Linda Stafford

Substitution of liothyronine at a 1:5 ratio for a portion of levothyroxine: effect on fatigue, symptoms of depression, and working memory versus treatment with levothyroxine alone.

OBJECTIVE To attempt to confirm a previous report of superior effectiveness of using two thyroid hormones rather than one hormone to treat hypothyroidism. METHODS This trial attempted to replicate prior findings, which suggested that substituting 12.5 microg of liothyronine (LT(3)) for 50 microg of levothyroxine (LT(4)) might improve mood, cognition, and physical symptoms in patients with primary hypothyroidism. Additionally, this trial aimed to extend the previous findings to fatigue and to assess for differential effects in subjects with low fatigue and high fatigue at baseline. A randomized, double-blind, two-period, crossover design was used. At an endocrinology and diabetes clinic, 30 adult subjects with primary hypothyroidism stabilized on LT(4) were recruited. Patients randomly assigned to treatment sequence 1 received their standard LT(4) dose in one capsule and placebo in another. Patients assigned to sequence 2 received their usual LT(4) dose minus 50 microg in one capsule and 10 microg of LT(3) in the other. At the end of the first 6 weeks, subjects were crossed over to receive the other treatment. Carryover and treatment effects were assessed by t tests. RESULTS Of the 30 enrolled study subjects, 27 completed the trial. The mean LT(4) dose was 121 +/- 26 microg/day at baseline. No significant differences in fatigue and symptoms of depression were found between treatments. Measures of working memory were unchanged. During substitution treatment, the free thyroxine index was reduced by 0.7 (P<0.001), total serum thyroxine was reduced by 3.0 microg/dL (P<0.001), and total serum triiodothyronine was increased by 20.5 ng/dL (P = 0.004). CONCLUSION With regard to the outcomes measured, substitution of LT(3) at a 1:5 ratio for a portion of baseline LT(4) yielded no better results than did treatment with the original dose of LT(4) alone.

PSYCHOMETRIC PROPERTIES OF THE DSM SCALE FOR DEPRESSION (DSD) WITH KOREAN-AMERICAN YOUTHS

As a first step in developing a reliable and culturally sensitive instrument to assess depression in Korean-American youths, this community-based methodological study was designed to evaluate the characteristics of the DSM Scale for Depression (DSD). A total of 104 Korean Americans, 11 to 13 years, participated in this study, and the response patterns of this group were compared with Korean- ( n = 20) and Anglo- ( n = 557) American youths assessed by the Teen Life Changes Survey (TLCS). Overall, Korean-American youths showed significantly higher mental distress scores than Anglos. The DSD was found to be a culturally appropriate instrument for Korean Americans with good reliability ( f =. 92) and validity demonstrated by correlating with related constructs (loneliness, self-esteem, coping, social support, mastery, and somatic symptoms). The highest correlation coefficient was observed between depression and somatic symptoms ( r =. 61). These findings are informative for the design of further studies of mental health of Korean-American youths.

IS CODEPENDENCY A MEANINGFUL CONCEPT

The concept of codependency has achieved a prominent place in the psychiatric, psychological, and addiction literature in a remarkably short period of time. Although the term was first developed in the substance abuse treatment arena, specifically referring to the wives of men who abuse alcohol, codependency has more recently been used almost generically to describe a dysfunctional style of relating to others (Irwin, 1995). The manner in which definitions of codependency have become increasingly inclusive are probably related to continuing input from the both the fashionable self-help movement and from some psychiatric perspectives. The purpose of this article is to review proposed definitions of codependency, discuss issues related to the validity of the codependency construct, and summarize efforts aimed at producing instruments to measure codependency. Additionally, I will address implications of this concept as related to psychiatric nursing education, practice, and research.

INTERPERSONAL REJECTION SENSITIVITY: TOWARD EXPLORATION OF A CONSTRUCT

This paper addresses the construct of interpersonal rejection sensitivity (IRS) as a phenomenon experienced by individuals in varying intensities. Selected theoretical frameworks are highlighted, as are developmental perspectives and research findings on the topic. Explication of this construct and better understanding by nurses of the pain felt by clients who experience rebuff could lead to more effective and sensitive interventions in a diversity of sittings. It is hoped that thoughtful exploration of this construct will lead to testable applications for practice.

A model for preparing nurses for the challenge of substance use disorders

Substance use disorders are considered to be the nations number one health problem. These continue to cause more deaths, illnesses, and disabilities than do other preventable health problems, providing ample support for the need for developing health professional competence in this area. This paper describes the specific steps used by The University of Texas‐Houston Health Science Center School of Nursing to infuse substance abuse content into the undergraduate curriculum, design a graduate subspecialty in addictions nursing, and offer continuing education on substance use disorders to nurses in acute care and community settings. The paper provides guidelines for other academic institutions engaged in the important task of increasing nursing competence related to substance use disorders.

Patient Advocacy at the APRN Level: A Direction for the Future

Patient advocacy is seen as a critical role for the nursing profession. Although there is an existing body of literature surrounding the registered nurse level of patient advocacy, little is known about the advanced practice registered nurse (APRN) and patient advocacy. This article examines the existing patient advocacy research literature and existing APRN competencies to provide direction for further research.

Increasing Psychiatric Mental Health Nursing HESI Grade Allocation Percentage in a Psychiatric Nursing Course

BACKGROUND Scant evidence is found in the literature regarding the unit-level Health Education Systems, Inc. (HESI) examinations. This study aims to (a) compare student Psych HESI examination scores between cohorts after increasing grade allocation from 5% to 15%, and (b) examine student perceptions of the impact of increasing the percentage of course grade allocation. METHOD An ex post facto research design analyzed differences in Psych HESI examination scores. HESI examination mean score differences between groups were analyzed using ANOVA. Narrative responses were analyzed using content analysis. RESULTS Psych HESI examination means increased from 836 in spring 2015 (5% of course grade) to 905 in fall 2015 (15% of course grade). Narrative response themes included (a) Validated Learning; (b) Compelled Participants to Study More; (c) Incongruent With Class Content and Preparation Books; and (d) Stress-Producing. CONCLUSION HESI examination scores improved with increasing course grade percentage allocated to the HESI score. Students indicated positive and negative perceptions of the increased grade allocation. [J Nurs Educ. 2018;57(10):604-608.].