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Important Intervention (important + intervention)
Selected AbstractsSafety and efficacy of vaccinesDERMATOLOGIC THERAPY, Issue 2 2009Brenda L. Bartlett ABSTRACT For the past two centuries, vaccines have provided a safe and effective means of preventing a number of infectious diseases. Although the safety of some vaccines has been questioned in recent years, the currently available vaccines are more than a millionfold safer than the diseases they are designed to prevent. Vaccines, however, should always be used in conjunction with other public health interventions. One important intervention is education because the general public can be led to believe that vaccines are unsafe and not needed by misinformation readily available electronically and in print. Not only are some vaccines available via injection but other vaccines are also given orally or intranasally. New vaccines are being studied for topical and intravaginal use. In addition, new systems are being developed for more efficient production of vaccines, especially for influenza. Vaccines are currently available for only a limited number of viral and bacterial diseases. In the future, it is anticipated that safe and effective vaccines will be developed against a number of other viral and bacterial infections as well as fungal and protozoan diseases. [source] Metformin use and diabetic pregnancy,has its time come?DIABETIC MEDICINE, Issue 3 2006G. Hawthorne Abstract The prevalence of Type 2 diabetes in women of childbearing age continues to grow as the incidence of Type 2 diabetes increases. Recent evidence shows that treatment of gestational diabetes ensures the best possible outcome for pregnancy complicated by gestational diabetes. Metformin is a logical treatment in these circumstances but there has always been concern about its safety for the fetus, particularly as it crosses the placenta and it may increase the risk of teratogenesis. Although evidence is accumulating that metformin is useful and has a role in polycystic ovary syndrome, a condition of insulin resistance, it is not yet accepted as treatment for Type 2 diabetes in pregnancy and gestational diabetes. Observational data supports the use of metformin in Type 2 diabetes in pregnancy and its role in gestational diabetes is currently under investigation. Metformin may become an important treatment for women with either gestational or Type 2 diabetes in pregnancy and indeed may have additional important benefits for women, including reducing insulin resistance, body weight and long-term risk of diabetes. There is a need for a randomized controlled trial in women with Type 2 diabetes in pregnancy with long-term follow-up of both mothers and children. Until then the best advice remains that optimized glycaemic control prior to conception and during pregnancy is the most important intervention for best possible pregnancy outcome. [source] Postfeedback development perceptions: Applying the theory of planned behaviorHUMAN RESOURCE DEVELOPMENT QUARTERLY, Issue 3 2006Alma McCarthy The primary purpose of management development programs is performance improvement at an individual and organizational level. Performance improvement results from knowledge, skill, or ability enhancement. An important intervention in management development is the use of 360-degree or multisource feedback (MSF), which leads to more effective career development activity resulting from enhanced self-awareness. The research model used to investigate self-reported postfeedback management development behavior is derived using the theory of planned behavior. The findings reveal that perceptions of the accuracy of MSF, cynicism, perceived organizational support, and age are significant predictors of postfeedback development behavior. The implications for research and practice are set out. [source] A theory of maternal engagement with public health nurses and family visitorsJOURNAL OF ADVANCED NURSING, Issue 2 2005Susan M. Jack PhD RN Background., Home visiting by public health nurses and family visitors is promoted as an important intervention for enhancing parent and child development. Mothers of children at-risk for developmental delays tend to be the most difficult to access and engage, and commonly drop out of home visiting programmes prematurely. Purpose., This paper reports a study developing a theory that describes the process by which mothers of children at-risk engage with public health nurses and family visitors in a blended home visiting programme. Methods., Grounded theory was used to guide the collection, recording, organization and analysis of the data. A purposeful sample of 20 mothers receiving public health nurse and family visitor home visits were recruited from a public health unit in Canada. Data were collected through client record reviews and 29 in-depth interviews that explored participants' experiences, beliefs and expectations about engagement. Data collection and analysis continued until all categories were saturated. Findings., Mothers felt vulnerable and frequently powerless when they allowed the service providers into their home. Mothers with children at-risk engage with public health nurses and family visitors through a basic social process of limiting family vulnerability, which has three phases: (1) overcoming fear; (2) building trust; and (3) seeking mutuality. The personal characteristics, values, experiences and actions of the public health nurse, family visitor and mother influence the speed at which each phase is successfully negotiated and the ability to develop a connected relationship. Conclusion., Public health nurses working with families at risk need to identify client fears and perceptions related to home visiting, and to explain the role of public health nurses and family visitors to all family members. Given the importance that mothers place on the development of an interpersonal relationship, it is important for home visitors continually to assess the quality of their relationships with clients. [source] Loving-kindness meditation to enhance recovery from negative symptoms of schizophreniaJOURNAL OF CLINICAL PSYCHOLOGY, Issue 5 2009David P. Johnson Abstract In this article, we describe the clinical applicability of loving-kindness meditation (LKM) to individuals suffering from schizophrenia-spectrum disorders with persistent negative symptoms. LKM may have potential for reducing negative symptoms such as anhedonia, avolition, and asociality while enhancing factors consistent with psychological recovery such as hope and purpose in life. Case studies will illustrate how to conduct this group treatment with clients with negative symptoms, the potential benefits to the client, and difficulties that may arise. Although LKM requires further empirical support, it promises to be an important intervention since there are few treatments for clients afflicted with negative symptoms. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65: 1,11, 2009. [source] Clinical Update on the Use of Niacin for the Treatment of DyslipidemiaJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2004Kathy Berra MSN Purpose To provide nurse practitioners (NPs) with clinical and practical information about the use of niacin in the treatment of dyslipidemia. Data Sources Research-based and review articles in the medical literature and National Cholesterol Education Program guidelines. Conclusions Niacin provides beneficial effects on all major lipid fractions, particularly high-density lipoprotein cholesterol and triglycerides. Niacin also reduces low-density lipoprotein (LDL) cholesterol; lipoprotein (a); and the number of highly atherogenic small, dense LDL particles. Niacin promotes angiographic regression when used in combination with other drugs that lower LDL cholesterol and can reduce cardiovascular risk in patients with coronary heart disease. Several niacin formulations are available, but the safety (i.e., from hepato-toxicity) and tolerability (i.e., severity of flushing) of these niacin formulations may differ. Implications for Practice Niacin therapy is appropriate for many types of lipid abnormalities, including complex dyslipidemias. NPs can take several steps to minimize potential side effects of niacin therapy and to ensure that patients adhere to this important intervention. [source] Lost Works of Art: the problem and a case studyART HISTORY, Issue 3 2000Ed Lilley This article, which is presented in two parts, aims to raise awareness of the position of lost works in art-historical practice. The first section seeks to question the status of the information which can exist regarding work of art that are no longer extant. Without claiming to be comprehensive, it details examples of the different sorts of material that may exist (photographs, engravings, explanatory texts, etc.) and considers these in relation to the original object. The secondary sources are considered individually, as being nearer to, or further from, the original, but they are also seen together as ,traces'. It is explicitly stated that these traces cannot provide access to the meaning of the original but that they may help to elucidate its ,message' (its historical, political or social significance). The second part focuses on two lost paintings by Leclerc which were shown, as pendants, at the 1756 exhibition of the Académie de Saint-Luc in Paris and which are now known only from a single critical text. One of them was a history painting, while the other was a genre scene. The latter, according to the textual source, depicted women in eighteenth-century dress disrobing on the banks of a stream. It is argued that such an immodest scene would not normally have been thought fit for public exhibition in eighteenth-century Paris and reasons are sought for its production and its exposure. The mid-eighteenth century saw doubts cast on frivolous erotic mythology (such as is seen in Leclerc's other painting) as being suitable for artistic depiction. Later events show that the loves of the gods were eclipsed by moral tales from ancient history (the rise of neoclassicism, in a word). It is suggested here, however, that Leclerc perhaps sought to provide an alternative. As his history picture and his genre scene were presently explicitly as pendants, he perhaps aimed to suggest that the way forward might be an acceptance of contemporary sexuality as a suitable subject in art. The paper is exploratory in every sense. It seeks to put the question of lost works on the agenda, to provide the first, rather than the last, word on the subject. In the final analysis, it is even suggested, not entirely frivolously, that Leclerc's paintings may never have existed. But even if they did not, a text describing possible pictures does, and this is of itself an important intervention in the thinking about suitable themes for depiction in eighteenth-century France. [source] Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurseBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2003M.J. Cork Summary Background The failure of patients to take medicines in a way that leads to clinical benefit is a major challenge. A consensus has emerged that, on average, compliance sufficient to obtain therapeutic objectives occurs about half the time, with noncompliance contributing to therapeutic failure in the other half. These figures refer to simple oral regimens. There has been little work assessing compliance/concordance with complex treatment regimens for atopic eczema. Asthma schools led by specialist nurses have been shown to improve knowledge, use of therapies and clinical outcome. Objectives To determine the effect of education and demonstration of topical therapies by specialist dermatology nurses on therapy utilization and severity of atopic eczema. Methods Fifty-one children with atopic eczema attending a paediatric dermatology clinic were followed for up to 1 year. At each visit the parent's knowledge about atopic eczema and its treatment and therapy utilization was recorded. The severity of the eczema was recorded using the six area, six sign atopic dermatitis severity score (SASSAD) and parental assessment of itch, sleep disturbance and irritability. At the first visit a specialist dermatology nurse explained and demonstrated how to use all of the topical treatments. This education was repeated at subsequent visits depending on the knowledge of the parent. Results At baseline less than 5% of parents had received/recalled receiving any explanation of the causes of eczema or demonstration of how to apply topical treatments. The eczema was poorly controlled in all children (mean SASSAD 42·9). Of the children, 24% were not being treated with any emollient cream/ointment; the mean use was 54 g weekly. Of the children, 25% were being inappropriately treated with potent or very potent topical steroids. Following repeated education and demonstration of topical therapies by a specialist dermatology nurse, there was an 89% reduction in the severity of the eczema. The main change in therapy utilization was an 800% increase in the use of emollients (to 426 g weekly of emollient cream/ointment) and no overall increase in the use of topical steroids, accounting for potency and quantity used. Conclusions, This study reinforces the importance of specialist dermatology nurses in the management of atopic eczema. It also confirms the opinion of patients, patient support groups, dermatologists and best practice guidelines that the most important intervention in the management of atopic eczema is to spend time to listen and explain its causes and demonstrate how to apply topical therapies. [source] Public Action, Agrarian Change and the Standard of Living of Agricultural Workers: A Study of a Village in KeralaJOURNAL OF AGRARIAN CHANGE, Issue 3 2006R. RAMAKUMAR This article describes and analyses the ways in which public action in the State of Kerala in India helped to transform the standard of living of hired workers in agriculture. Specifically, the article analyses the extent of land and asset ownership, access to credit, access to social security schemes and food distribution systems and the conditions of housing and sanitation of households participating in agricultural wage work. The article is based as a case study of Morazha desam in the Malabar region of Kerala, which had one of the most oppressive agrarian systems in India before 1956,57. In 1955, another economist had studied Morazha desam; this study was conducted before one of the most important interventions through public action , land reform , took place in Malabar. The 1955 study had characterized the conditions of life of agricultural workers as ,wretched in the extreme'. The present article documents the significant transformation in the quality of life that took place in Morazha after 1955, through a weakening of the factors that led to ,wretched' conditions of life in the earlier period. The destruction of traditional agrarian power by the state through land reform was the most critical step in this process. [source] Attributed disability: a spot of local difficultyJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2006George Peat PhD MCSP Abstract There has been an exponential growth of publications relating to the development and application of health measurement instruments. Condition-specific measures have formed a large part of this trend. This article questions the rationale behind the concept of condition-specific disability, a common domain in such measures, taking musculoskeletal medicine as an example. It argues that physical functions are seldom unique to a specific condition and that measurement specificity therefore relies on attributing functional consequences to the health condition of interest. The presence of multi-morbidity (musculoskeletal and non-musculoskeletal), and the influence of personal and environmental factors, pose problems for attribution that have seldom been empirically investigated. Furthermore, attributing disability to a specific health condition of interest potentially limits insights into important interventions such as managing co-morbid interactions and targeting barriers in the physical, social, and attitudinal environment. Efforts to identify regionally relevant item content and to measure participation in daily life are a step in the right direction. Attribution is not needed for either. [source] ,Shared-rhythm cooperation' in cooperative team meetings in acute psychiatric inpatient careJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2004P. VUOKILA-OIKKONEN rn phd The cooperative team meeting is one of the most important interventions in psychiatric care. The purpose of this study was to describe the participation of patients and significant others in cooperative team meetings in terms of unspoken stories. The narrative approach focused on storytelling. The data consisted of videotaped cooperative team meetings (n = 11) in two acute closed psychiatric wards. The QRS NVivo computer program and the Holistic Content Reading method were used. During the process of analysis, the spoken and unspoken stories were analysed at the same time. According to the results, while there was some evident shared-rhythm cooperation (the topics of discussion were shared and the participants had eye contact), there were many instances where the interaction was controlled and defined by health care professionals. This lack of shared rhythm in cooperation, as defined in terms of storytelling, was manifested as monologue and the following practices: the health care professionals controlled the storytelling by sticking to their opinions, by giving the floor or by pointing with a finger and visually scanning the participants, by interrupting the speaker or by allowing the other experts to sit passively. Implications for mental health nursing practice are discussed. [source] Challenges and strategies of increasing the production and use of Cochrane reviews: the Argentinean experiencePAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2008Agustín Ciapponi Summary The Cochrane Collaboration (CC), established in 1993, is an internationally renowned initiative dedicated to improving health care for the world's population. In the late 1990s, the Iberoamerican Cochrane Centre (IbCC) was created to promote the CC in Latin America. Because the production and use of Cochrane reviews were still low in 2002, Argentina implemented specific strategies and a model to expand the IbCC. The objective of this article was to describe strategies to increase the production and use of Cochrane reviews in Argentina. Methods used included surveys delivered to primary health care workers to provide data about their knowledge and use of the CC, and about the production of titles, protocols, and systematic reviews published in the Cochrane Library. Our survey showed that only 51% of a selected population of primary healthcare workers knew about the CC and only 23% knew about the Argentine Cochrane centre. In the previous year, 60% had never used the CC. To overcome these challenges, we used seven types of complementary strategies: (1) networking, (2) dissemination, (3) training, (4) support to Cochrane members, (5) strategic alliances, (6) research, and (7) fund-raising. An improvement in the production and use of Cochrane reviews was seen in Argentina, and the set of aforementioned strategies could be partly responsible for this increase. Multi-level networking, training and an appropriate centre's mother institution could be the most important interventions. More research is needed to explore this hypothesis. Lessons learned on this first evaluation will help us to continue with the development of the CC in Argentina. [source] | ||||||||||||||||||||||