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Selected Abstracts

The use of the nicotine inhaler in smoking cessation

CCRN (Staff Nurse), Jenny Sigel Burkett RN
Abstract Purpose: To raise awareness among nurse practitioners (NPs) about the nicotine inhaler by providing clinical and practical information about the use of the nicotine inhaler as a treatment option for smoking cessation. Data sources: This included data-based and review articles in the medical literature, tobacco use and dependence clinical practice guideline, and Medline and Cinahl search engines. Criteria for search keywords were "nicotine inhaler" and "nicotine replacement therapy." Initial search was done in December 2004. Conclusions: The nicotine inhaler has been tested as safe and efficacious in the treatment of tobacco cessation. Clinical trials show the nicotine inhaler to be useful alone or as an adjunct to other pharmacological therapies. Current national guidelines recommend that the nicotine inhaler be used in smoking cessation therapy. Implications for practice: The nicotine inhaler is appropriate for many different smokers, including certain types of cardiac patients. NPs can include the nicotine inhaler in a group of nicotine replacement therapies to ensure that smokers are successful in tobacco cessation. [source]

Osteoporosis-Related Kyphosis and Impairments in Pulmonary Function: A Systematic Review,

Robyn A Harrison
Abstract We conducted a systematic review to examine the relationship between osteoporotic vertebral fractures, kyphosis, and pulmonary function. Findings suggest modest but predictable declines in vital capacity related to the degree of kyphosis. However, there were only four studies, and all had significant methodologic limitations. Further high-quality research is needed. Introduction: Our objective was to systematically review the extent to which osteoporosis-related vertebral fractures and kyphosis affect pulmonary function. Materials and Methods: We used a literature search from 1966 to 2006 (using Medline, EMBASE, and hand searches of references) for studies examining pulmonary function in patients without known lung disease who had vertebral fractures or kyphosis secondary to osteoporosis. Two reviewers independently abstracted data. Heterogeneity precluded formal meta-analysis. Results: Initial searches yielded 453 articles. After applying eligibility criteria, only four case-control studies of limited quality (e.g., only one study was blinded) remained. Since 1966, only 109 patients (6 men) have been studied. All four studies reported reductions in vital capacity (VC), with values ranging from 68% to 94% of predicted values. This was quantified as a 9% reduction in predicted VC per vertebral fracture in one study. The degree of kyphosis clinically (one study) or radiographically (three studies) correlated with declines in VC; impairments were most notable at kyphotic angles >55°. Statistically significant differences in percent predicted VC were obtained only when arm span or recalled height, rather than measured height, was used (two studies). Conclusions: Despite conventional teaching, the evidence relating osteoporotic vertebral fractures or kyphosis to pulmonary function is limited. On the basis of available studies, declines in VC secondary to kyphosis seem modest and directly related to the number of vertebral fractures or degree of kyphosis. Future studies need longitudinal follow-up of larger numbers of men and women, appropriate proxies for height, standardized measures for pulmonary function and kyphosis, and efforts to blind outcomes ascertainment. [source]

Mammography screening in African American women

CANCER, Issue S1 2003
Evaluating the research
Abstract BACKGROUND Notwithstanding some controversy regarding the benefits of screening mammography, it is generally assumed that the effects are the same for women of all race/ethnic groups. Yet evidence for its efficacy from clinical trial studies comes primarily from the study of white women. It is likely that mammography is equally efficacious in white and African American women when applied under relatively optimal clinical trial conditions, but in actual practice African Americans may not be receiving equal benefit, as reflected in their later stage at diagnosis and greater mortality. METHODS Initial searches of Medline using search terms related to screening mammography, race, and other selected topics were supplemented with national data that are routinely published for cancer surveillance. Factors that potentially compromise the benefits of mammography as it is delivered in the current health care system to African American women were examined. RESULTS While there have been significant improvements in mammography screening utilization, observational data suggest that African American women may still not be receiving the full benefit. Potential explanatory factors include low use of repeat screening, inadequate followup for abnormal exams, higher prevalence of obesity and, possibly, breast density, and other biologic factors that contribute to younger age at diagnosis. CONCLUSIONS Further study of biologic factors that may contribute to limited mammography efficacy and poorer breast cancer outcomes in African American women is needed. In addition, strategies to increase repeat mammography screening and to ensure that women obtain needed followup of abnormal mammograms may increase early detection and improve survival among African Americans. Notwithstanding earlier age at diagnosis for African American women, mammography screening before age 40 years is not recommended, but screening of women aged 40,49 years is particularly critical. Cancer 2003;97(1 Suppl):258,72. © 2003 American Cancer Society. DOI 10.1002/cncr.11022 An erratum to this article is published in Cancer (2003) 97(8) 2047. [source]

Review of the long-term effectiveness of cognitive behavioral therapy compared to medications in panic disorder

Deepa N. Nadiga M.D.
Abstract Panic disorder is a recurrent and disabling illness. It is believed that Cognitive Behavioral Therapy (CBT) has a long-term protective effect for this disorder. This would offer CBT considerable advantage over medication management of panic disorder, as patients often relapse when they are tapered off their medications. This is a review of the literature about the long-term effectiveness of CBT. We searched for follow-up studies of panic disorder using CBT. Of the 78 citations produced in the initial search, most had major methodological flaws, including ignoring losses to follow-up, not accounting for interval treatment, and unclear reporting. Three papers met strict methodological criteria, and two of these demonstrated a modest protective effect of CBT in panic disorder patients. We make recommendations for well-designed studies involving comparisons of medications and cognitive behavior therapy. Depression and Anxiety 17:58,64, 2003. © 2003 Wiley-Liss, Inc. [source]

Sex differences in schizophrenia, a review of the literature

Dr. Alice Leung M.D.
Objective: To comprehensively and critically review the literature on gender differences in schizophrenia. Method: An initial search of MEDLINE abstracts (1966,1999) was conducted using the terms sex or gender and schizophrenia, followed by systematic search of all relevant articles. Results: Males have consistently an earlier onset, poorer premorbid functioning and different premorbid behavioral predictors. Males show more negative symptoms and cognitive deficits, with greater structural brain and neurophysiological abnormalities. Females display more affective symptoms, auditory hallucinations and persecutory delusions with more rapid and greater responsivity to antipsychotics in the pre-menopausal period but increased side effects. Course of illness is more favorable in females in the short- and middle-term, with less smoking and substance abuse. Families of males are more critical, and expressed emotion has a greater negative impact on males. There are no clear sex differences in family history, obstetric complications, minor physical anomalies and neurological soft signs. Conclusion: This review supports the presence of significant differences between schizophrenic males and females arising from the interplay of sex hormones, neurodevelopmental and psychosocial sex differences. [source]

Policy related to abdominoplasty in publicly funded elective surgery programs: a systematic review

Alan Pearson RN, DipNEd
Abstract Objectives, This systematic review set out to establish best practice in relation to policy for the inclusion/exclusion of abdominoplasty procedures within public health systems. Inclusion criteria, The review considered any studies relating to abdominoplasty that addressed issues of inclusion/exclusion from public funded health systems including criteria for clinical need, contraindications, fit/ready for surgery, policy compliance and issues in relation to surgical training. Search strategy, The search strategy sought to find published and unpublished studies and papers limited to English. An initial search of Medline and CINAHL was undertaken, followed by an analysis of keywords contained in the title, abstract and index terms. A second comprehensive search was then undertaken using Medline, CINAHL, EMBASE, AUSTROM, Health Business, and FullTEXT Elite and PsycINFO. The search was restricted to the period 1995,2005. Methodological quality, Each paper identified was assessed by two independent reviewers for methodological quality before inclusion in the review using an appropriate critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management and Assessment Review Instrument package. Results, A total of 19 papers were included in the review. Owing to the diverse nature of the papers no meta-analysis or meta-synthesis was able to be used to pool studies. The results are therefore presented in a narrative form. The papers identified were mainly retrospective audits and discussion/opinion papers. The main issues addressed were criteria to establish clinical need, contraindications and policy compliance. Conclusion, There are clinical indicators, mainly in relation to physical symptoms/dysfunction, to support exemption of some cases of abdominoplasty. For abdominoplasty to be conducted clinical need must be assessed and formally documented. Where clinical need is primarily based on psychological distress/dysfunction a formal psychiatric assessment should be used to justify surgery. [source]

Nurses' intention to leave the profession: integrative review

Mervi Flinkman
flinkman m., leino-kilpi h. & salanterä s. (2010) Nurses' intention to leave the profession: integrative review. Journal of Advanced Nursing,66(7), 1422,1434. Abstract Title.,Nurses' intention to leave the profession: integrative review. Aim., This paper is a report of a study conducted to (1) review and critique the published empirical research on nurses' intention to leave the profession and (2) synthesize the findings across studies. Background., Lack of nurses and nurse turnover represent problems for the healthcare system in terms of cost, the ability to care for patients and the quality of care. At a time of current nursing shortage, it is important to understand the reasons why nurses intend to leave the profession. Data sources., A review was conducted through an initial search of MEDLINE, CINAHL and PsycINFO computerized databases for the period from 1995 to July 2009. The keywords for the search were: Nurs* AND (Personnel turnover OR Career Mobility). Research on nurses' organizational turnover was excluded. Review methods., An integrative literature review was carried out using Cooper's five-stage methodology provided a framework for data collection, analysis and synthesis. Results., A total of 31 studies matching the inclusion criteria were identified. Variety in samples, measurement instruments and measures of intention to leave led to difficulties when attempting to compare or generalize study findings. A number of variables influencing nurses' intention to leave the profession were identified, including demographic, work-related and individual-related variables. Conclusions., Further research is needed using sound measurement instruments, consistent measures of leaving intention and more rigorous sampling. More in-depth research is needed to give nurses opportunities to explain in their own words the reasons for their intentions to leave. [source]

Management of perioperative hypertensive urgencies with parenteral medications,

Kartikya Ahuja MD
Abstract BACKGROUND: Hypertension is the major risk factor for cardiovascular (CV) disease such as myocardial infarction (MI) and stroke. This risk is well known to extend into the perioperative period. Although most perioperative hypertension can be managed with the patient's outpatient regimen, there are situations in which oral medications cannot be administered and parenteral medications become necessary. They include postoperative nil per os status, severe pancreatitis, and mechanical ventilation. This article reviews the management of perioperative hypertensive urgency with parenteral medications. METHODS: A PubMed search was conducted by cross-referencing the terms "perioperative hypertension," "hypertensive urgency," "hypertensive emergency," "parenteral anti-hypertensive," and "medication." The search was limited to English-language articles published between 1970 and 2008. Subsequent PubMed searches were performed to clarify data from the initial search. RESULTS: As patients with hypertensive urgency are not at great risk for target-organ damage (TOD), continuous infusions that require intensive care unit (ICU) monitoring and intraarterial catheters seem to be unnecessary and a possible misuse of resources. CONCLUSIONS: When oral therapy cannot be administered, patients with hypertensive urgency can have their blood pressure (BP) reduced with hydralazine, enalaprilat, metoprolol, or labetalol. Due to the scarcity of comparative trials looking at clinically significant outcomes, the medication should be chosen based on comorbidity, efficacy, toxicity, and cost. Journal of Hospital Medicine 2010;5:E11,E16. © 2010 Society of Hospital Medicine. [source]

Identification of quantitative trait loci for growth and carcass composition in cattle,

E. Casas
Summary A genomic screening to detect quantitative trait loci (QTL) affecting growth, carcass composition and meat quality traits was pursued. Two hundred nineteen microsatellite markers were genotyped on 176 of 620 (28%) progeny from a Brahman × Angus sire mated to mostly MARC III dams. Selective genotyping, based on retail product yield (%) and fat yield (%), was used to select individuals to be genotyped. Traits included in the study were birth weight (kg), hot carcass weight (kg), retail product yield, fat yield, marbling score (400 = slight00 and 500 = small00), USDA yield grade, and estimated kidney, heart and pelvic fat (%). The QTL were classified as significant when the expected number of false positives (ENFP) was less than 0.05 (F -statistic greater than 17.3), and suggestive when the ENFP was <1 (F -statistic between 10.2 and 17.3). A significant QTL (F = 19; ENFP = 0.02) was detected for marbling score at centimorgan (cM) 54 on chromosome 2. Suggestive QTL were detected for fat yield at 50 cM, for retail product yield at 53 cM, and for USDA yield grade at 63 cM on chromosome 1, for marbling score at 56 cM, for retail product yield at 70 cM, and for estimated kidney, heart and pelvic fat at 79 cM on chromosome 3, for marbling score at 44 cM, for hot carcass weight at 49 cM, and for estimated kidney, heart and pelvic fat at 62 cM on chromosome 16, and for fat yield at 35 cM on chromosome 17. Two suggestive QTL for birth weight were identified, one at 12 cM on chromosome 20 and the other at 56 cM on chromosome 21. An additional suggestive QTL was detected for retail product yield, for fat yield, and for USDA yield grade at 26 cM on chromosome 26. Results presented here represent the initial search for quantitative trait loci in this family. Validation of detected QTL in other populations will be necessary. [source]

Determining the skills for child protection practice: from quandary to quagmire?

Marjorie Keys
Abstract This article, the first of two, provides an account of an extended literature review that was undertaken in order to establish the evidence base for the learning and teaching of skills for child protection practice. It considers the contribution to the knowledge base from child abuse inquiries and from policies, guidelines and other documents from governmental departments and professional bodies. The subsequent analysis of terminology used for the review illustrates the complexity of searching for evidence that relates to concepts about which there are many differing perspectives, and also highlights the relevance to the study of activities undertaken by practitioners from a wide range of backgrounds. The paper describes the review method beginning with an initial search from which several hundred articles were located, only six of which generated evidence of value to the study. These six, however, highlighted a range of skills that provided the basis for a second, more focused search. Following an account of organisation and analysis of material, the paper concludes with discussion of some of the challenges presented during the process of this review, the complexities of which are reflected in the paper's title. A second paper will present the findings. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Determining the skills for child protection practice: emerging from the quagmire!

Marjorie Keys
Abstract This paper, the second in a series of two, presents and analyses the results of an extended literature review undertaken for a Master's dissertation, the purpose of which was to establish the evidence base for the learning and teaching of skills for child protection practice. The review, discussed in the previous paper, was carried out in two stages. An initial search yielded a very small number of studies of direct relevance but they provided the trigger and the key words for a second search. Many potentially useful areas had to be omitted from the second stage because of limited resources, but the two stages in the search generated large amounts of material, much of which was indirectly relevant to child protection practice. The review did not achieve the original aim of determining skills that are identified through research and other evidence as being essential for child protection practice, but it was possible to draw some conclusions. For example, evidence was found of the importance of a range of communication skills, whether these be child focused, carer focused or inter-professional. Skills in managing conflict and challenge were found to be crucial, with the importance of role clarification being acknowledged. There was some evidence of the use of decision-making skills and problem-solving skills, but little research that explored procedural skills. This paper reports on gaps in the literature identified by the review, and indicates where further research would be beneficial. Copyright © 2009 John Wiley & Sons, Ltd. [source]

A systematic review of selected caries prevention and management methods

James D. Bader
Abstract , A systematic review of the periodic scientific literature was undertaken to determine the strength of the evidence for the efficacy of professional caries preventive methods applied to high risk individuals, and the efficacy of professionally applied methods to arrest or reverse non-cavitated carious lesions. An initial search identified 1435 articles, of which 27 were eventually included in the review. Among the 22 studies addressing the prevention of carious lesions in caries-active or high risk individuals, the strength of the evidence was judged to be fair for fluoride varnishes and insufficient for all other methods. Among the seven studies addressing the management of non-cavitated carious lesions, the strength of the evidence for efficacy was judged to be insufficient for all methods. The results do not indicate that the preventive and management methods reviewed are not efficacious; rather, they demonstrate that not enough is known to determine the efficacy of the methods. Suggestions for strengthening the limited evidence base involve the following: i) increasing the number of studies that examine prevention among high risk individuals and non-surgical management of non-cavitated lesions, ii) including a wider variety of subject ages, iii) targeting aspects of the efficacy questions not yet addressed, iv) strengthening research methods employed in the studies, and v) reporting methods and outcomes more completely. [source]