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Useful Intervention (useful + intervention)
Selected AbstractsNutrition in patients with Type 2 diabetes: are low-carbohydrate diets effective, safe or desirable?DIABETIC MEDICINE, Issue 7 2005R. L. Kennedy Abstract Low-carbohydrate diets have been around for over 100 years. They have become very popular recently but the scientific basis for their use remains to be fully established. This article reviews the recent trials that have been published and also what is known about the effects of low-carbohydrate, high-protein diets on energy expenditure and body composition. Although many controversies remain, there is now mounting evidence that these diets can lead to effective weight loss and may thus be a useful intervention for patients who have, or are at risk of, diabetes. The practical aspects of using these diets as a short- to medium-term intervention are discussed. [source] Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophreniaJOURNAL OF CLINICAL NURSING, Issue 15 2009Wen-Chun Chen Aim and objectives., The objective of this study was to examine the efficacy of progressive muscle relaxation training on anxiety in patients with acute schizophrenia. Background., Many empirical studies have found progressive muscle relaxation training beneficial in reducing the psychological effects of anxiety. Progressive muscle relaxation training is also effective in reducing the distress symptoms associated with the symptomatology of schizophrenia. Design., An experimental randomised controlled trial using repeated measures. Method., The study was designed to examine the effects of progressive muscle relaxation training on patients diagnosed with schizophrenia. Study participants were acute psychiatric inpatients in Taiwan. Eighteen patients were block randomised and then assigned to an experimental or control group. The experimental group received progressive muscle relaxation training and the control group received a placebo intervention. Results from the Beck anxiety inventory were compared between groups as a pretest before intervention, on day 11 of intervention and one week post-test after the intervention was completed. Changes in finger temperature were measured throughout the experiment. Results., The degree of anxiety improvement was significantly higher in the progressive muscle relaxation training group than in the control group after progressive muscle relaxation training intervention (p < 0·0001) and at follow-up (p = 0·0446; the mean BAI score fell from 16·4 pretest to ,5·8 post-test. After adjusting for the change in patient finger temperature, the mean change in temperature was significantly different between the two patient groups. The average body temperature increased significantly after applying the progressive muscle relaxation training to patients with schizophrenia. Conclusion., This study demonstrated that progressive muscle relaxation training can effectively alleviate anxiety in patients with schizophrenia. Relevance to clinical practice., Progressive muscle relaxation training is potentially an effective nursing intervention in the reduction of anxiety in patients diagnosed with schizophrenia, depending on the quality of their mental status at the time of intervention. Progressive muscle relaxation training is a useful intervention as it is proven to reduce anxiety levels across a spectrum of psychiatric disorders. [source] Continuous infusion of prostaglandin E1 via the superior mesenteric artery can prevent hepatic injury in hepatic artery interruption through passive portal oxygenationLIVER INTERNATIONAL, Issue 2 2000Tsutomu Sato Abstract:Aims/Background: Hepatic artery interruption (HAI) causes severe ischemic liver damage, especially following hepatopancreatobiliary surgery. In order to inhibit a decrease in oxygen delivery after HAI, continuous infusion of PGE1 via the superior mesenteric artery (SMA) was administered in pigs and changes in hepatic blood flow and oxygen delivery were investigated. Furthermore, its effectiveness in the prevention of liver injury was evaluated by histology and serum enzyme levels. Methods: Animals were subjected to HAI without PGE1 infusion (control group n=6) and to continuous infusion of PGE1 (0.02 ,g/kg/min) into the SMA (PGE1 group n=6). Results and Conclusion: PGE1 infusion via the SMA not only increased the portal blood flow but also elevated the oxygen content of the portal blood. The reduction in oxygen delivery to the liver was 50% in the control group, and only 13% in the PGE1 group. Serum aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) levels 24 h after HAI in the control group were 3415±1283 IU/L and 9839±2959 respectively while in the PGE1 group they were 939±426 IU/L and 5510±1545 IU/L respectively. Histological examination showed massive necrosis in the control group at 72 h but only focal liver cell necrosis in the PGE1 group. Based on this finding and the fact that this treatment can be performed easily and safely, continuous infusion of PGE1 via the SMA may be a useful intervention to prevent severe liver damage after hepatic artery interruption. [source] Psychoeducation in bipolar patients with comorbid personality disordersBIPOLAR DISORDERS, Issue 4 2004Francesc Colom Background:, The co-occurrence of personality and bipolar disorders is quite common. Bipolar patients with personality disorders have been described as having poorer outcome than ,pure' bipolar patients. However, from a combined-approach point of view, a little has been done to improve the course of these patients. Psychoeducation has shown its efficacy in the prevention of relapses in the bipolar population but, to date, no data is available on its efficacy in the management of bipolar patients with personality disorders. Method:, The present study shows a subanalysis from a single-blind randomized prospective clinical trial on the efficacy of group psychoeducation in bipolar I patients. Bipolar patients fulfilling DSM-IV criteria for any personality disorder were randomized to either psychoeducational treatment or a non-structured intervention. There were 22 patients in the control group and 15 in the psychoeducation group. All patients received naturalistic pharmacological treatment as well. The follow-up phase comprised 2 years where all patients continued receiving naturalistic treatment without psychological intervention and were assessed monthly for several outcome measures. Results:, At the end of the follow-up phase (2 years), a 100% of control group patients fulfilled criteria for recurrence versus a 67% in the psychoeducation group (p < 0.005). Patients included in the psychoeducation group had a higher time-to-relapse and a significantly lower mean number of total, manic and depressive relapses. No significant differences regarding the number of patients who required hospitalization were found but the mean duration of days spent in the hospitalization room was significantly higher for the patients included in the control group. Conclusion:, Psychoeducation may be a useful intervention for bipolar patients with comorbid personality disorders. Further studies should address the efficacy of specifically tailored interventions for this common type of patients. [source] Psychological treatments for functional non-epileptic attacks: a systematic reviewACTA NEUROPSYCHIATRICA, Issue 4 2009Danielle Gaynor Objective: There is a lack of clarity about the most useful intervention for functional non-epileptic attacks (FNEA). Outcomes for this condition remain often poor, with considerable personal, social and economic impact. In order to guide clinical practice and future research in this area, we have performed a systematic review of the published literature on the psychological treatment of FNEA. Methods: A comprehensive literature search was carried out using key words: non-epileptic seizures; psychogenic seizures; psychogenic non-epileptic seizures; pseudoseizures; funny turns; non-epileptic attack; hysterical seizures; and pseudoepileptic. Studies specifically looking at psychological treatment of FNEA were identified. Studies of patients also having comorbid organic seizure disorders were excluded. Results: 17 studies that met the inclusion criteria were identified. A broad variety of psychological interventions for FNEA has been investigated. Only one randomised controlled trial has been completed to date. Existing evidence appears to suggest that various psychological treatments, including presenting the diagnosis, psychoeducation, behavioural therapies and mixed modality treatments, may be effective. Conclusion: While a range of psychological treatments may be beneficial for this patient group, we do not have clear evidence to suggest which treatment is most efficacious. Specific elements of presenting the diagnosis and psychoeducation may be required in addition to traditional cognitive behavioural therapeutic approaches. Large, methodologically robust studies are urgently required to establish the most effective form of treatment. [source] Implementation of a community liaison pharmacy service: a randomised controlled trialINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2008Tam Vuong PhD Objective The aim of this study was to provide a pharmacy service to improve continuity of patient care across the primary-secondary care interface. Setting The study involved patients discharged from two acute-care tertiary teaching hospitals in Melbourne, Australia, returning to independent living. Methods Consecutive patients admitted to both hospitals who met the study criteria and provided consent were recruited. Recruited patients were randomised to receive either standard care (discharge counselling, provision of compliance aids and communication with primary healthcare providers when necessary) or the intervention (standard care and a home visit from a community liaison pharmacist (CLP) within 5 days of discharge). Participant medication was reviewed during the visit according to set protocols and compliance and medication understanding was measured. All participants were telephoned 8,12weeks after discharge to assess the impact of the intervention on adherence and medication knowledge. Key findings The CLP visited 142 patients with a mean time of 4.2 days following hospital discharge (range = 1,14 days). Consultations lasted 15,105 min (mean, 49 min; SD, ± 21 min). The CLPs retrospectively coded 766 activities and interventions that occurred during home visits, subsequently categorised into three groups: counselling and education, therapeutic interventions and other interventions. No statistical difference was detected in the number of medications patients reported taking at follow-up: the mean value was 7.72 (SD, ± 3.27) for intervention patients and 7.55 (SD, ± 3.27) for standard-care patients (P = 0.662). At follow-up self-perceived medication understanding was found to have improved in intervention patients (P < 0.001) and significant improvements from baseline in medication adherence were found in both standard-care (P < 0.022) and intervention (P < 0.005) groups; however, adherence had improved more in intervention patients. Conclusion The community liaison pharmacy service provided critical and useful interventions and support to patients, minimising the risk of medication misadventure when patients were discharged from hospital to home. [source] Enhancing Intervention Fidelity: A Means of Strengthening Study ImpactJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2006Sharon Horner PURPOSE.,Intervention studies that address the goals of the Healthy People initiative are increasing, and many focus on health concerns of children and adolescents. The purpose of this paper is to present strategies and discuss the rationale for including intervention fidelity in study design. CONCLUSION.,Researchers need to verify that their interventions were delivered as designed (intervention fidelity), and that variations from the design can be assessed. Infidelity can result in non-significant findings that are not due to the study design but rather to elements that affected the intervention delivery. IMPLICATIONS.,Addressing intervention fidelity in study design supports the researcher's conclusion about associations between intervention and outcomes and helps reduce premature abandonment of potentially useful interventions. [source] Inappropriate prescribing in the elderlyJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2007P. Gallagher MB MRCPI Summary Background and objective:, Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. Methods:, We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. Results and discussion:, Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. Conclusion:, Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug utilization review tools should be designed on the basis of a country's national drug formulary and should be evidence based. [source] Use of topical misoprostol to reduce radiation-induced mucositis: Results of a randomized, double-blind, placebo-controlled trialJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 5 2006MJ Veness Summary Radiation-induced mucositis is an acute reaction of the mucosa of patients undergoing head and neck radiotherapy. It can have debilitating and dose-limiting consequences. There is no consensus on an accepted intervention that significantly reduces its severity. Misoprostol is a synthetic prostaglandin E1 analogue, with properties of a mucosal cytoprotectant. We designed a randomized, double-blind, placebo-controlled trial of misoprostol in patients with head and neck cancer. The aim of this study was to determine if topical misoprostol was effective in reducing the severity of radiation-induced mucositis in patients receiving radical dose radiotherapy. The effect of this intervention on a patient's general well-being was also investigated. The primary end-point of the study was the incidence of Radiation Therapy Oncology Group grade 3 mucositis. Between 1999 and 2002, 83 patients were recruited into the study at Westmead and Nepean Hospitals, Sydney. Forty-two patients were randomized to receive misoprostol and 41 to receive a placebo. Most patients received radiotherapy in the adjuvant setting (52 of the 83) and had either an oral cavity (42 of the 83) or an oropharyngeal (16 of the 83) cancer. We could not identify any significant difference in the incidence of severe mucositis based on whether patients were allocated to receive misoprostol or placebo. There was no significant difference in the mean area under the mucositis curve (13.2 vs 16.6; P = 0.1). Patients allocated to misoprostol did report slightly increased soreness (7.6 vs 6.9; P = 0.04) and a greater use of analgesics. However, this difference did not translate into a worse feeling of general well-being as measured by a simple visual analogue scale (5.8 vs 5.2; P = 0.3). In conclusion, we were unable to identify a reduction in radiation-induced mucositis in patients receiving misoprostol. There is a paucity of high-level evidence on potentially useful interventions and a continued need for new and innovative research, incorporating quality-of-life measurements, in patients experiencing radiation-induced mucositis. [source] | ||||||||||