Leslie-Faith M Taub

Abstract

Purpose: To assist the nurse practitioner (NP) to make a rapid diagnosis and develop a treatment plan for pelvic inflammatory disease (PID) in order to assist women to promote their health and reduce their risk of the unnecessary sequelae of infertility, tubal damage, and the possibility of a subsequent ectopic pregnancy.Data sources: Centers for Disease Control guidelines and recent clinical practice literature were searched to provide guidance on how to diagnose, treat, and educate the patient with PID.Conclusions: The incidence of PID is approximately 1 million women annually. PID is diagnosed in 1%-2% of sexually active women under the age of 25, with a higher incidence in African American women. Women with PID produce over 2 million emergency room and office visits and incur health care costs of over 4 billion dollars annually.Implications for practice: PID is associated with chronic pelvic pain, infertility, and ectopic pregnancy. Symptoms can range from subtle and indolent to acute and fulminant. Having a high index of suspicion for the diagnosis will assist the NP in treating patients with this disease. Empiric antibiotic therapy should be initiated in all women at risk who have uterine, adnexal, or cervical motion tenderness on a bimanual exam with no other explanation for these symptoms. Without response to treatment, if the diagnosis is unclear, or if a surgical emergency is being considered, prompt referral to a specialist is warranted. Secondary preventive measures are discussed.

Abstract

Purpose: To present a clinical case of idiopathic rapid eye movement sleep behavior disorder (RBD), differential diagnoses, selected treatments, and the pathology involved. Data sources: An Ovid data base search (covering 635 medical, neurologic, and psychiatric journals) was conducted using the search term RBD and limited to the years 2005-2009. This search strategy was used to locate clinical, research, and review articles providing the state of the science about RBD. A hand search was also conducted for seminal research papers as well as recent publications within the specialty of sleep disorders.Conclusions: RBD is a parasomnia with symptoms common to other disorders making it important to identify unique symptoms and diagnostic testing that helps differentiates these diseases. RBD can put the patient and the bed partner at risk for injury. Its prevalence is estimated to be 0.5% in older adults. Implications for practice: Nurse practitioners are primary care providers for older adults who may have complaints about behaviors associated with RBD. Knowledge of this disease process as well as its relationship with four other neurodegenerative diseases may provide an opportunity for early diagnosis and treatment of RBD and surveillance for and early diagnosis of the other neurodegenerative diseases in these patients.

Abstract

Background: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective: To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data: Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. Methods: Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results: Proportions of patients spending no extra time on foot care, shopping/cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3 min more per day. Discussion: Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices.

Abstract

Recent epidemiological, biological, and behavioral evidence suggests that sleep disorders may contribute to the development of diabetes; conversely, diabetes itself may contribute to sleep disorders. Sleep appears to moderate the neurohormones that regulate blood glucose. Sleep deprivation and sleep disorders contribute to pathophysiological changes associated with the development of type 2 diabetes. In people who already have diabetes, sleep deprivation contributes to elevations of hemoglobin A1c. Symptoms that occur as a result of diabetes, such as nocturia and neuropathic pain, may in turn contribute to sleep disturbance and exacerbate sleep deprivation. The purposes of this article are to examine the scientific basis for the associations between diabetes and sleep, identify gaps in the understanding of the empirical underpinnings of these relationships, and propose directions for future research.

Abstract

Purpose: To discuss the diagnosis and treatment of severe anemia in an older adult who presents the challenge of declining blood transfusion in a real-world scenario where critical thinking, evidence-based care, and collaboration with other providers must come together to serve this patient's unique needs. Data sources: Extensive review of the scientific literature on anemia and the situation in which a patient refuses blood transfusion presented in a case study format. Conclusions: A thorough physical assessment, complete health history, and appropriate diagnostic workup should be used to distinguish the normal effects of senescence from the signs and symptoms of anemia. Common conditions that cause anemia in the elderly include chronic disease, iron deficiency, and gastro-intestinal bleeding. These conditions may result in profound anemia. The challenge can be compounded when, because of religious tenets, a patient, does not accept a blood transfusion. This case study challenges nurse practitioners to apply knowledge, seek guidance, and make appropriate referrals to care for a patient in order to render care within the parameters of the patient's belief system. Implications for practice: The astute primary care provider recognizes that anemia is not an expected physiological change associated with aging but a manifestation of an underlying disease process. Fatigue, weakness, and dyspnea are all symptoms of anemia that, may be overlooked and attributed to the aging process. Further, in keeping with the principles of autonomy and self-determination, it. is the clinician's duty to work with all patients to restore them to a state of optimal health while respecting deeply held, spiritual beliefs.

Abstract

Purpose: To determine if selected client characteristics were factors influencing the provision of provider advice for diet, exercise, smoking cessation, alcohol cessation, eye and foot care, and influenza and pneumonia vaccine for those told by a provider that they had diabetes. Data sources: Data from the 2001 National Health Interview Survey were used in a secondary analysis to answer the research question. This study used a subsample who self-reported having provider-diagnosed diabetes; the subsample comprised 2287 unweighted subjects that, when weighted, represent 6.38% of the civilian noninstitutionalized individuals with diabetes in the United States. Conclusions: This study suggests that many patients are not receiving all the eight processes of care studied, particularly those with new onset diabetes, elders, black people, and Hispanics. Implications for practice: This study suggests that the present paradigm is not early prevention but treatment of established disease. Changes in entrenched thinking about clinical care need to be addressed. Patients with diabetes need to have an awareness that there is a standard of optimal care, and they should be encouraged to seek those who provide this care. Further, system changes may be required to address changes that are not easily made at the provider level.

Abstract

A policy analysis of access to health care was undertaken using a review of current studies and proposals for health care reform in order to uncover the issues of cost, quality, and scope of services that would be required to realize health care coverage for the 38.7 million Americans who remain uncovered. This national issue was explored at the state level, and it was also explored at the individual level by a description of those affected by age, race, ethnicity, health status, and gender. Finally, the author looks at health care reform as one of many other issues affecting the American citizen as choices are made about how to utilize limited resources.

Abstract

Using the 1998 ADA recommendations in diagnosing and treating type 2 diabetes in your clinical practice.