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 PURPOSE: Neurogenic 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.

Isolated Tuberculous Myositis: A Systematic Review and Multicenter Cases.

Objective: To investigate the clinical features and associated underlying conditions of isolated tuberculous myositis (ITBM), a rare extrapulmonary tuberculosis (TB). Methods: A systematic literature search and a multicenter survey were performed using a triangulation strategy. Data from the identified ITBM cases were extracted and analyzed to determine the underlying conditions, clinical presentations, treatments, and outcomes. Results: Based on the systematic review, we identified 58 ITBM, including 9 pediatric, cases in the literature published from 1981 to 2021 25 (43.1%) immunocompromised and 33 (56.9%) non-immunocompromised patients. Immunocompromised cases had a significant shorter symptom duration (median 30.0 vs. 75.0 days) and a higher prevalence of multilocular involvement (20.8% vs. 0%). Among 24 immunocompromised adult patients, dermatomyositis/polymyositis (DM/PM; n=10, 41.7%) were the most common underlying diseases in adults with ITBM identified in the systematic review. Over the past 20 years, 11 Korean adults with ITBM were identified in the multicenter survey. Of 7 immunocompromised cases, two (28.6%) were DM/PM patients. TB death rate of immunocompromised patients was 0.0% and 5/23 (21.7%) in the pediatric and adult ITBM cases identified in the systematic review, respectively, and 3/7 (42.9%) in survey-identified ITBM cases. Conclusion: ITBM has a unique clinical presentation including fever, tenderness, local swelling, overlying erythema, abscess formation and was associated with a grave outcome, especially in immunocompromised hosts. DM/PM was a highly prevalent underlying disease in both systematic review-identified and survey-identified immunocompromised ITBM patients.

Operative treatment options for Morton's neuroma other than neurectomy - a systematic review.

BACKGROUND: The effectiveness of operative treatments other than neurectomy for Morton's neuroma remains debatable despite several reported studies. This review aimed to evaluate the effects of operative treatments for Morton's neuroma other than neurectomy using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies. METHODS: Several electronic databases were searched for articles published until August 2021 that evaluated the outcomes of operative treatments other than neurectomy in patients diagnosed with Morton's neuroma. Data searches, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the clinical outcomes were evaluated using objective, subjective, and negative outcomes; complications; and reoperation rate and type. RESULTS: After reviewing 11,213 studies, 22 studies were finally included. Although a number of studies with high level of evidence are limited, we divided them according to four categories: (1) neurolysis with or without nerve transposition, (2) minimally invasive nerve decompression, (3) metatarsal osteotomy, and (4) additional procedures after nerve transection or neurectomy. All categories showed reliable outcomes except minimally invasive nerve decompression. The proportion of postoperative neurogenic symptoms was lower with neurolysis than with neurectomy. CONCLUSION: Whether the alternative procedures were superior to neurectomy remains unclear as the number of good quality studies was limited. The proportion of postoperative neurogenic symptoms was lower with neurolysis than with neurectomy. Furthermore, performing simultaneous dorsal transposition of the nerve along with neurolysis is more recommended than neurolysis alone. Surgeons should be more careful with minimally invasive deep transverse intermetatarsal ligament release and metatarsal shortening osteotomy as their effectiveness remains inconclusive. Finally, we strongly recommend performing intramuscular embedding or intermuscular transposition of the nerve cutting end if neurectomy or nerve transection is inevitable. LEVEL OF EVIDENCE: Level III, systematic review.

Corticosteroid Injection for Morton's Interdigital Neuroma: A Systematic Review.

BACKGROUD: 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.

Animal-Assisted Therapy as an Intervention for Older Adults: A Systematic Review and Meta-Analysis to Guide Evidence-Based Practice.

BACKGROUND: Animal-assisted therapy (AAT) can ameliorate diverse health problems in older adults. However, applications of AAT have been limited because of the lack of intervention guidelines for older adults. AIMS: This study aimed to explore applications of AAT to older adults, analyze its health effects, and provide evidence for future interventions. METHODS: A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data were analyzed based on both a narrative synthesis and a meta-analysis specifically for depression. RESULTS: A total of 47 studies were selected for analysis. About 45% focused on older adults with diseases such as dementia, and 57.4% selected dog(s) as an intervention animal. About 34.0% delivered interventions once a week, and the behavioral outcome domain was the most frequently investigated. The meta-analysis showed that the effect sizes of the AAT group were -1.310 (95% CI [-1.900, -.721]). LINKING EVIDENCE TO ACTION: This review provides evidence for AAT as an intervention in the physiological, psychosocial, cognitive, and behavioral domains of older adults. When planning interventions for older adults, nurses should consider intended health outcomes, appropriate therapeutic animals, and the consequent intervention contents.

Congenital heart disease diagnosed with echocardiogram in newborns with asymptomatic cardiac murmurs: a systematic review.

BACKGROUND: More than 50% of newborns with congenital heart disease (CHD) are unrecognized at birth; however, the use of echocardiogram (Echo) for diagnosing CHD in newborns with asymptomatic, non-syndromic cardiac murmurs (ANCM), has not been systematically reviewed yet. We aimed to identify the incidence of CHD diagnosed with Echo and systematically review whether Echo should be recommended in this patient group. METHODS: The methodology utilized in this systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Using the MEDLINE, EMBASE, Web of Science, and Cochrane Library databases, we performed a systematic review of publications reporting CHD diagnosed with Echo in newborns with cardiac murmurs. The quality of the included studies was evaluated using the Study Quality Assessment Tools developed by the National Institutes of Health. RESULTS: Of the 630 studies screened, six cohort studies, four cross-sectional studies, and two case reports were included in this review. The incidence of cardiac murmurs ranged from 0.6-8.6%. Among the 1928 newborns with ANCM, 719 (37.3%) were diagnosed with Echo as having CHD, and ventricular septal defect was the most common congenital malformation. More than 50% of the newborns showed moderate CHD necessitating outpatient cardiology follow-up, and 2.5% had severe CHD requiring immediate interventions, such as cardiac catheterization and heart surgery. CONCLUSIONS: In this systematic review, a high incidence of CHD in newborns with ANCM was detected using Echo. This indicates that the use of Echo for diagnosing CHD in healthy newborns with cardiac murmurs could be helpful in earlier detection of CHD, thereby improving clinical outcomes for newborns with severe CHD.

The long-term structural effect of orthoses for pediatric flexible flat foot: A systematic review.

BACKGROUND: We aimed to evaluate the structural effects of the long-term use of orthoses for pediatric flexible flat foot (PFFF) using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies. METHODS: A comprehensive literature search using five databases, namely MEDLINE, the Cochrane Library, Scopus, the Web of Science, and EMBASE, was performed for pertinent articles published before March 30, 2018. Studies with quantitative data on the effects of the long-term use of orthoses for PFFF were included. The search strategy was adapted as appropriate for all other databases searched considering the differences in indexing terms and search syntax for each database. RESULTS: Randomized controlled trials and prospective cohort studies could not prove the estimated effects of orthoses on the medial longitudinal arch. They revealed that flexible flat feet in young children slowly improved with growth, regardless of the type of footwear used. However, three of four case series studies revealed that positive long-term effects could be achieved using orthoses. CONCLUSION: There is no strong evidence that the long-term use of orthoses improved the structural problem of PFFF.

Community-based intervention to promote breast cancer awareness and screening: the Korean experience.

BACKGROUND: There are many differences in culture, community identity, community participation, and ownership between communities in Western and Asian countries; thus, it is difficult to adopt the results of community intervention studies from Western countries. In this study, we conducted a multicity, multicomponent community intervention trial to correct breast cancer myths and promote screening mammography for women living in an urban community in Korea. METHODS: A 6-month, 2-city community intervention trial was conducted. In the intervention city, 480 women were surveyed at baseline and 7 months later to evaluate the effects of the intervention program. Strategies implemented in the intervention city included community outreach and clinic and pharmacy-based in-reach strategies. RESULTS: This study showed a 20.4-percentage-point decrease in myths about the link between cancer and breast size, a 19.2-percentage-point decrease in myths concerning mammography costs, and a 14.1-percentage-point increase in intention to undergo screening mammography. We also saw a 23.4-percentage-point increase in the proportion of women at the action stage of the transtheoretical model in the intervention city. In the comparison city, smaller decreases and increases were observed. CONCLUSIONS: Our study showed the value of an intervention study aimed at reducing belief in breast cancer myths in an urban community in Korea. The invention also made women more likely to undergo mammography in future.

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.

Using ACHIS to Analyze Nursing Health Promotion Interventions for Vulnerable Populations in a Community Nursing Center: A Pilot Study.

OBJECTIVES: The purpose of the study was to describe the health promotion interventions of nurses serving a low-income urban population in an academic community nursing center (CNC) in Wisconsin. METHODS: The Omaha System (OS) was used to code client problems and nursing interventions for 9,839 visits at the CNC. A dataset created by the Automated Community Health Information System (ACHIS), a computerized clinical information system, was used. A pilot testing was performed with the ACHIS data repository. Each intervention was linked to a nursing diagnosis coded with modifiers as either actual or potential problems or health promotion issues. The Lundeen's Comprehensive Community-based Primary Health Care Model (CCPHCM) which emphasizes primary prevention and health promotion activities served as the conceptual framework for this study. RESULTS: A total of 58,747 modifiers were documented for 58,747 nursing diagnoses where a total of 9,836 nursing interventions were provided to 9,839 community center visits at the CNC. Although a majority of the nursing diagnoses (61.8%) were coded as actual problems as might be expected for this vulnerable population, 38% of the client problems were documented as potential problems (20.6%) and health promotion issues (17.7%.) Health Teaching, Guidance and Counseling (38.9%) and Case Management (25.8%) were the most frequently coded interventions. CONCLUSION: This research adds to the understanding of the importance of nurses' interventions toward health promotion with the vulnerable population. This preliminary analysis suggests that the ACHIS provide a clinical information system for collecting, storing, processing, retrieving, and managing clinical data in a data repository. [Asian Nursing Research 2009;3(3):130-138].

Changes in the ICNP Version 1.0 from Beta 2.

The International Classification for Nursing Practice (ICNP) Programme focuses on terminology for nursing practice and acknowledges that nursing practice is not static but changing and dynamic. A number of major revisions were made to the Beta 2 to develop the ICNP Version 1.0. Although the Beta 2 Version functioned to compare and combine data from different sources, there were many recommendations for improvement. In this paper, we examined the ICNP Version 1.0 and identified the changes from the Beta 2 Version. A major change was the use of new technology for development of the ICNP Version 1.0 using description logics. Another change to the new version is the single classification structure that was refined into representation of a 7 Axis Model. The new coding system and new guidelines for composing statements that were developed using an International Organization for Standardization (ISO) Standard are also discussed.

Participation in the International Classification for Nursing Practice (ICNP) programme.

The International Council of Nurses (ICN) is a federation of 129 national nurses associations. The International Classification for Nursing Practice (ICNP) is a programme of the ICN. The purpose of this paper is to describe the development and maintenance processes of the ICNP Programme that are used to increase participation. These include processes by which the ICNP was and continues to be developed, tested, distributed and implemented worldwide, with emphasis on the current version, ICNP Version 1.0. The ICNP is a unified nursing language that facilitates cross-mapping among local terms and existing terminologies. ICNP conforms to current terminology standards and criteria, for example, ISO standards and HL7. The ICNP Alpha and Beta Versions documented the progress of concept validation and classification of nursing phenomena and interventions. The ICNP Beta 2 Version was a combinatorial terminology organized in two multi-axial structures representing nursing phenomena and nursing actions. The ICNP Version 1.0, launched in 2005, changed the relatively straight-forward multi-axial structure into a compositional terminology through the application of description logics using Web Ontology Language (OWL) within Protégé, an ontology development environment. ICNP Version 1.0 is also represented in a multiaxial model (7-Axis) for nurses to compose nursing diagnosis, intervention and outcome statements. Language translations and clinical information systems applications are required to make the ICNP Version 1.0 available to nurses at the point of healthcare delivery. ICNP data collected in healthcare environments provide standardized terminology for nursing that allows comparison of nursing practice across health care settings, specialties and countries; facilitate data-based clinical and management decision making; and contribute to the development of guidelines and standards for best practices and optimal outcomes for patients, families and communities.