Older adult medication compliance: integrated review of randomized controlled trials.

OBJECTIVE: To examine interventions and outcomes of medication compliance studies in older adults. METHODS: An integrated review of randomized controlled trials was completed. RESULTS: Thirty-one of 57 studies reported significantly greater medication compliance in treatment subjects versus control subjects. Interventions included counseling, education, self-medication programs, cues and organizers, and decreasing dosing frequency. Decreasing dosing frequency and self-medication programs were successful, although not frequently evaluated. CONCLUSIONS: Future studies should address methodologic flaws (eg, small sample sizes, measurement validity issues), test theory-based interventions delivered by diverse providers, evaluate intervention dose, and examine persistence of compliance behavior changes.

Dyspnea management in lung cancer: applying the evidence from chronic obstructive pulmonary disease.

PURPOSE/OBJECTIVES: To provide an overview of mechanisms of dyspnea and causes of dyspnea in chronic obstructive pulmonary disease (COPD) and lung cancer and to critically review current pharmacologic and nonpharmacologic management of dyspnea for COPD and lung cancer. DATA SOURCES: Published articles, abstracts, textbooks, and the authors' personal experiences with dyspnea management in COPD and lung cancer. DATA SYNTHESIS: The causes of dyspnea in cancer are more varied than the causes of dyspnea in COPD; however, many are similar, thus providing the justification for recommending best practice from COPD research to be used in lung cancer. Dyspnea in both diseases is treated by corticosteroids, bronchodilators, antianxiety drugs, local anesthetics, and oxygen. However, when dyspnea is severe, morphine is the first choice. Using specific breathing techniques, positioning, energy conservation, exercise, and some dietary modifications and nutrient supplements can help with dyspnea management. CONCLUSIONS: Pharmacologic and nonpharmacologic management of dyspnea in COPD can be applied to dyspnea related to lung cancer. Further research in the management of dyspnea in lung cancer is required, particularly controlled studies with larger sample sizes, to determine the effectiveness of the application of COPD dyspnea management in lung cancer. IMPLICATIONS FOR NURSING: Previous studies provide a guideline for applying dyspnea management for COPD to cancer. The theoretical frameworks used in previous studies can be modified for conducting further study.

Beyond MEDLINE for literature searches.

PURPOSE: To describe strategies for a comprehensive literature search. ORGANIZING CONSTRUCT: MEDLINE searches result in limited numbers of studies that are often biased toward statistically significant findings. Diversified search strategies are needed. METHODS: Empirical evidence about the recall and precision of diverse search strategies is presented. Challenges and strengths of each search strategy are identified. FINDINGS: Search strategies vary in recall and precision. Often sensitivity and specificity are inversely related. Valuable search strategies include examination of multiple diverse computerized databases, ancestry searches, citation index searches, examination of research registries, journal hand searching, contact with the "invisible college," examination of abstracts, Internet searches, and contact with sources of synthesized information. CONCLUSIONS: Extending searches beyond MEDLINE enables researchers to conduct more systematic comprehensive searches.