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Polypharmacy among psychiatric patients is a concerning trend. From 2007-2010, 58.2% of women and 41.8% of men reported taking five or more prescription drugs within the last 30 days (CDC, 2014). Negative outcomes include prescription drug abuse, side effects, interactions, treatment failure, patient dissatisfaction, and lack of treatment control. The associated practice challenges have led to the following PICOT question. In persons with mental health issues receiving care at an outpatient mental health clinic, does engaging in mindfulness practice versus no mindfulness practice change polypharmacy use over a 3-month period?
The project purpose was to evaluate the effectiveness of Insight Timer mobile mindfulness app at helping patients self-manage distressing symptoms and reduce polypharmacy. Over three weeks, mental health clinic nurse practitioners (NPs) voluntarily recruited patients (n=12) over age 18 using as needed prescriptions (PRNs), and agreed to use Insight Timer mobile mindfulness app for adjunct symptom management. Consenting participants downloaded the mobile app, and completed a brief questionnaire measuring PRN use at the start of app use, and PRN use at their next visit. A Wilcoxon signed-rank test indicated a 10-week mindfulness app trial did not significantly lower total PRN doses compared with pre-app dosing (Z = -.534, p = .593). Paired t-tests revealed no significant change in pre (M = 65.17, SD = 28.64) versus post (M = 67.75, SD = 20.22) OQ45 life functionality results (t(11) = -.420, p = .683) (d = .121) as a result of app use.
Clinically relevant results illustrated 83.33% of participants taking greater than nine PRN doses over the study period used the app six times or more in place of medication. High PRN users employed the app frequently in place of medication regardless of total PRN doses taken. Practice implications and sustainability recommendations include incorporating mobile app use in treatment plans for high PRN users and educating NP’s on the tangible benefits of mindfulness apps in reducing polypharmacy and easing symptom distress on an ongoing basis.
Keywords: mindfulness, mhealth, mobile apps, mobile smart phone, online, RCT, behavior change, polypharmacy.
Yoga has become one of the most popular contemporary health approaches practiced by young adults in the United States. It is an ancient mind and body practice with origins in Indian philosophy dating to over 5,000 years ago. Yoga combines physical postures, rhythmic breathing, and meditative exercises to offer the participants a unique, holistic mind-body experience. In this report, the Sutras first introduced by Patanjali, an ancient Indian sage, are broken down into modern definitions. Each sutra has its own unique mental and physical benefits that can be attained by college students. Yama encourages maintaining a personal moral code. Niyama allows for personal connection and self-awareness. Asana refers to the poses that are still commonly practiced today. Pranayama helps to practice deep breathing. Pratyahara offers a disconnect from the world around us. Dharana allows us to focus and hone in on one thought. Dyana promotes a continuous flow of focus in meditation. Samadhi is reaching a state of pure relaxation. All of these take time and practice, but when implemented in different aspects of daily life, college students can reduce their overall stress and anxiety to improve focus and success.
In Arizona black women have a preterm birth rate of 40% higher than any other women. Black women in Maricopa County have the highest incidence of low birthweight and preterm birth. Preterm birth has been linked to cerebral palsy, blindness, cognitive difficulties, and ultimately, infant mortality. Preterm birth is defined by the World Health Organization as delivery of an infant before 37 weeks of gestation. Low birth weight is defined as 1500g or less with extremely low birthweight being 1000g or less. Infants with low birth weight contribute disproportionately to infant mortality. Chronic, toxic stress is a heavy contributor to the racial health disparity of preterm birth and low birth weight. Chronic stress may affect preterm birth by dysregulating the hypothalamic-pituitary-adrenal axis, altering the release of cortisol, leading to altered immune function, thus increasing infection and inflammation response (Giuregescu et. al). Studies have shown racial injustice is related to inflammatory stress response. This stress is exacerbated by the long history of injustice and neglect in healthcare due to implicit bias. Recommendations for improvement of this disparity includes cultural competency training for all healthcare professionals and mindfulness yoga training paired with Focused Support Groups for pregnant women for reducing racial stress.