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At least 325 records · Page 18Linked to original sources
PubMed2000

Evaluation of a single seizure: guidelines for advance practice nurses.

Deciding whether or not to treat a client after a single seizure can be challenging for the clinician. The risk of seizure recurrence is greatest in the first six months after the initial episode. The decision to treat a single seizure should be based on diagnostic and clinical findings that assess the client's risk for recurrence. When making treatment decisions, the clinician must consider the benefits and risks of single-seizure therapy. Careful consideration should be given to differential diagnosis, factors that induce symptomatic seizures and risk factors for epilepsy.

Adult↗
PubMed2004

Education, motivation and medication for African Americans: bringing hypertension guidelines to practice.

African Americans suffer from high rates of hypertension and hypertension-related complications. While racial/ethnic differences in blood pressure response to pharmacologic therapy have been described, most randomized hypertension trials with substantial enrollment of African Americans receiving standardized medical care do not support class-specific racial/ethnic differences in key clinical outcomes. Understanding health care systems and the socio-economic and demographic factors that impair access can enhance the ability of the provider to enlist and engage the patient for optimal blood pressure control and end organ protection.

Black or African American↗
PubMed1996

The use of continuous quality improvement methods to implement practice guidelines in asthma.

National asthma management guidelines have improved awareness of the rising morbidity and mortality from asthma but have not been widely implemented at a local level. This paper describes the use of continuous quality improvement techniques to facilitate the implementation of asthma management guidelines within a tertiary hospital setting. A baseline audit demonstrated satisfactory emergency assessment and treatment, but identified poor compliance with the patient education aspects of the asthma management plan. An evaluation of the literature demonstrated that programs combining asthma education and management were effective when directed towards adults with a recent severe asthma exacerbation. An asthma education and management service was developed to address these deficits. A repeat audit was conducted which identified improvements in asthma control and management skills for patients attending the education program, together with reductions in asthma re-admission rates for patients referred to the service. Ongoing quality assessments will target non-attenders to the service and the maintenance of asthma skills. An area Asthma Health Outcomes Council was formed to address the issues of asthma management throughout the area health service.

Adult↗
PubMed2001

Viral upper respiratory infections.

Clinical practice guidelines (CPG) hold great potential for providing a summary of large volumes of clinical evidence and a related set of practical recommendations. Nurse practitioners should become aware of the range of available CPGs and methods by which they can be evaluated for use. Appropriate evaluation of CPGs should include their overall reliability and validity, as well as their applicability in specific situations. This article is part of an ongoing series presenting individual CPGs.

Algorithms↗
PubMed2001

A decade in HIV treatment: what is the state of the art and how did we arrive.

Simultaneous developments in the understanding of human immunodeficiency virus (HIV) pathogenesis and the development of new sensitive assays to measure HIV RNA have contributed to new approaches in the management of HIV infection. This article reviews major scientific developments in the treatment of HIV disease and outlines current clinical guidelines for primary care providers. Because effective prescribing stems from understanding how medications achieve their clinical effect, the mechanisms of action of nucleoside reverse-transcriptor inhibitors (NRTIs), nonnucleoside reverse-transcriptor inhibitors (NNRTIs), and protease inhibitors (PIs) are covered. The evolution of therapy from NRTI monotherapy to PI- and/or NNRTI-containing combination therapy is traced.

Drug Therapy, Combination↗
PubMed2006

Implementation of the Texas Medication Algorithm Project patient and family education program.

OBJECTIVE: This article describes the implementation and utilization of the patient and family education program (PFEP) component of the Texas Medication Algorithm Project (TMAP). The extent of participation, types of psychoeducation received, and predictors of receiving at least a minimum level of education are presented. METHOD: TMAP included medication guidelines, a dedicated clinical coordinator, standardized assessments of symptoms and side effects, uniform documentation, and a PFEP. The PFEP includes phased, multimodal, disorder-specific educational materials for patients and families. Participants were adult outpatients of 1 of 7 community mental health centers in Texas that were implementing the TMAP disease management package. Patients had DSM-IV clinical diagnoses of major depressive disorder, with or without psychotic features; bipolar I disorder or schizoaffective disorder, bipolar type; or schizophrenia or schizoaffective disorder. Assessments were administered by independent research coordinators. Study data were collected between March 1998 and March 2000, and patients participated for at least 1 year. RESULTS: Of the 487 participants, nearly all (95.1%) had at least 1 educational encounter, but only 53.6% of participants met criteria for "minimum exposure" to individual education interventions. Furthermore, only 31.0% participated in group education, and 42.5% had a family member involved in at least 1 encounter. Participants with schizophrenia were less involved in the PFEP across multiple indicators of utilization. Diagnosis, intensity of symptoms, age, and receipt of public assistance were related to the likelihood of exposure to minimum levels of individual education. CONCLUSION: Despite adequate resources and infrastructure to provide PFEP, utilization was less than anticipated. Although implementation guidelines were uniform across diagnoses, participants with schizophrenia experienced less exposure to psychoeducation. Recommendations for improving program implementation and modification of materials are discussed.

Adult↗
PubMed1997

Educational assessment and teaching of older clients with pressure ulcers.

The importance of education in preventing and treating patients with pressure ulcers is evident by the inclusion of recommendations for educational objectives in the clinical guidelines by the Agency for Health Care Policy and Research. Both caregiver and client should be assessed for knowledge of pressure ulcers. Physical changes in vision, hearing, and cognition that might affect educating older clients are described. Strategies suitable for teaching older clients about the prevention and treatment of pressure ulcers are given.

Age Factors↗
PubMed2004

Weight loss interventions for adult obesity: evidence for practice.

BACKGROUND: One out of three adults is obese, making obesity the most common presenting chronic medical condition in the primary care setting. Obesity is associated with an increased risk of developing secondary illnesses resulting in a higher rate of morbidity. This chronic condition is a constant challenge facing international health care systems. A need for a systematic approach to treatment is essential to conquering obesity and improving patients' outcomes and quality of lives. Despite the existence of evidence-based guidelines, the proportion of primary care clinicians implementing weight loss counseling is low. APPROACH: This article identifies, critiques, and synthesizes the established body of research evidence for weight loss interventions. FINDINGS: The strategies that have been shown to be effective in the management and treatment of obesity are outlined. IMPLICATIONS: Finally, the feasibility of applying these findings to practice and the practical implications of these findings are discussed.

Adult↗
PubMed2005

Should ultrasound guidance be used for central venous catheterisation in the emergency department?

In September 2002, the National Institute of Clinical Excellence (NICE) issued guidelines for England and Wales suggesting that ultrasound guidance should be used for all electives, and should be considered for most emergency, central venous catheterisations.1 These guidelines propose a major change of practice for most clinicians practising in UK Emergency Departments. There are also resource and training implications. In this paper we systematically review the literature to establish what evidence exists for the routine use of ultrasound guidance in the placement of central venous catheters in adult patients attending the Emergency Department, and provide an overview of the practical elements of this procedure.

Adult↗
PubMed2000

The depression in primary care tool kit.

OBJECTIVE: A tool kit was developed to help primary care physicians overcome some of the barriers to recognition and management of depression. METHOD: Tools were collected from a variety of sources, categorized by function, and evaluated on the basis of previously established criteria, with the best tools selected for inclusion in the tool kit. New tools were developed when an adequate tool for a desired function was not available. The tool kit was reviewed and then revised based on the feedback from eleven experts on depression in primary care, five medical directors from health care systems or managed care companies, and eighteen primary care physicians. All eighteen primary care physicians completed a questionnaire after reviewing the tool kit as part of the evaluation process. RESULTS: Only five of the eighteen physicians were using any kind of tool for depression prior to reviewing the tool kit. All eighteen physicians indicated that they were likely to use one or more of the components of the tool kit. On average, physicians indicated they were likely to use 6.5 of the ten types of tools included in the kit. CONCLUSIONS: A depression tool kit containing screening, diagnostic, management planning, and outcomes assessment questionnaires as well as treatment and counseling guidelines, information tables, flow charts, and patient education materials is likely to be well received by primary care physicians. However, its effectiveness may have as much to do with how its use is organized and implemented as it does with the intrinsic value of its components.

Algorithms↗
PubMedDate not supplied

An overview of the new NICE guidelines on bipolar disorder.

Bipolar disorder can be a debilitating long-term condition characterised by extreme mood swings, ranging from elation to severe depression and sometimes coexisting mixtures of the two. This article looks at new guidance from NICE (2006) that provides recommendations for nurses on the assessment, treatment and long-term management of bipolar disorder.

Adolescent↗
PubMed2002

Update on managing hypercholesterolemia. The new NCEP guidelines.

1. The Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPIII) will significantly increase the number of Americans treated for hypercholesterolemia. 2. The ATPIII focuses on lowering low density lipoprotein cholesterol as a primary initiative and using exercise, diet, and pharmacotherapy as a means for lowering coronary heart disease and risks. 3. The new guidelines list low density lipoprotein cholesterol levels of less than 100 mg/dL as optimal for all clients. 4. The ATPIII places increased attention on high triglyceride levels (> 200 mg/dL) and on early detection and appropriate aggressive treatment for clients at risk for coronary heart disease and events.

Cholesterol, LDL↗
PubMed2001

Does a lipid clinic increase compliance with National Cholesterol Education Program Treatment Guidelines? Report of a case-matched controlled study.

Despite a national effort to promote measurement of cholesterol levels in adults, previous studies have shown that poor control is the norm. We sought to determine the effects of implementation of a structured lipid treatment program. Forty-one clinic-managed patients were matched with similar control patients. Clinic patients had more risk factors overall and therefore lower low-density lipoprotein (LDL) goals. They had significantly greater LDL reduction after the 6-month visit, resulting in a lower final LDL level. The percentage of patients reaching the LDL goal recommended by the National Cholesterol Education Program (NCEP) was the primary endpoint of the study. The NCEP guidelines were followed more frequently within the clinic, and significantly more clinic patients were treated to NCEP LDL goal than control patients. When indicated, medication was more frequently used and titrated in clinic patients. This study shows the efficacy of an organized lipid treatment clinic in management of dyslipidemia.

Cholesterol, LDL↗
PubMedDate not supplied

NICE guidelines to improve TB management and prevention.

In the UK although the majority of the population is at very low risk of TB due to vaccination, the number of cases reported is increasing. In response NICE has released fresh guidance on prevention and treatment. Nurses can play a crucial role in adherence due to the extent of their patient contact.

Antitubercular Agents↗
PubMed1994

How to put the Food Guide Pyramid into practice.

The Food Guide Pyramid represents changes and challenges for nutrition educators. Nutrition educators will have to change the focus, content, and teaching expectations for lessons. Use of the Pyramid will also require changes in the way the concepts of good nutrition are related to different audiences. In contrast to previous food guides, which represented a foundation diet, the Food Guide Pyramid represents the total diet, addressing overnutrition as well as undernutrition. The Food Guide Pyramid is a graphic representation of the Dietary Guidelines for Americans, and illustrates the key concepts of variety, moderation, and proportionality. For practitioners, one challenge is to find ways to effectively use the Food Guide Pyramid to teach clients how to put the Dietary Guidelines into action. Another challenge involves designing materials that adapt the messages of the Food Guide Pyramid to a variety of audiences. Teaching materials and instructions should emphasize the key concepts of the Food Guide Pyramid and should be clear, consistent, motivational, and culturally sensitive. Few educational materials are available to help practitioners with these challenges. In this article we outline the key changes that the Food Guide Pyramid embodies, and provide ideas and suggestions for using the Pyramid in a practice setting.

Diet↗
PubMed2001

Utilizing a systems approach to implement pressure ulcer prediction and prevention.

Efficient, effective patient care is an objective shared by all healthcare settings and systems. It is generally accepted that using national clinical guidelines facilitates pursuit of this objective. However, implementation of a guideline, or any process improvement activity, requires a systematic, collaborative approach from which new processes can be purposefully designed. This article reviews systems theory, presents the steps for process improvement using the Plan/Do/Check/Act cycle, and references a recent statewide quality improvement study conducted by the authors in collaboration with Stratis Health, a Minnesota Medical Peer Review Organization.

Beds↗
PubMedDate not supplied

Best practice in the assessment and management of diabetic foot ulcers.

Diabetes is an increasingly serious health issue in the rehabilitation population. Foot ulcers develop in approximately 15% of people with diabetes and are a preceding factor in approximately 85% of lower limb amputations. Nurses have significant opportunity to positively influence client outcomes and quality of life by promoting maintenance of healthy feet, identifying emerging problems, and supporting evidence-based self-care and interdisciplinary intervention. Best practice guidelines (BPG), such as those developed by the Registered Nurses Association of Ontario, provide a framework to enhance nursing practice and promote excellence in client care. This article highlights key evidence from the BPG, "Assessment and Management of Foot Ulcers for People with Diabetes," and other relevant diabetes literature. This information better equips rehabilitation nurses to promote ulcer prevention strategies; identifies key factors in ulcer risk; and utilizes current, best evidence for ulcer assessment, management, and evaluation.

Amputation, Surgical↗