Clinical Rounds

October 2011 
Volume 41  Number 10
Pages 25 - 27
  PDF Version Available!

Advanced practice registered nurses (APRNs) provide safe, high-quality, and effective care, according to a review of studies published between 1990 and 2008 that assessed patient outcomes. Findings suggest that APRNs have a vital role in improving patient care and can safely augment the physician supply to support efforts to expand access to healthcare.The review assessed all types of APRNs, including nurse practitioners (NPs), nurse midwives, nurse anesthetists, and clinical nurse specialists, over an 18-year span. Among the findings: * APRNs are providing an increasing amount of healthcare, especially to underserved populations. * The quality of care provided by NPs and nurse midwives in collaboration with physicians is as good as, or in some cases better than, care provided by physicians alone. * Use of clinical nurse specialists in acute care settings can reduce length of stay and cost of care.Source: Newhouse RP, Stanik-Hutt J, White KM, et al. Advanced practice nurse outcomes 1990-2008: a systematic review. Nursing Economic$. 2011;29(5).Four leading medical associations have updated the 2007 guidelines for diagnosing and treating stable chronic obstructive pulmonary disease (COPD). The seven primary recommendations are as follows: 1. Spirometry should be used to diagnose airflow obstruction only in patients with respiratory symptoms. Spirometry shouldn't be used to screen patients who don't have respiratory symptoms. 2. Stable patients with respiratory symptoms whose FEV1 is between 60% and 80% predicted may be treated with inhaled bronchodilators. 3. Stable, symptomatic patients with FEV1 less than 60% predicted should be treated with inhaled bronchodilators. 4. Symptomatic patients with FEV1 less than 60% predicted should receive monotherapy using either long-acting inhaled anticholinergics or long-acting inhaled beta-agonists. 5. Stable, symptomatic patients with FEV1 less than 60% predicted may be treated with combination inhaled therapies (long-acting inhaled

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