SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Asthma is chronic disabling condition that causes high levels of morbidity and mortality. New asthma guidelines provide evidence to guide clinical decisions about asthma management and advocate self-management programmes that involve the use of written personalized asthma action plan. Nurses have a vital role to play in improving outcomes for people with asthma.
Public demand and professional standards dictate that primary care providers must be prepared to offer guidance and advance care planning for end-of-life decision-making to their patients. The purpose of this study was to describe the relationship between nurse practitioners' (NPs) knowledge of legal guidelines for end-of-life decision-making, their knowledge of the clinical application of advance care planning (ACP), and their comfort in counseling patients on these issues and personal attitudes toward end-of-life care. This descriptive, correlational study used survey data from a convenience sample of 145 Washington State NPs. Most NPs in this study were reasonably knowledgeable about the legal guidelines for end-of-life decision-making and clinical applications for ACP. They were somewhat comfortable with counseling patients on end-of-life decisions and expressed positive attitudes toward end-of-life care. However, a significant number of NPs were ill-informed about the legal guidelines and few actually incorporated ACP into their clinical practice. The authors suggest educational programs should focus on addressing the problem of stable misinformation related to legal guidelines. In addition, education should offer NPs didactic information and role modeling to skillfully incorporate ACP into clinical practice.
Explore the source record for details and available documents.
OBJECTIVE: To determine the ability of accident and emergency (A&E) personnel to demonstrate metered dose inhaler technique. METHODS: 25 senior house officers and 25 nurses working in A&E were individually interviewed and assessed on their knowledge of inhaler technique and competence in demonstrating the correct use of a metered dose inhaler. RESULTS: Demonstration of inhaler technique was generally poor by the staff assessed. Although 22 (88%) of the senior house officers were aware of the British Thoracic Society guidelines, only 10 (40%) routinely checked inhaler technique when discharging asthmatic patients. CONCLUSIONS: The A&E department offers an important opportunity for patient assessment and reinforcement of metered dose inhaler technique. Staff should be made aware of the British Thoracic Society guidelines and be competent at assessing and teaching inhaler technique.
The recently published guidelines from the California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes provide recommendations that should help improve care in that population. This paper will summarize the guidelines and indicate which recommendations are evidence-based and which are based on expert opinion, as some aspects of the guidelines have not been examined in controlled clinical trials. Practitioners need to apply approaches to care that consider level of function and the patient's and family's wishes and values.
Asthma remains a serious global health problem that affects people of all ages. Many asthma management guidelines, both national and international, are available, but they are seldom implemented. The implementation of guidelines remains a challenge worldwide, as barriers exist at several levels. These barriers are generic, such as poverty, inadequate resources and poor infrastructure, or specific, such as organisational, health care provider and patient factors. The barriers are, however, potentially correctable, and the goal of guideline implementation is to translate evidence-based asthma management recommendations into real-life practice to improve patient health. This state of the art article reviews the challenges and current status of and strategies for asthma dissemination and implementation globally, and highlights the specific strategies for such improvement in developing countries.
The pathophysiology and the most common clinical features of female urinary incontinence were presented. The practical diagnostic and therapeutic approach to urinary incontinence in patients was discussed. New surgical techniques including endoscopy and modified sling operation (TVT) were analysed in terms of clinical efficacy. The pivotal role of educational programme aimed at rational treatment of female urinary incontinence, including both physicians and patients, was emphasized.
BACKGROUND: Recent guidelines from the US National Kidney Foundation Dialysis Outcomes Quality Initiative recommend an earlier start of dialysis treatment than has been common practice. Their implementation would have a substantial effect on patients' daily lives and would increase costs. The guidelines are largely opinion-based, because evidence is still lacking. METHODS: As part of a prospective multicentre study in the Netherlands, we included, between January, 1997, and May, 1999, all new patients with end-stage renal disease, for whom data were available on residual renal function 0-4 weeks before the start of dialysis. We recorded date of death or censoring until August, 2000. FINDINGS: 94 (37%) of 253 patients started dialysis treatment later than recommended by the US guideline. There was an increased mortality risk for these patients compared with those who started dialysis on time, although it was not significant (adjusted hazard ratio 1.66 [95% CI 0.95-2.89]). The adjusted difference in estimated survival time after 3 years on dialysis treatment was 2.5 months (1.1-4.0) in favour of timely starters. Conversely, the average delay in dialysis initiation for late starters, the extra time free of dialysis, was at least 4.1 months. INTERPRETATION: Although we observed a gain in survival time with a timely start of dialysis, it is probably a reflection of initiating dialysis earlier in the disease. We question the benefit of putting this guideline into daily practice, given the current clinical evidence and the effects it would have on patients and dialysis resources.
OBJECTIVES: This investigation was designed to determine the relationship between National Cholesterol Education Program (NCEP) ATP-II lipid guidelines and subclinical atherosclerosis, defined by electron beam tomography (EBT) calcified coronary plaque, in asymptomatic women. BACKGROUND: NCEP guidelines are used to identify women at increased risk for coronary artery disease (CAD) on the basis of low density lipoprotein cholesterol (LDLC) and high density lipoprotein cholesterol (HDLC) values. The relationship of the guidelines to subclinical atherosclerosis is unknown. METHODS: A total of 304 asymptomatic women underwent lipid and EBT evaluation and were classified as: 1) NCEP higher risk, with LDLC > or =130 mg/dl and/or HDLC <35 mg/dl, or lower risk with LDLC <130 mg/dl and HDLC > or =35 mg/dl; and 2) EBT+ if any calcified plaque was noted or EBT- if there was no calcified plaque. RESULTS: Forty-two percent of patients were EBT+, with a mean score of 227 and percentile of 73%; 58% were EBT-. Women who were EBT+ had significantly higher total cholesterol, LDLC and triglycerides than EBT- women, but only with ages < or =55 years; women >55 years demonstrated no differences. NCEP higher risk women made up 53.5% of the EBT+ and 37.7% of the EBT- groups; NCEP lower risk women accounted for 46.5% of the EBT+ and 62.3% of the EBT- groups. Assuming a higher risk in subjects with EBT-defined subclinical CAD than in those without, only 58.6% of the total group would be correctly identified by NCEP guidelines as either higher or lower risk, with correct identification of 65.5% of the younger and 52.2% of the older women. There was no correlation between either calcium percentile or score and any lipid measurement. CONCLUSIONS: This study demonstrates the shortcomings of employing NCEP guidelines to identify asymptomatic women with subclinical CAD, particularly women >55 years, and suggests increased utilization of EBT for primary prevention in the female population.
Group B Streptococcus (GBS) is a major cause of perinatal infectious morbidity and mortality in the United States. An estimated 50,000 women and 7,600 neonates experience GBS disease, and as many as 310 infants die each year. In 1992, the American Academy of Pediatrics published recommendations for identification and treatment of pregnant women colonized with GBS. In 1996, the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists developed more comprehensive guidelines. The article describes the central role of perinatal nurses in the identification of pregnant women colonized with GBS, patient education about GBS disease, and successful implementation of intrapartum GBS prophylaxis.
The case report of a young patient with an increase in blood pressure and heart rate offers the opportunity to discuss the clinical guidelines to explore and treat high blood pressure. The value of the 24 h blood pressure monitoring and the need for precise information on all drugs taken are stressed.
This is the first consensus document on the follow-up of the treated patient with non-small cell lung cancer that has been written by this group. The document has been drawn up by doctors coming from many different cultures and philosophical backgrounds. It acknowledges that there are published guidelines on the follow-up particularly those in trials, and does not wish to contradict these. There is lack of evidence-based medicine to recommend a strong general policy in this area. For those patients who were treated with curative intent the initial follow-up will depend upon the toxicity that is evident from the treatment given. Thereafter the interval between follow-up visits should be every 3 months for the first two years, then every 6 months for up to five years. Rapid and easy access to the multidisciplinary team should be available. Full examination and chest X-ray should be carried out on each visit but other investigations should be determined by clinical need. For those patients treated with palliative intent the interval between follow-up visits once the acute reactions have settled will depend upon the adequacy of the control of the symptom and the availability of separate palliative care teams. At all times the patient should have rapid access to the multidisciplinary team and in general frequent follow-up, that is at intervals of one to two months, may be appropriate during the first six months. Follow-up constitutes an important part of lung cancer management. Efforts should be made to gain clinical material to give us evidence-based guidelines.
BACKGROUND: In Crossing the Quality Chasm, the Institute of Medicine laid out principles to improve quality of care and identified chronic diseases as a starting point. One of those principles was the wise use of patient time, but current recommendations for chronic conditions do not consider time spent on self-care or its impact on patients' lives. OBJECTIVE: To estimate the time required for recommended diabetes self-care. METHODS: A convenience sample of 8 certified diabetes educators derived consensus-based estimates of the time required for all self-care tasks recommended by the American Diabetes Association. RESULTS: For experienced patients with type 2 diabetes controlled by oral agents, recommended self-care would require more than 2 extra hours daily. Elderly patients and those with newly diagnosed disease, or those with physical limitations, would need more time. Exercise and diet, required for self-care of many chronic conditions, are the most time-consuming tasks. CONCLUSION: The time required by recommended self-care is substantial. Crossing the Quality Chasm suggests how clinicians and guideline developers can help patients make the best use of their self-care time: elicit the patient's perspective; develop evidence on the health consequences of self-care tasks; and respect patients' time.
AIM: The aim of the symposium was to provide strategies to help overcome different types of nurse-patient communication problems, with particular reference to the renal disease setting. In this context, the importance of effective patient education to increase patient compliance played a vital role. The case studies presented and the subsequent discussions helped increase the awareness of important medical aspects, such as the increased risk of anaemia-related complications in diabetic patients and the importance of early referral and anaemia treatment in patients with renal disease. Strategies proposed were supported by best practice guidelines and the latest scientific data. METHODOLOGY: A moderator led an interactive session that included two video case studies, scientific presentations and panel discussions. The audience played an active role by expressing their opinions via keypads. The case studies and the views of the audience were discussed by a panel of experts, who related their experiences and advice. CONCLUSIONS: A good nurse-patient relationship is essential to meet the clinical, psychological and social needs of the patient in order to optimise treatment. Effective patient education is an important tool to meet patient's needs and increase treatment compliance. Moreover, optimal treatment of patients requires a multidisciplinary approach to allow early identification and treatment of associated co-morbidities. Anaemia-related co-morbidities are particularly important in diabetic patients with renal disease, since this patient group develops anaemia at an early stage and has a significantly increased risk of cardiovascular complications. In renal disease, there are well-defined guidelines and treatment options for anaemia-related co-morbidities, which can easily be adapted to a patient's needs in order to offer flexible, individualised treatment with the aim of improving treatment outcomes.
PURPOSE/OBJECTIVES: To review the mechanisms of multidrug resistance (MDR) in human cancer and the clinical use of MDR modulators to overcome or reverse P-glycoprotein (P-gp)-mediated MDR. DATA SOURCES: Current literature, ongoing clinical trials, and clinical experience. DATA SYNTHESIS: Agents, such as valspodar, that block the activity of P-gp can reverse or overcome MDR caused by overexpression of P-gp. The MDR modulator valspodar (PSC 833; Novartis Pharmaceuticals Corporation, East Hanover, NJ) is examined as a model for establishing nursing guidelines for this new class of therapeutic agents. CONCLUSIONS: The dose of some chemotherapy agents must be modified with concurrent valspodar administration. Studies examining the safety and efficacy of valspodar as a prototype of MDR modulators provide the basis for establishing nursing care guidelines. IMPLICATIONS FOR NURSING PRACTICE: Nursing care for the administration of valspodar includes understanding patient selection, criteria, dosing, and administration; side-effect management; patient monitoring and follow-up; and patient education.
Advances in the ability to detect and effectively treat osteoporosis lead to questions about when testing and treatment should be initiated. Disease management provides answers with the promise of both cost-effective use of resources and improved health outcomes. Applying the characteristics and principles of disease management to osteoporosis provides a powerful rationale for a population-based approach to this disease. Disease management makes it possible to systematically identify persons at risk, intervene with prevention and treatment programs, and measure clinical, quality of life, and economic outcomes. Clinical guidelines are a critical element in disease management. This article presents clinical guidelines developed recently by national medical and public health experts based on a review of available research and clinical evidence.
Long-term indwelling catheters often are incorrectly used and managed. Nurses insert and manage catheters, yet studies have shown that most nurses have limited scientific knowledge in the area of catheters and their care. This article will review the Agency for Health Care Policy and Research guidelines for recommended catheter use and suggest troubleshooting tips for catheter-related problems. The problems of infection, catheter selection and size, urinary leakage, encrustation, catheter blockage, and inadvertent catheter removal will be addressed. Patient and caregiver education tips also will be listed.
Atlanta children's hospital system initiates outpatient pediatric asthma disease management program to reduce inpatient admissions and ER visits while reducing costs. Children's Healthcare of Atlanta turned to the primary care physician community for front-line support in keeping mild asthma cases out of the hospital. By offering evidence-based practice guidelines, training for staff, and educational materials for patients and their families, the Partnership to ACE Asthma program is off to a running start. Learn how to set up a similar program.