The evolution of proton pump inhibitors for the treatment of gastroesophageal reflux disease.

PURPOSE: This article reviews the diagnosis and current treatment options for gastroesophageal reflux disease (GERD) available to nurse practitioners, with a focus on advances in proton pump inhibitor (PPI) therapy. DATA SOURCES: Review of scientific literature and clinical management guidelines for GERD treatment and PPI therapy from the PubMed database, Google Scholar, and other World Wide Web resources. CONCLUSIONS: A number of safe and effective treatment options exist for GERD. Recent developments in PPI technology may begin to address unmet needs in PPI therapy. IMPLICATIONS FOR PRACTICE: GERD is commonly diagnosed and treated by nurse practitioners in the primary care setting. Acid suppression therapy is the primary medical therapy for GERD. PPI therapy provides symptomatic relief of heartburn and regurgitation, as well as effective healing and maintenance of erosive esophagitis. Newer PPIs lengthen the duration of acid suppression and allow for more flexibility in dosing, which may improve medication adherence and decrease episodes of acid breakthrough.

Sickle-cell anemia and pulmonary hypertension.

PURPOSE: To provide nurse practitioners (NPs) information about sickle-cell disease (SCD) and pulmonary hypertension (PHTN) as a complication. A case study is presented to illustrate the diagnosis of PHTN in a patient with SCD. Clinical manifestations, diagnosis, and interventions for both SCD and PHTN are also discussed. DATA SOURCE: A literature search to support this case review was conducted in PubMed and SCOPUS using key search words. Specific information for the case study was obtained from a patient in a primary care setting. CONCLUSION: Pulmonary hypertension is frequently diagnosed secondary to hemoglobinopathies such as SCD. Patients with sickle-cell anemia, a lifelong hereditary hemoglobinopathy, are now surviving into adulthood because of the advances made in treatment. About one third of these patients develop pulmonary hypertension, a complication that carries a 40% mortality rate. Delayed diagnosis can affect the patient's quality of life. Timely diagnosis and referral is imperative, but only if the advanced practitioner is able to recognize this common complication. IMPLICATIONS FOR PRACTICE: Many patients with SCD are seen in primary care practices. Such is the situation for the patient in this case study. Familiarity with pulmonary hypertension secondary to SCD can increase the awareness of NPs of this potential consequence and initiate early diagnostic evaluation.

Parental disconnect between perceived and actual weight status of children: a metasynthesis of the current research.

PURPOSE: Obesity is one of the most common chronic diseases in childhood. Many studies offer a variety of explanations for the alarming increase in childhood obesity; however, none discuss why an apparent disconnect exists in parental perceptions of their child's weight status. The purpose of this article was to review the current research literature on parental perceptions about their children's weight. DATA SOURCE: The articles included in this review were retrieved through a literature search using PubMed. Key words used to obtain relevant articles include childhood obesity, childhood overweight, and parental perception. CONCLUSIONS: Several studies looked at parental perceptions of childhood obesity generated from the United Kingdom, Australia, Italy, and the United States. Universally, parents were more likely to misperceive their child's weight. This was especially true for parents who were themselves overweight. IMPLICATIONS FOR PRACTICE: If parents do not recognize their child as at risk for overweight or overweight, they cannot intervene to diminish the risk factors for pediatric obesity and its related complications. More research is needed to identify why this phenomenon occurs. Only then can effective interventions be initiated.

The effect of modified jazz dance on balance, cognition, and mood in older adults.

PURPOSE: The purpose of this pilot study was to evaluate the impact of jazz dance class instruction on balance, cognition, and mood (specifically depression) in 13 healthy, community-dwelling, English-speaking older women with a mean age of 68. DATA SOURCES: Data were collected using self-report questionnaires (Folstein Mini Mental Status Examination [MMSE] and Geriatric Depression Scale [GDS]), and the sensory organization test (SOT) for balance measurements (using the NeuroCom Smart Balance Master) was performed at three time periods in the study: time 1: between week 1 and week 2 of jazz class (baseline), time 2: between week 8 and week 9 of jazz class (midpoint), and time 3: after week 15 of jazz class (final measurement). CONCLUSIONS: Differences in mean MMSE and GDS scores over time were not significant; however, SOT scores showed an increasing trend (p < .001). Data analysis using analysis of variance with repeated measures showed that balance measures improved throughout the duration of the study (F(2,10)= 19.68, p < .001). Post hoc analyses using paired t tests with a Bonferroni correction indicated that significant increases in balance occurred from time 1 to time 2 and from time 2 to time 3. These preliminary pilot study findings suggest that jazz dance does not impact cognition or mood but may improve balance in older women. This finding may have significant implications for fall prevention in the postmenopausal population. IMPLICATIONS FOR PRACTICE: Because falls are a leading cause of morbidity and mortality in older adults of both genders, research is needed to evaluate both the impact of jazz dance on balance in older men and jazz dance as a fall prevention strategy in aging adults. Additionally, longitudinal research with a larger sample size is needed to test the effectiveness of jazz dance as a strategy for improving balance, cognition, and mood.

The effect of a senior jazz dance class on static balance in healthy women over 50 years of age: a pilot study.

The purpose of this pilot study is to assess the impact of a senior jazz dance class on static balance for healthy women over 50 years of age using the NeuroCom Smart Balance Master System (Balance Master). A total of 12 healthy women aged 54-88 years completed a 15-week jazz dance class which they attended 1 time per week for 90 min per class. Balance data were collected using the Sensory Organization Test (SOT) at baseline (pre), at 7 weeks (mid), and after 15 weeks (post). An equilibrium score measuring postural sway was calculated for each of six different conditions. The composite equilibrium score (all six conditions integrated to 1 score) was used as an overall measure of balance. Repeated measures analyses of variance (ANOVAs) were used to compare the means of each participant's SOT composite equilibrium score in addition to the equilibrium score for each individual condition (1-6) across the 3 time points (pre, mid, post). There was a statistically significant difference among the means, p < .0005. Pairwise (Bonferroni) post hoc analyses revealed the following statistically significant findings for SOT composite equilibrium scores for the pre (67.33 + 10.43), mid (75.25 + 6.97), and post (79.00 + 4.97) measurements: premid (p = .008); prepost (p < .0005); midpost (p = .033). In addition, correlational statistics were used to determine any relationship between SOT scores and age. Results indicated that administration of a 15-week jazz dance class 1 time per week was beneficial in improving static balance as measured by the Balance Master SOT.

Overweight and obesity in nurses, advanced practice nurses, and nurse educators.

PURPOSE: To quantify the incidence of overweight and obesity in nursing professionals and assess nurses' knowledge of obesity and associated health risks. DATA SOURCES: A mailed survey to 4980 randomly selected registered nurses from one state in each of six geographic regions. Response rate was 15.5% (n= 760). Descriptive statistics were calculated for continuous variables; categorical variables were summarized with frequency counts. RESULTS: The grand mean body mass index (BMI) of nurses surveyed was 27.2. Almost 54% were overweight or obese. Fifty-three percent of these nurses report that they are overweight but lack the motivation to make lifestyle changes. Forty percent are unable to lose weight despite healthy diet and exercise habits. Only 26% of respondents use BMI to make clinical judgments of overweight and obesity. Although 93% of nurses acknowledge that overweight and obesity are diagnoses requiring intervention, 76% do not pursue the topic with overweight and obese patients. DISCUSSION: Many nurses provide weight-related health information to the public. These data suggest that they may benefit from continuing education on obesity and its risks. Because 76% of nurses do not pursue the topic of obesity with patients, they may benefit from education on pursuing sensitive topics during a professional encounter. Nurse practitioners may play a key role in the education of both patients and registered nurses.

Promising new causal explanations for obesity and obesity-related diseases.

Current explanations for obesity center around a predisposition in genotype and phenotype, possibly triggered by an inflammatory process or event, and exacerbated by environmental and psychological factors. It is likely that a variety of physiologic factors may act in combination to produce clinical obesity. Leptin resistance may be an important neurochemical cause of obesity; elevated leptin levels have been correlated with weight gain over extended time periods. Genetic studies support the postulate that a gene originating with our cave-dwelling ancestors, critical to survival when food was scare, has evolved into a trigger for obesity and related diseases. A variety of biochemical markers are prevalent in obesity and obesity-linked disease states. C-reactive protein, interleukin-6, and others are elevated in obesity, supporting the hypothesis that inflammation plays a role in the condition. Tumor necrosis factor-alpha is overexpressed in obesity and diabetes, suggesting that it may be part of the link between the 2 conditions.

Assessment and differential diagnosis of abdominal pain.

Abdominal pain as a chief complaint can present a significant diagnostic challenge in the primary care setting. It is incumbent upon the primary care provider to have a thorough understanding of the many potential causes of abdominal pain, as well as a methodical, comprehensive, yet concise approach to its assessment.

Pediatric systemic lupus erythematosus: management issues in primary practice.

PURPOSE: To provide nurse practitioners (NPs) with an update on pediatric systemic lupus erythematosus (SLE) with an emphasis on management considerations for primary care practitioners. DATA SOURCES: An extensive literature review was conducted using both Medline and CINAHL databases. Research articles reflecting the most compelling findings were included in this review. CONCLUSIONS: NPs who care for children with SLE may be able to prevent or delay the morbidities associated with this disease and its treatments, if they keep abreast of the new information evolving in this realm of rheumatologic diseases. IMPLICATIONS FOR PRACTICE: As more is learned about pediatric SLE, better treatments have evolved such that the survival rates have increased. The primary care of pediatric SLE patients that is focused on preventing or delaying SLE morbidities may help to restore, maintain, or improve the quality of life for these patients.

Primary care management of patients following bariatric surgery.

PURPOSE: To evaluate the nutritional, psychosocial, and other primary care issues faced by nurse practitioners (NPs) and their patients in the long-term management of the increasing population of patients who have had bariatric surgery. DATA SOURCES: An extensive review of the literature provides the foundation for development of assessment and management strategies highlighted in a case study. CONCLUSIONS: Management of the patient after bariatric surgery does not end with successful surgical healing. Numerous long-term implications, including significant psychosocial and nutritional issues, require the informed attention of the primary care provider for the rest of the life span. IMPLICATIONS FOR PRACTICE: Each year an increasing number of obese patients pursue a surgical solution to obesity, up to an estimated 100,000 in 2004. Numerous long-term health implications are specific to this population. NPs can improve the quality of primary care to these patients by being informed regarding the different procedures and their impact on physiologic phenomena, and the psychosocial issues inherent to extreme weight loss.

A comparison of student outcomes following problem-based learning instruction versus traditional lecture learning in a graduate pharmacology course.

PURPOSE: To determine if there would be a difference in students' performance and level of satisfaction when taught pharmacology in a problem-based learning format as compared to traditional lecture format. DATA SOURCES: Control (n = 12) and experimental (n = 10) group means for middle-of-term examinations, final examinations, end-of-course numerical averages, and numerical scores of satisfaction were analyzed with a t test for statistically significant differences. CONCLUSIONS: There was no significant difference between groups for any of the items measured, suggesting that problem-based learning and traditional lecture format may be equally effective course delivery methods. Replication with a larger sample is recommended. IMPLICATIONS: The small sample size precludes generalizing results to the entire population, but outcomes of this pilot study suggest that problem-based learning may be at least as effective as traditional lecture and should be explored in larger studies.

Acute care of the elderly units: a positive outcomes case study.

Acute care of the elderly patient is a specialty area of practice. The elderly have a spectrum of needs including physiologic, psychosocial, functional, and financial needs that will alter their response to physiologic illness and the acute care experience in general. Acute care units specifically designed to meet the needs of elderly adults can have a dramatic impact on recovery from acute illness and long-term, postdischarge outcomes. This report describes the experience of one elderly patient hospitalized for the treatment of pneumonia. This elderly patient manifested a response to the acute care experience that was typical of his age cohort, including confusion and incontinence. Subsequent transfer to an acute care for the elderly unit maximized this patient's recovery and postdischarge placement.