Posts Tagged ‘doctorate of nursing practice’

Long time readers (and former patients) will be familiar with my aspirin mantra but now Medscape has published a CME course by Dr. Desiree Lie for health care providers in primary practice, general surgery (and other areas that may not be familiar with post-cardiac patient recommendations.)  As I may have mentioned before, in cardiac surgery – we routinely start aspirin in our patients prior to bypass surgery.

Don’t stop Aspirin before surgery

I’ve converted the CME course, Don’t stop Aspirin before surgery into a pdf – but if you want credit – you will have to go to Medscape and log in.  (For everyone else – it’s a nice read – and explains the importance of continuing aspirin in patients who are taking it for “secondary prevention” or are at high risk of cardiovascular events.

That’s because the complications of discontinuing aspirin therapy in these patients are WORSE than the minor risk of bleeding.  (Bleeding issues for most patients taking aspirin are fairly minor.. Now, clopidogrel (Plavix) and prasugrel (Effient) are another story!)

Wait a second… What’s secondary prevention?

They way to think about secondary prevention is “closing the barn after the cows are loose,” as one of my colleagues explains it.  This means that Aspirin has been prescribed to these patients after something has already happened – like a stroke, a heart attack, stents or cardiac surgery.  So in these patients – secondary prevention can be thought of as preventing a second event or further complications from a disease process we already know about.

Now, patients that are at high risk for cardiovascular events like diabetics or people with other kinds of blockages (peripheral vascular disease, renal artery stenosis) haven’t had a heart attack yet – but we think that they are at a high risk of this happening – so they take aspirin to prevent this (primary prevention).

In people who are at low or moderate risk – low cholesterol, nonobese, normal glucose, nonsmokers:  these people may take aspirin, but (probably not prescribed) and it is safe for them to discontinue aspirin before surgery.

But in the first two classes of patients (secondary prevention group/ high risk group) – stopping aspirin may actually INCREASE the risk of having a heart attack, stroke or other thrombotic event during surgery.  But if you are having surgery – be sure to check with your cardiologist or cardiac surgeon before.  Don’t rely on your PCP or general surgeon (it’s not their area of expertise) and they may not be up-to-date on the latest recommendations [hence the continuing education course].

A new chapter at Cartagena Surgery: the DNP program

Nashville, Tennessee

Back in Mexicali, MX after spending a week in Nashville, Tennessee for the start of my doctoral program in nursing.  It felt weird to be back in Nashville after so long (I lived there while attending Vanderbilt for my masters degree).  It was surprising how much had changed – the medical center and the university campus just continue to grow and grow!

But then again – with 70 people in the Fall 2012 DNP class, I guess it’s no surprise that the campus is growing.  About 15 of us are full-time students.  I’ll be heading off to Bogotá in a week to start some specialized study there – so between the DNP program and Bogotá – I might be posting a bit less often.

Fall 2012 class for DNP (doctorate of nursing practice) at Vanderbilt University

The DNP is a new degree that takes the place of the DNSc (doctorate of nursing science) or the ND (nursing doctorate) – depending on who you ask.  I know that sounds like alphabet soup to many people, so I’ll post some more information about the degree soon.  But the main thing to think about when thinking about doctoral degrees – is the focus behind the degree.

PhD – or a doctorate in Philosophy are Research degrees. (research with a capital ‘R’)  Think about labs, nursing theories and hard-core research..so think ‘nurse-scientists’.. I tell people to picture a nurse with a beaker and a bunsen burner.. Not entirely accurate but a good mental picture.

DNP – is a clinical doctorate – used to translate much of this research into improved clinical practice.  Clinical, clinical, clinical.. This is the degree for people who are still planning on working in the clinical (hospital-based or clinic-based) setting, seeing patients.  The courses in this program are designed to promote evidence-based practice – or using all of that research that our nurse-scientists (and other researchers) are publishing.

So the hope is that the DNP will be able to improve the care of patients by creating protocols and such.  As it is still a fairly new degree – there is currently a lot of cross-over among PhD trained nurses, and I suspect there always will be – it’s more a matter of preference in what a nurse wants to focus on during her doctorate education. (So don’t be surprised if your nurse practitioner has a PhD.)

There are still plenty of doctorates in education and other fields as well like administration because it takes all types of nurses to serve as faculty, deans of educational programs, and hospital administrators.

There are even a few doctorate of nursing science programs left – in Louisiana and Puerto Rico..

Now I apologize because this is a simplistic explanation that leaves out a lot of nuance but I’ll provide more information soon.  But now, I better get back to the books!


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