Anne Poppe

Subjective and objective sleep indices in women with irritable bowel syndrome.

Abstract  Patients with irritable bowel syndrome (IBS) commonly report sleep disturbances. This study examined self‐report (Pittsburgh Sleep Quality Inventory) sleep quality and polysomnography (PSG) sleep variables in 18 women with mild‐to‐moderate IBS, 18 with severe IBS and 38 with age‐ and gender‐matched controls. All women were studied on two consecutive nights in a sleep research laboratory where PSG data were collected. Retrospective and daily measures were obtained of self‐reported sleep quality, psychological distress and gastrointestinal symptoms across one menstrual cycle. Self‐report measures of psychological distress and sleep quality were significantly worse in the IBS‐severe (IBS‐S) group compared with controls. Rapid eye movement (REM) latency was higher in the two IBS groups on Night 1 than the control group (P = 0.06). Percentage time in REM was highest in the IBS‐S on Night 2. All groups demonstrated greater sleep disruption on Night 1 (adaptation) when compared with Night 2. These results highlight the importance of considering the ‘first‐night effect’ in those with IBS and the lack of concordance between self‐report and objective indices of sleep in women with IBS.

Anticipation of public speaking and sleep and the hypothalamic-pituitary-adrenal axis in women with irritable bowel syndrome

Background  Evidence suggests that subgroups of patients with irritable bowel syndrome (IBS) are hyper‐responsive to a variety of laboratory stress conditions.

Recommendations for nurse practitioner residency programs.

The purpose of this study was to identify and prioritize critical aspects needed in the design and execution of new nurse practitioner (NP) residency programs. Subjects answered a series of questions on formulating residency programs and on key outcomes and cost measures related to their sustainability. These results serve as potential guideposts for future work in NP residency standardization and sustainability development.

Advancing Post-Doctorate of Nursing Practice Residency Experience: First Year Reflections

An interprofessional team developed a yearlong post-doctorate of nursing practice (DNP) residency program funded by the Veteran Affairs (VA) Office of Academic Affiliations. As the VA’s first post-DNP residency, this multidisciplinary team sought to develop a mentoring environment that would provide DNP residents with increased clinical training, interprofessional networking, role transition, and dedicated mentoring. The authors discuss critical design elements for a successful residency design along with lessons learned. Initial findings support continuation and solidification of post-DNP residencies for new DNPs.

“Meet Me Where I Am”: Removing Barriers to End-of-Life Care for Homeless Veterans and Veterans Without Stable Housing

Objective: To describe the barriers and facilitators of end-of-life (EOL) care for Veterans without stable housing (VWSH) as perceived by Veterans at 1 VA medical center and EOL care staff. Design: Qualitative descriptive study. Secondary applied content analysis of data from interviews and focus groups in our parent study. Setting/Participants: VA Puget Sound Health Care System and VWSH. Results: The core emergent theme in the words of Veterans and health-care workers was “meet me where I am,” a statement of what many Veterans want most from their health care. Barriers and facilitators often reflected the presence or absence of important factors such as relationship and trust building, care coordination and flexibility, key individuals and services, and assistance in navigating change. Conclusions: These findings suggest that to improve health care for VWSH, interventions must be multifaceted, including a suite of support services, flexibility and creative problem-solving, and adaptations in communication approaches. The authors offer specific recommendations for improving EOL care for VWSH based on these findings.

Implementation of a novel population panel management curriculum among interprofessional health care trainees

BackgroundGaps in chronic disease management have led to calls for novel methods of interprofessional, team-based care. Population panel management (PPM), the process of continuous quality improvement across groups of patients, is rarely included in health professions training for physicians, nurses, or pharmacists. The feasibility and acceptance of such training across different healthcare professions is unknown. We developed and implemented a novel, interprofessional PPM curriculum targeted to diverse health professions trainees.MethodsThe curriculum was implemented annually among internal medicine residents, nurse practitioner students and residents, and pharmacy residents co-located in a large, academic primary care site. Small groups of interprofessional trainees participated in supervised quarterly seminars focusing on chronic disease management (e.g., diabetes mellitus, hypertension, or chronic obstructive pulmonary disease) or processes of care (e.g., emergency department utilization for nonacute conditions or chronic opioid management). Following brief didactic presentations, trainees self-assessed their clinic performance using patient-level chart review, presented individual cases to interprofessional staff and faculty, and implemented subsequent feedback with their clinic team. We report data from 2011 to 2015. Program evaluation included post-session participant surveys regarding attitudes, knowledge and confidence towards PPM, ability to identify patients for referral to interprofessional team members, and major learning points from the session. Directed content analysis was performed on an open-ended survey question.ResultsTrainees (n = 168) completed 122 evaluation assessments. Trainees overwhelmingly reported increased confidence in using PPM and increased knowledge about managing their patient panel. Trainees reported improved ability to identify patients who would benefit from multidisciplinary care or referral to another team member. Directed content analysis revealed that trainees viewed team members as important system resources (n = 82).ConclusionsStructured interprofessional training in PPM is both feasible and acceptable to trainees across multiple professions. Curriculum participants reported improved panel management skills, increased confidence in using PPM, and increased confidence in identifying candidates for interprofessional care. The curriculum could be readily exported to other programs and contexts.