Impact of culturally tailored shared medical appointments on diabetes self-care ability and knowledge in African Americans.

BACKGROUND: Type 2 diabetes mellitus (T2DM) continues to disproportionately affect African Americans, significantly impacting morbidity and mortality. Research suggests that addressing barriers that stem from socioeconomic circumstances, systemic inequalities, biological factors, and cultural factors may positively influence biometric indicators of health and diabetes control. OBJECTIVE: The aim of this study was to evaluate a diabetes shared medical appointment (SMA) model program that has been culturally tailored to address the unique social determinants of health barriers faced by an inner city African American population in Norfolk, Virginia. METHODS: A pilot study using a within-group pretest-posttest design was conducted. Information was collected from self-report surveys that included the Modified Michigan Diabetes Knowledge Test, the Diabetes Self-Efficacy Scale, and researcher generated surveys before and after a single-session three-hour SMA program. KEY RESULTS: The program increased perceived diabetes self-care confidence and perceived overall diabetes knowledge levels. Increases in knowledge scores were seen but not statistically significant. Participants reported high levels of satisfaction with the program model. DISCUSSION: Findings indicate that this model is an effective and engaging method of improving self-care ability and diabetes disease management knowledge among African Americans. Addressing unique circumstances and barriers experienced by this population may be more effective than usual traditional care approaches.

Advanced practice nursing initiatives in Africa, moving towards the nurse practitioner role: Experiences from the field.

AIM: This paper discusses the development and progression of the advanced practice nurse practitioner role in Africa. BACKGROUND: Providing adequate primary health care is problematic in Africa. The World Health Organization and International Council of Nurses proposed that nurses, specifically advanced practice nurse practitioners with the requisite skills in disease prevention, diagnosis and management, can be key to solving the primary care issue. SOURCES OF EVIDENCE: This paper utilized publications from PUBMED, CINAHL, policy papers, websites, workgroups, conferences, and the experiences and knowledge of authors involved in leading and moving forward key events and projects. DISCUSSION: Four African countries have formally adopted the advanced practice nurse practitioner role, with significant interest from countries throughout Africa, and ever-increasing requests for assistance regarding initiation, development and integration of advanced practice roles. Initiatives to advance the roles have been supported by the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network and Global Academy of Research and Enterprise. Next steps and projects for future role development are discussed. CONCLUSIONS: There is a progression towards the adoption of the advanced practice nurse practitioner role in Africa, and further mechanisms are suggested to allow full uptake and utilization. IMPLICATIONS FOR NURSING PRACTICE: Prioritization and investment in initiatives implementing nurse practitioner/advanced practice nurse roles in Africa allows nurses to pursue further education, advanced role and leadership opportunities consistent with Nursing Now goals. IMPLICATIONS FOR HEALTH POLICY: Implementation of nurse practitioner/advanced practice nurse roles increases the primary care workforce, consistent with recommendations and priorities in the World Health Organization Global Strategic Directions for Nursing and Midwifery 2021-2025 helping countries ensure that nurses optimally contribute to achieving universal health coverage and other population health goals.

A global perspective of advanced practice nursing research: A review of systematic reviews protocol.

INTRODUCTION: In 2020, the World Health Organization called for the expansion and greater recognition of all nursing roles, including advanced practice nurses (APNs), to better meet patient care needs. As defined by the International Council of Nurses (ICN), the two most common APN roles include nurse practitioners (NPs) and clinical nurse specialists (CNSs). They help ensure care to communities as well as patients and families with acute, chronic or complex conditions. Moreover, APNs support providers to deliver high quality care and improve access to services. Currently, there is much variability in the use of advanced practice nursing roles globally. A clearer understanding of the roles that are in place across the globe, and how they are being used will support greater role harmonization, and inform global priorities for advanced practice nursing education, research, and policy reform. OBJECTIVE: To identify current gaps in advanced practice nursing research globally. MATERIALS AND METHODS: This review of systematic reviews will provide a description of the current state of the research, including gaps, on advanced practice nursing globally. We will include reviews that examine APNs, NPs or CNSs using recognized role definitions. We will search the CINAHL, EMBASE, Global Health, HealthStar, PubMed, Medline, Cochrane Library Database of Systematic Reviews and Controlled Trials Register, Database of Abstracts of Reviews of Effects, Joanna Briggs Institute, and Web of Science electronic databases for reviews published from January 2011 onwards, with no restrictions on jurisdiction or language. We will search the grey literature and hand search the reference lists of all relevant reviews to identify additional studies. We will extract country, patient, provider, health system, educational, and policy/scope of practice data. We will assess the quality of each included review using the CASP criteria, and summarize their findings. This review of systematic reviews protocol was developed following the PRISMA-P recommendations. PROSPERO REGISTRATION NUMBER: CRD42021278532.

Advanced Practice Nursing Roles, Regulation, Education, and Practice: A Global Study.

Background and Objectives: Several subgroups of the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) have periodically analyzed APN (nurse practitioner and clinical nurse specialist) development around the world. The primary objective of this study was to describe the global status of APN practice regarding scope of practice, education, regulation, and practice climate. An additional objective was to look for gaps in these same areas of role development in order to recommend future initiatives. Methods: An online survey was developed by the research team, and included questions on APN practice roles, education, regulation/credentialing, and practice climate. The study was launched in August 2018 at the 10th Annual ICN NP/APNN Conference in Rotterdam, Netherlands. Links to the survey were provided there and via multiple platforms over the next year. Results: Survey results from 325 respondents, representing 26 countries, were analyzed through descriptive techniques. Although progress was reported, particularly in education, results indicated the APN profession around the world continues to struggle over titling, title protection, regulation development, credentialing, and barriers to practice. Conclusions and Practice/Policy Relevance: APNs have the potential to help the world reach the Sustainable Development Goal of universal health coverage. Several recommendations are provided to help ensure APNs achieve these goals.

The use of general anaesthesia in special care dentistry: A clinical guideline from the British Society for Disability and Oral Health.

BACKGROUND: General anaesthesia (GA) may be required to support the care of those seen in Special Care Dentistry (SCD) services for various reasons, such as enabling extensive dental care for people with severe learning disabilities or severe dental phobia. Guidance is needed for teams delivering SCD using GA due to the potential risks, implications, and costs of using GA to deliver dental care. AIM: To present evidence-based recommendations, where possible, for teams involved in providing GA for dental care for adults within SCD services. METHODS: A multidisciplinary working group, supported by a formal literature search and stakeholder involvement, iteratively produced and refined the recommendations presented. RESULTS: There was little evidence to inform the guidelines. Recommendations are therefore based mainly on the working group's expert consensus opinion. Clinical guidelines are presented as a set of overarching principles followed by six key sections reflecting patients' pathways from referral to dental services through to their care during and after GA. CONCLUSION: Guidelines are presented to support those providing GA to provide SCD. The need for comprehensive and person-centered assessment and planning is emphasized.

Visual analysis of global comparative mapping of the practice domains of the nurse practitioner/advanced practice nursing role in respondent countries.

BACKGROUND: Internationally, there is increasing demand for nurse practitioner (NP) and advanced practice nursing (APN) roles; however, high variability exists in how NP/APN roles are defined and understood. PURPOSE: The aim of this research was to improve our understanding of how the NP/APN is defined globally by: 1) examining role definitions, competencies, and standards of practice for advanced practice nurses internationally; 2) describing from a global perspective the core concepts and common features of NP/APN associated with practice domains; and 3) exploring the utility of text mining and visual analytics in identifying the clustered core concepts common to NP/APN roles organized around the five advanced practice domains of the Strong Advanced Practice Model. METHODS: This article describes the findings of a secondary analysis of an international NP/APN competency mapping project, using innovative text mining and visual analysis techniques to reexamine and summarize the NP/APN role in 19 countries from Africa, Australia, Asia, Europe, and North America. RESULTS: Although weak aggrupation/associations suggest that further work is needed to define the domains of advanced practice with associated model development, visual analysis points to the identification of common concepts and linkages between concepts for each practice domain of advanced practice outlined in the Strong Model. IMPLICATIONS FOR PRACTICE: The secondary text mining and visual analysis presented in this article allows for comparison of core elements between advanced practice role descriptions, standards, and competencies globally to ultimately provide a global perspective on the common features of NP/APN roles and areas where further delineation is required.

Oral health status of athletes with an intellectual disability competing in the Special Olympics GB National Games 2017.

Background The aim of this paper is to describe the oral health status of athletes with intellectual disabilities competing in the Special Olympics, GB National Games, held in Sheffield in August 2017.Methods and materials A convenience sample of athletes who participated in the Special Olympics Special Smiles screening programme was used. All data was recorded on validated Healthy Athletes screening forms.Results Of the 692 athletes that participated, 14% had untreated decay, 51.9% had at least one filling and 28.6% had signs of gingivitis. Furthermore, 6.2% reported pain from their mouth and 2.7% were found to require urgent treatment. Overall, 90.3% reported to clean their mouths at least once per day and 0.7% were found to be edentulous.Discussion The findings from this screening highlighted lower rates of decay, pain and urgent treatment need in comparison to Special Olympic screenings worldwide.Conclusion The oral health of athletes competing in the GB National Games 2017 was better than noted at most Special Olympic events throughout the world. There is little data published on the oral health of individuals with learning disabilities in the UK. These results provide valuable baseline data to monitor and review the oral health of Special Olympic athletes within Great Britain.

A mental health needs assessment of children and adolescents in post-conflict Liberia: results from a quantitative key-informant survey.

Between 1989 and 2004, Liberia experienced a devastating civil war that resulted in widespread trauma with almost no mental health infrastructure to help citizens cope. In 2009, the Liberian Ministry of Health and Social Welfare collaborated with researchers from Massachusetts General Hospital to conduct a rapid needs assessment survey in Liberia with local key informants (n = 171) to examine the impact of war and post-war events on emotional and behavioral problems of, functional limitations of, and appropriate treatment settings for Liberian youth aged 5-22. War exposure and post-conflict sexual violence, poverty, infectious disease and parental death negatively impacted youth mental health. Key informants perceived that youth displayed internalizing and externalizing symptoms and mental health-related functional impairment at home, school, work and in relationships. Medical clinics were identified as the most appropriate setting for mental health services. Youth in Liberia continue to endure the harsh social, economic and material conditions of everyday life in a protracted post-conflict state, and have significant mental health needs. Their observed functional impairment due to mental health issues further limited their access to protective factors such as education, employment and positive social relationships. Results from this study informed Liberia's first post-conflict mental health policy.

Respiratory and cardiovascular effects of metals in ambient particulate matter: a critical review.

In this review, we critically evaluated the epidemiological and toxicological evidence for the role of specific transition metals (As. Cr. Cu. Fe. Mn. Ni. Sc. Ti. V and Zn) in causing or contributing to the respiratory and cardiovascular health effects associated with ambient PM. Although the epidemiologic studies arc suggestive. and both the in vivo and in vitro laboratory studies document the toxicity of specific metals (Fe. Ni. V and Zn). the overall weight of evidence does not convincingly implicate metals as major contributors to health effects. None of the epidemiology studies that we reviewed conclusively implicated specific transition metals as having caused the respiratory and cardiovascular effects associated with ambient levels of PM. However, the studies reviewed tended to be internal ly consistent in identifying some metals (Fe, Ni, V and Zn) more frequently than others (As, Cu, Mn and Sc) as having positive associations wi th health effects. The major problem wi th which the epidemiological studies were faced was classifying and quantifying exposure. Community and population exposures to metals or other components of ambient PM were inferred from centrally- located samplers that may not accurately represent individual level exposures. Only a few authors reported findings that did not support the stated premise of the study; indeed, statistic ally significant associations are not necessarily biologically significant. It is likely that ·'negative studies" are under-represented in the published literature, making it a challenge to achieve a balanced evaluation of the role of metals in causing health effects associated with ambient PM. Both the in vivo and in vitro study results demonstrated that individual metals (Cu. Fe. Ni. V and Zn) and extracts of metals from ambient PM sources can produce acute inflammatory responses. However. the doses administered to laboratory animals were many orders of magnitude greater than what humans experience from breathing ambient air. The studies that used intratracheal instillation have the advantage of delivering a known dose to a specific anatomical location. but arc not analogous to an inhaled dose that is distributed over the surface area of the respiratory tract. Studies. in which laboratory animals or human volunteers inhaled CAPs best represent exposures to the general human population. The in vivo and in vitro studies reviewed provide indications that the probable mechanisms involved in the respiratory and cardiac effects from high metal exposures include: an inflammatory response mediated by formation of ROS, upregulation of genes coding for inflammatory cytokines, altered expression of genes involved in cell signaling pathways and maintenance of metals homeostasis.The fact that doses of metals many orders of magnitude greater than those existing in ambient air were required to produce measurable adverse effects in animals makes it doubtful that metals play any major role in respiratory and cardiovascular effects produced from human exposure to ambient PM. We suggest that future research priorities should focus on testing at more environmentally relevant exposure levels and that any new toxicological studies be written to include dosages in units that can be easily compared to human exposure levels.

Pulsed Erlotinib as Sole Treatment of Leptomeningeal Carcinomatosis: Can We Avoid the Use of Intrathecal Therapy?

Leptomeningeal carcinomatosis, a not uncommon complication of non-small cell lung cancer, is associated with poor prognosis, and median survival is reported in case series as weeks to months. The advent of targeted therapy may have positively impacted the prognosis of such patients recently. Standard approaches to treatment of leptomeningeal metastasis include intrathecal chemotherapy with or without cranial or craniospinal radiation and additional systemic therapy. We report a case of leptomeningeal metastasis in epidermal growth factor receptor overexpressing lung adenocarcinoma showing an excellent response with pulsed doses of erlotinib as the only therapy.

An exploratory study examining lipid-lowering medications in reducing fasting serum lipids in schizophrenia patients treated with atypical antipsychotics.

BACKGROUND: We present a retrospective study examining response to treatment with fibrates or statins in schizophrenia patients. METHODS: We identified the patient population using the Research Patient Data Registry. Demographic data, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and non-HDL cholesterol (non-HDL-C) levels were obtained before initiation of treatment with lipid-lowering medication (LLM) and after LLM treatment was initiated (N = 183). RESULTS: Treatment with LLMs resulted in a statistically significant decrease in total cholesterol, triglycerides, LDL-C, and non-HDL-C. An independent-samples t test comparing the statin treatment-alone group with the fibrate treatment-alone group showed a significant reduction in triglyceride levels from baseline to 1-year follow-up in the fibrate treatment-alone group. CONCLUSIONS: The results of this study indicate that schizophrenia patients respond to LLMs in a manner consistent with the general population. Future studies would benefit from a larger sample, as well as comparisons between more specific treatment groups, such as those defined by type of statin or fibrate, to observe differential effects on specific markers of dyslipidemia in this population.

A Large Intragenic Deletion in the ACADM Gene Can Cause MCAD Deficiency but is not Detected on Routine Sequencing.

We report of a family who has three members affected by medium-chain acyl-CoA dehydrogenase (MCAD) deficiency, one of whom sadly died in the neonatal period prior to diagnosis. Routine sequencing, available on a service basis in the UK, identified only a heterozygous mutation in ACADM gene (c.985A>G, p.Lys329Glu) in this family. Linkage analysis suggested a possible intragenic deletion which was confirmed by the use of array-based comparative genomic hybridization (aCGH). This second mutation was a large intragenic deletion encompassing at least exons 1-6 of the ACADM gene. Now that this deletion has been identified, several family members have come forward for carrier testing which was not possible previously. Larger deletions (20bp or more) have only previously been reported twice, but these may be a more frequent cause of MCAD deficiency than hitherto believed, due to fact that these are not anticipated and, therefore, the routine diagnostic techniques used will not identify them. This finding represents a useful learning point in the management of families with MCAD deficiency, and highlights that we should be routinely looking for larger deletions, when only one of the mutations can be identified on standard sequencing.

Herbal supplements in primary care: patient perceptions, motivations, and effects on use.

Relationships between primary care patients' herbal use and influencing factors were examined. Most felt that herbals were safer than prescription medications and preferred their use. There were significant relationships between perceived herbal safety and efficacy and other motivational factors with use. Supplement cost and demographics were less predictive of use.

Use of alternatives to air-fluidized support surfaces in the care of complex wounds in postflap and postgraft patients.

Air-fluidized support surface therapy has many drawbacks, such as dehydration, in an already difficult recovery for those wound patients who have undergone flap and graft surgery. In addition, patient care and handling are also problematic. Patients complain of discomfort, and the instability of the surface interferes with patient stability in side lying and semi-Fowler's positions. Alternative support surfaces can be considered for postflap or postgraft patients. Such technologies as alternating pressure, low-air-loss, and therapeutic nonpowered, advanced, and lateral rotation surfaces are widely used for pressure management in high-risk patients and those with existing pressure ulcers. These surfaces must be used within a total pressure ulcer management program that includes frequent turning and repositioning, skin and ulcer care according to evidence-based protocols, patient and caregiver instruction, nutrition, and offloading and positioning. The proposed recommendations require more research on the relative effectiveness of less expensive and more user-friendly support surfaces such as low-air-loss and nonpowered advanced support surfaces and is necessary in order to conclusively recommend one type of surface over another. However, at this time the available clinical studies and opinions remain positive.