veNTIlATIoN - Green Cross Publishing

abstracts
48
first fractures among postmenopausal women with
osteoporosis
sontag A,
Krege Jh
Journal of Bone
and Mineral
Metabolism, 7
January 2010
After the occurrence of the first fracture, osteoporosis is no longer a ‘silent’ disease, and the patient’s risk for
future fracture is increased several-fold. The authors from this US study from LLC, Lilly Corporate Center, Indianapolis,
assessed the location of first osteoporotic fractures among women with osteoporosis.
The Multiple Outcomes of Raloxifene Evaluation (MORE) trial was a fracture outcomes study of
postmenopausal women with osteoporosis. All subjects received supplements containing 500mg elemental
calcium and 400-600 IU vitamin D. Sontag and colleagues assessed the location of first fractures among
women with osteoporosis and no previous fractures at baseline from the placebo group of this trial after three
years of follow up. Prespecified fracture sites included vertebral fractures and nonvertebral fractures as defined
in the MORE study protocol.
Among 875 women (mean age, 64.5 +/- 7.4 years) with no prevalent vertebral or nonvertebral fractures, nine
per cent experienced their first fracture event during the trial. Fractures of radius and spine each occurred in
three per cent of patients. Fractures at other individual sites included ankle (0.6 per cent), metatarsal (0.6 per
cent), humerus (0.5 per cent), rib (0.5 per cent), patella (0.3 per cent), leg (0.2 per cent), hip (0.2 per cent) and
clavicle (0.1 per cent).
These data suggest that, for postmenopausal women with osteoporosis but no previous fractures, skeletal
care should include a focus on preventing spine and radius fractures.
fOCUs On: WOmen’s HealTH
Barriers to the use of hydrotherapy in labour
stark mA,
miller mg
Journal of
Obstetric,
Gynecologic
and Neonatal
Nursing 2009
Nov-Dec; 38
(6): 667-75
The objective of this US study from the Bronson School of Nursing, Western Michigan University, was to determine
nurses’ perceived barriers to the use of hydrotherapy in labour. While effective in relieving pain, reducing
anxiety, encouraging relaxation and promoting a sense of control, hydrotherapy is rarely used during labour.
Intrapartum nurses (n=401) attending a national convention (Association of Women’s Health, Obstetric and
Neonatal Nurses, 2007; n=225) and members of perinatal listserves (n=176) were recruited. A questionnaire
was designed for this study (Nurses’ Perception of the Use of Hydrotherapy in Labour).
Institutional but not individual characteristics (age, education and role) were associated with Nurses’
Perception of the Use of Hydrotherapy in Labour. Nurses who reported higher epidural rates (r=0.45, p=0.000)
and Caesarean section rates (r=0.30, p=0.000) reported more barriers. There was no difference in perception
of barriers for nurses at hospitals providing different levels of care; there were significant differences when
primary care providers were considered. Intrapartum nurses in facilities where certified nurse-midwives do
most deliveries reported significantly fewer barriers than nurses who worked in facilities where physicians
attended most deliveries (F=6.84, df=2, p=0.000).
The culture of the birthing unit in which nurses provide care influences perception of barriers to the use of
hydrotherapy in labour. Providing hydrotherapy requires a supportive environment, adequate nursing policies
and staffing, and collaborative relationships among the healthcare team.
patient perceptions of arm care and exercise advice after
breast cancer surgery
lee Ts,
Kilbreath sl,
sullivan g,
refshauge
Km, beith Jm
Oncology
Nursing Forum
2010 Jan; 37
(1): 85-91
The purpose of this recent Australian study from the Royal North Shore Hospital, Sydney, was to describe in
greater detail women’s experiences receiving advice about arm care and exercise after breast cancer treatment.
A total of 175 patients with breast cancer were recruited 6-15 months after their surgery from three hospitals
in the Sydney area. The patients completed a survey about their perceptions of arm activity after breast cancer
and were asked to respond to an open-ended question about their experience receiving advice about arm
care and exercise. Comments from 48 women (27 per cent) who volunteered responses were collated and
categorised.
Topics raised by respondents included perceptions of inadequate and conflicting advice, lack of
acknowledgment of women’s concerns about upper limb impairments, an unsupported search for information
about upper limb impairments, fear of lymphedema (also known as lymphatic obstruction), women’s demand
for follow-up physiotherapy and some positive experiences with supportive care.
Upper limb impairments are problematic for some breast cancer survivors and these concerns are not always
taken seriously by health professionals. To date, standardised advice is provided that does not meet the needs
and expectations of a cohort of women after breast cancer surgery.
Health professionals could better address patients’ concerns about upper limb impairments by providing
accurate advice relevant to the surgery.