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Background: Medication mismanagement is a continuous problem particularly in older people. Numerous interventions have been developed and tested in an attempt to improve adherence with medication in this client group. Objectives: This review aimed to examine the simple to complex interventions that have been used to assess and improve adherence with medication in older people. Design: An extensive review of the literature was performed and 20 relevant research papers and one report were chosen. Findings: Research papers were evaluated according to design, RCTs were analysed using the JADAD scoring system, systematic reviews and reviews of the literature were reviewed using the Critical Appraisal Skills Programme and subjected to a narrative analysis. This process assisted the development to emerging themes. Four themes were developed: patient barriers, health professional involvement, and health related outcomes and formation giving. Conclusions: The salient findings of the review infer that there is no clear definition of non-adherent behaviour. Quantitative interventions fail to assess patient choice in relation to medication taking. Pharmacist-driven interventions are resource intensive. Health care outcomes and clinical effectiveness are seldom addressed in interventions. Among the many difficulties encountered when attempting to use interventions to promote adherence with medication in older people is their perceptions and beliefs, the appropriateness of the medicines prescribed as well as the impact of lifestyle patterns: smoking, alcohol and diet. Many intervention studies are of poor quality and do not include a theoretical framework to underpin the interventions being used. More focused research is needed to improve understanding of the theoretical knowledge that underpins the complexities of adherence with medication in older people. In-depth qualitative studies can be used to develop such theory. In addition, the quality of intervention research can be improved by the inclusion of a research framework such as the Medical Research Council model. [Copyright &y& Elsevier]

Topical diclofenac sodium ( pennsaid)is a non-steroidal-anti-inflammatory drug that is used to manage the recurrent pain and symptoms of osteoarthritis of the knee. Pennsaid is applied topically , absorbed cutaneously and concentrates locally at the site of application. Towheed , et al. has shown that pennsaid is as efficacious as oral diclofenac as a mode of pain relief without systemic effects . The most common side effect induced by pennsaid is the development of dry skin at the site of application. This is caused by dimethyl sulfoxide which is the vehicle used in the pennsaid formulation. Dimethyl sulfoxide dissolves the natural oils in the skin causing dryness. [ABSTRACT FROM AUTHOR]

Since the inception of the community matron role in 2004 there has been much debate about the exact nature of the role in primary and secondary care. How to effectively skill-up and educate a diverse group of clinicians has been a hot topic. This study involved a small focus group of community matrons in training. The qualitative themes extracted from this work are reported on and suggest that practice-based learning is both valuable and efficacious. [ABSTRACT FROM AUTHOR]

Abstract: Background: Older people represent a sizeable population of the UK. Many older people receive drug treatment for long-term conditions. Adherence with medication is therefore an important clinical, financial and resource intensive concern. Objectives: This review aimed to examine patient''s beliefs, perceptions and views in relation to adherence with medication. Design: A comprehensive search of the literature was undertaken using numerous approaches. The search of revealed 30 research papers. Findings: Articles were initially evaluated using Critical Appraisal Skills Programme principles to identify those relevant to the review. Relevant studies were then subjected to a narrative analysis to assist the development of relevant themes. Four themes were identified; experience of adherence; perceptions and attitudes to medication adherence and non-adherence; patients acceptance of their illness and impact on medication taking behaviour and shared decision making. Conclusions: The findings of this review imply that there is a need for more emphasis on shared decision making between the older patient and the prescriber. Using this approach, adherence with medication may improve. There is also a need to develop a standardized measure of medication adherence. [Copyright &y& Elsevier]

Continuing professional development (CPD) is a mandatory aspect of nurse registration. In the NHS, more demanding professional roles compel nurses to develop and update their knowledge and skills through CPD. Even though CPD is an essential component of nurse education, research investigating community practitioners' views, experiences and perceptions of the link between reflection and CPD is limited. This phenomenological study explored community health practitioners' experiences of CPD and perceptions of the link between CPD and reflection. Ten community practitioners who specialized in district or school nursing and health visiting were interviewed using an in-depth approach. Data was analysed using thematic networks as a tool (Attride-Stirling, 2001). Findings revealed that community practitioners viewed CPD positively, perceived the benefits as both professional and personal development Development needs were identified through reflective practice and appraisal. Even though significant barriers were apparent, the organization provided opportunities to access formal and self-directed learning events. There is a need for organizations to invest in CPD of the workforce, consider cheaper alternatives for meeting CPD needs and for further research to assess the impact of CPD on clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this paper was to review the current literature clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information-processing model, the intuitive-humanist model and the clinical decision-making model. Background. Clinical decision making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognized from the literature; the information-processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information-processing model but also examines patient specific elements that are necessary for cue and pattern recognition. Design. Literature review. Methods. Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 to November 2005. Results. The characteristics of the three models of decision making were identified and the related research discussed. Conclusions. Three approaches to clinical decision making were identified, each having its own attributes and uses. The most recent addition to the clinical decision making is a theoretical, multidimensional model which was developed through an evaluation of current literature and the assessment of a limited number of research studies that focused on the clinical decision-making skills of inexperienced nurses in pseudoclinical settings. The components of this model and the relative merits to clinical practice are discussed. Relevance to clinical practice. It is proposed that clinical decision making improves as the nurse gains experience of nursing patients within a specific speciality and with experience, nurses gain a sense of saliency in relation to decision making. Experienced nurses may use all three forms of clinical decision making both independently and concurrently to solve nursing-related problems. It is suggested that O'Neill's clinical decision-making model could be tested by educators and experienced nurses to assess the efficacy of this hybrid approach to decision making. [ABSTRACT FROM AUTHOR]

Breast cancer is a common form of cancer in women of varying age. Due to the relationship between breasts, sexuality and reproduction, this form of cancer has an interconnected psychological and psychosocial influence on the wellbeing of women. Current understanding of the aetiology and pathogenesis of the disease has evolved as evidence supporting a role for genes such as the HER2 gene has emerged. HER2-positive breast cancer is a particularly progressive form of the disease as a result of its ability to differentiate and spread. Trastuzumab (Herceptin) forms part of the current treatment for this form of breast cancer; albeit costly, it has been shown to improve survival rates in women. For this reason it is now a recommended treatment for early-stage breast cancer. During and after treatment cycles, the breast cancer nurse and medical practitioners should be available to provide emotional support and advice on the manifestations of the disease, coping strategies and how breast cancer patients manage close family relatives. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a common complaint that affects millions of people worldwide. As there is no cure for OA, drug treatment is the main form of management. This can be achieved through the use of analgesics and anti-inflammatory drugs such as the NSAID diclofenac sodium. The chronic use of diclofenac sodium can lead to adverse gastrointestinal problems. The use of a topical formulation of diclofenac sodium aims to reduce this problem. Evidence from four randomized controlled trails of the efficacy and safety of topical diclofenac sodium as a method of pain relief for the treatment of OA of the knee is presented and discussed. Findings imply that topical diclofenac sodium is an efficacious and safe method of pain control in patients with OA of the knee. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a pathological condition that involves excessive production of mucus, chronic cough and inflammatory changes leading to airway limitation. The most common cause of COPD is cigarette smoking. COPD can be categorized into either chronic bronchitis or emphysema; both conditions can be differentiated by age and the production of copious, tenacious sputum. Patients with COPD are susceptible to pulmonary infections of bacterial or viral origin. Nurses should be aware of the subtle differences in conditions and the usefulness of antibiotics in the treatment of acute bacterial exacerbations of chronic bronchitis. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is spread by droplets and causes infections of the upper and lower respiratory tract. It is most common in infants, children under the age of five years and the elderly. Due to the nature of the transmission, infections with RSV are contagious but usually short lived. Pharmacological treatment involves the use of antiviral medication. Nurses caring for older people, infants or young children should be aware of the risk of transmission of RSV, pathogenesis and treatment options available to effectively manage the care of patients. [ABSTRACT FROM AUTHOR]

Up to 10% of women may suffer from polycystic ovary syndrome (PCOS). The clinical symptoms may vary, so the biochemical profile and ultrasonography are used to predict an accurate diagnosis. Many studies have indicated that a relationship may exist between hyperinsulineamia and hyperandrogenism but the exact pathogenesis remains obscure. PCOS is treated by a combination of surgery or pharmacological management. Treatment is not always successful therefore women in these cases require support and care from nursing staff to help overcome the disappointment of treatment failure. To support women with PCOS, nurses need to be knowledgeable about the condition and its clinical manifestations and available treatment options. This article aims to examine the current aetiology, clinical manifestations, pathophysiology, diagnosis and treatment options available to women with a diagnosis of PCOS. [ABSTRACT FROM AUTHOR]

Critical thinking is an important component of professional practice. It is the hallmark of the competent nursing practitioner and yet, there is no consensus on its definition, teaching nor learning strategies of critical thinking skills in nursing students. Although critical thinking appears to be desirable at all levels of nursing practice, evidence to support its educational development in nurses appears to be limited. If educators are to prepare nurses to become leaders in their profession, the educational development of these essential skills in nurses needs to be addressed. [ABSTRACT FROM AUTHOR]

In the UK, medication errors are a growing problem. Dobrzanski et al (2002) estimated that in one trust the incidence of medication error ranged between 35 to 70 per cent. Such high estimations are a cause for concern, particularly when the administration and supply of medicines, which directly involves nurses, can contribute to the cause of medication error. Part of the National Patient Safety Agency's (NPSA) role is monitoring medication errors in hospitals. Although the NPSA can provide information on drug alerts that target primary care organisations, obtaining accurate figures for medication errors is more difficult. Medication errors can be extremely harmful for older people, therefore nurses who prescribe or administer medicines should be assessed for mathematical competence, but also be aware of the potential problems that can arise from medication errors (Banning 2005). [ABSTRACT FROM AUTHOR]

Bacteria are unique microorganisms that have a variety of physiological functions which are beneficial to human beings. However, bacteria can also be harmful and cause infections if translocated from the gastrointestinal tract to the epithelial tissue following surgery. The process of translocation can lead to surgical wounds becoming contaminated with gastrointestinal microbes such as Escherkhia coli, Proteus or IKebsiella species. Bacteria can also cause severe gastrointestinal infections as a consequence of the ingestion of contaminated food. Food-borne bacterial infections can lead to serious consequences for the patient. Nurses managing the care of surgical patients and older people need to be aware of the physiological role that bacteria play but also the detrimental effects of bacterial translocation or ingestion particularly in older people, infants and people who are immunosuppressed. [ABSTRACT FROM AUTHOR]

Influenza is a common respiratory condition that has a history of developing into epidemics and pandemics. Individuals at risk of influenza and related complications include older people, young children and individuals with chronic renal, cardiac and respiratory diseases. Influenza can begin suddenly and is accompanied by fever, chills, aches, pains, headaches, fatigue, cough and generalized weakness that can last up to 14 days. Complications of influenza include secondary bacterial pneumonia, post-influenza encephalitis, changes in cardiac electrocardiogram and secondary bacterial infections, such as Staphylococcus aureus-induced myositis. The influenza vaccine is the main form of treatment. Suitably qualified nurse prescribers and nurses who supply and administer the vaccine under patient group directions should be sufficiently knowledgeable about the virus and how its transmission can be prevented in order to educate patients at risk of developing influenza about the role of the vaccine in the prevention of the disease. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is a Gram-positive bacterium that developed resistance to the penicillin derivative methicillin. Subsequently, methicillin-resistant S. aureus (MRSA) emerged as a bacterium that became less susceptible to the actions of methicillin and thus developed the ability to colonize and cause life-threatening infections. Globally, MRSA continues to cause hospital-acquired infections which are becoming difficult to treat owing to increasing glycopeptide resistance and the increasing development of community-associated MRSA. Nurses caring for patients in both hospital and community settings should be able to acknowledge the importance of MRSA, the difficulties of treating the bacterium and the need to comprehend and adhere to universal precautions that are important in the prevention of transmission of MRSA. INSET: KEY POINTS. [ABSTRACT FROM AUTHOR]

Cardiac disease continues to be a major cause of death in the Western world. Several preventive measures can be implemented to reduce the risk of a cardiac event. One of these measures is diet. A diet that is rich in fatty fish provides a considerable quantity of omega-3-fatty acids. These fatty acids have been shown to reduce the risk of cardiac events such as arrhythmias, stroke and thrombosis. The nurse has a key health education role to play in the promotion of healthy eating in order to reduce the incidence of cardiac events in patients with existing cardiac disease. INSET: KEY POINTS. [ABSTRACT FROM AUTHOR]

banning m (2005) Journal of Clinical Nursing14, 411–417Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing: independent nurse prescribers’ viewsThe purpose of this study was to explore nurses’ conceptions of evidence and evidence-based practice, whether there are differences between evidence-based practice and evidence-based medicine and to identify the uptake of research evidence in the workplace.The use and comprehension of the term‘evidence-based practice’ in relation to nursing shows remarkable variation. Numerous definitions are provided, some tend to be closely related to the concept‘evidence-based medicine’. Independent nurse prescribers need to be able to understand the concept of evidence-based practice to utilize and apply this concept in order to provide adequate medication management of their patients.Data were generated by focus group interview and open question questionnaire and analysed by analytical abstraction.Nurses offered a variety of views on the use and uptake of evidence in the workplace. Some nurses acknowledged that they did not read research papers but were aware that they used a lot of evidence in their practice. Nurses had difficulty differentiating evidence-based practice from evidence-based medicine.Nurses were familiar with the research process but not the canons of evidenced-based practice. The data generated indicate different levels of evidence are used by nurses. This may be a reflection of the level of intrigue of the nurses involved.The education and training of independent nurse prescribers should include the exploration of evidence from randomized controlled trials and from naturalistic studies and their contribution to evidenced-based practice and evidence-based medicine. Both concepts need to be explored in relation to the medication management of patients. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic inflammatory condition that involves all elements of the immune response. The aetiology of RA is complex and centres on the development of autoantibodies and immune complexes. The pathogenesis is multistage and involves cytokines, angiogenesis and rheumatoid factor. Nurses managing patients who suffer with RA need to he aware of the pathological changes involved in the disease and its contribution to the progression of the condition. The diagnosis of RA involves blood screening for rheumatoid factor, raised erythrocyte sedimentation rate (ESR), use of arthroscopy to provide evidence of histological changes in the synovium, presenting symptoms, and changes on X-ray. Patient assessment will consider both patient-specific and disease-specific variables, including evidence of non-articular manifestations of RA. Long-term care revolves around trying to maintain patient mobility and the protection of unaffected joints, monitoring for the side-effects from medication and progression of the disease or development of non-articular manifestations. INSET: KEY POINTS. [ABSTRACT FROM AUTHOR]

Obesity is a global problem, independent of age. The numbers of obese individuals are now reaching epidemic proportions around the world. This is contributing to the risk of inherent comorbidity. The pathophysiology of obesity, although widely debated, is still unclear with suggestions that multiple genetic mutations may have a key role in the development, but as yet no one genetic mutation is felt to be entirely responsible. Biochemical manifestations such as diabetes may play a role. The first goal of management of the obese patient will involve dietary and behavioural modification and a programme of physical exercise. In primary care settings, nurses are suitably placed to assess and manage obese patients (National Institute for Clinical Excellence (NICE), 2001a). The nursing profession needs to rise to the challenge and prepare nurses for a specialist role in obesity management. [ABSTRACT FROM AUTHOR]

This illuminative evaluation study gives insights into attitudes to learning, interaction and the perceived roles of theory, evidence, reading and previous experience. These insights lead us to question some aspects of the course as currently presented. Students indicated that they found the course material stimulating but prior guidance on the areas to read before commencing learning would have been helpful. Students were desperate to learn and to be successful but many were apprehensive about the intensity of the pharmacological content and diagnostic skills that are required to make a clinical diagnosis. Sadly, some students felt that the restriction of the extended nurse formulary, while valuable to their professional development and credibility as a nurse, would not enhance the care that could be provided to patients. This limitation was not realized until the course had commenced. This may have been avoided if an information day had been provided before commencing the course. For many students, a positive finding was the realization of the relevance to practice and the contribution that could be made to everyday nursing care. Future independent nurse prescribing students would benefit from the provision of pre-course reading, guided studies in pharmacology, normal physiology and physical examination skills before commencing the course of study. The use of a theoretical self-assessment tool would allow potential students to assess their suitability for the programme. Aspects of student learning need to be discussed early in the programme. [ABSTRACT FROM AUTHOR]

It has been shown that older people are more likely than younger people to be prescribed a variety and number of medications (Lindley and Tulley, 1992). Older people are especially vulnerable to the effects of medication, particularly because of the possibility of medication mismanagement and non-concordance with prescribed medication regimens. People become increasingly sensitive to the actions of drugs with increasing age and, added to the problems of memory deterioration and physiological changes, medication-taking behaviour can alter quite dramatically (National Prescribing Centre, 2000). Reductions in the quantity of prescribed medication and the use of prescribing indicators aim to improve concordance with medication in older people. Patient education should be an inclusive component of patient care, not a concern before patient discharge. Education can take numerous forms, both written and verbal, and it needs to be patient-centred and specific to the medication being discussed. As healthcare professionals, nurses, pharmacists and medical colleagues should work collaboratively to reduce the frequency of medication mismanagement in older people. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the life experiences of breast cancer patients.

Introduction: Nursing has come to play a prominent role in government health policy since 1997. Extending the scope of nursing practice into activities previously carried out by doctors can assist a managerialist and 'modernizing' project of increasing National Health Service (NHS) efficiency by removing demarcations between professional groups. Methods: Drawing on elements of poststructuralist linguistics, this paper presents an analysis of a key government speech in the context of a discussion of overall policy intentions. Results: The speech can be seen as an example of how government has attempted to use rhetoric to make its goals attractive to nurses. Conclusion: Policy-makers have to make their policies acceptable to those whom they expect to implement them. In this case, organizational efficiency, chiefly in terms of broader access to NHS services, as well as role substitution, is aligned with government policy promoting social enterprise and 'sold' to the nursing profession as enhancing its status compared with medicine. [ABSTRACT FROM AUTHOR]