UK clinical guideline for the prevention and treatment of osteoporosis Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department. Can intensive three-day programmes improve nurses' communication skills in cancer care? Prophylaxis of chemotherapy-induced febrile neutropenia with granulocyte colony-stimulating factors: where are we now? A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)
Introduction In 2008 , the UK National Osteoporosis Guideline Group ( NOGG ) produced a guideline on the prevention and treatment of osteoporosis , with an up date in 2013 . This paper presents a major up date of the guideline , the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men age 50 years or over . Methods Where available , systematic review s , meta-analyses and r and omised controlled trials were used to provide the evidence base . Conclusions and recommendations were systematic ally grade d according to the strength of the available evidence . Results Review of the evidence and recommendations are provided for the diagnosis of osteoporosis , fracture-risk assessment , lifestyle measures and pharmacological interventions , duration and monitoring of bisphosphonate therapy , glucocorticoid-induced osteoporosis , osteoporosis in men , postfracture care and intervention thresholds . Conclusion The guideline , which has received accreditation from the National Institute of Health and Care Excellence ( NICE ) , provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals who are involved in its management This study examined the  emergency nurse practitioner c and i date ( ENPC ) scope of practice in a Victorian emergency department ( ED ) . The emergency nurse practitioner ( ENP ) role is relatively new in Victoria and the scope of the ENP(C ) practice is yet to be defined . International research literature regarding the ENP role has focused on outcomes such as patient satisfaction , waiting times and /or ED length of stay , accuracy and adequacy of documentation , use of radiography , and patient education , health promotion and communication issues . A prospect i ve exploratory design was used to conduct this cohort study . There were 476 ENPC-managed patients between 14 July 2004 and 31 March 2005 with an average age of 29 years . The majority ( 77.2 % ) of ENPC-managed patients were discharged from the ED . The majority of the ENPC time was devoted to clinical practice ( 55 % ) and development of clinical practice guidelines ( 25 % ) . Of patients managed by the ENPC , 49.6 % required medications , 51 % required diagnostic imaging and 8.6 % required pathology testing during their ED stay . The most common discharge referrals were made to local medical officers ( 73.5 % ) and the most common referrals made for patients requiring admission were made to the plastic surgery ( 37.3 % ) and orthopaedic ( 35.5 % ) units . Extensions to the current scope of emergency nursing practice are pivotal to effective management of specific patient groups by ENP . The ENP model of care is an important strategy for the management of increased service dem and s in Victoria ; however , little is known about the scope of the ENPC practice and many outcomes of the ENP care are yet to be defined . Further research to better underst and the relationships between ENP outcomes is required if the contribution that ENPs make to emergency care is to be accurately quantified Effective communication is widely regarded as a crucial component of patient care that can determine patient satisfaction , compliance and recovery . The plethora of communication skills training programmes available to health professionals is also a testament to the importance of this element of care . However a review of studies evaluating the effectiveness of such training programmes concluded that little behavioural change in health professionals ' communication skills was evident . This paper reports the findings of a programme offered to cancer/palliative care nurses ( n=108 ) via eight condensed three-day workshops  at various UK venues . Behavioural change was assessed through evaluation of audiotaped nursing assessment s made pre- and six weeks post-course , scored along nine previously identified key communication areas . Mean overall scores rose by 6 points ( p<0.001 ) to 20 ( out of 27 ) with statistically significant improvements on eight of the nine individual areas . Improvements in subjective levels of confidence in the areas of communication found difficult pre-course were observed immediately post-course ( p<0.001 ) and were still evident six weeks later . Similar improvements immediately post-course for teaching communication skills to colleagues ( p<0.001 ) were further improved six weeks post-course for seven of the eight areas assessed . These results suggest that three-day training courses can lead to clinical ly relevant behavioural change and improvements in perceived confidence in communication and dissemination of skills Up date d international guidelines published in 2006 have broadened the scope for the use of granulocyte colony-stimulating factor ( G-CSF ) in supporting delivery of myelosuppressive chemotherapy . G-CSF prophylaxis is now recommended when the overall risk of febrile neutropenia ( FN ) due to regimen and individual patient factors is ≥20 % , for supporting dose-dense and dose-intense chemotherapy and to help maintain dose density where dose reductions have been shown to compromise outcomes . Indeed , there is now a large body of evidence for the efficacy of G-CSFs in supporting dose-dense chemotherapy . Predictive tools that can help target those patients who are most at risk of FN are now becoming available . Recent analyses have shown that , by reducing the risk of FN and chemotherapy dose delays and reductions , G-CSF prophylaxis can potentially enhance survival benefits in patients receiving chemotherapy in curative setting s. Accumulating data from ‘ real-world ’ clinical practice setting s indicate that patients often receive abbreviated courses of daily G-CSF  and consequently obtain a reduced level of FN protection . A single dose of PEGylated G-CSF ( pegfilgrastim ) may provide a more effective , as well as a more convenient , alternative to daily G-CSF . Prospect i ve studies are needed to vali date the importance of delivering the full dose intensity of st and ard chemotherapy regimens , with G-CSF support where appropriate , across a range of setting s. These studies should also incorporate prospect i ve evaluation of risk stratification for neutropenia and its complications Purpose This study aims to provide recommendations on the optimal strategies and interventions for the prevention , screening , assessment , and management of  cancer-related sleep disturbance ( insomnia and insomnia syndrome ) in adult cancer population s. Methods A systematic search of the published health literature was conducted to identify r and omized controlled trials , clinical practice guidelines , systematic review s , and other guidance documents . The Sleep Disturbance Expert Panel [ comprised of nurses , psychologists , primary care physicians , oncologists , physicians specialized in sleep disturbances , research ers , and guideline method ologists ] review ed , discussed , and approved the final version of the guideline . Health care professionals across Canada were asked to provide feedback through an external review process . Results Three clinical practice guidelines and 12 r and omized controlled trials were identified as the evidence base . Overall , despite the paucity of evidence , the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using st and ardized screening tools on a routine basis . While prevention of sleep disturbance is the desired objective , cognitive behavioral therapies are effective in improving sleep outcomes . As part of the external review with 16 health care providers , 81 % indicated that they agreed with the recommendations as written . Conclusions Sleep difficulty is a prevalent problem in cancer population s that needs greater recognition by health professionals . Prevention , screening , assessment , and treatment strategies supported by the best available evidence are critical . Recommendations and care path algorithms for practice are offered A.S.P.E.N. and SCCM are both nonprofit organizations composed of multidisciplinary healthcare professionals . The mission of A.S.P.E.N. is to improve patient care by advancing the science and practice of clinical nutrition and metabolism . The mission of SCCM is to secure the highest quality care for all critically ill and injured patients . Guideline Limitations : These A.S.P.E.N.−SCCM Clinical Guidelines are based on general conclusions of health professionals who , in developing such guidelines , have balanced potential benefits to be derived from a particular mode of medical therapy against certain risks inherent with such therapy . However , practice guidelines are not intended as absolute requirements . The use of these practice guidelines does not in any way project or guarantee any specific benefit in outcome or survival . The judgment of the healthcare professional based on individual circumstances of the patient must always take precedence over the recommendations in these guidelines . The guidelines offer basic recommendations that are supported by review and analysis of the current literature , other national and international guidelines , and a blend of expert opinion and clinical practicality . The population of critically ill patients in an intensive care unit ( ICU ) is not homogeneous . Many of the studies on which the guidelines are based are limited by sample size , patient heterogeneity , variability in disease severity , lack of baseline nutritional status , and insufficient statistical power for analysis . Periodic Guideline Review and Up date : This particular report is an up date and expansion of guidelines published by A.S.P.E.N. and SCCM in 2009 ( 1 ) . Governing bodies of both A.S.P.E.N. and SCCM have m and ated that these guidelines be up date d every three to five years . The data base of r and omized controlled trials ( RCTs ) that served as the platform for the analysis of the literature was assembled in a joint “ harmonization process ” with the Canadian Clinical Guidelines group . Once completed , each group operated separately in their interpretation of the studies and derivation of guideline recommendations ( 2 ) . The current A.S.P.E.N. and SCCM guidelines included in this paper were derived from data obtained via literature search es by the authors through December 31 , 2013 . Although the committee was aware of l and mark studies published after this date , these data were not included in this manuscript . The process by which the literature was evaluated necessitated a common end date for the search review . Adding a last-minute l and mark trial would have introduced bias unless a formalized literature search was re-conducted for all sections of the manuscript . Target Patient Population for Guideline : The target of these guidelines is intended to be the adult ( ≥ 18 years ) critically ill patient expected to require a length of stay ( LOS ) greater than 2 or 3 days in a medical ICU ( MICU ) or surgical ICU ( SICU ) . The current guidelines were exp and ed to include a number of additional subsets of patients who met the above criteria , but were not included in the previous 2009 guidelines . Specific patient population s addressed by these exp and ed and up date d guidelines include organ failure ( pulmonary , renal , and liver ) , acute pancreatitis , surgical subsets ( trauma , traumatic brain injury [ TBI ] , open abdomen [ OA ] , and burns ) , sepsis , postoperative major surgery , chronic critically ill , and critically ill obese . These guidelines are directed toward generalized patient population s but , like any other management strategy in the ICU , nutrition therapy should be tailored to the individual patient . Target Audience : The intended use of these guidelines is for all healthcare providers involved in nutrition therapy of the critically ill , primarily physicians , nurses , dietitians , and pharmacists . Methodology : The authors compiled clinical questions reflecting key management issues in nutrition therapy . A committee of multidisciplinary experts in clinical nutrition composed of physicians , nurses , pharmacists , and dietitians was jointly convened by the two societies
Although most study - authors were positive , we could not draw firm conclusions about any of the pharmaceutical interventions .
Even patients that received placebo intervention showed improvement .
There is weak evidence that reduction mammaplasty may be helpful to treat inframammary intertrigo .
Conclusions There is no evidence at all about the prevention of intertrigo and there is no firm evidence about its treatment .
Background Intertrigo in the large skin folds is a common problem .
There is a plethora of treatments , but a lack of evidence about their efficacy .
A nursing guideline on this matter had to be up date d and broadened in scope to other health care professionals .