2017 Gold Report Refines COPD Treatment Algorithms

“As with many other chronic diseases, laboratory measures don’t always consistently reflect the extent of a person’s clinical symptoms or quality of life.”

Updated recommendations for managing COPD.

(click image to expand)

It’s nearly autumn, the time of year when we start to see exacerbations of chronic lung disease, including COPD. That’s why we’ve included an informative and readable COPD update in this month’s AJN.

Authors Amy O’Dell and colleagues discuss the latest recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD was launched 20 years ago in order to disseminate strategies for the prevention and management of this disease. The most recent GOLD report was released in 2017, with its recommendations further tweaked this year.

Treatment category based on spirometry plus symptoms and history.

One of the most exciting aspects of the 2017 recommendations is the way in which spirometry and a person’s clinical symptoms and history of exacerbations have been put together in order to determine a patient’s treatment category.

In the past, spirometric measurements have been key drivers of treatment. Yet as with many other chronic diseases, laboratory measures don’t always consistently reflect the extent of a person’s clinical symptoms or quality of life. Some people have “off the charts” lab readings for some […]

2018-09-21T08:52:41-04:00September 21st, 2018|Nursing|0 Comments
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Quality of Life? Whatever the Patient Believes It Is

Illustration by Eric Collins / ecol-art.com

“What kind of life is that? That’s not how I would want to live.”

In AJN‘s September Reflections essay, “His Wonderful Life,” nurse Elizabeth Buckley interrogates her own judgmental response to a patient with a bluff, abrasive personality (he calls her ‘Nurse Ratchet during their first encounter) who requires nearly nonstop care to stay alive.

The patient has little hope of a meaningful recovery even if he survives the current hospitalization. The reader is surprised when, after a first grueling night of touch-and-go care, the author decides to take him on as her primary patient because she thinks it might be “a good learning opportunity.” (“I texted my friend who worked the day shift to sign me up; she replied that I was crazy.”)

A good life is in the eye of the beholder.

‘Philip,’ obese and with progressive dyspnea and multiple comorbidities, is sure he’ll soon be able to return to his bedbound existence at home watching old movies and chatting on Facebook; the physicians and other nurses are less hopeful. Gradually, over the course of five nights, the author’s respect and affection for the patient grows. He loves his life, however narrow it may seem to an outside observer.

2018-09-19T08:49:44-04:00September 19th, 2018|Nursing, patient experience, Patients, personal health practices|1 Comment
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What Nurses Need to Know About Antidepressant Medications

Rising rates of major depression and suicide.

A recently published Health of America report from Blue Cross Blue Shield, Major Depression: The Impact on Overall Health, highlights a dramatic rise in major depression diagnoses—up 33%—from 2013 to 2016. According to the report, women were found to have major depression at twice the rate of men.

Perhaps most startlingly, rates of major depression have risen 47% among millennials, while among adolescents the increase has been 47% in boys and 65% in girls.

‘Sorrowing Old Man,’ by Vincent Van Gogh. Photo by Peter Horree/Alamy Stock Photo.

In an equally disturbing trend, the CDC has noted that the rate of suicide in the United States rose more than 25% from 1999 to 2016, with 45,000 people dying by suicide in 2016 alone. Suicide rates are higher among people who have mental illnesses, and suicide is of particular concern among those who have depression. Yet the CDC also points out that more than half of people who died by suicide had not been diagnosed with a mental health condition.

An antidepressants primer for nurses.

Given the rapidly rising rates of depression diagnoses, nurses are increasingly likely to encounter patients […]

2018-09-14T10:19:30-04:00September 14th, 2018|mental illness, Nursing|0 Comments
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Why Do Children With Visible Disabilities Make Us Uncomfortable?

What do you do when you see a child who has obvious visible disabilities? Do you say hello? Do you turn away?

In this month’s Viewpoint, “Afraid to Notice: On Responding to Children with Visible Disabilities,” pediatric nurse Lindsey van Gennep talks about her experiences working with medically fragile children in the community. She has learned a lot about kids with various abilities and their capacity to simply be “kids,” and also a lot about how people react to children who are different.

“While taking them on field trips or to doctor’s appointments, I’ve noticed looks of sadness and pity. I’ve noticed the mothers who, assuming the child is mine, look at me as if I must have abused substances during pregnancy—looks of disgust.”

Pretending not to see.

But van Gennep found that the reactions of people who didn’t even acknowledge the child she was with could be even more upsetting.

“Four women with children walked by. They didn’t stare at her, or at me. Instead, they quickly looked away, as if they had just seen a stranger naked. They looked away—out of embarrassment that they had looked at all. The passing children followed their mothers’ cues and snapped curious eyes away from my patient.”

[…]

2018-09-12T11:28:10-04:00September 12th, 2018|Nursing|0 Comments
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Have A Seat—Or Maybe Not

Too much sitting is harmful.

Photo © blue jean images.

In this month’s AJN, author Linda Eanes sounds the alarm about the health risks associated with the way most of us spend much of our waking life: sitting down. Her article, “Too Much Sitting: A Newly Recognized Health Risk,” reviews research on the health effects of prolonged uninterrupted sitting (sitting for 30 minutes or more) and high-volume sitting (sitting for seven hours or more each day).

Studies show an association between high-volume and prolonged uninterrupted sitting and health risks, including cardiovascular disease, diabetes, and all-cause mortality. Sedentary time is also linked to obesity and an increased risk of certain cancers, including ovarian, endometrial, and colon cancer.

Eanes notes:

“Simply put, too much sitting, with its characteristic reduced energy expenditure and absence of whole body movement, may jeopardize health even in the presence of regular exercise.”

Exercise matters, but we’re still sitting too much.

Unfortunately, Eanes’s statement describes my life (see my September editorial) and that of most people I know: sitting at a desk, sitting while commuting, and doing some exercise a few hours a week. (Or what we like to think of […]

2018-09-10T10:06:16-04:00September 6th, 2018|Public health|0 Comments
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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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