NURSE PRACTITIONER最新文献

Abstract: Major depressive disorder (MDD) is a common mental health condition that significantly impacts an individual's quality of life and functioning. Accurate diagnosis and effective management are crucial to lessen its effects. This article provides an overview of the clinical assessment of MDD in adults, including diagnostic criteria, screening tools, and differential diagnosis. It also reviews traditional and emerging management strategies including pharmacotherapy, psychotherapy, lifestyle interventions, repetitive transcranial magnetic stimulation, and esketamine. Insights from the STAR∗D study, which shed light on the complexities of treating depression, are discussed to emphasize the importance of personalized treatment approaches.

Introduction: The Centers for Disease Control and Prevention Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022 emphasizes the need to establish referral options for patients with opioid use disorder. The purpose of this quality improvement (QI) project was to determine the effectiveness of the integration of Webster and Webster's Opioid Risk Tool (ORT) into current opioid prescribing practices to improve identification of patients at risk for opioid use disorder for appropriate referrals and pain treatment.

Methods: A QI design was used to compare referral rates to pain management, behavioral health, and substance use disorder treatment facilities before and after the implementation of the ORT among patients with chronic noncancer pain in an integrated primary care clinic in a rural region of Arizona. This article is a report of the project and compares pre- and postimplementation data to assess outcomes of a practice change.

Results: There were 375 participants in the project, including 212 in the preimplementation group and 163 in the postimplementation group. There were 46 referrals (22%) in the preimplementation group compared with 55 referrals (34%) in the postimplementation group.

Conclusion: In this project, referral rates to pain management, behavioral health, and substance use disorder treatment facilities increased after integration of the ORT. Providers can use the ORT to identify at-risk patients and provide a network of treatment options.

Abstract: The COVID-19 pandemic has been the 21st century's most significant public health emergency. In addition to the acute symptoms of COVID-19, many individuals are facing long-term health issues related to the infection. The terms "long COVID," "postacute sequelae of SARS-CoV-2 infection," "postacute COVID syndrome," and "long-haul COVID-19" refer to long-term consequences of SARS-CoV-2 infection. Symptoms may persist for weeks or months, reducing quality of life. Health practitioners must stay updated and take proactive measures to manage long COVID effectively. This manuscript provides an overview of risk factors, diagnostic tools, and management strategies, which serve as a resource for understanding and managing long COVID.

In celebration of its 50th year in publication, The Nurse Practitioner has asked 50 influential NPs for their thoughts on topics of import to the profession and its future, to be published in select months throughout the year. This month, five NPs share their wisdom on forging change in health care.

Abstract: Delayed wound healing, increased risk of surgical site infections, and other complications following surgical procedures have a widely documented link to diabetes due to insulin resistance inherent to the disease. Variations in perioperative glucose control not only affect patients with diabetes but may also contribute to even more significant risks in patients without diabetes due to perioperative stress hyperglycemia. Perioperative stress hyperglycemia can occur due to the body's physiological stress responses to the surgical procedure, perioperative medications, discontinuation of diabetes-related medication, or a combination of factors. Hospital-based hyperglycemia protocols are often structured only around diabetes; however, increasing evidence supports glucose monitoring protocols for patients without diabetes to ensure improved perioperative glucose control. Incorporating the standard practice of preoperative hemoglobin A1C (HgbA1C) testing gives the clinician perspective on issues of glucose and insulin metabolism before the surgical procedure. The HgbA1C helps determine safe and effective insulin doses for the perioperative treatment of hyperglycemia. By incorporating safe and effective perioperative glucose monitoring and insulin treatment protocols, the health care system can proactively reduce postoperative complications due to unrecognized and untreated hyperglycemia.

Abstract: The opioid epidemic remains a significant public health challenge in the United States. Nurse practitioners (NPs) play a crucial role in addressing this crisis. This article discusses the implications for NPs of the Centers for Disease Control and Prevention 2022 updated clinical practice guideline on opioid prescribing, focusing on four key areas: 1) deciding whether to initiate opioids, 2) determining appropriate opioids and dosages, 3) determining treatment duration and follow-up, and 4) implementing risk assessment and mitigation strategies. Adhering to this guideline enables NPs to optimize opioid prescribing practices and deliver patient-centered care that aligns with public health priorities to combat the opioid crisis.