The effectiveness of an osteoporosis prevention education programme for women in Hong Kong: a randomized controlled trial

Aims. The purpose of this study was to evaluate whether a nurse‐initiated education programme on four specific osteoporosis‐prevention related behaviours leads to their adoption or positive attitude changes compared with women who did not participate in this programme. Research method. The design was a randomized controlled design and the setting was a local private beauty clinic. Outcome measures. Pre‐, post‐ and follow‐up education data compared attitudes and consumption frequency before and after the education programme. Results. The results showed significant increases in the reported follow‐up for each behaviour: consumption of soya foods (mean = 4·3, SD = 0·5), milk (mean = 4·2, SD = 0·8), more exercise (mean = 4·3, SD = 0·5) and vitamin D/exposure to sunlight (mean = 4·2, SD = 0·9) for subjects in the case group compared with control group subjects (soya foods: mean = 3·3, SD = 0·9, P < 0·001; milk: mean = 3·0, SD = 0·9, P < 0·001; more exercise: mean = 3·4, SD = 1·0, P = 0·003; vitamin D/sunlight: mean = 2·7, SD = 0·9, P < 0·00). Most of the participants either disagreed (n = 11, 55·0%) or strongly disagreed (n = 9, 45·0%) that there was not enough information provided in the education programme to motivate them to change. On the satisfaction score, they rated the nurse's performance as either satisfactory (n = 11, 55·0%) or very satisfactory (n = 9, 45·0%) on presentation and ability to answer their questions and either satisfactory (n = 12, 60·0%) or very satisfactory (n = 8, 40·0%) on ability to describe each behaviour clearly. Conclusion. A targeted education programme conducted with Hong Kong women resulted in significantly increased consumption of calcium including soya‐based foods, milk and vitamin D. According to the reported attitudinal and behavioural intentions, participants’ positive feedback suggests that women who participated in this educational programme were motivated to make changes and benefited from the support of this nurse‐initiated education programme. Relevance to clinical practice. Osteoporosis was a serious health concern that most commonly affected women. As indicated by the results of this study, this educational programme can act as simple but effective nursing intervention to promote women's attitudinal and behavioural intentions towards osteoporosis‐prevention.     

Evaluation of an educational programme for family members of patients living with heart failure: a randomised controlled trial

Aims and objectives. To evaluate the effect of a group‐based multi‐professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. Background. When a person is diagnosed with heart failure, the daily life of the family members is also affected. Design. Randomised controlled trial. Methods. A total of 128 family members were randomly assigned to participate in a multi‐professional educational programme or a control group. Analysis of variance and regression analysis were used. Results. There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R² = 0·35) and depression (p = 0·021, R² = 0·37). Younger family members were found to have a higher quality of life (p < 0·01). Conclusion. Improved disease‐related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. Relevance to clinical practice. Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.     

Evaluating the effects of an Internet education programme on newborn care in Taiwan

Aim. The objectives of this study were to evaluate an Internet education programme provided to primigravida in the third trimester of pregnancy with the aim of enhancing mothers’ knowledge about newborn care and increasing their maternal confidence. Background. Shorter hospital stays have had an impact on the traditional role of mother–baby nurses in providing education about parenting to their parturient women. Internet education is an efficient way to provide nursing instruction. Design. A randomised controlled trial was used. A total of 118 women receiving prenatal care in a hospital clinic who met study criteria and who consented were assigned randomly to intervention and control groups. The study was conducted at a hospital in Taiwan. Methods. The target population was women at 32–34 weeks gestation, using the Internet on a regular basis. The primigravida were randomly assigned to either the control group (n = 57) or the experimental group (n = 61). Two primary outcome measures were newborn‐care knowledge and maternal confidence. Results. The changes in newborn‐care knowledge were 7·21 for the experimental group, compared with 1·95 for the control group; the difference between the least‐squares means computed by ancova was 5·73 and statistically significant (p < 0·001). The changes in maternal confidence were 8·46 for the experimental group and 3·05 for the control group; the difference between the least‐squares means computed by ancova was 5·94 and statistically significant (p < 0·001). Conclusion. Results suggest that Internet education about newborn care may contribute to greater care knowledge and maternal confidence. Relevance to clinical practice. Internet newborn‐care education programmes can achieve success in promoting newborn care and provide health professionals with evidence‐based intervention.     

Promoting evidence-based childhood fever management through a peer education programme based on the theory of planned behaviour

Aims and objectives. This study examined effectiveness of a theoretically based education programme in reducing inappropriate antipyretic use in fever management. Background. Paediatric nurses’ inconsistent, ritualistic antipyretic use in fever management is influenced by many factors including inconsistent beliefs and parental requests. Determinants of antipyretic administration, identified by the theory of planned behaviour, were belief‐based attitudes and subjective norms. Design. A quasi‐experiment explored group effects of a peer education programme, based on the theory of planned behaviour, on factors influencing paediatric nurses’ antipyretic administration. Surveys and chart audits collected data from medical wards at experimental and control hospitals one month pre and one and four months postpeer education programme. Methods. All nurses employed in targeted wards were eligible to participate in surveys and all eligible charts were audited. The peer education programme consisted of four one‐hour sessions targeting evidence‐based knowledge, myths and misconceptions, normative, attitudinal and control influences over and rehearsal of evidence‐based fever management. All nurses in experimental hospital targeted wards were eligible to attend. Peer education and support facilitated session information reaching those unable to attend sessions. Results. Two‐way univariate anova s explored between subject, experimental and control group and within subject factors, pre, post and latency data. Significant interactions in normative influence (p = 0·01) and intentions (p = 0·01), a significant main group effect in control influence (p = 0·01) and a significant main effect between audit data across time points (p = 0·03) highlight peer education programme effectiveness in behaviour change. Normative, control and intention changes postpeer education programme were maintained in latency data; mean temperature was not. Conclusion. The peer education programme, based on a behaviour change theory, initiated and maintained evidence‐based intentions for antipyretics use in fever management. Relevance to clinical practice. The promotion of evidence‐based change in organizational unit intentions and behaviour highlights the crucial role peer support and education can play in continuing educational programmes.     

Effects of a feeding skills training programme on nursing assistants and dementia patients

Aims and objectives. The purposes of this study were to develop a comprehensive feeding skills training programme for nursing assistants and to test the effects of this training programme on their knowledge, attitude and behaviour and the outcome of dementia patients including total eating time, food intake and feeding difficulty. Background. Dementia patients have a high probability of feeding problems that result in a substantial risk of malnutrition. Assisting residents with eating is a major task for nursing assistants and they require better training to provide adequate quality of nutritional care. Design methods. A quasi‐experimental study was conducted. Two convenience‐chosen dementia‐specialized long‐term care facilities in North Taiwan were randomly assigned into either a control or a treatment group. Sixty‐seven nursing assistants were enrolled (treatment: 31; control: 36). Twenty nursing assistants and the same number of dementia patients were observed during mealtime. The treatment group participated in a feeding skills training programme including three hours of in‐service classes and one hour of hands‐on training, whereas the control group did not receive any training. Results. The treatment group had significantly more knowledge (F = 47·7, P < 0·001), more positive attitude (F = 15·75, P = 0·001) and better behaviours (t = 6·0, P < 0·001) than the control group after the intervention. Dementia patients in the treatment group had significantly longer total eating time (t = 2·7, P < 0·05) and higher Edinburgh Feeding Evaluation in Dementia scores (more feeding difficulty) (t = 2·1, P < 0·05) than the control group. There was no significant difference on food intake between the two groups (t = 0·8, P = 0·49). Conclusion. This feeding skills training programme has been found to change nursing assistants’ knowledge, attitude, and behaviour as well as increasing the eating time for the dementia patients. Relevance to clinical practice. This study raises attention regarding on‐the‐job training for nursing assistants. Furthermore, the feeding problems among dementia patients should be further explored as well as the nutritional care.     

The depression status of patients with end‐stage renal disease in different renal replacement therapies

Depression is a common emotional problem among end‐stage renal disease (ESRD) patients, but there is a paucity of research comparing the prevalence of depression between patients in different types of renal replacement therapies in Taiwan. The purpose of this study was to describe the prevalence of depression among ESRD patients in Taiwan who received different treatment regimens, and to determine the factors related to depression among these participants across various treatment regimens. A convenience sample of 342 participants was recruited from two medical centres. Participants were diagnosed with ESRD and received one of three renal replacement therapies, and screened for depression using the Taiwanese Depression Questionnaire (TDQ). The prevalence of depression (defined as TDQ score above 19) varied by treatment type: 36·3% (27/102) among peritoneal dialysis (PD) patients, 18·5% (17/92) among haemodialysis (HD) patients and 14·8% (21/142) among transplant patients. There were significant differences in the TDQ scores between the three treatment types (p < 0·001), indicating that participants' depression status varied by treatment type. Prevalence of depression among PD patients was higher than among HD and transplant patients. Logistic regression analysis revealed that treatment duration (p < 0·01) was a predictor of PD patients' depression, whereas self‐reported health status was a predictor of depression among both HD patients (p < 0·01) and transplant patients (p < 0·05). Screening for and treatment of depression should be important parts of the standard care of ESRD patients. Pre‐ and post‐therapy counselling by nurses and early recognition of emotional difficulties may also help these patients adapt to psychosocial stressors.     

A comparison of written materials vs. materials and counselling for women with sexual dysfunction and multiple sclerosis

Aim. Evaluate whether symptoms of vaginal dryness, low libido, less intense or delayed orgasm could be improved in women with multiple sclerosis who took part in an education or education plus counselling programme. Background. Sexual dysfunction, a prevalent symptom in women with multiple sclerosis, can negatively affect quality‐of‐life. Methods. Women attending a large multiple sclerosis clinic were invited and 62 were randomized into one of two groups. Group 1 received written materials on primary, secondary and tertiary sexual dysfunction in multiple sclerosis as well as additional resources (books, websites, list of local psychologists specializing in sexual counselling). Group 2 received the same written materials as well as three counselling sessions from the clinic nurse, the latter two by telephone. The primary outcome measures were the expanded disability status scale and the multiple sclerosis intimacy and sexuality questionnaire‐19. Repeated‐measures analysis of variance was used to evaluate sexual dysfunction score over time and to compare two groups. Results. At baseline, total expanded disability status scale scores were not correlated with primary, secondary or tertiary sexual dysfunction. Total multiple sclerosis intimacy and sexuality questionnaire‐19 score was correlated with use of anti‐cholinergic medications [r (54) = 0·28, P < 0·05], but no other medications, alcohol or tobacco use. Both groups had equivalent and significant reductions in primary sexual dysfunction [F (1) = 14·79, P < 0·001] postintervention. There was a trend towards an interaction effect for tertiary sexual dysfunction [F (1) = 2·88, P = 0·096], in the direction of group 2 (education and counselling). Subjectively, women welcomed the opportunity to discuss sexual concerns and noted that the written information allowed a framework for initiating discussion with their spouses. Conclusion. Relatively straightforward interventions provided by a clinic nurse may help women cope with the symptoms of sexual dysfunction associated with multiple sclerosis. Women who do not benefit from basic interventions could then be referred to an expert sexual dysfunction practitioner. Relevance to clinical practice. Women with multiple sclerosis experience many disease‐related physical and emotional challenges of which sexuality is only one. Sensitivity to sexual dysfunction and being willing to approach the topic is appreciated by women with multiple sclerosis. Nurses do not require in‐depth expertise to offer some basic suggestions which may significantly improve life quality and assist the woman with multiple sclerosis to talk about or cope with sexuality issues.     

Effects of the culturally-sensitive comprehensive sex education programme among Thai secondary school students

Title. Effects of the culturally‐sensitive comprehensive sex education programme among Thai secondary school students. Aim. This paper reports on a study to evaluate the effectiveness of a culturally‐sensitive comprehensive sex education programme among Thai secondary school students. Background. Increasing number of adolescents in Thailand have been engaging in premarital sex. No theory‐based, abstinence‐oriented models of sex education have been evaluated in this population. Method. A quasi‐experimental study was conducted in 2006–2007. Outcome measures included sexual behaviour, condom use, intention to refuse sex, intention to use condoms, and knowledge regarding sexually transmitted infections/human immunodeficiency virus/acquired immunodeficiency syndrome and pregnancy. Findings. Students in the experimental group had lower levels of reported sexual intercourse at 3‐ and 6‐month follow‐ups, compared with those in control group (P < 0·01). Students participating in the programme had significantly greater intention to refuse sex in the future across time than controls (P < 0·05). Sexually active adolescents participating in the programme reported significantly lower frequencies of sexual intercourse across time than controls (P < 0·01). However, the programme did not influence consistent condom use (P > 0·05), although the intervention was associated with increased intention to use condoms (P < 0·01). Knowledge about sexually transmitted infections/human immunodeficiency virus/acquired immunodeficiency syndrome and pregnancy among students in the intervention group was significantly greater than that of the controls (P < 0·05). Conclusion. School nurses can play a major role by applying this kind of sex education programme. For nurse researchers, it would be useful to extend this research by considering alternative ways to foster condom use in the non‐commercial partnerships that have become common among adolescents.     

Individualized programme to promote self-care among older adults with asthma: randomized controlled trial

Title. Individualized programme to promote self‐care among older adults with asthma: randomized controlled trial. Aim. This paper is a report of a trial to examine the effectiveness of individualized self‐care education programmes in older adults with moderate‐to‐severe asthma. Background. Asthma is a common chronic disease in adults and a major cause of frequent work absences, emergency room visits, and hospitalization. The results of studies of self‐care education programmes have been largely supportive and suggest that they have positive outcomes for people with asthma. However, for older people with asthma, the effectiveness of computer‐aided, self‐learning video programmes has been controversial. Methods. Older adult patients with asthma (N = 148) were randomly assigned to one of three groups: usual care, individualized education, or individualized education with peak flow monitoring, and followed for 6 months. Data were collected from January to December 2006. The variables studied included demographic data, asthma self‐care competence, asthma self‐efficacy, and asthma self‐care behaviour. Findings. Patients in both individualized education groups reported higher asthma self‐care competence scores (F = 334·06 and 481·37, P < 0·001) and asthma self‐care and self‐efficacy scores (F = 104·08 and 68·42, P < 0·001) than patients in the usual care group. In addition, patients who received individualized education with peak flow monitoring had statistically significantly higher asthma self‐care behaviour and self‐efficacy scores (P < 0·001) and asthma control indicators (P = 0·025) than the education alone group. No differences were found among the three groups in unscheduled health service usage. Conclusion. Our results suggest that individualized education helps older people with asthma to enhance their self‐care behaviours, manage their disease, and increase their quality of life.     

A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failure

Aims and objectives. To evaluate the effectiveness and cost‐effectiveness of a community nurse‐supported hospital discharge programme in preventing hospital re‐admissions, improving functional status and handicap of older patients with chronic heart failure. Design. Randomized controlled trial; 105 hospitalized patients aged 60 years or over with chronic heart failure and history of hospital admission(s) in previous year were randomly assigned into intervention group (n = 49) and control group (n = 56) for six months. Intervention group subjects received community nurse visits before discharge, within seven days of discharge, weekly for four weeks, then monthly. Community nurse liaised closely with a designated specialist in hospital and were accessible to subjects during normal working hours. Control and intervention group subjects were followed up in the same specialist medical clinics. Primary outcome was the rate of unplanned re‐admission at six months. Secondary outcomes were number of unplanned re‐admissions, six‐minute walking distance, London Handicap Scale and public health care and personal care costs. Results. At sixth months, the re‐admission rates were not significantly different (46 vs. 57% in control subjects, p = 0·233, Chi‐square test). But the median number of re‐admissions tended to lower in the intervention group (0 vs. 1 in control group, p = 0·057, Mann Whitney test). Intervention group subjects had less handicap in independence (median change 0 vs. 0·5 in control subjects, p = 0·002, Mann Whitney test), but there was no difference in six‐minute walking distance. There was no significant group difference in median total public health care and personal care costs. Conclusion. Community nurse‐supported post‐discharge programme was effective in preserving independence and was probably effective in reducing the number of unplanned re‐admissions. The cost benefits to public health care were not significant. Relevance to clinical practice. Older chronic heart failure patients are likely to benefit from post‐discharge community nurse intervention programmes. More comprehensive health economic evaluation needs to be undertaken.     

The effects of gender and age on health-related quality of life following kidney transplantation

Aims and objectives. To evaluate whether gender, age and their interaction affect health‐related quality of life and overall health status following kidney transplantation. Background. Some investigators have examined the main effects of gender and/or age on health‐related quality of life following kidney transplantation, but the potential interaction effect of these measures on this outcome has not been reported. Design. This was a cross‐sectional, single‐centre study, based in one US geographic area. Methods. Self‐report survey data were provided by adult kidney transplant recipients using the SF‐36 Health Survey (SF‐36) and a visual analogue scale of overall health. SF‐36 physical and mental component summary and individual scales and overall health were measured prospectively at one time point post‐transplant. All adult patients were eligible to participate and rolling enrolment was employed. Statistical effects were tested using analysis of covariance (controlling for time post‐transplant). Results. Subjects (n = 138) included 66 women and 72 men. There were no effects of gender, age group, or their interaction on MCS or overall health scores (all p ≥ 0·12). Physical component summary scale data demonstrated: (i) a significant effect of gender (p = 0·025); (ii) a statistically marginal effect of age group (p = 0·068); and (iii) a statistically marginal gender by age group interaction effect (p = 0·066). Women reported poorer scores on the SF‐36 physical functioning (p = 0·049), role physical (p = 0·014) and bodily pain scales (p = 0·028). There was an effect of age group on physical functioning (p = 0·005), with younger patients reporting higher scores. Conclusions. Women report lower scores on several physical measures and may experience a greater reduction with age in physical health‐related quality of life than men. Physical functioning declines with age following kidney transplantation. Relevance to clinical practice. Findings may help healthcare professionals to develop gender‐ and age‐specific interventions to optimize health‐related quality of life of kidney transplant patients.     

Persistence and compliance of deferoxamine versus deferasirox in Medicaid patients with sickle-cell disease

What is known and Objective: Patients with sickle‐cell disease (SCD) receiving chronic transfusions of red blood cells are at risk of developing serious adverse effects. Iron chelation therapy (ICT) helps eliminate iron overload by binding with plasma iron to form a non‐toxic conjugate that can be safely excreted from the body. Two iron chelating agents are currently available in the United States: Deferoxamine (DFO) is an injectable formulation, and deferasirox (Exjade^®) is an oral suspension. This study compared the frequency of hospitalizations, persistence and compliance of patients with SCD from Medicaid programmes treated with DFO vs. deferasirox. Methods: Health care claims from Medicaid Florida (1998–2007), Missouri (1993–2008) and New Jersey (1996–2008) were analysed. Patients with continuous enrolment for ≥6 months prior to ICT initiation and ≥1 SCD diagnosis were included in the analysis. Patients were divided into four cohorts: patients treated with DFO (any‐DFO group) and patients treated with deferasirox (any‐deferasirox group); the latter was further divided into patients initiated on DFO and then switched to deferasirox (deferasirox switchers), and patients treated with deferasirox‐only (deferasirox‐only group). Frequency of hospitalization for crisis conditions related to SCD as well as length of stay pre‐ and post‐ICT treatment initiation were assessed. Persistence was defined as time to drug discontinuation with ≥1 Rx gap, using Kaplan–Meier approach. Compliance was estimated using a medication possession ratio (MPR) based on the drug exposure approach. Adjusted analyses of persistence and compliance were also conducted. Results: A total of 217 (mean age: 19·4 years, 39·2 men), 275 (20·1 years, 41·5% men), 105 (19·4 years, 42·9% men) and 166 (20·4 years, 41·6% men) patients were included in the any‐DFO, any‐deferasirox, deferasirox switchers and deferasirox‐only groups, respectively. After ICT initiation, the any‐deferasirox and deferasirox‐only groups experienced a statistically significant reduction in the frequency of hospitalizations relative to pretreatment [any‐deferasirox: from 0·09 to 0·06 hospitalizations per patient per month (pmpm), P = 0·0105; deferasirox‐only: from 0·11 to 0·07 hospitalizations pmpm, P = 0·0188], whereas it remained stable in the any‐DFO group at 0·08 hospitalizations pmpm (P = 0·9483). The Kaplan–Meier rates of medication persistence assessed at 6 and 12 months of follow‐up were significantly lower for DFO patients (6 months: 0·34, 12 months: 0·21) as compared to all deferasirox (0·51, 0·29, P = 0·0002), deferasirox switchers (0·56, 0·37, P = 0·0002) and deferasirox‐only (0·47, 0·24, P = 0·0176) patients. Similarly, compliance to treatment was significantly lower for patients treated with DFO (mean MPR: 0·64) compared with any‐deferasirox (0·78, P < 0·0001), deferasirox switchers (0·75, P = 0·0002) and deferasirox‐only (0·80, P < 0·0001) patients. Adjusted analyses of persistence and compliance yielded similar results. What is new and Conclusions: Based on a Medicaid population, patients treated with deferasirox were more compliant and persistent with their treatment than those treated with DFO. Frequency of hospitalizations was significantly reduced after treatment initiation for the any‐deferasirox and deferasirox‐only groups. Prospective studies controlling for potential clinical and treatment pattern differences between deferasirox and DFO patients are needed to assess whether the decreased hospitalizations after initiation of deferasirox are related to better treatment compliance.     

Assessment of a training programme for the prevention of ventilator‐associated pneumonia

Background: Ventilator‐associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICUs). Most published studies have analysed nurses' theoretical knowledge about a specific procedure; however, the transfer of this knowledge to the practice has received little attention. Aim: To assess the impact of training session on nurses' knowledge regarding VAP, compliance with VAP preventive measures, VAP incidence and determining whether nursing workload affects compliance. Method: A prospective, quasiexperimental, pre‐ and post‐study of the nursing team in a 16‐bed medical/surgical ICU. Pre‐intervention phase: a questionnaire to assess nurses' knowledge of VAP prevention measures, direct observation and review of clinical records to assess compliance. Intervention phase: eight training sessions for nurses. The post‐intervention phase mirrored the pre‐intervention phase. Findings: Nurses answered more questions correctly on the post‐intervention questionnaire than on the pre‐intervention (17·87 ± 2·69 versus 15·91 ± 2·68, p = 0·002). Compliance with the following measures was better during the post‐intervention period (p = 0·001): use of the smallest possible nasogastric tube, controlled aspiration of subglottic secretions and endotracheal tube cuff pressure, use of oral chlorhexidine and recording the endotracheal tube fixation number. VAP incidence remained unchanged throughout the study. However, a trend towards lower incidence of late (>4 days after intubation) VAP was observed (4·6 versus 3·1 episodes/1000 ventilation days, p = 0·37). Conclusion: The programme improved both knowledge of and compliance with VAP preventive measures, although improved knowledge did not always result in improved compliance.     

Manuka honey vs. hydrogel--a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers

Objective. Comparison of desloughing efficacy after four weeks and healing outcomes after 12 weeks in sloughy venous leg ulcers treated with Manuka honey (Woundcare 18+) vs. standard hydrogel therapy (IntraSite Gel). Background. Expert opinion suggests that Manuka honey is effective as a desloughing agent but clinical evidence in the form of a randomised controlled trial is not available. There is a paucity of research which uses Manuka honey in venous ulcers. Design. Prospective, multicentre, open label randomised controlled trial. Method. Randomisation was via remote telephone. One hundred and eight patients with venous leg ulcers having ≥50% wound area covered in slough, not taking antibiotics or immunosuppressant therapy were recruited from vascular centres, acute and community care hospitals and leg ulcer clinics. The efficacy of WoundCare 18+ to deslough the wounds after four weeks and its impact on healing after 12 weeks when compared with IntraSite Gel control was determined. Treatment was applied weekly for four weeks and follow‐up was made at week 12. Results. At week 4, mean % reduction in slough was 67% WoundCare 18+ vs. 52·9% IntraSite Gel (p = 0·054). Mean wound area covered in slough reduced to 29% and 43%, respectively (p = 0·065). Median reduction in wound size was 34% vs. 13% (p = 0·001). At 12 weeks, 44% vs. 33% healed (p = 0·037). Wounds having >50% reduction in slough had greater probability of healing at week 12 (95% confidence interval 1·12, 9·7; risk ratio 3·3; p = 0·029). Infection developed in 6 of the WoundCare 18+ group vs. 12 in the IntraSite Gel group. Conclusion. The WoundCare 18+ group had increased incidence of healing, effective desloughing and a lower incidence of infection than the control. Manuka honey has therapeutic value and further research is required to examine its use in other wound aetiologies. Relevance to clinical practice. This study confirms that Manuka honey may be considered by clinicians for use in sloughy venous ulcers. Additionally, effective desloughing significantly improves healing outcomes.     

Clinical impact of a pharmacist–physician co-managed programme on hyperlipidaemia management in Hong Kong

Objective: The study aimed to investigate the clinical impact of pharmacist–physician co‐managed programme on the management of hyperlipidaemia. Methods: The study was a prospective randomized controlled trial. Adult patients were selected if: (i) they were taking one or more lipid‐lowering agents with a valid lipid panel before their next follow up; (ii) had a baseline lipid profile within the previous 6 months; (iii) their lipid panel did not reach the targeted low‐density lipoprotein‐cholesterol (LDL‐C) goal based on the National Cholesterol Education Programme Adult Treatment Panel III. Pharmacists interviewed patients in the intervention group for 15–30 min to provide consultation on the drug regimen and lifestyle modifications. A telephone follow‐up every 4 weeks and a follow‐up interview on the date of the physician visit were scheduled. Patients in the control group received routine conventional care. The primary outcome measurement was the change in lipid panel between baseline and at the end of study. Results: One hundred and eighteen patients were recruited to the study [58 patients in intervention group (mean age 63 ± 10 years old) and 60 in control group (mean age 61 ± 12 years old)]. Starting with similar baseline levels, the end of study LDL‐C and total cholesterol levels for the intervention and control groups were LDL‐C: 2·80 ± 0·89 mmol/L and total cholesterol 4·75 ± 1·08 mmol/L vs. LDL‐C: 3·24 ± 0·78 mmol/L and total cholesterol 5·18 ± 0·93 mmol/L, respectively. The differences were statistically significant (P < 0·0015). Conclusion: The study showed that a pharmacist–physician co‐managed programme for hyperlipidaemic patient was effective in getting more patients to reach their target lipid levels.     

Evaluation of the effect of group counselling on post myocardial infarction patients: determined by an analysis of quality of life

Aim and objective. The aim of this study was to investigate the effect of group counselling program on quality of life in survivors of myocardial infarction. Background. Myocardial infarction is one of the most dramatic illnesses that can afflict patients. Despite decreases in mortality from coronary heart disease in most developed countries, mortality is increasing in most eastern European countries and developing countries. Design. A randomized‐controlled trial design. Methods. Sixty‐two patients with myocardial infarction were chosen, case group, (31 patients), distributed in five subgroup (each subgroup conclude six or seven patients) and control group (31 patients). A group‐counselling program was performed two days per week, each session last one hour. However, no counselling was performed for the control group. The quality of life score was estimated in both groups by the use of the MacNew Quality of Life after Myocardial Infarction questionnaire, before the group counselling program, and one month after the group counselling program, and the quality of life between both groups were compared. The data were analyzed using SPSS software. Results. Results indicated that there was no significant difference between the mean quality of life score of case and control groups before group counselling program. While there was a significant difference (P = 0·001) between the mean of quality of life score after the group counselling in both groups. The mean of quality of life score, before and after group counselling program indicated a significant difference (P < 0·001) in the case group, while there was no significant difference in the control group. The statistical comparison of the mean of quality of life score in general and in each dimensions before and after group counselling program indicated that there was a significant difference between before and after group counselling in the case group whereas in the control group it has slightly decreased. Pearson's correlation coefficient test (P = 0·002) showed a significant correlation between the duration of myocardial infraction and the quality of life score. The effectiveness of the planned counselling program on quality of life was estimated 24·08 by growth test. Conclusion. As indicated by the results of this study, group counselling program can promote patient's quality of life in all dimensions. Relevance to clinical practice. There is a need for nurses and physicians to apply group counselling program in a wide variety of settings ranging from community to intensive care, as a simple and safe intervention to promote patient's quality of life.     

An open trial of self‐help behaviours of clients with eating disorders in an online programme

Aim. The aim of this study was to evaluate the self‐help behaviour of individuals with eating disorders in an Internet‐based self‐help programme developed in the Asia‐Pacific region and to determine their compliance with the programme. Background. Eating disorders represent a growing health problem affecting both Western and Asian countries. Without timely and adequate treatment, individuals with eating disorders are at risk of premature death. Self‐help approaches for treating eating disorders offer therapeutic promise. Design. An open trial design was used. Method. This study, conducted from August 2006–July 2011, included 280 participants recruited from outpatient eating disorder clinics and treatment units and through a university student newspaper and Internet websites. This open trial evaluated an Internet‐based self‐help programme, which included components on healthy eating, family education, health assessment, motivation enhancement, self‐help strategies, and psychological health promotion. The progress of participants was followed up via monthly e‐mails. A tracking system was implemented to determine their compliance with the programme. Findings. A small majority of the participants (56·9%) were already undergoing treatment for their eating disorders. About 63% (n = 176) demonstrated self‐help behaviour, as manifested by their completion of health assessment questionnaires, involvement in motivation enhancement exercises, or the use of self‐help strategies such as monitoring, normalizing eating behaviour, and stress management. Improvements were observed in their eating disorder psychopathology, motivational stage of change and psychological health from baseline to the 1‐month follow up. Conclusion. Internet‐based self‐help programmes for eating disorders are helpful adjuncts to professional treatment.     

The effects of a nerve‐sparing procedure on urinary incontinence and sexual function among radical prostatectomy patients

Urinary incontinence (UI) and sexual dysfunction are common complications among patients after radical prostatectomy (RP). Although a nerve‐sparing procedure has been recommended to reduce these two complications, the benefits of this procedure still need to be examined in Taiwan. The purposes of this study were to describe and compare the changes over time in the urinary and sexual function of prostate cancer patients treated with or without nerve‐sparing RP. In this study, a longitudinal pre‐test and four post‐test study designs were employed. In all, 62 prostate cancer patients who had undergone an RP were recruited from two hospitals in southern Taiwan. Structure questionnaires and one‐hour pad tests were administered to the patients upon their first visit to the urological clinic (as baseline data) and at follow‐up visits at the clinic 3, 6, 9 and 12 months after RP. All of the patients experienced UI and sexual dysfunction from the first month after undergoing an RP to 12 months. A two‐way multivariate analysis of variance with repeated measurements indicated that the nerve‐sparing procedure (F = 4·41, p < 0·01) and time (F = 12·47, p < 0·001) significantly affected the combined dependent of UI and sexual function. The results of a univariate analysis of variance indicated that the International Index of Erectile Function (IIEF) scores were significantly different for patients who underwent the nerve‐sparing procedure (F = 7·72, p = 0·001), but pad weights were not altered by the effects of the nerve‐sparing procedure. Regarding the effects of time, the results demonstrated that both pad weights and IIEF scores changed significantly over time (F = 12·47, p < 0·001). This study demonstrates that nerve‐sparing positively affects sexual dysfunction, but that it exhibits limited benefit for UI in RP patients. These results can assist health care providers in providing patients with pre‐operation information.