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Journal articles on the topic 'Clinical Nursing: Primary (Preventative)'

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Author: Grafiati

Published: 10 December 2022

Last updated: 28 January 2023

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1

Endicott, Kendal M., Charles B. Drucker, Hakan Orbay, Joseph J. DuBose, Khanjan Nagarsheth, Shahab Toursavadkohi, and Rajabrata Sarkar. "Intraoperative Fragmentation and Retention of Endovascular Devices: Clinical Consequences and Preventative Strategies." Vascular and Endovascular Surgery 54, no. 2 (November 5, 2019): 118–25. http://dx.doi.org/10.1177/1538574419886193.

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Background: Expanded applications and increasing volumes of complex endovascular procedures have increased the risk of unintended intraoperative fragmentation and retention of catheters and sheaths. We describe a series of retained or fragmented endovascular devices, a quality improvement program to address this unmet need for improved detection of catheter fragmentation, and the results of this program. Methods: Cases utilizing endovascular devices that resulted in a retained catheter fragment were identified and analyzed during divisional quality improvement review. One consistent area of concern was operating room (OR) staff unfamiliarity with verifying the integrity of an endovascular device. In response, a slide-based training protocol of focused, endovascular nursing education was implemented. Following perceived lack of improvement after this approach, we developed a handheld visual reference display of the tips of common catheters and sheaths. Staff was surveyed before and after intervention to assess the educational value of the display and the impact on staff device familiarity. Results: All 4 described cases resulted in an unplanned return to the OR for retrieval of the fragmented catheter or sheath. No thromboembolic complications were observed, although associated intra-arterial thrombus was noted in 2 cases. Thirty-four OR nurses were polled to trial the visual reference display initiative, with 70% of those reporting primary surgical assignments outside of cardiovascular ORs. Introduction of the new visual reference display improved staff confidence in their ability to identify a broken device (2.4-3.7, P < .001). This improvement was most significant in OR staff with primary assignments in noncardiovascular services. Conclusion: Current OR standard operating procedures fail to address the potential for unintentionally retained catheters and wires during endovascular procedures. Our novel visual reference display of common endovascular items rather than conventional in-service training improved the ability of staff to identify device fragmentation at the time of the index procedure.

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Marshall, Bob, Sue Floyd, and Rachel Forrest. "Clinical outcomes and patients perceptions of nurse-led healthy lifestyle clinics." Journal of Primary Health Care 3, no. 1 (2011): 48. http://dx.doi.org/10.1071/hc11048.

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BACKGROUND AND CONTEXT: The Nurse-Led Healthy Lifestyle Clinics focussed on lifestyle issues for patients with known health inequalities. Much of the nursing was educative and preventative care. This evaluation assessed patient experiences and opinions, as well as clinical outcomes. ASSESSMENT OF PROBLEM: Information came from clinical outcome data for 2850 individuals and 424 patient satisfaction surveys. Results: Patients were aged 095 years (45% between 40 and 59 years); 60% Pakeha/European, 31.4% Maori, 4.2% Pacific and 4.4% other ethnicities. Only 19% of claimants (approximately 40% were Maori or Pacific) came from quintile 5 addresses, suggesting the target population was not reached effectively. Ninety-four percent of patients had a better understanding of their diagnosis, medication and treatment plan, and were more motivated to self-manage their health needs. This increase in patient empowerment is a significant outcome of the project. Clinical outcome data showed no significant differences between first and last clinic visits for average weight, blood pressure, smoking, glycosylated haemoglobin levels, waist circumference or cardiovascular risk. Significant improvements were shown in the Dartmouth Primary Care Cooperative Information results for social activity, change in health, and overall health (n=89). STRATEGIES FOR IMPROVEMENT: More effective techniques to access the target population have been implemented, as has an extended period for review of clinical outcomes. LESSONS: More focussed evaluation of clinical outcomes is necessary to provide quantitative data on the clinics. The large percentage of patients who felt more empowered to self-manage their health needs suggests the clinics were effective in this area. KEYWORDS: Nurse-led clinics; life style; program evaluation; patient satisfaction; health status disparities

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Gorelick, Philip B. "Community Engagement: Lessons Learned From the AAASPS and SDBA." Stroke 53, no. 3 (March 2022): 654–62. http://dx.doi.org/10.1161/strokeaha.121.034554.

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Community engagement is a means to help overcome challenges to the delivery of health care and preventative services. On the occasion of the 2021 International Stroke Conference Edgar J. Kenton III Lecture, I review community engagement strategies utilized in the AAASPS trial (African-American Antiplatelet Stroke Prevention Study) and SDBA (Studies of Dementia in the Black Aged) observational studies that I directed. The main community engagement strategies included use of home visits (bringing the study to the community), engagement of churches, community advisors, community physicians, other healthcare providers, major Black community organizations, and utilization of diversity training. Community engagement strategies were a major component of AAASPS and SDBA that helped to ensure successful recruitment and retention of an underrepresented community in clinical trial and observational studies. Lessons learned from these studies largely carried out in the 1980s and 1990s helped to dispel myths that Blacks could not be recruited into large-scale clinical trials, emphasized the importance of studying underrepresented groups with adequate statistical power to test primary study hypotheses, and provided foundational recruitment and retention methods for future consideration.

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WONG, Sio Mui, Wen ZENG, Iek Long LO, Chong LAM, and Hong Lei LOU. "Development and Psychometric Evaluation of a Chinese Instrument of Knowledge, Attitude and Preventive Practice on Dementia Care in Macao." American Journal of Alzheimer's Disease & Other Dementias® 38 (January 2023): 153331752211493. http://dx.doi.org/10.1177/15333175221149358.

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Background Very few instruments to integrate knowledge, attitude and practice into dementia care as a holistic perspective were available to the Chinese. Method This article documented the development of a 30-item self-administered Chinese instrument of knowledge, attitude and preventive practice on dementia care and reported the results of psychometric testing among 1500 Chinese in Macao Special Administrative Region (SAR), including 234 primary health professionals, 272 staff working at day-care centers and nursing homes, 586 high school students and 408 community-dwelling older people. The Chinese instrument was developed through literature review and committee review. The psychometric methods were used to evaluate the reliability and validity of the Chinese instrument as measures of knowledge, attitude and preventive practice on dementia care for the Chinese. Results The preliminary results indicated that the Content Validity Index of the Chinese instrument was .973 and Cronbach’s alpha coefficient of the Chinese instrument was .842, among which Knowledge subscale, Attitude subscale and Preventive Practice subscale were .749, .633 and .845 respectively. The means and standard deviation were 65.13 ± 24.56 for Knowledge subscale, 74.76 ± 8.37 for Attitude subscale, 73.22 ± 14.05 for Preventative Practice subscale, and 70.99 ± 11.27 for the Chinese instrument. Conclusion The 30-item self-administered Chinese instrument of knowledge, attitude and preventive practice on dementia care had satisfied the psychometric evaluation well enough to warrant further use, and could also have particular implications for other Chinese populations all over the world.

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Sartain, Sarah, John Price, Brooke Bitner, Elizabeth Wolfe, and Daniel Ortiz. "Determination of Antimicrobial Prescribing Practices in an Integrated Health System Emergency Department." Kansas Journal of Medicine 13 (June 25, 2020): 131–33. http://dx.doi.org/10.17161/kjm.v13i.13812.

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Introduction. Antibiotic stewardship utilizes interprofessional collaborative practices, including professionals from medicine, pharmacy, nursing, social services, and clinical laboratory science, to identify potential problems proactively. A tertiary care integrated health system’s Emergency Department (ED) aimed to identify antimicrobials prescribed to the outpatient community as part of a proactive antimicrobial stewardship project. Methods. A pilot, prospective, snapshot of a tertiary community hospital’s outpatient antimicrobial prescribing habits was conducted. All subjects were identified via a daily report of patients discharged from the ED over 30 days in the summer of 2017 and individually reviewed for prescribed antimicrobial(s). Exclusions were hospital admission, antimicrobial sensitivity, and antimicrobial courses less than five days or more than 14 days. The primary goal was determining the number of antimicrobial oral tablets/capsule prescriptions to adult outpatients within a 5 to 14-day treatment window. Secondary goals were to include the diagnosis, non-capsule/tablet antimicrobial, pediatric patients, and prescriptions outside the treatment window. Results. Total number of antimicrobial prescriptions over the 30-day period was 653 in 5,520 individual visits. Total number of adults prescribed oral antimicrobials was 467 (15.6 daily). Patients were diagnosed with infections including urinary tract, cellulitis, soft tissue injury, abscess, upper respiratory, dental caries, gastrointestinal, sexually transmitted, otitis media/externa, pneumonia, viral, pyelonephritis, tick-borne, fungal, Bell’s Palsy, and sepsis. The number of non-adult, non-oral, and outside window treatment antimicrobial prescriptions were 186 (6.2 daily). With an average 184 patients treated in the ED daily, approximately 11.8% received antimicrobial treatment on discharge. Conclusion. Important aspects of the project were the evaluation of antimicrobial prescribing habits for a midwest ED and identification of potential complications requiring future interventions for follow-up or preventative measures to assist in patient care and community health. Areas of practice improvement were identified inadvertently as a result of this project. Potential future studies included seasonal variability, whether the patient obtained a prescription and complied with treatment, and differences between inpatient and outpatient antimicrobial prescribing practices.

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Barton-Wright, Philip. "Clinical supervision and primary nursing." British Journal of Nursing 3, no. 1 (January 13, 1994): 23–30. http://dx.doi.org/10.12968/bjon.1994.3.1.23.

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Kieliszek, Agata, Chitra Venugopal, Blessing Bassey-Archibong, Fred Lam, Sheila Singh, and Nikoo Aghaei. "STEM-01. TARGETING BRAIN METASTASIS-INITIATING CELLS: A PREVENTATIVE APPROACH." Neuro-Oncology 22, Supplement_2 (November 2020): ii196. http://dx.doi.org/10.1093/neuonc/noaa215.818.

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Abstract BACKGROUND The incidence of brain metastases (BM) is tenfold higher than primary brain tumors. BM commonly originate from primary lung, breast, and melanoma tumors with a 90% mortality rate within one year of diagnosis. Current standard of care for BM includes surgical resection with concurrent chemoradiation, but does not extend median survival past 16 months, posing a large unmet need to identify novel therapies against BM. METHODS From a large in-house biobank of patient-derived BM cell lines, the Singh Lab has generated murine orthotopic patient-derived xenograft (PDX) models of lung, breast, and melanoma BM that recapitulate the stages of BM progression as seen in humans. Using these three PDX models, we identified a population of “pre-metastatic” brain metastasis-initiating cells (BMICs) that are newly arrived in the brain but have yet to form detectable tumors. Pre-metastatic BMICs are not detectable in human patients but are important therapeutic targets with the potential to prevent BM in at-risk patients. RESULTS RNA sequencing of pre-metastatic BMICs from all three PDX primary tumor models with subsequent Connectivity Map analysis identified novel compounds that have the potential of killing all three types of BMICs. In particular, we identified two compounds that have selective killing of BMICs in vitro from all three primary tumor cohorts while sparing non-cancerous cells. We further characterized their ability to inhibit the self-renewal and proliferative properties of BMICs. Ongoing in vivo work will investigate the compounds’ preclinical utilities in preventing BM. CONCLUSION Identification of novel small molecules that target BMICs could prevent the formation of BM completely and dramatically improve the prognosis of at-risk cancer patients.

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Tognetti, Valdinéia Maria, Naiara de Paula Ferreira-Nobilo, and Maria da Luz Rosário de Sousa. "Clinical management of caries by public and private university dental students." Revista de Odontologia da UNESP 42, no. 6 (December 2013): 401–7. http://dx.doi.org/10.1590/s1807-25772013000600002.

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OBJECTIVE: The aim of this study was to verify the clinical approach knowledge of graduate students from two colleges (public and private) concerning dental caries. MATERIAL AND METHOD:A case report containing patient general data, photos, and radiographs were presented for the students, which responded tests and a discursive question. Discursive answers were analyzed according to content analysis technique, and posteriorly dichotomized for statistical analysis. (Chi-square, p<0.05). RESULT: Response rates (n=72) were 85.71% in the public college, and 92.30% in the private college. After x-rays evaluation and considering the diverse dynamics by which both schools perform their patient care management, it was observed that less than 10% of the public college students would perform conservative procedures in primary teeth, while at least 30% of private college students would decide for conservative procedures for all cases (p<0.001). Concerning the permanent dentition, the majority of the public college students would perform "conservative" approach. "Preventative-conservative practice" was similarly observed amongst public and private college students. CONCLUSION:Both in public and in private college were similar curative e approaches (primary teeth) and preventative +conservative (permanent teeth).

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Primiero, Clare A., Tatiane Yanes, Anna Finnane, H. Peter Soyer, and Aideen M. McInerney-Leo. "A Systematic Review on the Impact of Genetic Testing for Familial Melanoma I: Primary and Secondary Preventative Behaviours." Dermatology 237, no. 5 (2021): 806–15. http://dx.doi.org/10.1159/000513919.

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<b><i>Background:</i></b> Increasing availability of panel testing for known high-penetrance familial melanoma genes has made it possible to improve risk awareness in those at greatest risk. Prior to wider implementation, the role of genetic testing in preventing melanoma, through influencing primary and secondary preventative behaviours, requires clarification. <b><i>Methods:</i></b> Database searches of PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library were conducted for studies describing preventative behaviour outcomes in response to genetic testing for melanoma risk. Publications describing original research of any study type were screened for eligibility. <b><i>Results:</i></b> Eighteen publications describing 11 unique studies were reviewed. Outcomes assessed are based on health behaviour recommendations for those at increased risk: adherence to sun-protective behaviour (SPB); clinical skin examinations (CSE); skin self-examinations (SSE); and family discussion of risk. Overall, modest increases in adherence to primary prevention strategies of SPB were observed following genetic testing. Importantly, there were no net decreases in SPB found amongst non-carriers. For secondary preventative behaviour outcomes, including CSE and SSE, increases in post-test intentions and long-term adherence were reported across several subgroups in approximately half of the studies. While this increase reached significance in mutation carriers in some studies, one study reported a significant decline in annual CSE adherence of non-mutation carriers. <b><i>Conclusions:</i></b> Evidence reviewed suggests that genetic testing has a modestly positive impact on preventative behaviour in high-risk individuals. Furthermore, improvements are observed regardless of mutation carrier status, although greater adherence is found in carriers. While additional studies of more diverse cohorts would be needed to inform clinical recommendations, the findings are encouraging and suggest that genetic testing for melanoma has a positive impact on preventative behaviours.

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Phillips, Lisa, Alison R. Yung, Narelle Hearn, Colleen McFarlane, Mats Hallgren, and Patrick D. McGorry. "Preventative Mental Health Care: Accessing the Target Population." Australian & New Zealand Journal of Psychiatry 33, no. 6 (December 1999): 912–17. http://dx.doi.org/10.1046/j.1440-1614.1999.00613.x.

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Objective: Preventative approaches to mental illness are becoming a focus of clinical and research settings. To date, however, few clinical programs have been established with this primary aim. This descriptive paper summarises patterns of referral to one service providing clinical care for young people known to be at high risk of developing a psychotic illness. Methods and results: A 20-month survey of referrals to the service revealed that most patients had a prolonged and circuitous route to assessment. Additionally, a lengthy time period elapsed between the onset of symptoms and initiation of help seeking. Conclusions: Information arising from this survey may influence the development of strategies to improve access to this service and others aimed at the prevention of psychosis. Further, this information may affect the development of generalised pre-ventative mental health services for young people.

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Kelly, Margaret. "PRIMARY CARE ACROSS CLINICAL SETTINGS." Nursing Clinics of North America 31, no. 3 (September 1996): 465–70. http://dx.doi.org/10.1016/s0029-6465(22)00158-x.

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Baker, Nicola. "Clinical governance within primary care." Practice Nursing 10, no. 1 (January 12, 1999): 18–19. http://dx.doi.org/10.12968/pnur.1999.10.1.18.

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Teichman, Ronald. "Occupational Health Nursing Guidelines for Primary Clinical Conditions." Journal of Occupational and Environmental Medicine 35, no. 2 (February 1993): 226–27. http://dx.doi.org/10.1097/00043764-199302000-00021.

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Leske, Jane S., Kim Whiteman, Thomas A. Freichels, and Jerilyn M. Pearcy. "Using Clinical Innovations for Research-Based Practice." AACN Advanced Critical Care 5, no. 2 (May 1, 1994): 103–14. http://dx.doi.org/10.4037/15597768-1994-2002.

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Making choices about patient-care interventions pervades critical care nursing practice. Research utilization activities provide the reasoning by which assessment parameters are established, preventative actions are identified, and interventions are evaluated in the clinical setting for positive effects on patient outcomes. For research results to be directly applicable, they must be transformed into clinical innovations specific to a patient population, clinical situation, or institutional setting. A brief summary of using research findings to design clinical innovations is provided. Examples of selected clinical innovations are included to illustrate the steps of the research utilization process. Clinical innovations are intended to improve or validate patient outcomes and are considered the key to quality patient care

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Klainberg, Marilyn. "Clinical Snapshot: Primary Biliary Cirrhosis." American Journal of Nursing 99, no. 12 (December 1999): 38. http://dx.doi.org/10.2307/3521991.

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Aghaei, Nikoo, Fred Lam, Chitra Venugopal, and Sheila Singh. "TAMI-03. IDENTIFICATION OF NOVEL DRIVERS OF LUNG-TO-BRAIN METASTASIS THROUGH IN VIVO FUNCTIONAL GENOMICS." Neuro-Oncology 22, Supplement_2 (November 2020): ii213. http://dx.doi.org/10.1093/neuonc/noaa215.892.

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Abstract Brain metastasis, the most common tumor of the central nervous system, occurs in 20-36% of primary cancers. In particular, 40% of patients with non-small cell lung cancer (NSCLC) develop brain metastases, with a dismal survival of approximately 4-11 weeks without treatment, and 16 months with treatment. This highlights a large unmet need to develop novel targeted therapies for the treatment of lung-to-brain metastases (LBM). Genomic interrogation of LBM using CRISPR technology can inform preventative therapies targeting genetic vulnerabilities in both primary and metastatic tumors. Loss-of-function studies present limitations in metastasis research, as knocking out genes essential for survival in the primary tumor cells can thwart the metastatic cascade prematurely. However, gene overexpression using CRISPR activation (CRISPRa) has the potential for overcoming dependencies of gene essentiality. We theorize that an in vivo genome-wide CRISPRa screen will identify novel genes that, when overexpressed, drive LBM. We have developed a patient-derived orthotopic murine xenograft model of LBM using primary patient-derived NSCLC cell lines (termed LTX cells) from the Swanton Lab TRACERx study. We are now poised to transduce LTX cells with a human genome-wide CRISPRa single guide RNA (sgRNA) library, and to subsequently inject the cells into the lungs of immunocompromised mice. We will then track the process of LBM using bioluminescent and MRI imaging until mice reach endpoint. Sequencing of primary lung tumors and subsequent brain metastases promises to uncover enriched sgRNAs, which may represent novel drivers of primary lung tumor formation and LBM. To the best of our knowledge, this study is the first in vivo genome-wide CRISPRa screen focused on identifying novel drivers of LBM, and can inform future preventative therapies to improve survival outcomes for NSCLC patients.

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Edmonds, Joyce K. "Clinical Indications Associated With Primary Cesarean Birth." Nursing for Women's Health 18, no. 3 (June 2014): 243–49. http://dx.doi.org/10.1111/1751-486x.12126.

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Slabaugh, Kristen, Shannon Harris, and Samuel Wilcock. "Initiation of Standardized Depression Screening in College Health: A Quality Improvement Project." Journal of Doctoral Nursing Practice 11, no. 2 (October 2018): 143–50. http://dx.doi.org/10.1891/2380-9418.11.2.143.

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Background: Depression is a leading health concern in college health. An on-campus health clinic was identified as conducting complaint-based screening. U.S. Preventative Services Task Force recommends standardized screening in all primary care settings. Objective: To implement a quality improvement project for standardized screening and referral of depressive symptoms and identify factors related to mentoring program interest in a college health clinic. Methods: Demographic survey and Patient Health Questionnaire-2 (PHQ-2) were distributed to students who met inclusion criteria. Positive screens received further intervention with Patient Health Questionnaire-9 (PHQ-9) and immediate evaluation, encouragement of follow-up, or educational handout. Results: Of students receiving primary care services at a college health center, 221 completed demographic surveys, 165 completed the PHQ-2, and eight students received interventions for positive screens. Furthermore, 74.6% of students expressed interest in a mentoring program. Conclusions: The project demonstrates ease of standardized screening in the college health setting without excessive burden to staff or budget. This is a critical preventative care measure for improving early detection and management of depression at college health centers. Implications for Nursing: Initiation of standardized screening on college campuses is a worthwhile investment and should be implemented by registered nurses (RNs) and advanced practice nurses. Support program initiation should be considered to help students with unmanaged symptoms.

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Ralston, Katherine. "THE MANAGEMENT OF MIGRAINE IN PRIMARY CARE." Journal of Neurology, Neurosurgery & Psychiatry 86, no. 11 (October 14, 2015): e4.176-e4. http://dx.doi.org/10.1136/jnnp-2015-312379.82.

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Migraine is a common and debilitating neurological disorder. This study aimed to audit the management of adults with migraine in a Newcastle GP practice against NICE guidelines (2012) on the acute and prophylactic treatment of migraine.A search of practice records for patients with a new diagnosis of migraine between December 2013–14 identified 38 patients. Medical records were reviewed to determine if their management was consistent with NICE guidance.Acute treatment was indicated in 35 patients, with 27 (77%) receiving correct treatment. 1 patient (3%) received unrecommended treatment, while 7 (20%) received no treatment. Prophylactic treatment was given to 11/13 (85%) patients where it was indicated. Of these, 6 (55%) received first line treatment, 1 (9%) second line treatment and 4 (36%) unrecommended treatment. All patients should be followed up after treatment initiation. This occurred or was planned in 14/35 (40%) acute patients and 6/11 (55%) prophylactic patients.The majority of patients with migraine received the correct acute treatment, however over one third of patients received unconventional preventative medication and follow up was sporadic. A template prompting the correct management of migraine has been incorporated into the computer system following this audit to improve patient care.

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Payne, Rupert. "Clinical pharmacology boost in primary care." Prescriber 32, no. 6 (June 2021): 4. http://dx.doi.org/10.1002/psb.1921.

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Epstein, C., and A. Bakanauskas. "Clinical management of DIC: early nursing interventions." Critical Care Nurse 11, no. 10 (November 1, 1991): 42–53. http://dx.doi.org/10.4037/ccn1991.11.10.42.

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Achievement of successful patient outcomes depends on the availability of a primary nurse responsible for all aspects of nursing care. A consistent caregiver not only has a grasp of phenomena at hand but possesses an overall perspective of recovery. Care can be evaluated and readjusted on a timely basis. Identification of signs of progress as well as deterioration may be facilitated through continuity of care. The primary nurse can provide meaningful, ongoing information to the patient and significant others as a means of optimizing their coping behaviors. Effective nursing care of the patient with DIC is enhanced by a thorough understanding of its pathophysiology and its clinical manifestations. When the critical care nurse has a comprehensive knowledge base and uses purposeful assessment skills, potential complications become much clearer and are avoided. The primary nurse who knows how to prioritize care is capable of anticipating the patient's needs. By integrating theory with practice, the critical care nurse functions from a position of strength in promoting quality patient care.

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Ingram, Nigel. "e-Clinical Governance. A Guide for Primary Care." Journal of Advanced Nursing 41, no. 5 (February 20, 2003): 519. http://dx.doi.org/10.1046/j.1365-2648.2003.26052.x.

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MARRELLI, TINA. "Focus on Safety at Home and Getting to That More Primary Care and Preventative Care Model." Home Healthcare Nurse 30, no. 9 (October 2012): 501–3. http://dx.doi.org/10.1097/nhh.0b013e31826bd0c4.

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Choudry, Fizzah A., Roshan P. Weerackody, Daniel A. Jones, and Anthony Mathur. "Thrombus Embolisation: Prevention is Better than Cure." Interventional Cardiology Review 14, no. 2 (May 20, 2019): 95–101. http://dx.doi.org/10.15420/icr.2019.11.

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Thrombus embolisation complicating primary percutaneous coronary intervention in ST-elevation myocardial infarction is associated with an increase in adverse outcomes. However, there are currently no proven recommendations for intervention in the setting of large thrombus burden. In this review, we discuss the clinical implications of thrombus embolisation and angiographic predictors of embolisation, and provide an update of current evidence for some preventative strategies, both pharmacological and mechanical, in this setting.

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Iannone, Luigi Francesco, Francesco De Cesaris, and Pierangelo Geppetti. "Emerging Pharmacological Treatments for Migraine in the Pediatric Population." Life 12, no. 4 (April 5, 2022): 536. http://dx.doi.org/10.3390/life12040536.

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Headaches in children and adolescents have high incidence and prevalence rates, with consequent elevated disability costs to individuals and the community. Pediatric migraine is a disorder with substantial clinical differences compared to the adult form. Few clinical trials have been performed specifically on primary headache in pediatric populations using acute and preventative treatments, often with conflicting findings. The limited high-quality data on the effectiveness of treatments are also due to the high placebo effect, in terms of reductions in both the frequency and intensity of migraine attacks in the pediatric population. The recent introduction of calcitonin gene-related peptide (CGRP) pathway inhibitors and ditans is changing the treatment of migraine, but the majority of the data are still limited to adulthood. Thus, few drugs have indications for migraine treatment in the pediatric age group, and limited evidence gives guidance as to the choice of pharmacotherapy. Herein, we review the current evidence of pharmacological treatments and ongoing clinical trials on acute and preventative treatments in the pediatric population with migraine.

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Grammatico, Megan A., Amiya A. Ahmed, Lauretta Grau, Anthony Moll, and Sheela Shenoi. "1644. “And the stick to fight TB is IPT”: Perspectives on TPT Implementation Among Senior Nurses in Rural South Africa." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S811. http://dx.doi.org/10.1093/ofid/ofaa439.1824.

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Abstract Background Tuberculosis (TB) disproportionately affects people living with HIV (PLH). The World Health Organization (WHO) has endorsed tuberculosis preventative therapy (TPT) in resource-limited settings with high HIV and TB burdens. South Africa has led global TPT efforts, yet implementation remains sub-optimal. Methods In a rural, impoverished region of South Africa with high TB and HIV prevalence, primary care clinic-based senior nurses were asked to participate in anonymous, semi-structured interviews assessing TPT knowledge, beliefs, and attitudes. The currently available regimen is isoniazid preventive therapy (IPT) for 12 months. Through an iterative process, a code list was generated and applied to each transcript. The data were analyzed using thematic analysis and Nvivo 12 software to identify facilitators and barriers to IPT prescribing. Results Among 22 nurses at 14 primary health clinics, 86% were female, median age 39 (IQR 31-54.8) years, with median 10.5 (IQR3-18) years of health care experience. Nurses felt that TPT was effective at preventing TB. Barriers to implementation included limited time to counsel patients due to understaffing in high-volume clinics and lack of documentation of IPT prescription in patients’ charts, which limited effective follow-up. Nurses certified in Nurse-Initiated Management of Antiretroviral Therapy (NIMART) expressed confidence in their IPT knowledge, but those not certified wanted additional training. Nurses identified patient-level factors impeding TPT implementation, including transportation, HIV-related stigma, mobility, particularly among men, and pill burden associated with length of IPT (12 months) with concurrent daily chronic medications. Facilitators included availability of IPT in both hospitals and primary care clinics, and capacity for task-shifting to other healthcare professionals (counselors, staff nurses). The impending rollout of 3HP (12 weeks of isoniazid-rifapentine) was viewed favorably. Conclusion Nurses identified limited time to counsel PLH and lack of standardized training programs as the main barriers to implementation of TB preventative therapy. Addressing these barriers will be critical to successful implementation of new TPT regimens. Disclosures All Authors: No reported disclosures

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Laserna Jiménez, Cristina, Mireia López Poyato, Isabel Casado Montañés, Eva Maria Guix‐Comellas, and Núria Fabrellas. "Paediatric nursing clinical competences in primary healthcare: A systematic review." Journal of Advanced Nursing 77, no. 6 (February 16, 2021): 2662–79. http://dx.doi.org/10.1111/jan.14768.

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Molinari, Victor. "Nursing Homes as Primary Care Sites for Psychological Practice." Clinical Psychology: Science and Practice 10, no. 1 (May 11, 2006): 112–14. http://dx.doi.org/10.1093/clipsy.10.1.112.

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Paradise, Matt, and Perminder Sachdev. "Vascular Cognitive Disorder." Seminars in Neurology 39, no. 02 (March 29, 2019): 241–50. http://dx.doi.org/10.1055/s-0039-1678582.

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AbstractThe term vascular cognitive disorder (VCD) refers to a heterogeneous group of disorders in which the primary feature is cognitive impairment attributable to cerebrovascular disease (CVD). This includes not only vascular dementia (VaD) but also cognitive impairment of insufficient severity to meet diagnostic criteria for dementia. VCD is recognized as the second most common cause of dementia after Alzheimer's disease (AD), but prevalence rates vary widely according to the diagnostic criteria employed. There have been recent attempts to standardize diagnostic criteria. VCD incorporates a range of neuropathological mechanisms including poststroke impairment, small and large vessel disease, and cases of mixed-pathology, with CVD interacting with AD and other neuropathologies. Recent neuroimaging data have improved our understanding of the etiology of VCD. Symptomatic treatments for VaD have modest benefit and there is increased focus on the primary and secondary preventative benefits of vascular risk factor control.

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MORGAN, WALTER A., and JOANN TROLINGER. "The Clinical Education of Primary Care Nurse Practitioner Students." Nurse Practitioner 19, no. 4 (April 1994): 62–66. http://dx.doi.org/10.1097/00006205-199404000-00012.

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Palmer, Diane. "Clinical Governance in Gastroenterology: Key Points for Primary Care." Journal of Advanced Nursing 40, no. 4 (November 2002): 485. http://dx.doi.org/10.1046/j.1365-2648.2002.24203.x.

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Want, David R., Petra Goodman, and Janet Selway. "Primary Care Nurse Practitioner Clinical Procedural Skills." Journal for Nurse Practitioners 18, no. 2 (February 2022): 200–204. http://dx.doi.org/10.1016/j.nurpra.2021.10.004.

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Dlangalala, Thobeka, Alfred Musekiwa, Alecia Brits, Kuhlula Maluleke, Ziningi Nobuhle Jaya, Kabelo Kgarosi, and Tivani Mashamba-Thompson. "Evidence of TB Services at Primary Healthcare Level during COVID-19: A Scoping Review." Diagnostics 11, no. 12 (November 27, 2021): 2221. http://dx.doi.org/10.3390/diagnostics11122221.

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Tuberculosis (TB) is still a major public health concern, despite the availability of preventative and curative therapies. Significant progress has been made in the past decade towards its control. However, the emergence of the novel coronavirus disease 2019 (COVID-19) has disrupted numerous essential health services, including those for TB. This scoping review maps the available evidence on TB services at the primary healthcare (PHC) level during the COVID-19 period. A comprehensive literature search was conducted in PubMed, Web of Science, Medline OVID, Medline EBSCO, and Scopus. A total of 820 articles were retrieved from the databases and 21 met the eligibility criteria and were used for data extraction. The emerging themes were the effect of the COVID-19 pandemic on TB services, patient and provider experiences, recommendations for TB services during the COVID-19 period, and the implementation of the recommendations. The review found that the mitigation strategies, as well as fear and stigma experienced at the start of the COVID-19 pandemic may have led to TB cases potentially going undetected, which may threaten TB treatment outcomes. Therefore, efforts must be directed at finding these missing cases and ensuring that PHC facilities are equipped to adequately diagnose and treat them.

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Phillippi, Julia C., Amy Bull, and Sharon L. Holley. "Expanding Primary Care Opportunities: Simulation for Clinical Reasoning." Journal of Nursing Education 52, no. 5 (April 12, 2013): 299–302. http://dx.doi.org/10.3928/01484834-20130412-02.

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Sharma, Nila, Elizabeth Harris, Jane Lloyd, Sabuj Kanti Mistry, and Mark Harris. "Community health workers involvement in preventative care in primary healthcare: a systematic scoping review." BMJ Open 9, no. 12 (December 2019): e031666. http://dx.doi.org/10.1136/bmjopen-2019-031666.

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ObjectivesTo review effective models of community health worker (CHW) involvement in preventive care for disadvantaged culturally and linguistically diverse (CALD) patients in primary healthcare (PHC) that may be applicable to the Australian context.DesignSystematic scoping review.Data sourcesThe studies were gathered through searching Medline, EMBASE, EMCARE, PsycINFO, CINAHL and online portals of relevant organisations.Eligibility criteriaAll selected studies were original research studies which essentially evaluated preventive intervention undertake by CHWs in PHC. The intervened population were adults with or without diagnosed chronic health disease, culturally and linguistically diverse, or vulnerable due to geographic, economic and/or cultural characteristics that impede or compromise their access to healthcare.Data extraction and synthesisData extraction was undertaken systematically in an excel spreadsheet while the findings were synthesised in a narrative manner. The quality appraisal of the selected studies was performed using effective public health practice project quality assessment tool.ResultsA total of 1066 articles were identified during the initial search of six bibliographic databases. After screening the title, abstract and full text, 37 articles met the selection and methodological criteria and underwent data extraction. A high-quality evidence-base supporting the positive impact of CHWs supporting patients’ access to healthcare and influencing positive behaviour change was found. Positive impacts of CHW interventions included improvements in clinical disease indicators, screening rates and behavioural change. Education-focused interventions were more effective in improving patient behaviour, whereas navigation interventions were most effective in improving access to services. Implementation was enhanced by cultural and linguistic congruence and specific training of CHWs in the intervention but reduced by short duration interventions, dropouts and poor adherence of patients.ConclusionThe evidence generated from this systematic scoping review demonstrates the contribution of CHWs to improving access to preventive care for patients from CALD and disadvantaged backgrounds by providing both education and navigational interventions. More research is needed on CHW training and the incorporation of CHWs into primary health care (PHC) teams.

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Burns, Penelope, Kirsty Douglas, Wendy Hu, and Peter Aitken. "The Future of Disaster Medicine is Based on Primary Care Involvement." Prehospital and Disaster Medicine 34, s1 (May 2019): s67. http://dx.doi.org/10.1017/s1049023x1900147x.

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Introduction:When disasters happen, people experience broad environmental, physical, and psychosocial effects that can last for years. Researchers continue to focus on the acute physical injuries and aspects of patient care without considering the person as a whole. People who experience disasters also experience acute injury, exacerbations of chronic disease, mental and physical health effects, effects on social determinants of health, disruption to usual preventative care, and local community ripple effects. Researchers tend to look at these aspects of care separately, yet an individual can experience them all at once. The focus needs to change to address all the healthcare needs of an individual, rather than the likely needs of groups. Mental and physical care should not be separated, nor the determinants of health. The person, not the population, should be at the center of care. Primary care, poorly integrated into disaster management, can provide that focus with a "business as usual" mindset. This requires comprehensive, holistic coordination of care for people and families in the context of their local community.Aim:To examine how Family Doctors (FDs) actually contribute to disaster response.Methods:Thirty-seven disaster-experienced FDs were interviewed about how they contributed to response and recovery when disasters struck their communities.Results:FDs reported being guided by the usual evidence-based care characteristics of primary practice. The majority provided holistic comprehensive medical care and did not feel they needed many extra clinical training or skills. However, they did wish to understand the systems of disaster management, where they fit in, and their link to the broader disaster response.Discussion:The contribution of FDs to healthcare systems brings strengths of preventative care, early intervention, and ongoing local surveillance by a central, coordinating, and trusted health professional. There is no reason to not include disaster management in primary care.

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Bucher, Dawn R. "Cultural Competence: Scholarly Nature of Clinical Practice of Nursing." Clinical Scholars Review 1, no. 2 (November 2008): 110–13. http://dx.doi.org/10.1891/1939-2095.1.2.110.

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This case study discusses combining Western and traditional medicine for a Native American woman who was treated for unruptured cerebral aneurysms and lung cancer. As her primary care provider, I managed and coordinated referral decisions, provided primary care, education, advocacy, and shared in decision making with the patient and her family.

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Jones, Siobhan. "Exploring the safety, tolerability, cost-effectiveness and efficacy of erenumab in chronic migraine." British Journal of Neuroscience Nursing 16, no. 1 (February 2, 2020): 16–25. http://dx.doi.org/10.12968/bjnn.2020.16.1.16.

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The complex pathophysiology of migraine is mirrored by the diverse pharmacological options available for sufferers, which have variable efficacy and tolerability. Recent studies have demonstrated that anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP MAbs) are efficacious in migraine prevention. An observational clinical audit was conducted, involving 16 adults with chronic migraine, all of whom had tried and failed four or more preventatives, including at least two cycles of onabotulinumtoxinA (Botox). The patients received 70 mg of erenumab at 4-weekly intervals. The objective was to assess the reduction in monthly headache days and severe headache days, reduction in acute treatments and improvement in quality of life compared with existing clinical data. This small audit demonstrated that erenumab could be an effective and well-tolerated migraine preventative for refractory patients who had not previously responded to four or more preventatives, including at least two cycles of Botox.

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Smithers, Hannah. "Routine asthma review." InnovAiT: Education and inspiration for general practice 7, no. 10 (August 27, 2014): 609–15. http://dx.doi.org/10.1177/1755738014546175.

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Asthma is the most common chronic condition seen in primary care and creates a significant work load in both primary and secondary care. Mortality and morbidity remain unacceptably high as the majority of both are avoidable with optimal use of preventative medicines. It is not only good practice to regularly review every patient with a long-term condition, but when coupled with self-management regular reviews improve clinical outcomes. All patients with asthma should therefore have the opportunity of a review at least once a year in primary care, which should be structured, patient-centred and promote self-management with the aim to minimise symptoms and enable patients to live a normal life. This article aims to provide a pragmatic approach to performing this review as a primary care clinician.

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Nance-Floyd, Betty, and Meg Zomorodi. "Clinical Site Development for the Clinical Nurse Leader in a Rural Primary Care Setting." Journal of Nursing Care Quality 33, no. 2 (2018): 95–99. http://dx.doi.org/10.1097/ncq.0000000000000322.

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Pullen, Richard. "A Clinical Review of Primary Biliary Cholangitis." Gastroenterology Nursing 43, no. 2 (2020): E48—E55. http://dx.doi.org/10.1097/sga.0000000000000480.

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Xue, Ying, and Jane Tuttle. "Clinical productivity of primary care nurse practitioners in ambulatory settings." Nursing Outlook 65, no. 2 (March 2017): 162–71. http://dx.doi.org/10.1016/j.outlook.2016.09.005.

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Tait, Allison R. "Clinical governance in primary care: a literature review." Journal of Clinical Nursing 13, no. 6 (September 2004): 723–30. http://dx.doi.org/10.1111/j.1365-2702.2004.00949.x.

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Mitsikostas, Dimos D., Leonidas I. Mantonakis, and Nikolaos G. Chalarakis. "Nocebo is the enemy, not placebo. A meta-analysis of reported side effects after placebo treatment in headaches." Cephalalgia 31, no. 5 (January 7, 2011): 550–61. http://dx.doi.org/10.1177/0333102410391485.

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The aim was to determine the magnitude of the nocebo (adverse effects following placebo administration) in clinical trials for primary headache disorders. We reviewed randomized, placebo-controlled studies for migraine, tension-type headache (TTH), and cluster headache treatments published between 1998 and 2009. The frequency of nocebo was estimated by the percentage of placebo-treated patients reporting at least one adverse side effect. The dropout frequency was estimated by the percentage of placebo-treated patients who discontinued the treatment due to intolerance. In studies of symptomatic treatment for migraine, the nocebo and dropout frequencies were 18.45% and 0.33%, but rose to 42.78% and 4.75% in preventative treatment studies. In trials for prevention of TTH, nocebo and dropout frequencies were 23.99% and 5.44%. For symptomatic treatment of cluster headache, the nocebo frequency was 18.67%. Nocebo is prevalent in clinical trials for primary headaches, particularly in preventive treatment studies. Dropouts due to nocebo effect may confound the interpretation of many clinical trials.

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Parker-Conrad, Jane, and Susan C. Jorgensen. "Book Review: Occupational Health Nursing Guidelines for Primary Care Clinical Conditions." AAOHN Journal 43, no. 11 (November 1995): 593. http://dx.doi.org/10.1177/216507999504301107.

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Dawson, N., J. Richards, and K. Frost. "The Ububele Baby Mat Service – A primary preventative mental health intervention in a culturally diverse setting." Journal of Child & Adolescent Mental Health 29, no. 1 (April 13, 2017): 85–97. http://dx.doi.org/10.2989/17280583.2017.1297308.

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Randall, Edith M. "Clinical Electrocardiography—A Primary Care Approach." Journal of Cardiovascular Nursing 1, no. 4 (August 1987): 85. http://dx.doi.org/10.1097/00005082-198708000-00011.

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Kahl, Carolina, Betina Horner Schlindwein Meirelles, Kamylla Santos da Cunha, Mariana da Silva Bernardo, and Alacoque Lorenzini Erdmann. "Contributions of the nurse’s clinical practice to Primary Care." Revista Brasileira de Enfermagem 72, no. 2 (April 2019): 354–59. http://dx.doi.org/10.1590/0034-7167-2018-0348.

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ABSTRACT Objective: To understand the repercussions of the nurse’s clinical practice on Primary Health Care. Method: Qualitative research with the theoretical and methodological contribution of Grounded Theory. Data collection took place between May and October 2016 in Florianópolis’ Primary Care service. The theoretical sample was comprised of 18 nurses divided into two groups. Results: nurses’ clinical practice has repercussions on the consolidation of the trust bond between individuals, families and communities, by amplifying the problem-solving efficacy of the Primary Health Care professional’s clinical practice. This is due to the implementation of clinical nursing protocols, and also the use of the International Classification for Nursing Practice. Final considerations: Nurses’ clinical practice has positive repercussions on the health of Primary Health Care users.

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Yeung, Aaron, Ogul E. Uner, Jill R. Wells, and Hans E. Grossniklaus. "Clinical and Histopathological Features of Corneal Primary Acquired Melanosis and Melanoma." Ocular Oncology and Pathology 7, no. 2 (2021): 103–7. http://dx.doi.org/10.1159/000511596.

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<b><i>Aim:</i></b> The aim of this study is to describe the clinical and pathologic features of corneal primary acquired melanosis (PAM) and melanoma. <b><i>Methods:</i></b> We describe 3 cases in total: two cases of corneal melanomas and 1 case of corneal PAM. The eyes were processed routinely for histopathological examination. Clinical histories, treatments, and outcomes were reviewed. <b><i>Results:</i></b> Corneal melanomas arose from recurrence of conjunctival melanoma or conjunctival PAM at the limbus. One patient had a recurrence after excision of a limbal melanoma, another had a de novo corneal melanoma, and the last patient had corneal PAM in the setting of conjunctival PAM with atypia. All lesions were excised with adjuvant alcohol debridement and cryotherapy with no recurrence ranging from 1 week to 8 years. <b><i>Conclusions:</i></b> Corneal melanomas arise at the limbus from corneal PAM or conjunctival atypia. They can appear after excisional removal of a conjunctival melanoma. Surgical excision with alcohol debridement and adjuvant cryotherapy is successful.

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Julius, Peter, Stepfanie N. Siyumbwa, Phyllis Moonga, Fred Maate, Trevor Kaile, Guobin Kang, John T. West, Charles Wood, and Peter C. Angeletti. "Clinical and Pathologic Presentation of Primary Ocular Surface Tumors among Zambians." Ocular Oncology and Pathology 7, no. 2 (2021): 108–20. http://dx.doi.org/10.1159/000511610.

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<b><i>Aim:</i></b> This study aimed to characterize the clinical and pathologic presentation of ocular surface tumors (OSTs) and to more precisely differentiate the grades of ocular surface squamous neoplasia (OSSN) and benign lesions among Zambians. <b><i>Methods:</i></b> Two-hundred sixty-five Zambian patients presenting with ocular surface growths, suspicious for OSSN, were recruited between November 2017 and November 2019 to a cross-sectional study to investigate their lesions. Sociodemographic data were collected, HIV infection status and vision tests were performed, and lesions were measured and documented. Lesions >2 mm in diameter were excised and sent for pathology analysis. In addition to the biopsies, tears, blood, and buccal swabs were collected. CD4+ T-cell counts were measured by flow cytometry. Lesions were classified according to the WHO guidelines. χ<sup>2</sup> and bivariate correlations were used to analyze variable associations and strengths with phi/Cramer’s V and correlation coefficients, respectively. Binary logistics was used to adjust for covariance. <b><i>Results:</i></b> In this study, 68.3% of the participants were found to be HIV positive. The most frequent diagnoses were invasive OSSN (45.3%), preinvasive OSSN (29.1%), and pterygium (22.6%). Invasive OSSN comprised keratinizing squamous cell carcinoma (SCC) (87.5%), basaloid SCC (3.3%), and spindle cell carcinoma (3.3%). Unusual carcinomas, not described previously, included hybrid SCC (5.0%) and acantholytic SCC (0.8%). Invasive OSSN had advanced tumor (T3/T4) staging (93.3%) at diagnosis. Lymphadenopathy was rare (2.3%), and metastasis was absent. Patients were mostly female (59.2%). Median age was 36 (interquartile ranges 33–41) years (ranges 18–81). Patients with invasive OSSN were more likely to present with pain (<i>p</i> = 0.007), redness (<i>p</i> = 0.034), excessive tearing (<i>p</i> = 0.0001), discharge (<i>p</i> = 0.011), bleeding (<i>p</i> = 0.007), reduced vision (<i>p</i> = 0.0001), fungating lesion (<i>p</i> = 0.001), and blindness (<i>p</i> = 0.005); location at temporal limbus (<i>p</i> = 0.0001), inferior limbus (<i>p</i> = 0.0001), or circumlimbal (<i>p</i> = 0.001); and extension to cornea (<i>p</i> = 0.006) and forniceal palpebral conjunctiva (<i>p</i> = 0.001). Invasive OSSN was associated with any smoking habit and alcohol consumption (<i>p</i> = 0.04 and 0.03, respectively). HIV positivity was strongly associated with OSSN (74.6% OSSN vs. 49.3% benign lesions; <i>p</i> = 0.0001; phi: 0.237 [<i>p</i> = 0.0001]). <b><i>Conclusion:</i></b> OSTs are very common in Zambia and are strongly associated with HIV coinfection. Patients with OSSN were more likely to be HIV positive than those with pterygia. Despite the commonality of OSTs in sub-Saharan Africa, these cancers have historically been poorly characterized.

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