What is a necessary knowledge base for sleep professionals?

Sleep medicine is multidisciplinary, and sleep medicine professionals should be trained to evaluate and treat all 88 sleep disorders. Sleep medicine specialists require a fund of knowledge that goes beyond what is obtained during a pulmonary fellowship. Skills required for a pulmonary sleep professional include: sleep medicine, neurobiology, psychiatry, neuro-psychology, neurology, pediatrics, and even limited exposure in otolaryngology, oral maxillofacial surgery, and dentistry. There is a paucity of published information concerning curricular requirements. Required skills for a sleep professional include proficiency in the clinical skills of sleep medicine as well as the technical skills of polysomnography. There is a very large knowledge content area requirement in both the basic sciences of sleep and the clinical aspects of sleep medicine. There are also important clinical skills content areas. As with all medical professionals, sleep professionals should have the highest ethical standards and a strong sense of responsibility toward their patients. A sleep medicine professional also has to be knowledgeable about administrative and legal aspects specific to sleep medicine. This essay reviews a sleep professional knowledge base model with emphasis on the requirements for a pulmonary sleep professional.

Screening for abuse: barriers and opportunities.

Domestic abuse is the leading cause of injuries and death among women of childbearing age in the United States. The broad purpose of this research is to discover how pregnant women's psychological and behavioral responses to abuse affect birth outcomes. To select a diverse sample of women, we identified 8 prenatal care sites and completed the human subjects approval process with each. Rates of screening for abuse range from all but 12 women over a 2-1/2-year period at one site to no screening for abuse at another site. In this article, we will review pertinent literature and discuss the supports and barriers we observed when implementing an abuse screening program using the Abuse Assessment Screen, a well-tested and valid clinical instrument. Suggestions will be made for improving the screening rates at those sites where screening is absent or inconsistent.

A retrospective chart review of gabapentin for the treatment of aggressive and agitated behavior in patients with dementias.

In a 24-patient case series from retrospective chart review, the authors examined the use of gabapentin for the treatment of aggressive and agitated behaviors in nursing home patients with a DSM-IV diagnosis of dementia. On Clinical Global Rating Scale scores, 17 of 22 patients were much or greatly improved; 4 were minimally improved; and only 1 remained unchanged. Two of the 24 patients discontinued use of the medication because of excessive sedation. No other significant side effects were noted in treatment lasting up to 2 years.

The evolution of advanced practice nursing in the United States: caring for women and newborns.

The evolution of advanced practice nurses to care for women and newborns has its roots in public health nursing of the latter decades of the 19th century. As we consider the challenges of practicing as advanced practice nurses in the 21st century, it is instructive to look back on 100 years of creating new programs and systems for delivering care. Such reflection helps us to clear our vision to imagine the future.

Abnormal Papanicolaou smears, genital tract infections, and contraception.

Cervical cancer ranks second among all cancers in women world-wide, and the rate of invasive cervical cancer among women under 50 is rising in the United States. Risk factors for abnormal Papanicolaou (Pap) smears and invasive cervical cancer include genital tract infections. This study was designed to compare the rates of genital tract infections and the contraceptive choices of a random sample of 800 women, using an ex post facto design. The Pap positive women had a significantly higher rate of genital tract infections than did the Pap negative women but did not differ significantly in use of contraceptive methods. Findings support those of other researchers suggesting genital tract infections as risk factors for abnormal Pap smears and are consistent with the literature in suggesting a role for oral contraceptive pills (OCPs) in acquisition of the human papillomavirus (HPV). Caregivers can help empower women to reduce their risks through informed choices about protection and sexual behaviors.