3/23/22, 12:08 PM Evidence–Based Health Evaluation and Application Transcript

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TRANSCRIPT

Capella University

Evidence–Based HealthEvaluation and Application

IntroductionPatient AssignmentAlicia BalewaConclusion

IntroductionPublic health improvement initiatives (PHII) provide invaluable data for patient–centered care, but their research is often conducted in a context different from theneeds of any individual patient. Providers must make a conscious effort to apply theirfindings to specific patients' care.

In this activity, you will learn about a PHII, and explore its application to a particularpatient's care plan.

OverviewYou continue in your role as a nurse at the Uptown Wellness Clinic. You receive an

il f th h J i P l Cli k th b tt t d it

3/23/22, 12:08 PM Evidence–Based Health Evaluation and Application Transcript

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email from the charge nurse, Janie Poole. Click the button to read it.

Good morning!

At last week's conference I spoke with Alicia Balewa, Director of Safe Headspace.They're a relatively new nonprofit working on improving outcomes for TBI patients,and I immediately thought of Mr. Nowak. At his last biannual cholesterol screening hementioned having trouble with his balance. This may be related to his hypertension,but he believes it's related to the time he was hospitalized many years ago afterfalling out of a tree, and expressed distress that this might be the beginning of a rapiddecline.

Ms. Balewa will be on premises next week, and I'd like to set aside some time for youto talk.

— Janie

Alicia BalewaDirector of Safe Headspace

OverviewInterview Alicia Balewa to find out more about a public health improvement initiativethat might apply to Mr. Nowak's care.

Interview:

I have a patient who might benefit from some ofthe interventions for TBI and PTSD you recentlystudied. What populations did your public healthimprovement initiative study?

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My father came home from Vietnam with a kaleidoscope of mental health problems.That was the 1970s, when treatment options for things like PTSD, TBI, and evendepression were very different. Since then there has been a lot of investment intreatment and recovery for combat veterans. That's excellent news for veterans intreatment now, but they're not looking at my dad, and how his TBI and PTSD haveaffected him through mid–life and now as a senior. That's why I started SafeHeadspace: to focus on older patients who are years or decades past their trauma,and find ways to help them.

Which treatments showed the strongestimprovement?Exercise. We were able to persuade about half of our participants — that's around400 people, mostly men ages 45–80 — to follow the CDC's recommendations formoderate aerobic exercise. Almost everyone showed improvement in mood, memory,and muscle control after four weeks. After that a lot of participants dropped out,which is disappointing. But of the 75 who stuck with it for another three months,muscle control improved 15%, mood improved 22%, and short–to–medium termmemory improved 61%. We didn't specify what kind of exercise, but we did ask themto record what they did every week, so that data is available.

Second was medication and therapy. Most of our participants didn't receive any kindof psychotherapy in the years immediately following their trauma, so we hadeveryone assessed by a team of psychotherapists. As a result of those assessments,40% of participants started on anti–depressant medication and 9% started takinganti–psychotics. Those who started taking medications now have regular contact witha therapist to manage that care. With some help at home to stick to the regimen, allbut a few have successfully followed their treatment plans. They've reported a 26%improvement in mood over six months, and a 6% improvement in memory.

The third treatment I want to mention is meditation. We only had a small groupinterested in trying it, but the results were dramatic. We prescribed daily meditation athome, just 10 to 15 minutes, with a weekly hour–long guided group meditation for all23 participants. After three weeks we lost two to disinterest, but the other 21 showedimprovements of over 70% in mood and memory, and 32% in muscle control.

Have you tried anything that hasn't worked?Sure. There are memory exercises for patients in elderly care, and things like Sudoku

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and crossword puzzles. We didn't see any gains with those. Some of our participantspreferred strength training to aerobic exercise, and the only improvement we saw inthat group was in muscle control, but only 4%, which is significantly less than theaerobic group.

I should also say that we were working with a willing group of participants. They knewthey needed help, and were motivated to get it. One of the hurdles we see withveterans, especially in older generations, is an unwillingness to acknowledge thatthey have a problem. We haven't had to wrestle with that because everyone whovolunteers to participate wants to be there.

Your organization is intervening with people whohave TBI and PTSD simultaneously. We have apatient with moderate TBI suffered almost 40 yearsago, but no history of PTSD. Have you separatedyour population and studied each separately?We haven't, no. In some cases we could, for those who come in with previousdiagnoses and medical records. But we have participants who either weren'tdiagnosed, were under–diagnosed at the time, or don't have records to show us.

ConclusionAs you've seen, a PHII can apply to a patient under yourcare. But it's not always a perfect fit, and it's important tothink carefully about how your patient's condition,symptoms, background, and experience compare to thatof participants in a PHII.

You may find it helpful to download the responses youmade in this activity.

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