Reducing children's exposure to school bus diesel exhaust in one school district in North Carolina.

Children who are exposed to diesel exhaust from idling school buses are at increased risk of asthma exacerbation, decreased lung function, immunologic reactions, leukemia, and increased susceptibility to infections. Policies and initiatives that aim to protect school children from the harmful effects of exposure to diesel exhaust range from general environmental air quality standards to more specific legislation that targets diesel exhaust near school children. School nurse standards of practice specify that school nurses should attain current knowledge of environmental health concepts, implement environmental health strategies, and advocate for environmental health principles. This article provides a description of the professional responsibilities of school nurses in protecting children from harmful environmental exposures, provides an overview of legislative initiatives intended to protect school children from diesel exhaust exposure, and summarizes one school district's effort to reduce diesel exhaust exposure among school children.

Screening for the social determinants of health: Referring patients to community-based services.

BACKGROUND: Screening patients for the social determinants of health (SDOH) allows clinicians to identify those needs and tailor referral efforts. Due to constraints on clinic time and monetary resources, a simple screening tool incorporated into existing clinic workflow increases its usefulness and impact. LOCAL PROBLEM: Our free, nurse-led, mobile health clinic (MHC) needed an enhanced process or tool for screening patients for SDOH. The purpose of this quality-improvement project was to screen adult patients in the MHC for SDOH needs and to increase volunteer staff perceptions of their knowledge and confidence in referring patients to relevant community-based services. METHODS: A screening process and tool was developed using guidelines from the Health Leads to identify patients' SDOH needs and related requests for assistance. The tool was introduced to and tested among volunteer staff through pretest/posttest surveys. INTERVENTIONS: Patients who visited the clinic were screened for the SDOH within the project period, and volunteer staff were surveyed about their perceptions of the screening tool. RESULTS: Sixty-four patients were screened for SDOH needs. Twenty-three percent reported food insecurity, 27% housing insecurity, 14% difficulty obtaining utilities, and 17% difficulty obtaining transportation; 28% requested assistance with their reported SDOH needs. Seventeen percent of patients reported two or more SDOH needs. At posttest, 100% of volunteer staff ( N = 9) indicated satisfaction with the SDOH screening questions, reported feeling knowledgeable about resources to use for patient referrals, and were confident in referring patients to needed resources. CONCLUSION: The screening tool aptly guided practice and was evaluated as "easy to use" for clinic patients and volunteer staff.

Implementing and feasibility testing depression screening using the electronic medical record for patients with type 2 diabetes admitted to the hospital.

AIM: Is it feasible to implement a programme to screen for depression in patients admitted to the hospital for diabetes complications and use the electronic medical record to notify providers of their patient's depression score and give suggestions for medication and counselling? DESIGN: A feasibility study was conducted with patients hospitalized with diabetes and depression in the Durham Veterans Affairs Medical Center, Durham, North Carolina, United States. METHODS: Patients with type 2 diabetes were screened for depression. The healthcare provider was notified via the electronic medical record about the patients' depression scores. The provider discussed options for management of depression with the patient and initiated treatment. RESULTS: The process of screening for depression at admission, notifying the provider by way of electronic medical record that the patient screened positive for depression with suggestions for medication and counseling was feasible and acceptable to providers and patients.

Patients' experience of adolescent idiopathic scoliosis surgery: a phenomenological analysis.

Background Adolescent idiopathic scoliosis is a three-dimensional curvature of the spine of unknown cause that occurs in often otherwise fit young people. A complex surgical procedure is required for the most severe curves. Quantitative literature suggests scoliosis surgery improves patients' lives, while qualitative literature focuses on patients' concerns rather than their experience. Aims To explore how adolescents interpret their perioperative experience. Method Six participants, aged 15-18, were interviewed and transcripts were analysed. Findings Four themes were identified: shock, fears and worries; parental interaction; coping; and motivation and positivity. Conclusion Participants were reluctant to share concerns, however those they shared related more to fear of the unknown and lack of control than specific issues such as pain. Participants depended on their parents, especially their mothers, during the perioperative period, and they recognised their parents' stress. Participants coped well, were motivated and had a positive outlook.

Prostate-specific antigen screening: a critical review of current research and guidelines.

PURPOSE: Screening for prostate cancer (adenocarcinoma of the prostate), using the prostate-specific antigen (PSA) test is controversial among health professionals and organizations who publish screening guideline recommendations for healthcare professionals. Controversy stems from conflicting research studies regarding the efficacy of PSA screening with regard to improved survival rates. This article serves as a critical review of the current guidelines and research to determine which screening practices may be most beneficial to utilize with patients. DATA SOURCES: Literature review of evidence for and against using the PSA test as a screening tool published from 2007 to 2012. CONCLUSIONS: Some earlier evidence is currently used to support the guideline recommendations published by professional organizations that recommend against routine screening of asymptomatic men. However, the majority of the latest research demonstrates consistent results showing a reduction in mortality associated with PSA screening. IMPLICATIONS FOR PRACTICE: Initiating screening at age 40, to obtain a baseline value, is recommended for primary care providers and is supported by the most recent evidence.

Diabetes self-management education interventions and glycemic control among hispanics: a literature review.

Diabetes self-management education interventions have been shown to improve glycemic control in Whites and African Americans with type 2 diabetes. Hispanic women and men, however, sometimes have barriers to management including lack of access to care, low English proficiency, low literacy, and cultural differences. This review examined the state of the science related to the effects of diabetes self-management education interventions on glycemic control in Hispanics. The 8 of 9 studies showed a significant decrease in glycated hemoglobin in experimental patients. The interventions also demonstrated the success of using community health workers, bilingual interventionists, culturally sensitive designs, and accessible interventions. Limitations included weak study designs, high attrition rates, and short duration of studies.