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Li L, Liang R, Zhou Y. Design and Implementation of Hospital Automatic Nursing Management Information System Based on Computer Information Technology. Comput Math Methods Med 2021; 2021:1824300. [PMID: 34950222 PMCID: PMC8691973 DOI: 10.1155/2021/1824300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022]
Abstract
Clinical nursing work fails to integrate various nursing tasks such as basic care, observation of patients' conditions, medication, treatment, communication, and health guidance to provide continuous and full nursing care for patients. Based on this, this paper uses the Internet of Things (IoT) technology to optimize the infusion process and achieve closed-loop management of medications and improve the efficiency and safety of infusion and medication administration by using a rational and effective outpatient and emergency infusion and medication management system. The system was built by applying wireless network, barcode technology, RFID, infrared tube sensing, and other technologies and was combined with actual nursing work to summarize application techniques and precautions. The application of this system will become a new highlight of medical informatization, improve patient experience, monitor infusion safety, enhance nursing care, reduce emergency medical disputes, improve patient satisfaction, and will create good social and economic benefits for the hospital.
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Affiliation(s)
- Lai Li
- Wuhan Third Hospital, Neurosurgery Department, Wuhan, Hubei 430070, China
- Wuhan Third Hospital, Wound Repair & Rehadilitation Centre, Wuhan, Hubei 430070, China
| | - Rong Liang
- Wuhan Third Hospital, Neurosurgery Department, Wuhan, Hubei 430070, China
- Wuhan Third Hospital, Wound Repair & Rehadilitation Centre, Wuhan, Hubei 430070, China
| | - Yumei Zhou
- Wuhan Third Hospital, Neurosurgery Department, Wuhan, Hubei 430070, China
- Wuhan Third Hospital, Wound Repair & Rehadilitation Centre, Wuhan, Hubei 430070, China
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Sekiziyivu BA, Bancroft E, Rodriguez EM, Sendagala S, Nasirumbi MP, Najjengo MS, Kiragga AN, Musaazi J, Musinguzi J, Sande E, Brad B, Dalal S, Byakika-Jayne T, Kambugu A. Task Shifting for Initiation and Monitoring of Antiretroviral Therapy for HIV-Infected Adults in Uganda: The SHARE Trial. J Acquir Immune Defic Syndr 2021; 86:e71-e79. [PMID: 33230029 PMCID: PMC7879828 DOI: 10.1097/qai.0000000000002567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND With countries moving toward the World Health Organization's "Treat All" recommendation, there is a need to initiate more HIV-infected persons into antiretroviral therapy (ART). In resource-limited settings, task shifting is 1 approach that can address clinician shortages. SETTING Uganda. METHODS We conducted a randomized controlled trial to test if nurse-initiated and monitored ART (NIMART) is noninferior to clinician-initiated and monitored ART in HIV-infected adults in Uganda. Study participants were HIV-infected, ART-naive, and clinically stable adults. The primary outcome was a composite end point of any of the following: all-cause mortality, virological failure, toxicity, and loss to follow-up at 12 months post-ART initiation. RESULTS Over half of the study cohort (1,760) was women (54.9%). The mean age was 35.1 years (SD 9.51). Five hundred thirty-three (31.6%) participants experienced the composite end point. At 12 months post-ART initiation, nurse-initiated and monitored ART was noninferior to clinician-initiated and monitored ART. The intention-to-treat site-adjusted risk differences for the composite end point were -4.1 [97.5% confidence interval (CI): = -9.8 to 0.2] with complete case analysis and -3.4 (97.5% CI: = -9.1 to 2.5) with multiple imputation analysis. Per-protocol site-adjusted risk differences were -3.6 (97.5% CI: = -10.5 to 0.6) for complete case analysis and -3.1 (-8.8 to 2.8) for multiple imputation analysis. This difference was within hypothesized margins (6%) for noninferiority. CONCLUSIONS Nurses were noninferior to clinicians for initiation and monitoring of ART. Task shifting to trained nurses is a viable means to increase access to ART. Future studies should evaluate NIMART for other groups (e.g., children, adolescents, and unstable patients).
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Affiliation(s)
- Brian Arthur Sekiziyivu
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Bancroft
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Evelyn M Rodriguez
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Samuel Sendagala
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | | | - Marjorie Sserunga Najjengo
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes N Kiragga
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Musaazi
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joshua Musinguzi
- AIDS Control Programme, AIDS Control Program, Ministry of Health, Kampala, Uganda
| | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Bartholow Brad
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shona Dalal
- World Health Organization, Geneva, Switzerland ; and
| | - Tusiime Byakika-Jayne
- Department of Public Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Andrew Kambugu
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Abstract
The primary goal of this single-group study was to determine the safety of a standard opioid titration order sheet to manage pain in ambulatory cancer patients. Secondary goals were to examine opioid toxicity and efficacy of this pain protocol. Twenty-seven patients who required fixed-dose opioids and who had uncontrolled pain were enrolled. All patients had their initial opioid dose titrated by the study physician using the opioid titration order sheet. Data were obtained by the study nurse during a weekly telephone interview and used to determine if pain was controlled. After initial titration, a trained study nurse titrated opioid doses based upon the standing order sheet. At each contact, patients were assessed for adverse effects, pain intensity, and analgesics used. Patients who completed the four-week trial (n = 17) did not differ from patients who did not complete the trial. No adverse effects were observed in 39 opioid titrations completed by the study nurse. Opioid toxicities, worst pain, usual pain, and pain-related distress declined from baseline to week four. Patients who were adherent to their prescribed medications reported significantly lower pain intensity and distress (psα .06). The opioid titration order sheet, used by a trained nurse, is safe to use in ambulatory cancer patients who have moderate to severe pain. Common opioid toxicities were reduced. The protocol also demonstrated initial efficacy in improving worst and usual pain and pain-related distress. Further research to establish efficacy of the protocol is recommended.
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Affiliation(s)
- Nancy Wells
- Vanderbilt University Medical Center, Vanderbilt University School of Nursing, Nashville, Tennessee, USA
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Abstract
Thrombolysis remains the most popular means of reperfusion following an acute ST-elevation myocardial infarction in the United Kingdom today. There is a wealth of evidence to support the early provision of thrombolysis care and a number of models of care delivery have been proposed to reduce the time delay from admission to hospital to administration of thrombolytic therapy. The movement of this treatment from the coronary care unit to the emergency department in association with the employment of specialist cardiac nurses has been associated with some time reductions. However the quality of evidence to support the employment of specialist cardiac nurses working outside the coronary care unit is limited. The author provides an overview of the main literature in this area outlining the models of care in operation and argues that there are lessons to be learned for future nursing research.
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Affiliation(s)
- Ian Jones
- School of Nursing, University of Salford, Peel House, Albert Road, Eccles, Manchester, M30 ONN, United Kingdom.
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Driscoll A, Currey J, Tonkin A, Krum H. Nurse-led titration of angiotensin converting enzyme inhibitors, beta-adrenergic blocking agents, and angiotensin receptor blockers for people with heart failure with reduced ejection fraction. Cochrane Database Syst Rev 2015; 2015:CD009889. [PMID: 26689943 PMCID: PMC8407457 DOI: 10.1002/14651858.cd009889.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Heart failure is associated with high mortality and hospital readmissions. Beta-adrenergic blocking agents, angiotensin converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs) can improve survival and reduce hospital readmissions and are recommended as first-line therapy in the treatment of heart failure. Evidence has also shown that there is a dose-dependent relationship of these medications with patient outcomes. Despite this evidence, primary care physicians are reluctant to up-titrate these medications. New strategies aimed at facilitating this up-titration are warranted. Nurse-led titration (NLT) is one such strategy. OBJECTIVES To assess the effects of NLT of beta-adrenergic blocking agents, ACEIs, and ARBs in patients with heart failure with reduced ejection fraction (HFrEF) in terms of safety and patient outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL Issue 11 of 12, 19/12/2014), MEDLINE OVID (1946 to November week 3 2014), and EMBASE Classic and EMBASE OVID (1947 to 2014 week 50). We also searched reference lists of relevant primary studies, systematic reviews, clinical trial registries, and unpublished theses sources. We used no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing NLT of beta-adrenergic blocking agents, ACEIs, and/or ARBs comparing the optimisation of these medications by a nurse to optimisation by another health professional in patients with HFrEF. DATA COLLECTION AND ANALYSIS Two review authors (AD & JC) independently assessed studies for eligibility and risk of bias. We contacted primary authors if we required additional information. We examined quality of evidence using the GRADE rating tool for RCTs. We analysed extracted data by risk ratio (RR) with 95% confidence interval (CI) for dichotomous data to measure effect sizes of intervention group compared with usual-care group. Meta-analyses used the fixed-effect Mantel-Haenszel method. We assessed heterogeneity between studies by Chi(2) and I(2). MAIN RESULTS We included seven studies (1684 participants) in the review. One study enrolled participants from a residential care facility, and the other six studies from primary care and outpatient clinics. All-cause hospital admission data was available in four studies (556 participants). Participants in the NLT group experienced a lower rate of all-cause hospital admissions (RR 0.80, 95% CI 0.72 to 0.88, high-quality evidence) and fewer hospital admissions related to heart failure (RR 0.51, 95% CI 0.36 to 0.72, moderate-quality evidence) compared to the usual-care group. Six studies (902 participants) examined all-cause mortality. All-cause mortality was also lower in the NLT group (RR 0.66, 95% CI 0.48 to 0.92, moderate-quality evidence) compared to usual care. Approximately 27 deaths could be avoided for every 1000 people receiving NLT of beta-adrenergic blocking agents, ACEIs, and ARBs. Only three studies (370 participants) reported outcomes on all-cause and heart failure-related event-free survival. Participants in the NLT group were more likely to remain event free compared to participants in the usual-care group (RR 0.60, 95% CI 0.46 to 0.77, moderate-quality evidence). Five studies (966 participants) reported on the number of participants reaching target dose of beta-adrenergic blocking agents. This was also higher in the NLT group compared to usual care (RR 1.99, 95% CI 1.61 to 2.47, low-quality evidence). However, there was a substantial degree of heterogeneity in this pooled analysis. We rated the risk of bias in these studies as high mainly due to a lack of clarity regarding incomplete outcome data, lack of reporting on adverse events associated with the intervention, and the inability to blind participants and personnel. Participants in the NLT group reached maximal dose of beta-adrenergic blocking agents in half the time compared with participants in usual care. Two studies reported on adverse events; one of these studies stated there were no adverse events, and the other study found one adverse event but did not specify the type or severity of the adverse event. AUTHORS' CONCLUSIONS Participants in the NLT group experienced fewer hospital admissions for any cause and an increase in survival and number of participants reaching target dose within a shorter time period. However, the quality of evidence regarding the proportion of participants reaching target dose was low and should be interpreted with caution. We found high-quality evidence supporting NLT as one strategy that may improve the optimisation of beta-adrenergic blocking agents resulting in a reduction in hospital admissions. Despite evidence of a dose-dependent relationship of beta-adrenergic blocking agents, ACEIs, and ARBs with improving outcomes in patients with HFrEF, the translation of this evidence into clinical practice is poor. NLT is one strategy that facilitates the implementation of this evidence into practice.
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Affiliation(s)
- Andrea Driscoll
- Deakin UniversitySchool of Nursing and MidwiferyGeelongAustralia
| | - Judy Currey
- Deakin UniversitySchool of Nursing and MidwiferyGeelongAustralia
| | - Andrew Tonkin
- Monash UniversityDepartment of Epidemiology and Preventive Medicine99 Commercial RoadMelbourneVictoriaAustralia3004
| | - Henry Krum
- Monash University/The Alfred HospitalDepartment of Epidemiology & Preventive MedicineCentral & Eastern Clinical School, The AlfredCommercial RoadMelbourneVictoriaAustralia3004
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Prakash V, Koczmara C, Savage P, Trip K, Stewart J, McCurdie T, Cafazzo JA, Trbovich P. Mitigating errors caused by interruptions during medication verification and administration: interventions in a simulated ambulatory chemotherapy setting. BMJ Qual Saf 2014; 23:884-92. [PMID: 24906806 PMCID: PMC4215375 DOI: 10.1136/bmjqs-2013-002484] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Nurses are frequently interrupted during medication verification and administration; however, few interventions exist to mitigate resulting errors, and the impact of these interventions on medication safety is poorly understood. OBJECTIVE The study objectives were to (A) assess the effects of interruptions on medication verification and administration errors, and (B) design and test the effectiveness of targeted interventions at reducing these errors. METHODS The study focused on medication verification and administration in an ambulatory chemotherapy setting. A simulation laboratory experiment was conducted to determine interruption-related error rates during specific medication verification and administration tasks. Interventions to reduce these errors were developed through a participatory design process, and their error reduction effectiveness was assessed through a postintervention experiment. RESULTS Significantly more nurses committed medication errors when interrupted than when uninterrupted. With use of interventions when interrupted, significantly fewer nurses made errors in verifying medication volumes contained in syringes (16/18; 89% preintervention error rate vs 11/19; 58% postintervention error rate; p=0.038; Fisher's exact test) and programmed in ambulatory pumps (17/18; 94% preintervention vs 11/19; 58% postintervention; p=0.012). The rate of error commission significantly decreased with use of interventions when interrupted during intravenous push (16/18; 89% preintervention vs 6/19; 32% postintervention; p=0.017) and pump programming (7/18; 39% preintervention vs 1/19; 5% postintervention; p=0.017). No statistically significant differences were observed for other medication verification tasks. CONCLUSIONS Interruptions can lead to medication verification and administration errors. Interventions were highly effective at reducing unanticipated errors of commission in medication administration tasks, but showed mixed effectiveness at reducing predictable errors of detection in medication verification tasks. These findings can be generalised and adapted to mitigate interruption-related errors in other settings where medication verification and administration are required.
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Affiliation(s)
- Varuna Prakash
- Faculty of Medicine, Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Christine Koczmara
- Institute for Safe Medication Practices Canada, Toronto, Ontario, Canada
| | - Pamela Savage
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Katherine Trip
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Janice Stewart
- Odette Cancer Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tara McCurdie
- Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Joseph A Cafazzo
- Faculty of Medicine, Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Patricia Trbovich
- Faculty of Medicine, Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- HumanEra, Techna Institute, University Health Network, Toronto, Ontario, Canada
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Henk JL. Failure to rescue: an evidence based glimpse. Nebr Nurse 2013; 46:9-10. [PMID: 24383232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Held-Warmkessel J. A patient with tumor lysis syndrome. Oncology (Williston Park) 2012; 26:16-21. [PMID: 25375006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
When caring for a patient with TLS, astute nursing care is required for positive patient outcomes. Assessments and monitoring are required for prompt management of complications and patient safety. Because of the skilled nursing care that Mr. B received, along with supportive medications and hydration, his renal function improved, with increased urine output, normalization of electrolytes, and return of his appetite.
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Levine MA, Shao W, Klein D. Monitoring of international normalized ratios: comparison of community nurses with family physicians. Can Fam Physician 2012; 58:e465-e471. [PMID: 22893349 PMCID: PMC3419004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine whether community-based, nurse-led monitoring of the international normalized ratio (INR) in patients requiring long-term warfarin therapy was comparable to traditional physician monitoring. DESIGN A retrospective cohort analysis of patients taking long-term warfarin therapy. SETTING The study used data gathered from 3 family medicine clinics in a primary care network in Edmonton, Alta. PARTICIPANTS Medical records of patients currently taking warfarin were examined. INTERVENTION Implementation of nurse-led monitoring in a primary care network in place of standard family physician INR monitoring. MAIN OUTCOME MEASURES The degree of INR control before and after the implementation of nurse-run INR monitoring was assessed. The average proportion of time spent outside of therapeutic INR ranges, as well as the average number of days between successive INR readings, was calculated and compared. The degree of control placed patients into either a good-control group (out of range ≤ 25% of the time) or a moderate-control group (out of range > 25% of the time) and these groups were compared. RESULTS Before nurse monitoring, INR values were out of range 20.4% of the time; after nurse monitoring they were out of range 19.2% of the time (P = .115); the time between sequential INR readings also did not differ before and after implementation of nurse monitoring (23.9 vs 21.6 days, P = .789). CONCLUSION Nurse-led monitoring of INR is as effective as traditional physician monitoring. Advantages of nurse-led monitoring might include freeing family physicians to see more patients or to spend less time at work. It might also represent potential cost savings.
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Abstract
The European Best Practice Guidelines recommend that 85% of patients with standard causes of chronic renal failure should achieve a target haemoglobin concentration of > or = 11 g/dL. However, patient outcomes need to be improved as many patients respond suboptimally to treatment and fail to reach these targets. Two multinational surveys of nursing practice in the management of renal anaemia in northern (with comparative data from Australia) and southern Europe were conducted. The aim was to assess variations in the role and amount of responsibility delegated to nurses in renal units throughout Europe and Australia. Patient care could be optimised by developing formal training and educational programmes for nephrology nurses and this has already occurred in many units in the UK.
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Affiliation(s)
- L Bennett
- Oxford Kidney Unit, The Churchill Hospital, Headington, Oxford, UK.
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Eisenberg S. The case of the overlooked osteoclasts. ONS Connect 2011; 26:21. [PMID: 22167997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Casey G. Pharmacodynamics: how drugs act on the body. Nurs N Z 2011; 17:24-29. [PMID: 22165772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Affiliation(s)
- Amanda Tarrington
- Birmingham City University/Heart England Foundation Trust, Birmingham
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Renaud A, Le Goudevèze S, Masson Y, Morell E. [Postoperative analgesia by continuous surgical wound infiltration]. Rev Infirm 2010:32-34. [PMID: 21197773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Aurélie Renaud
- Service de chirurgie viscérale et vasculaire, Hôpital d'instruction des armées Bégin, Saint-Mandé.
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Bombail M, Despiau F, Dalavat M. [Value of a thesaurus of nursing best practices in chemotherapy]. Rev Infirm 2010:38-40. [PMID: 21197775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Cranwell-Bruce LA. Drugs for Parkinson's disease. Medsurg Nurs 2010; 19:347-350. [PMID: 21337993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Lisa A Cranwell-Bruce
- Byrdine F. Lewis School of Nursing, College of Health and Human Sciences, Georgia State University, Atlanta, GA, USA
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Lange VZ. Successful management of in-hospital hyperglycemia: the pivotal role of nurses in facilitating effective insulin use. Medsurg Nurs 2010; 19:323-328. [PMID: 21337988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Clinical studies have shown glycemic control improves outcomes for the hospitalized patient with hyperglycemia or diabetes, and insulin use can achieve normoglycemia. The use of nurse-driven protocols for initiating and titrating insulin to improve patient outcomes significantly is described
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Flamant C, Denizot S, Caillaux G, Frondas A, Migraine A, Rozé JC. [Analgesia and sedation in premature newborns]. Soins Pediatr Pueric 2010:24-25. [PMID: 20925302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Analgesics and sedatives are routinely prescribed in intensive care on intubated premature newborns, to ensure their comfort and limit pain. The results of two studies show that there is no significant link between prolonged exposure to these treatments and a more unfavourable long-term neurological outcome.
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Fournier A, Laflamme F. [Pediatric psychiatry: children and antipsychotic drugs: clinical monitoring by the nurse assures a safe course in children taking antipsychotic drugs]. Perspect Infirm 2010; 7:19-21. [PMID: 21744626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Sanne I, Orrell C, Fox M, Conradie F, Ive P, Zeinecker J, Cornell M, Heiberg C, Ingram C, Panchia R, Rassool M, Gonin R, Stevens W, Truter H, Dehlinger M, van der Horst C, McIntyre J, Wood R. Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial. Lancet 2010; 376:33-40. [PMID: 20557927 PMCID: PMC3145152 DOI: 10.1016/s0140-6736(10)60894-x] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Expanded access to combination antiretroviral therapy (ART) in resource-poor settings is dependent on task shifting from doctors to other health-care providers. We compared outcomes of nurse versus doctor management of ART care for HIV-infected patients. METHODS This randomised non-inferiority trial was undertaken at two South African primary-care clinics. HIV-positive individuals with a CD4 cell count of less than 350 cells per microL or WHO stage 3 or 4 disease were randomly assigned to nurse-monitored or doctor-monitored ART care. Patients were randomly assigned by stratified permuted block randomisation, and neither the patients nor those analysing the data were masked to assignment. The primary objective was a composite endpoint of treatment-limiting events, incorporating mortality, viral failure, treatment-limiting toxic effects, and adherence to visit schedule. Analysis was by intention to treat. Non-inferiority of the nurse versus doctor group for cumulative treatment failure was prespecified as an upper 95% CI for the hazard ratio that was less than 1.40. This study is registered with ClinicalTrials.gov, number NCT00255840. FINDINGS 408 patients were assigned to doctor-monitored ART care and 404 to nurse-monitored ART care; all participants were analysed. 371 (46%) patients reached an endpoint of treatment failure: 192 (48%) in the nurse group and 179 (44%) in the doctor group. The hazard ratio for composite failure was 1.09 (95% CI 0.89-1.33), which was within the limits for non-inferiority. After a median follow-up of 120 weeks (IQR 60-144), deaths (ten vs 11), virological failures (44 vs 39), toxicity failures (68 vs 66), and programme losses (70 vs 63) were similar in nurse and doctor groups, respectively. INTERPRETATION Nurse-monitored ART is non-inferior to doctor-monitored therapy. Findings from this study lend support to task shifting to appropriately trained nurses for monitoring of ART. FUNDING National Institutes of Health; United States Agency for International Development; National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Ian Sanne
- Faculty of Health Sciences, University of the Witwatersrand
| | | | - Matthew Fox
- Center for Global Health and Development, Boston University
| | | | - Prudence Ive
- Faculty of Health Sciences, University of the Witwatersrand
| | | | | | | | | | | | | | | | - Wendy Stevens
- Faculty of Health Sciences, University of the Witwatersrand
| | - Handré Truter
- Faculty of Health Sciences, University of the Witwatersrand
| | | | | | - James McIntyre
- Faculty of Health Sciences, University of the Witwatersrand
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Taéron C. [Duloxetine]. Rev Infirm 2010:41-43. [PMID: 20701239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Ouellet J. [Anti-emetic and anti-anxiety agents]. Perspect Infirm 2010; 7:47-48. [PMID: 20653315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Bennetts PS, Pierce JD. Apoptosis: understanding programmed cell death for the CRNA. AANA J 2010; 78:237-245. [PMID: 20572411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Apoptosis, or programmed cell death, is a physiologic mechanism employed by most multicellular organisms to maintain homeostasis of body tissues. In balance with the production of new cells by mitosis, apoptosis provides for the orderly destruction and removal of cells that are no longer needed by the organism. Apoptosis occurs by complex pathways involving multiple biochemical signals and processes. Dysfunctional apoptotic mechanisms are the pathologic basis for many human diseases, including common disorders of the heart, lungs, brain, and endocrine systems. Researchers have demonstrated in animal models that neurodegenerative changes after the administration of anesthetic drugs are related to apoptosis. Anesthesia drugs have been found to induce apoptosis, perhaps through the production of reactive oxygen species. Propofol is a drug used in anesthesia that has unique antioxidant qualities that may be beneficial. The purpose of this article is to review, for nurse anesthesia providers, current information about the process of apoptosis, the role of apoptosis in comorbid diseases, and the implications of the effects of anesthesia drugs on normal apoptotic mechanisms that need to be evaluated as potential sources of risk or benefit to surgical patients.
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Affiliation(s)
- Paul S Bennetts
- Department of Nurse Anesthesia Education, University of Kansas, Kansas City, USA.
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25
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Taéron C. [Frovatriptan. For treatment of acute migraine]. Rev Infirm 2010:47-49. [PMID: 20198950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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26
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Ward-Smith P. Individual variations in drug responses. Urol Nurs 2010; 30:22-27. [PMID: 20359142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This article provides an overview of the modifiable and non-modifiable variables that influence drug responses. Knowledge of these issues need to be known by nurses to assure adequate medication is prescribed and treatment adherence occurs.
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Thomas M, Dhanani S, Irwin D, Writer H, Doherty D. Development, dissemination and implementation of a sedation and analgesic guideline in a pediatric intensive care unit...it takes creativity and collaboration. Dynamics 2010; 21:16-25. [PMID: 21226410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Sedation and analgesia are administered to critically ill children to provide comfort and pain relief, decrease anxiety and to promote patient safety in relation to life-saving treatments. A comprehensive practice guideline focused on ways to implement evidence-based sedation and analgesia practices was developed, disseminated and implemented by an interprofessional team in the pediatric intensive care unit (PICU) at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada. The goals of this quality of care initiative were to (1) reduce inconsistent practices, (2) improve patient outcomes related to comfort, and (3) enhance collaboration among health care team members caring for critically ill children. An evidence-based sedation and analgesia management (SAM) guideline for critically ill, intubated and ventilated infants and children was developed over a six-month period by a team composed of PICU physicians, pharmacists and nurses. The quality of patient care initiative focused on consistent use of (a) validated sedation and analgesia assessment tools, (b) a goal-directed approach by identifying daily therapeutic target scores and titrating interventions accordingly, and (c) non-pharmacologic, pharmacologic and adjunctive measures. The authors describe their experience in the development, dissemination and implementation of an interprofessional guideline directed at improving sedation and analgesia and patient safety in the PICU. Tools developed to support the practice change, challenges and lessons learned are shared.
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Affiliation(s)
- Margot Thomas
- Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, Ottawa.
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28
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Goarnisson C, Mekki FH. [The nurse's role in managing the multiple sclerosis patient]. Soins 2009:42-44. [PMID: 20014533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Clare Goarnisson
- Centre Mutualiste de Rééducation et de Réadaptation Fonctionnelle de Kerpape, Ploemeur
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29
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Gómez ICA, Núñez FC, Rodríguez NG, Arrabal JJG, Manzano AT, Moreno MRO, Rivas AMM, Picón JS. [Decentralizing review sessions for patients who have undergone an oral anticoagulant treatment]. Rev Enferm 2009; 32:8-14. [PMID: 20069953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Therapeutic use of oral anticoagulants began some fifty years ago. In the past decade, we have witnessed a large increase in the number of people who undergo oral anticoagulant treatment. A correct applied control on these patients, whether that control be carried out in a hospital setting or in a primary health care center, has been demonstrated to be effective in preventing serious complications; this fact taken into account with the improved life quality gained by avoiding displacements and inconveniences makes it obvious to conclude that decentralization benefits all concerned. There are various models available to use to manage oral anticoagulant treatment. In this analysis, the authors deal with the management carried out from a primary health care center which contacts patients after their dosis has been adjusted and validated by a hematologist at the Torrecárdenas Hospital Complex. As their hypothesis, the authors of this study plan to demonstrate the possibility of decentralizing the reviews of patients undergoing oral anticoagulant treatment, thereby avoiding trips in order to control and adjust their treatment. This is a non-random clinical study whose study group has been chosen by means of a non-probability criteria. This study lasted 12 months. The subjects were chosen from patients undergoing oral anticoagulant treatment registered in the hematology service's data base at the Torrecárdenas Hospital Complex in Almeria. Applied protocol for being included in this study was decentralization of coagulation. The study sample included 38,097 patients. This study included commentaries by the patients receiving this treatment as a fundamental element to prove its effectiveness.
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Abstract
In this article, you'll learn about 10 new drugs, including: * nebivolol HCl, the newest beta-adrenergic blocking agent for hypertension * methylnaltrexone bromide, a subcutaneous injection for opioid-induced constipation * alvimopan, a selective mu-opioid receptor antagonist to combat postoperative ileus.Unless otherwise specified, the information in the following summaries applies to adults, not children. Consult the product insert for information about each drug's safety during pregnancy and breast-feeding. Also consult a pharmacist, the product insert, or a comprehensive drug reference for more details on precautions, drug interactions, and adverse reactions for all these drugs.
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Affiliation(s)
- Daniel A Hussar
- Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, PA, USA
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31
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Abstract
In this article, you'll learn about six new drugs, including: * clevidipine, an I.V. antihypertensive for use when oral medication isn't feasible * romiplostim and eltrombopag olamine, new agents for chronic immune thrombocytopenic purpura * C1 inhibitor (human) for hereditary angioedema. Unless otherwise specified, the information in the following summaries applies to adults, not children. Consult the package insert for information about each drug's safety during pregnancy and breast-feeding. Also consult a pharmacist, the package insert, or a comprehensive drug reference for more details on precautions, drug interactions, and adverse reactions for all these drugs.
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Affiliation(s)
- Daniel A Hussar
- Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, PA, USA
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32
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Chevillotte J. [Postoperative use of injectable morphine]. Rev Infirm 2009:35-37. [PMID: 19702024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
MESH Headings
- Analgesia, Patient-Controlled/methods
- Analgesia, Patient-Controlled/nursing
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Drug Administration Schedule
- Drug Monitoring/methods
- Drug Monitoring/nursing
- Humans
- Infusions, Intravenous
- Infusions, Subcutaneous
- Injections, Intravenous
- Morphine/administration & dosage
- Morphine/adverse effects
- Pain Measurement
- Pain, Postoperative/diagnosis
- Pain, Postoperative/drug therapy
- Pain, Postoperative/nursing
- Postoperative Care/methods
- Postoperative Care/nursing
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33
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Taéron C. [Ribavirin]. Rev Infirm 2009:47-49. [PMID: 19702029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
Hepatitis C is a common cause of liver disease and many infected individuals remain undiagnosed. Patients may be asymptomatic or have non-specific symptoms, and community nurses can help to identify those at risk and arrange testing. Community nurses can also encourage and support infected individuals to attend specialist hospital clinics for assessment and treatment by giving clear and accurate information about infection and therapy, including common side-effects. Treatment lasts for 6-12 months and patients require regular monitoring with good support. This paper provides an overview of the diagnosis and management of hepatitis C and aims to educate community nurses about this viral infection.
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Affiliation(s)
- Ray Poll
- Sheffield Teaching Hospitals Foundation Trust.
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Abstract
The neonatal population is at extremely high risk for developing infections. Because of the premature infant's prolonged length of stay, these patients may receive several courses of antibiotics while hospitalized. Although the number of antibiotics used in this population is limited, the dosing regimens must be carefully prescribed and adjusted to account for changing pharmacokinetic parameters. In addition, the development of antimicrobial resistance should always be a concern. The neonatal nurse can help ensure antimicrobial regimens are given appropriately and monitor these regimens for efficacy and toxicity.
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Affiliation(s)
- Christine Domonoske
- Department of Pharmacy Services, Children's Memorial Hermann Hospital, Memorial Hermann Texas Medical Center, 6411 Fannin Street, Houston, TX 77030, USA.
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36
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Melis Tormos E. [Oral anticoagulant treatment]. Rev Enferm 2009; 32:48-54. [PMID: 19552155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Oral anticoagulant treatment is a preventive measure against thromboembolic disease; while this measure has very beneficial aspects, it is not exempt from risks since it has a few peculiar characteristics such as possible hemorrhages. The increasing number of patients who require anticoagulant medicine means that nurses may have to treat these patients in any forum where nurses work and therefore nurses need to know the traits this treatment measure entails. This article reviews the general characteristics of anticoagulant treatment and nurses' role in controlling this treatment.
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37
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Chevillotte J, Clavagnier I. [How to administer a medical prescription and prevent errors]. Rev Infirm 2009:35-36. [PMID: 19537152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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38
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Kurdi O. [The paravertebral block for postoperative pain in thoracic surgery]. Soins 2009:28-30. [PMID: 19475822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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39
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Becze E. Nursing considerations for capecitabine-based combination therapy. ONS Connect 2009; 24:14-15. [PMID: 19413236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Affiliation(s)
- Sue Jordan
- School of Health Science, Swansea University, Swansea, UK
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41
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Carson M. Assessment and management of patients with hypothyroidism. Nurs Stand 2009; 23:48-58. [PMID: 19186633 DOI: 10.7748/ns2009.01.23.18.48.c6741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article explains how to assess, diagnose and treat patients with an underactive thyroid gland (hypothyroidism), including an outline of replacement therapy options. The need for regular monitoring and ongoing support is also highlighted.
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42
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Hallquist D. Preventing contrast-associated nephropathy. Medsurg Nurs 2009; 18:64-66. [PMID: 19331305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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43
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Jayasinghe J. Non-adherence in the hypertensive patient: can nursing play a role in assessing and improving compliance? Can J Cardiovasc Nurs 2009; 19:7-12. [PMID: 19226885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
According to the Canadian Hypertension Society (Canadian Hypertension Education Program, 2008), hypertension remains a significant health problem that is projected to become a greater global burden in the next 20 years. Internationally, the estimated total number of adults with hypertension in 2000 was 972 million; 333 million in economically developed countries. Current trends suggest that the number of adults with hypertension will increase by about 60% to a total of 1.56 billion by 2025. Despite the availability of effective treatment, more than half of patients treated for hypertension drop out of care entirely within a year of diagnosis. Fifty per cent of patients who remain under medical supervision take only 80% of their prescribed medications. As a result, 75% of patients with a diagnosis of hypertension do not achieve optimum blood pressure control due to poor adherence to anti-hypertensive treatment. Nurses represent a formidable force in improving adherence and care outcomes by understanding the dynamics of compliance, and employing techniques in assessing and monitoring the problems of nonadherence. Nurses are well positioned to effectively use sustained strategies to improve adherence, thereby decreasing the global burden of hypertension. Using a case study approach, this author explores the dynamics of adherence and reviews techniques for assessing, monitoring, and improving compliance in hypertension therapy.
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Affiliation(s)
- Jackie Jayasinghe
- Hypertension Clinic, Capital District Health Authority, 4129 Dickson Building, 5820 University Ave., Halifax, NS B3H 1V8.
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44
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Buonocore D. Treatment of hyperglycemia. Crit Care Nurse 2008; 28:72-73. [PMID: 19047697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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45
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Abstract
Outpatient parenteral antimicrobial therapy (OPAT) is becoming more widespread. OPAT therapy can be used to treat certain patients who have cellulitis. The decision as to which patients to treat at home must be based on local PCT guidelines--not all patients are suitable for OPAT. OPAT improves patient quality of life by delivering care in the patient's home. This is highly skilled work and the community nurse must have appropriate training and support in order to gain the skills required.
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46
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Hinnen D. Insulin analog initiation and titration. J Am Acad Nurse Pract 2008; 20 Suppl 1:12-16. [PMID: 19402255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Debbie Hinnen
- Mid-America Diabetes Associates, Wichita, Kansas, USA
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47
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Breiterman-White R, Reznicek J. Laboratory trend analyses and proactive adjustments to minimize the need for holding epoetin alfa doses. Nephrol Nurs J 2008; 35:577-600. [PMID: 19260609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Holding doses of epoetin alfa (Epogen) alters the balance between red blood cell production and death rates, and leads to a decrease in hemoglobin (Hb) levels. Although clinical circumstances sometimes require that epoetin alfa doses be held, this can be minimized by monitoring longitudinal trends, predicting the probable future course of Hb, and intervening to proactively adjust epoetin alfa doses before holding is required.
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48
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Abstract
This article outlines a range of interventions that mental health nurses can use in the management of patients with hyperprolactinaemia induced by antipsychotic medication. The article is aimed primarily at mental health nurse prescribers, but is relevant to all mental health nurses to inform their care of people at risk of developing an elevated prolactin level.
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Affiliation(s)
- Adrian Jones
- Adult Mental Health, Wrexham Maelor Hospital, North East Wales NHS Trust, Wrexham.
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49
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Rejchapel-Messai J. [Management of cardiovascular diseases by the nurse]. Soins 2008:14. [PMID: 18998423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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50
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Albert NM. Improving medication adherence in chronic cardiovascular disease. Crit Care Nurse 2008; 28:54-65. [PMID: 18827087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Nancy M Albert
- Nursing Research and Innovation, Nursing Institute, Cleveland, Ohio 44195, USA.
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