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Bi-Weekly Follow-Up of Adult Patients Diagnosed With Schizophrenia to Increase Treatment Adherence: A Scoping Review
Get PDFPurpose/Background
Schizophrenia is a complex psychiatric disorder that can significantly affect a patient’s psychological state. Because of this, medication nonadherence is reported as one of the most common causes of relapse and rehospitalization in patients diagnosed with schizophrenia. Although long-acting injectable (LAI) antipsychotics can help provide more continuous treatment, they do not address other factors that affect treatment adherence. This scoping review will evaluate existing literature to assess if a multimodal approach, such as increased patient follow-ups in addition to scheduled, current-practice LAI treatment and management, may increase treatment adherence in adult patients diagnosed with schizophrenia.
Methods
A database search was conducted using CINAHL, PubMed Clinical Queries, Cochrane Library, Sage, and Medline Ovid from the dates 2013-2022. Articles were chosen if they were based on scientific research involving human subjects and if they provided full free-text access. Both quantitative and observational studies were used to provide alternate perspectives on medication interventions and health outcomes.
Results
After conducting a systematic database search, 117 articles were selected, and after applying exclusion criteria, ten articles were chosen to be included in this scoping review. The articles illustrated that LAIs decrease hospital length of stay and increase treatment adherence, but multimodal approaches were not adequately examined to determine their effectiveness.
Implications for Practice
The results of this scoping review support that LAIs are generally superior to oral antipsychotics in the treatment of adult patients with schizophrenia. However, there is not enough literature to determine the effectiveness of bi-weekly follow-ups in combination with LAI treatment to increase treatment adherence in adults diagnosed with schizophrenia. The implementation of bi-weekly follow-ups for schizophrenic patients still holds promise, but more studies are required to evaluate the effectiveness of LAI treatments and accompanying interventions to increase treatment adherence
Improved Bonding & Maternal Self-Efficacy in the NICU: A Scoping Review
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Mothers of infants admitted into the neonatal intensive care unit (NICU) are at risk for developing anxiety, depression, and post traumatic stress disorder (PTSD) related to their child’s hospitalization which impedes the mother-infant bonding and attachment process. Research shows that children of mothers suffering from these issues are more likely to develop their own behavioral, emotional and cognitive problems later in life. The purpose of this scoping review is to analyze the literature regarding methods to improve bonding and attachment between NICU patients and their mothers to improve long-term outcomes for the whole family.
Methods
The authors conducted a literature review from October 2020 to November 2022 using several qualified databases. After analyzing articles for relevancy and inclusion criteria, the remaining articles were screened for validity and reliability via a rapid critical appraisal tool to yield the 10 articles used for this scoping review. The levels of evidence and outcomes of each article were synthesized with a goal to determine which interventions can improve bonding and maternal self-efficacy in the NICU.
Results
Individualized education and family-centered care leads to positive outcomes that benefit both NICU patients and mothers. Individualized education was shown to increase confidence and improve mental health in NICU mothers. Specifically, increased maternal confidence truly makes the difference in the involvement of care for the patient and positively motivates the mother to prepare for discharge home.
Implications for Nursing Practice
When NICU mothers are given individualized education, it increases their self-efficacy, which strengthens the bond between the mother and her child. The authors hypothesize that a protocol of specific education and interventions for mothers would foster an environment of family centered care with the goal of increased family involvement, mother-infant attachment, and potentially decreased length of hospital stay
Patient Compliance with Colorectal Cancer Screening: A Scoping Review
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Colorectal cancer (CRC) is a leading cause of cancer deaths for women and men. Routine screening based on current national guidelines can decrease morbidity and mortality. Unfortunately, patient compliance with CRC screening remains low. This scoping review will evaluate the literature and examine the association between colorectal cancer screening modality and patient compliance.
Methods
Individual searches within PubMed, EBSCO, and Medline were completed using MeSh with the following key words: colorectal cancer screening, patient compliance, stool-based screening, direct visualization, and others. A literature review was completed for 10 critically appraised articles published between 2010 and 2020. The association of the modality of CRC screening, patient compliance, and patient education was assessed and compared. A summary evaluation table was composed to determine the associations between CRC screening and patient compliance.
Results
The articles included consisted of four systematic reviews/meta-analysis, three randomized controlled trials, one controlled trial without randomization, and two cohort/case-control studies. Of the study sample (N=10), all but one demonstrated statistically significant findings concerning patient education, CRC screening, and compliance. Noninvasive stool-based studies have a higher patient compliance rate than direct visualization tests. Direct visualization tests offer same-session detection and biopsy with polyp removal leading to decreased mortality.
Implications for Nursing Practice
Results provided in this scoping review highlight the importance of colorectal cancer screening in decreasing mortality. Patient compliance can be improved with comprehensive education, discussing the risks and benefits of screenings, and evaluating individual health beliefs or fears. Patients still hesitant with direct visualization tests should begin with noninvasive studies. All positive screenings from stool-based screenings require follow-up with a colonoscopy
Effectiveness of Perioperative Ketorolac versus Opioids: A Scoping Review
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Purpose
The purpose of this project will compare the effectiveness of ketorolac over opioids alone for pain management of patients 72 hours postoperatively.
Background
In recent years, there has been overwhelming evidence of opioid abuse and its adverse effects on patients’ lives. To combat this, significant attention has been paid to multimodal analgesia throughout the perioperative period to decrease patients’ exposure to opioids. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ketorolac, are being administered intraoperatively to reduce the need for opioids in patients\u27 post-surgical procedures.
Methods
A literature review was done on articles that evaluated perioperative adult human patients undergoing elective general anesthesia procedures in which the use of intraoperative NSAIDs, without narcotics, is justified. Eligibility criteria includes full-text, peer-reviewed, English articles within the last ten years that includes international studies. Search databases include a Boolean search of CINAHL, PubMed, Cochrane Library, and Google Scholar. Data abstracted are pain adjuncts, hemodynamic variables, pain scales, and patient satisfaction. Boolean operators used: “ketorolac” OR toradol AND “multimodal” AND “opioid” OR “narcotic” AND “intraoperative” OR “perioperative.”
Results
Conclusions were drawn from eight research articles which were appraised for the scoping review. The review suggests that ketorolac is as effective or superior to opioid medication for perioperative pain relief. The results also suggest that ketorolac decreases perioperative opioid consumption. Finally, ketorolac is no better or worse than opioids when judged on clinical healing time, side effects, and duration of analgesia.
Implications for Nursing Practice
This scoping review provides insight for the utilization of non-opioid analgesia for control of pain management postoperatively for surgical patients. With opioids being highly abused and having unwanted side effects, our review highlights evidence of reducing the use of opioids along with reducing postoperative pain and undesired side effects. Anesthesia providers should enhance their education on the benefits of using ketorolac intraoperatively versus the administration of opioids in the operating room
Impact of Opioid-Free Anesthesia on Postoperative Nausea & Vomiting: A Scoping Review
Get PDFPurpose The purpose of this DNP Scoping Review is to compare the current literature regarding the incidence of postoperative nausea and vomiting (PONV) in adult patients who underwent general anesthesia when opioids are used intraoperatively versus a multimodal non-opioid-based intraoperative general anesthetic plan Specific Aims: Incidence of postoperative nausea & vomiting Postoperative rescue antiemetic administration Length of stay in postoperative anesthesia care unit (PACU) Incidence of intraoperative adverse event
Positioning and Feeding Techniques Effective in Improving Sensorimotor Functions in Infants with Cleft Palate
Get PDFOrofacial clefts are the second most common type of birth defect in the United States and are continuing to grow each year (Nasreddine et al., 2021). Based on the National Birth Defects Prevention Network annual report in 2014, 1 in 1,700 babies were born in the United States with a cleft palate (Mai CT et al., 2019). While there are different types of orofacial clefts, for this research the term cleft palate will be used to determine appropriate interventions within the scope of occupational therapy, such as positioning, bottle modifications, and sensorimotor techniques. The impact of this birth defect can cause feeding challenges, auditory deficits, speech deficits, and oral-motor development which may require extensive support from caregivers, nurses, physicians, and therapists, among others (Redford-Badwal et al., 2003; Nahai FR, et al., 2005). Based on our findings, we recommend supine positioning during sleeping and side-lying with caution. Our feeding recommendations include oral stimulation, sensorimotor-based feeding techniques, as well as bottle modifications such as squeezable bottles, rigid bottles, larger nipple holes, and paladai feeding
Mini-Mental State Examination (MMSE) as Predictor of On-Road Driving Ability
Get PDFStudents met with a community OT practitioner who specializes in driving rehabilitation. The community practitioner identified a potential gap in referrals for individuals with cognitive impairment and on-road driving assessments. Due to the scarcity of driving rehabilitation practitioners, it is important to provide effective evaluation and interview. By identifying clients who are past the potential for safe on-road driving performance due to their score on a status examination, practitioners can reach more clients in a more efficacious manner. There exists a need for a more accurate screening measure to predict on road driving performance in individuals with cognitive impairment. The current most popular cognitive status examination used by physicians and neurologists is the Mini Mental Status Examination (MMSE). Therefore, our research question focuses on whether the MMSE can be used as a quality predictive measure for on-road performance in individuals with cognitive impairment. The databases were selected through the UTHSC library. These databases were associated with allied health, occupational therapy, mental health, and etc. Although research was mixed as to whether the MMSE was an accurate predictor of on-road driving performance, we conclude that the MMSE can be a valid quick screener for on-road driving performance. In order to provide best practice, it should not be used as a sole predictor of on-road driving abilities. Based upon conflicting research findings, we recommend using the MMSE with cautio
The Interaction Between Host G3BP and Viral Nucleocapsid Protein Regulates SARS-CoV-2 Replication
Get PDFG3BP1/2 are RNA-binding proteins that promote condensation to form stress granules in response to various cellular stresses, including viral infection. G3BP1/2 are prominent interactors of the nucleocapsid (N) protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the functional consequences of the G3BP-N interaction in the context of viral infection have remained unclear. Here we used structural and biochemical analyses to define the residues required for G3BP1-N interaction, followed by structure-guided mutagenesis of G3BP1 and N to selectively disrupt their interaction. We found that mutation of N-F17 led to selective loss of interaction with G3BP1 and consequent failure of the N protein to disrupt stress granule assembly. Introduction of SARS-CoV-2 bearing an F17A mutation in an in vivo hamster model resulted in significant decreases in viral replication, symptom severity, and pathology, suggesting that the G3BP1-N interaction promotes viral replication by suppressing the ability of G3BP1 to form stress granules
Improving Estimation of Coronary Artery Disease Risk Using Haptoglobin Genotyping
Get PDFAtherosclerotic cardiovascular disease (ASCVD) continues to be the leading cause of death worldwide. While several risk factors contributing to disease progression are well-known, pitfalls and limitations exist for estimating if or when an individual will develop the disease. Coronary artery disease (CAD), a subtype of ASCVD, causes myocardial infarction, contributing to significant morbidity and mortality. Current ASCVD risk estimator calculators lack comprehensiveness and do not include genetic or social determinants of health information, which are known to affect ASCVD risk.
Haptoglobin (Hp) genotype also influences CAD risk. Hp is a protein that binds free hemoglobin released from physiologic or pathologic erythrocyte turnover or destruction. If unbound, free hemoglobin causes oxidative stress, increasing the risk of atherosclerosis. The Hp genotype determines the haptoglobin protein’s effectiveness in entering tissues to bind the free hemoglobin. The three main Hp genotypes, Hp 1-1, Hp 2-1, and Hp 2-2, and their corresponding proteins, range from efficient to least efficient antioxidant, thereby influencing atherosclerosis risk. Hp 2-2 genotype has been shown to increase cardiovascular disease five times compared to the Hp 1-1 genotype in individuals with diabetes. Previous studies have dichotomized glycemia into diabetic and nondiabetic, not accounting for the spectrum of abnormal glucose and oxidative stress that exists with prediabetes and insulin resistance.
This dissertation aims to improve understanding of ASCVD risk estimation to describe how Hp genotyping affects CAD risk. First, a conceptual model that describes a more comprehensive ASCVD risk assessment approach than is currently used in clinical practice is described. This conceptual model depicts how adding social risk factors and Hp genotyping detects additional sources of increased oxidative stress, increasing ASCVD risk cumulatively. Next, a study was done that derived ASCVD risk scores from historical health records to determine the association between ASCVD risk score and CAD and carotid intima-media thickness (CIMT) in a sample of individuals with prediabetes. This study demonstrated that ASCVD risk score and category were not associated with a history of CAD but were associated and moderately correlated with CIMT measurements. Individuals with higher ASCVD risk scores were older and demonstrated higher systolic blood pressure and CIMT measurements. This study adds to existing literature that available ASCVD risk calculators may be suboptimal at estimating CAD risk, at least in some populations. Additionally, CIMT provides physiologic measurements to diagnose and track ASCVD, which is more clinically useful than ASCVD risk scores. Finally, a case-control study demonstrated Hp 2-2 genotype had four times higher odds of CAD compared to the Hp 1-1 genotype in individuals with prediabetes, supporting the compounded CAD risk of insulin resistance and abnormal glycemia with the Hp 2-2 genotype. Future research can build on these findings to include studies with larger numbers of participants and trials to see the effects of genotype-specific interventions on CAD risk and CIMT measurements
Hepatitis C Virus Screening Strategies to Improve Early Identification and Treatment: A Scoping Review
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Hepatitis C virus (HCV) is the most common bloodborne infection in the United States (Ludden et al., 2022). Sadly, over half of the individuals living with chronic HCV are unaware of their condition (Halket et al., 2022). Due to rising numbers, HCV screening guidelines have been updated to recommend that every adult be screened at least once (Patel et al, 2021). Despite these guidelines, screening rates remain low. This scoping review aims to examine current research on HCV screening and strategies to improve early diagnosis and treatment.
Methods
This review began with a literature search using CINAHL and PubMed and the key phrases hepatitis C, screening, birth cohort, CDC, electronic medical record (EMR), and lifestyle risk. Inclusion criteria were publication within the last five years, English language, and full-text availability. Seven of the 28 articles meeting this criteria were selected based on their applicability, high-quality, and rigor. Specific data points were abstracted from these articles and compiled in an Excel spreadsheet.
Results
Three studies that evaluated the effectiveness of universal screening versus risk and/or birth cohort screening found that universal screening resulted in higher screening rates. EMR interventions based on risk and/or birth cohort were evaluated in six of the studies, with all six reporting increased screening rates. Additionally, one study found that screening rates increased when EMR-based interventions were paired with provider education.
Implications for Nursing Practice
The results of this review suggest that application of universal screening and the incorporation of EMR-based interventions lead to an appreciable increase in HCV screening and diagnosis, but studies that implement these interventions based on universal screening guidelines are needed. Most importantly, this review revealed that healthcare providers and patients need education on current screening guidelines, testing, and treatment so HCV can be diagnosed and treated early