Home About us Contact
|
Home About us Contact | ||
|
|
||
Data Synthesis (data + synthesis)
Selected AbstractsImproving Diagnostic Accuracy Using an Evidence-Based Nursing ModelINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 4 2004Rona F. Levin PhD Diagnósticos de enfermagem; prática baseada em evidências; precisão diagnóstica Exactitud diagnóstica; práctica basada en la evidencia; diagnósticos de enfermería PURPOSE. To propose an evidence-based model (EBM) to improve diagnostic accuracy in nursing. DATA SOURCES. Published literature, experience, and expertise of authors. DATA SYNTHESIS. Using an EBM directs clinicians on how to use the best available evidence from the literature to determine the best fit between cues and diagnoses, integrate this evidence with clinician expertise and patient preferences, and conduct a self-evaluation of the process. CONCLUSIONS. Use of an EBM to teach nurses how to ask relevant diagnostic questions and provide a framework for nurse educators to teach evidenced-based practice may lead to developing more competent diagnosticians and improving diagnostic accuracy in nursing. OBJETIVO. Propor um modelo baseado em evidências (MBE) para melhorar a precisão diagnóstica na enfermagem. FONTE DE DADOS. Literatura publicada, experiência e conhecimento das autoras. SÍNTESE DOS DADOS. A utilização de um BEM orienta as enfermeiras clínicas sobre como utilizar a melhor evidência disponível na literatura para determinar o melhor ajuste entre as pistas obtidas e os diagnósticos, integrando esta evidência com o conhecimento clínico da enfermeira e as preferências do paciente, e conduzindo a uma auto-avaliação do processo. CONCLUSÕES. O uso de um modelo de prática baseado em evidências para ensinar as enfermeiras a formular perguntas relevantes e oferecer aos educadores de enfermagem uma estrutura para o ensino da prática baseada em evidências pode levar ao desenvolvimento de dianosticadoras mais competentes e melhorar a precisão diagnóstica na enfermagem. PROPÓSITO. Proponer un modelo basado en la evidencia (MBE) para mejorar la exactitud diagnóstica en enfermería. FUENTES DE DATOS. Bibliografía publicada, experiencia y especialización de los autores. SÍNTESIS DE LOS DATOS. Utilizando un MBE guía a los clínicos en cómo utilizar la mejor evidencia disponible en la bibliografía para determinar el mejor encaje entre los datos y los diagnósticos, integrar esta evidencia con la especialidad clínica y las preferencias del paciente y llevar a cabo una auto-evaluación del proceso. CONCLUSIONES. El uso de un modelo de práctica basada en la evidencia para enseñar a las enfermeras cómo hacer preguntas diagnósticas pertinentes y proporcionar un marco de trabajo para que las enfermeras docentes enseñen la práctica basada en la evidencia, puede llevar a desarrollar mayor competencia al diagnosticar y mejoras en la exactitud diagnóstica. [source] Environmental Nursing Diagnoses: A Proposal for Further Development of Taxonomy IIINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2003Pauline M. Green PhD PURPOSE. To propose further development of environmental diagnoses and to offer recommendations for expanding Taxonomy II to include more diagnostic labels that encompass the environmental domain. SOURCES. Literature in the disciplines of nursing, biology, toxicology, public health, sociology, and anthropology. DATA SYNTHESIS. Nurses need language to describe the human responses of individuals, families, communities, and global society to environmental health threats. CONCLUSIONS. New environmental diagnoses will lead to refinement of language that describes the contribution of nursing to an emerging international and community health priority. PRACTICE IMPLICATIONS. Environmental diagnostic labels will allow nurses to name responses and plan interventions that respond to instances or risks of exposure to threats from the physical and sociocultural environment. Search terms: Environmental contamination, environmental health threats, exposure, nursing diagnoses [source] Nursing Diagnosis and Nursing Theory: Exploration of Factors Inhibiting and Supporting Simultaneous UseINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2002FAAN, Noreen C. Frisch PhD PURPOSE. To explore the values and philosophies of nursing theories that inhibit the simultaneous use of nursing diagnosis and nursing theory. SOURCES.Published articles, books, book chapters. DATA SYNTHESIS. Four factors in the literature and reflected in practice may have had a negative influence on the use of nursing diagnoses: (a) commitment to the uniqueness of each person, (b) an abandonment of the nursing process, (c) a perspective that nursing care is an evolving interaction, and (d) a belief that theory-derived language is more articulate and precise than standard classifications. PRACTICE IMPLICATIONS.Strategies for combining theory and diagnoses include emphasizing the diagnostic terms as professional shorthand and permitting flexibility in modifying diagnoses as needed; widely disseminating the concept that classification can be used effectively with newer iterations of the nursing process reflecting circular, simultaneous, and intuitive processes; developing classification language based on concepts of hypothesis and perception; and including diagnostic categories associated with theoretical perspectives. Search terms:Nursing classifications, nursing diagnoses, nursing theory Diagnostics infirmiers et théories de soins: Exploration des facteurs qui freinent et soutiennent leur utilisation simultanée BUT.Explorer les valeurs et les conceptions à la base des théories de soins qui inhibent I'utilisation des diagnostics infirmiers avec les théories de soin. SOURCES.Articles, manuels, chapitres d'ouvrages. SYNTHÈSE DES DONNÉES.Les données de la littérature professionnelle et l'examen de la pratique ont permis d'identifier quatre facteurs qui ont pu avoir une influence négative sur l'utilisation des diagnostics infirmiers: (a) l'importance donnée au caractère unique de chaque personne; (b) l'abandon de la démarche de soins; (c) l'idée que le soin est fait d'interactions en évolution constante; (d) la croyance que le langage découlant de la théorie est plus précis et articulé que les classifications normalisées. IMPLICATIONS POUR LA PRATIQUE.Quelques stratégies pourraient faciliter la combinaison de la théorie et des diagnostics, notamment: souligner le fait que les termes des diagnostics constituent une sorte de sténographie professionnelle et permettre la flexibilité pour les modifier; disséminer le fait que les classifications peuvent être utiles dans une démarche de soin rénovée, reflétant les aspects circulaires, simultanés et intuitifs du raisonnement; développer un langage basé sur les concepts d'hypothéses et de perceptions et inclure des catégories diagnostiques associées à des courants théoriques. Mots-clés:Classifications de soins, diagnostics infirmiers, théories de soins Diagnóstico de enfermagem e teoria de enfermagem: Exploração dos fatores inibidores e estimuladores do seu uso simultâneo OBJETIVO.Explorar os valores e filosofias das teorias de enfermagem que inibem o uso simultâneo dos diagnósticos de enfermagem e das teorias de enfermagem. FONTES.Artigos publicados, livros, capítulos de livros. SÍNTESE DOS DADOS.Quatro fatores citados na literatura e refletidos na prática podem ter tido uma influência negativa no uso dos diagnóstics de enfermagem: (a) compromisso com a singularidade de cada pessoa, (b) um abandono do processo de enfermagem, (c) uma perspectiva de que o cuidado de enfermagem é uma interação que evolui e (d) uma crença de que uma linguagem derivada da teoria é mais articulada e precisa do que classificações padronizadas. IMPLICAÇÕES PARA A PRÁTICA.Estratégias para combinar teoria e diagnósticos incluem enfatizar os termos diagnóstics como uma taquigrafia profissional e permitir flexibilidade para modificar diagnósticos sempre que necessário, disseminando amplamente o conceito de que a classificação pode ser usada efetivamente com novas repetições do processo de enfermagem, refletindo processos circulares, simultâneos e intuitivos; desenvolver uma linguagem de classificação baseada em conceitos de hipótese e percepção; e incluir categorias diagnósticas associadas com perspectivas teóricas. Palavras para busca:Classificações de enfermagem, diagnóstico de enfermagem, teoria de enfermagem Diagnóstico enfermero y teoría enfermera: Exploración de factores que inhiben y apoyan una utilización simultánea PROPÓSITO.Explorar los valores y filosofías de teorías enfermeras, que inhiben la utilización simultánea de diagnósticos y teorías enfermeras. FUENTES.Artículos publicados, libros, capítulos de libros. SÍNTESIS DE LOS DATOS.Cuatro factores reflejados en la práctica y en la bibliografía, pueden haber tenido una influencia negativa en la utilizatión de los diagnósticos de enfermería: (a) compromiso a la singularidad de cada persona, (b) abandono del proceso de enfermería, (c) una perspectiva de que los cuidados de enfermería son una interacción que evoluciona y (d) una creencia de que el lenguaje derivado de la teoría, es más preciso y expresa mejor que las clasificaciones estándar. IMPLICACIONES PARA LA PRÁCTICA.Las estrategias para combinar la teoría y los diagnósticos enfermeros, incluyen: Dar énfasis a los términos diagnósticos como una abreviatura profesional, permitir ser flexible al modificar diagnósticos si es necesario, diseminar ampliamente el concepto de que la clasificación puede usarse eficazmente con nuevas iteraciones del proceso enfermero que reflejen procesos circulares, simultáneos e intuitivos, desarrollar lenguajes de clasificación basados en los conceptos de hipótesis y percepción, Incluir categorías diagnósticas asociadas con perspectivas teóricas. Términos de búsqueda:Diagnósticos enfermeros, clasificaciones enfermeras y teoría enfermera [source] Ineffective Family Participation in Professional Care: A Concept Analysis of a Proposed Nursing DiagnosisINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2002Aeran Lee MS PURPOSE. To discuss the label, definition, defining characteristics, and related factors of a proposed nursing diagnosis, "ineffective family participation in professional care." DATA SOURCES. Published research articles, clinical handbooks, textbooks. DATA SYNTHESIS. Although a number of familyrelated nursing diagnoses exist, none really addresses the problems encountered if family members are unwilling or unable to participate in patient care. This is critical because the bulk of care occurs outside the hospital setting. CONCLUSIONS. A new nursing diagnosis, "Ineffective family participation in professional care" is needed. This diagnosis has been submitted to the Nursing Diagnosis Extension and Classification for consideration. PRACTICE IMPLICATIONS. With this diagnosis nurses could encourage family participation in care more effectively by focusing on assessment and interventions. Participation familiale inefficace aux soins professionnels: Analyse conceptuelle d'un diagnostic infirmier proposé BUTS. Discuter du titre, de la définition, des caractéristiques et des facteurs favorisants d'un nouveau diagnostic infirmier: "participation familiale inefficace aux soins professionnels". SOURCES. Articles de recherche, extraits d'ouvrages cliniques. RÉSULTATS. Malgré la présence d'un certain nombre de diagnostics infirmiers centrés sur la famille, aucun d'entre eux ne désigne les problèmes posés par les familles qui ne souhaitent pas ou ne sont pas capables de participer aux soins du patient. Ce phénomène est important, compte tenu de la grande quantité de soins extrahospitaliers. CONCLUSIONS. II semble nécessaire de disposer d'un nouveau diagnostic infirmier "Participation familiale inefficace aux soins professionnels". Ce diagnostic a été soumis au Groupe d'Extension et de Classification des Diagnostics Infirmiers, afin qu'il soit étudié. IMPLICATIONS PRATIQUES. L'utilisation de ce diagnostic devrait permettre aux infirmières de focaliser l'évaluation et les interventions de soins, afin d'impliquer plus efficacement la famille dans les soins. Participação familiar ineficaz no cuidado profissional: Análise de conceito de um diagnóstico de enfermagem proposto OBJETIVO. Discutir o titulo, definição, características definidoras e fatores relacionados de um diagnóstico de enfermagem proposto, "participação familiar ineficaz no cuidado profissional". FONTES DE DADOS.Artigos de pesquisa publicados, manuais clínicos, livros-texto. ACHADOS.Embora exista um certo número de diagnósticos de enfermagem relacionados à família, nenhum deles trata realmente dos problemas encontrados quando membros da família não desejam ou não conseguem participar do cuidado do paciente. Isto é crítico, porque uma grande parte dos cuidados ocorre fora do ambiente hospitalar. CONCLUSãO.É necessário um novo diagnóstico de "Participação familiar eficaz no cuidado profissional". Este diagnóstico foi submetido à apreciação da Extensão e Classificação de Diagnósticos de Enfermagem. IMPLICAÇõES PARA A PRÁTICA.Com este diagnóstico, as enfermeiras podem encorajar a participação da família no cuidado de maneira mais efetiva, com enfoque em levantamento de dados e intervenções. Palavras para busca:Análise de conceito, diagnóstico de enfermagem, participação familiar Participación familiar ineficaz en cuidados profesionales: Análisis de concepto de este diagnóstico enfermero que se ha propuesto PROPÓSITO.Discutir la etiqueta, definición, características definitorias y factores relacionados del diagnóstico propuesto "participation familiar ineficaz en cuidados profesionales." FUENTES DE DATOS.Artículos de investigación publicados, manuales clínicos, libros de texto. RESULTADOS.Aunque existen varios diagnóstics enfermeros relacionados con la familia, ninguno realmente enfoca los problemas encontrados, si las familias no quieren o no pueden participar en el cuidado del paciente. Esto es crítico, porque la mayor parte de los cuidados tienen lugarfuera del entorno del hospital. CONCLUSIONES.Se necesita un nuevo diagnóstico de enfermería "participación familiar ineficaz en cuidados profesionales". Este diagnóstico ha sido presentado a Nursing Diagnosis Extension and Classification para su consideración. IMPLICACIONES PARA LA PRÁCTICA.Con este diagnóstico, las enfermeras podrían animar la participación familiar en los cuidados más eficazmente, centrándose en la valoración y las intervenciones. Términos de búsqueda:Análisis de concepto, diagnóstico enfermero, participación familiar [source] Spirituality and Religiousness: Differentiating the Diagnoses Through a Review of the Nursing LiteratureINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2001Lisa Burkhart PhD(c) PURPOSE. To differentiate the definitions of spirituality and religiousness as used in nursing literature. DATA SOURCES. Journal articles, books, book chapters. DATA SYNTHESIS. The nursing literature has been inconsistent in defining spirituality and religiousness. The spirituality literature defines spirituality as the broader concept, with religiousness as a subconcept, while the religiousness literature defines religiousness as the broader concept, with spirituality as a subconcept. CONCLUSIONS. Spirituality and religiousness are two separate nursing diagnoses with some common elements to both. PRACTICE IMPLICATIONS. The growth of parish nursing as an ANA-recognized specialty practice has heightened the awareness of caring for the human spirit. Clarity is needed in the terms used to define this specialty. [source] Sensitivity of superficial cultures in lower extremity wounds,JOURNAL OF HOSPITAL MEDICINE, Issue 7 2010Chayan Chakraborti MD Abstract BACKGROUND: Superficial wound cultures are routinely used to guide therapy, despite a lack of clear supporting evidence. PURPOSE: To conduct a systematic review of the correlation between superficial wound cultures and the etiology of skin and soft tissue infections. DATA SOURCES: Medline, EMBASE, CINAHL, Scopus. STUDY SELECTION: Articles published between January 1960 and August 2009 involving superficial wound cultures and deeper comparison cultures. DATA EXTRACTION: Two reviewers independently searched for abstracted information pertaining to the microbiology of lower extremity wounds sufficient to calculate the sensitivity and specificity of superficial wound cultures versus comparison cultures. DATA SYNTHESIS: Data pooled using a random-effects meta-analysis model. RESULTS: Of 9032 unique citations, 8 studies met all inclusion criteria. Inter-rater reliability was substantial (Kappa = 0.78). Pooled test sensitivity for superficial wound swabs was 49% (95% confidence interval [CI], 37-61%], and specificity was 62% (95% CI, 51-74%). The pooled positive and negative likelihood ratios (LRs) were 1.1 (95% CI, 0.71-1.5) and 0.67 (95% CI, 0.52-0.82). The median number of isolates for surface cultures (2.7, interquartile range [IQR] 1.8-3.2) was not significantly different than that for comparison cultures, (2.2, IQR 1.7-2.9) (P = 0.75). CONCLUSION: Few studies show a strong relationship between superficial wound swabs and deep tissue cultures, and the current data demonstrate poor overall sensitivity and specificity. The positive and negative LRs were found to provide minimal utility in influencing pretest probabilities. Results of this analysis show that wound cultures should not be used in lieu of local antibiograms to guide initial antibiotic therapies. Journal of Hospital Medicine 2010;5:415,420. © 2010 Society of Hospital Medicine. [source] Effect of hospitalist attending physicians on trainee educational experiences: A systematic review,JOURNAL OF HOSPITAL MEDICINE, Issue 8 2009Pradeep Natarajan MD Abstract BACKGROUND: Trainees receive much of their inpatient education from hospitalists. PURPOSE: To characterize the effects of hospitalists on trainee education. DATA SOURCES: MEDLINE, Database of Reviews of Effectiveness (DARE), National Health Service (NHS) Economic Evaluation Database (EED), Health Technology Assessment (HTA), and the Cochrane Collaboration Database (last searched October 2008) databases using the term "hospitalist", and meeting abstracts from the Society of Hospital Medicine (SHM) (2002-2007), Society of General Internal Medicine (SGIM) (2001-2007), and Pediatric Academic Societies (PAS) (2000-2007). STUDY SELECTION: Original English language research studies meeting all of the following: involvement of hospitalists; comparison to nonhospitalist attendings; evaluation of trainee knowledge, skills, or attitudes. 711 articles were reviewed, 32 retrieved, and 6 included; 7,062 meeting abstracts were reviewed, 9 retrieved, and 2 included. DATA EXTRACTION: Two authors reviewed articles to determine study eligibility. Three authors independently reviewed included articles to abstract data elements and classify study quality. DATA SYNTHESIS: Seven studies were quasirandomized one was a noncontemporaneous comparison. All citations only measured trainee attitudes. In all studies comparing hospitalists to nonhospitalists, trainees were more satisfied with hospitalists overall, and with other aspects of their teaching, but ratings were high for both groups. One of 2 studies that distinguished nonhospitalist general internists from specialists showed that trainees preferred hospitalists, but the other did not demonstrate a hospitalist advantage over general internists. CONCLUSIONS: Trainees are more satisfied with inpatient education from hospitalists. Whether the increased satisfaction translates to improved learning is unclear. Journal of Hospital Medicine 2009;4:490,498. © 2009 Society of Hospital Medicine. [source] Effects of rapid response systems on clinical outcomes: Systematic review and meta-analysisJOURNAL OF HOSPITAL MEDICINE, Issue 6 2007Sumant R. Ranji MD Abstract BACKGROUND A rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster-randomized trial. PURPOSE To evaluate the effects of RRSs on clinical outcomes through a systematic literature review. DATA SOURCES MEDLINE, BIOSIS, and CINAHL searches through August 2006, review of conference proceedings and article bibliographies. STUDY SELECTION Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies reporting effects of an RRS on inpatient mortality, cardiopulmonary arrests, or unscheduled ICU admissions. DATA EXTRACTION Two authors independently determined study eligibility, abstracted data, and classified study quality. DATA SYNTHESIS Thirteen studies met inclusion criteria: 1 cluster-randomized controlled trial (RCT), 1 interrupted time series, and 11 before-after studies. The RCT showed no effects on any clinical outcome. Before-after studies showed reductions in inpatient mortality (RR = 0.82, 95% CI: 0.74-0.91) and cardiac arrest (RR = 0.73, 95% CI: 0.65-0.83). However, these studies were of poor methodological quality, and control hospitals in the RCT reported reductions in mortality and cardiac arrest rates comparable to those in the before-after studies. CONCLUSIONS Published studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before-after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven. Journal of Hospital Medicine 2007;2:422,432. © 2007 Society of Hospital Medicine. [source] What is the Slowest-Yet-Normal Cervical Dilation Rate Among Nulliparous Women With Spontaneous Labor Onset?JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2010Jeremy L. Neal ABSTRACT Objective: To integrate research literature that has provided insights into the cervical dilation rate that may best describe the slowest-yet-normal dilation rate among nulliparous women when beginning with criteria commonly associated with active labor onset. Data Sources: A literature search from 1950 through 2008 was conducted using the Medline electronic database, reference lists from identified articles, and other key references. Study Selection: Research reports written in English with a focus on the cervical dilation and/or labor duration of low-risk, nulliparous women with spontaneous labor onset. Data Extraction: Classic and contemporary research literature was reviewed and organized under the following subheadings: Friedman Studies, Partograph Studies, Active Management of Labor Studies, Additional Studies. Data Synthesis: An integrative review of the literature approximated the slowest-yet-normal cervical dilation rate for nulliparous women when beginning with criteria commonly associated with active labor. Conclusions: The slowest-yet-normal linear dilation rate approximates 0.5 cm/hour for low-risk, nulliparous women with spontaneous labor onset when starting at dilatations traditionally associated with active labor onset. However, this linear rate must be evaluated judiciously in light of the physiological acceleration of dilation that occurs during typical labor. Given this, cervical dilation for this population is likely slower than 0.5 cm/hour in earlier active labor and faster in more advanced active labor. Faster dilation expectations (e.g., 1 cm/hour) likely contribute to an overdiagnosis of dystocia ("slow, abnormal progression of labor") in contemporary practice and, subsequently, to an overuse of interventions aimed at accelerating labor progress. [source] A Systematic Review of the Effectiveness of Breastfeeding Intervention Delivery MethodsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2009Barbara Pate ABSTRACT Objective: To analyze breastfeeding intervention delivery methods to determine the likelihood of successful breastfeeding outcomes of e-based interventions compared to provider-based interventions. Data Sources: Eligible studies were identified by searching MEDLINE, CINAHL, Academic Search Elite, Health Source: Nursing/Academic Edition, SOC INDEX, and PsycINFO. Study Selection: Studies were included if they were conducted in a developed country, published between the years 2004 and 2008, included a concurrent control group, and reported frequency data on breastfeeding initiation or duration. The suitability of design and quality of execution were evaluated using the Centers for Disease Control procedure for systematic reviews. Twenty-one articles met the criteria for inclusion. Data Extraction: Study design, demographics, intervention/control conditions, settings, sampling strategies, potential threats to validity, and breastfeeding outcomes were abstracted and entered into a database for analysis and synthesis. Data Synthesis: Odds ratios were calculated for each individual study, and studies were stratified into 2 groups by intervention delivery type. The pooled results indicated that studies using e-based interventions had a moderate effect on breastfeeding (odds ratio=2.2 [1.9-2.7], d=0.5); whereas provider-based interventions had very little to no effect (odds ratio=1.1 [1.0-1.2], d=0.03). Conclusions: Results indicate that breastfeeding promotion programs delivered via the Internet may be an appealing alternative to time-consuming and expensive provider-based breastfeeding education and support. [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] Are Maternal Cortisol Levels Related to Preterm Birth?JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2009Carmen Giurgescu ABSTRACT Objective: To examine the evidence related to the relationship between maternal cortisol levels and preterm birth. Data Sources: A search of Medline, PubMed, and Cumulative Index of Nursing and Allied Health Literature was conducted using the keywords preterm birth, preterm delivery, premature birth, and cortisol. Study Selection: Fifteen studies published in English were selected based on the inclusion criteria. There were no limitations on the dates of publication. Data Extraction: The data extracted were related to the gestational age at collection of biological samples, time of day at collection, and differences in cortisol levels between preterm and full-term groups. Data Synthesis: The majority of the studies suggested that maternal cortisol levels are related to preterm birth. Women with higher levels of cortisol had higher risk of having a preterm birth. Conclusions: Researchers can use the findings of this review to develop future studies that examine the relationship between cortisol levels and preterm birth. Health care providers need to assess pregnant women's stress levels more closely and provide appropriate referrals and treatment to ensure that any actions that may possibly lower stress are being taken to reduce the likelihood of preterm birth. [source] A Selective Review of Maternal Sleep Characteristics in the Postpartum PeriodJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2009Lauren P. Hunter ABSTRACT Objective: To determine the current knowledge of postpartum womens' sleep patterns, sleep disturbances, consequences of sleep disturbances, and known strategies for prevention in order to provide best practice recommendations for health care providers. Data Sources: A literature search from 1969 through February 2008 was conducted using the CINHL, Index of Allied Health Literature, Ovid, PsycINFO, and PubMed electronic databases in addition to reference lists from selected articles and other key references. Search terms included sleep, postpartum, sleep deprivation, and sleep disturbance. Study Selection: A critical review of all relevant articles from the data sources was conducted with attention to the needs of postpartum womens' sleep and implications for health care providers. Data Extraction: Literature was reviewed and organized into groups with similar characteristics. Data Synthesis: An integrative review of the literature summarized the current state of research related to sleep alterations in postpartum women. Conclusions: Postpartum women experience altered sleep patterns that may lead to sleep disturbances. The most common reasons for sleep disturbances are related to newborn sleep and feeding patterns. Although present, the relationships among sleep disturbance, fatigue, and depression in postpartum women lack clarity due to their ambiguous definitions and the variety of the studies conducted. Providers should encourage prenatal education that assists the couple in developing strategies for decreasing postpartum sleep deprivation. Alterations of in-hospital care and home care should be incorporated to improve the new family's sleep patterns. [source] Interventions for Weight Management in Postpartum WomenJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2008Colleen Keller ABSTRACT Objective:, To report the results of a comprehensive review of published intervention studies to identify the best evidence available for guiding weight management interventions in postpartum women. Data Sources:, Electronic searches were conducted of three electronic databases: Cumulative Index to Nursing and Allied Health Literature; Medline; and the Science Citation Index, Expanded, in the Web of Science from 1994 to May 2007. Keyword searches were conducted using the terms obesity, obese, overweight, postpartum, pregnancy weight, and weight management in postpartum women. Study Selection:, Six studies were selected that met the inclusion criteria of testing interventions and one that reported preintervention planning and targeted a weight management intervention for postpartum women. Data Extraction:, All six interventions showed significant impact with diet and exercise or some combination on body composition in the targeted sample of women. Data Synthesis:, The strengths of previous studies include an emphasis on precision in outcome measures and experimental conditions; limitations were that the theoretical basis for the interventions was frequently omitted and limited attention given to the cultural, social, and contextual factors established in descriptive research. Conclusions:, Interventions need to target women early in their childbearing years to have the most significant long-term impact. [source] A Review of Nursing Interventions to Foster Becoming a MotherJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2006Ramona T. Mercer Objective:, To determine the current state of knowledge of nursing interventions that foster the process of becoming a mother. Data Sources:, A literature search was conducted using CINAHL and PubMed electronic databases and other key references. Study Selection:, Reports on nursing intervention research published in English that focused on a facet of maternal behavior in the process of becoming a mother during pregnancy or during the first 4 months following birth, or both, were included. Twenty eight reports were found. Data Extraction:, Studies were reviewed, categorized, and analyzed and interventions synthesized to determine the current knowledge base for fostering becoming a mother. Categories included instructions for infant caregiving, building awareness of and responsiveness to infant interactive capabilities, promoting maternal-infant attachment, maternal/social role preparation, and interactive therapeutic nurse-client relationships. Data Synthesis:, Interactive therapeutic nurse-client relationships and maternal/social role preparation had greater impact on variables indicating progress in becoming a mother than formal teaching. Instructions without nurse input were ineffective. Conclusions:, Interactive reciprocal nursing interventions are the most effective in enhancing mother-infant interactions and maternal knowledge about infant care. Evidence is limited on how to foster the mother's feelings about herself in becoming a mother and attachment to her infant. JOGNN, 35, 568-582; 2006. DOI: 10.1111/J.1552-6909.2006.00080.x [source] Retention of Pregnancy-Related Weight in the Early Postpartum Period: Implications for Women's Health ServicesJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2005Lorraine O. Walker Objective: To examine the proportion of women who reached their prepregnant weight at 6 weeks postpartum and the average amount of weight retained or lost by this time; to determine predictors of early (6 week) postpartum weight retention; and to propose related implications for women's health care and services. Data Sources: The literature review was based on a search of Medline for the years 1986 to 2004 using the keywords postpartum weight with inclusion of additional articles known to the authors that did not appear in the electronic search. Study Selection: The resulting 83 articles were scrutinized to identify those that reported data on weight retention at 6 weeks postpartum (range, delivery to 3 months) and associated anthropometric, social, obstetric, or behavioral predictors. A total of 12 articles met inclusion criteria for the review. Data Extraction: Data were extracted related to the proportion of women achieving their postpartum weight at 6 weeks postpartum, the amount of weight retained or lost up to 6 weeks postpartum, and predictors of amount of weight retained or lost. Data Synthesis: On average, at 6 weeks postpartum, women retain 3 to 7 kg of the weight gained during pregnancy, with at least two thirds exceeding their prepregnant weights. Gestational weight gain is the most significant predictor of weight retention. Conclusions: Women vulnerable to obesity and weight gain need weight-related health care and improved access to such care to promote weight loss after 6 weeks postpartum. [source] Postpartum Depression Beyond the Early Postpartum PeriodJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2004IBCLC, Janice H. Goodman MSN Objective: To review the literature concerning maternal postpartum depression beyond the early postpartum period. Data Sources: A literature search was conducted using Cinahl, Medline, and PsychInfo electronic databases. Keywords included postpartum depression, postpartum depressive symptoms, course, prevalence, incidence, and remission. Study Selection: Studies selected included incidence of maternal depression or depressive symptoms, existing in the early postpartum period, and measured again at postpartum points from 6 months through 2 1/2 years after delivery. Only studies published in English were included. Twenty-three articles were located, and a recent relevant study conducted by the current author also was included. Data Extraction: Studies were reviewed and data organized according to year, sample characteristics, time of depression assessment, instrument used, cutoff score, rate of depression, and factors associated with depression at later postpartum time points. Data Synthesis: For a significant percentage of women, postpartum depressive symptoms continue for months or even years after giving birth. Factors associated with postpartum depression at later time points are identified. Conclusions: Continued evaluation of women with elevated depression levels at initial screening, and treatment for women whose depression does not remit spontaneously within the first few weeks or months postpartum is recommended. Further research is needed to understand the phenomenon of persistent postpartum depression. [source] Women's Decision Making About the Use of Hormonal and Nonhormonal Remedies for the Menopausal TransitionJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2003Rosemary Theroux Objective: To critically review qualitative research on women's decision making about the use of hormonal and nonhormonal remedies for the menopausal transition. Data Sources: Computerized searches in CINAHL, MEDLINE, Medscape, and PsychINFO databases, using the keywords decision making, hormone therapy, herbal remedies, attitude toward hormone therapy, and qualitative research; and ancestral bibliographies. Study Selection: Articles from indexed journals from 1982 to 2001 in the English language relevant to the keywords were evaluated. Sixteen studies met inclusion criteria and were included in the analysis. Data Extraction: Study findings were organized into several categories and compared and contrasted across publications and categories. Data Synthesis: Half of the researchers described decision making as a weighing of benefits and risks. Women's considerations, beliefs, and values, as well as interaction with the environment, were primary influences on the process. Conclusions: Major gaps in care for midlife women were identified. Women need information about the process of menopause and the range of available options for menopause management. Nurses can play a major role in providing information, counseling, and developing decision aids. Women's values and beliefs, cultures, life contexts, and desire for involvement in the decision should guide interventions. [source] Why Girls Smoke: A Proposed Community-Based Prevention ProgramJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2001Mary Ann Faucher CNM Objectives: To review the literature on reasons teenage girls start smoking and to identify the role and opportunities for nurses to have an impact on this public health problem. In addition, a proposed smoking prevention program targeted to teenage girls is presented. Data Sources: Information was gathered from professional journals and texts and from MEDLINE and PROQUEST. Keywords used in the searches were smoking prevention, tobacco use, smoking and adolescents, teenage girls and smoking, health education and smoking, and smoking prevention programs. Data Synthesis and Conclusions: Smoking initiation in teenage girls is a problem with ramifications for individual health as well as for public health. Although the literature demonstrates the rising incidence of smoking in teenage girls and evidence suggests the reasons girls start smoking differ from those of their male counterparts, a dearth of information on smoking prevention programs exists for this population. It is reasonable to assume that the best practices for adolescent smoking prevention can be applied to programs specifically for girls, along with efforts to address social influences, self-image, and self-esteem, which may be particularly important to teenage girls. The theory of reasoned action provides a framework for prevention strategies that target the behavioral beliefs and attitudes that influence teenage girls to smoke. Nurses can educate themselves about contributing factors that lead teenage girls to start smoking. Implementing this knowledge into nursing practice in a variety of settings could help meet the Healthy People 2010 goals of reducing teenage smoking to 16%. [source] symptom Experience in Women After HysterectomyJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2001Kimberly H. Kim RN Objective: To review the literature addressing the symptom experience of women after hysterectomy. Data Sources: Computerized searches in MEDLINE and CINAHL, as well as texts and references cited in articles. Key concepts in the searches included hysterectomy, sleep disturbance and pain, hysterectomy and fatigue, hysterectomy, depression, and depressed mood. Study Selection: Articles and comprehensive works relevant to key concepts and published after 1970, with an emphasis on new findings from 1990 to 2000. Sixty-four citations were identified as useful to this review. Data Extraction: Data were organized under the following headings: women and hysterectomy, biopsychosocial perspectives, common symptoms after hysterectomy (pain, disturbed sleep, fatigue, depressed mood, anxiety), and significance of review (implications). Data Synthesis: Literature suggests that after a hysterectomy, women experience complications during the postoperative recovery period that may vary with the type of surgical procedure. During this period, the quantity and quality of sleep as well as other symptoms (pain, fatigue, anxiety, and depression) are influenced by various physiologic, psychologic, and social factors. Despite limited evidence that sleep problems may occur frequently during the recovery period, only a few researchers have systematically examined sleep patterns in women after hysterectomy. None of these studies, however, used objective sleep measures or examined multiple dimensions of these women's lives. Conclusions: This review conceptualized the women's symptom experience as the experience of specific symptoms (pain, sleep disturbance, fatigue, depressed mood, and anxiety) that were influenced by biopsychosocial factors. [source] Improving Adherence to Abnormal Pap Smear Follow-UpJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2001Priscilla DeRemer Abercrombie RN Objective: To gain a better understanding of factors that affect follow-up and the strategies that have been found to improve follow-up after an abnormal Papanicolaou (Pap) smear test. Data Sources: A computer-based search of the literature was conducted using MEDLINE with the keywords adherence, nonadherence, compliance, Follow-up, and abnormal Pap smears. Study Selection: Research studies published between 1985 and 1999 in the English language were included. If relevant studies were cited in the articles reviewed, these studies also were reviewed. A total of 25 studies were reviewed. Data Extraction: A critical review of these studies was conducted, with special attention to implications for clinical practice as well as future research. The studies fell into two groups: factors associated with nonadherence and strategies developed to improve adherence. Data Synthesis: A number of factors were identified that affect adherence to follow-up among women with abnormal Pap smears. Some of these factors involve characteristics of the woman, such as demographics, social support, lack of understanding, and fear. Factors that pertain to the health care system, such as inconvenient clinic hours, male providers, and insensitive staff, also were identified. A number of strategies have been successful in improving follow-up, including telephone counseling, educational programs, and economic incentives. Conclusions: Nurses play a crucial role in Facilitating adherence to recommendations for follow-up. They can identify women at risk for poor follow-up, increase awareness of the factors that affect follow-up, and implement strategies shown to be successful in improving adherence. Future research should take into account the rnultifactoral nature of adherence as well as the patient's perspective. In addition, studies should be designed with special attention to generalizability and should include women from populations most at risk for cervical cancer. [source] Controversies related to red blood cell transfusion in critically ill patientsJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2010DACVECC, DACVIM, Jennifer E. Prittie DVM Abstract Objective , To review the evolution of and controversies associated with allogenic blood transfusion in critically ill patients. Data sources , Veterinary and human literature review. Human Data Synthesis , RBC transfusion practices for ICU patients have come under scrutiny in the last 2 decades. Human trials have demonstrated relative tolerance to severe, euvolemic anemia and a significant outcome advantage following implementation of more restricted transfusion therapy. Investigators question the ability of RBCs stored longer than 2 weeks to improve tissue oxygenation, and theorize that both age and proinflammatory or immunomodulating effects of transfused cells may limit efficacy and contribute to increased patient morbidity and mortality. Also controversial is the ability of pre- and post-storage leukoreduction of RBCs to mitigate adverse transfusion-related events. Veterinary Data Synthesis , While there are several studies evaluating the transfusion trigger, the RBC storage lesion and transfusion-related immunomodulation in experimental animal models, there is little research pertaining to clinical veterinary patients. Conclusions , RBC transfusion is unequivocally indicated for treatment of anemic hypoxia. However, critical hemoglobin or Hct below which all critically ill patients require transfusion has not been established and there are inherent risks associated with allogenic blood transfusion. Clinical trials designed to evaluate the effects of RBC age and leukoreduction on veterinary patient outcome are warranted. Implementation of evidence-based transfusion guidelines and consideration of alternatives to allogenic blood transfusion are advisable. [source] Hepatozoon americanum: an emerging disease in the south-central/southeastern United StatesJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2010Thomas M. Potter DVM Abstract Objective , To review the clinical epidemiologic and pathophysiologic aspects of Hepatozoon americanum infection in dogs. Data Sources , Data from veterinary literature were reviewed through Medline and CAB as well as manual search of references listed in articles pertaining to American canine hepatozoonosis. Veterinary Data Synthesis , H. americanum is an emerging disease in endemic areas of the United States. It is vital that practitioners in these areas become familiar with the clinical syndrome of hepatozoonosis and the diagnostic modalities that can be utilized to document the presence of infection. Additionally, veterinarians must understand the epidemiology of the disease in order to better prevent infections in their veterinary patients. Recent data have been published that shed new light on transmission of H. americanum to dogs; however, much remains unknown regarding patterns of infection and the natural vertebrate host source. Conclusions , While the prognosis for untreated H. americanum remains poor, for patients in which the disease is recognized and properly treated the outcome is favorable. Understanding the complex life cycle, numerous clinical symptoms, and treatment protocol will assist veterinarians who are treating patients with hepatozoonosis. [source] The ubiquitous role of zinc in health and diseaseJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2009DACVIM, Julia E. Cummings DVM Abstract Objective , To review zinc physiology and pathophysiology and the importance of zinc toxicity and deficiency in veterinary patients. Data Sources , A review of human and veterinary medical literature. Human Data Synthesis , There is a significant amount of original research in humans and animals on the role of zinc in multiple organ systems. There is also significant data available on human patients with zinc abnormalities. Veterinary Data Synthesis , Zinc deficiency has been studied in dogs with genetic disease and dietary deficiency leading to dermatological disease and immune deficiency. Zinc toxicity has been described after ingestion of metallic foreign bodies containing zinc. Conclusions , Historically, the role of zinc in health and disease has been studied through patients with toxicity or severe deficiency with obvious clinical signs. As the ubiquitous contribution of zinc to structure and function in biological systems was discovered, clinically significant but subtle deficiency states have been revealed. In human medicine, mild zinc deficiencies are currently thought to cause chronic metabolic derangement leading to or exacerbating immune deficiency, gastrointestinal problems, endocrine disorders, neurologic dysfunction, cancer, accelerated aging, degenerative disease, and more. Determining the causal relationships between mild zinc deficiency and concurrent disease is complicated by the lack of sensitive or specific tests for zinc deficiency. The prevalence of zinc deficiency and its contribution to disease in veterinary patients is not well known. Continued research is warranted to develop more sensitive and specific tests to assess zinc status, to determine which patients are at risk for deficiency, and to optimize supplementation in health and disease. [source] The use of vasopressin for treating vasodilatory shock and cardiopulmonary arrestJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2009DACVIM, Richard D. Scroggin Jr. Abstract Objective , To discuss 3 potential mechanisms for loss of peripheral vasomotor tone during vasodilatory shock; review vasopressin physiology; review the available animal experimental and human clinical studies of vasopressin in vasodilatory shock and cardiopulmonary arrest; and make recommendations based on review of the data for the use of vasopressin in vasodilatory shock and cardiopulmonary arrest. Data Sources , Human clinical studies, veterinary experimental studies, forum proceedings, book chapters, and American Heart Association guidelines. Human and Veterinary Data Synthesis , Septic shock is the most common form of vasodilatory shock. The exogenous administration of vasopressin in animal models of fluid-resuscitated septic and hemorrhagic shock significantly increases mean arterial pressure and improves survival. The effect of vasopressin on return to spontaneous circulation, initial cardiac rhythm, and survival compared with epinephrine is mixed. Improved survival in human patients with ventricular fibrillation, pulseless ventricular tachycardia, and nonspecific cardiopulmonary arrest has been observed in 4 small studies of vasopressin versus epinephrine. Three large studies, though, did not find a significant difference between vasopressin and epinephrine in patients with cardiopulmonary arrest regardless of initial cardiac rhythm. No veterinary clinical trials have been performed using vasopressin in cardiopulmonary arrest. Conclusion , Vasopressin (0.01,0.04 U/min, IV) should be considered in small animal veterinary patients with vasodilatory shock that is unresponsive to fluid resuscitation and catecholamine (dobutamine, dopamine, and norepinephrine) administration. Vasopressin (0.2,0.8 U/kg, IV once) administration during cardiopulmonary resuscitation in small animal veterinary patients with pulseless electrical activity or ventricular asystole may be beneficial for myocardial and cerebral blood flow. [source] The neurophysiology of dyspneaJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2008Matthew Scott Mellema DVM Abstract Objective , To review the human and veterinary literature regarding the neurophysiology of dyspnea and to provide evidence for the beneficial effects of several novel therapies aimed at the alleviation of dyspneic sensations. Data Sources , Data sources included scientific reviews, case reports, original research publications, and recent research conference proceedings. Human Data Synthesis , The use of blood oxygenation level-dependent functional magnetic resonance imaging technology has revealed that the brain regions activated by air hunger in humans are also those activated by fear, pain, and thirst perception. In human subjects, it has been found that agents known to enhance the firing of pulmonary slowly adapting receptors (SARs) can alleviate the sensation of dyspnea without altering central respiratory drive. Several small studies have also shown that nebulized opioids can reduce the sensation of dyspnea apparently via activation of peripheral opioid receptors in the lung. Veterinary Data Synthesis , There are several animal models relevant to both small and large animal clinical patient populations. Treatment of rats with a nebulized SAR sensitizing agent (furosemide) enhances SAR firing in response to lung inflation. Behavioral escape responses to airway occlusion are reduced in lightly anesthetized cats when treated with nebulized furosemide. Opioid agonists have been shown to inhibit the release of acetylcholine and other mediators from the airways of dogs and guinea pigs. Studies using a goat model with bilateral destruction of the pre-Bötzinger Complex do not support current paradigms of air hunger origination. Conclusions , Veterinary patients may benefit from an approach to dyspnea that incorporates an understanding of the origins of the unpleasant sensations associated with the condition. Several novel therapies have shown promise in alleviating dyspneic sensations without altering respiratory drive. Further study is needed to determine the safety and efficacy of these therapies in veterinary patients. [source] Apoptosis: A review of pro-apoptotic and anti-apoptotic pathways and dysregulation in diseaseJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2008Mauria A. O'Brien DVM Abstract Objective , To review the human and veterinary literature on the biology of apoptosis in health and disease. Data Sources , Data were examined from the human and veterinary literature identified through Pubmed and references listed in appropriate articles pertaining to apoptosis. Human Data Synthesis , The role of apoptosis in health and disease is a rapidly growing area of research in human medicine. Apoptosis has been identified as a component of human autoimmune diseases, Alzheimer's disease, cancer, and sepsis. Veterinary Data Synthesis , Research data available from the veterinary literature pertaining to apoptosis and its role in diseases of small animal species is still in its infancy. The majority of veterinary studies focus on oncologic therapy. Most of the basic science and human clinical research studies use human blood and tissue samples and murine models. The results from these studies may be applicable to small animal species. Conclusions , Apoptosis is the complex physiologic process of programmed cell death. The pathophysiology of apoptosis and disease is only now being closely evaluated in human medicine. Knowledge of the physiologic mechanisms by which tissues regulate their size and composition is leading researchers to investigate the role of apoptosis in human diseases such as cancer, autoimmune disease and sepsis. Because it is a multifaceted process, apoptosis is difficult to target or manipulate therapeutically. Future studies may reveal methods to regulate or manipulate apoptosis and improve patient outcome. [source] A case-based review of a simplified quantitative approach to acid-base analysisJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 5 2008DACVECC, Kate Hopper BVSc Abstract Objective , To present a simplified quantitative approach to acid-base analysis and to demonstrate its clinical utility. Data Sources , Original research articles and textbooks. Data Synthesis , A simplified quantitative approach to acid-base analysis is presented, which is derived from the Fencl-Stewart approach and calculates the magnitude of the effect on the standardized base excess (SBE) of 5 separate variables: (1) a free water effect (marked by sodium concentration), (2) an effect marked by the chloride concentration, (3) an albumin effect, (4) a lactate effect, and (5) a phosphate effect. Six clinical cases with acid-base abnormalities are presented in which the quantitative approach provides information that is not apparent from the traditional approach. Conclusion , This simplified quantitative approach provides a comprehensive evaluation of complex acid-base disorders, identifies individual processes and their relative influence on SBE, and aids in the development of an appropriate therapeutic plan. [source] Omega-3 Dietary Supplements and the Risk of Cardiovascular Events: A Systematic ReviewCLINICAL CARDIOLOGY, Issue 7 2009FCCM, Paul E. Marik MD Background Epidemiologic data suggest that omega-3 fatty acids derived from fish oil reduce cardiovascular disease. The clinical benefit of dietary fish oil supplementation in preventing cardiovascular events in both high and low risk patients is unclear. Objective To assess whether dietary supplements of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) decrease cardiovascular events across a spectrum of patients. Data Sources MEDLINE, Embase, the Cochrane Database of Systematic Reviews, and citation review of relevant primary and review articles. Study Selection Prospective, randomized, placebo-controlled clinical trials that evaluated clinical cardiovascular end points (cardiovascular death, sudden death, and nonfatal cardiovascular events) and all-cause mortality in patients randomized to EPA/DHA or placebo. We only included studies that used dietary supplements of EPA/DHA which were administered for at least 1 year. Data Extraction Data were abstracted on study design, study size, type and dose of omega-3 supplement, cardiovascular events, all-cause mortality, and duration of follow-up. Studies were grouped according to the risk of cardiovascular events (high risk and moderate risk). Meta-analytic techniques were used to analyze the data. Data Synthesis We identified 11 studies that included a total of 39 044 patients. The studies included patients after recent myocardial infarction, those with an implanted cardioverter defibrillator, and patients with heart failure, peripheral vascular disease, and hypercholesterolemia. The average dose of EPA/DHA was 1.8 ± 1.2 g/day and the mean duration of follow-up was 2.2 ± 1.2 years. Dietary supplementation with omega-3 fatty acids significantly reduced the risk of cardiovascular deaths (odds ratio [OR]: 0.87, 95% confidence interval [CI]: 0.79,0.95, p = 0.002), sudden cardiac death (OR: 0.87, 95% CI: 0.76,0.99, p = 0.04), all-cause mortality (OR: 0.92, 95% CI: 0.85,0.99, p = 0.02), and nonfatal cardiovascular events (OR: 0.92, 95% CI: 0.85,0.99, p = 0.02). The mortality benefit was largely due to the studies which enrolled high risk patients, while the reduction in nonfatal cardiovascular events was noted in the moderate risk patients (secondary prevention only). Meta-regression failed to demonstrate a relationship between the daily dose of omega-3 fatty acid and clinical outcome. Conclusions Dietary supplementation with omega-3 fatty acids should be considered in the secondary prevention of cardiovascular events. Copyright © 2009 Wiley Periodicals, Inc. [source] The feasibility of smoking reduction: an updateADDICTION, Issue 8 2005John R. Hughes ABSTRACT Aim To update conclusions of a previous review of smoking reduction on the extent to which (1) smokers spontaneously reduce their smoking, (2) smokers who try to quit and fail return to smoking less, (3) smokers can substantially reduce and maintain reductions via pharmacological and behavioral treatments and (4) smokers compensate when they reduce. Method Qualitative systematic review. Data sources Systematic computer searches and other methods. Study selection Published and unpublished studies of smokers not trying to stop smoking. We located 13,26 studies for each of the four aims. Data extraction The first author entered data with confirmation by second author. Data synthesis Due to the heterogeneity of methods and necessity of extensive recalculation, a meta-analysis was not feasible. Results Few daily smokers spontaneously reduce. Among those who try to stop smoking and relapse, some return to reduced smoking but whether they maintain this reduction is unclear. Nicotine replacement (and perhaps behavior therapies) can induce smokers not interested in quitting to make significant reductions in their smoking and maintain these over time. Some compensatory smoking occurs with reduction but significant declines in smoke exposure still occur. Conclusions These results indicate that reduction is feasible when aided by treatment. Whether reduction should be promoted will depend on the effect of reduction on health outcomes and future cessation. [source] | |||||||||||||||||||||||||