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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.

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PubMed2005

Designs in partially controlled studies: messages from a review.

The ability to evaluate effects of factors on outcomes is increasingly important for studies that control some but not all of the factors. Although important advances have been made in methods of analysis for such partially controlled studies, work on designs has been limited. To help understand why, we review the main designs that have been used for such partially controlled studies. Based on the review, we give two complementary reasons that explain the limited work on such designs, and suggest a new direction in this area.

Cluster Analysis↗
PubMed2005

Implications of stroke prevention trials: treatment of global risk.

Clinical trials have demonstrated that risk of cardiovascular events may be reduced in patients with stroke, using blood pressure (BP) reduction and statin therapy, independently of the presence of specific risk factors. These results suggest an alternative approach to secondary stroke prevention, focused more on global risk than on detection and modification of individual categorical risk factors such as hypertension, dyslipidemia, and diabetes mellitus. A risk-based approach is warranted because stroke patients are at high risk of several cardiovascular events, not just stroke, and because physiologic risk factors such as BP demonstrate a continuous, or log-linear, relationship with cardiovascular risk. Essential to the implementation of such an approach is the development of adequate risk stratification models for stroke patients. Based on limited available evidence, however, it appears that most patients who experience an ischemic stroke or TIA are at high long-term absolute risk of a subsequent cardiovascular event and should be treated with all available risk-reduction strategies.

Antihypertensive Agents↗
PubMed2003

Exercise during pregnancy: a practical approach.

Attitudes toward exercise during pregnancy have changed dramatically over the past 20 years. Recent studies show that, in most cases, exercise is safe for both the mother and fetus during pregnancy, and support the recommendation to initiate or continue exercise in most pregnancies. This report discusses the rationale behind the changes, and offers educational tools that may be employed to initiate behavioral change. We also propose exercise prescriptions for pregnant women who are sedentary, physically active, and competitive athletes. Armed with this information, the practitioner will be better equipped to counsel patients and incorporate a discussion on physical activity into prenatal visits.

Exercise↗
PubMed2005

The domino effect: obesity, type 2 diabetes and cardiovascular disease.

Rising levels of obesity in the UK are leading to corresponding increases in type 2 diabetes and threaten to jeopardize recent successes in combating cardiovascular disease. This article will discuss the key role district nurses have to play in breaking this continuum. Through health promotion activities, patient assessment and facilitating the early diagnosis of type 2 diabetes, community nurses can help reduce cardiovascular risk factors and ensure that holistic treatment regimens are initiated early on in the disease process. An overview of current regimens is provided. Effective monitoring of patients response to treatment will help diabetes specialists set and prioritize appropriate treatment goals.

Cardiovascular Diseases↗
PubMedDate not supplied

Giving medicinal information to mentally capacitated patients.

Roy was advised that a new drug which had just come on the market would assist his chronic depression. He was not given any further information, but after taking it for a few days found that it had a strong effect on his personality and he became aggressive and violent. As a consequence of a fight at work he lost his job and now claims that had he known of these effects he would not have taken the new drug.

Drug Therapy↗
PubMedDate not supplied

An overview of the current asthma disease management guidance.

Asthma is a common chronic disease that carries considerable costs both to the individual and to the NHS, despite the availability of effective treatments. All nurses will encounter patients with asthma during their professional careers; therefore, a basic understanding of asthma and its management is required. Asthma responds well to treatment, yet asthma deaths still occur. The variability of asthma symptoms requires the patient to bear the responsibility of disease management from day to day. Patient education is needed if asthma is to be managed well and, while inhaler devices provide an effective delivery system, inhaler technique needs to be taught and devices used correctly if maximum benefit is to be achieved. Personal asthma action plants improve asthma control, yet are currently underused. While compliance with long-term treatment is poor and the reasons for this are complex, understanding among healthcare professionals when managing asthma.

Adrenergic beta-2 Receptor Agonists↗
PubMedDate not supplied

Abbreviations: the need for legibility and accuracy in documentation.

This article explores the use of abbreviations in health care. It considers the current advice of the Nursing and Midwifery Council against the use of any abbreviations and suggests, in the interests of using time effectively, that it would be wise for directorates within trusts to create a list of approved abbreviations and symbols so that the dangers of misunderstandings are removed. It also considers how the problem of illegibility should be dealt with as a clinical governance issue.

Abbreviations as Topic↗
PubMedDate not supplied

Pre-conception care and support for women with diabetes.

This article discusses the National Service Framework for Diabetes: Standards (Department of Health, 2001), with the main focus on Standard 9: diabetes and pregnancy. It concentrates on pre-conception care and support for women with pre-existing diabetes to optimize the outcome of their pregnancy. The rationale for this is the need to understand how this standard affects women with diabetes during childbearing age. Following an introduction to aetiology and epidemiology of diabetes, the author examines the importance of pre-conception care for women with diabetes. An acknowledgement of the deficits within the clinical environment aids recommendations on improvement of education and knowledge for nurses. Health promotion and patient support is emphasized to facilitate an understanding of the impact of diabetes on pregnancy and the necessity of the multidisciplinary team involvement before, during and after birth.

Exercise↗
PubMed1997

Providing incentives to control health care costs and remain competitive in the marketplace: a pilot study.

Few marketplaces in the United States have been subject to as much scrutiny, and undergone as much transformation in the 1990s, as has health care. Even based on the slowest growth rates experienced in the 1980s and 1990s, the United States is projected to be spending $3,140,221 per minute on health care by the year 2000. The purpose of this study was to examine how coordination between providers of medical care, and working with their customers (i.e., payors) might reduce costs without compromising quality. Providing incentives to these groups of businesses that form the health systems can be a means for achieving both individual health system objectives. Because of the importance of pharmacists in health care delivery systems, they were considered an excellent group for testing and measuring the impact of incentive programs. The study involved a before and after six month period involving dispensing patterns through a pharmacy benefit manager. Incentives were provided to pharmacies based on percent improvement in generic substitution rates and formulary compliance. A network of 342 independent pharmacies, with their dispensing patterns monitored through a pharmacy benefit manager under its contract program. The results of the study were that generic substitution rates rose from the pre-trial period of 68.5% to 73.7% in the first three months of the trial period, and to 75.6% in the second three months of the trial period. The overall increase in substitution was from 68.5% in the base period to 74.7% over six months. These differences were statistically significant at the 0.05 level. Estimated savings to health plans on an annualized basis would be approximately $3.4 million, and the payout per conversion to pharmacies was $3.23. While not measured directly, no adverse clinical effects were reported due to substitutions. Thus, an incentive system to reward those health care providers can effectively control expenses to achieve mutually desirable goals of all parties. If properly structured, the providers, health systems of which they are a part, and payors can benefit. Using an incentive program like the one designed for this study, health systems may be able to be more competitive in marketing their services to payors.

Cost Control↗
PubMed2003

PD(X)MD: a new clinical information tool for patient care.

PD(X)MD is a new and promising evidence-based electronic primary care clinical information resource. It is geared primarily to the physician, as is its companion database, MDConsult, but it can also be very useful to medical and non-medical librarians seeking to quickly summarize current, accurate, and quality-filtered clinical information focusing on diagnosis, therapy, prognosis, and prevention.

Databases, Factual↗