What's Up in Nursing? Nursing Opinions Clinical Updates Neural tube defects Recent years have established a deficiency of folic acid intake in the periconceptual period is a cause of NTDs. Folic acid intake isn't 100% preventative of NTDs. Recent studies indicate a mother's obesity may be an independent risk factor in NTDs. Vaginal douching and fertility Douching increases risks of PID, chlamydia, endometriosis, cervical malignancy,ectopic pregnancy and reduced fertility. Decreased fertility is associated regardless of frequency, timing or solution used. Dietary supplements To be classified as a dietary supplement, a product must contain one or more dietary ingredients that augment the foods we eat. Supplements are not regulated by the FDA as are prescription medications, so the manufacturer is responsible for ensuring product safety. Supplements cannot be promoted as treatments for specific conditions. Many substances, such as melatonin and DHEA, have no established doses or data on long-term safety and effectiveness, but they must carry federal recommendations for daily consumption, similar to the recommended daily allowance for vitamins. Patient satisfaction in collaborative practices A recent study comparing patient satisfaction in collaborative practices (MD and non-physician providers, 75% of which were ARNPs) versus MD-only practices concluded the following: Few differences in patients' perception of care provided. Nonphysicians spent more time with patients and were less rushed. Suprisingly, since RNs pride themselves on providing high quality patient education, the patients' perception was that MDs provided more complete information. Acute angle closure glaucoma Misdiagnosis of acute angle closure glaucoma can lead to vision loss. Most commonly misdiagnosed by the primary care provider in atypical presentation as conjunctivitis. When the patient has complaints of red eyes and vision loss, think about acute glaucoma and encourage referral to an opthamologist. Mother and father interaction with infants in the first year Early post delivery release limits the time nurses have to observe parent interaction with their infants. An observed decrease in parent interaction with preterm infants suggests a need for increased time for RNs and ARNPs to help parents recognize their infants' abilities and capabilities before hospital discharge. Fathers reported more stress that mothers from their child's characteristics, especially from 3 to 12 months of age. As nurses, we need to include fathers in all aspects of parent education. Effect of the menstrual cycle on asthma presentations in the emergency department Perimenstrual women are presented to the emergency department with acute asthma much more than women with asthma in other phases of the menstrual cycle. This supports the possibility that something about the perimenstrual time period provokes asthma attacks. Obesity as a protective factor for post-menopausal osteoporosis A recent study supports this finding and confirms decreased sex hormone binding globulin (SHBG) due to hyperinsulinemia, which increases free steroid levels. Bone mineral density measurements are available and affordable and should be used to identify women at risk for osteoporosis. Note that many insurance companies do not pay for preventive studies now. Borderline personality disorder and health care utilization in primary care This diagnosis is difficult to manage and detect, suspect seen frequently in a primary care setting. A recent study shows higher use of primary care by borderline personality disorder patients. These patients should be referred for psychiatric care if possible to reduce the costs of health care with a patient who will often appeal for help and guidance and then practice opposite health behaviors.