Longitudinal study of impact of medication for opioid use disorder on Hamilton Depression Rating Scale.

OBJECTIVE: This study aimed to evaluate the longitudinal treatment effect on depression measured by Hamilton Depression Rating Scale (HAM-D) score in a randomized clinical trial for the treatment of opioid use disorder (OUD). METHODS: We conducted a secondary data analysis of data from the National Institute on Drug Abuse's Clinical Trials Network Protocol-0051. Patients with OUD (N = 570) were randomized to receive buprenorphine/naloxone (BUP-NX, n = 287) or extended-release naltrexone injection (XR-NTX, n = 283). The HAM-D score was completed at baseline and follow-up visit up to 36 weeks. A linear mixed model analysis was performed for log transformed HAM-D score and a generalized linear mixed model analysis was conducted for depression status. RESULTS: Compared with BUP-NX, subjects randomized to XR-NTX had higher HAM-D scores at weeks 1 and 3 (p<0.05). There were significant interactions between treatment and visit on HAM-D score and depression status during the first four weeks of treatments in individuals without lifetime major depressive disorder (MDD). Past year cocaine use was associated with HAM-D score and depression status just in individuals without MDD, whereas past year cannabis use was associated with HAM-D score and depression status just in individuals with MDD. Past year amphetamine use was associated with HAM-D score just in individuals without MDD, however, lifetime anxiety was associated with HAM-D scores regardless of MDD. CONCLUSION: When prescribing XR-NTX, particularly in the first month of treatment, it is essential to monitor for depressive symptoms. Screening for depression and multiple substance abuse may help clinicians identify appropriate treatment.

Readiness of Non-Veteran Health Administration Advanced Practice Registered Nurses to Care for Those Who Have Served: A Multimethod Descriptive Study.

Federal, state, and educational policy, as well as public and professional initiatives, should influence how care is delivered to veterans from non-Veteran Health Administration (VHA) advanced practice registered nurses (APRNs) located in civilian health care facilities. Due to the MISSION Act, more veterans are receiving care outside the VHA, but little is known about the readiness of APRNs to address the needs of this population. This mixed-methods study describes the perceptions of 340 non-VHA APRNs concerning practice, clinical needs, and challenges they face while delivering care to veterans. Survey results show only 8% of APRNs consistently asked about military service; less than 1% asked if the patient has a family member with military history; and only 25% applied research by inquiring into military history when patients presented with conditions like chronic pain, interpersonal violence, or insomnia. Technology use via mobile application was minimally reported (<1%). "Missing in Action," the overarching theme from qualitative data, included three subthemes: (a) absence facilitated collaboration with VHA, (b) concerns regarding personal competency in the care of the military person, and (c) lack of recognition of the significance of the need to know about military status. Practice implications proffered include implementation of mandatory inquiry into military service and enactment of APRN veteran-centric nursing competencies. Education actions involve updating graduate nursing programs to include veteran health content and increased policy awareness. Future research should encompass replication of this study in specific APRN roles and consist of ongoing evaluation of veteran care by the civilian sector as the MISSION Act is implemented.

Interventions for self-management of type 2 diabetes: An integrative review.

BACKGROUND: Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes? PURPOSE/OBJECTIVES: The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus. DESIGN: An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies. PROCEDURES: A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5). RESULTS: Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year. CONCLUSIONS: Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies.

Nurse practitioners' completion of Physician Orders for Scope of Treatment forms in West Virginia: A secondary analysis of 12 months of data from the state registry.

BACKGROUND AND PURPOSE: Advanced care planning documents, such as the Physician Orders for Life-Sustaining Treatment (POLST), require authorized medical provider signatures; only recently have nurse practitioners (NPs) been authorized to sign these forms. Recent legislation in West Virginia (WV) granting NPs signatory authority on POLST forms and the creation of a statewide registry provides an opportunity to examine the completion rates. The aim of this study was to investigate how recent legislation allowing NPs signatory authority for POLST forms has affected POLST completion. METHODS: Data were obtained from the WV statewide registry of POST forms completed by all authorized personnel. Forms submitted by NPs were compared with those completed by physicians on patient demographics, setting, resuscitation status, level of medical intervention, and errors. Variables were cross-tabulated by provider type to determine whether and how NP POST completion differed from that of physicians. CONCLUSIONS: Forty-five NPs submitted 430 POST forms to the WV registry, which constituted 14.4% of the POST forms received. Ten NPs in community and hospital specialist palliative care teams submitted more than two thirds of these 430 forms. Nurse practitioner-completed POST forms were more likely to order do not resuscitate and comfort measures than POST forms ordered by physicians (both p < .001) and to be without errors (p < .001). IMPLICATIONS FOR PRACTICE: Nurse practitioners practicing in specialist palliative care roles in communities and hospitals have embraced the use of POST and followed through on complete and accurate completion of the forms. With this signatory authority, primary and specialist NPs have the potential to improve end-of-life care.