The Impact of Preoperative Education on Patients Undergoing Elective Total Hip and Knee Arthroplasty: The Relationship Between Patient Education and Psychosocial Factors.

BACKGROUND: Preoperative education has been found to be responsible for patients having a realistic expectation of surgery as well as high level of satisfaction with their recovery. The Joint Academy offers preoperative educational classes for all patients undergoing elective knee and hip replacements. PURPOSE: The purpose of this descriptive study was to determine whether the education provided by The Joint Academy has an impact on anxiety, expectation, and preparedness in patients who undergo elective total knee or hip arthroplasty. METHODS: All patients who had total joint or hip arthroplasty over a 2-month period were invited to participate in this descriptive correlational study. RESULTS: Of the 49 study participants, 28 attended The Joint Academy. Those who attended The Joint Academy were more likely to hold surgical expectations that better correlated with actual experience (p = .425). There was no statistically significant difference between the groups for nervousness (p = .171) or feeling prepared for the surgery (p = .425). CONCLUSION: Offering education before knee or hip arthroplasty provides patients with an understanding of the expectations related to surgery.

Percutaneous Nephrostomy Infusion: Nursing Considerations for Treatment of Upper Urinary Tract Urothelial Carcinoma.

An intrarenal approach using a percutaneous nephrostomy tube is a novel method to deliver chemotherapy and biotherapy to patients with upper urinary tract urothelial carcinoma. A paucity of evidence exists regarding basic nursing implications for this unique treatment option. This column will provide suggested guidelines to administer intrarenal treatment via a percutanous nephrostomy tube.
.

Conceptual models to guide best practices in organization and development of State Action Coalitions.

The RWJF/AARP National Campaign for Action established a goal of establishing Action Coalitions in every state by 2012. Last year, a small Steering Committee formed in Nebraska and used two conceptual models to guide the organization and development of its Action Coalition. The purpose of this article is to present the Internal Coalition Outcome Hierarchy (ICOH) model that guided development of partnership and coalition building. The second model, Determining Program Feasibility, provided a framework for data collection and analysis to identify the opportunities and challenges for strategic program planning to accomplish identified key priorities for Nebraska. A discussion of the models' applications is included and offered as best practices for others seeking to form partnership/coalitions and establish action plans and priorities.

Health care in rural hospitals: a role for nurse practitioners.

Disparities in rural health care are associated with poor patient outcomes. There is a need to further evaluate opportunities to bridge the gaps and improve rural health care. This descriptive, exploratory study examined the current and potential expanded use of nurse practitioners (NPs) in rural hospitals of one Midwestern state. Surveys (N = 136) were mailed to chief executive officers (n = 68) and chief nursing officers (n = 68) of rural hospitals in Nebraska with a response rate of 57.3% and 80.8%, respectively. The majority of respondents represented critical access hospitals. A convenience sample of NPs (N = 19) who practiced in rural communities also completed written surveys. Findings identified potential opportunities to expand the use of NPs to provide emergency department coverage and inpatient hospital management of patients in rural hospitals. Education and training of NPs need to include the essential critical thinking and skill sets to manage these types of health care needs.

Management of exercise-induced bronchospasm in adolescents with asthma.

Physical activity in persons with asthma is important at any age but even more so in adolescents. Collaboration between the nurse practitioner and adolescent is essential to develop an asthma management plan that will provide for optimal physical activity and prevent asthma exacerbations while exercising.

Postnatal follow-up of prenatally diagnosed trisomy 16 mosaicism.

OBJECTIVE: To determine the long-term outcome of pregnancies prenatally diagnosed with trisomy 16 and identify variables associated with the outcome. METHODS: We reviewed all published and our unpublished data from trisomy 16 pregnancies for which outcomes were available for children of greater than 1 year of age. RESULTS: Nineteen cases were diagnosed with trisomy 16 on chorionic villus sampling (CVS) and 17 cases at amniocentesis. Age at last follow-up ranges from 1 to 13 years. Among the CVS group, four out of five patients, with a birth weight and/or length below -2 SD and postnatal growth information, showed catch-up growth (80%). Among the amniotic fluid (AF) group, the birth weight was available in 13 cases. Eleven of the 13 cases had a birth weight less than -2 SD. In eight cases, the length was also below -2 SD (length data unavailable in one case). Nine out of ten cases (90%) and seven out of eight (87.5%) showed catch-up growth for weight and length, respectively. In terms of development, no cases of CVS mosaicism had global developmental delay. One child had a history of delay in speech development. Among the AF-detected cases, 4/17 cases had global developmental delay. All four children with global developmental delay had more than one major malformation compared to 6 out of 32 children in the group with normal development (p = 0.004). The finding of uniparental disomy (UPD) was not associated with developmental delay. CONCLUSIONS: The majority of prenatally diagnosed trisomy 16 mosaic cases have a good postnatal outcome. However, the finding of mosaicism on AF and the presence of major congenital anomalies are associated with an increased risk of developmental delay.

A pilot study of bone density loss in menopausal women treated with chemotherapy for cancer.

GOALS OF WORK: To estimate the incidence and severity of bone loss in menopausal women diagnosed with cancer who receive treatment with chemotherapy. Also, to evaluate the use of bone loss prevention agents in this population. PATIENTS AND METHODS: A total of 25 postmenopausal women with newly diagnosed cancers who received chemotherapy for a minimum of six cycles were enrolled in this pilot study. All subjects underwent baseline bone mineral density (BMD) testing of the lumber spine (LS), left hip (LH), and femoral neck (FN). Of the 25 women, 22 also underwent follow-up BMD testing at 6 months. MAIN RESULTS: The median age of the subjects was 61 years (range 41-76 years) and the median age of menopause was 50 years (range 34-55 years). Of the 25 subjects, 9 used at least 1 g oral calcium daily, 4 used alendronate, 2 used raloxifene, and 1 used oral estrogen. The mean BMDs (g/cm2) with standard deviation above or below the mean for young adult women at baseline were: LS 0.996 (-0.5 SD), LH 0.876 (-0.5 SD), and FN 0.760 (-0.7 SD). The following values were obtained at 6 months: LS 0.965 (P<0.001), LH 0.847 (P<0.001), and FN 0.739 (P=0.009). CONCLUSIONS: Menopausal women diagnosed with cancer appear to have a high incidence of baseline bone loss, with significant additional loss during treatment. Use of agents for prevention/treatment of bone loss in this group is infrequent. A prospective, controlled analysis is indicated to determine the optimal utility of bone densitometry testing and osteoporosis prevention strategies in this population.

Strategies for acquiring affordable medications for seniors.

While Congress continues to debate issues related to Medicaredrug benefits, senior citizens grow increasingly frustrated withtheir monthly medication bills. Many seniors are unable to affordall of their medications, and therefore find that they must choosebetween those that are the most helpful and those that have thegreatest potential for severe medical consequences if missed. Op-tions are available for helping senior citizens with this financialburden, but many seniors are either unaware or unable to availthemselves of the existing programs. Several pharmaceutical com-panies have developed programs for the medically needy based onincome levels. Generic medications as opposed to trade names re-present substantial cost savings. Many pills can be split, thus pro-viding twice the dose for half the cost. Some community healthcenters offer access to prescriptions at decreased costs through fed-eral programs. This article explores the various options availableto senior citizens so that nurses may act as advocates for thesepatients.

Prenatal screening for birth defects: an update.

This article summarizes current second trimester prenatal screening methods, and describes recently developed first trimester screening tools. The advantages and potential pitfalls of first trimester screening are outlined.

Hospice utilization by male and female cancer patients in an end-of-life transition program.

OBJECTIVE: to determine if there were sex differences in patients' use of hospice services in a regional cancer center in Texas from 1998 to 2000. METHODS: A quality-of-life program for patients with cancer that included an end-of-life component was initiated in 1998 at a regional cancer center. The records of 1057 female and 986 male cancer patients who died from 1998 to 2000 were reviewed. Data on demographics, use of hospice care, length of stay, and location at time of referral were collected and analyzed. RESULTS: Hospice utilization increased in women (47% v 64%; p<.001) and men (53% v 66%; p<.001) who died of cancer from 1998 to 2000. Length of stay (LOS) in hospice did not change for women, but decreased significantly for men over that time (31 days v 14 days, p<.001). The number of men with stays of 14 days or less increased significantly (30% v 53%, p<.001). Subjects whose LOS were less than 14 days were more likely to be hospital inpatients at time of referral. CONCLUSIONS: The institution of a targeted end-of-life program was associated with increased utilization of hospice services in women with cancer at this regional cancer center. Length of stay in hospice was longer for women than men, and more men had very short (less than 14 day) stays. Hospice referrals from outpatient settings were associated with longer LOS.