The Impact of Text Messaging Based Smoking Cessation Interventions in Hospitalized Adult Smokers

Tobacco use is the leading cause of preventable death and disease in the world (WHO, 2008). Through both primary and secondary exposure, tobacco use affects every body system and every individual to whom nurses deliver care. According to the Center for Disease Control and Prevention (2012), each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and another 8.6 million live with a serious illness caused by smoking. Despite these risks, approximately 46.6 million U.S. adults smoke cigarettes (CDC, 2012). Tobacco abuse results in a costly burden on society. Annual smoking economic costs in the United States estimated for the years 2009–2012 were more than $289 billion, including at least$133 billion for direct medical care of adults, more than $156 billion in lost productivity,$5.6 billion (2006 data) for lost productivity due to exposure to secondhand smoke (CDC-MMWR, 2014). Quitting smoking is difficult and may require several attempts. Users often return to smoking because of withdrawal symptoms, stress, and weight gain (CDC, 2014). Stopping smoking is associated with many health benefits such as reducing the risk of lung and many other forms of cancers, reducing heart disease and reduced respiratory symptoms, and the reduction in the development of chronic obstructive pulmonary disease (COPD), (CDC, 2014). According to the CDC (2014), of the current U.S. adult cigarette smokers, 68.8% report that they want to quit completely. Starting in 2002, the number of former smokers has exceeded the number of current smokers. Smoking cessation is offered in many different options and is supported by many insurances. The purpose of this evidence based project was to add to the current knowledge and demonstrate how the use of a smart phone application can be translated into real world clinical practice to improve quality of care to the adult smoker wishing to obtain cessation. The 7-day follow back count of cigarettes per day along with the Nicotine Dependence Symptom Scale questionnaire was used to measure the effectiveness of the intervention and the degree of dependence from the baseline data at pre-intervention. The evidence based change project was based on the Transtheoretical Model of Behavioral change as it guides people to act on new behaviors modifying problem behaviors to acquire positive ones. Thirty-one potential participants were approached to participate in the project. Six participants were identified as interested in smoking cessation and agreed to participate. Soon only five would complete the project as one withdrew due to lack of interest. The data completed was analyzed and outcomes demonstrated that smoking cessation assistance through the help of a smart phone application can offer support and added motivation to quit smoking if the participant was interested in cessation. Additional scholarly inquiry regarding the topic is recommended

The Impact of Pelvic Floor Therapy on Adult Women with Intersticial Cystitis/Painful Bladder Syndrome

Interstitial cystitis/painful bladder syndrome is a major source of chronic pelvic pain and disability affecting women of all ages, predominantly age 18 years and over. Estimates of prevalence among US women range from 2.7% to 6.5% translating to 3.4 and 7.9 million women who have symptoms consistent with this debilitating condition (Kerr, 2009). The bladder epithelium has been the focus for diagnosing and treating symptoms of IC, however taking focus away from the bladder has opened the door for clinicians to explore pelvic floor dysfunction indicating that pelvic floor therapies should be a first line treatment for those women with IC/PBS (Peters & Carrico, 2006). In this evidence based practice change project, the problem of IC/PBS has been identified in a Urology/Gynecology practice in Northeastern Pennsylvania. Based on the clinical problem, a thorough literature review emphasized the solution of pelvic floor therapy as part of usual care to improve symptoms associated with IC/PBS. The evidence based change project was based on the Rosswurm and Larrabee Model. Several meetings were held with the office staff along with a local pelvic floor therapist to discuss details of the EBP change project including the effects this may have on the practice and patient centered care. The project was submitted to Misericordia University’s Internal Review Board and IRB approval was obtained for this project to move forward. Women who were 18 years or older who presented with symptoms of IC/PBS receive a complete history and physical examination, voiding diary, post void residual, full gynecological examination, urinalysis with culture, urine cytology if the patient had a smoking history, and a pain evaluation was performed. These women were invited to participate in the EBP change project. The O’Leary-Sant questionnaire which measures urinary and pain symptoms as well as how problematic these symptoms were to quality of life was performed for a baseline measure. The patient was then educated on usual care in conjunction with pelvic floor therapy. The EBP change project was explained and informed consent was reviewed. If the patient chose to be a part of the project, 8 to 12 sessions of pelvic floor therapy was provided by a trained physical therapist at a local rehabilitation center. The patient then returned to the practice setting at 4 weeks and 8 weeks for follow-up evaluation at which time the O’Leary-Sant questionnaire was readministered. The pre-test and post-test data was compiled to determine if women showed improvement of symptom and problem indices related to IC/PBS. All of the women in the project reported symptom and quality of life improvement

Closing the Loop: The Effects of Scheduling Patients\u27 Follow-up Prior to Emergency Department Discharge

Background: A large percentage of serious medical errors involve miscommunication during the hand-off of patients between medical providers. In addition, care providers do not effectively or completely communicate important information among themselves, to the patient, or to those taking care of the patient at home in a timely fashion. The communication method whether verbal, recorded, or written has proven to be ineffective. As healthcare disparities increase with healthcare complexity, it is important to extrapolate the best evidence based practice and bring these practices to the front line. Literature Search: A comprehensive literature search using the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE was performed. Medical Subject Headings (MeSH) were used in various combinations including key terms: emergency department, care coordination, and follow-up compliance. The search was limited to dates from 2004 to present, English language, Evidenced Based Medicine (EBM) reviews, Systematic Review (SR), Randomized Controlled Trials (RCT), and Human related. Selected studies demonstrated that scheduling patients’ follow-up prior to emergency department discharge has shown to be an effective method in increasing patient follow- up compliance. Several other beneficial outcomes including: increased patient satisfaction, decreased unscheduled visits to the emergency departments, possible avoidable costly hospital admissions, and an overall decrease in unnecessary health care expenditures have also been noted. Methodology: Patients who need follow-up within 30 days of emergency department discharge may be selected for enrollment. The intervention group will have follow-up scheduled for them prior to emergency department departure. The standard group will be given the hospital’s standard discharge instructions and make their own follow-up appointment. Outpatient provider offices will be contacted at 30 days following departure to ascertain if patients followed up. Selected descriptive and inferential statistics will be used as appropriate to examine follow-up compliance between groups, as well as sociodemographic factors that may impact follow-up compliance. Objective: The purpose of this research is to contribute to the growing body of knowledge supporting the transition of patient care. The project will evaluate the effects of scheduling patients for follow-up prior to emergency department discharge on followup compliance. There has been a continual growth of high level evidence that needs to be further developed and applied to the discharge of the emergency department patient

Daniel Maguire’s Sacred Choices: Method and Content

Daniel C. Maguire believes that a burgeoning world population is leading to environmental depletion and thus to human suffering and death on a massive scale. He is convinced that the only way to prevent these calamities is to permit abortion. In his examination of world religions, he finds doctrines that support abortion as a morally acceptable means of family planning. His argument in Sacred Choices, however, is fundamentally flawed. An analysis of his methods reveals inconsistencies in his reasoning. The doctrinal content supporting abortion rights that he claims to have found in each of the religions that he examines does not in fact exist