Toward Optimal Communication About HPV Vaccination for Preteens and Their Parents: Evaluation of an Online Training for Pediatric and Family Medicine Health Care Providers.

OBJECTIVE: Health care provider recommendation is a key determinant of human papillomavirus (HPV) vaccination. We developed an online training program for providers that addressed vaccine guidelines, hesitancy to strongly recommend the vaccine, and reluctance to discuss HPV infection as a sexually transmitted infection. DESIGN: Single-group evaluation with 3 waves. Providers completed a 29-item electronic survey with closed and open-ended response options after course completion. SETTING: Pediatric and family medicine practices in North Carolina. PARTICIPANTS: Prescribing clinicians (MD, DO, family nurse practitioner, physician assistant) who serve preteens aged 11 to 12 years. In wave 3, we expanded our communities to include nursing and medical staff. INTERVENTION: An asynchronous online course to promote preteen HPV vaccination. Topics included HPV epidemiology, vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP), preteen-provider-parent communication, topics about hesitancy to seek vaccination, subjects related to sexual health, and practice-level strategies to increase vaccination rates. The course, approved for 12 CME and CNE credits, was live for 4 weeks and available on-demand for 3 additional months. MAIN OUTCOME MEASURES: Provider-reported change in vaccine communication, perceptions of course content in improving practice, and satisfaction with materials. RESULTS: A total of 113 providers from 25 practices enrolled in the course and 69 (61%) completed an evaluation. Providers spent an average of 6.3 hours on the course and rated the CDC (Centers for Disease Control and Prevention)-ACIP Web site and multiple resources on hesitancy and communication about sexually transmitted infection vaccines most highly of all materials across the 3 waves. Almost all (96%) agreed the course will improve their practice. About half of all participants said they were either "much more likely" (28%) or "more likely" (19%) to recommend the vaccine after course participation. CONCLUSIONS: An online format offers a highly adaptable and acceptable educational tool that promotes interpersonal communication and practice-related changes known to improve providers' vaccine uptake by their patients.

The older person with diabetes: considerations for care.

With the increasingly ageing population worldwide, more older people are living with diabetes. The conditions that often accompany older age, such as dementia, renal impairment, visual impairment and manual dexterity difficulties, can make diabetes management complex and self-care challenging. However, the status of older people varies considerably, and so choice of glucose-lowering agents and clinical targets should be individualised to maximise safety and ensure that the risks of treatments do not outweigh the benefits. For many patients, there will be an increasing dependence on others to manage their diabetes care, so an appropriate skill mix among healthcare professionals and carers, adequate training and regular competency assessment are crucial to support patients to remain safe and symptom free from diabetes.

Women Who Bedshare More Frequently at 14 Weeks Postpartum Subsequently Report Longer Durations of Breastfeeding.

INTRODUCTION: Breastfeeding rates in the United States continue to fall short of Healthy People 2020 goals. Bedsharing has been promoted as a way of increasing breastfeeding durations. METHODS: We used prospectively collected Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) and PRAMS-2 data from 2276 women to explore whether bedsharing frequency predicts age at weaning. Bedsharing was assessed at 14 weeks after birth (PRAMS), and duration of breastfeeding was assessed at 2 years after birth (PRAMS-2). Cox proportional hazards models controlled for primiparity, cesarean birth, marital status, employment status, maternal race and ethnicity, and pregravid body mass index. RESULTS: Women in this sample reported high rates of bedsharing: only 15.7% of PRAMS respondents said they never shared a bed with their infant. We also observed a dose-response association between bedsharing frequency and breastfeeding duration when the analysis controlled for covariables: women who reported more frequent bedsharing at 14 weeks postpartum were more likely to wean later. Hazard ratios ranged from 1.18 (95% CI, 1.02-1.35) for "often" versus "always" bedsharing to 1.92 (95% CI, 1.66-2.24) for "never" versus "always." In other words, at any given infant age, women who always bedshared were more likely to keep breastfeeding. Women who always bedshared at 14 weeks postpartum breastfed their infant for a median of 13 months (95% CI, 12-14), compared with 10 months (95% CI, 9-11) for women who never bedshared at 14 weeks. DISCUSSION: Although we cannot rule out confounding by breastfeeding intention, our results suggest that bedsharing in early infancy might lead to later weaning. Regardless of infant feeding method, given the frequency of bedsharing reported by women in this and other samples, clinicians encountering pregnant and postpartum women should teach safe bedsharing practices.

Simulation to Prepare Graduate Nursing Students for Clinical Faculty Role.

Limited clinical sites and faculty to teach graduate students to be undergraduate clinical faculty have led to the exploration of innovative teaching strategies. This article describes and evaluates a simulation experience to supplement didactic learning about best clinical teaching practices within a graduate nursing course. Scenarios were created to simulate complex teaching situations with a patient, an undergraduate nursing student, and a clinical faculty member. Evaluations were positive regarding knowledge, performance, self-confidence, critical thinking, and satisfaction. Results of this project support the use of simulation in the preparation of graduate nursing students to become clinical faculty.

The Nurse's Role in Health Literacy of Patients With Cancer.

Patients with cancer are often faced with complex diagnoses that require decision making in a highly stressful environment. The role of the healthcare team is to ensure that patients have the information, tools, and resources needed to make informed decisions. However, low health literacy is a common and undervalued factor in the outcomes of patients, particularly those with cancer.

The impact of a diabetes local enhanced service on quality outcome framework diabetes outcomes.

BACKGROUND: The rising challenge of diabetes requires novel service delivery approaches. In the UK, Local Enhanced Services (LES) have been commissioned for diabetes. Health professionals from general practices (GPs) who signed up to LES were given additional training (and a monetary incentive) to improve management of patients with diabetes. All practices in the PCT were invited to the LES initiative, which ensured avoiding selection bias. The aim of the study was to examine the impact of LES in terms of diabetes Quality Outcome Framework (QOF) indicators: DM23(glycaemia), DM17(lipid) and DM12(blood pressure; BP). METHODS: QOF diabetes indicators were examined using data from 76 general practices for 2009-2010 in a large primary care trust area in Birmingham, UK. Data were extracted from Quality Management Analysis System. The primary outcome was a difference in achievement of QOF indicators between LES and NLES practices. A secondary outcome was the difference between LES and non-LES practices for hospital first and follow-up appointments. RESULTS: We did not find any difference for DM12(BP) and DM17(lipid) outcomes between LES and NLES practices. However, LES practices were more likely to achieve the DM23(glycaemia) outcome (estimated odds 1.459;95% CI:1.378-1.544; P=0.0001). The probability of achieving satisfactory level of DM23(glycaemia) increased by almost 10% when GPs belonged to LES groups compared with GPs in NLES group. LES practices were less likely to refer patients to secondary care. CONCLUSION: Overall, LES practices performed better in the achievement of DM23(glycaemia) and also referred fewer patients to hospital, thereby meeting their objectives. This suggests that the LES approach is beneficial and needs to be further explored in order to ascertain whether the impact exerted was due to LES.

Preventing type 2 diabetes: a role for every practitioner.

Type 2 diabetes accounts for approximately 90% of the three million people who have diabetes in the UK, and it presents a significant challenge to the NHS. The number of people developing the condition is rapidly increasing, and it is estimated that five million people will have diabetes by 2025. Diabetes can lead to the development of a number of disabling and costly complications including blindness, kidney failure, heart disease, stroke and amputation. Type 2 diabetes is treated by improvements in lifestyle, losing weight, treatment with a number of oral medications and, eventually, injection therapy including insulin. The increasing number of people with diabetes means it is a significant consumer of NHS resources. The development of type 2 diabetes is associated with a number of risk factors. There is strong and consistent evidence which shows that early detection of people at high risk followed by changes in lifestyle can reduce the incidence of type 2 diabetes and its complications, eg: diabetes. New guidance from the National Institute for Health and Clinical Excellence (NICE) on identifying people at high risk of developing type 2 diabetes and the provision of clinically and cost effective interventions to prevent or delay the onset of the condition has recently been published. This article summarises the guidance and particularly focuses on the role of nurses working in primary and community care settings.

How to manage hypoglycaemia.

Hypoglycaemia is a common side-effect of insulin therapy and of some oral hypoglycaemic tablets that stimulate insulin production. It affects quality of life, can prevent people with diabetes from achieving the blood glucose control required to reduce their risk of diabetes complications, and can also be fatal. This article defines hypoglycaemia, what causes it, how can it be identified and treated, and how nurses can support people at risk of this disabling and frightening condition.

Decolonizing personality assessment and honoring indigenous voices: a critical examination of the MMPI-2.

Utilizing a mixed methods approach located between constructivist-interpretivist and critical-ideological research paradigms (Ponterotto, 2005), the current study builds upon previous research (Pace et al., 2006) that investigated the cultural validity of the Minnesota Multiphasic Personality Inventory (MMPI)-2 in its use with American Indians. Thirty items from MMPI-2 scales F, 1, 6, 8, and 9 were identified via item analysis as reflecting significant differences in endorsement rates between an American Indian sample and the MMPI-2 normative group. Semistructured interviews focused on these 30 items were conducted with 13 American Indian participants from an Eastern Woodlands Nation in Oklahoma. Interviews were audio recorded, transcribed, and then coded for themes using a qualitative coding analysis. Nine themes emerged: core belief system, experiences of racism and discrimination, conflicting epistemologies, living in two worlds, community connectedness, responsibility and accountability to the community, traditional knowledge, stories as traditional knowledge, and language and historic loss. Results of the current study demonstrate how the MMPI-2 may pathologize Indigenous worldviews, knowledge, beliefs, and behaviors rather than accurately assess psychopathology. Implications for practice and future research are addressed.

Reducing the risk of complications associated with diabetes.

Complications associated with type 1 and type 2 diabetes can lead to microvascular and macrovascular damage, which can have financial implications for patients and the NHS, and affect quality of life. This article discusses the identification, management and prevention of complications associated with diabetes to relieve existing symptoms and reduce further damage.

Delivering patient education for people with diabetes.

Most people with diabetes manage their condition themselves. Successful self-management requires patients to understand their condition and the consequences of non-adherence to treatment so that they can be involved in decision-making and achieve agreed target blood sugar levels. Structured patient education is essential. This article explores how it should be provided.

A cultural-contextual perspective on the validity of the MMPI-2 with American Indians.

This study investigated the normative validity of the MMPI-2 with two distinct American Indian tribes. Differences occurred on 8 of the 13 basic validity and clinical scales (F, 1, 4, 5, 6, 7, 8, 9) between the MMPI-2 norms and both tribal samples. Elevated MMPI-2 scores of American Indians may not only reflect the possibility of psychological distress spurred by historical oppression and present adversity, but also an expression of a divergent worldview. Considering the context of the historical and social production of knowledge about American Indians, it is argued that researchers and practitioners, when interpreting MMPI-2 results for American Indians, should seriously consider their interpretive points of reference, which may be impacted by dominant cultural belief systems.

Hospice utilization: political, cultural, and legal issues.

The provision of end-of-life care is considered a substantive part of nursing, and hospice is often considered the "gold standard" of optimal end-of-life care. Unfortunately, however, only an estimated 43% of patients eligible for hospice actually receive hospice services (Harrison, Ford, & Wilson, 2005). The purpose of this article is to describe the political cultural, and legal issues associated with the underutilization of hospice care. Specifically, this article will outline the policy issues for accessing hospice under Medicare and Medicaid, the cultural and social issues in hospice utilization, and the legal implications of these issues. In addition, this article will serve to offer initial solutions to the problems at hand in order to guide nurses in promoting effective, efficient, and realized access to hospice services.

New insulin analogues and their impact on diabetes care.

The rising incidence of diabetes means that it is no longer viable for patients to be treated solely within the secondary care setting and primary health-care professionals, including community nurses working within community-based diabetes clinics, are likely to continue to take on greater responsibility for the assessment and management of patients with diabetes. This article discusses recent advances in insulin therapy--namely the advent of the new insulin analogues--and examines their likely impact on community nurses in terms of improved time management and quality of care for patients with diabetes on patients in terms of improved quality of care.