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Appropriate Interventions (appropriate + intervention)
Selected AbstractsCognitive and Functional Decline in Adults Aged 75 and OlderJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2002Sandra A. Black PhD OBJECTIVES: To simultaneously examine the influence of functional disability on the development of cognitive impairment and the influence of cognitive status on the development of functional disability over time and compare findings across ethnic groups. DESIGN: A population-based longitudinal study. SETTING: Galveston County, Texas. PARTICIPANTS: Three hundred sixty-five community-dwelling Hispanic Americans, African Americans, and non-Hispanic whites, aged 75 and older. MEASUREMENTS: Baseline measures included demographics, self-reported chronic medical conditions, functional disability, and cognitive status. Longitudinal measures included functional decline and cognitive decline. RESULTS: Substantial functional decline was associated with each additional error on the mental status measure; substantial cognitive decline was associated with each additional antecedent disability. These findings were evident across all three ethnic groups, even when taking into account the effects of demographic factors and chronic health conditions, although the specific chronic health conditions that influenced cognitive and functional decline were found to vary across the three ethnic groups. CONCLUSION: Our findings suggest that, rather than simply being correlated markers of increasing frailty, cognitive and functional decline appear to influence the development of one another. Clinicians need to be aware of these associations, which may affect the direction of preventive care and rehabilitation in the oldest old. Appropriate intervention may result in the prevention or delay of functional disability and cognitive decline. Awareness of the specific chronic health conditions that increase the risk for cognitive or functional decline in various ethnic groups, and the effect of comorbid disease, may also help efforts to prevent decline in older adults. [source] Microalbuminuria: Definition, Detection, and Clinical SignificanceJOURNAL OF CLINICAL HYPERTENSION, Issue 2004Robert D. Toto MD Proteinuria is a sign of abnormal excretion of protein by the kidney but is a nonspecific term including any or all proteins excreted. In contrast, albuminuria specifically refers to an abnormal excretion rate of albumin. Microalbuminuria refers to an abnormally increased excretion rate of albumin in the urine in the range of 30,299 mg/g creatinine. It is a marker of endothelial dysfunction and increased risk for cardiovascular morbidity and mortality especially, but not exclusively, in high-risk populations such as diabetics and hypertensives. Testing for microalbuminuria is now made easy by in-office dipstick tests (semi-quantitative) and widely available laboratory testing (quantitative). Physicians should screen all diabetics for albuminuria and strongly consider screening hypertensives to identify those at higher risk for cardiovascular disease. Appropriate intervention, including use of drugs that block the renin-angiotensin-aldosterone system, may be appropriate in such cases as suggested by the American Diabetes Association and the Seventh Report of Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. [source] Hidradenitis Suppurativa: Importance of Early Treatment; Efficient Treatment with ElectrosurgeryDERMATOLOGIC SURGERY, Issue 2 2008A. BURHAN AKSAKAL MD BACKGROUND Hidradenitis suppurativa is a challenging condition, both for the physicians and for the patients. Many surgical and medical approaches with different success rates have been undertaken. Early and appropriate intervention is a factor that significantly increases the success rate of the treatment of the disease. OBJECTIVE This study was conducted to evaluate the efficiency of electrosurgery treatment in early hidradenitis suppurativa. MATERIALS AND METHODS This study comprised 12 patients aged between 29 and 38 years (mean, 34 years) with a diagnosis of hidradenitis suppurativa Grade I (n=9) or Grade II (n=3). A surgical method consisted of excision of the areas with nodules and sinuses, up to the level of subcutaneous fat tissue, and leaving the surgical defect for secondary healing. RESULTS All patients completed the study. In 10 of 12 (83%) patients, 26 of 30 (86%) lesions, cure was observed in a mean of 16 days (range 15 to 21 days). Four lesions in 2 patients with Grade II became infected and required a short course of antibiotic therapy. CONCLUSION Electrosurgery will decrease the need for other systemic treatments, owing to its high cure rates. Our results showed that electrosurgery should be considered a top alternative in the treatment algorithm of hidradenitis suppurativa. [source] Pancreatic enzyme replacement therapy: exocrine pancreatic insufficiency after gastrointestinal surgeryHPB, Issue 2009J. Enrique Domínguez-Muñoz Abstract Exocrine pancreatic insufficiency (EPI) and resultant maldigestion occurs in up to 80% of patients following gastric, duodenal or pancreatic surgery. Accurate diagnosis is required to determine the appropriate intervention, but the conventional method of faecal fat quantification is time-consuming and not always readily available. The optimized 13C-mixed triglyceride (13C-MTG) breath test is an accurate alternative post-surgery. Pancreatic enzyme replacement therapy (PERT) is indicated post-surgery in patients with clinically evident steatorrhoea, weight loss or maldigestion-related symptoms. Given its favourable safety profile, PERT is also appropriate in asymptomatic patients with high faecal fat excretion as such patients are at high risk for nutritional deficits. However, published data evaluating PERT in this setting are limited. Uncoated powder preparations may be preferred in cases of low gastric acidity and partial or total gastric resection. In clinical studies, enteric-coated microspheres were associated with greater weight gain after surgery vs. uncoated preparations. This was confirmed in a recent study using the 13C-MTG breath test; fat absorption increased from <40% without therapy to almost 60% with enteric-coated minimicrospheres (40 000 lipase units/meal), with >60% of patients achieving normal breath test results (i.e. normal fat digestion) during PERT. A therapeutic algorithm for the treatment of EPI after surgery is also discussed. [source] The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritisJOURNAL OF CLINICAL NURSING, Issue 7-8 2010Nurcan Y Aims and objectives., The aim in this study was to evaluate the effect of local heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis. Background., Local heat application is used as a non-pharmacological practice for the treatment of knee osteoarthritis. On the other hand, literature reveals limited information on the effects of heat application. Design., The study was a comparative study. Methods., The patients with knee osteoarthritis were divided into two groups (23 patients in each) as intervention and control groups, and patients in the control group were applied with the routine medication of the physician. The intervention group received 20-minute heat application every other day for four weeks in addition to the routine medication. The data were collected using data collection form, Western Ontario and McMaster Universities Index and SF-36. Results., The Western Ontario and McMaster Universities pain and Western Ontario and McMaster Universities disability scores of the patients with knee osteoarthritis in control and intervention groups before and after the intervention were compared, and the differences for both scores in the change were found to be statistically significant (p < 0·05). Moreover, statistically significant differences were found between the control and intervention group patients in terms of changes in the scores for physical function, pain and general health perception (p < 0·05). Conclusions., It was found that heat application every other day decreased pain and disability of the patients with knee osteoarthritis. Also, heat application was found to improve the subdimensions of quality of life scores of physical function, pain and general health perception of patients. Relevance to clinical practice., The data obtained in this study on the efficiency of heat application on pain, stiffness, physical function and general health perception of patients with knee osteoarthritis may offer an insight into decision-making process for appropriate intervention. [source] Managing infant feeding practices: the competing needs of bulimic mothers and their childrenJOURNAL OF CLINICAL NURSING, Issue 6 2009Helen Stapleton Aim., This paper seeks to explain how bulimic mothers accommodated infant feeding demands in conjunction with managing their disordered eating practices. Background., Eating disorders are chronic and disabling illnesses primarily affecting women. There are few qualitative studies describing bulimia in the context of motherhood. Design., The study employed an inductive qualitative approach. Methods., A purposive sample of childbearing women (n = 16), who self-defined as living with an eating disorder, were recruited. Data were generated from one-to-one interviews; a thematic analysis identified key issues. Results., Participants were primarily responsible for ensuring child/ren's socialisation processes, including modelling appropriate dietary behaviours and these demands often conflicted with their personal needs for food restraint. Pressures to participate in social activities with children were widely experienced as stressful especially when these events focused on food. Participants viewed early and repeated exposure to ,healthy' eating as protective against their children acquiring an eating disorder and in this respect commercial child-care facilities provided alternative environments for children to explore food-related activities. Conclusions., Participants employed a variety of strategies to ensure children's exposure to normalising influences and socialising processes. Concerns about personal competencies with respect to food preparation and storage were articulated by all participants. Relevance to clinical practice., Professionals involved with providing care to mothers and their infants are well placed to support bulimic clients and to foster confidence in their mothering skills. Early and appropriate intervention is key to effecting positive changes in bulimic patterns, with potential benefits to women's future health and well-being and that of their children. [source] Treatment of acute otitis media in patients with a reported penicillin allergyJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 3 2000Falconer Otitis media occurs commonly in children, and is usually treated with an antibiotic. In this case report, amoxicillin was prescribed for a 6-year-old boy suffering from acute otitis media. As he had previously experienced a rash after the administration of a penicillin, the medication order was switched from amoxicillin to trimethoprim/sulfamethoxazole (TMP/SMX). In an effort to determine whether or not this intervention was appropriate, references were found using Medline, International Pharmaceutical Abstracts and the Cochrane Library. Issues to be addressed included the need for antibiotics in acute otitis media, the comparative efficacy and tolerability of antimicrobial agents and the reliability of reported penicillin allergies. Amoxicillin and TMP/SMX were found to be first-line agents in the treatment of acute otitis media owing to their efficacy, safety and cost, with neither drug being significantly better than the other. The need to treat otitis media with antibiotics remains controversial. Reported penicillin allergies were found to be an unreliable indicator of a potentially serious reaction. In conclusion, it was found that treatment with TMP/SMX was an appropriate intervention. [source] Tension pneumo-orbitus and pneumocephalus induced by a nasal oxygen cannula: Report on two paediatric casesJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2000Bj O'Brien Abstract: The present paper highlights the potential dangers of misplaced nasopharyngeal oxygen cannulae causing secondary pneumo-orbitus and pneumocephalus in two paediatric patients. While this complication is uncommon, early recognition allows prompt and appropriate intervention, with cessation of nasal oxygen, cannula removal, early investigation with computed tomography (CT) head/orbit scan and orbital or cranial decompression, if required. Early CT imaging identifies medial orbital or paranasal sinus fractures, the presence of sinusitis, associated intracranial air and assessment of the degree of orbital or intracranial tension. Antibiotics are not usually required for this type of clean injury unless pre-existing sinusitis is identified. In both cases, direct orbital decompression was performed with excellent results after identification of marked unilateral tense exophthalmos, delayed pupillary reactions to light and ophthalmopegia. [source] Perceptions of psychological first aid among providers responding to Hurricanes Gustav and Ike,JOURNAL OF TRAUMATIC STRESS, Issue 4 2010Brian Allen Psychological First Aid (PFA), developed by the National Child Traumatic Stress Network and the Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, has been widely disseminated both nationally and internationally, and adopted and used by a number of disaster response organizations and agencies after major catastrophic events across the United States. This study represents a first examination of the perceptions of providers who utilized PFA in response to a disaster. Study participants included 50 individuals who utilized PFA in their response to Hurricane Gustav or Ike. Findings indicated that participation in PFA training was perceived to increase confidence in working with adults and children. PFA was not seen as harmful to survivors, and was perceived as an appropriate intervention for responding in the aftermath of hurricanes. [source] Weight monitoring of breastfed babies in the United Kingdom , interpreting, explaining and interveningMATERNAL & CHILD NUTRITION, Issue 1 2006MA (Cantab), Magda Sachs BA Abstract Weighing infants in their first 6 months is an important aspect of growth monitoring and a common activity of child health care services worldwide. During the same 6 months, support for establishing breastfeeding and the promotion of continued exclusive breastfeeding are important activities of health professionals. Parents and health professionals may perceive conflicts between achieving both robust growth and continuing breastfeeding. In this narrative review, the literature on weighing breastfed babies in the United Kingdom is examined. A companion paper examined issues of growth charts, scales and weighing frequency and accuracy. This paper considers issues of interpretation of the plotted weight values for individual breastfed babies, noting the complexities of growth patterns, which may lead to difficulties of accurate identification of those individuals whose growth merits further investigation. Little attention has been given to issues of explaining the interpreted growth curves to parents and this issue is explored and noted as of importance for further study. Research evidence on choosing appropriate interventions to improve the growth of breastfed babies is reviewed. The paucity of such evidence leads to suggestions for future study. This review gathers together a wide range of literature from many different perspectives, with the hope of informing weight monitoring practice so that this can both identify infants whose weight may be of concern, and who may need appropriate intervention, and support continued breastfeeding. [source] Practitioner Review: Non-pharmacological treatments for ADHD: A lifespan approachTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 2 2010Susan Young Background:, Attention-deficit/hyperactivity disorder (ADHD) is a chronic and pervasive developmental disorder that is not restricted to the childhood years. Methods:, This paper reviews non-pharmacological interventions that are available at present for preschoolers, school-age children, adolescents and adults. Results:, The most appropriate intervention for preschoolers is parent training. For school-age children with moderate impairments there is some evidence to suggest that group parent training programmes and classroom behavioural interventions may suffice as a first-line treatment. For school-age children with severe impairments, interventions are more appropriate when combined with stimulant medication (i.e., integrated treatment packages are likely to be more successful than ,standalone' treatments). Multimodal interventions seem to be best suited for middle school/adolescent children, which most likely reflects that these interventions usually integrate home and school treatment strategies and often include an element of social skills training. Stimulant medication is generally the first line of treatment for adults but CBT has also been found to be effective at addressing the complex needs of this population. Conclusion:, Current research has largely ignored that ADHD is a developmental disorder that spans the preschool to adult years. Most studies focus on young school-age children and outside of this age group there is a dearth of controlled trials that provide conclusive evidence. As children mature the mode and agent of intervention will shift to reflect the developmental needs and circumstances of the individual. [source] Sociocultural Perceptions and Patterns of Cigarette and Alcohol Use among College Students in VietnamASIAN SOCIAL WORK AND POLICY REVIEW, Issue 3 2008Paul DuongTran This empirical study was conducted in the Socialist Republic of Vietnam to investigate cross-sectionally the influences of sociocultural contexts on the patterns of addictive substance use cigarette, alcohol, and illicit drugs. A sample of 202 monolingual adults who were enrolled in college courses at the University of Hanoi in Vietnam responded to a self-reported questionnaire in their native language on the frequency, quantity, and occasions of addictive behavior. The project staff were fluent in English and Vietnamese. The questionnaire was critically reviewed for its face validity and cultural appropriateness before being translated into Vietnamese. In addition to patterns of use, this research explored the central role of drinking alcohol and smoking cigarettes in peer socialization among college adults. Vietnam, like other Asian cultures, emphasizes initiation and conformity to social traditions and norms. The empirical findings provide invaluable knowledge of the complex roles of cigarette and alcohol in the social processes and relationship-building among college adults in Vietnam. Further knowledge will assist in identifying intervention approaches and health prevention that is more focused and congruent with cultural and social beliefs about this behavior and these substances. Its implications for research into culturally appropriate intervention and prevention are also discussed. [source] Combating resistance in a challenging, changing environmentCLINICAL MICROBIOLOGY AND INFECTION, Issue 2007F. W. Goldstein Abstract The prevalence of antimicrobial resistance for both Gram-positive and Gram-negative pathogens is escalating worldwide. Outbreaks of community- and hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) are being reported more frequently. Although antimicrobial resistance is well recognised as a global problem, decisions about appropriate intervention and treatment should be made at the level of the local hospital or healthcare system. Thus, local surveillance to identify prevalent pathogens, detect bacterial resistance and identify particular strains is necessary for selecting optimal treatment regimens. In addition, bactericidal antimicrobial agents with novel mechanisms of action and activity against multidrug-resistant bacteria, together with improved infection control measures, are needed to address this growing medical problem more effectively. [source] mTOR inhibitor-associated dermatologic and mucosal problemsCLINICAL TRANSPLANTATION, Issue 2 2010Josep M. Campistol Campistol JM, de Fijter JW, Flechner SM, Langone A, Morelon E, Stockfleth E. mTOR inhibitor-associated dermatologic and mucosal problems. Clin Transplant 2010 DOI: 10.1111/j.1399-0012.2010.01232.x. © 2010 John Wiley & Sons A/S. Abstract:, Mammalian target of rapamycin inhibitor use is associated with numerous adverse events, including dermatologic and mucosal problems. Awareness of these complications, which clinically manifest across a severity spectrum from minor through severe and may occur at varied time points after initiation of sirolimus therapy, can be useful to clinicians in both managing these events and determining the appropriate intervention(s) for patients. This manuscript examines the dermatologic and mucosal problems associated with mammalian target of rapamycin inhibitor use, reviews the literature, and provides personal experiences regarding the management and treatment of these adverse events. [source] The Conservation Relevance of Epidemiological Research into Carnivore Viral Diseases in the SerengetiCONSERVATION BIOLOGY, Issue 3 2007SARAH CLEAVELAND conservación de carnívoros; investigación epidemiológica; moquillo; rabia; Serengeti Abstract:,Recent outbreaks of rabies and canine distemper in wildlife populations of the Serengeti show that infectious disease constitutes a significant cause of mortality that can result in regional extirpation of endangered species even within large, well-protected areas. Nevertheless, effective management of an infectious disease depends critically on understanding the epidemiological dynamics of the causative pathogen. Pathogens with short infection cycles cannot persist in small populations in the absence of a more permanent reservoir of infection. Development of appropriate interventions requires detailed data on transmission pathways between reservoirs and wildlife populations of conservation concern. Relevant data can be derived from long-term population monitoring, epidemic and case-surveillance patterns, genetic analyses of rapidly evolving pathogens, serological surveys, and intervention studies. We examined studies of carnivore diseases in the Serengeti. Epidemiological research contributes to wildlife conservation policy in terms of management of endangered populations and the integration of wildlife conservation with public health interventions. Long-term, integrative, cross-species research is essential for formulation of effective policy for disease control and optimization of ecosystem health. Resumen:,Brotes recientes de rabia y moquillo en poblaciones silvestres del Serengeti muestran que las enfermedades infecciosas constituyen una causa significativa de mortandad que puede resultar en la extirpación regional de especies en peligro, aun en áreas extensas bien protegidas. Sin embargo, el manejo efectivo de una enfermedad infecciosa depende críticamente del entendimiento de la dinámica epidemiológica del patógeno. Los patógenos con ciclo infeccioso corto no pueden persistir en poblaciones pequeñas en ausencia de un reservorio de la infección más permanente. El desarrollo de intervenciones adecuadas requiere de datos detallados de las vías de transmisión entre reservorios y poblaciones de vida silvestre de preocupación para la conservación. Se pueden derivar datos importantes del monitoreo de poblaciones a largo plazo, de patrones de epidemias y de estudios de caso, del análisis genético de patógenos que evolucionan rápidamente, de muestreos sexológicos y de estudios de intervención. Examinamos estudios de enfermedades de carnívoros en el Serengeti. La investigación epidemiológica contribuye a las políticas de conservación de vida silvestre en términos de la gestión de poblaciones en peligro y de la integración de la conservación con intervenciones de salud pública. La investigación a largo plazo e integradora es esencial para la formulación de políticas efectivas para el control de enfermedades y la optimización de la salud del ecosistema. [source] Esthetic treatment modalities in men: psychologic aspects of male cosmetic patientsDERMATOLOGIC THERAPY, Issue 6 2007Richard G Fried ABSTRACT:, Male cosmetic patients represent a growing population of individuals who can substantially benefit from well-chosen esthetic interventions. Understanding some of the unique aspects of the male psyche can result in more effective recruitment of male cosmetic patients and aid the clinician in helping these patients to choose appropriate interventions. Specific recommendations for the physician, staff, and office environment are provided. Illustrations of emotional and functional benefits are provided that can be shared with patients to enhance expectations and satisfaction with outcomes. [source] General measures of cognition for the preschool childDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 3 2005Elizabeth O. LichtenbergerArticle first published online: 13 SEP 200 Abstract Preschool-age children who are experiencing delays in physical, cognitive, communication, social, emotional, or adaptive development are often referred for a comprehensive assessment to make diagnostic determinations and to help develop appropriate interventions. Typically cognitive assessment has a key role in a comprehensive evaluation of a young child. In this article, five individually administered tests of cognitive ability, normed for the preschool-age child, are reviewed. These specific tests include the Bayley Scales of Infant Development, 2nd edition, the Kaufman Assessment Battery for Children, 2nd edition, the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, the Stanford-Binet Intelligence Scale, 5th edition, and the Differential Abilities Scales. The following is provided for these cognitive instruments: a description of the test procedures, information on scoring systems, highlights of the technical qualities, and a summary of the general meaning of test results. The article concludes with strengths and limitations of the instruments. © 2005 Wiley-Liss, Inc. MRDD Research Reviews 2005;11:197,208. [source] Family Predictors of Antisocial Behavior in AdolescenceFAMILY PROCESS, Issue 2 2003Maja Dekovi, Ph.D. The goal of the present study was to examine the combined and unique ability of different aspects of family functioning to predict involvement in antisocial behavior in a large nonclinical (community) sample of adolescents. Distinction was made between global (e.g., family socio-economic status), distal (dispositional characteristics of parents), contextual (family characteristics), and proximal (parent-child interaction) factors that operate within families. Results show that proximal factors were significant predictors of antisocial behavior, independent of their shared variance with other factors. Consistent with the hypothesized mediational model, the effects of distal and contextual factors appear to be mostly indirect: after their association with proximal factors was taken into account, these factors were no longer significantly related to antisocial behavior. The implications of these findings for planning of developmentally appropriate interventions for ado-lesents and their families are discussed. [source] A health inequalities perspective on violence against womenHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2007Cathy Humphreys PhD BSocWk Abstract The present paper argues that the physical and mental health consequences of gender-based violence constitute a major public health problem in the UK and a source of significant health inequality. The concept of violence against women is explored alongside brief examples of the mental and physical health impact of this violence. While the impact on women's health is relatively uncontested, the extent to which social divisions such as poverty, class and minority ethnic status create specific vulnerabilities to violence are more controversial. A widely held view within the movement to support survivors within the UK has been that violence against women cuts across class and ethnicity, and is found in all communities and classes. A more nuanced discussion of the way in which poverty and ethnic background may create particular vulnerabilities is explored. Disentangling cause and consequence, and also the barriers to help-seeking for minority ethnic women are discussed. The role of social workers in addressing the way in which violence against women is both ubiquitous but marginal in their caseloads is discussed, and appropriate interventions to respond to health inequality issues are proposed. [source] Family caregiving of persons living with HIV/AIDS in Thailand: Caregiver burden, an outcome measureINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2006Niranart Vithayachockitikhun RN MSN PhD-student The present paper provides an initial picture of HIV/AIDS-affected families. It is evident that families play a major role of support for HIV/AIDS patients in Thai society. Caregiver burden is one of the patient-related outcomes, which is the most common outcome measure in caregiver research. The demands on the family caregivers of these patients are enormous and need to be addressed. The determinants that are associated with caregiver burden such as caregiver characteristics, patient characteristics and social stigma are important for nurses to minimize the burden of care so that appropriate interventions can be developed for persons with HIV/AIDS and family members who share the work of managing their care at home. [source] Emotional outcome after intensive care: literature reviewJOURNAL OF ADVANCED NURSING, Issue 1 2008Janice E. Rattray Abstract Title., Emotional outcome after intensive care: literature review. Aim., This paper is a report of a literature review to identify (a) the prevalence of emotional and psychological problems after intensive care, (b) associated factors and (c) interventions that might improve this aspect of recovery. Background., Being a patient in intensive care has been linked to both short- and long-term emotional and psychological consequences. Data sources., The literature search was conducted during 2006. Relevant journals and databases were searched, i.e. Medline and CINAHL, between the years 1995 and 2006. Review methods., The search terms were ,anxiety', ,depression', posttraumatic stress', ,posttraumatic stress disorder' and ,intensive care'. Results., Fifteen papers were reviewed representing research studies of anxiety, depression and posttraumatic stress, and seven that represented intensive care follow-up clinics and patient diaries. Being in intensive care can result in significant emotional and psychological problems for a number of patients. For the majority of patients, symptoms of distress will decrease over time but for a number these will endure for some years. Current evidence indicates that emotional problems after intensive care are related to both subjective and objective indicators of a patient's intensive care experience. Evidence suggests some benefit in an early rehabilitation programme, daily sedation withdrawal and the use of patient diaries. However, additional research is required to support such findings. Conclusion., Our understanding of the consequences of intensive care is improving. Psychological care for intensive care patients has lagged behind care for physical problems. We now need to focus on developing and evaluating appropriate interventions to improve psychological outcome in this patient group. [source] The conceptual structure of transition to motherhood in the neonatal intensive care unitJOURNAL OF ADVANCED NURSING, Issue 1 2007Hyunjeong Shin Abstract Title. The conceptual structure of transition to motherhood in the neonatal intensive care unit Aim., This paper is a report of a concept analysis of transition to motherhood for mothers with infants in a neonatal intensive care unit. Background., Mothers with infants in a neonatal intensive care unit have more difficulty in their transition to motherhood compared with mothers of healthy infants. The concept of transition to motherhood in the neonatal intensive care unit is not well-understood in nursing, often being confused with mothers' psychological responses in the neonatal intensive care unit. Methods., The concept analysis combined Rodgers' evolutionary method with Schwartz-Barcott & Kim's Hybrid method. Thirty-eight studies were reviewed and a purposive sample of 10 Korean mothers with infants in a neonatal intensive care unit was interviewed. Findings., Three critical attributes of transition to motherhood in the neonatal intensive care unit were identified: (1) time-dependent process, (2) psycho-emotional swirling and (3) hovering around the edge of mothering. These are caused by the antecedents (1) unexpected outcome of pregnancy, (2) awareness of the situation and (3) mother,infant separation. The consequences were: (1) delayed motherhood and (2) developing a sense of meaning concerning family and life. Additionally, five influencing factors to be alleviated were identified: (1) negative meaning attribution, (2) uncertainty, (3) social prejudice, (4) lack of opportunities to make contact with the infant and (5) the neonatal intensive care unit environment. Conclusions., This concept analysis should help nurses to understand the process of becoming a mother in a neonatal intensive care unit and plan appropriate interventions for mothers with special needs. [source] Raising Adult Vaccination Rates over 4 Years Among Racially Diverse Patients at Inner-City Health CentersJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2008Mary Patricia Nowalk PhD OBJECTIVES: To increase adult immunizations at inner-city health centers serving primarily minority patients. DESIGN: A before,after trial with a concurrent control. SETTING: Five inner-city health centers. PARTICIPANTS: All adult patients at the health centers eligible for influenza and pneumococcal vaccines. INTERVENTION: Four intervention sites chose from a menu of culturally appropriate interventions based on the unique features of their respective health centers. MEASUREMENTS: Immunization and demographic data from medical records of a random sample of 568 patients aged 50 and older who had been patients at their health centers since 2000. RESULTS: The preintervention influenza vaccination rate of 27.1% increased to 48.9% (P<.001) in intervention sites in Year 4, whereas the concurrent control rate remained low (19.7%). The pneumococcal polysaccharide vaccine (PPV) rate in subjects aged 65 and older increased from 48.3% to 81.3% (P<.001) in intervention sites in Year 4. Increase in PPV in the concurrent control was not significant. In logistic regression analysis, the likelihood of influenza vaccination was significantly associated with the intervention (odds ratio (OR)=2.07, 95% confidence interval (CI)=1.77,2.41) and with age of 65 and older (OR=2.0, 95% CI=1.62,2.48) but not with race. Likelihood of receiving the pneumococcal vaccination was also associated with older age and, to a lesser degree, with intervention. CONCLUSION: Culturally appropriate, evidence-based interventions selected by intervention sites resulted in increased adult vaccinations in disadvantaged, racially diverse, inner-city populations over 2 to 4 years. [source] Depressive Symptoms and Associated Factors in Children With Attention Deficit Hyperactivity DisorderJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 2 2004Nancy LeBlanc PhD(c) PROBLEM To compare depressive symptoms in children with attention deficit hyperactivity disorder (ADHD) to those in healthy children, and to explore the influence of individual and family factors on level of depression. METHODS Individual interviews with 68 children, ages 7 to 12 years, in order to complete the Children's Depression Inventory. FINDINGS Children with ADHD reported significantly more depressive symptoms than did children without ADHD; 14.7% of children with ADHD reached the threshold of a 19 point score, which suggests clinical depression. No significant effects of individual and family factors on level of depression were found. CONCLUSIONS Children with ADHD are more inclined to experience depressive symptoms than are healthy children. To plan appropriate interventions, nurses evaluating and working with children with ADHD should always consider a possible coexistence of depressive symptoms. [source] A review of the information and support needs of family carers of patients with chronic obstructive pulmonary diseaseJOURNAL OF CLINICAL NURSING, Issue 4 2009Ann-Louise Caress Aims and objectives., The objectives of this narrative review were to identify: (1) The information and support needs of carers of family members with chronic obstructive pulmonary disease; (2) appropriate interventions to support carers in their caregiving role; (3) information on carers' needs as reported in studies of patients living with COPD in the community. Background., Chronic obstructive pulmonary disease is a major health problem in the UK resulting in significant burden for patients, families and the health service. Current National Health Service policies emphasise, where medically appropriate, early discharge for acute exacerbations, hospital-at-home care and other models of community care to prevent or reduce re-hospitalisations of people with chronic conditions. Understanding carers' needs is important if health care professionals are to support carers in their caregiving role. Design., A narrative literature review. Methods., Thirty five papers were reviewed after searching electronic databases. Results., Few studies were identified which addressed, even peripherally, carers' needs for information and support, and no studies were found which described and evaluated interventions designed to enhance caregiving capacity. Several studies of hospital-at-home/early discharge, self care and home management programmes were identified which included some information on patients' living arrangements or marital status. However, there was little or no detail reported on the needs of, and in many cases, even the presence of a family carer. Conclusions., This review highlights the dearth of information on the needs of carers of chronic obstructive pulmonary disease patients and the need for future research. Relevance to clinical practice., There is little research based knowledge of the needs of carers of chronic obstructive pulmonary disease patients and interventions to assist them in providing care. This knowledge is critical to ensure that carers receive the information they need to carry out this role while maintaining their own physical and emotional health. [source] Menopausal symptom perception and severity: results from a screening questionnaireJOURNAL OF CLINICAL NURSING, Issue 7 2008FAANP, Judith A Berg PhD Background., Although it is widely acknowledged women experience symptoms during their transition from reproductive to postreproductive stage, there is inconsistency as to the prevalence of symptoms as well as their severity ratings. Aim and objectives., The purpose of this study was to describe symptom perception and severity in mid-life women volunteering for an intervention study for menopause symptom management. Design., A cross-sectional descriptive design was used to provide data on presenting symptoms in a sample of women negotiating the menopausal transition. Methods., A community-based sample of Caucasian women aged 43,55 years was recruited from national nursing media, local media and a variety of local community sources. A screening questionnaire was administered to determine qualification for study entry based upon symptom severity scores from the questionnaire. This report includes results from the screening questionnaire. Results., One hundred and sixty-five women were screened to obtain 110 qualified participants with mean age of 49·3 SD 3·04 years who were 4·7 SD 7 months past their last menstrual period. Sleep difficulties, forgetfulness and irritability were perceived by the highest number of women while sleep difficulties, night sweats, irritability and forgetfulness were rated the most severe. Conclusions., Findings from this study expand understanding of the menopause symptom experience, because few reports include symptom severity reports. All aspects of the symptom experience are necessary to develop appropriate interventions and to evaluate them. Relevance to clinical practice., Providing education about menopause symptoms is central to nursing practice of mid-life women. Therefore, nurses must keep abreast of current knowledge to prepare women for their transition to postreproductive phase or to reassure women who are surprised to find hot flashes are not the only symptoms encountered. [source] Evaluation of a falls prevention programme in an acute tertiary care hospitalJOURNAL OF CLINICAL NURSING, Issue 2 2007M Hth Sci, PG Dip Clin Epi, Teresa A Williams BN Aims and objectives., To evaluate a systematic, coordinated approach to limit the severity and minimize the number of falls in an acute care hospital. Background., Patient falls are a significant cause of preventable injury and death, particularly in older patients. Best practice principles mandate that hospitals identify those patients at risk of falling and implement interventions to prevent or minimize them. Methods., A before and after design was used for the study. All patients admitted to three medical wards and a geriatric evaluation management unit were enrolled over a six-month period. Patients' risk of falling was assessed using a falls risk assessment tool and appropriate interventions implemented using a falls care plan. Data related to the number and severity of falls were obtained from the Australian Incident Monitoring System database used at the study site. Results., In this study, 1357 patient admissions were included. According to their risk category, 37% of patients (n = 496) were grouped as low risk (score = 1,10), 58% (n = 774) medium risk (score = 11,20) and 5% (n = 63) high risk (score = 21,33) for falls. The incidence of falls (per average occupied bed day) was eight per 1000 bed days for the study period. Compared with the same months in 2002/2003, there was a significant reduction in falls from 0·95 to 0·80 (95% CI for the difference ,0·14 to ,0·16, P < 0·001). Conclusion., We evaluated a systematic, coordinated approach to falls management that included a falls risk assessment tool and falls care plan in the acute care setting. Although a significant reduction in falls was found in this study, it could not be attributed to any specific interventions. Relevance to clinical practice., Preventing falls where possible is essential. Assessment of risk and use of appropriate interventions can reduce the incidence of falls. [source] Culturally centered psychosocial interventionsJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 2 2006Guillermo Bernal Over the last few decades, psychologists and other health professionals have called attention to the importance of considering cultural and ethnicminority aspects in any psychosocial interventions. Although, at present, there are published guidelines on the practice of culturally competent psychology, there is still a lack of practical information about how to carry out appropriate interventions with specific populations of different cultural and ethnic backgrounds. In this article, the authors review relevant literature concerning the consideration of cultural issues in psychosocial interventions. They present arguments in favor of culturally centering interventions. In addition, they discuss a culturally sensitive framework that has shown to be effective for working with Latinos and Latinas. This framework may also be applicable to other cultural and ethnic groups. @ 2006 Wiley Periodicals, Inc. [source] Qualitative Outcome Analysis: Evaluating Nursing Interventions for Complex Clinical PhenomenaJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2000Janice M. Morse Purpose: To describe a method that allows evaluating nursing interventions derived from a qualitative research project, and that shows appropriate interventions. Organizing Framework: Qualitative research has expanded over the last decade and has contributed significantly to Inderstanding patients' experiences of health, illness, and injury. Yet the value of qualitative research in determining clinical interventions and subsequently evaluating the effects of these interventions on patients' outcomes has been limited. This method is used to confirm the efficacy of nursing interventions when experience changes over time, to extend the repertoire of intervention strategies, and to further clinicians' understanding of possible outcomes. Design: From a completed study, Qualitative Outcome Analysis (QOA) enhances the identification of meaningful intervention strategies and plans for utilization. The researcher identifies the type of qualitative data that will enable the interpretation and evaluation of interventions, devises a means of data ecording and analysis, and finally, disseminates the findings. Conclusions: QOA is a systematic means to confirm the applicability of clinical strategies developed from a single qualitative project, to extend the repertoire of clinical interventions, and to evaluate clinical outcomes. [source] A Review of the Health Beliefs and Lifestyle Behaviors of Women with Previous Gestational DiabetesJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2009Emily J. Jones ABSTRACT Objective: To critically review and synthesize original research designed to examine the health beliefs, including risk perceptions and health behaviors related to diet and physical activity of women with previous gestational diabetes mellitus. Data Sources: PubMed and CINAHL databases were searched for studies published in the last decade (1998-2008) that examined variables related to the health beliefs and behaviors of women with previous gestational diabetes mellitus. Keyword searches included health beliefs, health behaviors, perceived risk, gestational diabetes, type 2 diabetes, diet, physical activity, and postpartum. Study Selection: Eight articles, representing 6 studies, were selected that met the inclusion criteria of original research, dependent variable of health beliefs and behaviors of women with previous gestational diabetes mellitus, and measurement after pregnancy. Data Extraction: Articles were reviewed and discussed according to the concepts of risk perception and health beliefs, health behaviors related to diet and physical activity, and psychosocial factors related to women's health beliefs and behaviors. Data Synthesis: Data revealed common health beliefs and behaviors of women with previous gestational diabetes mellitus, including low risk perceptions for future type 2 diabetes mellitus and suboptimal levels of physical activity and fruit and vegetable intake. The majority of studies revealed a distinct knowledge-behavior gap among women with previous gestational diabetes mellitus, whereas others revealed a lack of knowledge regarding necessary lifestyle modifications. Conclusions: Findings from this review may assist women's health researchers and clinicians in developing appropriate interventions for increasing risk awareness, promoting self-efficacy for weight loss and physical activity behaviors, and decreasing rates of diabetes and cardiovascular disease among women with previous gestational diabetes mellitus. Further research is necessary to identify factors that influence the health beliefs and behaviors of women with previous gestational diabetes mellitus. Future research should focus on populations of greater racial, ethnic, and socioeconomic diversity, as the majority of studies have been conducted with non-Hispanic White, socioeconomically advantaged women. [source] | |||||||||||||||||||||||||||||||