Could Your Patient Have an Eating Disorder?

Eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder, affect approximately 14 million people in the U.S., three‐fourths of whom are female. Contrary to popular belief, eating disorders affect people of all ages. Women's health nurses can play a vital role in identifying adolescents and women who may be suffering from an eating disorder and referring them for specialized treatment.     

Is shift work making your patient sick? Emerging theories and therapies for treating shift work disorder

"Shift work" is a term that applies to a wide array of nontraditional work schedules. Shift work disorder (SWD) is a circadian rhythm sleep disorder experienced by a subset of shift workers that is characterized by excessive sleepiness during work and/or insomnia during scheduled sleep times. It is estimated to affect up to 2 million Americans, and is associated with increased morbidity and mortality from metabolic risk factors, cardiovascular and gastrointestinal diseases, depression, accidents, and some kinds of cancers. Patient history is all that is needed to make a diagnosis with the International Classification of Sleep Disorders-Second Edition criteria as described herein. Circadian rhythm disorders, in which an underlying misalignment of circadian rhythm with the sleep-wake cycle occurs, may be treated by behavioral and pharmacologic approaches, including the use of hypnotics to improve the duration of sleep. However, evidence is limited with these approaches in patients diagnosed with SWD. Other treatment options may include pharmacologic interventions such as modafinil and armodafinil, which have shown efficacy in this population. Combined therapy can reduce insomnia and excessive sleepiness, and improve attention and alertness during work shifts and the subsequent commute home.     

What Interventions Improve Outcomes for the Patient Who Is Depressed and in Pain?

Specific Clinical IssueThe purpose of this clinical consultation is to offer nurses evidence-based strategies to provide holistic care to their patients with comorbid depression and pain. The combination of depression and pain is common and, if not managed effectively, has negative outcomes. Treatment-resistance is one negative outcome. The worst-case scenario for unrelieved depression and/or pain is suicide.Major Practice Recommendations Based on Best EvidenceAntidepressants, particularly duloxetine, have had efficacy for pain and depression. Cognitive behavioral therapy, an evidence-based treatment for depression, has been found to decrease pain. Examples of additional interventions include exercise, relaxation techniques, mindfulness, and music. Providing holistic nursing care and working with other disciplines optimizes more effective management of these co-occurring conditions.     

Is Cognitive Therapy Suitable for Treating Individuals with Personality Dysfunction?

In this study, the impact of personality dysfunction on suitability for cognitive therapy was examined empirically. Thirty-six (36) mental health outpatients were evaluated with regard to the extent of personality dysfunction and suitability for short-term cognitive therapy. All participants were interviewed by a psychiatrist using the Personality Disorders Examination (PDE) to assess personality dysfunction, and by a psychologist using the Suitability for Short-Term Cognitive Therapy Scale (SSCT) to assess cognitive therapy suitability. Participants also completed the Millon Clinical Multiaxial Inventory–Revised (MCMI-II) to provide a multimethod assessment of personality dysfunction. Analysis of the correlations between suitability for cognitive therapy and personality dysfunction for both the independent-interviewer rated method (the PDE) and the self-report method (MCMI-II) indicated that greater dysfunction was significantly associated with poorer suitability for cognitive therapy. Results were most clear for the general therapy subscale of the SSCT relative to the cognitive therapy specific subscale. A tentative item analysis of the SSCT scale indicated that alliance potential (both in-session and out-of-session ratings), security operations, chronicity, personal responsibility for change, and compatibility with the cognitive therapy rationale were most strongly affected (negatively) by personality dysfunction. These data suggest that, although personality dysfunction has an impact on suitability, cognitive therapy may not be any more contraindicated than any other form of psychotherapy. Theoretical developments within cognitive therapy to address personality dysfunction specifically also support the use of cognitive therapy with this population. Suggestions for specific process and procedural modifications to cognitive therapy when working with personality dysfunction that address the factors that contribute to poor suitability are outlined.     

Is it possible for FDA regulatory scientists and industry scientists to work together?

The US Food and Drug Administration (FDA) was established as a regulatory agency to protect the public health by ensuring that foods, medications, devices, and many other products are safe, effective, and properly labeled. William Abrams demonstrated that scientists from the pharmaceutical industry and the FDA can work together with integrity and synergy to develop scientific and educational programs, thus paving the way for more recent precompetitive collaborations between the "regulators" and the "regulated."     

Could Your Patient be Taking Uber or Lyft Post-Anesthesia? A New Era for Transportation Policy and Practice Considerations

PurposeThe purpose of this project was to examine nurse anesthetists’ practice and encounters with ambulatory surgery patients experiencing transportation difficulties after the provision of anesthesia.DesignA mixed method approach was used.MethodsAn eleven-item questionnaire was disseminated nationally to 2,827 Certified Registered Nurse Anesthetists (CRNAs) practicing in the outpatient setting. The survey consisted of multiple-choice questions and open text for qualitative assessment. Questions focused on frequency of encounters with patients experiencing transportation difficulties post-anesthesia and policies for rideshare options.FindingsA total of 43% of responding CRNAs work in a clinical practice setting in which patients have the option of being discharged using rideshare (Uber/Lyft) but only if accompanied by an adult. Issues emerged around patient safety when using a rideshare service for discharge postanesthesia.ConclusionsThe proliferation of rideshare options may provide increased access to surgical services in the outpatient anesthesia care setting. Practice considerations associated with transportation policies for postanesthesia patients in the era of rideshare services are warranted.     

Is staff well-being and communication enhanced by multidisciplinary work shift evaluations?

Objective To study the implementation of multidisciplinary structured work shift evaluations at a pediatric intensive care unit (PICU) to enhance team communication.Design and setting Prospective, repeated measurements design, comparison of pre/post measurements and process measures in a Dutch tertiary care, university-affiliated PICU.Participants All 61 PICU staff members.Interventions Implementing multidisciplinary structured work shift evaluations. Before the implementation phase the PICU team received feedback training and eight participants (four physicians, four nurses) were trained as work shift evaluation leader.Measurements and results Outcome measures covered: (a) quality and process of the implementation through prestructured checklists during the 3 months of implementation, (b) a subjective evaluation of a feedback training on team communication as anticipated action and on the level of communication (about patients and with colleagues), and (c) emotional exhaustion complaints and work-related fatigue. The interdisciplinary structured work shift evaluations were implemented successfully as planned during the work shift; all staff were trained ahead, and the process was followed almost completely. Almost two-thirds (62%) of the staff felt a positive influence on team communication. Almost all staff members (92%) were satisfied regarding communication with their colleagues after the intervention, compared to 76% before. Emotional exhaustion in the PICU team decreased significantly after the implementation, but no differences in work-related fatigue levels were found.Conclusions As organizational change the implementation of a multidisciplinary structured work shift evaluation at a PICU was successful and team communication improved. Emotional exhaustion decreased during the study period.This study was made possible by support from the Social Fund for the Knowledge Sector (SoFoKles), Utrecht, The Netherlands     

Is patient acuity a proxy for patient characteristics of the AACN Synergy Model for Patient Care?

PURPOSE: To test the feasibility of using patient acuity indicators as proxy measures for the AACN Synergy Model for Patient Care patient characteristics. DESIGN AND METHODS: Secondary data analysis of a convenience sample of 481 patient ratings from adult and pediatric critical and noncritical medical surgical patients. FINDINGS: Combining dichotomous patient acuity indicators into multilevel categorical variables allowed evaluation of linear relationships between acuity and patient characteristics indicators. Of the 8 patient characteristics, only participation in care exhibited meaningful correlations with the acuity indicators. According to these findings, acuity indicators should not be substituted for the Synergy Model patient characteristics.     

Is there hope for chronic pain and headache?

Currently the clinical needs for pain and headache management are not met. Despite the numerous and exciting recent advances in understanding the molecular and cellular mechanisms that originate pain, we cannot yet fully explain the mechanism underlying the biology of chronic pain. Pain is a natural mechanism preserving our species survival; however, when the protective quality is lost, physiologic changes to the peripheral and central nervous systems result in the formation of chronic pain states. Once we understand how this chronic pain state is created, either through genetic, environmental, therapeutic, or other triggers we may be able to enhance our species existence, limiting maladaptive pain and suffering. The future therapeutic targets will need to address the genetics, neurophysiologic changes of the neurons and brain as well as help control immune systems including the glia. The key to successful headache and pain therapy is research aimed at prevention and minimizing the plastic changes triggering chronic pain.     

Is Autologous Salvaged Blood a Viable Option for Patient Blood Management in Oncologic Surgery?

Oncologic surgery is sometimes associated with substantial blood loss, and principles of patient blood management can be applied in the perioperative care of these patients. Although autologous salvaged blood is an option for perioperative blood conservation, it is often not used in oncologic surgery over concern of reinfusing tumor cells and thereby causing tumor dissemination. We reviewed the literature regarding safety and effectiveness of salvaged blood in oncologic surgery. Salvaged blood seems to be comparable to allogeneic blood in terms of safety. Because patients with primary or metastatic cancer are known to have circulating tumor cells in the absence of surgery, the concern of reinfusing malignant cells from the salvaged blood may be overstated. Reinfusion of salvaged blood has not been found to promote tumor dissemination or distant metastases. When used in patients with substantial blood loss, salvaged blood can be cost-effective. Intraoperative salvaged blood may be a useful adjunct to allogeneic blood resources.     

Patient Portals: Useful for Whom and for What? A Cross-Sectional Analysis of National Survey Data

Background  Patients who use patient portals may be more engaged and empowered in their care; however, differences in who accesses patient portals remain. The characteristics of who uses patient portals more frequently and who perceives them as useful may also differ, as well as which functions people use. Objective  We assessed the characteristics of patient portal users to examine who uses them more frequently and who perceives them as useful. In addition, we wanted to see if those who use them more frequently or perceive them to be more useful use different functions or more functions of patient portals. Methods  Pooled cross-sectional data from 2017 to 2018 Health Information National Trends Survey (HINTS) were used. Ordinal regression models were developed to assess frequency of use and perceived usefulness by demographics, and multivariable logistic regression models were used to examine the association between the use of 10 patient portal functions and frequency of use and perceived usefulness of patient portals. Results  The odds of using patient portals more frequently were higher among those with Bachelor''s degrees, incomes between $35,000 and $75,000, and those with two or more chronic conditions. Respondents with three or more chronic conditions had higher odds of rating patient portals as useful. Those who used their patient portal 10 or more times in the past year had higher odds of using all functions except for viewing test results compared with those who used their patient portal one to two times per year. Those who rated patient portals as “very useful” had higher odds of using seven of the functions compared with those who rated them “not very”/“not at all useful.” Conclusion  It is important to continue to assess usefulness, frequency of use, and overall patient portal function use to identify opportunities to increase patient engagement with patient portals.