U.S. Primary Care Provider Needs: An Analysis of Workforce Projections and Policy Implications.

The primary care (PC) physician workforce has consistently been projected as requiring additional numbers to meet the needs of the U.S. The Health Resources and Service Administration (HRSA) has reported the PC nurse practitioner (NP) workforce to be 90,000 NPs more than required to meet the PC needs of the U.S. With both clinician types contributing to the PC workforce in the country, it is difficult to understand such an oversupply of NPs with continued deficit in PC physicians. The purpose of this study was to investigate results and methods used for HRSAs current PC workforce projections and compare those with the same used for Bureau of Labor Statistics (BLS) and American Association of Medical Colleges (AAMC) projections. Methods included a review of technical documents, dashboards, and published reports. Interviews with subject matter experts were also completed. Projections were found to differ significantly, as did data and assumptions. Two of the three projections modeled physicians as the sole provider of PC. An integrated model gives the most comprehensive and accurate picture of PC workforce needs. The utilization of NPs as PC providers has been demonstrated to be safe and effective, with the potential to alleviate predicted shortages, improve patient care outcomes, reduce cost, and address PC inequities. Implications include improving workforce data, creating projections that mirror clinical integration in PC, adjusting workforce preparation funding, incentivizing interprofessional collaboration in research, addressing barriers to practice among non-physician providers, and leveraging growth in the NP workforce.

Factor V Leiden: Development of VTE in Surgery and Trauma Patients: A Systematic Review.

BACKGROUND: Factor V Leiden (FVL) is a hereditary thrombophilia, which causes the blood to be more hypercoagulable; in essence, the blood tends to clot more easily, especially under certain circumstances. It is the most common genetic mutation, causing thrombophilia in patients of white background. Patients that have FVL are at a higher risk to develop venous thromboembolism (VTE) after surgery and trauma. OBJECTIVE: The purpose of this review is to identify FVL as a risk factor, which may impede optimum acute cardiopulmonary management which may contribute to a longer length of stay (LOS) in the hospital. METHODS: This article is a systematic review of the literature involving research printed in peer-reviewed journals from 2015 to 2018. The University of Tennessee Health Science Center online library, PubMed, and Google Scholar were used for the literature search. RESULTS: The results of this study determined that although FVL is in fact a risk factor, which may impede optimum acute cardiopulmonary management which may contribute to a longer LOS, management of VTE is no different for a person with FVL compared with those without FVL. CONCLUSION: Factor V Leiden is a risk factor for the development of VTE, specifically deep vein thrombosis, in surgical, trauma, pregnant, and hormone replacement therapy patients, thus increasing LOS and recurrence of such events. Regardless of FVL status, management of VTE should be initiated promptly and discontinued when appropriate.

Neurogenic Stunned Myocardium: A Review.

Neurogenic stunned myocardium is a form of stress cardiomyopathy. The disorder is sometimes referred to as atypical Takotsubo cardiomyopathy. The pathophysiology of neurogenic stunned myocardium is hypothesized to involve significant overdrive of the sympathetic nervous system after a brain injury. Treatment options for a patient with a brain injury who has progressed to cardiogenic shock remain controversial, with no consistent guidelines. A patient with subarachnoid hemorrhage who progresses to cardiogenic shock with concurrent cerebral vasospasm presents a special treatment challenge. Neurogenic stunned myocardium is reversible; however, it must be recognized immediately to avoid or manage potential complications, such as cardiogenic shock and pulmonary edema. A multifaceted treatment approach is needed for the patient with cardiogenic shock and concurrent vasospasm.

Mast cell activation syndrome.

ABSTRACT: Mast cell activation syndrome (MCAS) is a systemic autoinflammatory disease in which mast cells behave erratically. It is unknown whether MCAS recently evolved or if it has been an unrecognized entity for years. Clinically, the patient may present in a constant to near-constant state of allergic reaction. However, the patient may also present with a variety of nonallergic symptoms. There is currently no curative treatment, and providers must prepare to be persistent in seeking symptom-management strategies. This case study describes the vast array of symptoms a typical MCAS patient may exhibit. There is a need for provider education and awareness of this disease that could affect up to 17% of the population on a spectrum from very mild to debilitating symptoms. MCAS is often either misdiagnosed or the diagnosis is greatly delayed due to a lack of provider awareness. Patients may approach primary care providers as their first line of treatment for their aberrant, mysterious symptoms, and therefore it is imperative that nurse practitioners are aware of the disease. Nurse practitioners can play a vital role in the management of MCAS using their attention to detail to recognize patterns, validate patients' experiences, and have a voice in diagnostic criteria consensus.

Chronic Obstructive Pulmonary Disease and Ventilator-Associated Pneumonia: An Analysis and Literature Review Into the Intensive Care Unit Exacerbation Progression and Acute Pulmonary Management.

The occurrence of ventilator-associated pneumonia (VAP) infections in mechanically ventilated patients has significantly affected how medical providers manage the severe acute pulmonary pathology in chronic obstructive pulmonary disease (COPD) and implement medical interventions to prevent infectious transmission to these patients in the intensive care unit. Severe COPD is present in more than 65 million people worldwide, thereby placing these individuals at an increased risk of intensive care unit admission and VAP contraction. Chronic obstructive pulmonary disease is well known as a risk factor for developing VAP and is related to adverse risk factors such as developing multiple drug-resistant bacteria. Evidence shows that COPD immunosuppression continues to be associated with pulmonary infection, but multiple modalities are available to combat and treat acute exacerbations before decompensation begins, thereby preventing prolonged endotracheal mechanical ventilation.

Education on Patient-Ventilator Synchrony, Clinicians' Knowledge Level, and Duration of Mechanical Ventilation.

BACKGROUND: Improved recognition of patient-ventilator asynchrony may reduce duration of mechanical ventilation. OBJECTIVE: To evaluate the effects of education about patient-ventilator synchrony on clinicians' level of knowledge and patients' mean duration of mechanical ventilation. METHODS: A quasi-experimental 1-group pretest-posttest study was performed in a 16-bed intensive care unit. Analysis included 33 clinicians and 97 ventilator patients. The intervention consisted of PowerPoint lectures on patient-ventilator synchrony. Data included test scores before and after the education, scores on the Acute Physiology and Chronic Health Evaluation II, and mean duration of mechanical ventilation. Differences in scores before and after education, mean duration of mechanical ventilation, and mean health evaluation scores before and after education were determined by using t tests. RESULTS: Of the 33 clinicians, 17 were registered nurses and 16 were respiratory therapists. Posttest scores were 63% higher than pretest scores (P < .001). Before the lecture, 47 patients had a mean health evaluation score of 21 (SD, 7.8) and mean duration of mechanical ventilation of 5.4 (SD, 4.6) days. After the lecture, 50 patients had a mean health evaluation score of 24.6 (SD, 8.2) and mean duration of mechanical ventilation of 4.8 (SD, 4.3) days. Mean health evaluation score was marginally higher after the lecture (P = .054). Mean duration of mechanical ventilation did not differ (P = .54). CONCLUSIONS: Clinicians' test scores increased significantly after patient-ventilator synchrony lectures. Mean duration of mechanical ventilation decreased by 0.6 days and health evaluation scores were marginally higher after the lectures.

Recommendations From an Early Adopter of a Doctor of Nursing Practice Program.

BACKGROUND: Many changes have occurred in DNP programs since they first began. University of Tennessee Health Science Center began the practice doctoral program in 1999 and today enrolls over 100 new baccalaureate nursing (BSN)-to-Doctor of Nursing Practice (DNP) students each year. More than 500 DNPs have graduated to date. METHOD: A review of the history and challenges of this program are presented as a potential exemplar for other programs to consider. RESULTS: Several changes have taken place, including a shift from Master of Science in Nursing (MSN)-to-DNP programs to almost all BSN-to-DNP programs, a new appreciation for writing skills, and movement away from a separate DNP project. CONCLUSION: Understanding these changes may help other schools of nursing as they begin DNP programs or transition from their MSN-to-DNP programs to BSN-to-DNP programs. [J Nurs Educ. 2016;55(10):563-567.].