Dementia Care: Confronting Myths in Clinical Management

Enormous challenges of this pervasive life-changing condition. Seeking help, often grasping at straws, victims, and their care providers are confronted with misinformation and myths when they search the internet or other sources. When Persons with Dementia (PWD) and their caregivers believe and/or act on false information, proper treatment may be delayed, and ultimately damage can be done. In this paper, we review commonly misunderstood issues encountered in caring for PWD. Our goal is to equip Primary Care Practitioners (PCPs) with accurate information to share with patients and families, to improve the outcomes of PWD to the greatest extent possible. While there are innumerable myths about dementia and its causes and treatments, we are going to focus on the most common false claims or misunderstandings which we hear in our Internal Medicine practice at Marshall Health. We offer suggestions for busy practitioners approaching some of the more common issues with patients and families in a clinic setting

The STOP COVID 2 study: Fluvoxamine vs placebo for outpatients with symptomatic COVID-19, a fully remote randomized controlled trial

BACKGROUND: Prior randomized clinical trials have reported benefit of fluvoxamine ≥200 mg/d vs placebo for patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This randomized, double-blind, placebo-controlled, fully remote multisite clinical trial evaluated whether fluvoxamine prevents clinical deterioration in higher-risk outpatients with acute coronavirus disease 2019 (COVID-19). Between December 2020 and May 2021, nonhospitalized US and Canadian participants with confirmed symptomatic infection received fluvoxamine (50 mg on day 1, 100 mg twice daily thereafter) or placebo for 15 days. The primary modified intent-to-treat (mITT) population included participants who started the intervention within 7 days of symptom onset with a baseline oxygen saturation ≥92%. The primary outcome was clinical deterioration within 15 days of randomization, defined as having both (1) shortness of breath (severity ≥4 on a 0-10 scale or requiring hospitalization) RESULTS: A total of 547 participants were randomized and met mITT criteria (n = 272 fluvoxamine, n = 275 placebo). The Data Safety Monitoring Board recommended stopping early for futility related to lower-than-predicted event rates and declining accrual concurrent with vaccine availability in the United States and Canada. Clinical deterioration occurred in 13 (4.8%) participants in the fluvoxamine group and 15 (5.5%) participants in the placebo group (absolute difference at day 15, 0.68%; 95% CI, -3.0% to 4.4%; log-rank CONCLUSIONS: This trial did not find fluvoxamine efficacious in preventing clinical deterioration in unvaccinated outpatients with symptomatic COVID-19. It was stopped early and underpowered due to low primary outcome rates. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov Identifier: NCT04668950

OWLOOK . . .

From the Rice Thresher Archive, a collection of newspaper articles published in the student newspaper for Rice University. Genre: New

The Reemergence of Syphilis Clinical Pearls for Consideration

Despite the near-eradication of syphilis in the United States in the late 1990s, new infections have surged over the past 20 years. Dubbed, "the great imitator," syphilis infections often can be misdiagnosed and resultantly untreated. This leads to people inadvertently infecting others. This article reviews the history of syphilis, including the unethical studies undertaken in the past; current epidemiology; treatment guidelines; and strategies to reduce new infections

Using Simulation to Prepare for Clinicals in Front-Loaded FNP Curricula

Background: Transitioning from a Master of Science degree to a Doctorate of Nursing Practice degree in a Family Nurse Practitioner program presents a challenge in course sequencing. If DNP coursework is placed after concurrent clinical and didactic courses, students will encounter situations in clinical that they have not studied in the didactic arena (increasing preceptor burden) and complete their clinicals a year before graduation. We adopted a front-loaded course sequence, placing didactic management courses before the start of clinical courses. However, students would now be exposed to didactic management content a year before beginning clinical. Methods: To enhance readiness for clinicals, we implemented a program, “Conquering Clinical,” which included a full day of simulation that reviewed four scenarios frequently encountered in primary care. Results: The students reported feeling both more confident and more competent in conducting a primary care encounter. Conclusion: A preclinical preparation program is beneficial to both students and preceptors

Family Nurse Practitioner/Psychiatric Mental Health Nurse Practitioner Collaboration in Drug-Seeking Telephone Triage Simulation in an Advanced Practice Registered Nurse Curriculum

Background: Many advanced practice nursing programs incorporate interprofessional collaboration into the curriculum. Few combine intraprofessional collaboration between nurse practitioner (NP) students of different population foci. Telephone triage is a skill that is rarely covered in NP education. Description: We describe a simulation program in which family nurse practitioner (FNP) students collaborate with psychiatric mental health nurse practitioner (PMHNP) students in a drug-seeking telephone triage scenario. The patient was portrayed by an improvisational actor. Forty-seven FNP students and 14 PMHNP students participated in the scenario. Outcome: Students reported that the telephone triage scenario was useful and that they would be more likely to both collaborate with and refer patients to NPs from the other specialties. Conclusions: With some modifications, combining FNP and PMHNP students in a telephone triage simulation scenario is beneficial to both groups of students

Making the invisible visible: Implementing an implicit bias activity in nursing education

Background: Implicit bias (IB) is a pervasive phenomenon that negatively impacts health outcomes. IB is unconscious bias that operates at a level in which the individual is not aware of its existence. There is no requirement to include IB content in nursing education. Purpose: We sought to raise awareness of IB and its influence on health outcomes and support a discussion on ways to mitigate the impact of IB. Methods: Through preparatory and interactive activities, students became familiar with IB and its effects on health outcomes, completed a selfassessment using the Implicit Association Test, and engaged in a faculty-facilitated discussion. This activity was implemented at four institutions in the United States and included 110 students at the BSN, MSN and DNP levels. Results: The activity received positive evaluations. A majority of students reported the preparatory learning activities were helpful, increased awareness of their biases and felt recognition of their IB would be helpful in managing their nursing care. Student narratives are also described in this report. Conclusions: Inclusion of IB content in nursing education is acceptable to students and faculty. The content is best included at multiple points in the course of study