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Burnett C, Evans DD, Mueller K. Managing Diabetes Mellitus in the Emergency Department. Adv Emerg Nurs J 2024; 46:58-70. [PMID: 38285424 DOI: 10.1097/tme.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Diabetes mellitus (DM) is a chronic medical condition that continues to increase in prevalence. Complications of DM, including diabetic ketoacidosis and hyperglycemic hyperosmolar state, often present in the emergency department requiring emergent management. Prompt assessment, diagnosis, evaluation of laboratory values, treatment, monitoring, and strict follow-up education are essential to the successful management of this complex disease. Common medications and management strategies are key elements to control DM. This article presents an overview of DM, including its prevalence, pathophysiology, presentations, and management.
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Affiliation(s)
- Caitlin Burnett
- Nell Hodgson Woodruff School of Nursing, Emory University Atlanta, Georgia
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2
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Davis WD, Evans DD. Guest Editorial: Emergency Nurse Practitioner Scope and Standards of Practice. Adv Emerg Nurs J 2024; 46:1-2. [PMID: 38285414 DOI: 10.1097/tme.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Wesley D Davis
- Family & Emergency Nurse Practitioner Program Coordinator and Associate Professor College of Nursing University of South Alabama Mobile, Alabama
| | - Dian Dowling Evans
- Professor Emeritus Emergency Nurse Practitioner Program Emory University Nell Hodgson Woodruff School of Nursing Atlanta, Georgia
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3
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Brown AC, Evans DD, Tucker P. Is Ketamine an Effective Treatment of Acute Agitation in the Emergency Department? Implications for APRN Practice. Adv Emerg Nurs J 2023; 45:253-259. [PMID: 37885076 DOI: 10.1097/tme.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
This article reviews the results of a randomized controlled trial, "Rapid Agitation Control with Ketamine in the Emergency Department: A Blinded, Randomized Controlled Trial" by D. Barbic et al. (2021), comparing time to sedation, level of sedation, and adverse outcomes between intramuscular ketamine versus intramuscular midazolam and haloperidol among acutely agitated patients presenting to the emergency department (ED). The findings are discussed in the context of practice change for patient stabilization within the ED. Emergency department nurse practitioners must employ continuing education and remain current with clinical practices and treatment options to ensure that patients receive optimal safe care. Although the use of midazolam and haloperidol has historically been the first-line treatment for the acutely agitated patient, use of ketamine shows promise in providing a safe alternative for expedited patient stabilization for acutely agitated patients presenting to the ED.
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Affiliation(s)
- Andrea C Brown
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Evans DD, Hoyt KS. Ophthalmologic Emergencies: Assessment and Management. Adv Emerg Nurs J 2023; 45:E9-E38. [PMID: 37885088 DOI: 10.1097/tme.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
There are an estimated 2-3 million emergency department (ED) visits in the United States for eye complaints. Although most patients who present to the ED have nontraumatic eye complaints, many seek treatment for eye trauma, which is a leading cause of unilateral blindness and vison impairment. Given the prevalence of eye-related emergencies, it is imperative that emergency care providers understand how to recognize and treat eye complaints to prevent permanent vision loss and disability. This article covers basic eye anatomy and physiology, discusses a systematic approach to the eye examination, and presents the evidence-based treatment of selected, common nonemergent and emergent eye complaints. For each complaint, essential history questions, examination techniques, differentials, and emergency management have been presented.
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Affiliation(s)
- Dian Dowling Evans
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Evans); and Hahn School of Nursing and Health Science, University of San Diego, San Diego, California (Dr Hoyt)
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Davis WD, Schumann L, Evans DD, Ramirez E, Wilbeck J. Guest Editorial: Exposing Research Misconduct and Data Misrepresentation Targeting Nurse Practitioners in Emergency Care. Adv Emerg Nurs J 2023; 45:165-168. [PMID: 37501265 DOI: 10.1097/tme.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Wesley D Davis
- Family and Emergency Nurse Practitioner Track Coordinator and Assistant Professor College of Nursing University of South Alabama Mobile, Alabama
| | - Lorna Schumann
- Commission Chair American Academy of Nurse Practitioners Certification Board Austin, Texas
| | - Dian Dowling Evans
- Professor Emeritus Emergency Nurse Practitioner Program Emory University Nell Hodgson Woodruff School of Nursing Atlanta, Georgia
| | - Elda Ramirez
- Professor of Clinical Nursing Cizik School of Nursing & UT Health, Houston, Texas
| | - Jennifer Wilbeck
- Emergency Nurse Practitioner Program Director and Professor Vanderbilt University School of Nursing Nashville, Tennessee
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6
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Page A, Evans DD. Catamenial Pneumothorax: An Unusual Cause of Abdominal Pain. Adv Emerg Nurs J 2023; 45:206-209. [PMID: 37501271 DOI: 10.1097/tme.0000000000000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
A catamenial pneumothorax is a very rare condition resulting in spontaneous and recurrent pneumothoraces that occur in relationship with menses (T. Marjański et al., 2016). Although rare, emergency providers should consider this condition when female patients present to the emergency department with chest discomfort and dyspnea during menstruation. This case describes a patient who presented to the emergency department with abdominal pain who was incidentally found to have a catamenial pneumothorax on diagnostic imaging for her complaint of acute abdominal pain.
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Affiliation(s)
- Amanda Page
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
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Alvarez M, Evans DD, Tucker P. Spontaneous Pneumothorax: Controversies in Treatment. Adv Emerg Nurs J 2023; 45:169-176. [PMID: 37501266 DOI: 10.1097/tme.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The Research to Practice column critiques a current research article and translates the findings, in the context of a case, to a practice change within emergency settings. This article reviews the findings of a randomized controlled trial conducted by A. Theille et al. (2017) comparing the use of needle decompression versus chest tube insertion for management of spontaneous pneumothorax. The study found that use of needle aspiration was safe and effective and was associated with fewer procedure-related complications and significantly shorter hospital stays. The investigators concluded that needle aspiration be used as a first-line, definitive treatment in management of a spontaneous pneumothorax. As emergency providers examine improved and equally effective approaches to care that are associated with less costs and potential complications, needle aspiration offers a beneficial approach and should be shared with patients when discussing treatment options to ensure shared decision making.
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Affiliation(s)
- Marlen Alvarez
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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8
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Davis WD, Schumann L, Evans DD, Ramirez E, Wilbeck J. Exposing research misconduct and data misrepresentation targeting nurse practitioners in emergency care. J Am Assoc Nurse Pract 2023; 35:337-339. [PMID: 37265352 DOI: 10.1097/jxx.0000000000000875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Wesley D Davis
- College of Nursing, University of South Alabama, Mobile, Alabama
| | - Lorna Schumann
- American Academy of Nurse Practitioners Certification Board, Austin, Texas
| | - Dian Dowling Evans
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | - Elda Ramirez
- Cizik School of Nursing, UT Health, Houston, Texas
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Bhimani A, Frenkel TS, Evans DD. The Use of Activated Charcoal in Toxicology and Implications for APRN Practice. Adv Emerg Nurs J 2023; 45:90-96. [PMID: 37106490 DOI: 10.1097/tme.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This Research to Practice article is designed to help aid advanced practice registered nurses (APRNs) with up-to-date research guidelines in order to establish evidence-based changes in clinical practice within emergency medical care. The article, "Activated Charcoal and Poisoning: Is It Really Effective?" by Aksay et al. (2022), examines whether the usage of activated charcoal (AC) in current treatment protocols for ingested poisonings adds benefits, given recent controversies in its use. Study variables included clinical findings in relation to the drug being ingested, the frequency and usage of an antidote, the rate of being intubated, and the duration of being hospitalized comparing poisoned patients who received AC with those who did not. APRNs need to be aware of the current guidelines to help establish the appropriateness of use when administering AC and be able to evaluate patients during and after the administering of AC. Improved awareness and education regarding the different treatment modalities for toxicology patients such as AC can help with certain kinds of poisonings in the emergency department.
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Affiliation(s)
- Alisha Bhimani
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Marco CA, Courtney DM, Ling LJ, Salsberg E, Reisdorff EJ, Gallahue FE, Suter RE, Muelleman R, Chappell B, Evans DD, Vafaie N, Richwine C. The Emergency Medicine Physician Workforce: Projections for 2030. Ann Emerg Med 2021; 78:726-737. [PMID: 34353653 DOI: 10.1016/j.annemergmed.2021.05.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE The goals of this study were to determine the current and projected supply in 2030 of contributors to emergency care, including emergency residency-trained and board-certified physicians, other physicians, nurse practitioners, and physician assistants. In addition, this study was designed to determine the current and projected demand for residency-trained, board-certified emergency physicians. METHODS To forecast future workforce supply and demand, sources of existing data were used, assumptions based on past and potential future trends were determined, and a sensitivity analysis was conducted to determine how the final forecast would be subject to variance in the baseline inputs and assumptions. Methods included: (1) estimates of the baseline workforce supply of physicians, nurse practitioners, and physician assistants; (2) estimates of future changes in the raw numbers of persons entering and leaving that workforce; (3) estimates of the productivity of the workforce; and (4) estimates of the demand for emergency care services. The methodology assumes supply equals demand in the base year and estimates the change between the base year and 2030; it then compares supply and demand in 2030 under different scenarios. RESULTS The task force consensus was that the most likely future scenario is described by: 2% annual graduate medical education growth, 3% annual emergency physician attrition, 20% encounters seen by a nurse practitioner or physician assistant, and 11% increase in emergency department visits relative to 2018. This scenario would result in a surplus of 7,845 emergency physicians in 2030. CONCLUSION The specialty of emergency medicine is facing the likely oversupply of emergency physicians in 2030. The factors leading to this include the increasing supply of and changing demand for emergency physicians. An organized, collective approach to a balanced workforce by the specialty of emergency medicine is imperative.
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Affiliation(s)
- Catherine A Marco
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH.
| | - D Mark Courtney
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Louis J Ling
- Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - Edward Salsberg
- George Washington University Fitzhugh Mullan Institute for Health Workforce Equity, Washington, DC
| | | | - Fiona E Gallahue
- Department of Emergency Medicine, The University of Washington, Seattle, WA
| | - Robert E Suter
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX; Department of Community Medicine, Oklahoma State University, Tulsa, OK; Department of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Robert Muelleman
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Bradley Chappell
- Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Nathan Vafaie
- Emergency Medicine Residents' Association (EMRA), Dallas, TX
| | - Chelsea Richwine
- George Washington University Fitzhugh Mullan Institute for Health Workforce Equity, Washington, DC
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Dowling Evans D, Hoyt KS, Davis WD, Wilbeck J. Revisioning the ENP Among Emergency Workforce Changes: Specialty or Population? Adv Emerg Nurs J 2021; 43:171-177. [PMID: 34397491 DOI: 10.1097/tme.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dian Dowling Evans
- Guest Editor Professor and Director Family/Emergency Nurse Practitioner Program Nell Hodgson Woodruff School of Nursing Emory University Atlanta, Georgia
| | - K Sue Hoyt
- Professor, ENP/NP Programs, University of San Diego Hahn School of Nursing and Health Science Beyster Institute for Nursing Research San Diego, California
| | - Wesley D Davis
- Assistant Professor Dual Family Nurse Practitioner/Emergency Nurse Practitioner Track Coordinator Emergency Nurse Practitioner Specialty Coordinator University of South Alabama Mobile, Alabama President-Elect American Academy of Emergency Nurse Practitioners Leander, Texas
| | - Jennifer Wilbeck
- Professor and Director ENP Specialty Vanderbilt University School of Nursing Nashville, Tennessee Executive Director American Academy of Emergency Nurse Practitioners Leander, Texas
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Brockett-Walker C, Lall M, Evans DD, Heron S. Racial Bias Among Emergency Providers: Strategies to Mitigate Its Adverse Effects. Adv Emerg Nurs J 2021; 43:89-101. [PMID: 33915556 DOI: 10.1097/tme.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Research to Practice column presents an analysis of current and controversial research findings with implications for practice change relevant to emergency care settings. This review critiques Johnson et al.'s (2016) investigation, titled "The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias," that examined emergency department characteristics and stressors and their effects on physician racial bias and decision making. Their findings suggest that unconscious biases can affect clinical decisions when providers experience increased cognitive stress. The implications are significant for emergency providers as resources are especially strained during the COVID-19 pandemic and as the adverse effects of unconscious bias on health disparities and patient outcomes have become clearly apparent. Implicit bias training (IBT) is recommended for emergency providers and has significant implications for medical and nurse educators in executing and evaluating IBT outcomes.
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Affiliation(s)
- Camille Brockett-Walker
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Drs Brockett-Walker and Evans); and Department of Emergency Medicine, Emory School of Medicine, Atlanta, Georgia (Drs Lall and Heron)
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Kelly UA, Evans DD, Baker H, Noggle Taylor J. Determining Psychoneuroimmunologic Markers of Yoga as an Intervention for Persons Diagnosed With PTSD: A Systematic Review. Biol Res Nurs 2017; 20:343-351. [PMID: 29130314 DOI: 10.1177/1099800417739152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a growing body of research on yoga as a therapeutic intervention for psychological symptoms of post-traumatic stress disorder (PTSD) accompanied by speculations on underlying physiologic mechanisms. The purpose of this systematic review is to identify, qualitatively evaluate, and synthesize studies of yoga as an intervention for PTSD that measured physiologic outcomes in order to gain insights into potential mechanisms. The focus is on studies evaluating yoga as a therapeutic intervention for PTSD rather than for trauma exposure, PTSD prevention, or subclinical PTSD. Multiple databases were searched for publications from the past two decades using terms derived from the question, "In people with PTSD, what is the effect of yoga on objective outcomes?" Eligibility criteria included yoga-only modalities tested as an intervention for formally diagnosed PTSD with at least one physiologic outcome. Results of this review confirmed that, though much of the published literature proposes physiological mechanisms underlying yoga's effects on PTSD, very few studies ( n = 3) have actually evaluated physiological evidence. Additionally, several studies had methodological limitations. In light of the limited data supporting yoga's beneficial effects on autonomic nervous system dysregulation, we present a theoretical model of the psychoneuroimmunologic processes associated with PTSD and the effects yoga may have on these processes to guide future research. Gaps in the literature remain for mechanisms related to activation of the hypothalamic-pituitary-adrenal axis and inflammation. Additional rigorous mechanistic studies are needed to guide development of effective yoga interventions for PTSD to augment existing evidence-based PTSD treatments.
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Affiliation(s)
- Ursula Ann Kelly
- 1 Atlanta VA Medical Center, Decatur, GA, USA.,2 Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Dian Dowling Evans
- 2 Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Helen Baker
- 2 Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
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Tucker PW, Evans DD, Clevenger CK, Ardisson M, Hwang U. Feasibility of nurses measuring gait speed in older community-dwelling Emergency Department patients. Geriatr Nurs 2016; 37:453-457. [PMID: 27477084 DOI: 10.1016/j.gerinurse.2016.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/13/2016] [Accepted: 06/19/2016] [Indexed: 11/27/2022]
Abstract
Gait speed assessment is a rapid, simple and objective measure for predicting risk of unfavorable outcomes which may provide better prognostic and reliable information than existing geriatric ED (Emergency Department) screening tools. This descriptive pilot project was designed to determine feasibility of implementing gait speed screening into routine nursing practice by objectively identifying patients with sub-optimal gait speeds. Participants included community-dwelling adults 65 years and older with plans for discharge following ED treatment. Patients with a gait speed <1.0 m/s were identified as "high-risk" for an adverse event, and referred to the ED social worker for individualized resources prior to discharge. Thirty-five patients were screened and nurse initiated gait speed screens were completed 60% of the time. This project demonstrates ED gait speed screening may be feasible. Implications for practice should consider incorporating gait speed screening into routine nursing assessment to improve provider ED decision-making and disposition planning.
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Affiliation(s)
- Paula W Tucker
- Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA 30033, USA; Emory University Hospital, Emergency Department, 1364 Clifton Road, NE, Atlanta, GA 30322, USA; Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA.
| | - Dian Dowling Evans
- Emory University Hospital, Emergency Department, 1364 Clifton Road, NE, Atlanta, GA 30322, USA; Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Carolyn K Clevenger
- Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA 30033, USA; Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Michelle Ardisson
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
| | - Ula Hwang
- Department of Emergency Medicine, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, P.O. Box 1620, New York, NY 10029, USA; GRECC (Geriatric Research, Education and Clinical Center), James J. Peters VA Medical Center, 130 Kingsbridge Road, Bronx, NY 10468, USA
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Abstract
This article discusses the current, evidence-based guidelines for managing venomous snakebites indigenous to the United States. A review of common varieties of venomous snakes, venom effects, risk factors for snakebites, and management strategies are presented to assist nurse practitioners in caring for snakebite victims.
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Affiliation(s)
- Dian Dowling Evans
- Emergency Nurse Practitioner Program at Emory University's Nell Hodgson Woodruff School of Nursing, Atlanta, Ga, USA
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Ilardi SS, Craighead WE, Evans DD. Modeling relapse in unipolar depression: the effects of dysfunctional cognitions and personality disorders. J Consult Clin Psychol 1997; 65:381-91. [PMID: 9170761 DOI: 10.1037/0022-006x.65.3.381] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Survival analytic models were used to determine the effects of Axis II pathology and dysfunctional cognitions on depressive relapse in a sample of 50 depressed inpatients followed 33 to 84 months (M = 49.9) postdischarge. In analyses based on follow-up interview measures, expected remission duration among patients without personality disorders was approximately 7.4 times longer than among patients with Axis II comorbidity. Attributional style also accounted for unique variance in the relapse model, with adaptive positive event attributions inversely related to relapse probability. Neither dysfunctional attitudes nor negative event attributions were significantly related to relapse. Dimensional Axis II Cluster B and C pathology ratings were associated with decreased survival time, whereas Cluster A pathology was associated with increased survival. Among measures obtained during index hospitalization, only the dimensional rating of Axis II pathology was significantly predictive, with a cumulative 8% decrease in expected survival for each Axis II criterion item met.
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Affiliation(s)
- S S Ilardi
- Department of Psychology, University of Colorado, Boulder 80309-0345, USA
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Abstract
A maximum likelihood factor analysis with Promax rotation was performed on the Montgomery-Asberg Depression Rating Scale for 340 adult inpatients in an Affective Disorders Program. Four factors were identified and labeled cognitive-pessimism, affective, cognitive-anxiety, and vegetative. Recommendations were offered for the research and clinical use of the factor scores.
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Affiliation(s)
- W E Craighead
- Department of Psychology, University of Colorado, Boulder 80309-0345, USA
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18
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Evans DD. HIV antibody testing of pregnant women. Med J Aust 1992; 157:843. [PMID: 1454031 DOI: 10.5694/j.1326-5377.1992.tb141315.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Blanchard EB, Appelbaum KA, Radnitz CL, Michultka D, Morrill B, Kirsch C, Hillhouse J, Evans DD, Guarnieri P, Attanasio V. Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache. J Consult Clin Psychol 1990. [PMID: 2186066 DOI: 10.1037//0022-006x.58.2.210] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sixty-six tension headache patients were randomly assigned to one of four conditions for 8 weeks: (a) progressive muscle relaxation (PMR) alone; (b) PMR plus cognitive therapy (PMR + Cog); (c) pseudomeditation, a credible attention-placebo control; or (d) continued headache monitoring. A comparison of overall headache activity (headache index), derived from a daily headache diary, for 4 weeks before treatment to 4 weeks after treatment, revealed that active treatment (PMR and PMR + Cog) was superior to either control condition. Moreover, level of headache medication consumption decreased significantly for the active treatment groups. Although headache-index comparisons of the two active treatments showed no advantage for adding cognitive therapy to PMR, a measure of clinically significant change showed a trend for PMR + Cog to be superior to PMR alone.
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Affiliation(s)
- E B Blanchard
- Center for Stress and Anxiety Disorders, State University of New York at Albany 12203
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20
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Blanchard EB, Appelbaum KA, Radnitz CL, Michultka D, Morrill B, Kirsch C, Hillhouse J, Evans DD, Guarnieri P, Attanasio V. Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache. J Consult Clin Psychol 1990; 58:210-5. [PMID: 2186066 DOI: 10.1037/0022-006x.58.2.210] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sixty-six tension headache patients were randomly assigned to one of four conditions for 8 weeks: (a) progressive muscle relaxation (PMR) alone; (b) PMR plus cognitive therapy (PMR + Cog); (c) pseudomeditation, a credible attention-placebo control; or (d) continued headache monitoring. A comparison of overall headache activity (headache index), derived from a daily headache diary, for 4 weeks before treatment to 4 weeks after treatment, revealed that active treatment (PMR and PMR + Cog) was superior to either control condition. Moreover, level of headache medication consumption decreased significantly for the active treatment groups. Although headache-index comparisons of the two active treatments showed no advantage for adding cognitive therapy to PMR, a measure of clinically significant change showed a trend for PMR + Cog to be superior to PMR alone.
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Affiliation(s)
- E B Blanchard
- Center for Stress and Anxiety Disorders, State University of New York at Albany 12203
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21
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Blanchard EB, Appelbaum KA, Radnitz CL, Morrill B, Michultka D, Kirsch C, Guarnieri P, Hillhouse J, Evans DD, Jaccard J. A controlled evaluation of thermal biofeedback and thermal biofeedback combined with cognitive therapy in the treatment of vascular headache. J Consult Clin Psychol 1990; 58:216-24. [PMID: 2186067 DOI: 10.1037/0022-006x.58.2.216] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One-hundred-sixteen patients suffering from vascular headache (migraine or combined migraine and tension) were, after 4 weeks of pretreatment baseline headache monitoring, randomly assigned to one of four conditions: (a) thermal biofeedback with adjunctive relaxation training (TBF); (b) TBF plus cognitive therapy; (c) pseudomediation as an ostensible attention-placebo control; or (d) headache monitoring. The first three groups received 16 individual sessions over 8 weeks, while the fourth group continued to monitor headaches. All groups then monitored headaches for a 4-week posttreatment baseline. Analyses revealed that all treated groups improved significantly more than the headache monitoring group with no significant differences among the three treated groups. On a measure of clinically significant improvement, the two TBF groups had slightly higher (51%) degree of improvement than the meditation group (37.5%). It is argued that the attention-placebo control became an active relaxation condition.
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Affiliation(s)
- E B Blanchard
- Center for Stress and Anxiety Disorders, State University of New York, Albany 12203
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22
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Fredrikson M, Blumenthal JA, Evans DD, Sherwood A, Light KC. Cardiovascular responses in the laboratory and in the natural environment: is blood pressure reactivity to laboratory-induced mental stress related to ambulatory blood pressure during everyday life? J Psychosom Res 1989; 33:753-62. [PMID: 2621677 DOI: 10.1016/0022-3999(89)90091-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiovascular activity recorded at rest and during mental stress in the laboratory was studied in relation to ambulatory recorded cardiovascular activity at work and at home. Fifty-five Type A men (M = 42.4 years) underwent a standardized laboratory mental stress protocol in which systolic blood pressure, diastolic blood pressure, and heart rate were recorded at baseline and during a 15 min mental arithmetic task (MAT). On a subsequent day, ambulatory blood pressure and heart rate were recorded at 20 minute intervals for 12-14 hr during normal activities at home and at work. Subjects completed a behavioral diary concurrently with each cuff inflation. High and Low groups were identified based upon a median split of their cardiovascular response levels at baseline and during the MAT. Subjects with high systolic blood pressure levels during the MAT had high systolic blood pressure at home, at work, during physical activity, and when they reported being 'stressed'. Baseline systolic blood pressure in the laboratory was less consistently related to ambulatory systolic pressure across ambulatory conditions. Diastolic blood pressure at baseline was related to ambulatory diastolic blood pressure at work, at home, and when resting. Diastolic blood pressure during the MAT was associated with higher diastolic pressure at work and at home. Heart rate at baseline and during the MAT was related to heart rate at work and during physical activity. Change scores derived by subtracting mean values during the MAT from baseline resting levels were not associated with ambulatory blood pressures or heart rates under any daily conditions. In the best case, systolic blood pressure measured during the MAT was related to systolic blood pressure during physical activity, to systolic blood pressure and heart rate during mental stress, to systolic and diastolic blood pressure at rest, and to systolic blood pressure and heart rate at work but not at home. We conclude that levels of blood pressure and heart rate measured in the laboratory, but not reactivity (i.e, change scores) during the MAT, are related to blood pressure and heart rate levels recorded in the natural environment, especially in the work setting.
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Affiliation(s)
- M Fredrikson
- Department of Psychiatry and Psychology, Karolinska Institute, Stockholm, Sweden
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23
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Abstract
A man with malignant fibrous histiocytoma of the thigh had avid uptake of Tc-99m MDP in the lesion. Review of tissue sections showed considerable accumulation of iron in the tumor. Iron is known to be a potential nidus for deposition of the Tc-99m diphosphonates. A review was made of tissue sections from two other reported cases of malignant fibrous histiocytoma which also had significant accumulation of Tc-99m diphosphonates. Both revealed iron within the tumor. The origin of the iron is unknown (perhaps from necrosis and hemorrhage, from trauma, or from innate phagocytic activity of the histiocytes). However, this observation may serve as a stimulus to studies attempting to discern the underlying mechanisms of extraosseous deposition of the Tc-99m diphosphonates.
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Affiliation(s)
- R P Spencer
- Department of Nuclear Medicine, University of Connecticut Health Center, Farmington 06032
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24
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Abstract
The ability of demographic, psychological testing and history information to predict which patients will terminate early from nonpharmacological treatment of headache (relaxation and biofeedback) was tested. Information from each of these areas was initially examined for differences between dropouts and treatment completers using univariate analyses. These analyses were followed by a canonical discriminate function analysis that predicted whether patients would complete treatment or drop out. Information from the three predictor sets combined resulted in 77.4% of the patients being correctly classified.
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Affiliation(s)
- D D Evans
- Duke University Medical Center, Durham, North Carolina 27710
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25
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Blanchard EB, Radnitz CL, Evans DD, Schwarz SP, Neff DF, Gerardi MA. Psychological comparisons of irritable bowel syndrome to chronic tension and migraine headache and nonpatient controls. Biofeedback Self Regul 1986; 11:221-30. [PMID: 3607089 DOI: 10.1007/bf01003481] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Comparisons were made among patients with IBS (n = 55), tension headache (n = 69), or migraine headache (n = 68) and nonpatient controls (n = 64) on the MMPI and several other psychological tests, including BDI, STAI, Life Events, and Psychosomatic Symptom Checklist. With two nonsignificant exceptions (MMPI scale F and Life Events) the groups were consistently ordered, in terms of increasing psychological distress: Normals less than Migraine Headache less than Tension Headache less than IBS. The IBS patients were more like the tension headache patients than any other group. Subgroups of IBS patients, on the basis of presence or absence of diarrhea or constipation in addition to abdominal pain, were generally not significantly different on the psychological tests.
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Blanchard EB, Andrasik F, Appelbaum KA, Evans DD, Myers P, Barron KD. Three studies of the psychologic changes in chronic headache patients associated with biofeedback and relaxation therapies. Psychosom Med 1986; 48:73-83. [PMID: 3511494 DOI: 10.1097/00006842-198601000-00006] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Three separate, but similar, studies are described in which the psychologic effects (depression, anxiety, and overall degree of psychosomatic distress) of nonpharmacologic treatment (relaxation and/or biofeedback training) for three kinds of chronic headache (tension, migraine, and mixed migraine and tension) were evaluated. Results showed consistently (across all three studies) significant reductions in depression and trait-anxiety associated with receiving treatment, regardless of headache type or treatment outcome. The significant reduction for overall degree of psychosomatic distress was not differentially related to receiving treatment and thus could have been due to prolonged monitoring of headaches or test-retest regression effects.
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Blanchard EB, Andrasik F, Appelbaum KA, Evans DD, Jurish SE, Teders SJ, Rodichok LD, Barron KD. The efficacy and cost-effectiveness of minimal-therapist-contact, non-drug treatments of chronic migraine and tension headache. Headache 1985; 25:214-20. [PMID: 3926719 DOI: 10.1111/j.1526-4610.1985.hed2504214.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Blanchard EB, Andrasik F, Evans DD, Hillhouse J. Biofeedback and relaxation treatments for headache in the elderly: a caution and a challenge. Biofeedback Self Regul 1985; 10:69-73. [PMID: 3910118 DOI: 10.1007/bf00998679] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Results for 11 older (60 years or greater) headache patients treated with combinations of biofeedback and relaxation are presented. Overall, only 18.2% were clinically improved after treatment. None of the 5 tension headache patients were improved. Suggestions for future work with the older headache patient are offered.
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Abstract
This is a case report of a patient with cystic renal cell carcinoma that had all of the ultrasound and computed tomographic features of benign multicystic renal disease. Although this benign entity is a possibility in some patients, thick-wall cystic lesions of the kidney must be considered malignant until proven otherwise and surgery cannot be avoided.
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Abstract
Computed tomography (CT) is an accurate and efficient means for evaluating and characterizing renal masses. Using established criteria, benign cortical cysts may be accurately differentiated from complex cysts or solid renal lesions. We report a case of cyst wall thickening simulating a cystic tumor that occurred after percutaneous aspiration of a simple renal cyst.
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Evans DD, Hinrichsen CF. Proceedings: Case report of a trilaminar human embryo. J Anat 1974; 118:397-8. [PMID: 4448785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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McLeod GM, Evans DD. Australia antigen in Tasmania. Med J Aust 1973; 1:957. [PMID: 4715404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
The preparation and some
reactions of the N-tosyl derivative of 3-(2?- nitropropenyl)indole
(1), indole-3-carbaldehyde (2), indole-3- glyoxylamide (3), and 2,3-di-hydrocarbazol-4(1H)-one (7) are described. The N-tosylnitropropenyl derivative (1) was converted into α-methyl-1-
tosyltryptamine, and the reaction of
2,3-dihydro-9-tosyl-carbazol-4(1H)-one (7) with ethoxyethynylmagnesium bromide and in the Mannich and Cope-Knoevenagel reactions are described.
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Evans DD, Weale J, Weyell DJ. Synthesis of some tricyclic amines - Hexahydro-1H-indenoazepines and a Hexahydro-1H-benzo-quinoline and -isoquinoline. Aust J Chem 1973. [DOI: 10.1071/ch9731333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
2,3,4,4a,5,6-Hexahydro-1H-indeno[7,1-cd]azepine
(6), 2,3,3a,4,5,6- hexahydro-1H-benzo[de]quinoline (10),
2,3,3a,4,5,6-hexahydro-1H- benz[de]isoquinoline (12), isolated as their
hydrochlorides, and 2,3,4,4a,5,6-hexahydro-1H-indeno[7,1-bc]azepine (8) have been
prepared by lithium aluminium hydride reduction of the corresponding lactams
which were synthesized from the appropriate tricyclic ketones by Beckmann
rearrangement or Schmidt reaction. The base (8) was also synthesized from
1,2,3,4-tetrahydronaphthalene-1,8-dimethanol (15).
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