Journal of the American Academy of Nurse Practitioners
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J Am Acad Nurse Pract · Nov 2008
ReviewPostpartum management for gestational diabetes mellitus: policy and practice implications.
The pathogenesis of gestational diabetes mellitus (GDM) and insulin resistance, risk factors, links to diabetes following the pregnancy, and clinical practice recommendations for this population are reviewed. Economic implications and future research needs are included. ⋯ Nurse practitioners need to be cognizant of the risks for diabetes and should follow clinical practice recommendations for routine screening and implementing preventive strategies for women who experience GDM. Office reminder systems such as standardized documentation flow sheets and electronic medical records may assist with provider adherence to practice recommendations. Strict postpartum screening and management may help reduce risks for developing diabetes in this vulnerable population.
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J Am Acad Nurse Pract · Oct 2008
ReviewImproving patient outlook in rheumatoid arthritis: experience with abatacept.
To examine the importance of improving patient outlook in rheumatoid arthritis (RA) and to discuss the role of the nurse practitioner (NP) who, through the assessment of patient-reported outcomes and in acting as an advocate for the patient with the wider healthcare team, has a crucial part to play in managing the overall well-being of the patient. This article will draw on the clinical experience to date with abatacept, a first-in-class therapy that has been approved for the treatment of RA in patients with an inadequate response to either traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, or biological DMARDs, such as tumor necrosis factor-alpha antagonists. ⋯ The use of more patient-centered measures of response are gaining increasing importance both in clinical trials and in clinical practice, and as such the NP has an important role in ensuring that both the physical and the psychological needs of patients are met. Clinical trials to date have shown that abatacept provides significant and clinically meaningful improvements in patient-reported outcomes, as well as demonstrating significant clinical benefits and a consistent safety profile, thus representing a valuable treatment option within the RA treatment armamentarium.
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J Am Acad Nurse Pract · Aug 2008
ReviewTreatment of mild to moderate dehydration in children with oral rehydration therapy.
To review current literature on the effectiveness of oral rehydration therapy (ORT) in the treatment of mild to moderate dehydration in children. ⋯ Current practice in the treatment of mild to moderate dehydration in children does not match both AAP and WHO guidelines, which are based on evidence supporting ORT effectiveness. Treatment with ORT allows children more flexibility to be treated at home and thus decreases hospital stay. Evidence shows that the time required to initiate ORT is actually quicker than IV therapy and allows for a less stressful therapy that can be performed in the home.
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J Am Acad Nurse Pract · Aug 2008
ReviewCaregiver burden among dementia patient caregivers: a review of the literature.
To identify current evidence of factors influencing dementia-related caregiver burden (CB), describe patient and caregiver characteristics associated with CB, and describe evidence-based interventions designed to lessen the burden of caregiving. ⋯ The ability to properly assess the dementia patient-caregiver dyad related to CB is critical to decreasing its negative physical and psychological health outcomes. Appropriately tailored interventions can improve the health and well-being of both caregiver and patient.