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Effective Adjunct (effective + adjunct)
Selected AbstractsEffectiveness of nurse-led cardiac clinics in adult patients with a diagnosis of coronary heart diseaseINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2005Tamara Page RN BN HyperbaricNursCert GradDipNSc(HighDep) MNSc Executive summary Background, Coronary heart disease is the major cause of illness and death in Western countries and this is likely to increase as the average age of the population rises. Consumers with established coronary heart disease are at the highest risk of experiencing further coronary events. Lifestyle measures can contribute significantly to a reduction in cardiovascular mortality in established coronary heart disease. Improved management of cardiac risk factors by providing education and referrals as required has been suggested as one way of maintaining quality care in patients with established coronary heart disease. There is a need to ascertain whether or not nurse-led clinics would be an effective adjunct for patients with coronary heart disease to supplement general practitioner advice and care. Objectives, The objective of this review was to present the best available evidence related to nurse-led cardiac clinics. Inclusion criteria, This review considered any randomised controlled trials that evaluated cardiac nurse-led clinics. In the absence of randomised controlled trials, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Participants were adults (18 years and older) with new or existing coronary heart disease. The interventions of interest to the review included education, assessment, consultation, referral and administrative structures. Outcomes measured included adverse event rates, readmissions, admissions, clinical and cost effectiveness, consumer satisfaction and compliance with therapy. Results, Based on the search terms used, 80 papers were initially identified and reviewed for inclusion; full reports of 24 of these papers were retrieved. There were no papers included that addressed cost effectiveness or adverse events; and none addressed the outcome of referrals. A critical appraisal of the 24 remaining papers identified a total of six randomised controlled trials that met the inclusion criteria. Two studies addressed nurse-led clinics for patients diagnosed with angina, one looked at medication administration and the other looked at educational plans. A further four studies compared secondary preventative care with a nurse-led clinic and general practitioner clinic. One specifically compared usual care versus shared care introduced by nurses for patients awaiting coronary artery bypass grafting. Of the remaining three studies, two have been combined in the results section, as they are an interim report and a final report of the same study. Because of inconsistencies in reporting styles and outcome measurements, meta-analysis could not be performed on all outcomes. However, a narrative summary of each study and comparisons of specific outcomes assessed from within each study has been developed. Although not all outcomes obtained statistical significance, nurse-led clinics were at least as effective as general practitioner clinics for most outcomes. Recommendations, The following recommendations are made: ,The use of nurse-led clinics is recommended for patients with coronary heart disease (Level II). ,Utilise nurse-led clinics to increase clinic attendance and follow-up rates (Level II). ,Nurse-led clinics are recommended for patients who require lifestyle changes to decrease their risk of adverse outcomes associated with coronary heart disease (Level II). [source] A Novel Pacing Maneuver to Localize Focal Atrial TachycardiaJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2007F.R.A.C.P., UWAIS MOHAMED M.B.B.S. Background: Although focal atrial tachycardias cannot be entrained, we hypothesized that atrial overdrive pacing (AOP) can be an effective adjunct to localize the focus of these tachycardias at the site where the post-pacing interval (PPI) is closest to the tachycardia cycle length (TCL). Methods: Overdrive pacing was performed in nine patients during atrial tachycardia, and in a comparison group of 15 patients during sinus rhythm. Pacing at a rate slightly faster than atrial tachycardia in group 1 and sinus rhythm in group 2 was performed from five standardized sites in the right atrium and coronary sinus. The difference between the PPI and tachycardia or sinus cycle length (SCL) was recorded at each site. The tachycardia focus was then located and ablated in group 1, and the atrial site with earliest activation was mapped in group 2. Results: In both groups the PPI-TCL at the five pacing sites reflected the distance from the AT focus or sinus node. In group 1, PPI-TCL at the successful ablation site was 11 ± 8 msec. In group 2, PPI-SCL at the site of earliest atrial activation was 131 ± 37 msec (P < 0.001 for comparison). In groups 1 and 2, calculated values at the five pacing sites were proportional to the distance from the AT focus or sinus node, respectively. Conclusions: The PPI-TCL after-AOP of focal atrial tachycardia has a direct relationship to proximity of the pacing site to the focus, and may be clinically useful in finding a successful ablation site. [source] Religion and spirituality in psychotherapy: a practice-friendly review of researchJOURNAL OF CLINICAL PSYCHOLOGY, Issue 2 2009Brian C. Post Abstract The role of religion and spirituality in psychotherapy has received growing attention in the last two decades, with a focus on understanding the ways that religion and spirituality relate to therapists, clients, and treatment methods. The authors reviewed recent empirical research on religion and spirituality in psychotherapy to inform practitioners about effective ways to incorporate the sacred into their clinical work. Three main areas are covered: religion/spirituality and therapists, religion/spirituality and clients, and religious/spiritual interventions. Research indicates that therapists are open to religious/spiritual issues, that clients want to discuss these matters in therapy, and that the use of religious/spiritual interventions for some clients can be an effective adjunct to traditional therapy interventions. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65:131,146, 2009. [source] Nitrous oxide as an adjunct in tumescent liposuctionJOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2005Garrett Bird Summary Background, Nitrous oxide (N2O) has been used as an anesthetic for over 300 years. It is safe, easy to use, and effective. In this article we will document N2O use as an adjunct to tumescent liposuction. The history, mechanism of action, use, and safety in ambulatory surgery of N2O are reviewed. Objective, The authors intend to review the history of both tumescent liposuction and N2O in surgery, discuss the possible adverse reactions, and present guidelines for the use of N2O during tumescent liposuction. Methods, A Medline review of articles, 1966,2004, related to N2O was performed, using the search terms nitrous, oxide, safety, toxicity, mechanism, anesthetic, surgery, risks, and delivery. Articles that were cited by the authors of this subset of original articles were also used when appropriate. Articles were rated and included based on date of publication, level of evidence, and applicability to tumescent liposuction. Results and conclusions, Nitrous oxide is safe, easily administered, inexpensive, and is an effective adjunct to tumescent liposuction. It provides a high level of pain control, and is patient controlled, while not putting the patient at risk of full anesthesia. When used correctly, with proper equipment, it poses little risk to either patients or healthcare workers. [source] Beneficial effects of preoperative intravitreal bevacizumab on trabeculectomy outcomes in neovascular glaucomaACTA OPHTHALMOLOGICA, Issue 1 2010Yoshiaki Saito Abstract. Purpose:, This study aimed to investigate the effects of preoperative intravitreal bevacizumab (IVB) on outcomes in trabeculectomy for neovascular glaucoma (NVG). Methods:, Charts for 52 NVG eyes of 52 consecutive patients who received primary trabeculectomy with mitomycin C (MMC) were reviewed. Postoperative follow-up periods for all patients were , 4 months. Thirty-two consecutive eyes were treated without IVB (control group) and 20 consecutive eyes received IVB (1.25 mg) 10 ± 11 days before trabeculectomy (IVB group). The main outcome measures were postoperative intraocular pressure (IOP) and incidence of postoperative complications. Surgical success was defined as IOP< 21 mmHg with or without medication (qualified or complete success, respectively). Failure was defined as IOP exceeding these criteria, phthisis bulbi, loss of light perception or additional glaucoma surgeries. Kaplan,Meier survival analysis with the log-rank test was performed to compare surgical success rates between the two groups. Results:, Complete and qualified success rates at 6 months were 95% versus 50% and 95% versus 75% in the IVB and control groups, respectively. The IVB group achieved significantly better surgical success rates than the control group (complete success, p < 0.001; qualified success, p = 0.026). Postoperative hyphaema on day 1 or hyphaema with a duration of > 1 week occurred significantly less frequently in the IVB group than in the control group (p = 0.009, p = 0.014, respectively). The incidence of serious complications such as endophthalmitis, phthisis bulbi and a marked decrease in visual acuity did not increase in the IVB group. Conclusions:, This retrospective study showed that preoperative IVB decreased postoperative hyphaema and increased surgical success rates, and thus may be an effective adjunct to trabeculectomy in NVG. [source] | ||||||||||