ABSTRACT
PURPOSE/OBJECTIVES: To review literature about hormone-replacement therapy (HRT) for breast cancer survivors, including potential risks and benefits, long-term health outcomes, research directions, and nursing's role in counseling these patients. DATA SOURCES: Journal articles, abstracts, text excerpts. DATA SYNTHESIS: HRT after menopause delivers proven benefits, including decreased risk of cardiovascular disease and osteoporosis and improved quality of life (QOL). As more women survive breast cancer, health risks resulting from treatment-induced menopause must be considered. Breast cancer survivors traditionally have not been offered HRT out of fear of cancer reactivation. This prohibition is being reexamined as data accumulate about estrogen's benefits. CONCLUSION: Further prospective research is needed to develop criteria for the prudent use of HRT after breast cancer. IMPLICATIONS FOR NURSING PRACTICE: Nurses can develop standards for patient education about HRT options and, when they are prescribed, design appropriate tools to measure HRT's impact on QOL, symptom relief, and long-term health outcomes.
Subject(s)
Breast Neoplasms , Estrogen Replacement Therapy/adverse effects , Estrogen Replacement Therapy/nursing , Patient Education as Topic , Survivors , Breast Neoplasms/chemically induced , Female , Humans , RiskABSTRACT
This paper describes a nutrition education experiment in which traditional direct instruction was compared with a problem-solving method called anchored instruction (AI). Participants were 69 children ages 9 to 15 years, with insulin-dependent diabetes mellitus (IDDM), who attended a diabetes camp. Following pretesting, campers were assigned to AI or direct instruction control classes. Posttests involved evaluating diabetes knowledge, personal meal plan knowledge, ability to choose an appropriate meal from a buffet line, and ability to pack appropriate meals for an overnight campout. AI and direct instruction both produced significant knowledge gains in this study. However, because the scores for the two groups did not differ, this study was unsuccessful in replicating results of other studies or extending the findings to selected measures of actual behavior.
Subject(s)
Diabetes Mellitus, Type 1/diet therapy , Nutritional Sciences/education , Patient Education as Topic/methods , Adolescent , Child , Female , Humans , Male , Nursing Evaluation Research , Problem Solving , Teaching/methodsABSTRACT
This study's hypotheses were that both shortly after instruction and after an 8-month follow-up, diabetic children taught via anchored instruction (AI), a format for problem solving, would outperform controls. Subjects were 81 9-15-year-old campers with insulin dependent diabetes who were randomly assigned to AI or control groups for two 45-min small group teaching sessions. Als viewed a video about a girl who mismanages her diabetes during intercurrent illness, and they were challenged to identify, define and solve her errors. Controls learned sick-day management via conventional direct instruction. At the end of the 2-week camp, AI and control groups' scores on factual knowledge were equal. AIs were more likely than controls at the end of the camp (0.75 vs. 0.54, P < 0.05) and 8 months later (0.59 vs. 0.38, P < 0.02) to provide a rationale for the use of remembered guidelines. Across all campers, this ability to link guidelines and their rationales was significantly correlated (r = 0.55, P < 0.01) with the number of self-management practices employed by campers who suffered an illness between the end of camp and the 8-month follow-up. Only one long-term behavioral difference between groups emerged: Als' parents shared in making most diabetes decisions on sick days, while controls' parents left more decision making to their children. AI appears at least as good as conventional teaching, and may better 'link' rules and reasons, perhaps aiding daily real-life problem solving.
Subject(s)
Diabetes Mellitus, Type 1/prevention & control , Patient Education as Topic/methods , Problem-Based Learning/methods , Self Care , Teaching Materials , Videotape Recording , Adolescent , Analysis of Variance , Camping , Child , Cooperative Behavior , Diabetes Mellitus, Type 1/complications , Educational Measurement , Female , Follow-Up Studies , Humans , Male , Parents/education , Parents/psychology , Practice Guidelines as Topic , Program Evaluation , Self Care/methods , Self Care/psychology , TennesseeSubject(s)
Hospital-Patient Relations , Patient Advocacy , Respiratory Therapy Department, Hospital/trends , Efficiency , Forecasting , Organizational Culture , Patient Satisfaction , Planning Techniques , Quality of Health Care/trends , Respiratory Therapy/education , Respiratory Therapy/trends , Respiratory Therapy Department, Hospital/organization & administration , Staff Development/trends , United States , WorkforceABSTRACT
Anterior cervical fractional interspace decompression (ACFID) is an anterior cervical partial discectomy that provides adequate neuroforaminal decompression but avoids segmental collapse and spontaneous fusion. Of 63 patients, 55 were followed from six to 49 months postoperatively (mean, 23 months). Good or excellent results were obtained in 64% of the patients and in 70% of the non-Workers' Compensation patients. Eighty-five percent of the patients and 91% of the non-Workers' Compensation patients were satisfied with the results of surgery. Eighty-seven percent of the patients returned to their original work status. An average of only 1 mm of disc space height was lost. Only two (4%) disc spaces spontaneously fused. ACFID is indicated for radiculopathy due to both soft and hard discs and can be particularly valuable in treating patients with disc herniation adjacent to a previous fusion or radiculopathy with multiple-level myelographic filling defects.
