Category: nursing education

Urinary Incontinence: What You Need to Know

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Urinary incontinence (UI) is a common condition characterized by the involuntary loss of urine. There are several types of UI, each with distinct pathophysiology, signs and symptoms, and treatment approaches.

Stress incontinence occurs when weakened pelvic floor muscles or damage to the urethral sphincter allow urine leakage during activities that increase abdominal pressure, such as coughing, sneezing, or exercise. The pathophysiology involves insufficient urethral closure pressure to counteract increased intra-abdominal pressure. Symptoms include leakage with physical exertion. Treatment focuses on strengthening pelvic floor muscles through Kegel exercises, biofeedback, and electrical stimulation. Surgical options like midurethral slings may be considered for severe cases [1,2].

Urge incontinence, also known as overactive bladder, results from involuntary detrusor muscle contractions. Pathophysiology involves neurogenic or myogenic dysfunction leading to detrusor overactivity. Patients experience sudden, intense urges to urinate followed by involuntary urine loss. First-line treatments include behavioral modifications and pelvic floor exercises. Antimuscarinic medications like oxybutynin or solifenacin are commonly prescribed. Newer options include beta-3 adrenergic agonists like mirabegron [3,4].

Overflow incontinence occurs when the bladder cannot empty completely, leading to frequent small volume leakage. Causes include detrusor underactivity or bladder outlet obstruction. Symptoms include difficulty initiating urination, weak stream, and dribbling. Treatment aims to address the underlying cause, such as alpha-blockers for prostatic obstruction or intermittent catheterization for neurogenic bladder [5,6].

Mixed incontinence involves a combination of stress and urge symptoms. Management typically starts with conservative measures for the predominant type, followed by pharmacological or surgical interventions as needed 7.

Functional incontinence results from physical or cognitive impairments that prevent timely toileting. Environmental modifications, prompted voiding, and addressing underlying conditions are key management strategies 8.

Transient incontinence is temporary and often resolves when the underlying cause (e.g., urinary tract infection, medication side effect) is addressed. Recent advances in UI management include the use of botulinum toxin injections for refractory overactive bladder, sacral neuromodulation for various types of UI, and the development of newer pharmacological agents with improved side effect profiles.

Urinary incontinence (UI) is the involuntary loss of urine, affecting millions of people worldwide, particularly women and older adults. There are several types of UI, each with distinct causes and symptoms. The main types include stress incontinence (leakage during physical exertion), urge incontinence (sudden, intense urge to urinate followed by involuntary urine loss), overflow incontinence (inability to fully empty the bladder leading to frequent dribbling), and functional incontinence (physical or cognitive impairments preventing timely toileting). Mixed incontinence, combining multiple types, is also common. While UI can significantly impact quality of life, many effective management strategies are available, and it’s important for affected individuals to seek medical advice for proper diagnosis and treatment.

References:

  1. Lukacz ES, et al. (2022). Urinary Incontinence in Women: A Review. JAMA, 327(13):1286-1297.
  2. Capobianco G, et al. (2023). Stress Urinary Incontinence: An Update on Definitions, Pathophysiology, Diagnoses and Management. J Clin Med, 12(3):795.
  3. Reynolds WS, et al. (2022). Diagnosis and Management of Overactive Bladder in Adults. JAMA, 327(15):1498-1509.
  4. Griebling TL. (2022). Overactive Bladder in Elderly Patients: Risk Factors, Diagnosis, and Treatment. Drugs Aging, 39(2):101-113.
  5. Jiang YH, Kuo HC. (2022). Underactive Bladder-Current Understanding of Pathophysiology, Diagnosis and Management. Int J Mol Sci, 23(3):1394.
  6. Osman NI, Chapple CR. (2023). Contemporary Concepts in the Aetiopathogenesis and Management of Chronic Urinary Retention. Nat Rev Urol, 20(2):107-122.
  7. Aoki Y, et al. (2022). Urinary incontinence in women. Nat Rev Dis Primers, 8(1):43.
  8. Wagg A, et al. (2023). A narrative review of models of care for older people with urinary incontinence. Neurourol Urodyn, 42(1):143-152.
  9. Gibson W, Wagg A. (2022). Urinary incontinence in the frail elderly. Nat Rev Urol, 19(8):484-495.
  10. Peyronnet B, et al. (2023). Management options for women with refractory urgency urinary incontinence: a systematic review with meta-analysis. Int Urogynecol J, 34(2):215-232.

Preparing for Your Ph.D. Comprehensive Exam

Kari LaneLeave a comment

Most doctoral students have to complete a written and/or oral comprehensive (comps) exam to enter candidacy. The comprehensive exam’s purpose is to determine if the learner is adequately prepared to enter the dissertation research stage of their education.  

“This past August, I sat my doctoral comprehensive exams. It was a grueling, exhausting process, and the months leading up to the exams were some of the most stressful of my life. I don’t think that I have ever cried so much in my life; from exhaustion, stress, fear, and from the worst bout of impostor syndrome I had felt since beginning grad school.”

~Stephanie Hedge, a PhD Candidate at Ball State University

Image created with Bing Image Creator

The comprehensive exam is a test of your preparation to work as an independent scholar at the highest level. These are typically completed after the learner has completed coursework. The learner must be able to demonstrate :

  1. competency and mastery of concepts in the field of the learner’s academic discipline.
  2. expertise in the breadth of the literature the learner’s field/specialty.
  3. knowledge of the research methodologies (quantitative, qualitative, and mixed methods) and how to apply them in the learner’s areas of specialization
  4. theories and concepts that contribute to the body of knowledge in the learner’s discipline.

What your written exam will look like depends on your department. You may be asked to respond to a series of questions to test your broad knowledge of your field. You may be required to generate a grant proposal or prepare full articles for publication. The key is to talk to your supervisor and find out what is expected. Then prepare!

Ways to Prepare for Comps

1. Take notes. Establish a note-taking system, do this when you begin your studies. Some people organize their notes in a spiral notebook, while others use a digital system. Tag each entry with keywords. If you have an open book exam, or if you end up writing a proposal for your written component, these digital systems can be extremely helpful. When you’re looking for an article or book during an exam, these tags can save you time.

2. Keep your literature organized. Organize your literature in the way you learn best. That may be a file box with paper copies, or electronic copies of each article. In Ph.D. programs, you will read thousands of articles, therefore, you need to begin your program of study with an organization method and stick to it throughout your program.

3. Educate yourself. As you read and take notes, try to determine where you need to fill knowledge gaps. Are you up on the latest research in the field? Do you need to look for more sources?

4. Study. Review your previous written papers (with faculty feedback on them), and re-read articles on specific topics. Pay special attention to concepts that you are less familiar with or feel unsure about.

5. Gain the Support of Others. Get your support group together. Tell them how they can support you as you move into this milestone. Find a study partner or group, they do not need to be experts in your specific field, but if they can be there to bounce ideas off of, it helps. Ask other students about their exam experiences. It is easy to feel isolated and alone when studying, but including others in your study plan can help make studying easier (and more fun!)

Once the Written Portion is Done, Begin to Get Ready for your Orals

1. Once you have completed your written exam, begin to practice for your oral exam. Practice answering aloud, speaking slowly and deliberately. If you’re nervous during your exam, you’ll naturally speed up a bit. Come up with different ways to ask your committee clarifying questions. When you get a question you don’t understand, or you draw a blank, ask for clarification, or say you do not know, but can find out and will get back to them. Use a water bottle or beverage to give you time to think of your answer. Take a drink and think through your response.

2. Rephrase. Rephrase questions before answering. This saves the questioner from interrupting you with a rephrasing of the question or, worse, you not answering the question.

3. It’s okay to say, “I don’t know.” The oral exam is meant to find out what you know…and what you don’t. When you get a question that’s beyond your area of knowledge, you might say something like, “I haven’t thought about that, but I will look into this concept further.

4. Keep some brief notes. Keep a few notes at the ready and a copy of your written exam answers if allowed. You can look down at those papers when you are formulating your response, or verify the definition of a word or two.

5. Know Your Literature. You will not, of course, be expected to provide detailed citations. But, you should demonstrate familiarity and facility with a range of the literature. You should be able to appropriately reference the scholars whose arguments are relevant to a particular issue. You may occasionally include the name of a book or article and the date of its publication.

“The interview process in this exam is challenging, but it is generally a collegial experience. The examiners are looking to test, but not destroy your confidence. By the time you get to that point, if there is a question about your overall competence it should have surfaced on the written portion of the exam.”

~Andrew  J. Spencer

Additional Resources

The Comprehensive Exam: A Reflection, with Qualifiers

https://www.insidehighered.com/blogs/gradhacker/surviving-studying-comprehensive-exams

Click to access comprehensive-exam-strategies.pdf

https://www.uopeople.edu/blog/what-is-a-comprehensive-exam/

http://www.ethicsandculture.com/blog/2015/lessons-learned-from-my-comprehensive-exam

Medication Safety

Kari LaneLeave a comment

The article “Improving Medication-Related Safety for Residents in Nursing Homes: A Qualitative Study” aimed to better understand RNs’ perceptions of medication safety concerns and potential solutions for nursing home (NH) residents, this prospective, qualitative study used semi-structured phone interviews. The research team recruited 12 RNs from two nursing homes in the northeastern United States. The Systems Engineering Initiative for Patient Safety constructs informed the interview guide, coding, and qualitative theme identification.

Results categorized non–user-friendly charting systems and highlighted more experience with paper-based charting under the technology component. For the organization component, participants emphasized the importance of teamwork, communication, and leadership. Participants also noted how education and nationality of training impact medication administration safety. Task-related concerns included different care approaches, extreme workload variation, and task prioritization during the day as critical issues. Staff shortages were expressed as an environment-related concern. The findings underscore the importance of an appropriate nurse-to-patient ratio, user-friendly charting systems, and customizing the medication administration interface in the charting system (Shieu et al., 2025).

Reference

Shieu, B., Lee, Y., Epps, F., Wang, M., and Harris, J., (2025). Improving medication-related safety for residents in nursing homes: A qualitative study. Journal of Gerontological Nursing, 0(0), 1-6. https://doi.org/10.3928/00989134-20250102-03

Protecting Your Hearing on the Farm: A Critical Health Priority

Kari LaneLeave a comment

As a farmer, you’re exposed to a variety of loud noises on a daily basis – from tractors and combines to livestock and grain dryers. While these sounds may seem like an unavoidable part of farm life, they pose a serious risk to your hearing health. This article aims to highlight the dangers of noise-induced hearing loss (NIHL) in agriculture, its long-term consequences, and practical ways to protect your hearing.

The Dangers of Noise-Induced Hearing Loss in Agriculture

Farming is consistently ranked as one of the occupations with the highest risk for hearing loss. A study by Lie et al. (2016) found that farmers have a 38% higher risk of hearing loss compared to other occupations. The primary culprit is prolonged exposure to high noise levels from farm machinery and equipment.

Many common farm activities produce noise levels well above the safe threshold of 85 decibels (dB).

Most people’s ears ring after they are exposed to loud noises. The ringing or tinnitus can sound a bit different to different people, a ring like a bell, a buzzing like bees, or just noise that doesn’t go away. Audiologists measure how loud a sound is in units called decibels (dB). Hearing loss can happen due to repeated exposure over time (years usually). However, hearing loss can occur due to a one-time very loud noise exposure of 120 dB. Think of 120 dB as how loud an indoor basketball stadium is when everyone is cheering, rock concerts, or jet planes at the ramp. The table below was taken from Penn State Extension, and describes what sounds are too loud and how long you can go daily without hearing protection without damage. Remember though, this is what we know now, and can change as we learn more about how our ears work and heal.

Exposure to these noise levels for extended periods can cause permanent damage to the delicate structures in your inner ear, leading to noise-induced hearing loss.

Long-Term Consequences of Noise-Induced Hearing Loss

The effects of NIHL extend far beyond just difficulty hearing. Recent research has highlighted several long-term consequences:

A study by Curhan et al. (2019) found that hearing loss is associated with accelerated cognitive decline and an increased risk of dementia. Mid-life hearing loss doubles the risk of developing dementia compared to any other single risk factor. Poor hearing performance is significantly associated with lower cognitive function in cross-sectional and longitudinal analyses. Hearing impairment is associated with brain atrophy in regions important for auditory processing and cognition, including the temporal gyrus, hippocampus, amygdala, precuneus, and prefrontal cortex. People with age-related hearing impairment show increased levels of phosphorylated tau in cerebrospinal fluid, a biomarker associated with Alzheimer’s disease. Hearing loss may lead to social withdrawal, reducing cognitive stimulation. The brain may reallocate cognitive resources to process degraded auditory input, leaving fewer resources for other cognitive tasks. There may be underlying factors contributing to hearing loss and cognitive decline.

Difficulty communicating can lead to social withdrawal and isolation, potentially impacting mental health. Impaired hearing can make it challenging to detect warning signals or approaching vehicles, increasing the risk of farm-related accidents.

Impact of hearing aids on cognitive function

Some studies suggest that using hearing aids may help maintain better cognitive function over time compared to those who don’t use them. A recent clinical trial found that hearing aids reduced the rate of cognitive decline by almost 50% over three years in older adults at high risk of dementia. Hearing aids and other interventions can be costly, and severe hearing loss may impact your ability to work efficiently. Hearing loss can significantly reduce overall quality of life, affecting relationships and daily activities.

Protecting Your Hearing on the Farm

The good news is that NIHL is largely preventable. Here are some effective strategies to protect your hearing:

  1. Use Hearing Protection: Always wear earplugs or earmuffs when operating loud machinery. A study by McCullagh et al. (2016) found that consistent use of hearing protection devices can significantly reduce the risk of hearing loss among farmers.
  2. Limit Exposure Time: Follow the 60/60 rule – if you must be exposed to loud noise, limit it to 60 minutes and then take a 60-minute break in a quieter environment.
  3. Maintain and Upgrade Equipment: Regular maintenance can help reduce noise levels. When possible, invest in quieter, modern equipment.
  4. Create Quiet Zones: Designate areas on your farm for noise-free breaks.
  5. Get Regular Hearing Check-ups: Annual hearing tests can help detect NIHL early when interventions are most effective.
  6. Education and Training: Participate in hearing conservation programs. Cramer et al. (2018) found that targeted education can improve farmers’ use of hearing protection.

Types of hearing protection that can be used when a person is in loud environments.

Conclusion

Your hearing is a precious asset that, once damaged, cannot be fully restored. By understanding the risks of NIHL and implementing protective measures, you can preserve your hearing health and ensure a long, productive farming career. Remember, protecting your hearing is not just about maintaining your ability to hear – it’s about safeguarding your overall health, safety, and quality of life.

References

  1. Lie, A., Skogstad, M., Johannessen, H. A., Tynes, T., Mehlum, I. S., Nordby, K. C., … & Tambs, K. (2016). Occupational noise exposure and hearing: a systematic review. International archives of occupational and environmental health, 89(3), 351-372.
  2. Curhan, S. G., Willett, W. C., Grodstein, F., & Curhan, G. C. (2019). Longitudinal study of hearing loss and subjective cognitive function decline in men. Alzheimer’s & Dementia, 15(4), 525-533.
  3. McCullagh, M. C., Banerjee, T., Yang, J. J., Bernick, J., Duffy, S., & Redman, R. (2016). Gender differences in use of hearing protection devices among farm operators. Noise & health, 18(82), 168.
  4. Cramer, M. E., Wendl, M. J., Sayles, H., Duysen, E., & Achutan, C. (2018). Knowledge, attitudes, and practices for respiratory and hearing health among Midwestern farmers. Public Health Nursing, 35(4), 308-315.
  5. Feder, K., Michaud, D., McNamee, J., Fitzpatrick, E., Davies, H., & Leroux, T. (2017). Prevalence of hazardous occupational noise exposure, hearing loss, and hearing protection usage among a representative sample of working Canadians. Journal of occupational and environmental medicine, 59(1), 92-113.
  6. Neitzel, R. L., Andersson, M., & Andersson, E. (2016). Comparison of multiple measures of noise exposure in paper mills. The Annals of occupational hygiene, 60(5), 581-596.

Nursing and Workplace Bullying

Kari LaneLeave a comment

Workplace bullying is a serious and pervasive problem in the nursing profession that negatively impacts nurses, patients, and healthcare organizations. Studies estimate that 30-50% of nurses experience bullying at some point in their careers. This paper will examine the prevalence and consequences of nurse bullying, analyze contributing factors, and propose evidence-based strategies to prevent and address bullying behaviors in nursing workplaces.

Prevalence and Impact

Bullying in nursing takes many forms, including verbal abuse, social isolation, intimidation, withholding information, and excessive criticism. New graduate nurses are particularly vulnerable, with over 30% reporting bullying experiences in their first year of practice. The impacts of bullying are multifaceted. Many of the concepts that can impact bullying in the workplace might include increased stress, anxiety, depression, burnout, intent to leave the profession, compromised quality of care and safety risks, higher turnover, absenteeism, and financial costs.

Contributing Factors

Several factors contribute to the prevalence of bullying in nursing:

  • Hierarchical culture and power imbalances
  • High-stress work environments
  • Lack of management support and accountability
  • Normalized “nurses eat their young” mentality
  • Inadequate training on professional communication

Prevention Strategies

Addressing nurse bullying requires a multifaceted approach from establishing clear anti-bullying policies to identifying key mentors who do not bully their mentees. Education and training on recognizing and responding to bullying regardless of your position is important to begin the change process. As this education continues a clear anti-bullying policy needs to be created and mandated across the health system. Bullying can occur from a person of power to a person with less power or it can be a parallel peer to peer bullying situation. All types and forms of bullying must be addressed.

Your change agents will need to help leaders model and reinforce a culture of civility, teamwork, and respect. Adding confidential, non-punitive reporting mechanisms for bullying incidents will be important. More difficult, is empowering individuals who are bullied to feel as though they can report the incidents. People in general have a general fear if repercussions, enhancing an open and nonjudgmental leadership style is key.

Most hospital systems and many clinic systems have confidential employee support programs. Providing access to counseling, mentoring, and other support services for any employee who experience bullying will be important. Leaders will need to consistently enforce consequences for bullying behaviors through progressive disciplinary action. Collaboration with Human Resources to ensure system policies are enforced and all parties are treated with mutual respect will be essential.

Leaders can improve work conditions by addressing bullying in the workplace. Addressing underlying stressors like inadequate staffing may be helpful. Train nurses in constructive approaches to addressing conflicts and differences. Encourage and equip all staff to safely intervene when witnessing bullying behaviors. Utilize staff surveys and other tools to monitor the prevalence of bullying and effectiveness of interventions.

The key is taking a comprehensive, multi-faceted approach that addresses bullying at the individual, unit, and organizational levels. Leadership commitment and consistent enforcement of policies are critical for creating lasting change.

Approaching New Anti-Bullying Campaign Strategies with the Change Theory

Implementing an anti-bullying policy using Change Theory can be an effective approach to addressing workplace bullying in healthcare settings. Here’s a description of how this might be done, supported by scholarly references:

The first step in Lewin’s Change Theory is “unfreezing,” which involves creating awareness of the need for change and preparing the organization for it. Conduct a thorough assessment of the current bullying situation in the organization. Share data and personal stories to highlight the prevalence and impact of bullying. Engage stakeholders at all levels to recognize the need for change.

The Change stage involves implementing the new anti-bullying policy and associated interventions. Develop a comprehensive anti-bullying policy with clear definitions, reporting procedures, and consequences. Provide education and training on recognizing and responding to bullying behaviors. Implement reporting systems and support mechanisms for targets of bullying. Empower bystanders to intervene safely when witnessing bullying.

The final stage, Refreezing, involves solidifying the changes and making them a permanent part of the organizational culture. Consistently enforce the anti-bullying policy. Regularly assess the effectiveness of interventions and make adjustments as needed. Integrate anti-bullying measures into ongoing training and performance evaluations. Celebrate successes and share positive outcomes to reinforce the new norms.

Conclusion

Preventing workplace bullying is essential for creating safe, healthy work environments where nurses can thrive and provide optimal patient care. By implementing comprehensive prevention strategies and fostering a culture of respect, healthcare organizations can significantly reduce the incidence and impact of nurse bullying. Ongoing commitment from leadership, staff engagement, and continuous evaluation are key to sustainable change. With concerted effort, the nursing profession can eliminate the “eating our young” mentality and cultivate supportive, collegial workplaces for all nurses. Lewin’s Change Theory can assist leadership in healthcare organizations to implement new policies and ensure those new policies

References

Edmonson, C., & Zelonka, C. (2019). Our own worst enemies: The nurse bullying epidemic. Nursing Administration Quarterly, 43(3), 274-279.

Smith, C. R., Palazzo, S. J., Grubb, P. L., & Gillespie, G. L. (2021). Standing up against workplace bullying behavior: Recommendations from newly licensed nurses. Nursing Forum, 56(2), 265-274.

Burnes, B. (2020). The origins of Lewin’s three-step model of change. The Journal of Applied Behavioral Science, 56(1), 32-59.

Stagg, S. J., Sheridan, D. J., Jones, R. A., & Speroni, K. G. (2013). Workplace bullying: The effectiveness of a workplace program. Workplace Health & Safety, 61(8), 333-338.

Laschinger, H. K. S., Wong, C. A., & Grau, A. L. (2012). The influence of authentic leadership on newly graduated nurses’ experiences of workplace bullying, burnout and retention outcomes: A cross-sectional study. International Journal of Nursing Studies, 49(10), 1266-1276.

Simons, S. R., & Mawn, B. (2010). Bullying in the workplace—A qualitative study of newly licensed registered nurses. AAOHN Journal, 58(7), 305-311.

MacIntosh, J., Wuest, J., Gray, M. M., & Cronkhite, M. (2010). Workplace bullying in health care affects the meaning of work. Qualitative Health Research, 20(8), 1128-1141.

Usher Syndrome

Kari LaneLeave a comment


Usher syndrome is an inherited condition that causes both hearing loss and progressive vision loss due to retinitis pigmentosa (RP). It is the most common cause of combined deafness and blindness.

Pathophysiology
Usher syndrome results from mutations in genes involved in the development and function of specialized cells in the retina and inner ear. These mutations lead to abnormal development or degeneration of hair cells in the inner ear, causing hearing loss and progressive degeneration of photoreceptor cells in the retina, causing vision loss.

Genetic Transmission
Usher syndrome is inherited in an autosomal recessive pattern. This means:

  • Both parents must carry a copy of the mutated gene to pass it on
  • Each child of carrier parents has a 25% chance of inheriting the condition
  • At least 11 genes have been associated with different types of Usher syndrome

Types:
There are three main clinical types:

  • Type 1: Profound hearing loss or deafness at birth
    • Severe balance problems from birth – children often have delayed motor development and don’t walk until 18 months or later
    • Vision problems usually begin around age 10 or in early teens
    • Night blindness and loss of peripheral vision due to retinitis pigmentosa (RP)
  • Type 2: Moderate to severe hearing loss at birth
    • Normal balance
    • Vision problems begin in late teens or early 20s
    • Night blindness and gradual loss of peripheral vision due to RP, but progression is typically slower than in Type 1
    • Central vision often retained into adulthood
  • Type 3: Born with normal hearing and near-normal balance
    • Progressive hearing loss starting in childhood or teens
    • Vision loss begins in teens or early adulthood
    • Balance may deteriorate over time
    • About 50% experience balance problems

Signs and Symptoms

  • Hearing loss (congenital or progressive)
  • Progressive vision loss due to RP (night blindness, peripheral vision loss)
  • Balance problems (mainly in Type 1)
  • Delays in motor development in children (Type 1)

Potential Treatment Options
While there is no cure, management focuses on:

  • Hearing aids or cochlear implants for hearing loss
  • Low vision aids and mobility training for vision loss
  • Vestibular rehabilitation for balance issues
  • Genetic counseling for families for future conception
  • Emerging therapies like gene therapy are under investigation

References

  1. Arias-Peso, B., Calero-Ramos, M. L., López-Ladrón García de la Borbolla, C., López-Domínguez, M., Morillo-Sánchez, M. J., Méndez-Martínez, S., Sánchez-Gómez, S., & Rodríguez-de-la-Rúa, E. (2024). Multidisciplinary approach to inherited causes of dual sensory impairment. Graefe’s Archive of Clinical & Experimental Ophthalmology, 262(3), 701–715. https://doi.org/10.1007/s00417-023-06153-7
  2. Castiglione, A., & Möller, C. (2022). Usher Syndrome. Audiology Research, 12(1), 42–65. https://doi.org/10.3390/audiolres12010005
  3. Mahmood, R., Mahmood, F., Faisal, M. N., Mahmood, A., Muzaffar, H., Mahmood, M., Abbas, G., Mahmood, T., & Arshad, M. (2022). Usher Syndrome and Its Genetic Characterization. Pakistan Journal of Science, 74(5), 392–402
  4. Miyoshi, T., Belyantseva, I. A., Sajeevadathan, M., & Friedman, T. B. (2024). Pathophysiology of human hearing loss associated with variants in myosins. Frontiers in Physiology, 01-18. https://doi.org/10.3389/fphys.2024.1374901

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Parents Experiencing Miscarriage

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This is an excellent article on miscarriage (Compassionate Care for Parents Experiencing Miscarriage in the Emergency Department A Situation-Specific Theory) that was published recently in the Advances in Nursing Science Journal. A summary of the article includes:

In numerous countries, parents who experience miscarriage often seek help in the emergency department (ED). Many parents express dissatisfaction with the care they receive, while nurses frequently feel uncertain about how to provide the best support. This article outlines the creation of a situation-specific theory called “Compassionate Care for Parents Experiencing Miscarriage in the ED,” which is built on four key concepts: change trigger, transition properties, conditions of change, and interventions. This theory was developed through an extensive literature review, two empirical studies, Transitions Theory, and the collaborative efforts of an experienced team. The thorough process of developing this theory aids its practical application and encourages the creation of new theories.

Emond, Tina PhD, RN; de Montigny, Francine PhD, RN; Webster, Jessica MN, RN, PNC(C); Zeghiche, Sabrina PhD; Bossé, Mylène RN. Compassionate Care for Parents Experiencing Miscarriage in the Emergency Department: A Situation-Specific Theory. Advances in Nursing Science 47(3):p 288-301, July/September 2024. | DOI: 10.1097/ANS.0000000000000493

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The Site may contain (or you may be sent through the Site) links to other websites or content belonging to or originating from third parties or links to websites and features in banners or other advertising. Such external links are not investigated, monitored, or checked for accuracy, adequacy, validity, reliability, availability, or completeness by us. WE DO NOT WARRANT, ENDORSE, GUARANTEE, OR ASSUME RESPONSIBILITY FOR THE ACCURACY OR RELIABILITY OF ANY INFORMATION OFFERED BY THIRD-PARTY WEBSITES LINKED THROUGH THE SITE OR ANY WEBSITE OR FEATURE LINKED IN ANY BANNER OR OTHER ADVERTISING. WE WILL NOT BE A PARTY TO OR IN ANY WAY BE RESPONSIBLE FOR MONITORING ANY TRANSACTION BETWEEN YOU AND THIRD-PARTY PROVIDERS OF PRODUCTS OR SERVICES.

PROFESSIONAL DISCLAIMER

The Site cannot and does not contain medical/health advice. The medical/health information is provided for general informational and educational purposes only and is not a substitute for professional advice. Accordingly, before taking any actions based upon such information, we encourage you to consult with the appropriate professionals. We do not provide any kind of medical/health advice. THE USE OR RELIANCE OF ANY INFORMATION CONTAINED ON THE SITE IS SOLELY AT YOUR OWN RISK.

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Charcot-Marie-Tooth (CMT)

Kari LaneLeave a comment

Charcot-Marie-Tooth (CMT) disease is a group of inherited peripheral neuropathies affecting motor and sensory nerves. CMT can cause a a child to lose feeling and movement in their extremities. Sometimes this disease affects speech, breathing and swallowing. With this condition, the peripheral nerves (the nerves outside the brain and spinal cord) don’t work properly.

Pathophysiology


CMT results from mutations in genes involved in the structure and function of peripheral nerves. The pathophysiology varies depending on the specific type:

  1. Demyelinating forms (CMT1, CMT4, CMTX): Mutations affect Schwann cell function, leading to defective myelin production or maintenance. This results in reduced nerve conduction velocities.
  2. Axonal forms (CMT2): Mutations primarily affect axonal structure or function, leading to axonal degeneration.
  3. Intermediate forms: Show features of both demyelinating and axonal neuropathies.

The common end result is progressive axonal loss, leading to muscle weakness and sensory deficits.

Genetic Transmission


CMT can be inherited in several patterns:

  1. Autosomal dominant: Most common in CMT1 and CMT2
  2. Autosomal recessive: Seen in some forms of CMT4
  3. X-linked: CMTX1 (mutations in GJB1 gene)

The most common mutations involve:

  • PMP22 gene duplication (CMT1A)
  • MPZ gene mutations (CMT1B)
  • GJB1 gene mutations (CMTX1)
  • MFN2 gene mutations (CMT2A)

X-linked CMT (CMTX) has a unique inheritance pattern compared to other forms of CMT

Inheritance through females

  • When a female has X-linked CMT, each of her children (regardless of gender) has a 50% chance of inheriting the CMT-causing mutation.
  • This is because females have two X chromosomes, and can pass either the affected or unaffected X chromosome to their children.

Inheritance through males

  • When a male has X-linked CMT, all of his daughters will inherit the CMT-causing mutation.
  • None of his sons will inherit the CMT-causing mutation.
  • This is because males have one X and one Y chromosome. They always pass their X chromosome (which carries the mutation) to their daughters and their Y chromosome to their sons.

Key points

  • X-linked CMT can be inherited through both males and females, but the pattern differs.
  • Females can pass it to children of either gender.
  • Males will only pass it to their daughters, not their sons.
  • The inheritance pattern is different from autosomal dominant or recessive forms of CMT.

Severity

  • Males with X-linked CMT typically have more severe symptoms than females.
  • Females may have milder symptoms or be asymptomatic carriers due to having two X chromosomes (one normal, one with the mutation).

In summary, X-linked CMT can be inherited through both males and females, but the inheritance pattern and likelihood of passing on the condition differs based on the parent’s sex.

Signs and Symptoms

  1. Motor symptoms:
    • Progressive distal muscle weakness and atrophy
    • Foot deformities (pes cavus, hammer toes)
    • Difficulty walking, frequent tripping
    • Hand weakness and atrophy in later stages
  2. Sensory symptoms:
    • Reduced sensation in feet and hands
    • Neuropathic pain in some cases
  3. Other features:
    • Reduced or absent deep tendon reflexes
    • Scoliosis in some patients

Progression of CMT can be Quite Different for Different People

The progression of CMT syndrome can vary significantly between individuals, even within the same family. Here are some key points about how the progression can differ:

  1. Age of onset: Symptoms typically appear in adolescence or early adulthood, but can start anytime from early childhood to late adulthood. Some individuals may not realize they have CMT until later in life due to very mild symptoms.
  2. Rate of progression: CMT is generally slowly progressive, but the rate can vary. Some people experience rapid progression, while others have very slow progression over decades.
  3. Severity of symptoms: The severity ranges from mild cases with minimal impairment to severe cases causing significant disability. Most people fall in the moderate range.
  4. Distribution of symptoms: While CMT typically affects the feet and lower legs first, some individuals may experience hand and arm involvement earlier or more severely than others.
  5. Types of symptoms: The balance between motor and sensory symptoms can differ. Some people may have more muscle weakness, while others experience more sensory loss.
  6. Specific impairments: The development of foot deformities, hand dexterity issues, or breathing problems can vary widely between individuals.
  7. Impact on daily activities: The effect on walking, balance, fine motor skills, and overall quality of life differs for each person.
  8. Genetic factors: Different genetic mutations associated with CMT can lead to variations in disease progression and severity.
  9. Environmental factors: Lifestyle, overall health, and environmental factors may influence how the disease progresses in different individuals.
  10. Response to interventions: The effectiveness of treatments and interventions can vary between individuals, affecting the overall course of the disease.

It’s important to note that even within families carrying the same genetic mutation, there can be significant variability in how CMT progresses. Regular monitoring and personalized management are crucial due to this variability in progression.

Treatment Plans

There is no cure for CMT, so treatment focuses on symptom management and supportive care including physical therapy, occupational therapy, orthopedic interventions, pain management, genetic counseling for parents, and regular monitoring. Physical and occupational therapy might involve stretching and strengthening exercises, gait training, use of adaptive devices to improve hand and leg function, and strategies for regular activities of daily living (such as dressing, walking, grooming, toileting). Orthopedic interventions might include ankle-foot braces (also called ankle-foot orthoses or AFOs) for foot drop, or orthopedic surgery for deformities or scoliosis. Pain management can include over the counter pain medications, alternative pain therapy, or narcotics. Adults and parents of children with CMT can undergo genetic counseling. Finally, patients will be monitored for disease progression and deterioration.

References

  1. Aldihan, K. A., AlRashedi, M. J., Helayel, H. B., AlMutlak, M., & Hameed, S. T. (2023). Severe Dry Eye Disease in Charcot-Marie-Tooth Disease: A Comprehensive Case Report. American Journal of Case Reports, 24, 1–4. https://doi.org/10.12659/AJCR.941094
  2. Choi, J. E., Seol, H. Y., Seok, J. M., Hong, S. H., Choi, B. ‐O., & Moon, I. J. (2020). Psychoacoustics and neurophysiological auditory processing in patients with Charcot‐Marie‐Tooth disease types 1A and 2A. European Journal of Neurology, 27(10), 2079–2088. https://doi.org/10.1111/ene.14370
  3. Silsby, M., Yiannikas, C., Fois, A. F., Kennerson, M. L., Kiernan, M. C., Fung, V. S. C., & Vucic, S. (2024). Upper and lower limb tremor in Charcot-Marie-Tooth neuropathy type 1A and the implications for standing balance. Journal of Neurology, 271(4), 1776–1786. https://doi.org/10.1007/s00415-023-12124-z
  4. Waldman, L. E., Michalski, M. P., Pfeffer, G. B., Giaconi, J. C., & Learch, T. J. (2023). Charcot-Marie-Tooth Disease of the Foot and Ankle: Imaging Features and Pathophysiology. Radiographics, 43(4). https://doi.org/10.1148/rg.220114

Taking Multiple Choice Exams

Kari LaneLeave a comment

Most nursing school exams, use a multiple-choice format, however, you might also see multiple answer format, hot spot (or point at the answer on an image), or a case study format. Before taking an application exam, students need to develop some test-taking savvy. Taking multiple-choice tests effectively requires a combination of test-taking strategies, time management, and a solid understanding of the subject matter. Here are some tips to help you succeed.

  • Read the Instructions: Carefully read the test instructions and any specific guidelines provided by the instructor. Understand the scoring system, whether there’s a penalty for guessing, and any other important details.
  • Focus on Keywords: Pay close attention to keywords in the question and answer choices. Sometimes, one word can make an option incorrect or correct.
  • Question Stem: The question stem consists of the necessary “background” information or context then a question or an unfinished statement.
    • The stem begins with a patient scenario or other key information which usually includes the central idea, problem, concept, definition, or procedure. Images could also be included. In an application-level question, information in the stem covers the context to help you understand what is occurring.
    • After the student has read the context, a question is posed. The student must decide how to answer based on the answer choices provided.
    • The question is usually worded in one of two basic formats: (1) a question, or (2) a partial sentence (sentence fragment). Let’s look at some example questions.
    • What would you tell Mr. G’s wife?
      or You should explain this situation to Mr. G’s wife as …
    • Therefore, the patient scenario (i.e., what is happening), along with the question, constitutes the entire stem.

Example:
Mr. G is 87 years old; he has been admitted with congestive heart failure and pulmonary edema. He has been on a nonrebreather mask at 15 liters/minute. Today his oxygen saturation levels have been dropping to less than 87%.

  • The Answer Options: In a multiple-choice test item, there are several options. Usually, there are 4 options, but occasionally there are 3 or 5 options. There are two kinds of options within one exam item: The correct answer, and the distractors.
    • The correct answer. One option is the correct answer.
    • Distractors. The other options are called distractors. A distractor is an incorrect response used to give you other possibilities to answer.
    • The example (#4 above) is an application-level question. Why? The question asks you to make a decision based on a case scenario. First, you must know what a normal range for a pulse ox is. Second, you must know how many liters/minutes of oxygen given in a nonrebreather mask is the maximum.
  • Learn how to deal with keywords in the stem
  • An exam item about the MOST urgent action, the BEST response, or the FIRST step implies that more than one of the options listed might be appropriate. But only one is most, or best, or first. Very frequently, application-level exam questions have keywords in the stem.
  • I recommend circling that keyword or writing it down on scratch paper.
  • Use Context Clues: Consider the context of the question and the material covered in the course. Sometimes, you can infer the answer from related information.
  • Using a Benchmark. After you read the first answer choice, decide if you think it sounds correct or not. If it doesn’t, move to the next choice. But if it does, mentally mark that answer choice. This doesn’t mean that you’ve decided it is the right answer. It just means it is the best one you’ve seen thus far. This answer becomes your standard by which you measure all other answers.
    • All other choices must be benchmarked against that standard. That choice is correct until you find one that is better. When you decide that no other answer is as good as the standard, make sure it answers the question before making it your final choice.
    • Valid Information. Remember that all the information in the question is valid and may be needed to determine the correct answer. This is not true for all the information in the answers. They are designed to distract you and frequently contain superfluous information. If it appears that two unrelated topics are discussed in the question, do not ignore either one. If you first determine the relationship between the topics, then you will be better able to answer the question correctly.
    • Difficult Words. Don’t choose an answer just because it is the only one with words you recognize. Test writers don’t put make-believe words on the test. If you only recognize the words in one answer, make sure it is correct and answers the question before you choose it. If you can eliminate it, then you increase your chances of getting the right answer even if you have to guess.
  • Try dissecting difficult words. Notice prefixes and suffixes for clues.
    •  Notice words like may, can, will often, rarely, etc.  Often an answer choice will be wrong because it doesn’t contain these words but has definitive words like ‘exactly’ and ‘always’ which leaves no room for exception.  Be alert for “switchback words such as “but”, “although”, nevertheless” which indicate a shift in thought and alters the nature of the question. Difficult Questions  Don’t waste too much time on questions that appear too hard or difficult. Try to identify any obviously incorrect answers and guess at the remaining answer choices before giving up.   Brainstorm each possible choice independently from the other choices. Ask yourself if it is possible that it could be the correct answer. When you systematically go through each answer you are often able to discover things you might have overlooked by only scanning the answers.
  • Watch for Qualifiers: Be cautious of words like “always,” “never,” “only,” and “most.” These qualifiers can change the meaning of a statement and lead you to the correct answer.
  • Don’t Second-Guess Too Much: Once you’ve made your choice, stick with it unless you have a good reason to change. Overthinking can lead to incorrect answers.
  • Trust Your Gut: Often, your initial instinct is correct. If you don’t know an answer right away, trust your intuition, and don’t overthink it.
  • If you are uncertain, guess intelligently.
  • For many of the multiple-choice questions, two answer choices can be eliminated with minimal effort. This can reduce the risk of random guessing and increase your chances for success.
  • Time Management: Keep an eye on the clock. Don’t spend too much time on a single question. If you’re unsure, make an educated guess and move on. You can return to it later if you have time.
  • Do not agonize over any one question. Stay within the budget for each question.
  • Determine the correct answer before you even read the answer choices.
  • Stay Calm: Stay calm and focused throughout the test. Anxiety can affect your performance, so take deep breaths and manage stress.
  • Don’t Leave Any Questions Blank: In most cases, there’s no penalty for guessing, so make sure to answer every question. If you’re unsure, make an educated guess.
  • Prepare in Advance: Effective multiple-choice test-taking begins with good preparation. Study the material thoroughly and understand the concepts, so you can approach the questions with confidence.
  • Practice with Sample Tests: If you can, practice with sample multiple-choice tests to get a sense of the format and types of questions you’ll encounter.
  • Sleep and Nutrition: Get a good night’s sleep before the test, and have a nutritious meal to ensure your brain is functioning at its best.

Remember that different strategies work for different people, so adapt these tips to your personal preferences and the specific requirements of your test. Practice and experience will also improve your multiple-choice test-taking skills over time.

Branchio-Oto-Renal (BOR) Syndrome

Kari LaneLeave a comment

Branchio-Oto-Renal (BOR) syndrome is a genetic disorder affecting the development of the neck, ears, and kidneys.

Pathophysiology


BOR syndrome results from mutations in genes involved in embryonic development, primarily EYA1, SIX1, and SIX5. These genes play crucial roles in the development of the branchial arches, otic vesicles, and kidneys. Mutations disrupt normal tissue formation, leading to the characteristic features of BOR syndrome.

Genetic Transmission

BOR syndrome is primarily inherited in an autosomal dominant pattern. This means that only one copy of the mutated gene is needed to cause the disorder’ an affected individual has a 50% chance of passing the mutation to each offspring; and the condition can affect both males and females equally.

Some key points about genetic transmission

  • EYA1 mutations account for about 40% of BOR syndrome cases.
  • SIX1 and SIX5 mutations are less common causes.
  • Some cases may result from de novo mutations.

Signs and Symptoms

BOR syndrome exhibits variable expressivity, even within families. Common features include branchial anomalies that can include branchial cleft cysts or fistulae in the neck. Otic (ear) abnormalities such as hearing loss (sensorineural, conductive, or mixed), malformations of outer, middle, or inner ear, and/or preauricular pits or tags. Renal (kidney) abnormalities ranging from mild (e.g., abnormal kidney shape) to severe (e.g., renal agenesis) which can progress to end-stage renal disease later in life. Other possible features can also occur including but not limited to facial abnormalities (e.g., long, narrow face), cleft palate, or lacrimal duct stenosis.

Treatment Plans

There is no cure for BOR syndrome, so treatment focuses on managing symptoms and complications:

  1. Hearing management:
    • Regular audiological assessments
    • Hearing aids or cochlear implants as needed
    • Speech and language therapy
  2. Branchial anomalies:
    • Surgical removal of cysts or repair of fistulae if causing problems
  3. Renal care:
    • Regular monitoring of kidney function
    • Management of hypertension if present
    • Dialysis or kidney transplantation for end-stage renal disease
  4. Other interventions:
    • Surgical correction of ear malformations if desired
    • Treatment of associated conditions (e.g., cleft palate repair)
  5. Genetic counseling for affected individuals and families

References

  1. Biggs, K., Crundwell, G., Metcalfe, C., Muzaffar, J., Monksfield, P., & Bance, M. (2022). Anatomical and audiological considerations in branchiootorenal syndrome: A systematic review. Laryngoscope Investigative Otolaryngology, 7(2), 540–563. https://doi.org/10.1002/lio2.749
  2. Cacciatori, E., Aleo, S., Scuvera, G., Rigon, C., Marchisio, P. G., Cassina, M., & Milani, D. (2022). From clinical to molecular diagnosis: relevance of diagnostic strategy in two cases of branchio-oto-renal syndrome – case report. Italian Journal of Pediatrics, 48(1), 1–6. https://doi.org/10.1186/s13052-022-01369-5
  3. Peusner, K. D., Bell, N. M., Hirsch, J. C., Beraneck, M., & Popratiloff, A. (2021). Understanding the Pathophysiology of Congenital Vestibular Disorders: Current Challenges and Future Directions. Frontiers in Neurology, 12, 1–10. https://doi.org/10.3389/fneur.2021.708395
  4. Yalcouyé, A., Traoré, O., Diarra, S., Schrauwen, I., Esoh, K., Kadlubowska, M. K., Bharadwaj, T., Adadey, S. M., Kéita, M., Guinto, C. O., Leal, S. M., Landouré, G., & Wonkam, A. (2022). A monoallelic variant in EYA1 is associated with Branchio‐Otic syndrome in a Malian family. Molecular Genetics & Genomic Medicine, 10(7), 1–8. https://doi.org/10.1002/mgg3.1995