Archive for the ‘HIV/AIDS’ Category

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Tragic Plane Crash, Truvada Concerns, Changing Infection Rates: AIDS/HIV Issues in the News

July 21, 2014
Truvada

Truvada / via Wikimedia Commons

By Jacob Molyneux, AJN senior editor

There have been a number of recent high-profile news stories as well as some notable new research related to HIV/AIDS and its treatment and prevention.

First, AJN would like to add its voice to those expressing heartfelt regret at the deaths of a number of prominent and widely respected HIV advocates and researchers in the Malaysia Airlines jet that appears to have been shot down over Ukraine last week.

The Truvada controversy. Those who who died on the plane had been heading to an international conference in Melbourne, Australia, where one of the hot topics under discussion would be the pros and cons of the continuing expansion of the use of the antiretroviral drug Truvada beyond the treatment of existing HIV infection to long-term prophylactic use by the uninfected.

The topic is particularly timely here in New York where Governor Cuomo last week announced that New York State would make Truvada a centerpiece of its HIV-prevention strategy. The drug, taken every day, is more than 90% effective in preventing infection, but, as an NPR story recently described, a number of experts have raised concerns about widespread long-term use of Truvada for HIV prevention, noting

  • serious potential side effects of Truvada.
  • the $1,300/a month cost of the drug.
  • the reduction in the use of condoms by some of those taking Truvada, which could lead to higher rates of other sexually transmitted diseases.

Read the rest of this entry ?

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Addressing Health Care Disparities: Best Practices for LGBT Patients

June 9, 2014

By Sylvia Foley, AJN senior editor

Lawrence Johnson feeds his partner of 38 years, Alexendre Rheume, at a nursing care facility. Rheume suffered from Parkinson's dementia. The couple struggled to find a facility welcoming of them as a couple. Photo © Gen Silent documentary film / http://gensilent.com.

Lawrence Johnson feeds his partner of 38 years, Alexendre Rheume. Rheume suffered from Parkinson’s dementia. Photo © Gen Silent documentary film / http://gensilent.com.

It’s arguably easier these days to identify as “queer”—lesbian, gay, bisexual, or transgender (LGBT). Our society has come a long way since 1969, when the infamous Stonewall riots and other events heralded the gay rights movement. Many LGBT people can live more openly and fully as who they are. Yet this population—which constitutes an estimated 5% to 10% of the U.S. population—continues to receive often substandard health care. In this month’s CE feature, “Addressing Health Care Disparities in the Lesbian, Gay, Bisexual, and Transgender Population: A Review of Best Practices,” Fidelindo Lim and colleagues explore these disparities and explain why it’s important for nurses in all practice settings to know how to address them. Here’s a quick overview.

The health care needs of people who are lesbian, gay, bisexual, or transgender (LGBT) have received significant attention from policymakers in the last several years. Recent reports from the Institute of Medicine, Healthy People 2020, and the Agency for Healthcare Research and Quality have all highlighted the need for such long-overdue attention. The health care disparities that affect this population are closely tied to sexual and social stigma. Furthermore, LGBT people aren’t all alike; an understanding of the various subgroups and demographic factors is vital to providing patient-centered care. This article explores LGBT health issues and health care disparities, and offers recommendations for best practices based on current evidence and standards of care.

Lim and colleagues also consider issues specific to LGBT youth and older adults, and discuss the Joint Commission’s recommendations for health care leaders. And they provide

  • a practice guide to improving cultural competence.
  • a detailed list of Web-based resources, including videos.
  • evidence-based strategies for promoting inclusive patient- and family-centered care.

For more, read the article and listen to our podcast with the lead author; both are free. We invite you to share your experiences and insights with us below.

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Nursing, HIV/AIDS, Continuity of Care, Treatment Advances, and the ACA: The Essentials

March 6, 2014

As the Affordable Care Act takes effect, a timely overview in AJN of recent developments in screening, treatment, care, and demographics of the HIV epidemic

CascadeofCare

The ‘cascade of care’ (from the AJN article)

The newly released March issue of Health Affairs is devoted to looking at the ways the Affordable Care Act (ACA) will affect Americans with HIV/AIDS and those who have recently been in jail. One crucial feature of the ACA is that it prevents insurance companies from refusing coverage to those with a number of preexisting conditions. If you have a preexisting condition and don’t get insurance through work, you know how important this is.

Unfortunately, a large majority of those with HIV and AIDS do not have private health insurance. One article in the March issue of Health Affairs draws attention to the plight of the 60,000 or so uninsured or low-income people with HIV or AIDS who will not receive health insurance coverage because their states are among those that have chosen to opt out of the ACA provision that expands Medicaid eligibility. This means many patients in these states may lack consistent care and reliable access to life-saving drugs.

Antiretroviral therapy (ART) improves patient quality of life and severely reduces expensive and debilitating or fatal long-term health problems in those with HIV/AIDS. As noted in AJN‘s March CE article, “Nursing in the Fourth Decade of the HIV Epidemic,”

The sooner a patient enters care, the better the outcome—especially if the patient stays in care, is adherent to combination antiretroviral therapy (cART), and achieves an undetectable viral load.

The authors, pointing out that only 66% of those with HIV in the U.S. are currently “linked to care” and, of these, only about half remain in care, argue that

“[e]ngaging and retaining people with HIV infection in care is best achieved by an interdisciplinary team that focuses on basic life requirements, addresses economic limits, and treats comorbid conditions such as mental illness and hepatitis C infection.”

But there’s a lot more in this article about screening, advances in drug therapy, treatment, and epidemiology that all nurses will need to know as the ACA brings more HIV-infected patients into every type of health care setting. Here’s the overview, but we hope you’ll read the article itself, which is open access, like all AJN CE features: Read the rest of this entry ?

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AJN’s December Issue: Working During a Pandemic, HIV Foot Care, Healing Pet Visits, a Focus on Narrative

November 27, 2013

AJN1213.Cover.OnlineAJN’s December issue is now available on our Web site, just in time for some holiday reading. Here’s a selection of what not to miss.

Working during a pandemic. Flu season is in swing, but how do nurses feel about working during a flu pandemic? Researchers investigating terrorism and catastrophic events found that up to 96% of health care workers reported being unable or unwilling to work during some emergencies, with some infectious diseases associated with the highest rates of unwillingness. “Predictors of Nurses’ Intentions to Work During the 2009 Influenza A (H1N1) Pandemic,” December’s original research CE, suggests that providing adequate resources during an emergency (such as personal protective equipment) will not only ensure the safety of patients, nurses, and nurses’ families, but may also increase nurses’ willingness to work in times of crisis. Earn 2.5 CE credits by reading this article and taking the test that follows. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

HIV foot care. Peripheral neuropathy, which causes debilitating symptoms such as burning pain and sensation loss in the foot, continues to be prevalent in people with HIV, but is often overlooked. “HIV Peripheral Neuropathy and Foot Care Management” reviews what is known about distal sensory peripheral neuropathy in HIV patients, and provides nurses with information on its assessment and management. You can earn 2.5 CE credits by reading this article and taking the test that follows.

Hospital noise reduction strategies. The importance of maintaining a quiet, restful environment for patients has long been recognized by nurses. Our Cultivating Quality article, “Quiet at Night: Implementing a Nightingale Principle,” describes how nurses implemented a noise-reducing strategy in their hospital to provide patients with an optimal environment for care. Listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article or downloading the podcast from our Web site.

Family pets in hospitals. Animal therapy for hospital patients can reduce stress and depression, and may aid in the healing process. “Family Pet Visitation” describes how nurses at one hospital instituted a pet visitation program to help patients feel more comforted and supported. Don’t miss the podcast interview with the author (click on the podcast icon on the first page of the article if you’re using your iPad, or visit our podcasts page).

Read the rest of this entry ?

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A Face in a Village: Remembering a First Encounter with AIDS in Africa

February 8, 2012

We’d already guessed there was a problem at the health post—we hadn’t received the last several monthly statistical reports. As a Peace Corps volunteer in the Central African Republic in the early 1990s, I reviewed these reports as part of my job at the regional health office. Another part of my job was to join a supervisory team as it traveled over dirt roads to check on health facilities from hospitals down to the village health posts staffed by a single nurse. A few months into my assignment, on our way to the provincial hospital, the team decided to stop by this particular health post to find out why we weren’t receiving reports.

That’s from “A Face in a Village,” the February Reflections essay in AJN by Susi Wyss, the author of a well-received recent novel, The Civilized World (Henry Holt, 2011). Set in Africa, the novel, like this essay, was inspired by the author’s international health career. In this essay, Wyss recalls a vivid first encounter with the ravages of AIDS and the hopelessness it inspired. (Click through to the PDF version for a cleaner read.)—JM, senior editor

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World AIDS Day, 30 Years On from That Fateful MMWR

December 1, 2011

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

“In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.”

So began the MMWR of June 5, 1981—the first herald of what became known as AIDS. Reading that report now, knowing the devastation that would follow, is chilling.

Today is World AIDS Day. It has been 30 years.

In some ways, we need this day more than ever, to remind us of the devastating potential of this condition—the Centers for Disease Control and Prevention (CDC) reports that only 28% of people in the U.S. infected with HIV get the treatment they need to suppress the virus. We need it to remind us of the millions who continue to suffer and die from it, mostly in Africa where two thirds of the AIDS cases occur.

We should also take time today to celebrate the victories. We’ve come far in the last 30 years. Effective treatments have been developed. Civil rights protections have been put in place. People with HIV can now live long, joyful, productive lives. Thirty years ago it was a death sentence, one that devastated those it affected—physically, socially, economically. Now it is a manageable illness that appears close to being controlled. Read the rest of this entry ?

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Military Metaphors, Unnecessary Admissions, New Blogs, Keeping Secrets

September 29, 2011

It’s a common scenario: a 90-year-old resident of a U.S. nursing home — call her Ms. B. — has moderately advanced Alzheimer’s disease, congestive heart failure with severe left-ventricular dysfunction, and chronic pain from degenerative joint disease. She develops a nonproductive cough and a fever of 100.4°F. The night nurse calls an on-call physician who is unfamiliar with Ms. B. Told that she has a cough and fever, the physician says to send her to the emergency room, where she’s found to have normal vital signs except for the low-grade fever, a normal basic-chemistry panel and white-cell count, but a possible infiltrate on chest x-ray. She is admitted to the hospital and treated with intravenous fluids and antibiotics. During her second night in the hospital, Ms. B. becomes confused and agitated, climbs out of bed, and falls, fracturing her hip. One week after admission, she is discharged back to the nursing home with coverage under the Medicare Part A benefit. The episode results in about $10,000 in Medicare expenditures, as well as discomfort and disability for Ms. B.

There is an alternative scenario, however . . .

That’s from an article in NEJM called “Reducing Unnecessary Hospitalizations of Nursing Home Residents.” In any health care system of as much complexity as ours, there’s bound to be a huge amount of waste. The article gives a good example of how the skills of NPs might be put to excellent use both saving a lot of money for Medicare and making the lives of nursing home residents a whole lot nicer. It may be cheaper, but it’s not “rationing”—it’s rational.

Now a matter of language rather than money: the Viewpoint essay by Kathleen Thies in the October issue of AJN is about the use of military language to refer to nursing staff. Here’s how it begins, and you can click the link to read the whole article, including the author’s suggestion for an alternative terminology. We’d love to know whether the author’s perspective resonates with you:

How often have you heard the term frontline staff used to refer to direct care nurses and others working at a patient’s bedside? It conjures images of the great world wars, of soldiers marching across battlefields to fight the enemy. The infantry are invariably young, dispensable, interchangeable. Commands are issued by generals and passed down through the ranks. No questions are asked.

Blog roll update: We’ve added some interesting new blogs to our blogroll (they’re not new blogs, actually, just new to our blogroll). A few of them are by MDs, such as The Carlat Psychiatry Blog and Movin’ Meat, and a couple of are by nurses, such as madness: tales of an emergency room nurse, which has a good short post about why it doesn’t always help to be a nurse when your family member is in the hospital (there have been a few posts on this topic lately in different venues, I think?). Also added: The Nursing Ethics Blog, which is run by two people, a nursing professor/ethicist and a philosopher. It should be interesting to explore.

As the editor of the Reflections column (and this blog), I read hundreds of submissions each year about dying patients, with a subgenre of submissions devoted to dying infants or miscarriages. Read the rest of this entry ?

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A Primary Source Reminder from the Early Days of HIV/AIDS

June 6, 2011

By Maureen Shawn Kennedy, AJN editor-in-chief

Last week, I received a press release from the National Institutes of Health noting the publication 30 years ago of the first ‘official’ report that many consider to have heralded the beginning of the AIDS epidemic—a report in the MMWR (Morbidity and Mortality Weekly Report), a publication of the Centers for Disease Control and Prevention (CDC), about cases of Pneumocystis carinii pneumonia and Kaposi’s sarcoma in otherwise healthy young men who all happened to be gay.

This report (which included various causative theories, including speculation that the weakened immune system among these gay men might somehow have resulted from the use of lifestyle drugs such as amyl nitrate!), seemed late in coming for those of us who’d been seeing unusual infections among gay men since the mid-1970s.

In 1975, I became aware of these young men when they started coming for diagnostic consultation with the physicians I worked with in a private hematology–oncology practice in New York City. No one could figure out why they had developed opportunistic infections that were normally seen only in patients who’d been on chemotherapy or who had other immune disorders. We talked about the fact that similar cases were being seen at the (now defunct) St. Vincent’s Medical Center in Greenwich Village. Read the rest of this entry ?

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On the Road to the International Council of Nurses Conference in Malta

May 2, 2011

By Shawn Kennedy, AJN editor-in-chief

So I’m on my way to Valletta, Malta (Malta is a small Southern European country in the Mediterranean Sea between Sicily and North Africa and a five-hour ferry ride from Libya) for the International Council of Nurses (ICN) meeting. Since there’s no direct flight from my usual airport (Newark, New Jersey) to Malta, it was a no-brainer to go through Paris (April, Paris?) and stop there for a few days. I hadn’t been to Paris before—it was everything I thought it would be, and more. And its reputation as the “City of Light” is well deserved (see the photo of the Eiffel Tower at night, courtesy of my husband).  

This will be my third ICN meeting—I attended the centennial meeting in London, and then one a few years later in Copenhagen. It’s amazing to meet nurses from all over the world, many of whom are grappling with issues similar to those confronting us.

Many, though, are dealing with issues far worse than our own. For example, nurses from sub-Saharan Africa face enormous odds in the face of internal conflicts as well as HIV and AIDS, and nurses in Japan have recently dealt with a series of disasters. These nurses amaze me.

And then there are colleagues who seem to be on the same professional development trajectory we’re on. Read the rest of this entry ?

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What’s Ugly? — And Other Crucial Conversations for Nurses

April 18, 2011

By Shawn Kennedy, AJN editor-in-chief

Metal billboard, Bubaque, Guinea-Bissau, 2010. Photo by Dawn Starin.

Our monthly Art of Nursing department—often, a poem or image somehow related to health care—is a unique feature for a scholarly publication, but one we feel strongly about. We believe that in order to provide truly holistic care, nurses need to know about more than evidence-based clinical content—they also need to be aware of many other aspects of the human experience. 

One thing art teaches us is that people don’t always see things the same way. What’s beautiful, illuminating, or at least useful to one person may be ugly or offensive to another. Consider billboards with public health messages. To some, such a billboard may seem to be an eyesore blotting the landscape; to others, the image and message is a powerful tool for disseminating life-saving information. Our September 2010 Art of Nursing (click through to the PDF version) showcased billboards in Guinea-Bissau, a poor country with HIV prevalence  of epidemic proportions. The billboards, photographed by Dawn Starin (here’s a blog post she wrote about them), are used to encourage people to get tested. A blog post by AJN senior editor Sylvia Foley about the column noted concerns some had expressed about these billboards:

Are the billboards effective? Starin writes, “Although the billboards are fabulous to look at, many health professionals I spoke with thought they exemplified time and money wasted, in part because of the high nationwide illiteracy rate.” One health worker emphasized the need for more culture-specific studies on sexual practices and tradition, so that appropriate education programs could be developed.

On the other hand, here’s an excerpt from a recent comment by one reader of Sylvia’s blog post:

I think using public health billboards in Guinea-Bissau to combat the epidemic of HIV-AIDS is a great tool to reach out to the community and create awareness. Creative billboards do in fact attract people’s attention especially when it’s something as important as getting tested for HIV and AIDS. I can speak from personal experience as one day I was driving down a major highway in Miami, Florida and saw a very creative billboard about getting tested. The message on the billboard stuck with me for days until I decided to get tested. These billboards may not motivate everyone to get tested but I’m sure I wasn’t the only one that this billboard inspired to get tested.

We don’t know the results of this commenter’s test results—we can only hope they were negative. But the important point is that the billboard was effective: this person got tested. 

What are some other notable billboards promoting public health messages? If you’ve seen them, send us photos of the billboards (to Shawn dot Kennedy at WoltersKluwer dot com). We’ll post them online (and credit you!) and help spread the word.

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