Invest in yourself: the Internet: uses in administrative research and practice

There have been marked movements toward using the Internet in research and practice. No administration today can ignore the Internet either in research or practice. This method has replaced the traditional ways of collecting data and retrieving information. The use of the Internet for data collection and in practice has advantages and disadvantages; however, some researchers and practitioners have to take the lead in using such methodology, since it is a promising means for administrative and nursing research as well as nursing practice.     

Disasters and development: Part 3: Assessing trade-offs in investing in vulnerability reduction

This lesson describes how a government decides whether and how much it should spend on vulnerability reduction. There are techniques and methods by which decision-makers compare development alternatives. The differences between the risk that a potentially catastrophic event will occur and uncertainty are described, with uncertainty providing greater difficulty in economic analyses. There is a range of methods for identifying the complex mix of competing costs and benefits associated with any restructuring of investment priorities to accomplish disaster mitigation. The possibilities are described in terms of the opportunity costs and present value. Impact and consequent losses include: (1) direct monetary effects; (2) indirect monetary effects; (3) direct, non-monetary effects; (4) indirect, non-monetary effects; and (5) loss of non-renewable natural resources. The difficulties in assigning values to these effects are described, as well as the means of judging the cost-effectiveness of such interventions. An advantage of screening projects using a framework of analytical methods is that it can assist in focusing on a variety of possible outcomes and make the factors influencing these outcomes quite explicit.     

Fluconazole and testosterone: in vivo and in vitro studies.

Fluconazole (UK-49,858), a novel bis-triazole antifungal agent, was given orally to groups of 10 male volunteers at doses of 25 and 50 mg/day for 28 days. Blood samples for testosterone estimation were taken from these and from a placebo group at several time points on days 1, 14, and 28 of the study, and the assay results demonstrated that the compound had no significant effect on circulating testosterone levels. Similarly, in studies with rat Leydig cells in vitro, fluconazole at concentrations up to 10 micrograms/ml was found to be only a weak inhibitor of testosterone production, whereas ketoconazole caused more than 50% inhibition at 0.1 microgram/ml. It is concluded that fluconazole, in contrast to ketoconazole, has little effect on the biosynthesis of testosterone by mammalian cells.     

Inequalities in health: Evaluation and effectiveness in practice

This paper details the findings from a project that assessed the contribution made by nurses, midwives and health visitors to targeting health and social need. This is an important theme within the Northern Ireland Regional Strategy entitled 'Health and well-being into the next millennium: a regional strategy for health and social well-being 1997-2002', which is concerned with addressing inequalities in health status and social well-being. In response to this initial survey, the paper also highlights the second phase of the project that was the development of an evaluation manual specifically designed to assist health-care practitioners in establishing evaluation frameworks and in applying evaluation techniques and methods. The paper describes four research case studies that are intended to illustrate the kinds of evaluation methods necessary to cover the stages of evaluation, needs assessment, structure, process and outcome, and to reflect the experience of applied evaluation as it occurs in practice as opposed to how it appears in textbooks.     

Insomnia in Adults: Etiology and Management

Insomnia is a significant problem in adults that frequently goes undiagnosed and untreated. Untreated insomnia is often associated with undiagnosed medical or psychiatric disorders that increase morbidity and mortality. Sleep patterns change with aging, and the presence of comorbid conditions leads to a higher prevalence of sleep disorders in older adults. Practitioners should inquire about sleep disorders with every patient encounter to increase diagnosis and treatment. Effective treatment of insomnia is available with nonpharmacologic and pharmacologic treatment modes.     

Aspirin: benefit and risk in thromboprophylaxis

Aspirin is often perceived either as a harmless panacea or as a useless poison which causes endless, needless trouble. We have carefully reviewed the literature on all aspects of aspirin and find that neither view is justified. Regular use of even low-dose aspirin (150 mg/day or less) may lead to clinically-important adverse events, particularly haemorrhage. The risk of such an event is considerably outweighed by the benefit for patients with a significant risk of a thromboembolic event. For individuals without a clear risk of thrombosis or thromboembolism, the balance is more even: indiscriminate aspirin- taking is to be discouraged.      

Hypertension in pregnancy: diagnosis and treatment

Hypertension affects 10% of pregnancies in the United States and remains a leading cause of both maternal and fetal morbidity and mortality. Hypertension in pregnancy includes a spectrum of conditions, most notably preeclampsia, a form of hypertension unique to pregnancy that occurs de novo or superimposed on chronic hypertension. Risks to the fetus include premature delivery, growth retardation, and death. The only definitive treatment of preeclampsia is delivery. Treatment of severe hypertension is necessary to prevent cerebrovascular, cardiac, and renal complications in the mother. The 2 other forms of hypertension, chronic and transient hypertension, usually have more benign courses. Optimal treatment of high blood pressure in pregnancy requires consideration of several aspects unique to gestational cardiovascular physiology. The major goal is to prevent maternal complications without compromising uteroplacental perfusion and fetal circulation. Before an antihypertensive agent is prescribed, the potential risk to the fetus from intrauterine drug exposure should be carefully reviewed.     

Pain in dementia: recognition and treatment

The presentation and management of pain in older adults with dementia are highly complicated. This article addresses assessment challenges and nonpharmacological and pharmacological management strategies related to pain in those with dementia. Vigilant monitoring of comfort level and the effective use of multidimensional pain management strategies could substantially increase quality of life for older adults with dementia.     

Osteoporosis in men: prevalence and investigation

In the past, osteoporosis was thought to affect only women; however, in the last decade it has become apparent that osteoporosis is common in men, particularly elderly men. Osteoporosis affects as many as 2 million men in the United States. Osteoporosis most commonly affects the hip and the lumbar vertebrae, but other bones, such as the radius, tibia, and ribs, may also fracture. The main feature of the etiology of the disease is that low bone mineral density results in increased susceptibility to bone fracture. The World Health Organization has defined osteoporosis as a bone mineral density T-score value >2.5 SDs below the mean observed in young adult women. Although the validity of this score for evaluating men has been questioned and it is not clear whether a male or female reference database should be used, it is nonetheless often used in this way. The disease affects men differently than women in a number of respects. It manifests itself later in life in men than in women, probably because men initially have greater bone mass. Mortality and morbidity associated with hip fractures are high in all elderly individuals, but they are substantially higher in men than in women. Unlike in women, there is an underlying cause for the osteoporosis in almost half of affected men. Thus, for elderly men, a complete history and physical examination may reveal some remediable conditions; treating these may stop further progression of the disease and prevent further morbidity or mortality. Corticosteroid therapy for arthritis or asthma is a common cause of osteoporosis in elderly men. Hypogonadism is a recognized cause of osteoporosis in men treated for carcinoma of the prostate with androgen withdrawal therapy; treatments to modify the effects of these agents on bone are available. Consumption of large amounts of alcohol will eventually result in osteoporosis in some elderly men. Moreover, alcohol can predispose confused elderly patients to falls and to fracture bones that are already osteoporotic. Hyperthyroidism is associated with a reduction in bone mineral density and an increased likelihood of bony fracture. A careful search for undiagnosed hyperthyroidism in elderly osteoporotic men may prove worthwhile. Vitamin D deficiency is common among older men and could contribute to an increase in fractures. Routine analyses of blood and biochemistry should be carried out in any older male patient with newly diagnosed osteoporosis. Dual x-ray energy absorptiometry should be performed on every new patient with newly diagnosed osteoporosis.