Meditation for Anxiety: A Holistic Approach to Treatment.

This comprehensive integrated literature review provides evidence-based information on mindfulness meditation as a primary care treatment for anxiety. A variety of databases were utilized for article collection including MEDLINE Complete, CINAHL Plus with full text, Cochrane library, APA PsycInfo, APA PsycTests, Health Source: Nursing/Academic Edition, and PsycARTICLES. Research suggests anxiety can be treated effectively with a minimum of 8 weeks of meditation practice. Meditation is a cost effective and safe treatment modality that can be incorporated into the care of patients struggling with anxiety.

The Gut-Brain-Microbiome Connection: Can Probiotics Decrease Anxiety and Depression?

Anxiety and depression are highly prevalent mood disorders worldwide. Complete remission of symptoms is often difficult to achieve, despite following recommended treatment guidelines. Numerous antidepressants and anxiolytics exist, and new drugs are being developed constantly, yet the incidence of common mood disorders continues to rise. Despite the prevalence of these issues, mental health treatment has not evolved much in recent years. An exciting area of research uncovered in the past decade is the gut-brain-microbiome axis, a bi-directional communication pathway. Because the human microbiome is closely related to mood, research is being done to investigate whether probiotic supplementation could potentially affect symptoms of anxiety and depression.

Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica.

BACKGROUND: Treatment of polymyalgia rheumatica (PMR) can be challenging. The most efficacious and cost-effective treatment of PMR is some type of glucocorticoid (GC), with necessary treatment duration typically one year or longer. This duration of GC use is often associated with significant morbidity. Numerous studies have been and are being conducted that focus on alternative treatment modalities. OBJECTIVES: This literature review explores alternatives to glucocorticoid monotherapy in the treatment of PMR. DATA SOURCES: An integrative literature review was conducted to evaluate peer-reviewed literature on the topic. An electronic literature search was performed in the Cochrane Database of Systematic Reviews, and an EBSCO search identified relevant articles in the following databases: MEDLINE Complete, Academic Search Premier, Cumulative Index of Nursing and Allied Health (CINAHL) Plus, PsycInfo, Education Source, SocINDEX, the CDC, and PubMed. CONCLUSIONS: Agents such as methotrexate and tocilizumab have been used successfully in conjunction with oral glucocorticoids and have demonstrated steroid-sparing effects. A promising adjunctive treatment is the monoclonal antibody, tocilizumab, which has been studied as both adjuvant and monotherapy. Further research in the efficacy, safety, and affordability of these agents is warranted. IMPLICATIONS FOR PRACTICE: Because PMR is commonly diagnosed and managed in primary care, providers should keep abreast of the most current recommendations concerning optimal treatment options and carefully weigh the risks versus benefits of long-term GC use. This expanding area of research may assist primary care providers to better treat and manage PMR as well as reduce long-term treatment risk by minimizing corticosteroid use when possible.

Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting.

CONTEXT: Heart failure (HF) is a complex, life-limiting disease that is prevalent and burdensome. All major cardiology societies and international clinical practice guidelines recommend the integration of palliative care (PC) interventions alongside usual HF management. OBJECTIVES: The purpose of this review of the literature was to evaluate the various barriers to the early initiation of PC for HF patients in the primary care setting. METHODS: An integrative literature review was conducted in order to assess and incorporate the diverse sources of literature available. An EBSCO search identified relevant articles in the following databases: Medline complete, Academic Search Premier, CINAHL, PsycINFO, Cochrane Library, and SocINDEX. The search was limited to full text, peer reviewed, English only, and published between 2010 and 2019. RESULTS: Barriers to the integration of PC for HF patients include poor communication between provider/patient and interdisciplinary providers, the misperception and miseducation of what PC is and how it can be incorporated into patient care, the unpredictable disease trajectory of HF, and the limited time allowed for patient care in the primary care setting. CONCLUSION: The results of this review highlight a lack of communication, time, and knowledge as barriers to delivering PC. Primary care providers caring for patients with HF need to establish an Annual Heart Failure Review to meticulously evaluate symptoms and allow the time for communication involving prognosis, utilize a PC referral screening tool such as the Needs Assessment Tool: Progressive Disease-Heart Failure, and thoroughly understand the benefits and appropriate integration of PC.

Analysis of common barriers to rural patients utilizing hospice and palliative care services: An integrated literature review.

BACKGROUND AND PURPOSE: The aim of this literature review is to explore barriers and potential solutions related to hospice (HC) and palliative care (PC) services among rural residents. Although the healthcare system is continually advancing, healthcare providers may not be optimizing HC and PC referrals for the growing rural population who underutilize these services. Suggested methods to close the utilization gap between HC and PC services among rural patients appear feasible, but universal effectiveness cannot be determined. METHODS: An integrative literature review was conducted to evaluate diverse sources of literature. An electronic literature search was carried out using databases MEDLINE, CINAHL, Cochrane, PsycINFO, and Pubmed. The search was limited to English only, full text, peer reviewed, and published between 2010 and 2016. Search terms included rural, hospice, palliative, care access, and barriers. CONCLUSION: There are several barriers that interrelate to decreased utilization of PC and HC for rural populations and there are many options for overcoming them to equalize care. IMPLICATIONS FOR PRACTICE: Although advances to the general healthcare system are expediently rising, the rural patient population seems to fall short of these important life-changing services, especially in the realm of PC/HC. Beginning in primary care, this patient population can be affected and included in a positive manner.

Available screening tools for adults suffering from bipolar affective disorder in primary care: An integrative literature review.

PURPOSE: To assess the efficacy of six tools utilized in primary care for the screening of bipolar affective disorder (BPAD). BPAD has historically been underdiagnosed or misdiagnosed followed by inappropriate treatment leading to detrimental relapses, suicide, and increased risks for comorbidities. DATA SOURCES: An electronic search was conducted to identify articles in the following databases: MEDLINE, CINAHL, Cochrane Library, ERIC, National Guideline Clearinghouse, PsycINFO, Psychology and Behavioral Sciences collection, and PsycARTICLES. Other information was also collected from the NIH, CDC, Healthy People 2020, the Black Dog Institute, and the Center for Quality Assessment and Improvement for Mental Health. CONCLUSION: Evidence indicates that primary care providers are often the first and sometimes sole provider, which signifies the importance of early detection and screening of BPAD in primary care. By implementing the use of appropriate screening tools and following recommended treatment and intervention guidelines, the prevention of relapse is increased, and comorbidities are more frequently diagnosed leading to an overall improved quality of life. IMPLICATIONS FOR PRACTICE: Primary care practitioners play a vital role in appropriately screening for BPAD and implementing the recommended treatments to increase prevention of relapse and promote a healthier and more socially successful quality of life.

Oral sucrose for pain control in nonneonate infants during minor painful procedures.

PURPOSE: To provide information regarding the effective use of oral sucrose as an analgesic for immunization and venipuncture procedures in the older infant. DATA SOURCES: Evidence-based literature including original clinical trials, reviews, and clinical practice guidelines. CONCLUSIONS: Most infants are exposed to multiple minor painful procedures during the first year of life. Oral sucrose solution in a 24% concentration at a dose of 2 mL approximately 2 min prior to the painful procedure has been shown effective in reducing pain during immunizations and venipuncture in the outpatient setting in infants aged 1-12 months old. IMPLICATIONS FOR PRACTICE: Oral sucrose solution should be used as a pain reduction intervention in infants up to 12 months of age undergoing minor painful procedures. Its proven effectiveness as an analgesic, low rate of minor adverse events, ease of administration, and excellent availability make sucrose a good choice for this purpose. Additional research is needed regarding dose response in different infant age groups, optimal concentration of sucrose solution, need for multiple sucrose dosing, adjustment for multiple painful procedures, and addition of optimal nonpharmacologic interventions as a combination approach.

Blending technology in teaching advanced health assessment in a family nurse practitioner program: using personal digital assistants in a simulation laboratory.

PURPOSE: This article describes the development and implementation of integrated use of personal handheld devices (personal digital assistants, PDAs) and high-fidelity simulation in an advanced health assessment course in a graduate family nurse practitioner (NP) program. A teaching tool was developed that can be utilized as a template for clinical case scenarios blending these separate technologies. DATA SOURCES: Review of the evidence-based literature, including peer-reviewed articles and reviews. CONCLUSIONS: Blending the technologies of high-fidelity simulation and handheld devices (PDAs) provided a positive learning experience for graduate NP students in a teaching laboratory setting. Combining both technologies in clinical case scenarios offered a more real-world learning experience, with a focus on point-of-care service and integration of interview and physical assessment skills with existing standards of care and external clinical resources. Faculty modeling and advance training with PDA technology was crucial to success. IMPLICATIONS FOR PRACTICE: Faculty developed a general template tool and systems-based clinical scenarios integrating PDA and high-fidelity simulation. Faculty observations, the general template tool, and one scenario example are included in this article.

Pharmacological prevention of combat-related PTSD: a literature review.

Preventing posttraumatic stress disorder (PTSD) could have a significant positive impact on military readiness and quality of life. Few studies have examined whether pharmacological agents may prevent PTSD, and there has not been a systematic and critical review of these studies in order to guide future research efforts. We performed a literature review of articles examining the use of pharmacological agents for the prevention of PTSD. A total of 27 articles met inclusion criteria for the review and their results are summarized. The review points to corticosteroids and propranolol as the most promising agents for future research. Gamma-Amino butyric acid mimetic drugs received the least support. Complementary approaches using psychotherapy and pharmacological agents could also yield good results. Research aimed at determining the potential efficacy of these agents could start being carried out in the field with smaller numbers of personnel that has not been personally injured but have witnessed traumatic events. In addition, psychological interventions immediately after postdeployment could be used in large numbers of soldiers. Preliminary studies regarding the use of pharmacologic agents for the secondary prevention of PTSD are promising. However, much larger studies are needed before implementation in generalized practice.

Empowering the primary care provider to optimally manage mild traumatic brain injury.

PURPOSE: This article provides current, evidence-based information regarding the management of mild traumatic brain injuries for the primary-care provider. DATA SOURCES: Literature review of the evidence-based literature, including peer-reviewed articles and reviews of published randomized controlled trials and clinical practice guidelines. 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 professional society guidelines. A clinical practice toolkit is provided to assist the primary care provider to optimize delivery of comprehensive care for this population in the community.

Exploring the value of an international service-learning experience in Honduras.

The purpose of this study was to determine the effect of an international service-learning experience in Honduras on the cultural competence of the participants. The study included a quantitative portion in which participants utilized the Cultural Competence Assessment instrument as a pretest-posttest evaluation of change in cultural competence, and a qualitative portion in which students discussed their feelings about the experience. The quantitative portion showed an increase in cultural competence behaviors following the experience. The qualitative portion resulted in four themes that emerged from the interviews: a) stepping outside my world, b) connecting with culturally different people, c) awe of community, and d) learning innovation. These results indicate that the international service-learning experience was successful in increasing the participants' ability to provide culturally congruent care.

How can primary care providers manage pediatric obesity in the real world?

PURPOSE: To provide information regarding evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. DATA SOURCES: Evidence-based literature including original clinical trials, literature reviews, and clinical practice guidelines. 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 guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity. A toolkit for primary care implementation and maintenance interventions is provided.