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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.
CALCICHEW-D 3 FORTE CHEWABLE TABLETS PRESCRIBING INFORMATION (Please refer to full Summary of Product Characteristics when prescribing) Presentation: Chewable tablet containing 1250mg calcium carbonate (equivalent to 500mg of elemental calcium) plus 400IU colecalciferol (equivalent to 10 micrograms vitamin D 3 ). Uses: Treatment and prevention of vitamin D/calcium deficiency. Supplementation of vitamin D and calcium as an adjunct to specific therapy for osteoporosis, in pregnancy, in established vitamin D dependent osteomalacia and in other situations requiring therapeutic supplementation of malnutrition. Dosage and administration: Oral (suck or chew). Adults and elderly: Two tablets daily. Children: Not intended for use in children. Hepatic impairment: No dose adjustment required. Renal impairment: Should not be used in patients with severe renal impairment. Contraindications: Diseases and/or conditions resulting in hypercalcaemia and/or hypercalciuria, renal stones, hypervitaminosis D, hypersensitivity to ingredient(s) especially soybean oil and peanut. Precautions: Monitor serum calcium and creatinine levels, particularly in elderly patients on cardiac glycosides or diuretics and in patients with high tendency to calculus formation. Use with caution in patients with impaired renal function. Take into account risk of soft tissue calcification. Avoid in patients with phenylketonuria or sugar intolerance. Prescribe with caution in patients with sarcoidosis. Use with caution in immobilised patients. Additional doses of calcium or vitamin D should only be taken under close medical supervision. Interactions: Tetracyclines (take HELP PROTECT THE FRAGILE ELDERLY Calcium and/or vitamin D deficiency in the elderly can lead to loss of muscle tone and an increase in falls and osteoporotic fractures. 1-5 Calcichew-D 3 Forte is indicated for the treatment and prevention of calcium and vitamin D deficiency. 6 2 hours before, or 4 to 6 hours after Calcichew-D 3 Forte), bisphosphonates or sodium fluoride (take 3 hours before Calcichew-D 3 Forte), thiazide diuretics, corticosteroids, cardiac glycosides, ion exchange resins (cholestyramine), laxatives (paraffin oil). Calcichew-D 3 Forte should not be taken within 2 hours of eating foods high in oxalic acid (e.g. spinach and rhubarb) or phytic acid (e.g. whole cereals). Side effects: Hypercalcaemia, hypercalciuria, constipation, flatulence, nausea, abdominal pain, diarrhoea, pruritus, rash, urticaria. Use in pregnancy and lactation: Can be used in case of calcium and vitamin D deficiency. Daily intake in pregnancy should not exceed 1500mg calcium and 600IU colecalciferol (15 micrograms vitamin D 3 ). Avoid overdose as permanent hypercalcaemia affects developing foetus. Calcium and vitamin D 3 pass into breast milk so consider this when giving additional vitamin D to the child. Pharmaceutical precautions: Do not store above 30°C. Keep container tightly closed. Legal category: Pharmacy product. Product Authorisation No: 535/1/3. Product Authorisation holder: Shire Pharmaceuticals Ltd., Hampshire International Business Park, Chineham, Basingstoke, Hampshire RG24 8EP UK. Distributed in Republic of Ireland by: Cahill May Roberts, P.O. Box 1090, Chapelizod, Dublin 20, Republic of Ireland. Further information is available on request. Date of revision: July 2007. CALCICHEW is a registered trademark of Shire Pharmaceuticals Ltd in the Republic of Ireland. Their strength is our forte Adverse events should be reported to the Pharmacovigilance Unit at the Irish Medicines Board (IMB) (imbpharmacovigilance@imb.ie). Information about adverse event reporting can be found on the IMB website (www.imb.ie). Adverse events may also be reported to Shire Pharmaceuticals Ltd on +44 1256 894000. References: 1. Perez-Lopez FR. Maturitas 2007;58: 117-137. 2. Dawson- Hughes B & Bischoff-Ferrari HA. J Bone Miner Res 2007; 22: S2; v59-v63. 3. Lin JT & Lane JM. Phys Med Rehabil Clin N Am 2005; 16: 109-128. 4. Heaney RP. Endocrinology and Metabolism Clinics 1998; 27(2): 255-265. 5. Hunter DJ & Sambrook PN. Arthritis Res 2000; 2(6): 441-445. 6. Calcichew- D 3 Forte. Summary of Product Characteristics. July 2007. Date of preparation: January 2009. IRE/CDF/09/0001 ®
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