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PubMedDate not supplied

The effectiveness of neurological rehabilitation in multiple sclerosis.

The difficulties inherent in demonstrating the effectiveness of an intervention that is as all-inclusive and poorly defined as neurorehabilitation, especially in a condition as unpredictable and variable as Multiple Sclerosis (MS), are not to be underestimated. They require strict adherence to rigorous methodology and, in particular, the consistent use of a range of clinically appropriate and scientifically sound measures of outcome. Incorporating this approach, it is possible to evaluate rehabilitation at four different levels, including (1) the broadest concept of service delivery; (2) packages of comprehensive care; (3) individual components of the package; and finally, (4) the intrinsic elements of the rehabilitation process. Most recent studies have focused on in-patient rehabilitation and have demonstrated benefits across disability, handicap, and quality of life in patients with mild to severe disability. Such benefits persist following discharge into the community. Studies evaluating service delivery and components of the rehabilitation package are in progress, but few investigators have taken on the intrinsic elements or 'black box' of rehabilitation. These recent studies underline the fact that the evaluation of rehabilitation is feasible. Such studies are important, not simply to justify funding but to ensure continuing improvement of the way in which MS is managed.

Evaluation Studies as Topic↗
PubMed2000

Withholding and withdrawing life-sustaining treatment.

Withholding or withdrawing life-sustaining therapies is ethical and medically appropriate in some circumstances. This article summarizes the American Medical Association's Education for Physicians on End-of-life Care (EPEC) curriculum module on withholding or withdrawing therapy. Before reviewing specific treatment preferences, it is useful to ask patients about their understanding of the illness and to discuss their values and general goals of care. Family physicians should feel free to provide specific advice to patients and families struggling with these decisions. Patients with decision-making capacity can opt to forego any medical intervention, including artificial nutrition/hydration and cardiopulmonary resuscitation.

Cardiopulmonary Resuscitation↗
PubMed2000

A family physician's guide to monitoring methotrexate.

Methotrexate has a long history of use in the treatment of various immunologic diseases, including rheumatoid arthritis and psoriasis. Although the drug is usually prescribed by a subspecialist, a family physician may assume responsibility for monitoring methotrexate therapy. Major toxic effects, such as hepatic, pulmonary, renal and bone marrow abnormalities, require careful monitoring. Minor toxic effects, such as stomatitis, malaise, nausea, diarrhea, headaches and mild alopecia, are common but respond to folate supplementation. Methotrexate is administered once weekly as a single dose or in divided doses given over a 24-hour period. To reduce the incidence of major toxic effects, methotrexate should never be given in daily doses. Relative contraindications include renal dysfunction, liver disease, active infectious disease and excessive alcohol consumption. Both women and men of reproductive age should use birth control during methotrexate therapy. Potential drug interactions include salicylates and nonsteroidal anti-inflammatory drugs, which are both commonly used in patients with rheumatoid arthritis or psoriasis. A premethotrexate evaluation is important to ensure proper patient selection for this effective but potentially toxic drug.

Antimetabolites, Antineoplastic↗
PubMed2000

Patient/provider education is cornerstone of successful DM approach to asthma.

Never underestimate the power of education in managing asthma. Even when you think you're doing all you can to educate patients and providers, at least one new study suggests there is usually ample room for improvement. See how one organization intends to build on its early success in the effective management of asthma through education.

Asthma↗
PubMedDate not supplied

A guide to patient education.

Effective patient education can help patients feel less anxious, more in control of their lives, and better able to play an active role in the perioperative state of the surgical process. As patient educators, nurses fulfill a vital role in teaching patients how to manage the challenges they may face. Many learning theories can be used alone or combined with various teaching techniques (see Table 2). Ultimately, however, the key to effective patient education is the concern and commitment of the nurse educator.

Humans↗
PubMed2000

Managing asthma in adults.

Asthma is a chronic inflammatory disorder of the airways with a spectrum of presentations--from intermittent but mild symptoms to persistent symptoms with chronicity. The key to successful management of the disease process is not only to treat the acute symptoms of wheezing, breathlessness, chest tightness, and cough but also to suppress the underlying inflammatory component. Management requires an integrated approach that incorporates patient education, control of environmental triggers, the judicious use of an appropriate agent to suppress underlying inflammation, addition of adjunctive therapy to optimize primary control, and the supplemental use of a bronchodilator to control breakthrough symptoms. Inhaled corticosteroids are the most effective agents for primary control of patients with persistent asthma. The nonsteroidal antiinflammatory agents cromolyn and nedocromil are alternative choices for primary control. Adjunctive or secondary controllers include maintenance bronchodilators such as salmeterol and long-acting theophylline as well as leukotriene modifiers. Concurrent therapy with an inhaled corticosteroid and a long-acting beta agonist has been shown to provide better asthma control than therapy with either an inhaled corticosteroid plus a leukotriene modifier, an inhaled corticosteroid plus theophylline, or higher doses of an inhaled corticosteroid alone.

Adult↗
PubMed2001

The management of hypercholesterolemia revisited.

Coronary artery disease (CAD) is the major cause of death in the United States. This disease places a large economic burden on society stemming from both loss of productivity and use of health care resources. The primary factor that has been extensively correlated with risk for CAD is elevated cholesterol levels. The lack of efficacy with dietary restriction alone and the limitations, adverse effects, and drug interactions associated with current lipid-lowering therapies have caused health care providers to search for safer and more efficacious agents.

Anticholesteremic Agents↗
PubMed2000

Nurse practitioners and the Internet.

This article describes the Internet as an easily accessible, up-to-date, and valuable information system that nurse practitioners must master to keep up with the needs of their patients and today's healthcare system. It contains a comprehensive review of the multiple uses of the Internet that include education, communication, clinical decision making, and research, and can serve as an update to the information in the healthcare and nursing literature. Strategies are suggested to incorporate the Internet into practice.

Communication↗
PubMedDate not supplied

Principles of cancer prevention and early detection.

Oncology nurses are becoming involved more frequently in answering questions regarding cancer prevention and detection. This article includes a discussion of basic underlying principles of cancer prevention and detection, including types of prevention, frequently used epidemiologic terms, validity assessments of cancer screening tests, and strategies for risk assessment. An understanding of basic principles related to cancer prevention and detection is necessary to provide information and patient education that is accurate and beneficial to patients and their families. With this background information, oncology nurses can help develop programs for cancer prevention and control.

Chemoprevention↗