Tricyclic and Tetracyclic Antidepressants for the Prevention of Frequent Episodic or Chronic Tension-Type Headache in Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Tension-type headaches are a common source of pain and suffering. Our purpose was to assess the efficacy of tricyclic (TCA) and tetracyclic antidepressants in the prophylactic treatment of tension-type headache. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the ISI Web of Science, and clinical trial registries through 11 March 2017 for randomized controlled studies of TCA or tetracyclic antidepressants in the prevention of tension-type headache in adults. Data were pooled using a random effects approach. KEY RESULTS: Among 22 randomized controlled trials, eight included a placebo comparison and 19 compared at least two active treatments. Eight studies compared TCAs to placebo, four compared TCAs to selective serotonin reuptake inhibitors (SSRIs), and two trials compared TCAs to behavioral therapies. Two trials compared tetracyclics to placebo. Single trials compared TCAs to tetracyclics, buspirone, spinal manipulation, transcutaneous electrical stimulation, massage, and intra-oral orthotics. High-quality evidence suggests that TCAs were superior to placebo in reducing headache frequency (weighted mean differences (WMD): -4.8 headaches/month, 95% CI: -6.63 to -2.95) and number of analgesic medications consumed (WMD: -21.0 doses/month, 95% CI: -38.2 to -3.8). TCAs were more effective than SSRIs. Low-quality studies suggest that TCAs are superior to buspirone, but equivalent to behavioral therapy, spinal manipulation, intra-oral orthotics, and massage. Tetracyclics were no better than placebo for chronic tension-type headache. CONCLUSIONS: Tricyclic antidepressants are modestly effective in reducing chronic tension-type headache and are superior to buspirone. In limited studies, tetracyclics appear to be ineffective in the prophylactic treatment of chronic tension-type headache.

Perceptions of the Role of the Doctor of Nursing Practice-Prepared Nurse: Clarity or Confusion.

Confusion and disagreement about the DNP degree and its implications continues despite the rapid and steady growth of DNP programs. There is a paucity of literature that examines nurses' perceptions of the role of the DNP-prepared nurse. The purpose of this study was to explore how nurses perceive the role of the DNP-prepared nurse and identify areas of ambiguity in understanding the roles that DNP-prepared nurses fulfill. A descriptive, cross-sectional design, using self-administered questionnaires, explored the perceptions of n = 340 nurses with various educational levels and backgrounds. Descriptives of the sample and instruments were conducted as well as chi-square analyses to detect differences in perceptions across levels of education. Results indicated that nurses clearly supported the DNP degree with a focus on the improvement of health care outcomes through the roles of leadership in health organizations, policy, interprofessionalism, and translation of evidence into practice. Multiple areas of confusion concerning the role of DNP-prepared nurse existed in academia, academia leadership, and scholarship. In order to reduce role ambiguity, the distinctive contributions of the DNP-prepared nurse must be embraced, valued, and operationalized. Otherwise, the role of the DNP-prepared nurse will continue to be discussed, debated, and challenged.

Doctor of nursing practice programs across the United States: a benchmark of information: part I: program characteristics.

The number of doctor of nursing practice (DNP) programs in the United States has dramatically increased. To date, there is a lack of benchmark data regarding DNP program attributes; thus, the purpose of this investigation was to generate such a database. Because of the volume of information gathered, the results are presented in a two-part article. Part I consists of DNP program characteristics, which include location of program, type of program, delivery, plan of study, program length, number of credits, cost, program tracks, practice course name, review of programs still offering the master's degree for advanced practice nurses (APNs), and the availability of nursing education electives. Part II consists of information regarding DNP admission criteria. A cross-sectional, descriptive design was used to explore 137 DNP programs across the United States. Data were collected exclusively via university Web sites. Descriptive statistics including frequencies, percentages, means, and standard deviations were calculated and presented in report, table, or figure format. This comprehensive DNP program characteristic database is the first, to our knowledge, that is available for review. As universities prepare to develop, amend, and seek accreditation for their DNP programs, knowledge of these characteristics would be helpful to compare, contrast, and construct curricula.

Doctor of nursing practice programs across the United States: a benchmark of information: part II: admission criteria.

The adoption of the doctor of nursing practice (DNP) degree by the American Association of Colleges of Nursing has led to the exponential growth of DNP programs across the United States. This article is Part II of a 2-part series exploring DNP program information. The purpose of this research was to create a benchmark of information that can be used to compare and contrast programs throughout the United States. Part I discussed DNP program characteristics. Part II consists of DNP admission criteria that include graduate record examination (GRE) requirements, grade point average (GPA), national certification, degree requirements, specialty foci, clinical hours, and prerequisite courses. A cross-sectional, descriptive design was used to explore 137 DNP programs across the United States. Data were collected exclusively via university Web sites. Descriptive statistics were calculated and presented in report, table, or figure format. As we move forward with the DNP, effective selection of students is of critical importance because admission and retention of outstanding candidates will ultimately strengthen the field of nursing. The data generated by this research provides programs with a starting point for discussion regarding admission criteria for the DNP degree.

Veteran satisfaction with RN voice-mail greeting.

Voice-mail communication is often used to convey information between the registered nurse (RN) and the Veteran. Using a pretest-posttest design, this study examined whether implementation of a standardized voice-mail greeting had an impact on Veteran satisfaction and the number of messages left on the RN voice-mail. Veterans were more satisfied and there was a significant decrease in RN voice-mail messages post-implementation. This study highlights effects of the voice-mail greeting and has implications for other health care settings.

Impact of health literacy and patient trust on glycemic control in an urban USA population.

Diabetes, with its consequences of premature death, complications, and economic costs, is a precursor to a public health crisis that is expected to worsen over the next several decades. The improvement of diabetes outcomes, specifically glycemic control as measured by glycosylated hemoglobin concentration (HbA1c), can impact this critical situation. A quantitative study was conducted that examined health literacy and patient trust as predictors of glycemic control. The related factors of demographics, socioeconomic status, diabetes knowledge, self-care activities, and depression were also considered. Implementing a cross-sectional, predictive design, a convenience sample of 102 patients with diabetes was recruited from two urban primary care clinics in the USA. A simultaneous multiple regression was conducted. The regression analysis was significant, with patient trust and depression accounting for 28.5% of the variance in HbA1c. There was a significant positive relationship between socioeconomic status and health literacy and between diabetes knowledge and health literacy. The results support promotion of the patient-provider relationship, depression screening among individuals with diabetes, and exploration of new strategies for diabetes education. Future research is needed to advance the framework, ascertain which factors engender patient trust, and determine the role of health literacy in glycemic control.

Perceptions of distance education among nursing faculty members in North America.

A strategy to increase access to nursing education, train nurses for practice, and prepare future nurse educators is distance education. Faculty member shortages are cited as the main reason for not accepting qualified applicants. Faculty members are the core of nursing education. In order to address nursing faculty members' concerns regarding distance education and to assist in faculty member recruitment, retention, growth, and development in order to improve and enhance the quality of distance education, one must answer the question: What are nursing faculty members' perceptions of distance education in nursing? Utilizing a number of databases to locate research specific to this topic, this article provides an integrative review of the nursing literature to ascertain the faculty members' perspective of distance education. The research was analyzed, findings summarized, and limitations mentioned. Utilizing a brief supplementary review of the literature, the implications, recommendations, and need for future research are discussed.

Assessment and measurement of health literacy: an integrative review of the literature.

Research linking health literacy to health knowledge, health behaviors, health outcomes, health disparity, health status, and increasing health-care costs is prevalent around the globe. Given the importance of health literacy, it is prudent to examine the tools available to assure that patients are health-literate. This article provides an integrative review in order to investigate what has been developed to evaluate health literacy in the health-care setting. The research questions considered include: (i) Which instruments or screening tools are available to assess or measure health literacy in the clinical setting?; and (ii) What are the psychometric properties, advantages, and limitations of the identified tools? A number of databases are utilized to locate research specific to this topic. The research is analyzed, the findings are summarized, and the limitations are mentioned. The implications, recommendations, and the need for future research are discussed.

Health literacy: a concept/dimensional analysis.

The terms "health" and "literacy" form a powerful concept that has evolved from the 1970s to one that has garnered the attention of a wide range of disciplines; most notably, education and health care, but also library science, public health, and the mental health arena. There are many definitions of health literacy, but none that encompass the totality by which the concept is constructed. This paper presents an analysis of the concept of health literacy using the technique of concept/dimensional analysis. A clear understanding of the concept is essential as health literacy has implications that are far-reaching and impact both the individual and society.