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At least 541 records · Page 30Linked to original sources
PubMed2006

Technology insight: Clinical role of magnetic resonance angiography in the diagnosis and management of renal artery stenosis.

Noninvasive modalities, including duplex ultrasonography, renal scintigraphy, CT angiography and magnetic resonance angiography (MRA), may usefully contribute to diagnosis and treatment planning in patients with suspected renal artery stenosis. Important technical developments have increased the accuracy and feasibility of MRA for the detection of renal artery stenosis. A number of different MRA techniques can be applied to the study of renal arteries, but contrast-enhanced MRA represents the most valuable approach; several studies corroborate the high diagnostic accuracy of this technique, especially for the detection of atherosclerotic renal artery stenosis. A combined MRA protocol, which might include angiographic information provided by contrast-enhanced technique in addition to renal flow information derived from phase-contrast imaging, could help in classifying patients appropriately. Limitations of renal MRA include low accuracy in the evaluation of renal fibromuscular dysplasia and in the assessment of patients who undergo stenting of the renal arteries. This review describes the MRA techniques applied to the study of renal artery stenosis, including the technical features of current approaches and forthcoming developments. An overview of the clinical role of MRA, in conjunction with the other diagnostic modalities, in the identification and management of patients with renal artery stenosis, is also presented.

Algorithms↗
PubMed1999

What nutrition knowledge and skills do primary care physicians need to have, and how should this be communicated?

The last Heelsum workshop agreed that general practitioners should concentrate on dietary advice for treatment or secondary prevention, though nutritional advice for health is part of the doctor's work with pregnancy, infants and the very old. Nutrition prescriptions contrast with drug prescriptions. For drugs information is authoritative, evidence-based and easily available. Drug prescriptions are potentially liable to litigation. Dietary prescriptions are less serious and more the patient's responsibility. Nutrition information comes in a plethora of different forms, some of it unscientific, some out of date, some commercially biased. While waiting for some system (?authoritative, ?electronic) that can help general practitioners (GPs) organise nutrition information, there are three modern books that have been written by nutrition specialists for GPs in the English language (there may be others in North America) and another was written for practice nurses. As well as general books like this most large countries have expert reports on some nutritional topics by government committees available for reference. In relating foods and food components to disease, most of the reliable evidence is about their effect on risk factors-plasma cholesterol, blood glucose, blood pressure or body weight. A smaller amount of evidence relates food intake data from large cohort studies to incidence of disease. Very few randomised controlled trials (the ultimate evidence-based medicine) have been achieved for nutrition. Dietary recommendations may have to change with time because of new research-and drugs. Advice for secondary prevention of coronary heart disease is shown as an example of this.

Coronary Disease↗
PubMed2000

Alcohol screening and brief intervention: dissemination strategies for medical practice and public health.

This paper introduces the concept of risky drinking and considers the potential of alcohol screening and brief intervention (SBI) to reduce alcohol-related problems in medical practice and in organized systems of health care. The research evidence behind this approach is reviewed. Potential strategies for the dissemination of SBI to systems of health care are then discussed within the context of a public health model of clinical preventive services. There is an emerging consensus that SBI should be promoted in general healthcare settings, but further research is needed to determine the best ways to achieve widespread dissemination. In an attempt to provide an integrative model that is relevant to SBI, dissemination strategies are discussed for three target groups: (1) individual patients and practitioners; (2) health care settings and health systems; and (3) the communities and the general population. Dissemination strategies are considered from the fields of social change, social science, commercial marketing and education in terms of their potential for translating SBI innovations into routine clinical practice. One overarching strategy implicit in the approaches reviewed in this article is to embed alcohol SBI in the more general context of preventive health services, the utility of which is becoming increasingly recognized as a critical supplement to more traditional clinical medicine.

Alcoholism↗
PubMed1998

The effect of education, assessment and a standardised prescription on postoperative pain management. The value of clinical audit in the establishment of acute pain services.

A study involving 2738 patients in 15 hospitals in the United Kingdom was undertaken to evaluate the effect of simple methods of pain assessment and management on postoperative pain. The study consisted of four parts: a survey of current practice in each hospital; a programme of education for staff and patients regarding pain and its management; the introduction of formal assessment and recording of pain and the use of a simple algorithm to allow more flexible, yet safe, provision of intermittent intramuscular opioid analgesia; and a repeat survey of practice. One hospital from each of the former health regions of England and Wales was selected for inclusion in the project. Hospitals included representatives of different size units (university, large and small district general hospitals). As a result of the study, there was an overall reduction in the percentage of patients who experienced moderate to severe pain at rest from 32% to 12%. The incidence of severe pain on movement decreased from 37% to 13% and moderate to severe pain on deep inspiration from 41% to 22%. Similar decreases were seen in the incidence of nausea and vomiting. There was also a slight reduction in the incidence of postoperative complications. This study shows that simple techniques for the management of postoperative pain are effective in reducing the incidence of pain both at rest and during movement and should form part of any acute pain management strategy.

Analgesics, Opioid↗
PubMed2003

Providing evidence-based information to patients in general practice and pharmacies: what is the acceptability, usefulness and impact on drug use?

BACKGROUND: A common and often integral method of delivering patient information is the use of patient guides. However, the acceptability, utility and impact of evidence-based therapeutic guides on physicians, pharmacists and patients have not been well evaluated. METHODS: This study was a prospective evaluation of 53 general practitioners' offices and 30 community pharmacies from three locations in Canada. Evidence-based guides were provided to 1176 patients who presented to either a general practitioner or a community pharmacist and were interested in receiving information about sore throat, heartburn, or osteoporosis (http://www.ti.ubc.ca/canadadrugguide). The acceptability, utility and impact of the guides were assessed via structured patient telephone interviews, structured health professional interviews, and patient chart audits. RESULTS: Eighty to 90% of patients reported that the guides were 'very easy' to understand. Fifty six per cent/47%/38% (sore throat/heartburn/osteoporosis) of patients rated the guides as 'very' or 'extremely' useful. Seventy-two per cent/67%/58% of respondents reported that the information helped them make decisions about their treatment. Ninety eight per cent of physicians and 92% of pharmacists reported that the guides helped their patients understand the issues involved in their treatment. None of the analyses showed any significant differences in prescribing of medications between the intervention and control groups. INTERPRETATIONS: Patients found these evidence-based guides to be useful, easy to understand, and that they helped them in their understanding of treatment options and the decision-making process. Physicians and pharmacists reported that the guides helped their patients understand the issues involved in their treatment. Further research is required to determine the degree to which providing evidence-based guides to patients can impact on prescribing and patient outcomes.

Adult↗
PubMedDate not supplied

Patient and caregiver perceptions of cancer pain control.

OBJECTIVES: This study measured the perceptions of cancer patients and caregivers in Utah concerning knowledge about and adequacy of pharmacologic cancer pain control. MATERIALS AND METHODS: A descriptive survey was sent to a stratified random sample of adult cancer patients obtained from the Utah Tumor Registry. Questionnaires asked cancer patients and caregivers about their knowledge of pain control and about perceptions of the adequacy of pharmacologic cancer pain management. RESULTS: The study had a 52% response rate (259 of 500) after two mailings. Eighty-five percent (219 of 259) of the respondents stated that they had no cancer pain. With the first mailing, a "no pain" response was not offered as an option. When the researchers realized that this might be a possible response, a second mailing was sent, which may be the reason for the high response rate. CONCLUSIONS: Cancer literature indicates that much cancer pain is not effectively controlled. The majority of the respondents of this study reported no pain. Because this result is different than that reported in the literature, it may indicate that education of healthcare providers, patients, and families can improve cancer pain management and control. It may also indicate an inability of the study to obtain data from those patients having cancer pain. This study should be repeated with a focused population of advanced stage cancer patients with types of cancer typically producing high levels of cancer pain.

Adult↗
PubMed2001

The role of advanced practice psychiatric nurses in treating tobacco use and dependence.

Tobacco use is treatable and the benefits of smoking cessation are impressive, yet like other health care providers, psychiatric nurses have failed to consistently assess and treat tobacco use effectively. Tobacco use continues to cause illness, disability, and death at unprecedented rates. Nicotine addiction is drug abuse and it is a chronic disease and needs to be treated as such. There are clear health benefits to smoking cessation regardless of the age of smoking initiation or the age of smoking cessation. Advanced practice psychiatric nurses (APPNs) are in a unique position to make an impact on a smoker's risk of suffering from tobacco-related diseases: the treatment of choice is the combination of pharmacotherapy and psychosocial interventions, both within the realm of APPN practice; psychiatric and substance abusing patients consistently demonstrate increased rates of cigarette smoking compared with healthy controls; and tobacco use is drug abuse, a treatable chronic disease. The ability of APPNs to deliver psychotherapeutic and pharmacologic care secures a position in the forefront of treating tobacco use. In addition to intervention, psychiatric nurses need to step up and take an active role in initiating and supporting tobacco control policy and legislation.

Counseling↗
PubMed2001

The Internet in oncology nursing.

OBJECTIVES: To explore the implications of the internet for oncology nursing practice, education, and research. DATA SOURCES: Published articles, texts, research studies, review articles, and online documents pertaining to the internet. CONCLUSIONS: The internet has influenced nearly every aspect of society. As the worldwide communications infrastructure strengthens, access devices become affordable, and more countries contribute content in their native language, this technology becomes a truly global phenomenon. This affords oncology nursing a voice that extends beyond the community support group to millions of internet users. IMPLICATIONS FOR NURSING PRACTICE: Internet access, quality of information, and privacy of data transmitted are among the greatest challenges that face oncology nurses who integrate this technology into practice.

Authorship↗