Audrey Snyder

Gentle Massage Improves Disease- and Treatment-Related Symptoms in Patients with Acute Myelogenous Leukemia

Objective Cancer treatment is reported to be stressful, and patients diagnosed with hematologic cancers often exhibit higher levels of anxiety and emotional distress than individuals with other malignancies. Management of these symptoms in patients with hematologic cancer presents significant challenges, as many of them are in and out of the hospital while undergoing high dose chemotherapy. Oncology patients use complementary modalities such as therapeutic massage in an attempt to alleviate disease and treatment-related symptoms, including anxiety and emotional distress. In the current study, the feasibility of a novel massage intervention delivered over the continuum of care, as well as assessment of the immediate and cumulative effects of massage, was examined in patients with acute myelogenous leukemia. Methods A mixed-methods, unmasked, prospective, randomized study was conducted with two groups: a usual care alone control group and a massage therapy intervention plus usual care group. Results Significant improvements in levels of stress and health-related quality of life were observed in the massage therapy group versus the usual care alone group, after adjusting for anxiety level, including both immediate and cumulative effects of massage. Conclusions While the findings of the current study regarding acceptability, feasibility, and potential efficacy of therapeutic massage as a complementary health-enhancing intervention in patients diagnosed with acute myelogenous leukemia are very promising, the relatively small size of the study sample limits generalizability.

Decreasing ED Length of Stay with Use of the Ottawa Ankle Rules Among Nurses

ED crowding threatens patient safety and public health. Several studies have evaluated the ability of emergency departments in the United States to handle the demands that are being placed on them daily. ED crowding is widespread throughout the United States, with little evidence that the problem is being resolved. Emergency departments play a valuable role in the health care system because they act like a type of safety net. However, according to a recent report by the Institute of Medicine, this safety net is at a point where it is no longer effective. The potential dangers of ED crowding have become more visible as a result of recent reports on news broadcasts of unfortunate events regarding patients who were left unattended in waiting rooms. ED crowding refers to situations in which the number of patients in treatment areas exceeds the capacity of the department, thus leading to the treatment of patients in makeshift care areas or hallway beds. Several surveys have discussed the implications of ED crowding. These surveys linked crowding to delays in diagnosis and treatment, a decrease in quality of care, and unacceptable patient outcomes. ED crowding has the potential to affect anyone who is injured suddenly or has an unexpected illness that requires urgent treatment. Nurses have opportunities to help alleviate overcrowding in the emergency department. With the implementation of protocols, emergency nurses may be able to play an active role in decreasing ED throughput time. A system of rules has been developed to assist practitioners in identifying significant ankle fractures without the overuse of radiographic tests. These rules have been established as the Ottawa Ankle Rules (OARs). Providers use these rules to determine if a radiograph is indicated in the evaluation of an ankle or foot injury. Emergency nursing staff can learn how to use the OARs to anticipate and treat patients with ankle and foot injuries. If the OARs indicate that a radiograph is needed, the nurse can order it according to protocols. It was hypothesized that implementation of a nurse-driven protocol to assess patients with non–life-threatening ankle and foot injuries with use of the OARs would result in a significant decrease in the total length of stay (LOS) in the emergency department.

Risk screening for cardiovascular disease and diabetes in Latino migrant farmworkers: a role for the community health worker.

Abstract Diabetes and heart disease are two of the leading causes of death for Hispanics living in the United States (American Heart Association [AHA] in Circulation 123:e18–e209. doi:10.1161/CIR.0b013e3182009701, 2010). As the Hispanic population continues to grow, the need for low-cost, non-invasive methods to detect at risk populations for such diseases becomes more important. Once at risk individuals are detected, prevention strategies can be implemented. Studies have shown that Latino community health workers (CHWs) are effective educators, patient advocates and health promotion motivators for patients with known heart disease or diabetes. This pilot study examined the accuracy with which Latino CHWs could determine migrant farmworkers at risk for diabetes or cardiovascular disease (CVD) in rural Virginia. This quasi-experimental study supports the hypothesis that Latino CHWs can use non-invasive diabetes and CVD screening tools with similar accuracy as a registered nurse. The screening tools used were the American Diabetes Association’s diabetes risk calculator and a non-laboratory screening tool for CVD risk designed by Gaziano et al. (Lancet 371:923–931, 2008). The terms Latino and Hispanic will be used interchangeably.

A Pilot Study Exposing Novice Medical and Nursing Students to Point-of-Care Sonography Skills

Point-of-care sonography is a valuable tool used in medical practice. A free health clinic was the venue for the authors’ approach to hands-on training for medical and nursing students. Students were surveyed before and after the event regarding their experience and their ability to successfully perform six targeted sonographic skills. The primary outcome was the change presurvey to postsurvey in the students’ assessment of their ability to perform scans on patients and identify the anatomic structures in the six skill areas. An experienced sonographer monitored each scan and confirmed skill application. One hundred nineteen sonograms were performed. Most students (23/29) did not report competence in any of the six assessed skills prior to the study. On average, students developed competence in three of six skill areas. Before the study, 3 of 29 students (10%) reported being able to perform scans on patients and identify the major anatomic structures. After the study, 20 of 28 students (71%) reported that they could perform scans and identify these structures. This change was significant (P < .0001, χ2).