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Different Interventions (different + intervention)
Selected AbstractsInterventions to improve adherence to medication in people with type 2 diabetes mellitus: the role of nursesEUROPEAN DIABETES NURSING, Issue 2 2006Deputy Director, H Hearnshaw BSc, PhD Reader in Primary Care Abstract Summary Nurses now provide the majority of education and support for people with diabetes both in community and hospital settings. However, there are very few studies on nurse-led interventions to improve adherence to medication, a crucial element of the self-management of diabetes. The four studies reviewed formed a subgroup of a Cochrane review on interventions to improve adherence to medication in people with type 2 diabetes. Search terms were ,type 2 diabetes mellitus' and ,compliance' or ,adherence'. Studies were included if they assessed adherence to medical treatment specifically, rather than other aspects of self-management. Out of the 21 studies selected for review, four described an intervention delivered by a nurse. All four studies were from the USA and used an intervention delivered by telephone. Different interventions (two educational programmes, one automated telephone management system, one tracking system for health service and medication use) were backed up by a scripted nurse call. While patients in two studies reported improvements in self-care behaviour, only one measured a significant improvement in blood glucose control. Although some studies asked patients to report on their adherence to medication taking, responses from patients were not explicitly presented. The studies reviewed show the potential for generating evidence for the effectiveness of nurse-led diabetes management programmes. Further high-quality studies into this area are desperately needed, and they should consider new ways of evaluating complex interventions to generate more evidence. Copyright © 2006 FEND. [source] Brief alcohol intervention,where to from here?ADDICTION, Issue 6 2010Challenges remain for research, practice ABSTRACT Brief intervention (BI) is intended as an early intervention for non-treatment-seeking, non-alcohol-dependent, hazardous and harmful drinkers. This text provides a brief summary of key BI research findings from the last three decades and discusses a number of knowledge gaps that need to be addressed. Five areas are described: patient intervention efficacy and effectiveness; barriers to BI implementation by health professionals; individual-level factors that impact on BI implementation; organization-level factors that impact on BI implementation; and society-level factors that impact on BI implementation. BI research has focused largely upon the individual patient and health professional levels, with the main focus upon primary health care research, and studies are lacking in other settings. However, research must, to a larger degree, take into account the organizational and wider context in which BI occurs, as well as interaction between factors at different levels, in order to advance the understanding of how wider implementation of BI can be achieved in various settings and how different population groups can be reached. It is also important to expand BI research beyond its current parameters to investigate more ambitious long-term educational programmes and new organizational models. More widespread implementation of BI will require many different interventions (efforts, actions, initiatives, etc.) at different interlinked levels, from implementation interventions targeting individual health professionals' knowledge, skills, attitudes and behaviours concerning alcohol issues, BI and behaviour change counselling to efforts at the organizational and societal levels that influence the conditions for delivering BI as part of routine health care. [source] A Kindling Model of Pharmacoresistant Temporal Lobe Epilepsy in Sprague,Dawley Rats Induced by Coriaria Lactone and Its Possible MechanismEPILEPSIA, Issue 4 2003Ying Wang Summary: ,Purpose: The aim of this study was to develop a new animal model of pharmacoresistant temporal lobe epilepsy (TLE) by repeated intramuscular injection of Coriaria lactone (CL) at subthreshold dosages and to explore the mechanisms that might be involved. Methods: Healthy male Sprague,Dawley rats (n = 160) were randomized into four groups during the kindling process: three groups (n = 50 for each group) received CL injection at subthreshold dosages (1.25, 1.5, and 1.75 mg/kg, respectively), and ten received normal saline (NS) injection as a control group. The maximal human adult dosage of carbamazepine (CBZ), valproate (VPA), and phenytoin (PHT) was administered as monotherapy to different groups of kindled rats for 1 month (n = 20 for each group). Changes in EEG recording, seizure number, intensity (expressed as grade 1,5 according to Racine stage), and duration, including spontaneous seizures during different interventions, were compared. The expression of P-170, a multiple drug resistance gene (MDR1) encoding P-glycoprotein, was measured in brain samples from different groups of experimental rats by using an image analysis and measurement system (ImagePro-Plus 4.0). Results: A total of 70 (46.7%) rats were fully kindled with a median of 15 (seven to 20) CL injections. Electrocorticogram (ECoG) including hippocampal (EHG) monitoring revealed the temporal lobe origins of epileptiform potentials, which were consistent with the behavioral changes observed. Spontaneous seizures occurred with frequency and diurnal patterns similar to those of human TLE. The antiepileptic drugs (AEDs) tested lacked a satisfactory seizure control. The maximal P-170 expression was in the kindled rats with AED treatment; the next highest was in the kindled rats without AED intervention. Nonkindled SD rats with CL injection also had increased P-170 expression compared with control SD rats. Conclusions: The study provided a simple and stable animal TLE kindling model with pharmacoresistant properties. The pharmacoresistance observed in the kindled rats to CBZ, VPA, and PHT at maximal human adult dosages together with the increased P-170 expression was a distinct feature of this model. This model might be used in further investigations of the mechanisms involved in pharmacoresistant TLE and for developing new AEDs. [source] Industry sponsorship and selection of comparators in randomized clinical trialsEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2010D. N. Lathyris Eur J Clin Invest 2010; 40 (2): 172,182 Abstract Background, Most clinical trials on medical interventions are sponsored by the industry. The choice of comparators shapes the accumulated evidence. We aimed to assess how often major companies sponsor trials that involve only their own products. Methods, Studies were identified by searching ClinicalTrials.gov for trials registered in 2006. We focused on randomized trials involving the 15 companies that had sponsored the largest number of registered trials in ClinicalTrials.gov in that period. Results, Overall, 577 randomized trials were eligible for analysis and 82% had a single industry sponsor [89% (166/187) of the placebo-control trials, 87% (91/105) of trials comparing different doses or ways of administration of the same intervention, and 78% (221/285) of other active control trials]. The compared intervention(s) belonged to a single company in 67% of the trials (89%, 81% and 47% in the three categories respectively). All 15 companies strongly preferred to run trials where they were the only industry sponsor or even the only owner of the assessed interventions. Co-sponsorship typically reflected co-ownership of the same intervention by both companies. Head-to-head comparison of different active interventions developed by different companies occurred in only 18 trials with two or more industry sponsors. Conclusions, Each company generates a clinical research agenda that is strongly focused on its own products, while comparisons involving different interventions from different companies are uncommon. This diminishes the ability to understand the relative merits of different interventions for the same condition. [source] Postdischarge nursing interventions for stroke survivors and their familiesJOURNAL OF ADVANCED NURSING, Issue 2 2004Kelly L. McBride MSc RN Background. The physical, cognitive, and emotional sequelae of stroke underscore the need for nursing interventions across the continuum of care. Although there are several published studies evaluating community interventions for stroke survivors, the nursing role has not been clearly articulated. Aim. The aim of this paper is to report a study to describe, using a standardized classification system, the nursing interventions used with stroke survivors during the initial 6 weeks following discharge home. Methods. In the context of a randomized controlled trial, two nurse case managers provided care to 90 community-dwelling stroke survivors who were assigned to the intervention arm of the trial. The nursing documentation was analysed, using the Nursing Intervention Classification (NIC) system, to identify and quantify the interventions that were provided. Findings. Stroke survivors received, on average, six different interventions. There was a trend for those who were older, more impaired, and who lived alone to receive more interventions. The most commonly reported interventions included those directed towards ensuring continuity of care between acute and community care, family care, and modifying stroke risk factors. The study was limited to the nursing documentation, which may represent an underestimation of the care delivered. Conclusions. The NIC system was useful in capturing the interventions delivered by the nurse case managers. Nursing interventions are often not clearly articulated and less often use standardized terminology. Describing nursing activities in a standard manner will contribute to an increase in nursing knowledge and to evidence-based practice. [source] Apathy in Alzheimer's DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2001Allan M. Landes MA Apathy, or loss of motivation, is arguably the most common change in behavior in Alzheimer's disease (AD) but is underrecognized. Apathy represents a form of executive cognitive dysfunction. Patients with apathy suffer from decreased daily function and specific cognitive deficits and rely on families to provide more care, which results in increased stress for families. Apathy is one of the primary syndromes associated with frontal and subcortical pathology, and apathy in AD appears to have multiple neuroanatomical correlates that implicate components of frontal subcortical networks. Despite the profound effects of this common syndrome, only a few instruments have been designed to specifically assess apathy, and these instruments have not been directly compared. Assessment of apathy in AD requires clinicians to distinguish loss of motivation from loss of ability due to cognitive decline. Although apathy may be misdiagnosed as depression because of an overlap in symptoms, current research has shown apathy to be a discrete syndrome. Distinguishing apathy from depression has important treatment implications, because these disorders respond to different interventions. Further research is required to clarify the specific neuroanatomical and neuropsychological correlates of apathy and to determine how correct diagnosis and treatment of apathy may improve patient functioning and ease caregiver burden. [source] Quality of life in patients with right- or left-sided brain tumours: literature reviewJOURNAL OF CLINICAL NURSING, Issue 11 2008Alvisa Palese Bcsn Aims., To determine if patients with left- or right-sided hemisphere neoplasm perceive their quality of life (QoL) differently. Background., It is not clear whether patients with a lesion in the left hemisphere have a different QoL than those with a lesion in the right hemisphere. (1) In the pre-operative period, patients with a left-sided lesion may have different symptoms according to the position of the tumour. (2) Studies on patients with brain injury demonstrate an association between left frontal lesions and depression: depression can alter the patients' perception of QoL. (3) In the postoperative period, right-handed patients may be disadvantaged by surgical trauma to the motor cortex in the left hemisphere. (4) During the different phases of the disease, the various functions of the two hemispheres may influence the patient's capacity to control QoL; also, as suggested by authors, both the ego and the conscience are mostly located in the left hemisphere. This is the reason that patients with a left-sided lesion may perceive a worse QoL. Methods., A review of literature was carried out using the Medline database (1966,2007) and CINHAL (1982,2007), using the following Mesh Terms and key words: brain neoplasm, tumour or cancer, hemispheric dominance or laterality or right or left hemisphere, QoL. Results., Seven studies emerged that documented non-homogeneous results and which included different populations. The association between QoL and the side of the lesion was evaluated. Conclusions., The lack of a substantial number of recent, robust follow-up studies investigating the QoL in patients at different stages of disease and treatment indicates that more research is needed. Relevance to clinical practice., Understanding the QoL in patients with brain neoplasm and the differences between right and left hemisphere sites of the neoplasm can help nurses develop different interventions and offer more guidance for effective clinical intervention. [source] A systematic review of nursing contributions to mobility rehabilitation: examining the quality and content of the evidenceJOURNAL OF CLINICAL NURSING, Issue 11c 2007Rosie Kneafsey BSc Aims., This paper summarizes the results of a systematic literature review to examine the quality and content of the evidence relating to nursing approaches to improving the mobility and movement of older people. Background., Older people experiencing health breakdown often develop problems with movement and mobility and nurses play a role in helping patients to either adapt to or overcome these difficulties. Methods., Electronic searches were undertaken of Medline, CINAHL, Amed and Cochrane Database of systematic reviews. Papers about nursing approaches to promoting mobility and movement were critically appraised using quality assessment checklists. Papers addressing safe moving and handling, falls prevention, health promotion, rehabilitation or teamworking in general were excluded. Results., Sixteen research and 33 informational papers were included and comprise the review. Many research papers used weak designs and small sample sizes, limiting their ability to control for important confounding variables. Although numerous studies examined effectiveness, only one used a randomised controlled trial design. Papers were grouped into four interlinked sets. These were promoting mobility and preventing immobility; walking and exercise; neuro-developmental principles; and rehabilitation patient handling. Conclusions., Specific foci for nursing assessment and interventions to promote patients' mobility have been identified. However, the fragmented nature of the evidence makes it difficult to make recommendations for nursing practice. Future research should be conducted by multi-professional research teams to identify the most effective approaches to promoting patients' mobility and to explore overlaps between different members of the rehabilitation team. Relevance to clinical practice., Regaining the ability to move and walk is often a key concern for patients who have suffered health breakdown. Although nurses provide patients with assistance the evidence available does little to direct nurses as to the best approach towards mobility rehabilitation. It is important that nurses play a role in measuring the efficacy of different interventions to promote rehabilitation. [source] School-Based Obesity Interventions: A Literature ReviewJOURNAL OF SCHOOL HEALTH, Issue 4 2008Fadia T. Shaya PhD ABSTRACT Background:, Childhood obesity is an impending epidemic. This article is an overview of different interventions conducted in school settings so as to guide efforts for an effective management of obesity in children, thus minimizing the risk of adult obesity and related cardiovascular risk. Methods:, PubMed and OVID Medline databases were searched for school-based obesity interventions with anthropometric measures in children and adolescents between the ages of 7 and 19 years from June 1986 to June 2006. Studies were reviewed by duration, type of intervention, and defined qualitative and quantitative measures, resulting in a yield of 51 intervention studies. Results:, The interventions ranged from 4 weeks in length to as long as 8 continuing years. In total, 15 of the intervention studies exclusively utilized physical activity programs, 16 studies exclusively utilized educational models and behavior modification strategies, and 20 studies utilized both. In addition, 31 studies utilized exclusively quantitative variables like body mass indices and waist-to-hip ratios to measure the efficacy of the intervention programs, and another 20 studies utilized a combination of quantitative and qualitative measures that included self-reported physical activity and attitude toward physical activity and the tested knowledge of nutrition, cardiovascular health, and physical fitness. A total of 40 studies achieved positive statistically significant results between the baseline and the follow-up quantitative measurements. Conclusions:, No persistence of positive results in reducing obesity in school-age children has been observed. Studies employing long-term follow-up of quantitative and qualitative measurements of short-term interventions in particular are warranted. [source] New guideline for tramadol usage following adverse drug reactions reported to the Iranian pharmacovigilance center,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 2 2007K. Gholami Pharm D Abstract Background Tramadol was introduced as injection and oral form to Iranian Pharmaceutical Market in 2002. Shortly after, the injection form of the drug was observed at the top of suspected drug list of Adverse Drug Reactions (ADRs) received monthly by Iranian Pharmacovigilance Center (IPC). Objectives To detect, assess and report total number of Tramadol-induced ADRs received by IPC. To assess the frequency of reported Tramadol-induced ADRs before and after interventions. To design a guideline for prevention of probable ADRs due to Tramadol injection. Methods A descriptive study was conducted on spontaneous reporting received by IPC from April 2002 to February 2005. All ADRs suspected to be induced by Tramadol registered in the database during mentioned period were analysed. To assess the effect of different interventions based on Spontaneous Reporting System, the trend of reporting frequency of Tramadol-induced ADRs was evaluated before and after interventions. Results There were 337 cases of Tramadol-induced ADRs describing 939 reactions, reported to IPC during the study period. Although causal relationship had not been established, three cases of deaths appeared among the reports. The severity of reactions led to implementation of limitations on injectable Tramadol distribution to community pharmacies and the restriction of its use to hospitals only. Since most adverse reactions were dose-dependent, the drug potency of injectable Tramadol available in the country changed from 100,mg to 50,mg. The assessment of ADR reports received by IPC showed that the frequency of adverse reactions registered in the centre was reduced considerably following these interventions. Conclusion Designing a detailed programme by Pharmacovigilance Centres and closely monitoring of newly marketed pharmaceutical products is highly recommended. Copyright © 2006 John Wiley & Sons, Ltd. [source] Variations in the orthotic management of cerebral palsyCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2002Christopher Morris Abstract Objective Anecdotal reports that children with cerebral palsy were provided different orthoses in two adjacent UK health districts were investigated using an observational comparative case study. Method The populations were compared using an epidemiological register of children with cerebral palsy, which confirmed that a comparable health service response could be expected. Merging data from the register with the orthotic patient database facilitated comparison of the orthoses prescribed in each district. A survey questionnaire was used to gather the perceptions of clinicians in both districts to understand how each team decides which orthosis to prescribe. Results There was considerable variation in the types of orthoses prescribed between districts, and particularly of ankle foot orthoses. Survey respondents from the same profession described having the same roles, although clinicians expressed different responsibilities for initiating and sanctioning orthotic prescriptions in their district programmes. The survey also suggested that most clinicians were uncertain when prescribing orthoses, and clinical practice was therefore largely determined by professional preference. Conclusion Defining the spectrum of activity limitation in geographically defined populations would enhance health services research and assist in the development of trials using different interventions to reduce those limitations. [source] Validity and clinical feasibility of the ADHD rating scale (ADHD-RS) A Danish Nationwide Multicenter StudyACTA PAEDIATRICA, Issue 2 2009N Szomlaiski Abstract Aim: To establish the validity of a Danish version of the Attention Deficit Hyperactivity Disorder Rating Scale (ADHD-RS), secondly to present national norm scores compared to that of United States and other European data and thirdly to evaluate ADHD-RS when used for monitoring treatment effectiveness. Methods: A Danish translation of the ADHD-RS was used on a normative sample of 837 children. Two clinical samples, 138 hyperkinetic disorder (HKD) cases and 110 clinical controls were recruited from eleven Danish Child and Adolescent Mental Health (CAMH) centres and assessed according to usual clinical standards. The HKD children were rated by parents and teachers at baseline and at follow-up 3 months later. Results: Internal validity of ADHD-RS was high and the factor structure supported the diagnostic classification system ICD-10. The questionnaire discriminated HKD patients in a mixed clinical sample, and was sensitive to change in symptom load as measured before and after commencing of the treatment. Conclusion: The Danish version of ADHD-RS is valid and clinically feasible when measuring HKD symptom load in a CAMH-setting. The questionnaire provides useful data in patient management, quality improvement and service planning as well as in effectiveness studies of different interventions for patients with HKD and related disorders in routine clinical settings. 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