Assessment of cancer-related fatigue must take into account both the physical symptoms and psychological distress. Interventions for cancer-related fatigue must emphasise the importance of psychological distress associated with this problematic side effect. Priority should be given to nausea/vomiting when managing cancer-related fatigue. Future research ought to focus on symptom clusters.
Fatigue is one of the most common problems experienced by patients with cancer, regardless of diagnostic site or treatment modality. Differing from fatigue experienced by the general population, fatigue in cancer is not relieved with rest. It is pervasive and can have a profound effect on quality of life. Generally, patients with cancer develop their own approaches to deal with this challenge, but may not always initiate the most effective strategies.
Nurse-led central venous catheter (CVC) placement is a safe alternative to medical led CVC placement. Nurse-led CVC services can potentially improve organisational efficiency and patient safety. Training, education and adequate procedural volumes are all necessary to ensure optimal outcomes. Larger international studies are required to identify the impact of nurse-led CVC services.
For many years, CVC insertion was the doctor's domain. However, CVC insertion by nurses began to evolve in the late 1990s. This role has continued to develop with the number of nurse-led vascular access services steadily increasing. The measurement of the effectiveness of nurse-led clinics should be an integral part of the service and should encompass the areas of audit, evaluation and research. To date, research in this area is sparse.
Research indicates that there is an inverse relationship between a healthcare professional's experience and their rate of complications as demonstrated in...]]>
Patients with mental illness are vulnerable to weight gain and metabolic risk induced by antipsychotic medication, therefore, proactive monitoring and management are critical in improving outcomes. Suboptimal metabolic monitoring even after the introduction of monitoring guidelines suggests the need for matching guidelines with appropriate training and quality assurance programmes. There is a need to bridge the research gap through investigating the optimal methods of detecting, preventing and treating metabolic risk in mentally-ill patients; the implementation of effective monitoring methods is crucial. An integrated evidence-based approach linking physical and mental health aspects using a shared care model with general and specialist services would need to be developed to suit the local heath service delivery system.
Previous research suggests that metabolic risks are increased in patients receiving antipsychotic medication and that there is appreciable yield from routine testing.
A focus on improving children's self-regulatory skills can be an effective component of interventions aimed at reducing obesity. Future research should consider additional attitudinal and motivational pathways through which high-risk children can improve eating and activity patterns that protect against obesity.
Approximately 17% of US children are classified as obese, with low-income children showing higher rates of obesity than middle income children.
Practitioners should inform parents of higher sudden infant death syndrome risk because of bed sharing, especially for smokers and very young infants. Parents should be encouraged to share a room with an infant, not a bed. Additional case control studies are needed on all aspects of bed sharing. Future research should explore parental decision making for sleep location and position.
Sudden infant death syndrome (SIDS) remains the leading cause of infant mortality in USA and most developed countries. After studies in the late 1980s and early 1990s which identified the prone sleep position as a main risk for SIDS, campaigns to promote back sleeping were initiated, and the number of SIDS declined significantly.
A comprehensive systems approach in primary care (using supportive interdisciplinary collaboration linked to domestic violence (DV) services) could increase identification and referral of women for DV support. DV training for primary care nurses should include building clinician/advocate partnerships. Nursing intervention research on DV for primary care should include examination of outcomes for women referred to DV services.
Between 15–71% of women are thought to experience lifetime DV with highest rates among women living in disadvantaged communities.
Warming local anaesthetic solution to body temperature reduces pain from infiltration. In places where local anaesthetic is frequently used, for example in accident and emergency, warming local anaesthetic before infiltrating it is a simple and inexpensive way to reduce further pain in patients, using readily available equipment. Future research should investigate the combined effect of warming and buffering the local anaesthetic solutions on the pain of its infiltration.
Local anaesthetic is frequently used in emergency settings as well as in elective surgical and dental procedures. The pain associated with injecting the local anaesthetic is not only due to the needle stick, but is also due to the injection of the local anaesthetic substance which causes burning and stinging sensations. It is a cause of distress to patient and doctor alike. Several methods have been described to reduce the pain of infiltrating local anaesthetics,...]]>
A delay in the introduction of solid foods beyond 6 months does not protect from allergic disease and should not be recommended. A randomised controlled trial (RCT) investigating the specific effect of early versus delayed introduction of solid foods is needed.
A delay in introduction of solid foods has been suggested for decades as a means of preventing atopic diseases due to infants' immature immune system and hence inability to handle a wide variety of food antigens.
Women should be informed that a relatively low level of alcohol increases the risk of impaired fetal growth and preterm birth. Health professionals should advise pregnant women that since it is difficult to estimate how much alcohol they are consuming, avoiding alcohol is best for the baby. Pregnant women who drink heavily should be provided with counselling, antenatal services, and appropriate interventions in a non-judgemental and supportive environment. Research examining the association between the dose and pattern of maternal drinking and fetal outcomes is needed.
Controversy surrounds the issue of alcohol and pregnancy. Whether it is safe for pregnant women to consume low levels of alcohol is hotly debated.
Participation in a 8-week course of Mindfulness-Based Stress Reduction (MBSR) may reduce irritable bowel syndrome (IBS) symptoms and improve quality of life for women with IBS. Patient education for women with IBS should now include MBSR as a potential treatment option.
IBS is common with prevalence estimates ranging from 3.7% to 22% worldwide.
The study highlights the mental health benefits of regular physical activity in the prevention of future depressive illness among older adults. Physical activity appears to be effective for promoting mental health and preventing depression, although further study is needed of different types of depression, for example, recurrent or chronic depression. Future studies, specifically randomised trials, should also determine the relationship between dose, and type, of physical activity and depression, and unexpected events in a prospective design if physical activity is to be routinely recommended.
Depression is approximately twice as prevalent among women compared with men and is associated with functional disability, co-morbid medical conditions and social deprivation.
Concepts such as ‘critical thinking and nursing competence’ are paramount to nursing practice. Chang et al, explore this relationship in practicing nurses. The importance of their work surrounds the positive correlation between critical thinking and nursing competence and the implications for nursing practice: Engage a learner-centred approach; Use the expertise of practicing nurses to guide thinking of novice nurses; Develop nurses' reflective practice.
The complexities of our healthcare environments call for ever increasing professional accountability and decision making of the practicing nurse. Patient outcomes and indicators of quality and safety clearly underscore the demand for high levels of critical thinking and nursing competence.
Maternal perception of an active fetus and fetal hiccups is associated with reduced likelihood of late stillbirth. A sudden change in maternally perceived fetal activity, particularly reduced fetal movements (RFM), is associated with late stillbirth and women should be encouraged to seek advice if this occurs. Research is needed to examine the possible link between a single period of vigorous fetal activity and risk of late stillbirth. The relationship between fetal hiccups, fetal breathing movements and their loss in compromised fetuses merits deeper exploration.
There has been no reduction in stillbirth rates for over two decades in many high-income countries, with approximately 1 in 200 pregnancies being affected after 24 weeks gestation in the UK.
Stacey et al conducted a retrospective case-controlled...]]>
Cognitive development is enhanced with any breastfeeding, but more significantly with at least 4 months of breastfeeding. Preterm infants may especially benefit from breastfeeding. Studies using multi-ethnic participants should be conducted to see if the increase in cognitive ability shown in this study holds true among other ethnic groups.
The health benefits of breastfeeding for infants have been well documented. International
Data from the Millennium Cohort Study, which measured a random sample of all infants born in England, Wales, Scotland and Northern Ireland from 2000 to 2002...]]>
Generalist nurses (eg, practice nurses) can contribute to the social support element of weight loss interventions to improve participation and adherence. Coaching patients within weight loss interventions (in person or remotely by email or phone) requires further specialist training in motivational interviewing and weight management. Establishing which elements (within a complex programme) are effective in specific contexts would be useful to refine nursing practice in weight management.
Obesity prevalence trends are a public health concern in many parts of the world. Excess body fat is linked to adverse health outcomes.
There is hope for adults who were obese as children that they still can avoid serious health consequences by losing weight. Nurses can use these findings to help overweight and obese adults to see real benefits for losing weight. The fact that 64% of those overweight or obese (and 82% of those who were obese) as children were obese as adults, whereas less than 15% who were normal weight as children became obese as adults, provides compelling impetus for childhood obesity prevention and treatment. Since the damage to health was found to occur in overweight and obese adults, regardless of their childhood weight status, obesity prevention and treatment is needed throughout the lifespan. Further research is needed to determine the most efficacious, feasible and cost-effective interventions that sustain a healthy body weight throughout the lifespan. Do those who were overweight or obese as...]]>
Combined oral contraceptives (OCs) increase the risk of venous thromboembolism (VTE). The risk of VTE in users of OCs containing desogestrel, gestodene, cyproterone and drospirenone is around twice that of levonorgestrel OCs users. Differences in VTE risk should be taken into consideration when prescribing OCs.
Oral contraceptives first introduced in the 1960s contained high doses of estrogen and progestin. These were associated with increased risk for cardiovascular disease (CVD), including VTE, and high estrogen dose was thought to be responsible.
Nurses need to be mindful of adolescent needs and viewpoints in planning diabetes education programmes for this population. Further research is needed to determine what education strategies are most effective with this population and provide the balance between promoting adolescent independence while maintaining parental involvement at this critical time.
Adolescence is a time when youth with type 1 diabetes are expected to assume greater responsibility for self-management of their chronic illness, yet, they may have insufficient knowledge, skills and maturity to do this. Their beliefs and need for structured diabetes education (SDE) are important in planning programmes that best support young people with diabetes during this transitional period.
Using a qualitative design, Chaney et al conducted five focus groups with 21 young people with type 1 diabetes between the ages of 13 and 19 years from three acute hospitals in Northern Ireland. Three...]]>
Nurses working in the neonatal intensive care unit (NICU) need to be mindful of the conflicting evidence supporting the use of heparin for maintenance of intravenous locks. This study highlights the unsubstantiated and potentially dangerous routine practice of heparin administration for maintenance of intravenous locks in neonates. Animal studies focusing on the use of heparin for maintenance of small-bore, low-flow central line catheters should be conducted to establish feasibility for subsequent neonatal studies.
The use of intravenous locks in neonates requiring stays in the NICU is widespread worldwide. These intravenous locks are used for administration of intermittent medications as well as administration of intravenous fluids and/or blood products. This study by Arnts et al investigates the efficacy of heparin for maintaining patency of intravenous locks as compared with normal saline solution in NICU patients. An additional aim was to examine potential other variables...]]>
Psychosocial variables can help to explain patient outcomes following total knee replacement. In particular, lower levels of depressive symptomatology and dysfunctional coping, and higher levels of education, problem-focused coping, internal health locus of control and perceived adequacy of assistance from others were predictive of enhanced outcomes at 6 months postsurgery. Rehabilitation providers should consider the merit of incorporating and evaluating psychosocial screening tools to identify individuals at risk of poor outcomes. Research is needed on the effectiveness of interventions targeting these psychosocial variables. Rehabilitation providers should consider the merit of incorporating interventions such as coping skills training into existing programmes to improve postsurgery outcomes.
Approximately a quarter of individuals who undergo knee replacement exhibit little or no improvement after surgery, or are unsatisfied with their outcome,
Antioxidant use could be harmful to older women. Calcium use is associated with lower mortality risk in older women. Dietary supplements should be used to treat symptomatic nutrient deficiency disease. Further research is needed to explore the relationship between dietary supplement use and mortality risks.
Within the context of the Iowa Women's Health Study, Mursu et al assessed the relationship between dietary supplement use and total mortality risk among a large, population-based sample of older women. Previously, antioxidant use was thought to be protective. However, findings from this study provide evidence that some antioxidants may be harmful to older women.
The Iowa Women's Health Study,
This meta-analysis was the first attempt to summarise the effect of lifestyle interventions on erectile dysfunction. The results strongly suggest that adoption of healthy lifestyle based on quality of diet and increased physical activity may help reduce the burden of sexual dysfunction in man.
Erectile dysfunction (ED) is defined as the consistent inability to attain or maintain a penile erection of sufficient quality to permit satisfactory sexual intercourse. ED is an important cause of decreased quality of life in men.
This study underscores the importance of fostering new graduate nurses' critical thinking dispositions (CTD) as possible predictors of research use in practice. Emphasising new graduates' CTD in nursing education may also increase research use as defined in the Research Use Questionnaire (RUQ). Use of multivariate analysis in this study highlights a need for complex ways of examining predictors of research use. Further research to confirm possible predictors of research use is needed.
There is a significant and growing interest in understanding how knowledge, and more specifically research evidence, is applied to nursing practice.
Clinicians should inform patients that vitamin E significantly increased the risk of prostate cancer among healthy men, and should be avoided. Extended follow-up of common doses of vitamins and supplements may reveal new and critically significant findings.
The lifetime risk for prostate cancer in the USA is currently estimated to be 16%. The objective of this study was to determine the long-term effect of vitamin E and selenium on the risk of prostate cancer in healthy men who had participated in the original selenium and vitamin E Cancer Prevention Trial (SELECT). For the follow up study, a total of 35 533 men from 427 study sites in the USA, Canada and Puerto Rico were included in randomised trials between 2001 and 2004.
This follow-up study included 34 887 men who were randomly assigned to one of four treatment groups for the previous 7–12...]]>
Data from this study support the assertion that the use of non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy is associated with increased risk of spontaneous abortion and should, therefore, be used with caution. However, other factors such as socio-economic status and co-existing illnesses may have biased these results. Further research is needed to explore the effect of taking NSAIDs during pregnancy and the other factors identified. Future research should include data relating to the use of both prescription and over-the-counter NSAIDs.
NSAIDs are one of the commonest classes of drugs taken by pregnant women. Data about the risks associated with this remains equivocal. The study by Nakhai-Pour et al explored whether the use of NSAIDs during pregnancy is associated with increased risk of spontaneous abortion.
This study examined data from one Province in Canada extracted from a provincial database. Women who had had a...]]>
Kangaroo care, swaddling/facilitated tucking and non-nutritive suckling are effective techniques for diminishing responses to procedural pain in preterm and newborn term infants. The comparative effectiveness of these techniques against other commonly used methods needs further analysis. There is insufficient research in the 1-month to 3-year-old age group to make any recommendations. Different techniques may be appropriate across this group according to age and disability. Further research using evoked cortical responses is essential.
Painful procedures are often performed on infants and young children, and they can have life long consequences, particularly when repeated frequently and if pain is not managed effectively. The preverbal population is especially vulnerable, and we have a responsibility to protect the fragile developing nervous system. However, it has proved difficult to extrapolate analgesic techniques from adults to infants. There have been several reviews of pharmacological therapies for procedural pain and...]]>
Pharmacist support with medication therapy is an effective adjunct to primary care. Understanding the role of nurses in disease management and Patient Centered Medical Homes is needed. Future studies are needed that examine nurses and medication management.
The Patient Centered Medical Home (PCMH) is an approach to providing comprehensive primary care that enhances effective communications between patients and their physicians. The PCMH is being implemented in healthcare organisations in the USA with enthusiasm and endorsement by policymakers and organisations responsible for reimbursement.
For...]]>
Low sodium diet in normotensive Caucasians showed less than 1% decrease in systolic blood pressure (SBP) and 3.5% decrease in hypertensive Caucasian populations. Further controlled studies are needed on the effect of sodium reduction among Blacks and Asians. Sodium reduction diet resulted in significant increase in lipids (plasma cholesterol and triglycerides) and hormones (renin, aldosterone, and catecholamine). Research on long-term hormonal and lipid effects of sodium restriction diets is needed.
Low sodium diets have been a major hypertension prevention and treatment theme. Evidence supporting interventions of reduced sodium intake as a generalised hypertension prophylaxis initiative remains ambiguous.
There is robust evidence for significant benefits of regular exercise training on physical fitness and function in patients receiving renal replacement therapy (RRT). Data support the use of regular exercise to improve cardiovascular health in patients undergoing renal replacement therapy albeit robust data from large scale randomised controlled trials (RCTs) designed to investigate cardiovascular health outcomes are lacking. Clinicians should counsel patients with chronic kidney disease (CKD) to increase physical activity levels and inform them that there is scientific evidence that regular exercise benefits health. Potential referral to clinical exercise programs should be considered. Future studies should stratify participants based on CKD aetiology and stage, include sufficient sample size, and employ a rigorous RCT design using exercise as an adjunctive therapy versus pharmacotherapy alone in a translational setting. Dialysis nurses have a unique opportunity to lead the translation of intradialytic exercise from research...]]>
Increasingly, there is recognition that women with heart disease have greater psychological morbidity than men. Owing to increased rates of depression and other factors, such as older age, women are less likely to adhere to behaviour change strategies and attend cardiac rehabilitation (CR). A tailored and targeted approach, using a gender-based framework and a theoretically derived behaviour change strategy, can improve depressive symptoms in women following an acute cardiac event. The worth of tailoring and targeting strategies to women's readiness to change behaviours as well as the likely benefit of providing a gender-based approach to care delivery. The need to replicate this study in other study settings and in women from cultural and linguistically diverse groups. The importance of measuring process measures and ensuring monitoring of intervention fidelity in research.
In developed countries, coronary heart disease (CHD) contributes to death and disability among...]]>
Models of care supporting continuous support during labour were shown to be more likely to result in a spontaneous vaginal birth. Women receiving continuous support required less analgesia and were less likely to report negative feelings about the birth experience. Women receiving continuous support experienced shorter labours and their babies were less likely to have low 5-min Agpar scores. Therefore, such models of care should be considered for more extensive implementation in clinical practice settings.
There is a need for further research into models of care, which provide continuity of care and support to women during labour and birth. Future studies should compare outcomes between different types of continuous support (eg, support provided by persons of the woman's choosing and that provided by hospital staff) as well as the views of the people providing the support. There is also a...]]>
A music-based multitask exercise programme can improve gait, balance and risk of falling among community living older adults. A music-based exercise programme may be effective in encouraging adherence to an exercise intervention. Adding music to a multitask exercise programme does not interfere with programme efficacy.
Falls are a major health concern among older adults, with an estimated one-third of older adults experiencing at least one fall annually.
Trombetti et al investigated the effectiveness of a music-based multitask exercise programme (Jaques-Dalcroze eurhythmics) on improving gait, balance...]]>