Smoking cessation: clinical steps to improve compliance

Smoking tobacco contributes to and exacerbates many chronic diseases of aging, including hypertension, stroke, COPD, heart disease, and atherosclerosis. It is also associated with an increased risk of peptic ulcers and of cancers of the lungs and oral cavity. Older patients generally continue to smoke because of physiologic and psychological addiction to nicotine. Nicotine administration through gum or patch eases the symptoms of nicotine withdrawal for highly-tolerant patients. Detecting and treating alcohol abuse, depression, or life stress may then make it easier to motivate the patient to quit smoking. Physician advice combined with follow-up visits and phone calls has been shown to be one of most effective methods of getting patients to stop smoking.     

Understanding motivation to enhance patient compliance

Motivation as a psychological concept is important in health care because frequently good care is dependent on the motivation of the patient, his/her family and the practitioners within the healthcare team. In addition, nurses need to be motivated to keep up to date with professional developments. This article describes George Kelly's framework of motivation and suggests recommendations to enhance practice in this area. The main conclusion is that although external determinants can encourage a person to engage in a particular activity the most effective kind of motivation is that which is internally mediated.     

Prevention of intellectual disabilities: early interventions to improve cognitive development

The isothermal enthalpy changes with time of a dental composite were examined by microcalorimetry to isolate the effects of different filler concentrations and curing times on chemical aging of these composites. Urethane dimethacrylate (UDMA) monomer, zirconia-silica (ZS) powder, and 3-methacryloxypropyltrimethoxysilane (MAPM) were used as organic and inorganic matrices, and a coupling agent, respectively. The composite was mixed in different ratios and cured by visible light. The enthalpy changes with time for 0, 15, 45, 75% ZS-filled UDMA and 75% MAPM-silanated ZS-filled UDMA cured for 13, 30, 90, 150, and 300 s were measured at 37.0 degrees, 57.0 degrees, and 65.5 degrees C until equilibrium. Increased curing time and filler concentration caused the excess enthalpy changes (dH) and their rate of change (dH/dt) to increase with annealing time and apparent equilibrium was reached faster. In addition, dH showed nonlinear dependence with the increase in filler concentration by showing a maxima for samples containing 25 wt% filler. Further, filler silanation caused dH/dt to increase and required shorter times to reach apparent equilibrium. dH also reached a minimum when samples contained silanated filler, compared to composites containing unsilanated filler. It was concluded that the shorter curing time caused the occurrence of spontaneous densification, which facilitated continual resin curing; and longer curing time caused higher crosslinking of the organic phase. Moderate concentration of inorganic phase restricts the molecular motion of the surface layer of polymer onto filler particles, and the polymer is regarded as highly crosslinked, while a higher filler concentration forms aggregates that are covered by the polymer which causes a decrease in the molecular packing of the resin, and is reflected as low enthalpy values. Finally, silanation of the filler showed a highly endothermic reaction that is probably due to breaking and forming of bonds at the interface between the organic and the inorganic phases in the composites.     

Patient-oriented interventions to improve communication in a medical office visit.

Examined an intervention to improve the patient's contribution to communication in a medical office visit. In Study 1, 53 women awaiting a medical appointment were assigned either to a group that was asked to list 3 questions to ask their physician or to a control group. Ss who listed questions asked more questions in the visit and reported being less anxious. In Study 2, with 49 women, a 3rd group received a message from their physician encouraging question asking. Both experimental groups asked more of the questions they had wished to, had greater feelings of control, and were more satisfied with the visit and with the information they received. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial interventions for patients with coronary artery disease: a meta-analysis

BACKGROUND: Narrative review strategies and meta-analyses have shown that drug treatment and exercise rehabilitation regimens can reduce psychological distress and postmyocardial infarction mortality and recurrence. OBJECTIVE: To question whether the addition of psychosocial interventions improves the outcome of a standard rehabilitation regimen for patients with coronary artery disease. METHODS: We performed a statistical meta-analysis of 23 randomized controlled trials that evaluated the additional impact of psychosocial treatment of rehabilitation from documented coronary artery disease. Anxiety, depression, biological risk factors, mortality, and recurrence of cardiac events were the clinical end points that were studied. Mortality data were available from 12 studies, and recurrence data were available from 10 of the 23 studies. RESULTS: The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. The psychosocially treated patients showed greater reductions in psychological distress, systolic blood pressure, heart rate, and cholesterol level (with effect size differences of -0.34 [corrected], -0.24, -0.38, and -1.54, respectively). Patients who did not receive psychosocial treatment showed greater mortality and cardiac recurrence rates during the first 2 years of follow-up with log-adjusted odds ratios of 1.70 for mortality (95% confidence interval [CI], 1.09 to 2.64) and 1.84 for recurrence (CI, 1.12 to 2.99). CONCLUSIONS: The addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychological distress, and some biological risk factors. The benefits were clearly evident during the first 2 years and were weaker thereafter. At the clinical level, it is recommended to include routinely psychosocial treatment components in cardiac rehabilitation. The findings also suggest an urgent need to identify the specific, most effective types of psychosocial interventions via controlled research.     

Effectiveness of public health interventions in food safety: a systematic review

Reflective practice is now widely debated as a means of improving nursing practice. However, assumptions about reflective practice are rarely clarified and seldom subjected to critique. Therefore, the purpose of this paper is to take up Clarke, James & Kelly's suggestion that limits to the scope and depth of reflection be considered. This is achieved by reflecting on what these authors claim it means to reflect in action. Four arguments are presented: (i) that nurses cannot be conscious of all aspects of nursing practice because there are aspects of practice that cannot be represented in consiousness, (ii) that those aspects of practice that can be represented in consciousness can be so only imperfectly, (iii) that all such representations are not reflexive, and (iv) that any representation in the form of an internal dialogue that could be regarded as reflection is overdetermined. Implications for reflexivity are then considered.     

Effectiveness of clinical pharmacist interventions in a hemodialysis unit

Many patients with end-stage renal disease are treated with a complex pharmacotherapeutic regimen that requires constant and thorough monitoring. The role of a clinical pharmacist in contributing to the care of patients receiving long-term hemodialysis in an outpatient dialysis unit was assessed. Therapeutic interventions provided routinely by the clinical pharmacist were recorded and then categorized and evaluated by two independent clinical pharmacists with expertise in nephrology pharmacotherapeutics. Of the 205 interventions recorded, 97.6% were initiated by the clinical pharmacist and 91.7% were accepted by the medical team; 80.9% were judged to have primarily affected the quality of care. The purposes of interventions were drug selection in 32.2% of cases, drug discontinuation in 19.0%, dose selection in 24.4%, and therapeutic monitoring in 24.4%. Most interventions were initiated in response to abnormal laboratory test results. When the interventions were ranked according to clinical significance, 34.6% were involved with the preservation of major organ function and 62.4% with improvement of the quality of care to acceptable standards. Of all the interventions accepted by the medical team, 90.5% resulted in positive patient outcome; 7.9% resulted in no observable change or had no effect on outcome. The results demonstrate the potential influence and effectiveness of clinical pharmacy interventions on the drug therapy of patients receiving long-term hemodialysis.     

Effectiveness of grief therapy: A meta-analysis.

This meta-analysis addressed the question of how effective grief therapy is and for whom, using B. J. Becker's (1988) techniques for analyzing standardized mean-change scores. Analyses were based on 35 studies (N?=?2,284), with a weighted mean effect size (ES) of δ+?=?0.43 (95% confidence interval?=?0.33 to 0.52). Clients in no-treatment control groups showed little improvement (d=?=?0.06), possibly because of the relatively long delay between loss and treatment in most studies (mean delay?=?27 months). Moderators of treatment efficacy included time since loss and relationship to the deceased. Client selection procedures, a methodological factor not originally coded in this meta-analysis, appeared to contribute strongly to variability in ESs: a small number of studies involving self-selected clients produced relatively large ESs, whereas the majority of studies involving clients recruited by the investigators produced ESs in the small to moderate range. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Low vision: physician screening helps to improve patient function

Low vision is a common problem of older patients. As a primary care practitioner, you are not expected to treat most ocular problems, but you can play an important role by identifying patients with visual impairment. Familiarize yourself with the normal visual changes that occur with aging as well as the more common age-related ocular diseases, including glaucoma, cataracts, age-related macular degeneration, and diabetic retinopathy. You can identify patients with visual problems with a careful history and basic in-office tests of visual acuity. Refer patients found to have visual impairment to an eye care specialist for further evaluation.     

Cognitive interventions to improve face-name recall: The role of personality trait differences.

To explore the relationship of personality trait differences to the ability of older adults to benefit from an intervention to improve face–name recall, 3 previously validated methods of intervention were used in conjunction with the NEO Personality Inventory. Ss were 156 community-dwelling elderly. The 3 treatment conditions all included a standard imagery mnemonic for remembering names and faces but differed in the method of nonmnemonic training (imagery, relaxation, and imagery?+?judgment) administered before teaching the mnemonic device. As in prior studies, there was an overall improvement in the number of face–name pairs remembered after the intervention. In the group of Ss as a whole, Ss who scored higher on the openness factor of the NEO scored significantly higher on all face–name outcome measures regardless of training conditions. Furthermore, there was a significant interaction between treatment condition and scores on Subfactor O1 (fantasy) of the openness factor. Higher scores on the fantasy subfactor were related to greater improvements in the imagery condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of error management training: A meta-analysis.

Error management training (EMT) is a training method that involves active exploration as well as explicit encouragement for learners to make errors during training and to learn from them. Past evaluation studies, which compared skill-based training outcomes of EMT with those of proceduralized erroravoidant training or of exploratory training without error encouragement, have yielded considerable variation in effect sizes. The present meta-analysis compiles the results of the existing studies and seeks to explain this variation. Although the mean effect of EMT across all 24 identified studies (N = 2,183) was positive and significant (Cohen's d = 0.44), there were several moderators. Moderator analyses showed effect sizes to be larger (a) for posttraining transfer (d = 0.56) than for within-training performance and (b) for performance tasks that were structurally distinct (adaptive transfer; d = 0.80) than for tasks that were similar to training (analogical transfer). In addition, both active exploration and error encouragement were identified as effective elements in EMT. Results suggest that EMT may be better suited than error-avoidant training methods for promotion of transfer to novel tasks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Should we pay the patient? Review of financial incentives to enhance patient compliance

OBJECTIVE: To determine whether financial incentives increase patients' compliance with healthcare treatments. DATA SOURCES: Systematic literature review of computer databases--Medline, Embase, PsychLit, EconLit, and the Cochrane Database of Clinical Trials. In addition, the reference list of each retrieved article was reviewed and relevant citations retrieved. STUDY SELECTION: Only randomised trials with quantitative data concerning the effect, of financial incentives (cash, vouchers, lottery tickets, or gifts) on compliance with medication, medical advice, or medical appointments were included in the review. Eleven papers were identified as meeting the selection criteria. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted and analysed using odds ratios and the number of patients needed to be treated to improve compliance by one patient. RESULTS: 10 of the 11 studies showed improvements in patient compliance with the use of financial incentives. CONCLUSIONS: Financial incentives can improve patient compliance.     

Effectiveness of HIV interventions among women drug users

A prospective cohort study was conducted among chronic injecting and crack cocaine drug using women. The hypothesis tested was that participation in a standard-plus-innovative intervention was more likely to produce behavior change than participation in a standard intervention. Standardized intervention protocols and corresponding instruments were designed. Data were collected on drug and sex risk behaviors at baseline and six-month follow-up intervals. The level of behavioral change in two intervention arms--standard and a standard-plus-innovative intervention--was measured by composite sex risk and drug risk scores using the generalized estimating equation approach. The results show that on four risk measures the enhanced intervention was significantly associated with positive change in both drug use and sexual behavior: less frequent drug use, less drug use during sex, and more frequent condom use during particular frequencies for specific types of sexual activities. Public health interventions are effective when targeting specific risk behaviors through interventions tailored to prevent HIV and reduce risk behaviors among specific cultural and gender groups.     

Psychotherapeutic interventions in physical health: Effectiveness and economic efficiency.

Reviews the literature to determine (a) whether psychotherapy exerts a favorable influence on physical health, and (b) whether psychotherapy can be employed to change physical health on a cost-effective basis. Research with overutilizers of medical services, surgical patients, and other groups is discussed in terms of methodological adequacy, and problems faced by researchers in these areas are explored. The effectiveness and economic efficiency of psychotherapeutic preparation for surgery is strongly supported. Studies with overutilizers are promising, but randomized experiments are needed. Implications for inclusion of coverage of psychotherapy under national health insurance are discussed. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

临床护理干预对精神分裂症病人服药依从性的影响

目的:探讨临床护理干预对精神分裂症病人服药依从性的影响.方法:2009年1月～2010年10月,选取我院90例精神分裂症病人,随机分为两组,对照组病人采用一般性访谈和传统药物治疗,观察组病人则在药物治疗的基础上采用健康教育、心理护理等干预措施.结果:干预前两组病人服药依从性比较无统计学意义(P>0.05),护理干预后观察组依从性明显高于对照组,两组比较有统计学意义(P<0.05).结论:接受护理干预后病人服药依从性得到巩固,复发率下降,这对提高治疗效果、预防病情复发有着积极的意义.