Shared Decision Making and PSA Screening

PSA article screenshot“Should men get PSA tests to screen for prostate cancer?”

The Wall Street Journal posed the question in an informal, online poll last September. An accompanying article featured a debate between Richard Ablin, who’d discovered the prostate-specific antigen (PSA) in 1970, and an oncologist, Oliver Sartor. Ablin argued that the PSA test should be used only to screen men with a family history or active symptoms. For all other men, he said, a coin toss would be as effective. Sartor countered that the test finds cancers that can be treated early, acknowledging that for most men surveillance instead of active treatment is appropriate. Ablin retorted, “If we really could determine which cancers need treatment and which don’t, we wouldn’t be having this debate.”

The passage above is from this month’s AJN Reports by Joy Jacobson, “Navigating the PSA Screening Dilemma.”

The article gives a great overview of one of the big screening debates of the moment. Many of these debates are driven by changes in guidelines along with a dawning awareness in the medical community that certain tests we’ve assumed to be wholly beneficial, wholly necessary for most patients, may in fact be more harmful than not for many patients, leading to unnecessary treatment, anxiety, and waste of valuable resources.

The article also incorporates a discussion of the role being envisioned for “shared decision making” in helping patients make informed choices that are right for them. Let us know […]

2016-11-21T13:08:30-05:00January 23rd, 2013|Nursing|0 Comments
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Original Research: Perioperative Medication Withholding in Patients With Parkinson’s Disease

Drawing of the face of a Parkinson's disease patient showing characteristic symptoms: mainly hypomimia, a expression-less mask-like face. Appeared in Nouvelle iconographie de la Salpétrière [Tome 1] : clinique des maladies du système nerveux / publiée sous la direction du professeur Charcot,... ; par Paul Richer,... Gilles de la Tourette,... Albert Londe,.... - 1888. Chapter "Habitude exterieure et facies dans la paralyse agitante". Plate XL1V 1888 drawing of face of a Parkinson’s patient revealing “characteristic symptoms: mainly hypomimia, a expression-less mask-like face.” Appeared in Nouvelle iconographie de la Salpétrière [Tome 1] : clinique des maladies du système nerveux./Wikimedia Here’s the abstract of our January original research CE article, “Original Research: Perioperative Medication Withholding in Patients with Parkinson’s Disease: A Retrospective Electronic Health Records Review.”

Abstract

Background: Carbidopa-levodopa (Sinemet), the gold-standard treatment for Parkinson’s disease, has a short half-life of one to two hours. When patients with Parkinson’s disease are placed on NPO (nil per os, or nothing by mouth) status for surgery, they may miss several doses of carbidopa-levodopa, possibly resulting in exacerbation of Parkinson’s disease symptoms. Clear guidelines regarding perioperative symptom management are lacking.

Objectives: The goals of this study were threefold: to measure the perioperative duration of the withholding of carbidopa-levodopa in patients with Parkinson’s disease, to record the time of day surgeries were performed on these patients, and to record perioperative exacerbations of Parkinson’s disease symptoms.

Methods: We conducted a retrospective review of patient electronic health records at a […]

2016-11-21T13:08:31-05:00January 18th, 2013|nursing research|0 Comments
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What Can’t Be Taught in Nursing School

JanuaryReflectionsBy Jacob Molyneux, senior editor

The January Reflections essay in AJN, “A Special Kind of Knowledge,” is a revised excerpt from a forthcoming book, Crossing the River Sorrow, One Nurse’s Story, by Janet L. Richards. (The book will be published in June by Vantage Press.) In the essay, the author remembers an encounter she had several decades ago as a nursing student caring for a newly paralyzed young woman. Here’s a paragraph from near the start:

I stood by Carrie during those first harrowing hours in the ICU as she awaited surgery, everyone still hoping for the best. As a brand-new student, I was a silent observer, unsure of how to participate. Her young husband also watched, slumped against the heater under the window at his wife’s bedside. His eyes blazed, wild with fear and disbelief as he struggled to make sense of his sudden immersion into the alien world of disability. I could identify. Pressure sores, urinary catheters, bowel programs, and spasms—these were now part of my new and ever-expanding medical vocabulary. A spinal cord severed at C6 meant life as a quadriplegic. Suddenly this book knowledge seemed all too real.

And here’s a few lines from near the end, to give a sense of the crucial insight the author gained as she struggled to bridge the gap between herself, her patient, and the patient’s husband:

Pain can be palpable as it moves across the space between two people, molten, […]

2016-11-21T13:08:32-05:00January 17th, 2013|nursing perspective, students|3 Comments
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How Bad Is the Flu Right Now, and Should Nurses Get Vaccinated?

Shawn Kennedy, MA, RN, AJN editor-in-chief

The news has been full of reports about the influenza outbreak, deaths from complications, and shortages of vaccine and antivirals. Is the flu season as bad as purported, or are we experiencing media hype? Nurses are frequently asked for information by family, friends, and neighbors (and strangers—I was in a restaurant once and a diner at a nearby table, having overheard my conversation with a colleague, leaned over and asked if he could ask me a health question!), so here’s the latest information.

WeekEndingJanuary5FluView Week ending 1/5/2013; brown indicates states w/ widespread flu activity. CDC

According to the latest Centers for Disease Control and Prevention (CDC) report for the week ending January 5, epidemiologists from all states except three reported (see map) widespread “influenza-like illness” (ILI, meaning fever and cough or sore throat). California and Mississippi reported regional activity and Hawaii reported sporadic activity. The District of Columbia reported local spread. And while officials in some cities and states declared public health emergencies, the CDC notes that “influenza activity remained elevated in the U.S., but may be decreasing in some areas.”

One of the indicators is the proportion of people seeking treatment for ILI. Thus far, that number has risen as high as 6.0%, but has since fallen to 4.3%, as of January 5. In prior years deemed as moderately severe flu seasons, that indicator rose as high as 7.6%.

So in terms of history, we’re […]

2016-11-21T13:08:33-05:00January 14th, 2013|nursing perspective|6 Comments
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Fear of Violence: A Poor Rationale for Better Mental Health Care

Insulin shock therapy is given in Lapinlahti Hospital, Helsinki in 1950s (Wikimedia) Insulin shock therapy is given in Lapinlahti Hospital, Helsinki in 1950s (Wikimedia)

By Doug Olsen, PhD, RN, associate professor, Michigan State University College of Nursing, and AJN contributing editor. Olsen regularly addresses topics related to nursing ethics.

There are many good reasons to provide better mental health care in the United States; however, the prevention of mass murder is not one of them.

Mental disorders involve great suffering, and many people who could find some relief through treatment either don’t receive it in a timely fashion or never receive it at all. After the large psychiatric hospitals of the mid-20th century discharged their patients in waves of deinstitutionalization starting in the 1970s, many of the resources that were promised to support these people in the community never materialized. In recent decades, many persons with mental disorder have ended up in the prison system, often for minor offenses, where treatment, if received at all, can be harsh and inadequate. (See: Early, P. (2006). Crazy: A Father’s Search Through America’s Mental Health Madness). A

Adequate resources to support all persons with serious and persistent mental illness in the community would prevent and alleviate a tremendous […]

2016-11-21T13:08:34-05:00January 11th, 2013|Ethics, Nursing, Patients, safe staffing|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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