Karen Hayes

Intrasubject medication adherence patterns.

The purpose of this prospective descriptive study was to explore the patterns of intrasubject (between medication) adherence of two similarly timed, twice-daily medications using the Medication Event Management System® electronic monitoring cap. Medication adherence was measured for 6 months using electronic monitoring in 25 adult renal-transplant recipients. Data were available from 7,119 electronic medication events. Results indicated that two twice-daily medications scheduled to be taken simultaneously were taken within 5 min of each other 77% of the time and within 10 min, 92% of the time. When only the first scheduled dose of the day was examined, the results are 79% and 95%, respectively. These findings are important to researchers and clinicians who must evaluate medication adherence in transplant recipients while balancing cost and subject burden. This study provides empirical support for monitoring a single immunosuppressive medication electronically to estimate medication adherence with double or triple immunosuppressive drug therapy.

Developing interactive continuing education on the Web.

BACKGROUND To meet the continuing education needs of advanced practice nurses, on-line continuing education modules were designed as part of a grant-funded nurse practitioner learning project. METHOD Three modules were planned from the results of a nurse practitioner (n=187) survey of computer availability and skills, topic preference, and their potential for taking on-line continuing education. RESULTS The development and implementation of two of the three modules demonstrates the interactive framework, extensive use of links, pre- and posttesting, and on-line registration. The two modules were designed to be interactive, realistic self-studies that closely resemble clinical practice. CONCLUSIONS Outcome data are currently being collected on-line and will be analyzed for efficacy of this delivery system for continuing education.

Acute Low Back Pain in the Emergency Department

Emergency departments across the nation are confronted multiple times a day with patients who present with complaints of acute low back pain. The role of the practitioner in the emergency department is to carefully evaluate the low back pain symptom as a potentially serious illness. The primary focus of this article is to discuss the historical and physical “red flags” that warrant a more detailed evaluation of this common chief complaint. Nonspecific low back pain is a diagnosis of exclusion. History is the key to differentiating mechanical acute low back pain from more serious etiologies. Age, duration of pain, history of trauma, location and radiation of pain, systemic complaints, history of cancer, neurologic deficits, psychological and social risks, and functional pain are important considerations during history taking. The physical examination of the patient with acute low back pain is based on the history and guides the practitioner to determine the extent of examination necessary to distinguish serious from more simple nonspecific low back pain. Abnormal vital signs are of particular concern and are “red flags.” The focused physical examination of the back includes inspection of the back, range of motion, and a thorough neurologic examination. An abdominal examination should be conducted to exclude intra-abdominal pathology such as aneurysm or masses. Rectal examinations are critical in anyone with complaints of saddle anesthesia or who may have cauda equina syndrome. Nonorganic are also causes for low back pain. Diagnostic studies include laboratories for infection, radiograph studies when the patient meets criteria, computerized axial tomography, and magnetic resonance imaging along with ultrasound aid in the differential diagnosis of patients with low back pain. Admission criteria of patients with nonspecific low back pain without evidence of neurologic findings is the inability to perform activities of daily living at home. The goal for patients with acute low back pain is the restoration of normal daily activities with medications, activity, patient education, and, at times, adjuvant therapy. Overall, the prognosis is good for patients with mechanical low back pain.

Evaluation of interactive online courses for advanced practice nurses

Purpose The purpose of this study was twofold: (a) to examine the effectiveness of two interactive online learning modules for advanced practice nurses (APNs) and (b) to examine the participants’ demographic characteristics and their perceptions of the strengths and weaknesses of online learning. Data sources A purposive sample of 73 registered nurses and APNs enrolled in graduate study or continuing education completed an online learning course. These participants were pretested and post-tested using a knowledge test developed by the authors. Participants were also surveyed for demographic characteristics and perceptions toward online learning. Conclusions The findings of this study support case-based online learning as a successful method in the education of APNs. The evaluation of the online modules and the enthusiasm from students indicated success of this teaching/learning method. The majority of learners responded positively toward the online method of learning and included comments that indicated they enjoyed learning using this method, would like to have the site available at their practice locations for reference, and would like to have other courses designed and delivered in this manner. Implications for practice and education The effectiveness and quality of the online instruction ultimately matter most to student satisfaction in online courses. The future of online education is dependent on well-structured, interactive, and substantive programs. Educators are challenged to continually assess and evaluate the changing learning needs of APNs.Purpose The purpose of this study was twofold: (a) to examine the effectiveness of two interactive online learning modules for advanced practice nurses (APNs) and (b) to examine the participants’ demographic characteristics and their perceptions of the strengths and weaknesses of online learning. Data sources A purposive sample of 73 registered nurses and APNs enrolled in graduate study or continuing education completed an online learning course. These participants were pretested and post‐tested using a knowledge test developed by the authors. Participants were also surveyed for demographic characteristics and perceptions toward online learning. Conclusions The findings of this study support case‐based online learning as a successful method in the education of APNs. The evaluation of the online modules and the enthusiasm from students indicated success of this teaching/learning method. The majority of learners responded positively toward the online method of learning and included comments that indicated they enjoyed learning using this method, would like to have the site available at their practice locations for reference, and would like to have other courses designed and delivered in this manner. Implications for practice and education The effectiveness and quality of the online instruction ultimately matter most to student satisfaction in online courses. The future of online education is dependent on well‐structured, interactive, and substantive programs. Educators are challenged to continually assess and evaluate the changing learning needs of APNs.

Homeless Patient With Tuberculosis in the Emergency Department

Homeless individuals with unique situations and frequently with tuberculosis present to the emergency department. The practitioner faces a myriad of challenges that require a variety of assessment skills. Special attention needs to be given to assess mental health, substance use and abuse, residential history, victimization, and perceived health status. The behavioral model for vulnerable populations provides a framework for access to health services and a method for determining health outcomes of the homeless. It also outlines a format for factors used in assessing this population. Continued use of this model offers a template for healthcare for the homeless and use of the emergency department.

An Adult With Thyroid Storm: Masquerading as Atrial Fibrillation in the Emergency Department

Thyroid storm is a serious, life-threatening clinical condition. Diagnosis is largely based on careful assessment of history and clinical presentation, and confirmed with laboratory findings. A wide range of clinical manifestations can occur with thyroid storm and hyperthyroidism, as illustrated in the case presentation, making openness to this differential diagnosis essential. Once identified, thyroid storm requires prompt emergency management and identification of the underlying cause. A wide variety of medications and treatments are available to treat hyperthyroidism.

Case study of hip fracture in an older person.

Purpose To discuss proximal femoral (hip) fractures as the leading cause of hospitalization for injuries among older persons, using a case example that illustrates not only the orthopedic injury but also how an older persons chronic problems complicate the acute event. Data Sources Extensive review of scientific literature on the conditions discussed, supplemented by the case study. Conclusions Hip fractures in older adults can present multiple challenges to care when complicated by preexisting or coexisting conditions. This case of an older man with a hip frac‐ture emphasizes the resuscitation priorities for the patient found after a “long lie” and the impact of chronic alcoholism and mal‐nutrition, which lead to serious complica‐tions. Implications for Practice Careful physical and psychosocial assessment is important for determining the pre‐senting problem and comorbid conditions. Priorities for postoperative management of hip fracture and its complications guide the nurse practitioner through the successful return of the patient to the community.