Lesley Andrews

Dietary Flavonoids for the Prevention of Colorectal Cancer

To assess whether dietary flavonoids have an effect on the incidence of colorectal adenoma and colorectal cancer.

Non-Specialist Health Worker Interventions for the Care of Mental, Neurological, and Substance-Abuse Disorders in Low- and Middle-Income Countries.

Mental, neurological, and substance misuse (MNS) disorders, such as depression, psychoses, bipolar disorders, selfharm/suicide, epilepsy, dementia, and the misuse of alcohol/illicit drugs, are among the highest sources of disability in the world. Lowand middle-income countries (LMICs) make up about 85% of the global population and account for approximately 75% of the global burden of MNS disorders. Considering the high levels of disability, morbidity, mortality, and economic costs associated with MNS, it is not surprising that the World Health Organisation (WHO) has identified MHNs as one of the key priorities for LMICs to address. However, LMICs face substantial challenges in providing services to people with MNS disorders, due to not only the availability of financial resources but also, and perhaps more importantly, the lack of appropriately skilled staff, with less than one psychiatrist and mental health nurse for every 100,000 people in more than half of all LMICs. This, coupled with poor access to mental health services outside of urban hospital settings, has driven the need to develop different approaches to care delivery that focus on local community-based mental health care. One such approach is to delegate basic mental health interventions to non-specialist health workers (NSHWs), such as doctors, nurses, and allied health professionals not specifically trained in mental health, and other professionals with health roles (OPHRs), such as teachers and community-level workers. By doing this it is hoped that not only more people with MNS disorders will have access to care, but that more specialised professionals, such as psychiatrists and mental health nurses, will be freed up to address more complex cases.

Antiplatelet and Anticoagulant Drugs for Prevention of Restenosis/Reocclusion After Peripheral Endovascular Treatment

NURSING IMPLICATIONS Peripheral arterial disease (PAD) is a long-term condition that has a negative impact on health, including decreased mobility and increased morbidity and mortality, if risk factors and symptoms are not managed appropriately. It is characterized by atherosclerotic stenosis and occlusions in the peripheral arteries, which often results in intermittent claudication. The aim of treatment, dependent on the severity of the condition, is to relieve symptoms, improve quality of life, and reduce the risk of cardiovascular complications. Treatments include lifestyle changes, vasoactive drug therapy, and endovascular interventions. Endovascular interventions include balloon angioplasty, endovascular stents, adjunctive or alternative treatments, and techniques and surgical reconstruction to unblock or bypass occluded or narrowed arteries. Themajor challenge of endovascular interventions is the maintenance of long-term patency, as restenosis/reocclusion is common; however, the use of antithrombotic drugs may have a role to play in overcoming this limitation. Current treatment strategies generally involve the administration of aspirin, unfractionated heparin, or low-molecular-weight heparin (LMWH) and antiplatelet drugs or anticoagulants. Therefore, a systematic review of the available evidence was required that critically appraised the effectiveness of antithrombotic drugs in preventing restenosis/reocclusion after endovascular therapy.

Surgical Versus Nonsurgical Interventions for Treating Patellar Dislocation

BackgroundPatellar (knee cap) dislocation, characterized by trauma of the surrounding connective tissue with subsequent displacement of the patella out with its normal position, is a common orthopaedic injury seen in children and young adults. The injury is most often sustained during sporting activ

Different Types of Intermittent Pneumatic Compression Devices for Preventing Venous Thromboembolism in Patients After Total Hip Replacement.

Venous thromboembolism (VTE), presenting as deep venous thrombosis (DVT) or pulmonary embolism (PE), is a common complication after major joint surgery such as total hip replacement (THR). This occurs because of a combination of patient-specifi c predisposing factors and factors associated with the surgical procedure itself including release of thromboplastins in response to the insertion of instruments into the medullary canal for implanting the prosthetic components, reduction in venous blood fl ow associated with limb position during the procedure, and postoperative immobility. Preventative measures commonly used in patients undergoing THR include prophylactic anticoagulation and mechanical methods such as intermittent pneumatic compression (IPC) devices, or a combination of both. Intermittent pneumatic compression devices have several advantages over prophylactic anticoagulation therapy in that they are generally well-tolerated by patients and do not increase the risk of bleeding, which is particularly useful when anticoagulation is contraindicated. When applied to the foot, calf, or whole leg, IPC devices decrease venous stasis and improve blood fl ow velocity by mimicking the natural activity of the calf muscle through intermittent cycles of compressed air, which alternately infl ate and defl ate the air bladders within cuffs. A wide range of IPC devices are available that offer variation in the length and location of the sleeve and the bladder, the frequency and duration of activation, the rate at which the pressure increases, the maximum pressure that is achieved, and whether the compression is simultaneous or sequential. It is therefore important to evaluate the effectiveness of different IPC devices for prophylaxis against VTE after THR in order to inform clinical decision making.

ENDOSCOPIC OR SURGICAL INTERVENTION FOR PAINFUL OBSTRUCTIVE CHRONIC PANCREATITIS.

ENDOSCOPY NURSING Background Chronic pancreatitis (CP) is a progressive inflammatory condition of the pancreas. Many different factors, including genetic links, auto-immunity, metabolic abnormalities, and anatomical malformations, are thought to cause CP; however, alcohol is the leading cause of CP in the Western world. Ongoing inflammation can eventually lead to fibrosis and loss of pancreatic function, which is often associated with the development of diabetes, malabsorption, weight loss, and general deterioration in the individual’s health. Severe, constant, and disabling abdominal pain is the most common presenting symptom, which can have a major impact on the affected individual’s quality of life with consequent repeated hospitalizations and absence from work. Although the pathogenesis of the pain is not completely understood, it is thought that ductal and parenchymal hypertension, caused by an elevated pressure in the main pancreatic duct due to the presence of strictures, calculi, or both, plays an important role. CP cannot be cured; therefore, the primary goals of treatment are to achieve long-term pain relief, manage complications, and improve quality of life. ENDOSCOPIC OR SURGICAL INTERVENTION FOR PAINFUL OBSTRUCTIVE CHRONIC PANCREATITIS

Music for Insomnia in Adults.

BACKGROUND About one-third of the adult population is estimated to experience insomnia, which can have a detrimental effect on the quality of life of those affected. Insomnia is characterized by difficulty in initiating and/or maintaining sleep or experiencing nonrestorative sleep, which can lead to increased risk of accidents, higher work absenteeism, and the development of other conditions such as depression and anxiety. Currently, management of insomnia includes the use of pharmacological, psychological, and behavioral interventions as well as a range of complementary and alternative therapies. Pharmacotherapy, although commonly used, is often accompanied with unwanted physiological and psychological side effects, such as daytime sleepiness, which can affect the ability of individuals to perform daily activities. Alternatives to pharmacological interventions include, for example, education in sleep hygiene, cognitive behavioral therapy, neurofeedback brain training, and bright light therapy. Music is frequently used by individuals as a self-help strategy for the management of insomnia. It is thought that listening to slow relaxing music has an effect on the neuroendocrine and sympathetic nervous systems that leads to a reduction in heart rate, blood pressure, and respiratory rate, therefore inducing a state of relaxation. Music has also been linked to a reduction in circulating noradrenaline, which is involved in the onset of sleep.