Cognitive-behavioral therapy for anxious children: from evidence to practice.

BACKGROUND: Anxiety is the most common mental health problem in children, yet less than one third of children with anxiety disorders seek treatment. Cognitive-behavioral therapy (CBT) is recommended as a first-line treatment for childhood anxiety. However, current practice generally does not include CBT due to issues of feasibility, affordability, and transportability. AIMS: The primary purpose of this review was to appraise current literature regarding the effectiveness of individual CBT for childhood anxiety. Secondary purposes were to identify reasons for the discrepancy between current evidence and practice as well as to offer suggestions to overcome this dilemma. METHODS: A systematic review of the literature published between 2007 and 2012 was conducted, searching four databases--Cochrane, PubMed, CINAHL, and PsycINFO. FINDINGS: In all 10 studies reviewed, individual CBT significantly reduced rates of anxiety diagnoses when compared with controls, and was equally effective or superior to comparison therapies. The only exception was when CBT was compared to a combination of CBT and pharmacological management, in which case the latter was more effective. LINKING EVIDENCE TO ACTION: Each study included in this review employed hour-long sessions over a minimum of 12 visits. In order to meet clinical demands and patient preferences, affordability, and feasibility of CBT interventions must be addressed. A brief, manualized CBT program that can be supported to be clinically effective is proposed as an evidence-based solution for anxious children in outpatient mental health and primary care settings.

Using clinical pathways to aid in the diagnosis of necrotizing soft tissue infections synthesis of evidence.

BACKGROUND: Necrotizing soft tissue infections (NSTIs) are rare, rapidly spreading infections that occur in the soft tissue compartments. The mortality rate is high and has been found to decrease if patients are treated early and aggressively with surgical debridement and broad-spectrum antibiotics. Unfortunately these infections present similarly to other types of skin and soft tissue infections (SSTIs) making diagnosis difficult. AIMS: This paper reviews the evidence surrounding the early diagnosis of NSTIs. This was used to develop a clinical practice guideline (CPG) for implementation in the emergency department (ED) setting to assist the provider in distinguishing NSTIs from SSTIs to potentially decrease the time from presentation to diagnosis. METHODS: A review of the literature was performed. Studies were identified and critiqued by two reviewers independently for clinical relevance, study design, and statistical analysis. RESULTS: Signs and symptoms, or "hard signs," associated with NSTIs include: pain out of proportion to the exam, rapidly spreading infection, presence of bullae, skin ecchymosis or sloughing, gas in the tissues, skin anesthesia, edema extending beyond the erythema, and symptoms of sepsis. Unfortunately only 43% of the patients with an NSTI will present with these signs. Studies have found an association between laboratory values and NSTIs with the most commonly associated findings being leukocytosis, azotemia, and hyponatremia. Using these complimentary clinical and laboratory values, the Laboratory Risk Indicator for NECrotizing fasciitis (LRINEC) score is an emerging tool that providers can use to determine the risk of an NSTI. A clinical pathway was developed and implemented in the ED for all patients presenting with an SSTI to assist providers in confirming or negating the presence of an NSTI. IMPLICATION FOR PRACTICE: Educating ED providers about the signs, symptoms, and laboratory findings associated with NSTIs will lead to earlier diagnosis and treatment and decreased morbidity and mortality.

A literature review on breathing retraining as a self-management strategy operationalized through Rosswurm and Larrabee's evidence-based practice model.

PURPOSE: The purpose of this article is to critically appraise and synthesize the literature on breathing retraining as a self-management strategy for individuals with chronic obstructive pulmonary disease (COPD) guided by Rosswurm and Larrabee's evidence-based practice model. DATA SOURCES: Scientific literature review, grey literature review, and hand searching. CONCLUSIONS: An exhaustive review of the literature revealed evidence that regularly practiced pursed lip breathing is an effective self-management strategy for individuals with COPD to improve their dyspnea. IMPLICATIONS FOR PRACTICE: It is expected that implementation of this non-pharmacological self-management intervention will improve perception of dyspnea, functional performance, and self-efficacy in individuals with COPD.

A review of the efficacy of the self-management model on health outcomes in community-residing older adults with arthritis.

BACKGROUND: Chronic disease and disability have a significant impact on individuals, families, and society, resulting in limitations in personal care, premature loss of wages, higher mortality rates, and overall poor quality of life. Arthritis is a painful disease that limits physical activity, social functioning, and mental health and is hallmarked by an increasing prevalence in community-dwelling older adults. Self-management strategies reduce pain and disability while improving self-efficacy and quality of life. AIMS: The purpose of this review is to evaluate the efficacy of the self-management program in adults with arthritis on the outcome of functional disability. METHODS: Literature review. Search strategy included MEDLINE, CINAHL, and the Cochrane Library from 1985 to 2008 for studies using self-management interventions. RESULTS: Across studies of chronic disease, effect sizes were moderate for most variables. Subgroup ana- lyses for arthritis only demonstrated a greater magnitude of effect in variables related to functional health. CONCLUSIONS: While this review suggests small efficacy in the self-management program, with improvement in certain cognitive-behavioral markers for self-management, the functional gains that can be achieved in a growing older adult population translate into a larger effect overall.

Community-based senior health promotion program using a collaborative practice model: the Escalante Health Partnerships.

Recent research demonstrates that, although the risk of disease and disability clearly increases with age, poor health need not be an inevitable consequence of aging. A healthy lifestyle is more influential than genetic factors in assisting older adults avoid the decline and deterioration traditionally associated with aging. Many effective strategies for reducing disease and disability are widely underused. The Escalante Health Partnerships is a community-based, nurse-managed health promotion and chronic disease care management program for community-residing older adults. The program base supports a multidisciplinary, collaborative practice model, which has responded to the health needs of members of a community at high risk of having or developing chronic conditions. Preliminary comparisons of the health status of program participants with national norms demonstrate that these seniors report better general health, performance of roles, and social functioning, with the strongest correlations occurring between general health and vitality and between general health and role-physical. In addition, these participants have 4.2 doctor visits per year, in comparison with 7.1 office visits for a national comparison group and 1.6 hospital days per year, in comparison with 2.1 hospital days in the same referenced population. This collaborative partnership is a model that can be replicated cost-effectively in other communities.