Beth Fahlberg

House dust mite sublingual immunotherapy: Results of a US trial

BACKGROUND Few trials of sublingual immunotherapy (SLIT) in the United States have been reported. OBJECTIVE This randomized, placebo-controlled feasibility SLIT study compared the safety and physiologic effects of high- versus low-dose Dermatophagoides farinae vaccine. METHODS Thirty-one D farinae-sensitive adults with allergic rhinitis with or without mild intermittent asthma were eligible for randomization to high-dose maintenance vaccine (n = 10, 4200 allergen units [approximately 70 μg of Der f 1/d]), low-dose maintenance vaccine (n = 10; 60 allergen units [approximately 1 μg of Der f 1/d]), or placebo (n = 11) over 12 to 18 months. Medication-symptom scores and adverse events were monitored, serum D farinae-specific IgE and IgG4 levels were measured, and bronchial reactivity to D farinae was determined at baseline and 6-month intervals. RESULTS Of the 31 randomized subjects, 6 withdrew because of non-treatment-ascribed events. Four withdrew because of treatment-ascribed effects: high-dose group, 1 of 10 (gastrointestinal symptoms); low-dose group, 1 of 10 (gastrointestinal symptoms); and placebo group, 2 of 11 (headache and increased nasal symptoms). Thus 21 subjects completed the study: high-dose group, 9; low-dose group, 7; and placebo group, 5. Eleven of the 21 subjects experienced mild-to-moderate gastrointestinal symptoms, throat irritation, or both (high-dose group, 5/9; low-dose group, 4/7; and placebo group, 2/5). No severe systemic reactions were noted. No differences in symptom-medication scores were found. High-dose SLIT increased the bronchial threshold to allergen challenge and increased serum D farinae-specific IgG4 levels, whereas low-dose SLIT and placebo had no significant effect. CONCLUSIONS High-dose D farinae SLIT was generally tolerable, increased serum D farinae-specific IgG4 levels, and improved the bronchial threshold to allergen challenge. Larger US trials are warranted.

Promoting patient dignity in nursing care.

I RECENTLY MET a remarkable woman named Patricia,* who at age 80 remains staunchly independent despite a body that’s growing old and frail and a world growing smaller each day due to the limitations imposed by her health problems. I’ve learned a lot from Patricia about how to promote dignity in caring for patients. Dignity has been defined as “an inherent characteristic of being human, it can be felt as an attribute of the self, and is made manifest through behaviour that demonstrates respect for self and others....[A]n individual’s dignity is affected by the treatment received from others.”1 It’s a complex concept that means different things to different people, and it can be deeply embedded in culture. A person’s sense of dignity is influenced by many things—level of independence, perceived control, symptom management, and attitudes of care providers to name a few. Most important is how our patients see themselves, and how they believe others see them.

Hypertension among adults living in Haiti: An integrative review

AIMS AND OBJECTIVES To determine what is known about hypertension among adults living in Haiti. BACKGROUND Hypertension is the leading cause of morbidity, the identified cause of heart failure in 45% of patients and is associated with more than 70% of cardiovascular disease-related hospital admissions in Haiti. DESIGN An integrative review of the literature. METHODS Searching four databases from 2007 to 2018, Whittemore and Knafls method was used to review the literature. Three nurse researchers independently reviewed and appraised each publication applying the Johns Hopkins Evidence-based Practice Appraisal tool. RESULTS Eight publications were identified and appraised for level and quality of evidence. The synthesis of the literature yielded common themes of (i) high prevalence of hypertension among adults living in rural areas, (ii) public health challenges, (iii) lack of knowledge and awareness of hypertension and (iv) barriers to effective treatment. CONCLUSION Hypertension is a highly prevalent disease in Haiti that is understudied and warrants attention. To better serve this vulnerable population, culturally tailored prevention strategies and disease management programmes are recommended. RELEVANCE TO CLINICAL PRACTICE There is a lack of quality evidence to guide nurses in the management of hypertension for this vulnerable population. Identification of barriers to effective treatment among this underserved population will assist nurses and other healthcare professionals in identifying best possible practices for patient care in clinical settings across Haiti.

Dying in America: A nursing response to the IOM's call to action.

ON SEPTEMBER 17, 2014, the Institute of Medicine (IOM) released Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The interdisciplinary panel members responsible for this consensus report thoroughly examined current circumstances for those who are dying and made recommendations for improvement. Many nurses care for terminally ill patients and their families. Many of us have also experienced this journey with our loved ones. We know how hard this time of life is for the patient and the family. And we’re frustrated when the healthcare system, which should be helping to ease the burden, instead contributes to their suffering and distress. Witnessing these situations, we become distressed ourselves and want to do something, yet we often feel powerless. But you as a nurse can make a difference by using your professional expertise and advocacy skills to apply the practical recommendations from the Dying in America report. Many of these recommendations are things that we as nurses can influence or implement to improve outcomes for patients and their families. The report’s findings and recommendations are divided into five major areas. The following suggestions for applying the recommendations to your nursing practice are based on the report’s recommendations in those five areas.1