Journal of the American Association of Nurse Practitioners最新文献

Background: Lung cancer has been the leading cause of cancer-related deaths among women in the United States since 1987, with many cases diagnosed at advanced stages, despite screening methods like low-dose CT scans. Although smoking remains the primary risk factor for lung cancer, nonsmoking women, who make up 20% of lung cancer cases in the United States, are also at risk. However, there are no established guidelines for screening nonsmoking women, even as lung cancer rates rise in this group.

Purpose: The study explores potential risk factors that may influence cancer staging and assesses the potential benefits of low-dose computed tomography (LDCT) screening for nonsmoking women.

Methodology: This retrospective chart review analyzed 300 female patients diagnosed with lung cancer between 2019 and 2023. Data collected included smoking status, age, risk factors like family history, secondhand smoke, pulmonary comorbidities, cancer stage, and histology.

Results: A logistic regression model found that pulmonary comorbidities, a history of another cancer, and smoking status significantly influenced the likelihood of being diagnosed with advanced-stage (III or IV) lung cancer. Nonsmoking women with history of a lung comorbidity or history of cancer were more likely to be diagnosed at an earlier stage (I or II).

Conclusion: The study suggests that lung cancer screening (with LDCT) could enhance early detection and staging in high-risk nonsmoking women, especially those with pulmonary comorbidities or history of other cancers.

Implications: The results underscore the importance of expanding lung cancer screening criteria to include high-risk nonsmoking women, particularly those with pulmonary comorbidities or prior cancer history.

Background: Major depressive disorder (MDD) remains challenging to diagnose due to reliance on subjective clinical assessments, sparking interest in objective biological markers. Complete blood count (CBC) parameters reflect underlying biological processes, such as inflammation and oxygen transport dysfunction, both of which are implicated in MDD pathophysiology.

Objectives: The purpose of this systematic review is to explore the potential role of CBC parameters as biomarkers for diagnosing and assessing the severity of MDD.

Data sources: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, analyzing studies published between 2014 and 2024. Databases searched included PubMed, CINAHL Complete, Scopus, PsycINFO, and Web of Science. A total of 22 studies met the inclusion criteria.

Conclusions: The majority of studies (17 out of 22) found that low red blood cell indices and elevated neutrophil-to-lymphocyte ratio were associated with symptoms such as fatigue, cognitive impairment, and chronic inflammation. Although individual CBC parameters showed moderate diagnostic utility, composite CBC scores demonstrated promise in identifying patients with higher MDD severity. However, only a small number of longitudinal studies (5 of 22) examined CBC changes over time or in response to treatment, and findings were mixed. Therefore, although CBC parameters show potential for clinical integration, their predictive value for treatment outcomes remains inconclusive and warrants further investigation.

Implications for practice: Standardizing CBC biomarker thresholds and further exploring the role of inflammation in MDD are essential for clinical integration. Complete blood count biomarkers hold promise for enhancing early detection and enabling personalized treatment approaches in primary care and psychiatric settings.

Background: Given their emphasis on holistic, patient-centered care, nurse practitioners (NPs) and physician assistants (PAs) play an increasingly critical role in the care of patients with gastrointestinal conditions, including irritable bowel syndrome (IBS).

Objectives: To review key clinical considerations for the diagnosis and management of IBS, focusing on IBS with diarrhea (IBS-D), alongside 2 case presentations.

Data sources: PubMed and Google Scholar searches of English-language articles published between January 1, 2009, and April 2, 2025, were conducted to identify publications on the burden, diagnosis, and treatment of IBS-D.

Results: Data indicate that IBS-D impairs quality of life, daily activities, and work productivity and imposes a substantial socioeconomic burden. A positive diagnostic approach involving a detailed medical history and physical examination, with limited laboratory testing in the absence of alarm features, is recommended to facilitate timely and accurate diagnosis. Effective ongoing management relies on a patient-provider relationship that uses shared decision making, patient education and empowerment, and a personalized treatment strategy targeting the IBS subtype and most bothersome symptoms. Treatments considered for IBS-D include dietary management, over-the-counter agents, United States Food and Drug Administration-approved medications, neuromodulators, and gut-brain behavioral therapies.

Conclusions: Positive diagnosis of IBS-D and an evidence-based, symptom-targeted therapeutic approach are recommended to minimize disease burden.

Implications for practice: Both NPs and PAs are well positioned to provide individualized, compassionate, and competent care to patients with IBS-D. Communicating a confident, positive diagnosis and collaborating on a treatment plan that considers symptom presentation and most bothersome symptoms can improve patient outcomes.

Background: Patient engagement leads to improved disease outcomes; however, an unmet need exists for understanding and disseminating the benefits of patient engagement and shared decision making (SDM) in pulmonary arterial hypertension (PAH).

Purpose: To develop an expert consensus on strategies for patient engagement and SDM in PAH.

Methodology: United States (US)-based physicians ( n = 5), Advanced Practice Providers ( n = 5), and Registered Nurses (RNs; n = 3) who are responsible for managing patients with PAH were recruited to a double-blinded modified-Delphi panel (two survey rounds and a virtual consensus meeting). Consensus was defined as ≥80% of panelists rating their agreement or disagreement using a 9-point Likert scale.

Results: Engaged patients actively participate in SDM by asking questions, providing feedback, and following up routinely, which in turn leads to improved disease management in PAH. Factors that motivate engagement include provider encouragement and social support. Factors that discourage engagement include frustration due to symptom severity and medication side effects, poor health literacy, and financial burden. Communicating the importance of risk assessments and resources to address poor health literacy are areas that require improvement. Creating an action plan that involves patients and family members and educating and encouraging patients to research and understand PAH are essential components of SDM.

Conclusions: Consensus was reached on the importance of SDM and strategies to empower patients to be more engaged in their PAH management.

Implications: The identified areas of improvement may motivate greater involvement of patients, and their caregivers, in the management of PAH to advocate for their goals and preferences.

Background: Positive airway pressure (PAP) remains the gold standard therapy for obstructive sleep apnea. Mood state negatively affects PAP tolerance, adjustment, and adherence and subsequent health-related quality of life (HRQOL).

Purpose: This secondary analysis examined complex relationships among sleep, mood state, and HRQOL variables from the Apnea Positive Pressure Long-term Efficacy Study (APPLES) national data set.

Methodology: Using Amos, structural equation modeling was conducted to examine the mediating effect of mood state on HRQOL among PAP and sham (subtherapeutic) PAP users ( N = 1,105).

Results: Mood significantly mediated the relationship between sleep variables and HRQOL, including sleepiness (β = -0.07, p < .01) and sleep efficiency (β = 0.05, p < .01). Mood was the strongest HRQOL predictor in the model (β = -0.40, p < .01). Mood also significantly mediated the relationship between age (β = 0.08, p < .01), gender (β = -0.04, p < .05), Black ethnicity (β = 0.04, p < .05), marital status single (β = -0.05, p < .05), and HRQOL.

Conclusions: Mood significantly mediated the effects of sleepiness and sleep efficiency on HRQOL. Additional findings indicated potential health disparities related to PAP use, underscoring the need for personalized intervention strategies. Insights from this study highlight the importance of addressing mood state to improve PAP-related outcomes.

Implications: Understanding the relationship between mood and HRQOL among PAP users is essential in improving management strategies, including successful approaches to promote PAP tolerance, adjustment, and adherence. Future research to explore the PAP use-mood-HRQOL triad is warranted.

Abstract: This article explores the evolving landscape of pharmacogenomics (PGx) and the shift from reactive to preemptive testing in clinical practice. Although many PGx tests are currently performed after adverse drug reactions or when considering specific drugs, there is a growing movement toward obtaining genetic information before medication decisions are made. Through the case of Sarah Jenkins, the article demonstrates how identifying genetic variants related to drug metabolism can guide personalized treatment plans, leading to reduced adverse side effects and improved patient outcomes. Key benefits include the prevention of toxicity, reduction of health care costs by avoiding trial-and-error prescribing and related complications, and enhanced patient engagement. Challenges to widespread implementation are discussed, such as the need for comprehensive health care provider education, data privacy and security concerns, and significant cost and reimbursement barriers, particularly in the US health care system. The article concludes by emphasizing the necessity of finding solutions to these challenges to unlock the full potential of preemptive PGx testing and ensure equitable access to personalized medicine.

Abstract: Family Nurse Practitioner students often navigate graduate education while managing personal, professional, and emotional stressors. Many enter programs with histories of trauma, which may impair learning and performance in rigid, high-stakes academic environments. This pilot study explored the feasibility and perceived impact of implementing trauma-informed educational practices (TIEP) in an asynchronous Family Nurse Practitioner course using the Substance Abuse and Mental Health Services Administration's six principles to trauma-informed care as a framework. A mixed methods design was used with two consecutive student cohorts. Trauma-informed strategies were embedded into the course. Quantitative data were collected by pre-intervention and postintervention surveys. Qualitative feedback was obtained from open-ended responses and course evaluations. All students who completed the pre-intervention survey (n = 25) reported at least one adverse childhood experience, with over half citing trauma related to their nursing practice. Post-intervention surveys (n = 12) indicated high satisfaction with the trauma-informed course modifications. Thirty-three students provided qualitative feedback through the postintervention survey and course evaluations. Across data sources, students emphasized emotional safety, faculty connection, and the value of wellness reminders. Three themes emerged: (1) prioritizing wellness and emotional safety, (2) trauma is a daily lived reality for students, and (3) connection and communication. Findings suggest that TIEP can be feasibly integrated into asynchronous graduate Nurse Practitioner (NP) education and are well received by students. Although the study did not measure academic or clinical performance outcomes, TIEP aligns with the American Association of Colleges of Nursing Essentials for competency-based graduate education and supports ethical preparation for advanced practice.

Background: Medicaid beneficiaries have disparate access to buprenorphine, a lifesaving medication for opioid use disorder (OUD) that can be prescribed in primary care settings. Nurse practitioners (NPs) are a growing primary care workforce, but their buprenorphine prescribing habits compared with physicians and the impact of recent policy changes on their practice is unknown.

Purpose: To characterize buprenorphine prescribing by primary care NPs and physicians to Medicaid beneficiaries with OUD and to examine the impact of the removal of the buprenorphine waiver on prescribing behavior.

Methods: A retrospective analysis was conducted using Medicaid prescription data from Philadelphia between 2017 and 2023. Descriptive statistics along with t -tests were conducted to analyze the data. Clinical complexity was measured by presence of comorbidities indicating more severe OUD (e.g., hepatitis C, wounds).

Results: Primary care NPs became the largest group of buprenorphine prescribers to Medicaid beneficiaries with OUD by 2023. Both physicians and NPs treated patients with similar levels of clinical complexity. The removal of the X-waiver was not associated with significant changes in buprenorphine prescribing rates for either provider type.

Conclusions: NPs play a critical role in expanding access to buprenorphine treatment for Medicaid patients with OUD. Similar patient complexity across providers supports the potential for broader NP involvement in OUD care. The lack of change after X-waiver removal suggests that other factors influence prescribing practices.

Background: Understanding personal and geographic factors associated with smoking is important to design and implement interventions focused on reducing cancer health disparities. Scant research has been published recently regarding factors associated with smoking history associations within rural communities.

Purpose: To examine demographic factors and rural residence history for associations with smoking history.

Methodology: In a cross-sectional study of cancer-related behaviors, 1,786 adults (mean age 47.9 ± 17.5 years; 53% female, 84% White) completed an online survey in 2020. We examined factors associated with smoking history (having smoked at least 100 cigarettes) using independent t-tests, chi-square tests, and logistic regression.

Results: Of the participants, 36% had a rural residence history and 49% had a smoking history. A larger proportion of men than women (61% vs. 37%; p < .001), White than Black participants (50% vs. 39%; p = .001), and rural than nonrural residents (53% vs. 46%; p = .005) had a smoking history. Logistic regression analysis revealed that the young age group (18-30) was less likely (p = .002), whereas the middle age group (31-50) was more likely (p < .001) to have a smoking history than those older than 50 years. Rural residence was associated with a smoking history among women (p < .001), but not among men (p = .70) in this sample.

Conclusions: Tobacco control efforts are needed to focus on middle-aged men in general and women with rural residence history.

Implications: Nurse practitioners are uniquely positioned to directly contribute to future research with self-identified rural populations that could help inform future public health policy.