Anticoagulation for Stroke Prevention in Atrial Fibrillation.

Cardioembolic stroke from atrial fibrillation causes substantial death and disability in the United States. Treatment with oral anticoagulants provides safe and effective stroke prevention for high-risk patients. This article reviews strategies for the use of anticoagulation and highlights the nurse's role in patient education.

An interprofessional experience preparing a collaborative workforce to care for older adults.

The development and evaluation of an interprofessional education (IPE) pre-professional geriatrics experience involving learners from 10 different health discipline programs is described. The experience provided learners with opportunities to use small-group collaborative approaches in two 3-hour interprofessional sessions. Learners gained exposure to geriatric principles and awareness of the needs of older adults and their families using case studies developed by experienced interprofessional faculty. Learners completed pre- and post-experience surveys and worksheets on their confidence to function in interprofessional teams, knowledge of other disciplines, perceptions of importance of each discipline in providing older adult care, and the qualities considered for a successful team. Data were collected over three offerings of the experience (2016, 2017, 2018) and analyzed using paired sample t-tests and ANOVA. A total of 562 learners participated with outcome measures indicating increased knowledge of older adult services different health professionals provide and increased confidence in knowing when to complete care referrals. Mean increase in learners' confidence to function in interprofessional teams was significant, suggesting the experience was effective in facilitating confidence in functioning and improving views of other disciplines' roles. This experience demonstrated that learners gained exposure to apply geriatric principle skills and critical thinking as interprofessional team members.

The role of Doctor of Nursing Practice-prepared nurses in practice settings.

BACKGROUND: The role of the Doctor of Nursing Practice-prepared nurse (DNP) outside of academic settings has not been clearly articulated or widely explored, and therefore the value DNP-prepared nurses bring to their practice settings is largely unknown. This study: (1) surveyed existing DNP programs to identify the nonacademic settings in which their DNP graduates were employed and (2) conducted semistructured interviews with employers to identify the role and value of the DNP-prepared nurse in nonacademic settings. METHOD: Data were collected from January 2016 to August 2016 in two parts: (1) an online survey of the DNP programs and (2) qualitative semistructured telephone interviews with employers. First, we conducted an online survey of program directors (or their equivalent) from 288 DNP programs across the United States to capture descriptive information about current DNP programs (e.g., location, modality, profit status), the types of nonacademic institutions that hire their graduates, percentage of graduates employed by each setting, and the contact information for these employers. Employers were identified either by DNP program directors through the online survey or by a convenience sampling method. Using semistructured telephone interviews, we asked questions to employers in different care settings about the role of the DNP in these settings and how the DNP compares to other nurse leaders and advanced practice nurses (APRN). Employers were asked to describe the role of the DNP-prepared nurse working in direct patient care roles such as APRNs or as leaders, administrators, and managers. FINDINGS: Descriptive thematic analyses were derived from the interviews, to identify the roles DNP-prepared nurses filled and how they compared to other nurse leaders and advanced practice nurses in these settings. A total of 130 DNP program directors responded to the online survey. Twenty-three employers participated in semistructured telephone interviews. The thematic analysis resulted in four main themes regarding the role of the DNP-prepared nurse in non-academic settings: "DNP-Prepared Nurse Positions and Roles," "Perceived Impact of the DNP-Prepared Nurse on Staff, Patient, and Organizational Outcomes," "Comparison of the DNP-Prepared Nurse to Other Nurses With Advanced Training," and "Challenges Experienced by Nurses With DNP Degrees. DISCUSSION: The role of the DNP-prepared nurse in nonacademic settings is unclear. These DNP-prepared nurses typically function as APRNs in clinical care or as health care system leaders. While there is a low number of DNPs in clinical practice settings, the number is expected to grow as more graduate and enter practice. Thus, knowledge of the roles, value, and outcomes of the DNP-prepared nurse can guide practice setting leaders on how to best use DNP-prepared nurses in their setting.

Providing self-management education to patients with type 2 diabetes mellitus: Addressing basic nutrition and hypoglycemia.

NPs and other primary care providers will continue to encounter a growing population of patients with type 2 diabetes mellitus. Helping patients engage in self-care behaviors is essential to achieve blood glucose control and prevent diabetes-related complications. This article explores opportunities to provide education to patients with diabetes mellitus on the important self-care topics of nutrition and hypoglycemia during a primary care visit.

Evaluation of a depression screening and treatment program in primary care for patients with diabetes mellitus: insights and future directions.

PURPOSE: To evaluate a collaborative depression care program by assessing adherence to the program by internal medicine clinic (IMC) staff, and the program's effectiveness in treating depression in patients with diabetes mellitus. We also describe the rate of depression among patients with diabetes in the IMC. DATA SOURCES: Data for this program were obtained from a de-identified disease registry and included 1312 outpatient IMC visits in adult patients with diabetes between March 2011 and September 2011. CONCLUSIONS: Collaborative depression care results in high rates of screening for and identification of depression, high rates of antidepressant utilization, and improved depression scores; however, more focused interventions are needed to improve diabetes outcomes in patients with depression and diabetes. IMPLICATIONS FOR PRACTICE: The results indicate that the multidisciplinary IMC staff can work together with patients to identify and monitor depression within primary care. This study provides valuable information about models of depression care that can be implemented and evaluated in a clinical setting.

Gaze-induced Desçemet's folds secondary to a primary pterygium.

PURPOSE: To report a case of gaze-induced Desçemet's folds secondary to a primary pterygium. METHODS: Interventional case report, chart review, and literature review. RESULTS: Slitlamp examination of a 49-year-old man showed Desçemet's folds in the left eye on extreme right gaze secondary to the restrictive effect of a primary pterygium. The folds correlated with increasing astigmatism documented on corneal topography and restricted ocular motility and diplopia on attempted adduction. CONCLUSIONS: To the authors' knowledge, this is the first reported case of folds induced in Desçemet's membrane secondary to the tethering effect of a primary pterygium.

Prevention of recurrent Reis-Bücklers dystrophy following excimer laser phototherapeutic keratectomy with topical mitomycin C.

PURPOSE: To report a case of excimer laser phototherapeutic keratectomy (PTK) for Reis-Bücklers dystrophy with a single intraoperative application of adjunctive topical 0.02% mitomycin C (MMC). METHODS: Interventional case report and review of the literature. RESULTS: A 73-year-old woman with visually significant Reis-Bücklers dystrophy underwent PTK of her right eye with 0.02% adjunctive MMC for visual rehabilitation. Before treatment, best corrected visual acuity (BCVA) was 20/400. The left eye had previously undergone PTK on 2 occasions without MMC, and the dystrophy had recurred following each treatment. One year after the procedure, her MMC-treated cornea remains clear with no recurrence of Reis-Bücklers dystrophy. CONCLUSIONS: The use of topical MMC in conjunction with PTK may be a safe and effective treatment of Reis-Bücklers dystrophy and may be helpful in preventing recurrence of the disease.