Venous thromboembolism knowledge among older post-hip fracture patients and their caregivers.

Patient education about venous thromboembolism (VTE) prevention is needed to prevent complications and costly re-hospitalization. Nurses are uniquely positioned to provide vital education as patients transition from the inpatient setting to after discharge. Still, little is known about patient knowledge deficits and those of their caregivers. The purpose of this study was to explore VTE prevention knowledge in a sample of older hip fracture patients and family caregivers. At the time of hospital discharge, surveys were completed by hip fracture surgery patients (≥65; n=30) and family caregivers (n=30). Participants reported needs for more prophylactic anticoagulation and side effects education. Mean education satisfaction was 3.49 out of 5 among patients and 3.83 among caregivers. Focused patient education regarding the wisdom of VTE prevention, potential risks involved, and patient and caregiver roles in advocating for better prevention measures is needed for these patients at risk for hospital readmission secondary to VTE.

Translational research: connecting evidence to clinical practice.

Translational research can be conceptualized within several blocks or spheres of knowledge transfer and focused on closing the gap between new discoveries and their endpoint application to clinical practice, health decision-making, and health policy. Although support for type 1 translational research (the classical bench-to-bedside paradigm) is common, it is types 2 and 3 that have the ultimate impact on sustaining important changes in clinical practice as health decision-making and policy are changed to support the practice innovation. The Clinical Translational Science Centers (issued by the National Institutes of Health in the USA) provide many successful examples in which nurses are key stakeholders in achieving these translational goals for the improvement of clinical practice.

Diagnosing depression in Alzheimer disease with the national institute of mental health provisional criteria.

OBJECTIVE: To compare the rates of depression in Alzheimer Disease (AD) determined using National Institute of Mental Health (NIMH) provisional criteria for depression in AD (NIMH-dAD) to those determined using other established depression assessment tools. DESIGN: Descriptive longitudinal cohort study. SETTING: The Alzheimer's Disease Research Centers of California. PARTICIPANTS: A cohort of 101 patients meeting NINDS-ADRDA criteria for possible/probable AD, intentionally selected to increase the frequency of depression at baseline. MEASUREMENTS: Depression was diagnosed at baseline and after 3 months using NIMH-dAD criteria and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders. Depressive symptoms also were assessed with the Cornell Scale for Depression in Dementia (CSDD), the Geriatric Depression Scale (GDS), and the Neuropsychiatric Inventory Questionnaire. RESULTS: The baseline frequency of depression using NIMH-dAD criteria (44%) was higher than that obtained using DSM-IV criteria for major depression (14%; Z = -5.50, df = 101, p <0.001) and major or minor depression (36%; Z = -2.86, df = 101, p = 0.021) or using established cut-offs for the CSDD (30%; Z = -2.86, df = 101, p = 0.004) or GDS (33%; Z = -2.04, df = 101, p = 0.041). The NIMH-dAD criteria correctly identified all patients meeting DSM-IV criteria for major depression, and correlated well with DSM-IV criteria for major or minor depression (kappa = 0.753, p <0.001), exhibiting 94% sensitivity and 85% specificity. The higher rates of depression found with NIMH-dAD criteria derived primarily from its less stringent requirements for the frequency and duration of symptoms. Remission rates at 3 months were similar across instruments. CONCLUSIONS: The NIMH-dAD criteria identify a greater proportion of AD patients as depressed than several other established tools.

Writing an application for a human subjects institutional review board.

After reading this article, readers will be able to do the following: understand the role and responsibilities of an institutional review board (IRB); recognize the major areas that must be addressed in an IRB submission; and avoid common mistakes in writing a research application submission to an IRB.

Methodological issues in estrogen treatment trials for Alzheimer's disease.

Over the past two decades, many clinical trials have been conducted using different forms of estrogen therapy with and without progestin supplementation in an effort to treat diagnosed Alzheimer's disease. Design variations among these trials may account for the inconsistent results of these investigations and the persistent gap in knowledge about the appropriate use of estrogen in the treatment paradigm for degenerative diseases.

Estrogen replacement therapy, Alzheimer's disease, and mild cognitive impairment.

This article highlights the latest findings regarding estrogen replacement therapy in the treatment and prevention of Alzheimer's disease (AD) and mild cognitive impairment in women. Despite considerable evidence from observational studies, recent randomized clinical trials of conjugated equine estrogens, alone and in combination with progestin, have shown no benefit for either the treatment of established AD or for the short-term prevention of AD, mild cognitive impairment, or cognitive decline. Based on the evidence, there is no role at present for estrogen replacement therapy in the treatment or prevention of AD or cognitive decline, despite intriguing results from the laboratory and from observational studies. However, numerous questions remain about the biologic effects of estrogens on brain structure and function. Additional basic and clinical investigations are necessary to examine different forms and dosages of estrogens, other populations, and the relevance of timing and duration of exposure.