Joyce Anastasi

Abstract

Distal sensory peripheral neuropathy (HIV-DSP) affects upwards of 50% of people living with HIV. Causing often debilitating symptoms of tingling, numbness and burning, HIV-DSP can result in disability, unemployment and low quality of life. Comorbidities further complicate nursing care, heightening risk of polypharmacy and symptom exacerbation. Therefore, a neurological sensory assessment, combined with the patient's self-report of symptoms, can help nurse practitioners visualize, quantify and understand symptoms. Common pharmacological interventions include antiepileptics, antidepressants, analgesics and medical marijuana. The complexity of care for individuals with HIV-DSP merits a comprehensive approach. Implications for practice include interdisciplinary management with neurologists, podiatrists, mental health providers, and nurse-led counseling inclusive of patient safety teaching.

Abstract

Traditional Chinese medicine encompasses many different practices, most notably acupuncture and moxibustion. Traditionally, these modalities are used in combination to augment treatment but seldom are they tested together in clinical studies. Numerous acupuncture studies have been conducted in Asia, Europe, and the United States but there have been few randomized controlled trials utilizing moxibustion outside of East Asia. Limited studies have described the use of a moxibustion control or placebo procedure. The methods for developing an acupuncture and moxibustion protocol used in a randomized controlled trial for irritable bowel syndrome, diarrhea predominant in adults are described here. Our approach conformed to the scientific rigor for a clinical trial and was consistent to the foundations of traditional Chinese medicine.

Abstract

Patients with irritable bowel syndrome (IBS) have often associated the worsening of symptoms with specific foods. Research is starting to catch up with what patients have reported about food interaction and their symptoms, and the role of diet is being increasingly recognized for the management of IBS. Clinical guidance for nurse practitioners can be challenging because of limited data and guideline consensus along with the nuances of symptoms associated with IBS subtypes. This article summarizes some of the key themes and dietary recommendations by various gastrointestinal organizations, public health agencies, and dietary associations. By addressing the relevance of diet for symptom alleviation, nurse practitioners are able to better support patients and collaborate with dietitians to improve symptom management.

Abstract

Gluten-free diets are increasing in popularity among consumers and fueling a global market of gluten-free products. A gluten-free diet is the only treatment for celiac disease (CD). However, many patients are self-reporting and suspecting "gluten sensitivity" after gastrointestinal symptoms, such as bloating, abdominal pain, or diarrhea, resolve on a gluten-free diet without formal evaluation testing for food allergies or CD. The terms related to gluten and/or wheat intolerance, nonceliac gluten sensitivity or wheat sensitivity, CD, and wheat allergy can be confusing. These forms of intolerance combined affect approximately 10% of the United States population. In this article we clarify the range of gluten and/or wheat disorders, clinical features, diagnosis, and management.

Abstract

Background: One of the principal diagnostic methods in Traditional Chinese Medicine (TCM) is the inspection of the tongue. This method involves examination of the shape, size, color, and texture of the tongue body and coat and helps reveal the state of organ functions and progression of conditions. Literature on tongue observations for patients who have human immunodeficiency virus (HIV) is minimal. Objective: The goal of this study was to provide a clinical "snapshot" of initial tongue assessments of 159 patients living with HIV, who participated in an acupuncture clinical trial for chronic nausea. The aim was to explore the similarities and differences observed in tongue assessments. Design: This study was part of a prospective, randomized, controlled, double-blinded (subjects and evaluators), parallel-groups, acupuncture clinical trial for treating chronic nausea. Setting: The study was conducted at a large urban New York City academic health center. Patients: The patients in this study were 159 individuals who had HIV infections and who had histories of chronic nausea for ≥3 months. Main Outcome Measures: Initial tongue assessments were recorded for seven basic characteristics: (1) tongue color; (2) tongue shape; (3) tongue body quality; (4) coat color; (5) coat weight; (6) coat surface; and (7) tongue action. Results: The overall tongue picture seen in these patients was that the tongue was swollen and toothmarked, had a pink body with cracks, and had a thick, dry white coat. Conclusions: The HIV disease itself and the use of long term medications affect the Blood, Qi, Yin, and Yang. The observation of the tongue provides a window into the process of the disease and, ultimately, insight for clinical care. This sample population snapshot illustrates the complex processes seen in long-term chronic conditions managed by pharmacologic medications.

Abstract

OVERVIEW: Despite the decline in the incidence of central nervous system disease associated with HIV, distal sensory peripheral (DSP) neuropathy continues to be prevalent in this population, causing debilitating symptoms and affecting quality of life. Patients typically present with numbness, tingling, burning pain, and loss of sensation in the toes and soles of their feet. Although this complication causes loss of protective function and puts patients at elevated risk for injury, infection, and falls, foot care for people with HIV is often overlooked. This article reviews what is known about DSP neuropathy in HIV and discusses relevant foot care guidelines, adopted from the literature on other conditions associated with neuropathic foot disorders.