The Granny-Nanny: A Guide for Parents and Grandparents Who Share Child Care,by Lee Edwards Benning

In recent years interest has increased toward mental exercise as a way to promote healthy cognitive aging. Consistent findings have shown that declines in working memory performance are associated with aging. Sudoku is a popular puzzle game that has task demands similar to working memory processes. Younger and older adults completed a battery of tests and solved Sudoku puzzles. The results showed that Sudoku performance had a significant relationship to working memory. This suggests that Sudoku has the potential to become a new focus in the study of mental exercise and cognitive aging.     

Maximizing the Impact of a Symposium to Facilitate Change in Student Attitudes about Interdisciplinary Teamwork

Elderly patients, including those with dementia, have more complex health care needs, which may be more effectively served by interdisciplinary teams. Yet, few health care students receive interdisciplinary education. This article describes the improved outcomes of a second annual symposium for health care students on interdisciplinary care for older adults with dementia. Students (n = 109) completed a pre/post assessment using the Attitudes Toward Healthcare Teams Scale. A t-test for paired samples indicated a statistically significant increase in pre-post test scores (p < .001); we observed a larger effect size of change in student attitudes for this symposium than the first (η² = .48). The results support the value of pedagogical changes in facilitating a greater change in student attitudes about interdisciplinary teamwork.     

Use of an Electronic Health Record Clinical Decision Support Tool to Improve Antibiotic Prescribing for Acute Respiratory Infections: The ABX-TRIP Study

BACKGROUND

Antibiotics are often inappropriately prescribed for acute respiratory infections (ARIs).

OBJECTIVE

To assess the impact of a clinical decision support system (CDSS) on antibiotic prescribing for ARIs.

DESIGN

A two-phase, 27-month demonstration project.

SETTING

Nine primary care practices in PPRNet, a practice-based research network whose members use a common electronic health record (EHR).

PARTICIPANTS

Thirty-nine providers were included in the project.

INTERVENTION

A CDSS was designed as an EHR progress note template. To facilitate CDSS implementation, each practice participated in two to three site visits, sent representatives to two project meetings, and received quarterly performance reports on antibiotic prescribing for ARIs.

MAIN OUTCOME MEASURES

1) Use of antibiotics for inappropriate indications. 2) Use of broad spectrum antibiotics when inappropriate. 3) Use of antibiotics for sinusitis and bronchitis.

KEY RESULTS

The CDSS was used 38,592 times during the 27-month intervention; its use was sustained for the study duration. Use of antibiotics for encounters at which diagnoses for which antibiotics are rarely appropriate did not significantly change through the course of the study (estimated 27-month change, 1.57 % [95 % CI, ?5.35 %, 8.49 %] in adults and ?1.89 % [95 % CI, ?9.03 %, 5.26 %] in children). However, use of broad spectrum antibiotics for ARI encounters improved significantly (estimated 27 month change, ?16.30 %, [95 % CI, ?24.81 %, ?7.79 %] in adults and ?16.30 [95%CI, ?23.29 %, ?9.31 %] in children). Prescribing for bronchitis did not change significantly, but use of broad spectrum antibiotics for sinusitis declined.

CONCLUSIONS

This multi-method intervention appears to have had a sustained impact on reducing the use of broad spectrum antibiotics for ARIs. This intervention shows promise for promoting judicious antibiotic use in primary care.     

Families and genetics: Bridging the gap between knowledge and practice

The Human Genome Project (HGP) and news of genetic breakthroughs are pervasive to most of our lives today. Yet how many of us have had formal education in genetics? When and how do we integrate this knowledge into our clinical practice? This article discusses the relevance of genetics to newborn and infant nursing practice and how new genetic knowledge affects patients and their families. Approaches to educating clinicians about genetics within the context of the family are described, as newborn and infant nurses emphasize the family in their daily work and frequently work with children and families with genetic diagnoses. Education and research from the University of Illinois at Chicago College of Nursing are used as examples to describe the integration of genetics into the practice of nurses caring for newborns, infants, and their families. Copyright 2002, Elsevier Science (USA). All rights reserved.     

Adolescent Perceptions of Relevant Social Problems

PROBLEM: Social problems can be a significant stressor for adolescents. Disturbed youth often experience negative outcomes to social problems, solve problems poorly, and display distortions in reasoning about social problems. METHODS: A series of focus groups was conducted with adolescents (N = 36), and the data was analyzed inductively. Activities to increase the rigor of the study data (establishing credibility, trustworthiness, and transparency) were incorporated into the phenomenological research design. FINDINGS: Five social problem themes with critical attributes were perceived to be relevant to teenagers in today's society. CONCLUSIONS: Adolescents' social problems shift in response to a changing society. Findings from this study can be used to help target assessments and treatment plans when working with disturbed youth.     

Acute hemodynamic and neurohumoral effects of moxonidine in congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy

Elevated plasma norepinephrine (PNE) has been shown to be an important predictor of morbidity and mortality in patients with congestive heart failure (CHF). Moxonidine selectively stimulates imidazoline receptors located in the medulla, which centrally inhibit sympathetic outflow. PNE is suppressed and peripheral vasodilation reduces systemic blood pressure. This study evaluated the acute neurohumoral and hemodynamic effects of a single dose of oral moxonidine in 32 patients (22 men, mean ± SD age 66 ± 10 years) with CHF. All patients were in New York Heart Association functional class III and stabilized on chronic therapy with diuretics, digitalis, and angiotensin-converting enzyme inhibitors. The mean PNE concentration was 509 ± 304 pg/ml at baseline. Patients underwent invasive hemodynamic monitoring after double-blind randomization to either placebo (n = 12), moxonidine 0.4 mg (n = 9), or moxonidine 0.6 mg (n = 11). Moxonidine produced a dose-dependent, vasodilator response compared with placebo. Analysis of the time-averaged change from baseline over 6 hours demonstrated that moxonidine 0.6 mg caused significant reductions in mean systemic arterial pressure (p <0.0001), mean pulmonary arterial pressure (p <0.005), systemic vascular resistance (p <0.05), pulmonary vascular resistance (p <0.01), and heart rate (p <0.05). Stroke volume was unchanged. PNE was reduced substantially (−180 pg/ml at 4 hours, p <0.005) and the reduction was highly correlated with the baseline level (r = −0.968). Moxonidine was well tolerated in this single-dose study and resulted in a modest, dose-dependent, vasodilator response, with substantial reductions in systemic and pulmonary arterial blood pressure. Trials designed to evaluate the clinical efficacy of chronic moxonidine therapy in CHF added to conventional therapy would be appropriate.     

Paced Respiration for Vasomotor and Other Menopausal Symptoms: A Randomized, Controlled Trial

BACKGROUND

Paced respiration has been internationally recommended for vasomotor symptom management, despite limited empirical evidence.

OBJECTIVE

To evaluate efficacy of a paced respiration intervention against breathing control and usual care control for vasomotor and other menopausal symptoms.

DESIGN

A 16-week, 3-group, partially blinded, controlled trial with 2:2:1 randomization and stratification by group (breast cancer, no cancer), in a Midwestern city and surrounding area.

PARTICIPANTS

Two hundred and eighteen randomized women (96 breast cancer survivors, 122 menopausal women without cancer), recruited through community mailings and registries (29 % minority).

INTERVENTIONS

Training, home practice support, and instructions to use the breathing at the time of each hot flash were delivered via compact disc with printed booklet (paced respiration intervention) or digital videodisc with printed booklet (fast shallow breathing control). Usual care control received a letter regarding group assignment.

MAIN MEASURES

Hot flash frequency, severity, and bother (primary); hot flash interference in daily life, perceived control over hot flashes, and mood and sleep disturbances (secondary). Intervention performance, adherence, and adverse events were assessed.

KEY RESULTS

There were no significant group differences for primary outcomes at 8-weeks or 16-weeks post-randomization. Most intervention participants did not achieve 50 % reduction in vasomotor symptoms, despite demonstrated ability to correctly do paced respiration and daily practice. Statistically significant differences in secondary outcomes at 8 and 16 weeks were small, not likely to be clinically relevant, and as likely to favor intervention as breathing control.

CONCLUSIONS

Paced respiration is unlikely to provide clinical benefit for vasomotor or other menopausal symptoms in breast cancer survivors or menopausal women without cancer.     

Antithrombotic therapy for valve disease: Native and prosthetic valve

The use of antithrombotic agents to prevent thromboembolic events in patients with valvular heart disease is common. Recent studies using improved diagnostic techniques have allowed better elucidation of valvular abnormalities and re-evaluated the incidence and risk of thromboembolism. We review the recent literature examining the risk of thromboembolic events in various valvular abnormalities, and the use of different antithrombotic agents in the prevention of thromboembolic events. We also review the current recommended practice in both native valve abnormalities and prosthetic heart valves.