BACKGROUND: Preoperative education has been found to be responsible for patients having a realistic expectation of surgery as well as high level of satisfaction with their recovery. The Joint Academy offers preoperative educational classes for all patients undergoing elective knee and hip replacements. PURPOSE: The purpose of this descriptive study was to determine whether the education provided by The Joint Academy has an impact on anxiety, expectation, and preparedness in patients who undergo elective total knee or hip arthroplasty. METHODS: All patients who had total joint or hip arthroplasty over a 2-month period were invited to participate in this descriptive correlational study. RESULTS: Of the 49 study participants, 28 attended The Joint Academy. Those who attended The Joint Academy were more likely to hold surgical expectations that better correlated with actual experience (p = .425). There was no statistically significant difference between the groups for nervousness (p = .171) or feeling prepared for the surgery (p = .425). CONCLUSION: Offering education before knee or hip arthroplasty provides patients with an understanding of the expectations related to surgery.
Background: In nursing care homes (NCHs), the use of end-of-life care (EoLC) medication has traditionally been requested and prescribed on an individual basis during each resident's last days of life. However, some GPs are reluctant to prescribe EoLC medication in anticipation of symptoms occurring if, at the time of their visit, the resident is symptom-free. Even when prescribed, care home staff can experience difficulties obtaining the medication out of hours. This can result in residents not having access to appropriate medications when they are experiencing symptoms. Aim: This audit aimed to assess the feasibility of NCHs with Gold Standards Framework in Care Homes (GSFCH) accreditation keeping EoLC medications 'as stock', rather than having the medication prescribed and dispensed for individual residents when residents became symptomatic. Methods: Meetings were held with nurse managers of four NCHs with GSFCH accreditation, local pharmacists and the hospice pharmacist. A strategy to implement the stock medication was prepared. A baseline review of the notes of deceased residents 6 months pre-implementation was undertaken and information regarding symptoms and EoLC medication extracted. The review continued for 6 months after the stock EoLC medication was obtained. Results: Three NCHs participated. The notes of 92 deceased residents were examined. Fifty-three per cent of decedents were found to have experienced common EoLC symptoms. The numbers with access to EoLC medication increased once the stock medication was in place. However, some residents still had their own drugs dispensed, despite stock drugs being available. Conclusions: There is a need for all dying residents to have access to EoLC medication. The proper facilitation and implementation of EoLC medication 'as stock' into NCHs with expertise in caring for dying people could save monies at a time of NHS austerity measures. If the NCHs had relied solely on the stock medication, the reduction in medication waste would have been significant. The introduction of stock medication would also solve problems associated with obtaining medication out of hours. Conflicts of interest: none
Disparities in rural health care are associated with poor patient outcomes. There is a need to further evaluate opportunities to bridge the gaps and improve rural health care. This descriptive, exploratory study examined the current and potential expanded use of nurse practitioners (NPs) in rural hospitals of one Midwestern state. Surveys (N = 136) were mailed to chief executive officers (n = 68) and chief nursing officers (n = 68) of rural hospitals in Nebraska with a response rate of 57.3% and 80.8%, respectively. The majority of respondents represented critical access hospitals. A convenience sample of NPs (N = 19) who practiced in rural communities also completed written surveys. Findings identified potential opportunities to expand the use of NPs to provide emergency department coverage and inpatient hospital management of patients in rural hospitals. Education and training of NPs need to include the essential critical thinking and skill sets to manage these types of health care needs.
Menopausal women diagnosed with cancer appear to have a high incidence of baseline bone loss, with significant additional loss during treatment. Use of agents for prevention/treatment of bone loss in this group is infrequent. A prospective, controlled analysis is indicated to determine the optimal utility of bone densitometry testing and osteoporosis prevention strategies in this population.
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