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Prevention Treatment (prevention + treatment)
Selected AbstractsBehavioral intervention to promote smoking cessation and prevent weight gain: a systematic review and meta-analysisADDICTION, Issue 9 2009Bonnie Spring ABSTRACT Aims The prospect of weight gain discourages many cigarette smokers from quitting. Practice guidelines offer varied advice about managing weight gain after quitting smoking, but no systematic review and meta-analysis have been available. We reviewed evidence to determine whether behavioral weight control intervention compromises smoking cessation attempts, and if it offers an effective way to reduce post-cessation weight gain. Methods We identified randomized controlled trials (RCTs) that compared combined smoking treatment and behavioral weight control to smoking treatment alone for adult smokers. English-language studies were identified through searches of PubMed, Ovid MEDLINE, CINAHL, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials. Of 779 articles identified and 35 potentially relevant RCTs screened, 10 met the criteria and were included in the meta-analysis. Results Patients who received both smoking treatment and weight treatment showed increased abstinence [odds ratio (OR) = 1.29, 95% confidence interval (CI) = 1.01, 1.64] and reduced weight gain (g = ,0.30, 95% CI = ,0.57, ,0.02) in the short term (<3 months) compared with patients who received smoking treatment alone. Differences in abstinence (OR = 1.23, 95% CI = 0.85, 1.79) and weight control (g = ,0.17, 95% CI = ,0.42, 0.07) were no longer significant in the long term (>6 months). Conclusions Findings provide no evidence that combining smoking treatment and behavioral weight control produces any harm and significant evidence of short-term benefit for both abstinence and weight control. However, the absence of long-term enhancement of either smoking cessation or weight control by the time-limited interventions studied to date provides insufficient basis to recommend societal expenditures on weight gain prevention treatment for patients who are quitting smoking. [source] DXA scanning in women over 50 years with distal forearm fracture shows osteoporosis is infrequent until age 65 yearsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2008H. Lashin Summary Aims:, Women with distal forearm fracture (DFF) may have low bone mineral density (BMD) and merit Dual Energy Xray (DXA) scanning. However patient age at fracture and the database for ,healthy' subjects may influence how many have osteoporosis and require DXA scans. Osteoporosis prevalence in DFF patients by age was investigated using local or nHanes III databases for BMD. Methods:, A total of 186 women over 50 years consecutively referred with DFF over 1 year were audited without exclusion criteria. BMD of L2,4 and femoral neck (Hologic QDR4500A) was measured and T - and Z -scores calculated from a local database or nHanes III. Results:, Of 90 patients aged 50,64 years, 21.1% had femoral neck T -score < ,2.5 and 7.7% < ,3.0 (local) and 8.8% and 4.4% respectively (nHanes III). Patients aged 65,74 years (n = 61) included 19.7% with T -score < ,2.5 (nHanes III = 10%). 41.2% (nHanes III = 28.6%) of patients > 75 years had femoral neck osteoporosis. Including patients with spine T < ,2.5 increased the proportion to 31.1% (50,64 years) and 34.4% (65,74 years) with no extra over 75 years. Weight predicted low BMD ineffectively (area under ROC = 70%). Conclusion:, Osteoporosis is infrequent in women with DFF below 65 years. As fracture prevention treatment yields significant fracture reduction only in patients with T -score < ,2.5, DXA scanning below 65 years is not justified. After 65 years scanning is justified at all ages, as even in the elderly patients osteoporosis is present in < 50% of patients with DFF. Using nHanes III limits the number of DFF patients warranting treatment. Low body weight is unreliable for identifying osteoporosis. [source] Effects of low-dose warfarin and aspirin versus no treatment on stroke in a medium-risk patient population with atrial fibrillationJOURNAL OF INTERNAL MEDICINE, Issue 1 2003N. Edvardsson Abstract. Edvardsson N, Juul-Möller S, Ömblus R, Pehrsson K (Sahlgrenska University Hospital, Malmö University Hospital, Bristol-Myers Squibb Bromma; and Karolinska University Hospital; Stockholm, Sweden). Effects of low-dose warfarin and aspirin versus no treatment on stroke in a medium-risk patient population with atrial fibrillation. J Intern Med 2003; 254: 95,101. Objectives. To assess the optimal stroke prevention treatment for patients with atrial fibrillation (AF) and a low,medium risk (,4%) of stroke. Design. A total of 668 patients with persistent or permanent AF, without an indication for full dose and with adequate rate control on sotalol, were randomized to warfarin 1.25 mg + aspirin 75 mg daily (W/A, 334 patients) or no anticoagulation (C, 334 patients). The mean follow-up period was 33 months. The protocol intended to verify a 37% relative risk reduction provided a 4% stroke incidence in the C group. Results. The stroke incidence was less in the W/A group, although the reduction was not statistically significant (W/A 9.6% versus C 12.3%). Four haemorrhagic strokes were identified, two in each group. Secondary end-points were transient ischaemic attacks (TIA) (W/A 3.3% versus C 4.5%), all cause mortality (W/A 9.3% versus C 10.8%), cardiovascular morbidity (W/A 17.7% versus C 22.2%) and the combination of stroke + TIA (W/A 11.7% versus C 16.5%). Bleedings were documented in 19 versus four patients (W/A 5.7% versus C 1.2%) (P = 0.003), although none fatal. Sinus rhythm (SR) was recorded occasionally in 68 patients (W/A 9.6% versus C 10.8%). The stroke incidence tended to be higher in those with SR than without, 16.2% versus 10.4%. Conclusions. Our results were inconclusive, but consistent with a small beneficial effect of W/A for reduction of stroke and major vascular events in AF patients at moderate risk. The low-dose regiment produced, however, a significantly increased risk of bleedings. Documented SR occasionally recorded may represent a subpopulation that warrants full dose warfarin. [source] Mental health practitioner's attitude towards maintenance neuroleptic treatment for people with schizophreniaJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2007N. HARRIS phd bsc(hons) rmn rgn Pharmacological relapse prevention treatment for people with schizophrenia can last for years if not the person's lifetime. The attitude mental health practitioners (MHPs) hold regarding this treatment can have profound effects on service users' decisions related to treatment. The small number of studies focusing on this issue concentrates on the use of ,depot' preparations. To develop a validated inventory to assess the attitudes of MHPs towards treatment and evaluate the attitudes of a sample of MHPs. The inventory was developed in three stages; item selection, piloting and psychometric testing. The validated inventory was administered to a sample of 50 MHPs undertaking a degree level course in the psycho-social management of psychosis. The final inventory consisted of 21 attitudinal items and four items related to the practitioner's confidence. Results from the sample revealed areas of agreement, variation and uncertainty. A valid and reliable inventory has been developed. The administration of the inventory to 50 MHPs returned results which reflect variable attitudes and perceptions of competency towards maintenance neuroleptic treatment. This diversity in attitudes may have an impact on management of people with a diagnosis of schizophrenia and clinical outcomes. [source] Consent and long-term neuroleptic treatmentJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2002N. R. Harris phd bsc(hons) rmn The involvement of clients in the process of developing their care and treatment package is well established. If a genuine collaboration in treatment is achieved one of the fundamental bases of this process lies with ,informed consent'. Neuroleptic medication forms the basis of relapse prevention treatment for people suffering from schizophrenia with non-adherence to treatment seen as the largest cause of relapse. This paper reviews the complex and difficult issues in obtaining informed consent for this client group from within the context of the nurse's role and the problems that arise as a consequence of the blurring of professional boundaries. Throughout the paper reference is made to the expectations made by the UKCC, which provides clarification of nurses' practice in this area. [source] | ||||||||||