The Gut-Brain-Microbiome Connection: Can Probiotics Decrease Anxiety and Depression?

Anxiety and depression are highly prevalent mood disorders worldwide. Complete remission of symptoms is often difficult to achieve, despite following recommended treatment guidelines. Numerous antidepressants and anxiolytics exist, and new drugs are being developed constantly, yet the incidence of common mood disorders continues to rise. Despite the prevalence of these issues, mental health treatment has not evolved much in recent years. An exciting area of research uncovered in the past decade is the gut-brain-microbiome axis, a bi-directional communication pathway. Because the human microbiome is closely related to mood, research is being done to investigate whether probiotic supplementation could potentially affect symptoms of anxiety and depression.

Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica.

BACKGROUND: Treatment of polymyalgia rheumatica (PMR) can be challenging. The most efficacious and cost-effective treatment of PMR is some type of glucocorticoid (GC), with necessary treatment duration typically one year or longer. This duration of GC use is often associated with significant morbidity. Numerous studies have been and are being conducted that focus on alternative treatment modalities. OBJECTIVES: This literature review explores alternatives to glucocorticoid monotherapy in the treatment of PMR. DATA SOURCES: An integrative literature review was conducted to evaluate peer-reviewed literature on the topic. An electronic literature search was performed in the Cochrane Database of Systematic Reviews, and an EBSCO search identified relevant articles in the following databases: MEDLINE Complete, Academic Search Premier, Cumulative Index of Nursing and Allied Health (CINAHL) Plus, PsycInfo, Education Source, SocINDEX, the CDC, and PubMed. CONCLUSIONS: Agents such as methotrexate and tocilizumab have been used successfully in conjunction with oral glucocorticoids and have demonstrated steroid-sparing effects. A promising adjunctive treatment is the monoclonal antibody, tocilizumab, which has been studied as both adjuvant and monotherapy. Further research in the efficacy, safety, and affordability of these agents is warranted. IMPLICATIONS FOR PRACTICE: Because PMR is commonly diagnosed and managed in primary care, providers should keep abreast of the most current recommendations concerning optimal treatment options and carefully weigh the risks versus benefits of long-term GC use. This expanding area of research may assist primary care providers to better treat and manage PMR as well as reduce long-term treatment risk by minimizing corticosteroid use when possible.

Evaluating knowledge, confidence, and self-efficacy of NPs and PAs in the emergency department: extended focused assessment using sonography in trauma.

BACKGROUND: Developing and translating knowledge gained in the classroom into skills that are practiced in the clinical setting is an ongoing, iterative, and dynamic process. Health care clinicians require continually evolving knowledge, ongoing education, and hands-on skills practice particular to the specialty. PURPOSE: This prospective observational study was conceived based on the existing evidence demonstrating that Point of Care Ultrasound (POCUS) is not routinely taught in nurse practitioner (NP) or physician assistant (PA) graduate programs. This study examines outcomes of an educational intervention aimed at improving knowledge, self-confidence, and self-efficacy of the Extended Focused Assessment using Sonography in Trauma (E-FAST examination) for both NPs and PAs working in emergency settings. METHODOLOGY: Twenty participants attended a short course including both didactic learning and hands-on learning of the E-FAST examination. Participants rated themselves using a self-assessment tool for pre- and postintervention self-evaluation. The Wilcoxon signed-rank test was used to evaluate data. A second tool used to evaluate participants' hands-on use of the E-FAST examination is the Objective Structured Assessment of Ultrasound, in which participants were evaluated by clinical experts. These data were assessed using regression analysis. RESULTS: Participants showed improvement on the pre/post course self-assessment tool. Participants also showed proficiency using ultrasound and analyzing images as evaluated by experts. CONCLUSIONS: A short multimodal course can improve clinicians' knowledge, confidence, and self-efficacy in the use of POCUS and the E-FAST examination. IMPLICATIONS: Hands-on education is a valuable tool for ongoing learning.

Comparing Aerobic Exercise with Yoga in Anxiety Reduction: An Integrative Review.

Anxiety is a common mental health disorder that affects many Americans yet often goes unrecognized or undertreated. The purpose of this article is to review the current literature to assist in determining which alternative and complimentary therapy, aerobic exercise or yoga, is most beneficial in reducing anxiety symptoms. The literature search process resulted in a total of 14 articles included in the review. Results indicate that yoga is more effective in decreasing anxiety symptoms than aerobic exercise. Health care providers can use this information to help recommend an alternative form of therapy for patients.

Loneliness in adults: Evidence-based research and interventions for NPs.

Loneliness is a complex psychophysiologic concept, a health risk factor, and a worrisome trend across the globe. This article reviews the latest research on the negative health effects associated with loneliness. Evidence-based NP interventions aimed at improving patients' perceived social connections are also explored.

Positive precepting: Identifying NP student learning levels and needs.

BACKGROUND AND PURPOSE: Clinical preceptors are vital partners in the education of nurse practitioner (NP) students. This article describes NP student learning stages and proposes strategies preceptors can use to facilitate precepting NP students who enter clinical rotations at varied learner levels. METHODS: Searches were conducted in the Cumulative Index to Nursing and Allied Health Literature and PubMed and EBSCOhost interfaces to MEDLINE using terms related to NPs, students, higher education, and preceptorship. Because only 10 publications met the inclusion criteria focusing on precepting NP students at different levels, literature from related health fields are included in the discussion. CONCLUSIONS: Benner's Novice to Expert Model is applied to NP education in primary care settings to describe the clinical levels of learning. Clinical teaching methods that focus on either preceptor- or student-led communication are described, followed by a discussion of the association between methods and levels of learners. IMPLICATIONS FOR PRACTICE: Nurse practitioners who precept NP students at various levels of their clinical learning can apply specific teaching methods that are delineated in this article. By recognizing the unique needs of NP students at different levels, preceptors can help facilitate their experiential learning.

Implementing Yoga Into the Management of Patients With Refractory Low Back Pain in an Outpatient Clinic Setting.

Purpose: To evaluate the effectiveness of implementing yoga into the treatment of patients with chronic low back pain. Design: Quantitative analysis with opportunity for qualitative feedback. Method: Effectiveness of this complementary treatment was assessed using a pretest/posttest design of patients who volunteered to participate in yoga classes as part of their back pain management. Measurements included low back pain rating, perception of back pain interference with daily activities, and self-efficacy in dealing with chronic low back pain. Findings: Although no statistically significant findings were found due to the small sample size, most participants demonstrated improved individual scores on all measurement surveys including qualitative comments. Conclusion: Based on the findings of this pilot study, further studies on implementing yoga into the treatment of chronic low back pain are encouraged.

Nurses as Instruments of Healing: Self-Care Practices of Nurses in a Rural Hospital Setting.

OBJECTIVE: To better understand current self-care practices and health-promoting behaviors of nursing staff in a rural hospital and determine if there is a need for further development of a holistic self-care program for nursing staff in the hospital. METHOD: In this cross-sectional, descriptive study, a structured questionnaire was used to collect data on current self-care practices and health needs and interests of hospital registered nurses, licensed practical nurses, and certified nursing assistants from inpatient, outpatient, and emergency departments. A convenience sample of 45 was employed. RESULTS: Most prevalent self-care practices included humor/laughter/play, music, spirituality/prayer, healthy sleep habits, reading, healthy nutrition, and walking. At least 75.6% answered to be extremely or likely to use three of five fitness programs (95% confidence interval [CI: 63.05%, 88.15%]). All four nutrition education programs were rated extremely likely or likely by at least two thirds of respondents (66.7%; 95% CI [52.93%, 80.47%]). Other programs of interests included health education programs and job stress management programs. Majority would participate in self-care program at work if one was offered (73.3%; 95% CI [60.37%, 86.23%]). CONCLUSIONS: Majority of nursing staff recognize the importance of self-care. There is a strong preference toward fitness programs and nutrition education programs at work to other programs.

Stopping the tsunami of stress in primary care.

This article provides an overview of the psychoneuroimmunologic impact of stress on illness along with a review of mind/body therapies to counteract the effects of stress. Primary care providers are encouraged to promote stress reduction and translate evidence into practice by recommending mind/body therapies.

Cardiovascular Update: Risk, Guidelines, and Recommendations.

This article provides an update of the current status of cardiovascular disease (CVD) in the United States, including a brief review of the underlying pathophysiology and epidemiology. This article presents a discussion of the latest American Heart Association guidelines that introduce the concept of promoting ideal cardiovascular health, defined by seven identified metrics. Specific CVD risk factors and utilization of the 10-year CVD event prediction calculator are discussed. In addition, current management recommendations of health-related conditions that increase risk for CVD, such as hypertension and hypercholesterolemia, are provided. Finally, a discussion of detailed evidence-based lifestyle recommendations to promote cardiovascular health and reduce CVD risks concludes the update.

Hypothyroidism: challenges when treating older adults.

Hypothyroidism frequently affects older adults' general sense of health, their cognitive abilities, and quality of life. Management decisions regarding when to start treatment and at what dosage to begin medication are influenced by both laboratory values and patient symptoms. Although specific guidelines regarding management of hypothyroidism in older adults do not exist, general recommendations include initiating hormone replacement with levothyroxine (Levoxyl(®), Synthroid(®), and others) at 12.5 mcg to 25 mcg and titrating the dose slowly based on response at 6-week intervals. Multiple medications and certain foods can interact with levothyroxine; therefore, the best dosage time is when a person is fasting or 4 hours postprandial. Using a consistent brand-name drug for hormone replacement with levothyroxine is important due to variations in the active ingredient in generic formulations. Providers need to be aware of the prevalence of hypothyroidism and management issues when caring for older adults.

A progressive nurse practitioner student evaluation tool.

PURPOSE: To describe the process of designing a new progressive nurse practitioner student clinical evaluation tool based on competencies. DATA SOURCES: Selected research articles and professional organization published guidelines. CONCLUSIONS: Evaluation of nurse practitioner students' clinical performance is an important and often complex responsibility of faculty. The clinical evaluation tool should reflect the changing expectations associated with particular courses across the curriculum and be based on the competencies identified by the National Organization of Nurse Practitioner Faculties. Collaboration by faculty is the key to development of an accurate and useful clinical evaluation tool. IMPLICATIONS FOR PRACTICE: The progressive nurse practitioner clinical evaluation tool presented here is the result of integrating specific clinical course outcomes and competencies recognized by key nurse practitioner associations.

Cardiovascular risk in minority and underserved women in Appalachian Tennessee: a descriptive study.

PURPOSE: The purposes of this study were to translate current knowledge regarding cardiovascular risk factors, screening, and prevention to a disparate population of women and to ascertain the cardiovascular health status and risk factors in a sample of minority and underserved Appalachian women. DATA SOURCES: Demographic data were collected from a voluntary sample of women from a disparate population living in Appalachian Tennessee. A coronary risk profile recorded family health history, personal health history, and lifestyle habits affecting risk for cardiovascular disease. Physiologic measurements included body mass index, blood pressure, fasting glucose, cholesterol levels, ankle brachial index, and carotid artery stenosis. CONCLUSIONS: Women in Appalachia Tennessee from a disparate population have high risks for heart disease and stroke. This is a critical time to address any modifiable risk factors and aggressively treat underlying cardiovascular diseases such as hypertension and hypercholesterolemia. IMPLICATIONS FOR PRACTICE: Nurse practitioners (NPs) often provide primary care to women who may not be aware of their cardiovascular risks or actual disease. NPs can ensure that their practice incorporates primary and secondary cardiovascular prevention through screening, individual health education, and aggressive evidence-based treatment plans for women.

Ankle brachial index as a prognostic tool for women with coronary artery disease.

BACKGROUND AND OBJECTIVES: Coronary artery disease (CAD) is the leading cause of death among women both nationally and internationally. Despite increased knowledge regarding CAD in women, early diagnosis remains a difficult clinical task. A correlation between peripheral arterial disease (PAD) and CAD has been noted in previous research; however, these studies were either retrospective or did not focus on women. This research investigates the correlation of ankle brachial index (ABI), measurements used to diagnose PAD, and presence of CAD in women, in an effort to determine the predictive value of ABI specifically in women. SUBJECTS AND METHODS: A prospective correlation design was used to study women (n = 30) who were undergoing a diagnostic cardiac catheterization. Ankle brachial index readings were obtained prior to the catheterization procedure. Catheterization findings were grouped according to absence of CAD or presence of 1-vessel or multivessel CAD and coupled with each woman's ABI and recorded cardiovascular risk factors. RESULTS: Peripheral arterial disease (based on ABI of <0.90 mm Hg) was found in 13.3% of the women. A significant correlation was found between ABI of less than 0.90 mm Hg and increasing age (t = -2.30, P =.029). Coronary artery disease was found in 82.1% of the women; more than half (57.1%) had multivessel disease. Absence of CAD was noted in 17.9%. Women with CAD were older than women without CAD (F = 3.86, P =.035). No significant differences were found between presence or absence of PAD based on ABI and diagnosis of no coronary disease or 1-vessel or multivessel coronary disease. CONCLUSIONS: This study failed to show the expected correlation between ABI of less than 0.90 mm Hg and CAD, but did show a significant correlation of age with presence of both PAD and CAD. Further research that focuses specifically on women is needed and should include a larger sample, additional unique cardiovascular risk factors, and innovative diagnostic tests to determine presence of CAD in women early in the disease process.

Ankle brachial index measurement in primary care setting: how long does it take?

BACKGROUND: Peripheral arterial disease (PAD) affects over 8 million people in the United States and has been found to be associated with an increased incidence of coronary and carotid artery disease. The ankle brachial index (ABI) measurement is a highly specific noninvasive screening and diagnostic test for PAD, but is rarely performed in primary care office settings. This study sought to determine the actual performance time involved in completing an ABI in a primary care office. METHODS: Data were collected by one provider on a convenience sample of women who met the inclusion criteria. The time was recorded at the beginning and upon the completion of the ABI procedure for each patient. Analysis of the time data was completed and barriers to performing the ABI were recorded by the provider. RESULTS: The average time to complete an ABI was 5 minutes, with a range of 3-11 minutes. In 83.8% of patient encounters, the ABI procedure took less than 6 minutes to complete. Barriers identified by the provider included the additional time needed to explain the test and assist patients into the proper testing position. CONCLUSIONS: The actual performance time for an ABI in a primary care setting takes an average of 5 minutes, but additional time may be required for patient preparation and education. With proper scheduling and training, the ABI can be completed in a timely manner. The ABI is an important screening/diagnostic test that can be performed in primary care and potentially impact patient treatment plans.

Correlation of ankle-brachial index values with carotid disease, coronary disease, and cardiovascular risk factors in women.

BACKGROUND: Recent studies indicate that the use of ankle-brachial index (ABI) measurements helps identify patients with peripheral arterial disease. Previous research also reveals a relationship between peripheral arterial disease and higher incidence of cardiac mortality and morbidity. PURPOSE: The purpose of this study was to investigate the correlation of a low ABI (<0.90 mm Hg) with coronary artery disease, diabetes, hypercholesterolemia, body mass index greater than 25, a sedentary lifestyle, smoking, and carotid artery disease. METHODS: A descriptive correlational design was used to study a population (N = 810) of fairly healthy women who self-selected to undergo cardiovascular screening that they paid for out of pocket. Cardiac disease and most of the data on risk factors were obtained using questionnaires. Carotid artery stenosis was determined by ultrasound. Hypotheses were tested using chi2 and independent t test. RESULTS: A statistically significant relationship was found between a low ABI and the presence of moderate to severe carotid artery stenosis (chi2 = 5.90, P = .015). A low ABI (<0.90 mm Hg) was not significantly related to cardiac disease (chi2 = 0.83, P = .362), diabetes (chi2 = 1.82, P = .177), hypercholesterolemia (chi2 = 0.01, P = .930), claudication (chi2 = 2.06, P = .151), physical activity (chi2 = 1.17, P = .884), or body mass index (t = 1.12, P = .270). CONCLUSION: The significant relationship between low ABI and carotid artery stenosis illustrates that atherosclerosis occurs in multiple arterial beds simultaneously. The lack of association between ABI and the other variables probably reflects the self-report nature of the data collected on these variables. Ankle-brachial index measurements may be useful in future research as a tool for early recognition of cardiovascular disease.