +0100 4760023 http://www.medworm.com/index.php?rid=4760022&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00614.x Conclusions: Interventions can be stratified based on initial screening of children and adolescents so that selection of treatment options is optimized. For all treatments, lifestyle modifications include attention to diet and activity level. Levels of initial success, as well as maintenance of target body mass index, may be related to the intensity and duration of interventions; involvement of family may increase success rates. For failed lifestyle interventions, or for patients with extreme obesity and/or certain comorbidities, pharmacologic or surgical options should be considered.Implications for practice: Many intensive programs have shown success, but the resources required for these approaches may be unavailable to the typical community provider and family. However, using current gu... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4760022 Tue, 26 Apr 2011 23:00:00 +0100 4760022 http://www.medworm.com/index.php?rid=4760021&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00616.x Conclusions: Living with hypertension encompassed living with many tensions and challenges. It was described by five organizing themes, each of which involved two basic themes held in tension. The organizing themes were: (a) centrality of HTN; (b) controllability of HTN; (c) visibility of HTN, (d) accessibility and quality of health care; and (e) existential reality.Implications for practice: Interventions are needed to help clients deal with the tensions and challenges; these include a greater focus on partnering with clients, individual and group educational activities, and developing community partnerships. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4760021 Tue, 26 Apr 2011 23:00:00 +0100 4760021 http://www.medworm.com/index.php?rid=4760020&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00617.x Conclusions: AAD affects one in five people on antibiotics. Risk factors for the development of AAD include the use of broad‐spectrum antibiotics and host factors such as age, health status, hospitalization status, and exposure to nosocomial pathogens. About a third of AAD cases have CDAD. Meta‐analysis showed that administration of probiotics led to a statistically significant relative risk reduction of 44% for AAD and 71% for CDAD.Implications for practice: Extended hospital stays, readmissions, and higher hospital costs are just some of the consequences of ADD and CDAD. Strategies currently used include discontinuing or changing the inciting antibiotic, restricting high‐risk antibiotics, and encouraging the use of antibiotics based on sensitivity reports. Healthcare spending, morb... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4760020 Tue, 26 Apr 2011 23:00:00 +0100 4760020 http://www.medworm.com/index.php?rid=4749798&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00606.x Conclusions: Knowledge scores showed a small positive trend while favorable self‐perception of oral health increased significantly in the experimental group. The experimental group demonstrated a significant increase in frequency of brushing and flossing teeth, marked reduction in intake of high sugar drinks, and reported more than twice as many visits for a dental check‐up than the control group. Significant barriers to obtaining oral health services were identified.Implications for practice: Because adverse pregnancy outcomes have been linked to periodontitis in numerous research studies, pregnant women must be educated about the importance of oral health and the necessity of a check‐up. APNs are in an ideal position to educate women and assist them to obtain necessary oral health ... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4749798 Tue, 26 Apr 2011 17:33:03 +0100 4749798 http://www.medworm.com/index.php?rid=4727573&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00609.x Conclusions: Twenty‐seven percent of households tested positive for at least one contaminant, including total coliforms (18%), arsenic (6%), synthetic organic chemicals (6%), nitrates (2%), fluoride (2%), and E. coli (<1%). Eighty‐nine percent of households testing positive for total coliforms were positive at re‐test. Respondents expressed greatest concern for biological contamination and took multiple precautionary actions, although only 31% had ever tested their water for contaminants. Higher levels of education, income, and age, as well as homeowner status, were significantly associated with previous testing.Implications for practice: Recommendations for communicating abnormal results, mitigating risks, and overcoming logistical challenges are presented. (Source: Journal of th... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4727573 Mon, 18 Apr 2011 23:00:00 +0100 4727573 http://www.medworm.com/index.php?rid=4727572&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00610.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4727572 Mon, 18 Apr 2011 23:00:00 +0100 4727572 http://www.medworm.com/index.php?rid=4727571&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00611.x AbstractThe 2009‐2010 AANP National Nurse Practitioner Sample Survey was designed to replicate a survey conducted previously in 1988, 1998, and 2004. The survey collected data on variables such as nurse practitioner (NP) education, specialization, practice patterns and settings, compensation, and prescribing. With responses from 13,562 practicing NPs, the survey provided a comprehensive description of the practicing NP population. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4727571 Mon, 18 Apr 2011 23:00:00 +0100 4727571 http://www.medworm.com/index.php?rid=4727570&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00612.x Conclusions: Mean aggregate global scores showed no significant improvement between scores at entry and graduation. For 10 students with pre‐ and post‐performance data, there was no improvement in skill scores for any measure. Skill assessed on one measure worsened.Implications for practice: FNP students show no improvement in skills in working with interpreters with the current curriculum. An enhanced curriculum is needed. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4727570 Thu, 31 Mar 2011 23:00:00 +0100 4727570 http://www.medworm.com/index.php?rid=4660235&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00597.x Conclusions: Tai Chi is a safe alternative exercise for patients who are at risk of CHD or with existing CHD. Implementing Tai Chi exercise may improve serum lipids, blood pressure, and heart rate.Implications for practice: Nurse practitioners (NPs) are in an ideal position to facilitate health promotion and disease prevention. NPs may prescribe Tai Chi as an alternative exercise therapy for their patients who are at risk for developing CHD and even for those with existing CHD. Tai Chi exercise may help prevent and even reverse the progression of cardiac disease. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4660235 Wed, 30 Mar 2011 23:00:00 +0100 4660235 http://www.medworm.com/index.php?rid=4660234&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00603.x Conclusions: NPs involved in the management of patients with chronic hepatitis C are well positioned to provide supportive care and contribute to the development of effective treatment strategies that maximize the opportunity for successful treatment outcomes. Although peginterferon alfa plus ribavirin therapy is associated with a well‐described series of side effects, effective measures are available for the management of these events that permit the continuation of treatment and enhance the likelihood of attaining sustained virologic response. NPs can play a pivotal role in ensuring that these measures are in place in a preemptive manner. For example, growth factor supplementation represents an alternative to dose reduction or treatment discontinuation in selected patients with neutrop... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4660234 Wed, 30 Mar 2011 23:00:00 +0100 4660234 http://www.medworm.com/index.php?rid=4660233&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00606.x Conclusions: Knowledge scores showed a small positive trend while favorable self‐perception of oral health increased significantly in the experimental group. The experimental group demonstrated a significant increase in frequency of brushing and flossing teeth, marked reduction in intake of high sugar drinks, and reported more than twice as many visits for a dental check‐up than the control group. Significant barriers to obtaining oral health services were identified.Implications for practice: Because adverse pregnancy outcomes have been linked to periodontitis in numerous research studies, pregnant women must be educated about the importance of oral health and the necessity of a check‐up. APNs are in an ideal position to educate women and assist them to obtain necessary oral health ... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4660233 Wed, 30 Mar 2011 23:00:00 +0100 4660233 http://www.medworm.com/index.php?rid=4646580&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00598.x Conclusion: Foot conditions are an important concern among homeless individuals. To add to the complexity of foot‐related problems, many respondents (N= 56) from this survey reported a history of diabetes, hypertension, and peripheral vascular disease. The majority (N= 92) of those surveyed value healthy feet and education related to foot care. Condition of shoes, socks, and foot odor was identified by participants (n= 62) as a major deterrent to using foot care services.Implication for practice: To increase use of foot care programs among homeless adults, services must be offered during the day time when they are not competing to secure nightly shelter. Foot care programs should be innovative and tailored to their unique needs and address concern for sensitivity to feet, sock, and shoe ... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4646580 Sun, 27 Mar 2011 23:00:00 +0100 4646580 http://www.medworm.com/index.php?rid=4646579&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00599.x Conclusions: Pharmacy students demonstrated significantly better knowledge than medical and NP students with respect to identifying and selecting management strategies for possible DDIs. However, there is much room for improvement for all groups.Implications for practice: An increase in curricular content that focuses on DDIs has the potential to better prepare medical, pharmacy, and NP students for practice situations involving DDI alerts, and to increase the quality of patient care. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4646579 Sun, 27 Mar 2011 23:00:00 +0100 4646579 http://www.medworm.com/index.php?rid=4646578&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00600.x Conclusions: The emerging evidence base for this use of silver dressings in clinical practice on chronic wounds does not provide absolute evidence of antimicrobial efficacy because there are limited large, well‐designed RCTs. To supplement this gap, more rigorously controlled long‐term, randomized studies of human subjects with chronic wounds are needed.Implications for practice: It is essential that advanced practice nurses (APNs) be knowledgeable of the wound bacterial balance continuum. For deciding appropriate wound healing strategies, they also need to critically appraise the current literature as it changes for the latest information on antimicrobial efficacy of silver dressings. Until research clarifies the inconclusive evidence, APNs must provide holistic and accurate assessmen... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4646578 Sun, 27 Mar 2011 23:00:00 +0100 4646578 http://www.medworm.com/index.php?rid=4646577&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00602.x Conclusions: COPD disease affects millions of Americans and is physically and psychologically distressing. The hallmark of chronic obstructive pulmonary disease is irreversible airflow limitation and dyspnea. Dyspnea is a major contributor to decreased exercise capacity and functional status in this population. Understanding the methods to complete a functional assessment is important for all practitioners caring for this population.Implications for practice: This paper provides an overview of current methods used to assess functional status, including pulmonary function testing, exercise testing, and anthropomorphic and self‐report measurements. In addition, there is discussion of the indications and contraindications for exercise testing in chronic obstructive pulmonary disease and the... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4646577 Sun, 27 Mar 2011 23:00:00 +0100 4646577 http://www.medworm.com/index.php?rid=4646576&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00601.x Conclusions: There is currently a critical shortage of primary care providers and an aging population requiring management of chronic medical conditions. Although NPs are trained in health promotion, disease prevention, and medical management and are well equipped to treat patients in primary care, the work can be overwhelming to the novice NP. A mentoring program could help the new NP further develop competencies and capabilities as a provider. However, there is a gap in the literature concerning any mentoring programs for novice NPs. Nonetheless, the literature review has provided a mentoring definition, program models, desired characteristics of nurse mentors, and barriers to mentoring programs. It has also described the benefits, goals and outcomes of a mentoring relationship. These in... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4646576 Sun, 27 Mar 2011 23:00:00 +0100 4646576 http://www.medworm.com/index.php?rid=4699876&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00604.x Conclusions: The Game of Health was well received by patients and was effective in modifying behaviors to achieve a healthier lifestyle and to improve body composition. Primary care providers need to consider how to make lifestyle change programs available to their patients to complement clinical interventions. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4699876 Tue, 01 Mar 2011 00:00:00 +0100 4699876 http://www.medworm.com/index.php?rid=4660232&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00607.x Conclusions: Hwa‐Byung is a culture‐bound syndrome caused by long‐standing suppressed anger prevalent among older immigrant women of Korean heritage. Although the concept of Hwa‐Byung was reported more than a decade ago, it has not been studied cross‐culturally nor described sufficiently in the literature.Implications for practice: The use of appropriate guidelines and an understanding of Hwa‐Byung is essential for proper assessment, diagnosis (especially to distinguish it from clinical depression), and culturally sensitive management of this condition. Korean versions of screening tools are provided as online supporting information. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4660232 Tue, 01 Mar 2011 00:00:00 +0100 4660232 http://www.medworm.com/index.php?rid=4646575&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00605.x Conclusions: Elders' experiences with the production of self‐care were characterized by three themes: preparation, monitoring, and evaluation. Self‐care production was found to be cognitively challenging consistent with the finding that 60% of the participants had difficulty with a cognitive task requiring complex cognitive skills. This finding may explain why the production of self‐care became a social phenomenon in which elders demonstrated resourcefulness in seeking assistance from surrounding support systems.Implications for practice: Nurse practitioners can support better health outcomes in older adults with hypertension by using valid and reliable measures for assessing complex cognitive skills, assessing individuals' progress in self‐care production, and identifying individu... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4646575 Tue, 01 Mar 2011 00:00:00 +0100 4646575 http://www.medworm.com/index.php?rid=4618048&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00595.x Conclusions: Transgender persons remain marginalized and may remain closeted and at risk for negative psychosocial consequences. For those that do come out, other issues present, including the navigation of gender transition and psychosocial and physical changes that may be positive and/or negative. Examples of positive effects may include satisfaction of living authentically and decrease in depression. Negative effects may include social discrimination and loss of relationships. To provide holistic care, NPs need to be aware of transgender lives in social context and of their healthcare needs.Implications for practice: Suggestions for cultivating a supportive healthcare environment include the usage of sensitive language and an appropriate health history and physical examination. Further,... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4618048 Tue, 01 Mar 2011 00:00:00 +0100 4618048 http://www.medworm.com/index.php?rid=4533791&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00608.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4533791 Tue, 01 Mar 2011 00:00:00 +0100 4533791 http://www.medworm.com/index.php?rid=4461565&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00589.x Conclusions: Current hypertension guidelines provide detailed management strategies, particularly for patients at high risk for CV events. NPs may help improve CV outcomes through careful diagnosis, risk stratification, and disease management, including improved patient education of the benefits of rational and sustained management of hypertension.Implications for practice: Early diagnosis, evidence‐based treatment, and ongoing disease management of hypertension can be expected to improve CV outcomes. Treatment initiation with combination therapy, preferably with single‐pill combinations that incorporate an agent that modulates the renin‐angiotensin‐aldosterone system, provides an approach that is safe, effective, and well tolerated and which can be tailored to the needs of the ind... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4461565 Thu, 10 Feb 2011 00:00:00 +0100 4461565 http://www.medworm.com/index.php?rid=4461564&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00591.x Conclusions: Seventy percent of subjects reported experiencing a moderate level of fatigue, 12% a high level of fatigue. Pearson bivariate correlations indicated significant total fatigue scores and a strong correlation with anxiety (r= .580, p < .01) and depression (r= .572, p < .01). No patients reported high levels of social support; 57 (23%) patients received low levels of social support; and 195 (77%) patients reported moderate social support. Overall, fatigue was significantly predicted by anxiety, depression, and pain. Subjective support, income per month, and employment status were negatively correlated with fatigue scores.Implications for practice: These results yielded a profile of women who are at increased risk for heightened fatigue and suggest ways to intervene clinical... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4461564 Thu, 10 Feb 2011 00:00:00 +0100 4461564 http://www.medworm.com/index.php?rid=4461563&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00593.x Conclusions: Research suggests that all AF patients should continue anticoagulant therapy long term, even if they convert to sinus rhythm. Adequate rate control or rhythm control does not appear to reduce the need for lifelong antithrombotic therapy.Implications for practice: While an individualized treatment approach to AF is essential, a strong focus in the care of the older adult with AF should be on maintaining therapeutic International Normalized Ratio (INR) levels. Improved quality of life is more dependent on reducing thromboembolic events and subsequent sequelae of stroke. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4461563 Thu, 10 Feb 2011 00:00:00 +0100 4461563 http://www.medworm.com/index.php?rid=4461562&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00594.x Conclusions: APNs experience both challenges and successes in caring for women who live with IPV. Findings consist of interpretations of clinical stories to uncover knowledge embedded in practice. Healing practices and ways of being survival facilitators for women and children are identified and described.Implications for practice: APNs are in a unique position to help families who live with abuse, but may lack resources and knowledge about the most effective interventions. They may become cynical and frustrated with feelings of futility when faced with the repeating patterns associated with the cycle of violence. The goals of this study are to promote more comprehensive understanding of IPV and stimulate changes in education, practice, research, and health policy. (Source: Journal of the ... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4461562 Tue, 01 Feb 2011 00:00:00 +0100 4461562 http://www.medworm.com/index.php?rid=4420875&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2011.00596.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4420875 Tue, 01 Feb 2011 00:00:00 +0100 4420875 http://www.medworm.com/index.php?rid=4339770&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00581.x Conclusions: Most study participants were overweight; however, body image discrepancy (difference between perceived actual and ideal body image) did not increase as anticipated and was negatively related to body mass index; suggesting those participants' perceptions of ideal body image increased with increasing body size and was reliable. Body attitude subscale scores had varying relationships to weight status.Implications for practice: Further study is warranted examining why an acceptance of a greater body image occurs, potentially leading to a greater understanding of the influences of body image integration on health behaviors. Clinicians working with Mexican American women should consider weight reduction interventions that are based on an individual assessment of the perceptions of b... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4339770 Thu, 13 Jan 2011 00:00:00 +0100 4339770 http://www.medworm.com/index.php?rid=4339777&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00577.x Conclusions: Cost savings and convenience offered by RCs are attractive to urban patients, and given sufficient cost savings they are likely to seek care there. All else equal, one would require cost savings of at least $30.21 to seek care from an NP at RC rather than a physician at private office, and $83.20 to wait one day or more.Implications for practice: Appointment wait time is a major determinant of careseeking decisions for minor illnesses. The size of the consumer utility associated with the convenience feature of RCs indicates that there is likely to be further growth and employment opportunities for NPs in these clinics. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4339777 Tue, 11 Jan 2011 00:00:00 +0100 4339777 http://www.medworm.com/index.php?rid=4339776&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00582.x Conclusions: One fourth of the respondents were considering beginning exercise within the next month; 23% had exercised regularly for more than 6 months and 39% indicated that they exercised regularly. Most respondents believed the pros of exercise outweighed the cons, and as the pros increased, so did the likelihood of exercising.Implications for practice: In approaching the subject of exercise among obese and overweight individuals it is important for the APN to understand behavioral change. Thus, it would be more fruitful to ask, “What would it take to move those who intend to begin exercising to the next stage?” For health behavior change to occur, the pros must be twice as numerous as the cons. In clinical practice, reviewing and adding to the pros of exercise as outlined by the p... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4339776 Tue, 11 Jan 2011 00:00:00 +0100 4339776 http://www.medworm.com/index.php?rid=4339775&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00584.x Conclusion: This work indicates that parents have varying foci on causation of obesity, and differ in focus on nutrition and physical activity. Most of the parents in this study were aware of healthy nutrition, and about one third of them believed in the benefits of physical activity for children and did not see being overweight or obese as a barrier to physical activity. The first group was confident in being able to deliver healthy nutrition to their family, and the second group was characterized by a focus on physical activity and its role in childhood obesity. Both groups agreed that exercising and sports are very important to a child's health status.Implications for practice: Nurse practitioners have a unique role in the health system and are one of the best facilitators to deliver he... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4339775 Tue, 11 Jan 2011 00:00:00 +0100 4339775 http://www.medworm.com/index.php?rid=4339774&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00583.x Conclusions: RNs who had a lower BMI were more successful in losing weight than RNs who had a higher BMI. They were also more successful in their weight loss attempts if they did not use a diet regimen.Implications for practice: RNs who were successful in losing weight did not use a specified dietary regimen. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4339774 Tue, 11 Jan 2011 00:00:00 +0100 4339774 http://www.medworm.com/index.php?rid=4339773&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00585.x Conclusions: There were no significant statistical differences in mean weight or BMI on weeks 1 and 5. However, on week 10, there was a statistically significant difference for waist circumference in both clinics (p= .0466). Knowledge base improved in both clinics with a premean (0 score = 87 ± 18) and postmean (0 score = 93 ± 14). Both sites received high scores for patient satisfaction.Implications for practice: The shared medical group visits program implemented in both clinic sites demonstrated that this is an effective model in which to provide intensive patient education, foster peer support, and facilitate health‐related behavioral changes. Peer support, self‐management, and continuity appear to be important factors in behavior change and improved knowledge. (Source: Journal o... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4339773 Tue, 11 Jan 2011 00:00:00 +0100 4339773 http://www.medworm.com/index.php?rid=4339772&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00587.x Conclusions: Pharmacotherapy as a strategy for managing overweight, obese, and extremely obese individuals remains controversial. Risk versus benefit and overall safety of prescription drugs for weight loss management remains a primary focus for consideration among clinicians and a viable topic for evidence‐based outcomes research.Implications for practice: Overweight and obesity are well accepted as critical risk factors and predictors of morbidity and mortality in individuals of all ages from childhood to senescence. In the United States, overweight and obesity exist in epidemic proportions. It is critical that primary care providers be knowledgeable about pharmacologic factors related to obesity. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4339772 Tue, 11 Jan 2011 00:00:00 +0100 4339772 http://www.medworm.com/index.php?rid=4339771&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00588.x Conclusions: Silver‐tipped catheters retarded the development of the biofilm. The use of cranberry juice/extract showed few if any adverse reactions and avoided the problems of induced antibiotic resistance or introduction to supra‐infections, such as Clostridium difficile infection. The immune stimulant OM‐89 shows promise and may lead to simple and inexpensive preventive measures. Further research is needed to include elders, both men and women, and elders with long‐term indwelling catheters.Implications for practice: Nurse practitioners (NPs) can assure that basic nursing principles regarding long‐term indwelling catheter care are upheld, measures such as proper assessment and insertion, as well as the appropriate use of silver‐tipped catheters. NPs can prescribe cranberry j... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4339771 Tue, 11 Jan 2011 00:00:00 +0100 4339771 http://www.medworm.com/index.php?rid=4407884&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00590.x Conclusions: Strategies to optimize responses to PDE5 therapy are summarized by the mnemonic “EPOCH”: Evaluating and educating to ensure realistic expectations of therapy; Prescribing a treatment individualized to the couple's needs and preferences; Optimizing drug dose/regimen and revisiting key educational messages at follow‐up visits; Controlling comorbidities via lifestyle counseling, medications, and/or referrals; and Helping patients and their partners to seek other forms of therapy if they have decided not to use a PDE5 inhibitor.Implications for practice: The “EPOCH” mnemonic may remind NPs of steps to optimize treatment outcomes with PDE5 inhibitors. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4407884 Sat, 01 Jan 2011 00:00:00 +0100 4407884 http://www.medworm.com/index.php?rid=4339769&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00586.x Conclusions: Ordinal multiple logistic regression with gender and ethnicity controlled for revealed two major factors (high body mass index and poor/fair general health status) contribute to body dissatisfaction across gender and ethnicity in California adolescents. Other factors related to body dissatisfaction varied with ethnicity and gender.Implications for practice: Gender‐ and ethnicity‐specific interventions to improve body image in adolescents must be developed. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4339769 Sat, 01 Jan 2011 00:00:00 +0100 4339769 http://www.medworm.com/index.php?rid=4311082&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00580.x Conclusion: Urachal disorders occur in 1 of 5000 persons. Complications from these disorders are even rarer. Early recognition of these anomalies can reduce the incidence of more serious complications such as secondary infections, sepsis, abscess formation, recurrent cystitis, and neoplasms.Implications for practice: Nurse practitioners will encounter patients with stable and acute complications from urachal anomalies. Awareness of these anomalies can expedite diagnosis, treatment, and referral therefore improving patient outcomes. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4311082 Sat, 01 Jan 2011 00:00:00 +0100 4311082 http://www.medworm.com/index.php?rid=4311081&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00592.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4311081 Sat, 01 Jan 2011 00:00:00 +0100 4311081 http://www.medworm.com/index.php?rid=4227176&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00579.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4227176 Wed, 01 Dec 2010 00:00:00 +0100 4227176 http://www.medworm.com/index.php?rid=4136657&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00561.x Conclusions: Although the major risk factors for CVD are largely preventable, CVD rates are increasing to epidemic proportions. Traditional advice giving to decrease CVD risk is minimally effective. MI combined with TTM is an effective counseling technique, which motivates patients who are resistant and ambivalent to change. MI is an appropriate, evidence‐based strategy to promote cardiovascular health.Implications for practice: NPs working in primary care can integrate MI with TTM into ongoing patient encounters to facilitate positive behavior changes in their patients over time. Thus, NPs can play a key role in decreasing the growing burden of CVD in North America. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136657 Fri, 05 Nov 2010 00:00:00 +0100 4136657 http://www.medworm.com/index.php?rid=4136656&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00562.x Conclusions: NPs reported that they felt well‐prepared and moderately effective in providing lifestyle change counseling. Participant attendance was high and in‐person sessions were implemented with good success. Participants in the lifestyle program were more satisfied with the program, reporting that the program was a good experience.Implications for practice: Implementation of a lifestyle program to prevent T2D in primary care is feasible and acceptable to NPs and participants. Developing a structured program may improve health outcomes. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136656 Fri, 05 Nov 2010 00:00:00 +0100 4136656 http://www.medworm.com/index.php?rid=4136655&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00564.x Conclusions: Breast MRI had a higher sensitivity than mammography and ultrasound in all studies comparing breast MRI. The specificity was lower for breast MRI than for mammography in five out of six studies. The ultrasound had a higher sensitivity than mammography in all five studies examining women with dense breast tissue.Implications for practice: Women who fall into high‐risk categories should be screened yearly with breast MRI and mammography. Women with dense breast tissue according to a standardized density score should be screened yearly with ultrasound and mammography. Women in the general population should be screened yearly with mammography. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136655 Fri, 05 Nov 2010 00:00:00 +0100 4136655 http://www.medworm.com/index.php?rid=4136654&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00565.x Conclusions: Results from this study found that both higher systolic and diastolic blood pressure were positively associated with higher depressive symptom scores (r= .20 and .18, p < .05). Higher depressive symptoms scores were, in turn, significantly associated with lower social support scores (r=–.44, p < .001). However, total social support scores were not significantly correlated with blood pressure readings. Higher depressive symptom scores were associated with increased systolic blood pressure independent of social support.Implications for practice: Findings of the present study suggest the importance of appropriate social support to help alleviate depressive symptoms. However, to effectively control blood pressure in patients with depressive symptoms, other pathophysiologic... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136654 Fri, 05 Nov 2010 00:00:00 +0100 4136654 http://www.medworm.com/index.php?rid=4136653&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00566.x Conclusion: A diagnosis of T‐cell PLL was made after a computed tomography scan of the abdomen confirmed splenomegaly and a bone marrow biopsy showed a hypercellular marrow infiltrated with numerous small lymphocytes, consistent with this disease. Currently, there is no optimal treatment for T‐cell PLL, but alemtuzumab has shown success with extending survival 1–3 years.Implications for practice: This case presented several ethical and practical challenges for this patient and her family in making a decision for chemotherapy treatment. This case underscores the need for the physicians and nurse practitioners to establish a collaborative relationship with patient, family, and other care providers when advocating for or against treatment. (Source: Journal of the American Academy of Nur... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136653 Fri, 05 Nov 2010 00:00:00 +0100 4136653 http://www.medworm.com/index.php?rid=4136652&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00568.x Conclusions: Binge drinking rates were high (63% of female, 83% of male students). Binge eating was reported by 48% of students and was correlated with healthy and unhealthy weight loss behaviors. Female students were more likely to endorse the use of skipping meals, fasting, use of diet pills, laxatives, and self‐induced vomiting.Implications for practice: Binge drinking and disordered eating behaviors are practiced by both male and female students and are common occurrences on college campuses. Nurse practitioners need to be aware of these behaviors, their co‐occurrence, and the need to assess and intervene with students who are at risk for the negative health outcomes associated with the use of these behaviors. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136652 Fri, 05 Nov 2010 00:00:00 +0100 4136652 http://www.medworm.com/index.php?rid=4136651&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00569.x Conclusions: Best available evidence showed more support in favor of allowing families at the bedside during CPR. Implementation of policies and procedures allowing family presence enables facilities to change and grow in a holistic and family‐oriented atmosphere.Implications for practice: With this evidence‐based knowledge the APN will be able to disseminate information to facilitate collaborative change in current practices surrounding staff education, decision making, and self‐governance. The APN can then address controversial changes when developing formal policies and procedures, which will increase patient satisfaction and outcomes. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136651 Fri, 05 Nov 2010 00:00:00 +0100 4136651 http://www.medworm.com/index.php?rid=4136650&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00570.x Conclusions: The NPs sampled were satisfied with benefits, challenge, and autonomy. They were minimally satisfied with professional growth, intrapractice partnership, and collegiality. Twenty‐seven percent of NPs indicated intent to leave current positions; a small percentage (5.5%) indicated intent to leave the nursing profession and the NP role as a direct care provider (5.5%). There were significant differences in job satisfaction based on intent to leave current positions, and higher job satisfaction scores were significantly related to intent not to leave current positions. There was a significant negative relationship between job satisfaction and anticipated turnover. This study contributes to the current literature that has minimally addressed NP job satisfaction and has not addre... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136650 Fri, 05 Nov 2010 00:00:00 +0100 4136650 http://www.medworm.com/index.php?rid=4136649&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00571.x Conclusions: Until the late 1990s, healthcare‐associated MRSA (HA‐MRSA) was the predominant cause of serious infections. Recently, CA‐MRSA has caused infections in previously healthy nonhospitalized people. Major demographic and epidemiological differences exist between the two types of resistant bacteria; the emergence of CA‐MRSA suggests new implications for primary care.Implications for practice: PCNPs will undoubtedly treat MRSA infections and need a comprehensive understanding of the pathogenicity, diagnosis, and management of CA‐MRSA to ensure expedient and appropriate treatment. This will help to prevent invasive disease as a result of improperly treated infections. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136649 Fri, 05 Nov 2010 00:00:00 +0100 4136649 http://www.medworm.com/index.php?rid=4136648&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00572.x Conclusions: Reviewing manuscripts requires a high level of professional expertise and commitment. This article describes the history and benefits of peer review and provides a practical overview of the peer review process. A template has also been developed to serve as a checklist for critical elements relating to peer review.Implications for practice: Peer review has a critical role in improving the quality of nursing's published knowledge base and ultimately the quality of patient care. The ability to provide sound critique of nursing manuscripts is essential to the continued development of advanced practice nursing (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136648 Fri, 05 Nov 2010 00:00:00 +0100 4136648 http://www.medworm.com/index.php?rid=4136647&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00573.x Conclusions: The yoga group had lower morning and 5 p.m. salivary cortisol and improved emotional well‐being and fatigue scores.Implications for practice: Breast cancer survivors are at risk for chronic psychosocial distress that may alter activity of the hypothalamic–pituitary–adrenal axis, resulting in aberrant regulation of cortisol secretion and increased risk of immune dysfunction and cancer progression. Regular yoga practice may be a low‐risk, cost‐effective way to improve psychosocial functioning, fatigue, and regulation of cortisol secretion in breast cancer survivors. These findings require validation with a larger randomized study. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136647 Fri, 05 Nov 2010 00:00:00 +0100 4136647 http://www.medworm.com/index.php?rid=4198494&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00578.x Conclusions: A number of safe and effective treatment options exist for GERD. Recent developments in PPI technology may begin to address unmet needs in PPI therapy.Implications for Practice: GERD is commonly diagnosed and treated by nurse practitioners in the primary care setting. Acid suppression therapy is the primary medical therapy for GERD. PPI therapy provides symptomatic relief of heartburn and regurgitation, as well as effective healing and maintenance of erosive esophagitis. Newer PPIs lengthen the duration of acid suppression and allow for more flexibility in dosing, which may improve medication adherence and decrease episodes of acid breakthrough. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4198494 Mon, 01 Nov 2010 00:00:00 +0100 4198494 http://www.medworm.com/index.php?rid=4146360&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00567.x Conclusions: Cirrhosis is the leading cause of portal hypertension in Europe and North America. Esophageal varices are a result of the portosystemic collaterals the body develops to decompress the portal system. Hemorrhage from esophageal varices is a major cause of morbidity and mortality. Prevention of a primary bleed is the goal of therapy and is accomplished with nonselective ß‐blockers.Implications for practice: Very few patients with portal hypertension and esophageal varices are on ß‐blockers. Use of nonselective ß‐blockers has been found to lower portal pressure and decreases the risk of bleeding from esophageal varices and therefore decreases mortality. Patients unable to use ß‐blockers can undergo endoscopic variceal ligation as an alternate method to reduce risk of b... Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4146360 Mon, 01 Nov 2010 00:00:00 +0100 4146360 http://www.medworm.com/index.php?rid=4136658&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00574.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136658 Mon, 01 Nov 2010 00:00:00 +0100 4136658 http://www.medworm.com/index.php?rid=4136646&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00576.x Conclusions: NPs rated both their perceptions of collaboration with physician colleagues and levels of autonomy as high. Yet, there was no significant correlation between these variables.Implications for practice: Collaboration between NPs and physician colleagues is said to improve the quality and cost of health outcomes and also leads to professional satisfaction. Further research into the relationships between collaboration and autonomy are necessary to understand these complex concepts. (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4136646 Mon, 01 Nov 2010 00:00:00 +0100 4136646 http://www.medworm.com/index.php?rid=4079506&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00553.x Abstract  (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4079506 Thu, 30 Sep 2010 23:00:00 +0100 4079506 http://www.medworm.com/index.php?rid=4079505&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00554.x Abstract  (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4079505 Thu, 30 Sep 2010 23:00:00 +0100 4079505 http://www.medworm.com/index.php?rid=4079504&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00555.x Abstract  (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4079504 Thu, 30 Sep 2010 23:00:00 +0100 4079504 http://www.medworm.com/index.php?rid=4079503&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00557.x Abstract  (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4079503 Thu, 30 Sep 2010 23:00:00 +0100 4079503 http://www.medworm.com/index.php?rid=4079502&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00558.x Abstract  (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4079502 Thu, 30 Sep 2010 23:00:00 +0100 4079502 http://www.medworm.com/index.php?rid=4079501&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00559.x Abstract  (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4079501 Thu, 30 Sep 2010 23:00:00 +0100 4079501 http://www.medworm.com/index.php?rid=4079500&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00560.x Abstract  (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4079500 Thu, 30 Sep 2010 23:00:00 +0100 4079500 http://www.medworm.com/index.php?rid=4057887&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00575.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4057887 Thu, 30 Sep 2010 23:00:00 +0100 4057887 http://www.medworm.com/index.php?rid=4057886&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00552.x (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=4057886 Thu, 30 Sep 2010 23:00:00 +0100 4057886 http://www.medworm.com/index.php?rid=3931162&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00540.x Abstract (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=3931162 Tue, 31 Aug 2010 23:00:00 +0100 3931162 http://www.medworm.com/index.php?rid=3931161&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00501.x Abstract (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=3931161 Tue, 31 Aug 2010 23:00:00 +0100 3931161 http://www.medworm.com/index.php?rid=3931160&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00539.x Abstract (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=3931160 Tue, 31 Aug 2010 23:00:00 +0100 3931160 http://www.medworm.com/index.php?rid=3931159&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00538.x Abstract (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=3931159 Tue, 31 Aug 2010 23:00:00 +0100 3931159 http://www.medworm.com/index.php?rid=3931158&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00536.x Abstract (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=3931158 Tue, 31 Aug 2010 23:00:00 +0100 3931158 http://www.medworm.com/index.php?rid=3931157&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00541.x Abstract (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=3931157 Tue, 31 Aug 2010 23:00:00 +0100 3931157 http://www.medworm.com/index.php?rid=3931156&cid=s_32344_27_f&fid=32344&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1745-7599.2010.00537.x Abstract (Source: Journal of the American Academy of Nurse Practitioners) Journal of the American Academy of Nurse Practitioners journals http://www.medworm.com/rss/comments.php?id=3931156 Tue, 31 Aug 2010 23:00:00 +0100 3931156