Journal of the American Academy of Nurse Practitioners

PURPOSE: To provide evidence-based information that will guide nurse practitioners in instituting the most current cervical cancer screening recommendations. DATA SOURCES: A literature search covering the years 2006 to the present conducted through Medline, CINAHL, and OVID. CONCLUSIONS: Human papillomavirus (HPV) cervical infections are highly prevalent among females under 21 years, yet this age group has a low incidence of cervical cancer...

PURPOSE: This integrative review identifies and examines research literature focused on physical activity promotion provided in primary care settings to older adult patients in order to evaluate the effectiveness of provider-delivered interventions on elders short- and long-term activity levels. DATA RESOURCES: A comprehensive review of original research published in English from all countries through May 2010 was performed. Relevant literature was identified through MEDLINE, CINAHL, and ProQuest on-line databases...

PURPOSE: The purpose of this study was to determine the prevalence of undiagnosed hearing loss in adults in two busy primary care rural health centers. DATA SOURCES: Using Otoacoustic Emissions (OAE) testing, participants were screened for hearing loss by trained personnel. Participants were those who presented to the primary care provider with complaints other than hearing loss or ear problems. CONCLUSION: Of the 86 participants, 48.8% were found to have failed OAE testing, indicating some type of undiagnosed hearing loss...

PURPOSE: To provide primary care providers with a general overview of the genetic disorder tuberous sclerosis complex (TSC). By understanding the disease mechanism for this genetic condition, providers can effectively care for TSC patients and properly educate families who are affected by TSC. The article also describes the multi-system clinical presentation of the disease to assist primary care providers with an early diagnosis. DATA RESOURCES: Research articles and evidence-based guidelines found through MEDLINE and the World Wide Web...

PURPOSE: To evaluate the use of FRAX® (Fracture risk assessment tool) for changes in bone health risk factors and treatment decision-making. DATA SOURCES: A convenience sample of seventeen women, 50 years and older, English-speaking, generally healthy, with the ability to perform weight-bearing exercise, presenting for a DXA scan in a Midwestern city between August 2009 and November 2009, and not already being treated for osteoporosis or osteopenia. Self-administered diet and exercise questionnaires were completed by participants, followed by individual counseling related to FRAX® absolute risk and NOF guidelines...

PURPOSE: The purpose of the study is to examine what sensory system predominates to maintain balance (e.g., visual, vestibular, and somatosensory) among people in their twenties and thirties. DATA SOURCES: A subset of individuals from a larger descriptive cross-sectional study was assessed. A sample of 194 (males = 28%, females = 72%) young adults in the second and third decades of life had anthropometric measurements (height, weight, waist circumference, hip circumference, and leg length) taken and body mass index and waist-to-hip ratio were calculated...

PURPOSE: To examine the relationships between lifestyle, health behaviors, and health status for underserved adults. DATA SOURCES: A convenience sample of 84 adults responded to a questionnaire on lifestyle, health behaviors, health indices, and health status. Health status was measured by the 12-Item Short-Form Health Survey (SF-12). CONCLUSIONS: The majority of the sample was white, female, ranged in age from 19 to 64 years, and had an annual income range of $0-$25,000...

PURPOSE: Nurse practitioners (NPs) in Ontario, Canada, experience many barriers to practice that negatively influence their ability to increase access to comprehensive primary healthcare services. A NP-Led Clinic Model has helped to overcome many of the barriers and has had a real impact on access to care. DATA SOURCES: Legislative and regulatory documents from the government of Ontario were reviewed. Reflection upon the barriers to NP practice in Ontario and the positive impact of the new model of care is presented...

PURPOSE: To describe the process of designing a new progressive nurse practitioner student clinical evaluation tool based on competencies. DATA SOURCES: Selected research articles and professional organization published guidelines. CONCLUSIONS: Evaluation of nurse practitioner students' clinical performance is an important and often complex responsibility of faculty. The clinical evaluation tool should reflect the changing expectations associated with particular courses across the curriculum and be based on the competencies identified by the National Organization of Nurse Practitioner Faculties...

PURPOSE: To examine a case of nonalcoholic fatty liver disease (NAFLD) and review the incidence, pathophysiology, appropriate diagnostic procedures and imaging, clinical considerations, and treatment options. DATA SOURCES: Findings from the history, physical examination, and diagnostic testing of a 39-year-old man with elevated liver enzymes presenting to the hepatology clinic; a search of evidence-based literature in the PubMed and CINAHL database with the terms "fatty liver,"nonalcoholic fatty liver disease," and "nonalcoholic steatohepatitis...

PURPOSE: To provide information on current evidence-based clinical management of venous thromboembolism (VTE) for nurse practitioners working for older adults in long-term care facilities. METHODS AND DATA RESOURCES: A systematic review and summary using current clinical guidelines and reliable clinical research studies: American Medical Directors Association, American College of Chest Physicians, Medline, PubMed, Refworks, and CINAHL. CONCLUSIONS: The management of VTE focuses on a comprehensive approach including acute and long-term pharmacologic approach, surgical and mechanical approach, prophylaxis of recurrent VTE, maintaining INR, and monitoring lab values...

PURPOSE: The purpose of this article is to provide, in a concise format, information about evidence-based decision-making strategies and support tools available for appropriate antimicrobial prescribing. A brief review of the current status of antimicrobial resistance, prescribing practices of nurse practitioners (NPs), and factors associated with inappropriate prescribing practices is included to further explicate the need for such support tools. DATA SOURCES: Journal articles, Internet websites, reference texts...

PURPOSE: To evaluate the role of counseling for patients undergoing screening for type 2 herpes simplex virus (HSV-2). Using pre- and post-screening questionnaires, we evaluated correlations between demographic factors, measures of self-efficacy and follow-through with the screening test, and willingness to take antiviral medication and share results with sexual partners. DATA SOURCES: Subjects (N= 115) were recruited as part of usual care at a private, urban family practice...

PURPOSE: Homelessness is a growing public health and social concern in our society. The purpose of this qualitative descriptive study was to gain insight into the unique experiences of nurse practitioners (NPs) who provide health care to the homeless. DATA SOURCES: Audio-taped, open-ended interviews were conducted with nine NPs from southeast and northeast Wisconsin. CONCLUSIONS: Five themes and 13 subthemes emerged from the NPs' accounts...

PURPOSE: The Provus Discrepancy Model is applied to suggest revisions to consensus curriculum and regulatory guidelines for nurse practitioners (NPs) seeking prescriptive authority. DATA SOURCE: Literature review related to prescribing policy, regulation, NP role competencies, and pharmacologic trends. CONCLUSION: The document "Curriculum Guidelines and Regulatory Criteria for Family Nurse Practitioners Seeking Prescriptive Authority to Manage Pharmacotherapeutics in Primary Care" should be examined for relevance to current prescribing practice, scope, and influences that emerged since publication...

PURPOSE: To describe key points in the diagnosis and treatment of and patient education for actinic keratosis. DATA SOURCES: Selected review of scientific literature. CONCLUSIONS: Actinic keratosis is a common skin lesion seen in primary care that results from exposure to ultraviolet light. Accurate and timely diagnosis is essential to prevent progression to squamous cell carcinoma. IMPLICATIONS FOR PRACTICE: Nurse practitioners can make a positive impact on patients' health by promoting treatment adherence and follow-up in primary care...

PURPOSE: To present an illustrative case study of a patient with spontaneous intracranial hypotension (SIH) and to increase awareness of this condition among nurse practitioners (NPs). DATA SOURCES: A literature search was conducted, and deidentified patient information forms the basis of this presentation. The authors' experience and appropriate images enhance the presentation of the case study. CONCLUSIONS: SIH is a condition that typically occurs without a traumatic event, although it can be associated with minor trauma...

PURPOSE: To provide an in-depth synthesis of the literature on polymyalgia rheumatic (PMR) and giant cell arteritis (GCA) that will assist the primary care nurse practitioner (NP) in recognizing the variety of symptom presentations, accurately evaluating laboratory data, developing a plan of care that includes current treatment guidelines, and adroitly managing patients for improved outcomes. DATA SOURCES: A thorough search of the literature was conducted including MEDLINE, CIHAHL, and PubMed encompassing the decades from the 1970s to the present...

PURPOSE: To discuss the role of nurse practitioners (NPs) in motivating and guiding patients with type 2 diabetes to self-manage their disease, achieve their treatment goals, and have a more positive treatment experience. DATA SOURCES: Personal experience; clinical studies. CONCLUSIONS: NPs play a key role in educating patients and helping them understand the need for, and benefits of, improved diabetes control. Yet, achieving improved diabetes control goes far beyond sharing information...

PURPOSE: Failure to achieve and maintain glycemic targets in patients with type 2 diabetes (T2D) is a major clinical issue. Effectively combating the barriers that postpone timely intensification, and educating patients on available treatment options, are key roles of the nurse practitioner. This article summarizes practical considerations in the management of T2D at this stage. DATA SOURCES: Published guidelines for the management of T2D, primary and review articles, and Food and Drug Administration (FDA) prescribing information...