A clinical guideline on the use of acustimulation on managing adult orthopaedic patients with postoperative nausea and vomitingChow, Hoi-yee, Elaine., 周愷怡. January 2011 (has links)
published_or_final_version / Nursing Studies / Master / Master of Nursing
Effectiveness of meal replacement on type 2 diabetes mellitus and intermediate hyperglycemia patients : a systematic reviewWang, Ning, 王宁 January 2014 (has links)
Background: Lifestyle intervention is recommended as one important approach for Diabetes Mellitus management. Type 2 Diabetes Mellitus could be controlled and maintained by lifestyle intervention with no or less medications. It can delay the onset of diabetes related complications. Meal Replacement is one important lifestyle intervention. It modifies the composition and amount of nutrition intake, through daily meal, in order to control body weight and other metabolic indices. Effectiveness of meal replacement was examined by randomized controlled trials. Reviewing these studies systematically would demonstrate the clinical implication and other benefit of meal replacement, further more to guide the implementation in practice. Method: Search the online literature databases for related Randomized Controlled Trials. Analyze and compare different strategies of these interventions, as well as the outcomes. The effect of MR would be categorized into on body weight, on blood glucose, on serum lipid and on hypoglycemic medication and prognosis. The economic benefit would also be one important objective. Result: MR intervention achieved body weight reduction, and considerable controlling effect on glucose and lipid. Majority of studies also reduced the hypoglycemic medication and improved prognosis. Conclusion: MR is one considerable intervention for T2DM and Intermediate Hyperglycemia patients. It could be integrated into structured lifestyle intervention for prevention and treatment. It also brings economic benefit so that reduce health care burden. Further research is needed for better effectiveness in practice. / published_or_final_version / Public Health / Master / Master of Public Health
As rates of obesity have increased this disease has become a common problem that physicians are faced with treating. This paper aims to review the different options for patients and determine the best treatments for obesity. Modalities that are considered include dietary treatment, exercise, pharmacologic treatment, and weight loss surgery. This study compares reduced calorie diets, low fat diets, low glycemic index/load diets, the Mediterranean diet, and low carbohydrate diets. The validity of exercise as an effective prescription for obesity is evaluated and debunked. Pharmacologic treatments that are contrasted include those drug therapies that are currently approved by the United States Food and Drug Administration for the long-term treatment of obesity. Those are orlistat, lorcaserin and phentermine/topiramate. The surgical treatments reviewed include vertical banded gastroplasty, adjustable gastric banding, Roux-en Y gastric bypass, biliopancreatic diversion, and biliopancreatic diversion with duodenal switch. After a comprehensive review of the literature the conclusion reached was that treatment for obesity should begin with the least invasive options and those that have the least potential for harm. That is, diet should be a first course of action. Among diets a Mediterranean diet or another culturally adapted low glycemic index/load diet is best. However, more studies are needed to determine how to translate the diets for different cultures and individual tastes. When diets are unable to produce enough weight loss, pharmacologic treatments are considered. Among them, lorcaserin and phentermine/topiramate do not have enough long-term studies to warrant a strong recommendation as of the publishing of this paper. The only other option available, orlistat, comes with many uncomfortable gastrointestinal side effects, so it is also not an ideal option. In addition, orlistat does not produce the amount of weight loss that is seen with surgical procedures. Patients and physicians considering surgical treatment for obesity will find that the best option is laparoscopic adjustable gastric banding.
No description available.
A randomized comparison of individual cognitive-behavioural therapy and pelvic floor rehabilitation in the treatment of provoked vestibulodyniaGoldfinger, Corrie 20 November 2013 (has links)
Provoked vestibulodynia (PVD) is the most common condition leading to painful intercourse and is currently best understood within a biopsychosocial framework. Although the usefulness of non-medical treatment options for vulvar pain is recognized by many, there is limited research investigating the effectiveness of these treatments using a biopsychosocial approach to outcome measurement. Furthermore, there is little evidence to support the mechanisms by which these treatments lead to pain reduction. This study aimed to address these gaps by investigating two non-medical treatment options: individual cognitive-behavioural therapy (ICBT) and pelvic floor rehabilitation (PFR). Twenty women with PVD were randomly assigned to eight sessions of either ICBT or PFR. Participants were assessed at pre-treatment, post-treatment, and 6-month follow-up via gynecological examination, structured interviews and standardized questionnaires measuring pain, psychological, and sexual variables, quantitative sensory testing, and a pelvic floor muscle (PFM) evaluation. The primary outcome was change in intercourse pain intensity. Secondary outcomes included changes in other features of vestibular pain (e.g., frequency), cotton-swab test pain intensity, vestibular sensitivity, sexual functioning, PFM functioning, and pain cognitions. Changes in psychosexual and PFM functioning were investigated as predictors of treatment outcome. Results indicated no differences in the effectiveness of the treatment groups with respect to pain outcomes, with both groups demonstrating significant reductions in pain. Between-group differences were minimal in other areas, with some suggestion that participants in the ICBT group fared better with respect to sexual functioning, while participants in the PFR group demonstrated more improvements in PFM tone. Participants in both groups demonstrated meaningful improvements in pain cognitions, with the ICBT group demonstrating greater changes in rumination. The study was not able to detect significant predictors of treatment outcome. The results of the study suggest that both ICBT and PFR may lead to clinically meaningful improvements in pain, as well as in other areas of psychosexual functioning. Future treatment studies should consider incorporating general chronic pain clinical trial recommendations to allow for better comparison of outcomes with other studies. / Thesis (Ph.D, Psychology) -- Queen's University, 2013-11-19 18:16:18.353
Yu, Xiao Wen
University of Macau / Institute of Chinese Medical Sciences
The evaluation of three treatment strategies in subjects with type I diabetes mellitus undergoing intensive diabetes management : metabolic, psycho-social and educational implicationsKalergis, Maria. January 1996 (has links)
Three approaches, differing in flexibility of self-adjustments of insulin to food intake & exercise, have been identified in intensive management of Type I diabetes mellitus. They involve the exchange system (Protocols A/B) & carbohydrate counting (Protocol C) dietary strategies. The goal of this cross-over study was to determine differences among the approaches in terms of metabolic control (primarily glycated hemoglobin-GHb) and psycho-social adaptation (quality of life (QofL), self-efficacy (SE), stress & perceived complexity) in 15 adults with insulin-dependent diabetes. / There were no significant differences in terms of metabolic control, self-efficacy and quality of life. Perceived complexity increased (p $<$ 0.0001) as subjects progressed from protocols A to C (least to most flexible). However, the subjects continued with Protocol B (n = 12) or Protocol C (n = 3) at the end of the study. Subjects who were very accurate in their self-monitoring of blood glucose (SMBG) reporting were also accurate in counting carbohydrate (p $<$ 0.001), more confident (SE) in their ability to adjust their insulin (p $<$ 0.05) and more satisfied (QofL) with their diabetes (p $<$ 0.01). / This study indicated that patients who are not ready to undertake carbohydrate counting need not be excluded from intensive management programs. Accuracy in SMBG reporting can be used to direct educational efforts.
Chu, Chung-yin., 朱仲賢.
published_or_final_version / Public Health / Master / Master of Public Health
An evidence-based dietary fiber enrichment programme for relieving constipation in elderly orthopaedic patientsTai, Siu-king, Rosetti, 戴筱荊 January 2013 (has links)
Constipation is a multifactorial digestive disorder highly prevailing among the hospitalized elderly Orthopaedic patients. Unlike Western countries, laxative therapy is used to be the first line remedy for constipation in many hospitals of Hong Kong although fiber-rich diet has been proven by numerous studies as the best alternative with low cost and less complications. This dissertation is a translational nursing research which aims at formulating a programme of using fiber-rich food products for relieving constipation in elderly Orthopaedic patients, based on the best available research evidences. It was started with an integrated and systematic review of papers studying the dietary interventions for relieving constipation and reducing laxative consumption in elderly with ADL dependency. Seven relevant studies were identified and critically appraised using the methodology checklist for RCTs designed by Scottish Intercollegiate Guidelines Network (SIGN). After summarizing and synthesizing the data, three dietary interventions with 1+ level of evidence were concluded as the most effective strategies for eradicating the clinical issue. Following assessment of the implementation potential of the proposed innovation in designated clinical setting in terms of transferability, feasibility and cost-benefit ratio, an evidence-based dietary fiber enrichment programme was developed with recommendations for patient recruitment, intervention and evaluation. Furthermore, to assure a smooth change of practice and to determine the effectiveness of the programme, comprehensive plans of communication with different stakeholders, pilot study and evaluation were also subsequently established. With this evidence-based programme, the prevalence of functional constipation and laxative consumption are hoped to be reduced in elderly Orthopaedic patients. / published_or_final_version / Nursing Studies / Master / Master of Nursing
A clinical guideline for management of lymphoedema using nurse-led manual lymphatic drainage therapy鄧潔心, Tang, Kit-sum January 2013 (has links)
Breast cancer is the number one cancer in female in Hong Kong. Breast cancer-related lymphoedema causes both physical and psychological sufferings in breast cancer survivors and significantly degrades their quality of life. Medical costs for these women are substantially higher than women without lymphoedema. Effective and standardized intervention for these patients will be beneficial to both patients and healthcare institutes. The dissertation aims to evaluate the current evidence on the effectiveness of manual lymphatic drainage in managing breast cancer-related lymphoedema, to develop an evidence-based guideline for nurse-led manual lymphatic drainage in managing breast cancer-related lymphoedema as well as to assess its implementation potential and to design implementation strategies and an evaluation plan for its adoption in a local public hospital in Hong Kong. A systematic search of the literature revealed seven studies on manual lymphatic drainage for breast cancer related lymphoedema that met the selection criteria of the dissertation. Methodological quality of the selected studies was evaluated according to the method developed by the Scottish Intercollegiate Guidelines Network and data were extracted and synthesized. Five of the trials were of moderate to good methodological quality and they demonstrated that manual lymphatic drainage was safe and had additional benefits over exercise and compression alone especially in patients with early lymphoedema. A protocol on manual lymphatic drainage for breast cancer related lymphoedema was subsequently developed. The implementation potential of the protocol in the local setting was established by examining its feasibility, evaluation potential and cost-benefit. Adoption of the program was found to be able to produce a potential annual saving of HK$ 444,200 for the hospital on top of benefits to patients and staff. A three-phase implementation plan was designed in which an implementation team would initiate and guide the proposed change through a careful communication plan and a pilot study would be conducted to confirm feasibility of the protocol. An evaluation plan including patient, healthcare provider and system outcomes would then help ensure the effectiveness and sustainability of the manual lymphatic drainage protocol and guide its future refinement. / published_or_final_version / Nursing Studies / Master / Master of Nursing
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