How Well Are Nurse Practitioners Prepared to Treat Common Musculoskeletal Conditions?

BACKGROUND: Musculoskeletal disorders affect a third of the U.S. population and are among the most prevalent, costly, and debilitating medical conditions. Basic familiarity with musculoskeletal conditions is essential for all primary care providers, including nurse practitioners (NPs). PURPOSE: The purpose of this study was: (1) to estimate the quantity of musculoskeletal education provided in NP programs; (2) to evaluate NPs' perceptions of their own confidence in providing musculoskeletal care versus other areas of primary care; and (3) to determine how well NPs score on a test of basic musculoskeletal knowledge. METHODS: An online self-reporting survey was conducted to evaluate NPs' knowledge, competence, and confidence in treating common musculoskeletal disorders. RESULTS: Most NPs receive fewer than 10 hours of musculoskeletal education, are subjectively less confident about their musculoskeletal skill set compared to other areas of primary care, and lack the basic knowledge to competently manage musculoskeletal problems in primary care. CONCLUSION: The findings of this study confirm earlier conclusions that, like our physician colleagues, the vast majority of nurse practitioners lack adequate preparation to manage common nonsurgical musculoskeletal problems.

The bipolar sealing device: reducing blood loss in orthopaedic surgery.

Perioperative blood management continues to be a challenge in major orthopaedic surgical procedures. Techniques used have varied through the years, and ongoing attempts to minimize patients' exposure to allogeneic blood continue to be explored. To date, the majority of blood management options focus on either blood replacement with safe effective blood products or the preoperative stimulation of red blood cell production in the surgical patient with erythropoietin. This article describes a new device that uses thermal energy to inhibit blood loss from soft tissue and bone during orthopaedic surgery. Early clinical trials indicate that the bipolar device may reduce blood loss and decrease exposure to blood transfusions.

Psoriatic arthritis.

Psoriatic arthritis is an inflammatory arthritis associated with the skin disorder psoriasis. The exact etiology of psoriatic arthritis is unknown, although more than 40% of people with the cutaneous disease of psoriasis are estimated to also have joint involvement. This article presents an overview of psoriatic arthritis, including the origin, genetic influence, and immunologic factors involved in its evolution. The clinical features of psoriatic arthritis are also reviewed in this article, and a discussion of the diagnosis and treatment is included.

Perioperative care for patients with sickle cell who are undergoing total hip replacement as treatment for osteonecrosis.

Sickle cell disease, which is characterized by chronic hemolytic anemia, is prevalent in the United States. In addition to the profound multisystem effects of vasoocclusion associated with sickle cell disease, osteonecrosis of the femoral head classically develops at an early age. Because of advanced medical technology and new treatment modalities, patients with sickle cell disease are living longer. More adults with this genetic disease are becoming candidates for total hip arthroplasty. This article describes the pathophysiology of sickle cell anemia, explains the process of osteonecrosis, and discusses total hip arthroplasty in this unique patient population.

Viscosupplementation: a new treatment option for osteoarthritis.

Osteoarthritis (OA), a degenerative joint disease affecting articular cartilage and synovial joint fluid, is the most common of the rheumatic diseases. OA is a huge public health issue that diminishes the quality of life of millions in the United States. Current treatments for OA include physical therapy, antiinflammatories, narcotics, steroids, and surgery. Unfortunately there is currently no cure for OA and many of the effective treatment modalities have many harsh side effects. Quite recently patients suffering from OA had little alternative to total joint replacement surgery once they exhausted their allotment of steroid injections and started to experience the GI complications associated with traditional NSAIDs. The introduction of viscosupplements, injectable compounds that mimic healthy synovial fluid and often relieve the suffering caused OA, has given patients with OA a longer-term, nonsurgical treatment alternative.