Effects of Atomoxetine for the Treatment of Neurogenic Orthostatic Hypotension in Patients With Alpha-synucleinopathies: A Systematic Review of Randomized Controlled Trials and a Focus-Group Discussion

Background@#and PurposeNeurogenic orthostatic hypotension (nOH) is one of the most important nonmotor symptoms in patients with α-synucleinopathies. Atomoxetine is a selective norepinephrine transporter blocker that is a treatment option for nOH. This systematic review and expert focus-group study was designed to obtain evidence from published data and clinical experiences of Korean movement-disorder specialists about the efficacy and safety of atomoxetine for the pharmacological treatment of nOH in patients with α-synucleinopathies. @*Methods@#The study comprised a systematic review and a focus-group discussion with clinicians. For the systematic review, multiple comprehensive databases including MEDLINE, Embase, Cochrane Library, CINAHL, PsycInfo, and KoreaMed were searched to retrieve articles that assessed the outcomes of atomoxetine therapy. A focus-group discussion was additionally performed to solicit opinions from experts with experience in managing nOH. @*Results@#The literature review process yielded only four randomized controlled trials on atomoxetine matching the inclusion criteria. Atomoxetine effectively increased systolic blood pressure and improved OH-related symptoms as monotherapy or in combination with other drugs. Its effects were pronounced in cases with central autonomic failure, including multiple-system atrophy (MSA). Atomoxetine might be a safe monotherapy regarding the risk of supine hypertension. @*Conclusions@#Atomoxetine is an effective and safe option for short-term nOH management, which could be more evident in patients with central autonomic dysfunction such as MSA. However, there is a paucity of evidence in the literature, and data from the focus-group discussion were inadequate, and so further investigation is warranted.

Corticosteroid Injection for Morton’s Interdigital Neuroma: A Systematic Review

Background@#This review aimed to evaluate the effects of corticosteroid injections on Morton’s neuroma using an algorithmic approach to assess the methodological quality of reported studies using a structured critical framework. @*Methods@#Several electronic databases were searched for articles published until April 2020 that evaluated the outcomes of corticosteroid injections in patients diagnosed with Morton’s neuroma. Data search, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and clinical outcomes were evaluated using various outcome measures. @*Results@#With 3–12 months of follow-up, corticosteroid injections provided satisfactory outcomes according to Johnson satisfaction scores except in two studies. Visual analog scale scores showed maximal pain reduction between 1 week and 3 months after injection. We found that 140 subjects out of 469 (29.85%) eventually underwent surgery after receiving corticosteroid injections due to persistent pain. @*Conclusions@#Corticosteroid injections showed a satisfactory clinical outcome in patients with Morton’s interdigital neuroma although almost 30% of the included subjects eventually underwent operative treatment. Our recommendation for future research includes using more objective outcome parameters, such as foot and ankle outcome scores or foot and ankle ability measures. Moreover, studies on the safety and effectiveness of multiple injections at the same site are highly necessary.

Corticosteroid Injection for Morton’s Interdigital Neuroma: A Systematic Review

Background@#This review aimed to evaluate the effects of corticosteroid injections on Morton’s neuroma using an algorithmic approach to assess the methodological quality of reported studies using a structured critical framework. @*Methods@#Several electronic databases were searched for articles published until April 2020 that evaluated the outcomes of corticosteroid injections in patients diagnosed with Morton’s neuroma. Data search, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and clinical outcomes were evaluated using various outcome measures. @*Results@#With 3–12 months of follow-up, corticosteroid injections provided satisfactory outcomes according to Johnson satisfaction scores except in two studies. Visual analog scale scores showed maximal pain reduction between 1 week and 3 months after injection. We found that 140 subjects out of 469 (29.85%) eventually underwent surgery after receiving corticosteroid injections due to persistent pain. @*Conclusions@#Corticosteroid injections showed a satisfactory clinical outcome in patients with Morton’s interdigital neuroma although almost 30% of the included subjects eventually underwent operative treatment. Our recommendation for future research includes using more objective outcome parameters, such as foot and ankle outcome scores or foot and ankle ability measures. Moreover, studies on the safety and effectiveness of multiple injections at the same site are highly necessary.

Practice-based Evidence for Health Promotion in Underserved Clients with Hypertension in Primary Health Care Settings

PURPOSE: The purpose of this study was to explore practice-based evidence for health promotion in vulnerable populations with hypertension in primary health care settings. METHODS: Two methodological procedures were adopted for this triangulation study. In the first phase, the sample was obtained from the computerized clinical data repository of a community nursing center. A total of 286 clients were assessed for hypertension as an actual circulation problem as coded in the Omaha System. In the second phase, a qualitative focus group was surveyed through semi-structured interviews conducted by nine advanced practice nurses who had been serving the hypertensive patients. RESULTS: The community nurses provided essential primary healthcare services including health teaching guidance and counseling, and surveillance to vulnerable populations living in medically underserved community. There was a significant positive correlation between knowledge and behavior (r=.53, p<.01), between knowledge and health status (r=.40, p<.05), and between behavior and health status (r=.48, p<.01). CONCLUSION: This triangulation study encompassed not only quantitative findings from the computerized records of clients but also other information acquired from advanced practice nurses. This study contributes to understanding the importance of health promotion nursing interventions even with populations already diagnosed with chronic diseases such as hypertension.

Evidence-based Nursing Practice for Health Promotion in Adults With Hypertension: A Literature Review

PURPOSE: This paper is a report of the results of a literature review conducted with the goal of identifying the nursing process components: assessment, diagnoses, interventions and outcomes related to health promotion in adults with hypertension in primary settings. METHODS: A search of MEDLINE, CINAHL, and PantherCat Online Catalogue of UWM database, PsycInfo, Cochrane Database, and Social Services Abstracts was conducted to retrieve literature published from 1988 to 2006. RESULTS: A total of 115 articles were reviewed. Overall, 70 relevant studies were selected on health promotion in adults with hypertension in primary settings. A total of 39 nursing process components (nursing diagnoses outcomes and interventions) related to health promotion with adults with high blood pressure were identified in primary healthcare settings. CONCLUSIONS: Research-based evidence material provides an evidence-based nursing practice guideline with specific nursing process components on the topic. The evidence-based nursing practice guideline developed from this referential study for promoting health of adults with hypertension should be reflected in nursing practice in primary healthcare settings. For a future study, focus groups and key informant interview are recommended with nurses who actually provide nursing services in primary healthcare settings to clients who are diagnosed with high blood pressure.

A Study on Spiritual Well-being of Hemodialysis Patients / 간호학회지

The purpose of this study was to investigate the spiritual well-being of hemodialysis patients and the correlation between spiritual well-being and demographic characteristics and disease related characteristics. The subjects for this study were 98 patients who were diagnosed as having chronic renal failure and were being treated at the hemodialysis units of three hospitals located in Seoul, Pusan and Taegu, Korea. Data were collected from October 27, 1997 to November 15, 1997 by an investigator interviewing with a structured questionnaire. Palautizion and Ellison(1982)'s spiritual well-being scale was used after some modification. The results of this study are as follows; To analyze the differences between demographic characteristics, spiritual well-being, and disease characteristics and the spiritual well-being, T-test and ANOVA were used. 1. There were statistically significant differences in spiritual well-being for the demographic characteristics of age(p=0.0145) religious affiliation(p=0.0001) and level of education(p=0.04). 2. There were statistically significant differences in spiritual well-being for the disease characteristics perceived health status(p=0.0014) and vigor(p=0.01). 3. The mean score for spiritual well-being in hemodialysis patients was 57.10of a possible range 22-88. Among the components of spiritual well-being, the mean score for religious well-being was 27.01 of a possible range 11-44, and for existential well-being 30.09 of a possible range of 11-44. 4. Correlation between general characteristics and spiritual well-being showed that there were significantly positive correlations for level f education(p=0.0036), perceived health status(p=0.0001), vigor(p=0.0036), perceived health status(p=0.0001), vigor(p=0.0036) and religion (p=0.0004).