Twenty-Four-Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals.

Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18-94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was -10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (-8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation

Exercise as medicine: Providing practitioner guidance on exercise prescription

The purpose of this study was to examine the effect of a practitioner education program (consisting of education on exercise guidelines and exercise prescription) on practitioner (i) confidence in prescribing exercise and (ii) rate of prescribing exercise. A pre-post study design was utilized. A two-session practitioner education and a toolbox of resources was developed and implemented in January 2020, targeting 12 eligible practitioners at a large primary care and functional medicine office in New York City. A three-question confidence survey was given pre and post. Fifty randomly selected charts were reviewed at baseline (pre), and 25 charts were reviewed monthly for 3 months (February – April 2020) post. There were significant increases and a large effect size in both confidence in prescribing exercise (30% to 89% [p = .020, Phi = 0.596]) and individualizing an exercise prescription between pre- and post-education sessions (20% to 78% [p = .023, Phi = 0.578]). There was also a sustained and significant increase (24% to 63% [p < .001, Phi = 0.379]) in exercise prescription over the three-month period following the education sessions. No statistically significant data was obtained regarding increasing the rate of physical activity among patients. The evidence from this study demonstrates the effectiveness of increasing practitioner confidence and uptake of exercise prescription through education sessions that provide them with the knowledge and tools to properly assess patients’ activity level and offer individualized exercise recommendations

Practical Implications for Site Based Well Child Visits in Head Start

Children in poverty are at greater risk for developmental and health problems and face significant barriers in accessing routine preventive healthcare. Evidence based guidelines recommend stricter adherence to the schedule of well-child care to promote early identification and treatment. Literature indicates that well-child visits in school settings make a difference among low-income children with unmet preventive healthcare needs. This study describes the implementation of a well-child visit program in a Head Start site with enrollments of children living in poverty. The comparison study design measured the aggregate percentage of children up to date with well-child visits against historical pre-data. There were clinical increases in the proportion of children up to date with the site-based intervention. Implications support the establishment of school-based health centers in Head Start sites that provides well-child visits as well as illness management

Improving Access Through Implementation of Site-Based Well-Child Visits in Head Start

Children in poverty are at greater risk for developmental and health problems and face significant barriers in accessing routine preventive healthcare. Evidence based guidelines recommend stricter adherence to the schedule of well-child care to promote early identification and treatment. Literature indicates that well-child visits in school settings make a difference among low-income children with unmet preventive healthcare needs. This study describes the implementation of a well-child visit program in a Head Start site with enrollments of children living in poverty. The comparison study design measured the aggregate percentage of children up to date with well-child visits against historical pre-data. There were increases in the proportion of children up to date with the site-based intervention. Implications support the establishment of school-based health centers in Head Start sites that provides well-child visits as well as illness management

A Rubric For Improving The Quality Of Online Courses

All of the graduate students in the School of Nursing take some of their Master of Science courses online. A group of six School of Nursing faculty members and a graduate student received funding to determine best practices in online courses. The group developed an evaluation rubric to measure quality in the graduate online curriculum. They then applied the rubric to the core courses which are primarily offered online and are required for all graduate nursing students. The project had a positive impact on faculty by offering a tool useful for online course evaluation and development. Additionally it brought to attention the needs of faculty member development in online education. Copyright ©2008 The Berkeley Electronic Press. All rights reserved

Descriptive study of nursing scope of practice in rural medically underserved areas of Africa, South of the Sahara

Aims: The aims of this study are to describe the scope of “non-nursing duties” carried out by nurses, in rural low-resource regions of Tanzania, and describe how the role of nurses is viewed in their communities. Background: More than 70% of Tanzanians live in rural areas. Nurses are more likely than physicians to practice in these communities. As a result nurses are frequently forced to function beyond their educational preparation and expand their practice to meet the health needs of the community. Design: This exploratory study sampled two randomly selected district hospitals, with associated health centers and dispensaries (small village clinics), in each of the four target-regions (Tanga, Mtwara, Singida, and Shinyanga). Methods: In November 2014, members of the Faculty of Nursing at Kilimanjaro Christian Medical University–College (KCMUCo) in Moshi, Tanzania interviewed nurses, health facility managers, non-nurse health professionals, and health service consumers. Results/findings: Nurses at all levels of education, with or without additional training, are prescribing for patients and performing minor surgical procedures, well beyond their educational preparation. The consensus by all participants is that nurses should receive training in skills to provide primary care as a solution to the lack of providers. Conclusion: Strengthening health services by advancing the nurses’ role is an innovative way to improve health care outcomes in Tanzania

Providers as Weight Coaches: Using Practice Guides and Motivational Interview to Treat Obesity in the Pediatric Office

Motivational interview techniques combined with an evidence-based guideline provide valuable tools for the treatment of childhood obesity. The National Association of Pediatric Nurse Practitioners&apos; Healthy Eating and Activity Together guidelines were adopted in a rural pediatric office. After a 6-month pilot, effectiveness of treatment was evaluated with a retrospective chart review. The results suggest that children were motivated for healthy lifestyle changes but had difficulty maintaining motivation and compliance with healthy change choices after 1-2 months; however, with consistent use of motivational interviewing techniques combined with diet and exercise counseling, there was a trend toward lowered body mass index and waist measurements