Mary Williams

Adherent and nonadherent medication-taking in elderly hypertensive patients.

Nonadherence to medications is a significant reason why patients fail to control their blood pressure. Little work has been attempted to conceptualize medication-taking behaviors from the patient’s perspective. This study examined factors that influence elderly hypertensive patients’ adherence or nonadherence to prescribed medications. Using a qualitative descriptive research design, 21 hypertensive elderly people were interviewed. Two domains of adherence were identified: purposeful use of the medication for the control of patient’s blood pressure and establishing and maintaining patterns of medicationtaking. Two similar domains also emerged for nonadherence: purposeful and incidental. Adherence behaviors were dependent on the person’s decision to take hypertension medication, access to medications, and ability to initiate treatment and maintain a medication-taking pattern. The timing and location of pills were integral parts of establishing patterns of taking medications. Inadequate access to medications or interruption of a person’s pattern were associated with the incidental missing of medications.

Psychological factors influencing weight loss maintenance: An integrative literature review

Purpose: Weight loss is critical in the fight against obesity yet only about 20% of individuals maintain weight loss long term. This review examines the psychological factors influencing weight loss maintenance. Data sources: An electronic search was used to identify studies from 2003 to 2009 in the following databases: MEDLINE, CINAHL, PsycINFO, Psychology and Behavioral Sciences Collection, PsycARTICLES. Conclusion: Evidence indicated avoiding dichotomous thinking, eating to regulate mood, and disinhibited eating were associated with weight loss maintenance. Increased dietary restraint, perceived benefits outweighing costs, lower/stable levels of depression, and more positive body image were also associated with weight loss maintenance. Results were inconclusive on unrealistic weight loss expectations and failure to achieve weight loss goals. Implications for practice: Practitioners can play a pivotal role in screening clients for these factors and recommending treatment to increase the likelihood of successful weight loss maintenance.Purpose: Weight loss is critical in the fight against obesity yet only about 20% of individuals maintain weight loss long term. This review examines the psychological factors influencing weight loss maintenance. Data sources: An electronic search was used to identify studies from 2003 to 2009 in the following databases: MEDLINE, CINAHL, PsycINFO, Psychology and Behavioral Sciences Collection, PsycARTICLES. Conclusion: Evidence indicated avoiding dichotomous thinking, eating to regulate mood, and disinhibited eating were associated with weight loss maintenance. Increased dietary restraint, perceived benefits outweighing costs, lower/stable levels of depression, and more positive body image were also associated with weight loss maintenance. Results were inconclusive on unrealistic weight loss expectations and failure to achieve weight loss goals. Implications for practice: Practitioners can play a pivotal role in screening clients for these factors and recommending treatment to increase the likelihood of successful weight loss maintenance.

A systematic review of the effectiveness of garlic as an anti-hyperlipidemic agent.

Purpose To 1) conduct a thorough search of the literature for randomized controlled trials (RCTs) addressing the efficacy of garlic as an antihy‐perlipidemic agent, 2) critically appraise those studies, and 3) make a recommendation for practicing health care professionals. Data Sources Two independent reviewers extracted data from the articles identified from several data bases, using the previously tested Boyack and Lookinland Methodological Quality Index (MQI) as the standard. Results Six of ten studies found garlic to be effective. The average drop in total cholesterol was 24.8 mg/dL (9.9%), LDL 15.3 mg/dL (11.4%), and triglycerides 38 mg/dL (9.9%). The over‐all average MQI score was 39.6% (18%‐70%). Major shortcomings of many of the RCTs included short duration, lack of power analysis and intention to treat analysis, as well as lack of control of diet as a confoundingvariable. Conclusion/Implications The low methodological quality of the studies make it difficult to recommend garlic as an antihyperlipidemic agent. Until larger RCTs of longer duration, which correct the existing methodological flaws, are designed and carried out, it is best not to recommend garlic be used to treat mild to moderate hyperlipidemia.

The efficacy and tolerability of SSRI/SNRIs in the treatment of vasomotor symptoms in menopausal women: A systematic review

Purpose: To systematically review the evidence related to the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) used for the treatment of vasomotor symptoms in perimenopausal and postmenopausal women. Data sources: Medline, CINAHL, and the Cochrane Library databases were searched to identify randomized controlled trials (RCTs). Eighteen trials met the criteria for review. Conclusions: Results from these trials indicate that paroxetine, citalopram, escitalopram, venlafaxine, and desvenlafaxine are effective in reducing the frequency and severity of hot flashes. Fluoxetine and sertraline appear to be less effective and should be considered second‐line options for treatment. Implications for practice: The SSRIs and SNRIs can reduce hot flashes by 65% and begin working within the first week. Patient response is variable and if one drug does not improve hot flashes, another can be tried after a 1‐ to 2‐week drug trial. Paroxetine, citalopram, and escitalopram appear to have the fewest adverse effects. Considering cost, paroxetine and citalopram are the most cost‐efficient.

Efficacy of green tea in the prevention of cancers

Understanding the literature about the efficacy of green tea consumption in preventing and slowing the progression of cancers is critical. A systematic review of the literature was conducted using an electronic search to identify studies from 2000 to 2008 in the following database: Alt HealthWatch, CINAHL, Medline, Health Source--Consumer Edition, Health Source: Nursing/Academic Edition, Web of Science (ISI), and the Cochrane Library. Although the evidence from this review suggested associations between green tea consumption and a decreased risk for some cancers, the findings were inconclusive. In selected cases, green tea was effective in slowing the progression of the earlier stages of cancer. However, contrary evidence is reported and the dose and duration of use is variable. Most evidence stems from self-reports. Research using more rigorous designs to investigate the efficacy of green tea in humans is needed.

PRACTICAL CONSIDERATIONS in Establishing Sustainable International Nursing Experiences

ABSTRACT An understanding of global health and the development of cultural competence are important outcomes of todays baccalaureate nursing programs. Thoughtfully designed international experiences can provide excellent opportunities to achieve those outcomes. Based on 16 years of providing international experiences within a baccalaureate curriculum, components are identified that contribute to the development of a sustainable international program. Areas addressed in the article are evaluating the fit with university and college mission, establishing the program within the university operational structure, selecting faculty and students, developing sites, designing a course, and program evaluation.

Consulting with children in the development of self-efficacy and recall tools related to nutrition and physical activity.

PURPOSE This article chronicles our efforts to develop an instrument with and for children-complete with insights, multiple iterations, and missteps along the way. The instruments we developed assess childrens self-efficacy and recall related to healthy eating and physical activity. DESIGN AND METHODS Five focus groups were held with 39 children to discuss the evolving instrument. RESULTS A nine-item self-efficacy instrument and a 10-item recall instrument were developed with Flesch-Kincaid grade levels of 1.8 and 4.0, respectively, which fifth graders can complete in less than 5 min. PRACTICE IMPLICATIONS When assessing children in clinical practice or research, we should use instruments that have been developed with childrens feedback and are child-centered. Without that assurance, assessment results can be questionable.

Assessing postprandial glucose using 1,5-anhydroglucitol: An integrative literature review

Purpose: Recent studies have determined postprandial blood glucose is an independent risk factor for macrovascular complications. This risk exists, despite having HbA1C results within acceptable ranges for diabetes. 1,5‐Anhydroglucitol (1,5AG) has been proposed as an appropriate indicator to detect and screen for postprandial hyperglycemia (PPHG). This review discusses the efficacy of 1,5AG to predict PPHG in order to reveal those who may be at risk for macrovascular complications. Data Sources: An electronic search was conducted from 2003 to 2008 in the following databases: Medline, CINAHL, Health Source: Nursing/Academic Edition, and Pre‐CINAHL. Any articles relating to 1,5AG as a marker for PPHG were used. The search was limited to any human research articles published in English. All articles were reviewed for additional relevant studies. Conclusions: 1,5AG was found to be a reliable indicator of PPHG, even when HbA1C levels were within target ranges. 1,5AG may be a simple and effective tool for primary care providers to identify those at risk for macrovascular complications, who would otherwise go unnoticed if assessed by HbA1C alone.

REVIEW: Diagnostic accuracy for coronary artery disease of multislice CT scanners in comparison to conventional coronary angiography: An integrative literature review

Purpose: To examine the quality of cardiac imaging done by multislice computed tomography (MSCT) and its ability to correctly identify significantly occluded segments of coronary arteries compared with quantitative coronary angiography. Data sources: Databases searched were CINAHL, MEDLINE, EBSCO, Academic Search Premier, and Web of Science and Health Source: Nursing/Academic edition. Keywords used were “Computed Tomography,” “Coronar* Angiogra*,” and “Coronary Artery Disease.” Studies from peer‐reviewed journals published from 2002 to 2008 that compared quantitative coronary angiography to MSCT were evaluated. Additional sources were identified from review of reference lists from articles found in the electronic search. Conclusions: MSCT was best employed to screen for the absence of disease in patients who were in sinus rhythm, who had no previous bypass grafts or stents placed, had a low risk of calcifications, and who were not obese. Both 40‐ and 64‐slice technology demonstrated the highest accuracy in screening for the absence of disease on a vessel‐based analysis. Implications for Practice: Those who have multiple risk factors and are asymptomatic should still be screened via catheterization. More studies are needed to determine the effectiveness of newer 64‐slice technology as a tool to positively identify CAD.Purpose: To examine the quality of cardiac imaging done by multislice computed tomography (MSCT) and its ability to correctly identify significantly occluded segments of coronary arteries compared with quantitative coronary angiography. Data sources: Databases searched were CINAHL, MEDLINE, EBSCO, Academic Search Premier, and Web of Science and Health Source: Nursing/Academic edition. Keywords used were “Computed Tomography,”“Coronar* Angiogra*,” and “Coronary Artery Disease.” Studies from peer-reviewed journals published from 2002 to 2008 that compared quantitative coronary angiography to MSCT were evaluated. Additional sources were identified from review of reference lists from articles found in the electronic search. Conclusions: MSCT was best employed to screen for the absence of disease in patients who were in sinus rhythm, who had no previous bypass grafts or stents placed, had a low risk of calcifications, and who were not obese. Both 40- and 64-slice technology demonstrated the highest accuracy in screening for the absence of disease on a vessel-based analysis. Implications for Practice: Those who have multiple risk factors and are asymptomatic should still be screened via catheterization. More studies are needed to determine the effectiveness of newer 64-slice technology as a tool to positively identify CAD.

Make each patient count.

Overcoming barriers to clinical preventive services.