Search

Background: New treatment options for cutaneous melanomas with a poor prognosis have been available since 2011, including immune therapies and targeted drugs. Randomized controlled trials have demonstrated that these treatments improve survival, but no population-level studies have been available to date. Methods: All patients in the database of the Center for Cancer Registry Data (Zentrum für Krebsregisterdaten) who had a diagnosis of melanoma (ICD10: C43) in the years 2000 to 2019 were included in the study. The relative five-year survival (5YRS) was calculated for four 5-year periods (2000-04, 2005-09, 2010-14, 2015-19). The data were standardized/stratified according to sex, age group, and UICC stage to correct for differences between regions and over time. Regression models were used to detect statistically significant secular trends. Results: 301 486 individuals were included in the study. The overall 5YRS rose from 93% (2000-04) to 95% (2015-19). The 5YRS in 2015-19 was similar to or greater than that in 2000-04 for all subgroups. The largest rises in 5YRS were between 2010-14 and 2015-19, and specifically in advanced stages: for UICC stage IV tumors, the 5YRS rose from 31% to 36%. There was a significant rising trend across the four time periods (p < 0.001). Conclusion: The survival of melanoma patients has improved over the past 20 years. From 2010-14 to the most recent period, the largest changes were seen in advanced tumor stages. This favorable development coincided with the introduction of new therapies. [ABSTRACT FROM AUTHOR]

Staffing shortages in LTC facilities are a major problem. Studies indicated that very few from the active labor force are willing to spend their productive years in an organization that neither pays well nor provides-good benefits or career advancement opportunity. As the US population composition changes, a new constituency of workers mostly from Mexico, has grown more evident in Texas LTC facilities. However, these workers often are unable to speak or understand English. The purpose of this project was to develop a protocol for teaching non-English speaking Spanish staff adequate amounts of 'nursing home-English' to become more effective (higher retention, more job satisfaction). Eight non-English speaking staff (5 females and 3 males) participated in weekly sessions. All except one had less than 12 years of schooling with an average age of 33. The Oral Proficiency Interview revealed that all staff but one scored in pre-novice category (< 15 English words). Each of 10 sessions introduced 12+ words focusing on emergency issues, illness, organizational directory, unit locations, ASLs, people descriptives, room content, personal items, OSHA terminology, etc. English words were introduced using various media, i.e. tape recordings, flash cards, and phonetic written and oral presentations. Results showed Spanish speaking staff learned an average of 50 words with increased willingness to participate, learn more, and remain on the job longer. Responses by this group defy the misconception that Spanish speakers prefer not to learn English.

In this study contaminant distribution in an operating room is evaluated experimentally to be able to compare different ventilation concepts afterwards. Low-turbulent unidirectional ventilation (LAF) is used in this study. Heated dummies are positioned around the operating table, which release tracer particles that surrogate airborne germs and measured in critical areas for bacteria spread. Measurement results are evaluated and compared in terms of the degree of protection as well as the local air quality index. It is shown that realistic arrangements limit the usage of the degree of protection. Also, low local air quality indices show recirculation areas appearing at the operating table.

PURPOSE: To identify the best screening protocol to prevent neonatal group B streptococcal (GBS) sepsis through literature review. DATA SOURCES: Selected research articles, texts, and Internet sources. CONCLUSIONS: Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and American College of Nurse Midwives (ACNM) have issued guidelines describing methods to identify pregnant women at risk of intrapartum transmission of GBS to their babies. Studies have been conducted to discover the superiority of one prevention method over the other but no consensus has been reached. IMPLICATIONS FOR PRACTICE: Before widely used prevention methods, approximately 8,000 babies each year became infected with GBS; of those, 400 died and many survivors suffered life-long sequelae. Adoption of an appropriate protocol can prevent transmission of GBS from a colonized mother to her infant. Clinicians should implement either universal culture-based or risk factor-based screening guidelines for prenatal diagnosis and intrapartum prophylaxis of GBS disease. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the incidence, assessment, and management of intimate partner violence (IPV) from a cultural perspective emphasizing the values, strengths, and health care needs of African-American women. DATA SOURCES: Review of the published scientific literature, U.S. Bureau of Justice Statistics and the National Crime Victimization Survey (NCVS) supplemented with hypothetical cases. CONCLUSIONS: Violence is a social and public health emergency affecting over 10% of the population during their lives and 22% of women who are physically assaulted by an intimate. Roughly 3 million to 4.4 million women report being battered annually, although this is a low estimate. Neither gender nor age nor sexual orientation protects one from IPV. Violent crime causes 2.2 million known injuries with a huge cost in hospital days and other expenses. IMPLICATIONS FOR PRACTICE: Women often hesitate to report violence; health care professionals detect as few as 5% of battered women. Women suffer for months and years before accurate diagnosis. Clinicians need to be vigilant in case finding, education, prevention, and treatment. Cultural differences in values and beliefs, and behavioral norms influence evaluation, treatment, and referral. [ABSTRACT FROM AUTHOR]

PURPOSE: To review the pathophysiology of asthma, present a case study, and provide management strategies for treating this common, yet complex disorder in children and adults. DATA SOURCES: Selected clinical guidelines, clinical articles, and research studies. CONCLUSIONS: Asthma is a chronic inflammatory airway disorder with acute exacerbations that currently affects approximately 14 million-15 million children and adults in the United States. Costs for asthma are staggering and nurse practitioners (NPs) are frequently presented with management decisions for the acute treatment and chronic management of this disorder. Disparities exist with the occurrence of asthma between race and gender. Additionally, there is an increased incidence in acute exacerbations resulting from poor long-term control and follow-up care among the socioeconomically disadvantaged. IMPLICATIONS FOR PRACTICE: Standards of care, along with new and emerging treatment strategies, guide NPs in providing the most comprehensive care to those affected with this chronic disorder. Knowledge about the pathophysiology of asthma and correlated to the case presentation enhances understanding treatment strategies for NPs who are often faced with providing care for patients with this chronic disorder that may sometimes present in an acute exacerbation. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the clinical syndrome called dementia with Lewy bodies (DLB) and highlight its common and unique characteristics with respect to diagnosis and management. DATA SOURCES: Review of the scientific literature including psychiatric literature, reports of clinical trials, and clinical practice guidelines. CONCLUSIONS: DLB is a clinical and histopathologic disease, which is second only to Alzheimer's disease (AD) as a cause of dementia in older adults. The clinical syndrome of DLB includes cognitive and motor deterioration reminiscent of symptoms associated with AD and Parkinson's disease (PD) respectively. IMPLICATIONS FOR PRACTICE: The late life intersection of cognitive and motor symptoms can present significant challenges in the primary care setting. Recognizing key features of common neurodegenerative disorders is essential to accurately diagnosing and appropriately treating the growing population of older adults who suffer from AD, PD, and DLB. [ABSTRACT FROM AUTHOR]

PURPOSE: To review the epidemiology and clinical features of migraine and to discuss the use of the 5-HT1B/1D agonists (triptans) in the treatment of moderate to severe migraine. DATA SOURCES: A Medline search was conducted for relevant recent articles on migraine and the efficacy and safety of the triptans. CONCLUSIONS: With the advent of a standardized classification system for headache to simplify migraine diagnosis, new approaches to treatment, and effective new therapies, such as the triptans, many patients have obtained significant relief from the pain and disability associated with migraine. IMPLICATIONS FOR PRACTICE: The key to successful migraine management is to provide the most effective treatment at the earliest possible time. Under the step-care approach to migraine management, the mildest and most conservative treatment was recommended as a first step, without regard for the degree of the patient's pain or disability. This approach has been replaced by stratified care, in which migraine management is based on the severity of the patient's pain and disability. Under the stratified approach, patients with moderate or severe migraine would be prescribed effective migraine-specific drugs, such as the triptans, as first-line therapy. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe herpes zoster ophthalmicus in relation to the anatomy, pathophysiology, course, diagnostic considerations, and management for the primary care provider. DATA SOURCES: Actual case study supplemented with an extensive review of current scientific and psychosocial literature. CONCLUSIONS: Herpes zoster ophthalmicus (HZO) is an extension of a herpes zoster (HZ) infection involving the fifth cranial (trigeminal) nerve, which results from the reactivation of a latent varicella virus among individuals who had contracted a varicella infection sometime within their lifespan. IMPLICATIONS FOR PRACTICE: Due to the vague presenting symptomology of HZO, many patients may be misdiagnosed lessening the chance for prompt diagnosis and therapeutic intervention. Educational awareness, listening to psychosocial concerns of the patients, and immediate referral can decrease potential chronic side effects of the disorder. [ABSTRACT FROM AUTHOR]

PURPOSE: To inform the nurse practitioner of the common causes of chronic cough, to educate how each cause can be identified, and to suggest treatment options for the most common causes. DATA SOURCE: Selected research and review articles from professional journals. CONCLUSION: Chronic cough is a common presenting complaint in the primary care setting. Although at first the symptom may seem simple, the etiology, diagnosis, and treatment of chronic cough can be challenging. Furthermore, without proper identification of the cause, effective treatment most likely will not be obtained. IMPLICATIONS FOR PRACTICE: By familiarizing oneself with this topic, nurse practitioners will feel confident in treating chronic cough. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the classical features of Marfan's syndrome to help nurse practitioners (NPs) diagnose it in the early stages of progression and perhaps prevent many of its deleterious effects. DATA SOURCES: Selected research-based articles in the scientific literature and classic medical texts. CONCLUSIONS: The cause of Marfan's syndrome is unknown, but studies have linked it with a disorder of chromosome 15. It is a degenerative connective tissue disorder that affects the musculoskeletal, ocular, integumentary, respiratory, and neurologic systems. The most lethal effect is on the cardiovascular system causing dissecting aortic aneurysms. IMPLICATIONS FOR PRACTICE: Early diagnosis is essential for a positive course of management. Marfan's syndrome can have fatal consequences and is often underdiagnosed and misdiagnosed. [ABSTRACT FROM AUTHOR]

PURPOSE: To review the literature related to health promotion during the perimenopausal years and suggest methods for integrating those changes into the lifestyles of women in primary care. DATA SOURCES: Selected scientific literature and guidelines for exercise programs. CONCLUSIONS: The transition into perimenopause presents an opportunity for addressing health promotion issues, such as diet and exercise. As a woman senses perimenopausal changes, health awareness emerges. Such personal insight motivates the woman to implement lifestyle changes. IMPLICATIONS FOR PRACTICE: Considering the average women will spend approximately one third of her life past menopause, a concerted effort is needed to ensure her well-being. Diet and exercise represent two modifiable areas of concern for perimenopausal women. Dietary selections of phytoestrogens, calcium, fiber and fat along with exercises plans are relatively simple interventions to begin the process of change. [ABSTRACT FROM AUTHOR]

PurposeTo provide an overview of current diagnostic protocols of Alzheimer's disease (AD), screening techniques, tests, and a review of standard and new treatments.Data SourcesSelected articles from the scientific literature, online sources, and standard texts were examined.ConclusionsStandard tools, such as the Geriatric Depression Scale, the Mini Mental State Evaluation, and the 7-Minute Screen, are useful in the primary care setting for screening elderly patients. Other tools, such as the Clinical Dementia Rating (CDR) and the Global Deterioration Scale, are useful for staging and monitoring progression of disease and response to treatment. Clinical diagnostic testing is still in developmental stages, but the hope is to have a reliable and objective diagnostic tool in order to diagnose AD in the earliest stages.Implications for PracticeThe diagnosis and treatment of AD is becoming a more frequent challenge in the primary care office. Clinicians must keep abreast of the rapid changes in new technologies in order to make informed diagnostic and therapeutic decisions. [ABSTRACT FROM AUTHOR]

PurposeTo review the literature on and discuss the role of the primary care provider in assessing and managing overweight children before they become obese.Data SourcesSelected research, national guidelines and recommendations, and the professional experience of the authors.ConclusionsThe focus of primary care involves early detection and family interventions that are designed for lifestyle modifications, specifically for improved nutrition and an increase in regular physical activity, to achieve optimal child health. Early identification and management of children who exceed a healthy weight for height, gender, and age will prevent the increasing incidence of pediatric obesity. Early prevention and management of pediatric overweight and obesity will also decrease the potential for associated medical and psychosocial problems.Implications For PracticePediatric obesity has risen dramatically in the United States during the last two decades; it is a significant child health problem that is preventable and largely under-diagnosed and under-treated. It is essential to discuss prevention of obesity with parents at every well-child visit; treatment should be initiated when patterns of weight gain exceed established percentiles for increasing height for age and gender. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the components of the female athlete triad, including definitions and clinical criteria for diagnosis, methods of screening, and treatment options. DATA SOURCES: Selected scientific literature; standard diagnostic guidelines. CONCLUSIONS: The female athlete triad is a cascading event consisting of disordered eating, amenorrhea, and osteoporosis. This disorder can occur in any sport but is seen most often in events that emphasize thinness and appearance such as gymnastics, ballet, and diving. It can often go unrecognized and result in irreversible bone loss and possible death. IMPLICATIONS FOR PRACTICE: Primary care nurse practitioners (NPs) may be the first health care professionals encountering these females; they need to recognize the risk factors and institute a multidisciplinary approach to treatment. The treatment team should be composed of the patient, the NP, a dietitian, a psychologist, psychiatrist, or psychiatric nurse specialist, and the patient's family, coaches, and trainers. [ABSTRACT FROM AUTHOR]

PURPOSE: To determine if patients recovering from open heart surgery were able to read and understand written discharge instructions and further to analyze the level of difficulty of standard discharge instructions and consent forms for open heart surgery. DATA SOURCES: After screening for visual acuity and efficiency, literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine test (REALM) and comprehension was tested by a post-test of five questions based on the discharge instructions. Flesch-Kincaid scores were calculated on four sets of standard written discharge instructions and consent forms. CONCLUSIONS: Results from the study indicated that the REALM test was more accurate than the reported grade level and that reading skills are needed to understand and comprehend information needed for post-operative care. The study further substantiated that health care facilities are not providing written instructional material that is within the reading level of the patient. IMPLICATIONS FOR PRACTICE: Illiteracy can have a major impact in the health care system. Low reading skills can disempower and can prove to be costly for patients who are requiring health care services. Further investigation is needed on the impact of patients' reading skills on the health care system. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the growing problem of allergic rhinitis (AR) and the latest recommendations on its diagnosis and management for the nurse practitioner (NP) in primary care settings. DATA SOURCES: Recent clinical research, review articles and consensus guidelines, and the author's clinical experience. CONCLUSIONS: The prevalence of AR is increasing, possibly due to increased airborne pollutants, poor ventilation, and rising levels of indoor allergens. Allergic disease is systemic and rarely involves a single symptom. Treatments include reducing exposure to allergens as well as pharmacotherapy. IMPLICATIONS FOR PRACTICE: Patient education is crucial for successful management and includes understanding the allergic basis of symptoms, reducing allergen exposure, understanding proper use of medications, and reassessing the plan on a regular basis. [ABSTRACT FROM AUTHOR]

PurposeTo define the esophageal motor disorders of achalasia and esophageal spasms and describe their presentation in the clinical setting.Data SourcesSelected research-based articles, textbooks, and expert opinion. A case study is presented.ConclusionsThe presentation of esophageal motor disorders may not be clear, particularly when the presenting symptom is chest pain. Determining whether the pain is cardiac or digestive in origin is crucial.Implications for PracticeProgressive dysphagia for both solids and liquids is the major symptom of achalasia; other symptoms include regurgitation, chest pain, and nocturnal cough. Diffuse esophageal spasm typically causes substernal chest pain with nonprogressive dysphagia and odynophagia for both liquids and solids. Dysphagia related to esophageal motility is characterized by a sensation of swallowed food 'sticking' in the throat or chest; there is no problem initiating the act of swallowing. [ABSTRACT FROM AUTHOR]

PurposeTo review the pathophysiology, clinical presentation, and management options for antiphospholipid antibody syndrome (APS), a potentially life-threatening coagulation disorder.Data SourcesSelected scientific literature, consensus guidelines, and expert opinion.ConclusionsClinical features that should alert the clinician to consider APS include recurrent fetal loss, arterial or venous thrombosis, thrombocytopenia and livedo reticularis. One should be suspicious of this diagnosis in a younger patient, one with an autoimmune disease, or family history of autoimmune disease. To confirm the diagnosis one needs both clinical and laboratory abnormalities.Implications for PracticeThe signs and symptoms of APS are varied and could be confused with many disorders. The primary care provider needs to be aware of this syndrome in order to include it in the differential diagnosis and appropriately recognize and refer the patient in a timely manner. [ABSTRACT FROM AUTHOR]