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PubMed2006

Evidence-based medicine.

Evidence-based medicine (EBM) has become a watchword for "the new" medical practice in the new century. Whether it represents a paradigm shift or simply a codification of the scientific method in medicine will be debated for years to come. Regardless of the place of EBM in medicine, this "movement" has served an important role in moving physician practice into the realm of becoming more scientific (albeit empirical) and transparent. There are still many problems to be addressed in the global application of the best evidence for medical practice. These include low-quality studies, delays in implementation of clear-cut improvements, outright fraud and deceit, and wariness on the part of physicians to change their practice. By working to understand the underpinnings of EBM (basic statistical concepts and critical thinking) we can advance the practice of medicine along the moral high road of science.

Delivery of Health Care↗
PubMed1997

The combat of non-compliance during prophylactic lithium treatment.

Non-compliance is the most frequent cause of recurrence during prophylactic lithium treatment and is associated with poor response and high levels of suicidality. Non-compliance is a complex phenomenon and may have a number of causes. When manic-depressive patients fare badly under the conditions of so-called 'naturalistic' trials, this usually indicates that such conditions are inadequate for long-term maintenance treatment. Prophylactic lithium treatment must be accompanied by measures to sustain compliance and counteract drop-out, and these measures build on three cornerstones, namely information, support and supervision.

Aftercare↗
PubMed2006

Ethics and pharmaceutical medicine -- the full report of the Ethical Issues Committee of the Faculty of Pharmaceutical Medicine of the Royal Colleges of Physicians of the UK.

The practice of pharmaceutical medicine brings with it ethical challenges and dilemmas often very different from those encountered in the practice of clinical medicine. Having established a framework of guiding ethical principles, this report aims to look in some detail at specific areas of possible ethical concern to pharmaceutical physicians, offering practical advice and guidance on good practice. The report covers issues related to pharmaceutical research, including dissemination of research findings, communication with other health professionals and patients and involvement of pharmaceutical physicians and companies in the provision of patient services. The primacy of the interests of patients and the wider public is emphasised, and the possible impact of new developments in pharmaceutical technology is explored. It is hoped that the report will help those working in pharmaceutical medicine and act as a stimulus for wider discussion and debate.

Biomedical Research↗
PubMed2004

Compliance with advice and appropriateness of emergency presentation following contact with the HealthDirect telephone triage service.

OBJECTIVE: Evaluation of compliance with advice and appropriateness of emergency presentation following contact with a telephone triage service (HealthDirect). METHODS: Compliance rates, triage distributions and admission rates were determined using linked HealthDirect and ED records for patients living within 2 km of an ED that presented during 2000. RESULTS: Of 13 019 presentations, 842 (6.5%) were HealthDirect contacts. In the HealthDirect group there were a greater proportion of patients under the age of 15 (290, 34% vs 1598, 13.1%) and women (481, 57% vs 5610, 46%). The triage distributions and admission rates for HealthDirect contacts and other patients were similar (HealthDirect 37.6% admitted, 95% CI 34-41, others 38.4% admitted, 95% CI 38-39, Pchi2 = 0.67). Of 3996 callers to HealthDirect, 3167 (79%) complied with advice with 963 (61%) complying with advice to present and 212 (9%, 95% CI 8-10%) presenting despite advice to defer presentation. Triage distributions and admission rates for compliers and non-compliers were similar (compliers 38% admitted, 95% CI 34-41, non-compliers, 37% admitted, 95% CI 30-44, Pchi2 = 0.89). CONCLUSIONS: HealthDirect contacts were of similar appropriateness to non-HealthDirect presenters and appear to attend the ED independent of HealthDirect advice. HealthDirect has a limited capacity to influence ED utilization or workload.

Adolescent↗
PubMed2006

Learning to observe relationships and coping.

Milieu relationships provide the critical background presence to staff's attempts to motivate, regulate, and teach patients how to cope with stress. Forging a connection with hospitalized children and adolescents demands attention to how they respond to adults and engage with staff around milieu expectations. Assessment guides that deal with these issues are presented. Important aspects of children's relatedness are presented in the context of their working models of adults and the influence of these representations on their response to staff. Coping skills are explained with particular emphasis on behavioral coping strategies. Tied to the assessment process are interventions that emphasize staff's role in helping patients manage strong affects and avoid the use of nonproductive behavior regulation strategies.

Adaptation, Psychological↗
PubMedDate not supplied

Formulation of a plan of care for culturally diverse patients.

PURPOSE: To formulate a plan of care for a culturally diverse population and develop a resource for the healthcare team in providing culturally competent care. DATA SOURCES: Books, journal articles. DATA SYNTHESIS: Healthcare workers are challenged to provide appropriate care for an increasingly diverse population. A cluster of nursing diagnoses were used to develop a plan of care addressing the unique challenges of caring for a diverse population served by a community hospital. CONCLUSION: A care plan was devised and inserted into the nursing diagnosis-based nursing documentation computer system for easy access when needed. PRACTICE IMPLICATIONS: A care plan for a diverse population can promote respectful and excellent care for every patient.

Adaptation, Psychological↗
PubMed2006

Evidence-based practice: review of clinical evidence on the efficacy of glucosamine and chondroitin in the treatment of osteoarthritis.

PURPOSE: To evaluate past and current evidence from randomized controlled trials on the efficacy of glucosamine sulfate (GS), glucosamine hydrochloride (GH), and chondroitin sulfate (CS) for the treatment of osteoarthritis (OA). DATA SOURCES: An extensive review of four meta-analyses and a review of the findings of the recently published Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) funded by the National Institutes of Health. FINDINGS: Review of previous studies on the efficacy of GS, GH, and CS in the treatment of OA showed inconclusive results because of weak research design. The GAIT attempted to provide clarity on the use of GH and CS in treating knee pain from OA by using a rigorous research design to elicit cause and effect. The GAIT results showed that GH and CS were not effective in reducing knee pain in the study group overall; however, these may be effective in combination for patients with moderate-to-severe knee pain. IMPLICATIONS FOR PRACTICE: There is now clinical evidence indicating that recommending GS, GH, and CS for the treatment of mild knee pain from OA is ineffective. Further research needs to be done to identify specific characteristics in patients that results in a positive response. Until the findings of the GAIT undergo further peer review, the results of the research needs to be interpreted with caution.

Chondroitin↗
PubMed2005

Risk management--the forensic nursing response 'ability'.

As risk managers begin to reconsider their nursing roles and responsibilities, the impact of the forensic applications are endless. The forensic element of the role as a health care professional is a very real entity that is often overlooked as the responsibility of someone else. All nurses are responsible for their own documentation, patient care outcomes, knowledge, and education, and must be prepared to speak intelligently to, or defend all, in a court of law. Health care is dynamic and health care facilities should be committed to displaying and ultimately providing an environment of safety and trust to patients. Risk management offers a proactive and preventative approach to meeting these changes effectively. Be prepared--know what the risks are.

Clinical Competence↗