Women's use of information regarding hormone replacement therapy

For perimenopausal women, an important decision is whether or not to use hormone replacement therapy (HRT). The decision is complex because HRT involves judgment in weighing gains and losses related to physiological risk. Gains involve relief of hot flashes and prevention of osteoporosis; losses include cancer mortality and side effects of medication. A policy-capturing study of 283 perimenopausal women showed that the factor of most frequent concern was relief of hot flashes. Cluster analyses identified four major groups. Group 4 had an n of 9 and the lowest R2, making interpretation of data questionable. The largest group responded to hot flashes alone; the second to hot flashes and osteoporosis; and the third to hot flashes, somewhat to osteoporosis, but also to side effects of estrogen/progestin therapy. Results indicate nursing interventions should anticipate differences in women's concerns and tailor counseling appropriately.     

Improving readability of patient education materials

Functional illiteracy contributes to negative long-term health consequences for patients who must understand and adhere to complex health care instructions and, therefore, is of primary importance to community health nurses. This problem is compounded when English is the patient's second language. A process for improving patient education materials (PEMs) through adaptation or creation of new materials to meet the health needs of diverse groups is presented. The process was applied to a popular health education program used with school-age children and their parents to teach them home management of asthma. Target parents were known to read at a 5th-grade level, and English was a second language for many of them. Therefore, extensive revision of the existing PEMs was required. The steps to successful revision included assessing readability and comprehensibility, editing the materials, and evaluating the new PEMs to determine the effectiveness of the revision measures.     

The impact of medical terminology on readability of patient education materials

Most health-related literature is written above the reading ability of the lay audience; however, no studies to date have identified the impact of medical terms on readability of health education materials. The purpose of this study was to identify whether there was a change in calculated reading levels of patient education brochures after medical terms were removed from analysis passages. The reading levels of 5 patient education brochures were analyzed before and after removal of medical terms, using both the Fry and Simple Measure of Gobbledegook (SMOG) readability formulas. Results indicated that the reading levels for all brochures were significantly lower after removal of medical terminology, but they remained above the 5th to 6h grade level recommended by health education experts. Findings hold implications for healthcare professionals in relation to the development and evaluation of patient education materials.     

Developing printed materials for patient education

While most nurses recognize the educational needs of their patients, time has become a major deterrent to optimal teaching. This is especially true in critical care, where patients are being transferred earlier or directly discharged. Written information which is available to the patient at home can help to bridge this gap. Because "ready made" materials are limited and often costly, this article will discuss the steps of creating printed materials tailored to your patients' needs.     

The hormone replacement therapy self-efficacy scale

The hormone replacement therapy self-efficacy scale ¶This study describes the initial development and psychometric evaluations of an instrument to measure self-efficacy in hormone replacement therapy (HRT) use. The development of the scale was based upon Bandura's self-efficacy construct. The sample was 116 women who were 50 years old and above and who were current or past users of HRT. Factor analysis was used to develop construct validity and Cronbach's alpha was used to compute reliabilities. Factor analysis isolated two factors, efficacy beliefs in HRT (EBs-HRT) and outcome expectations in HRT (OEs-HRT). The developed tool contains 14 items, eight items compose the EBs-HRT subscale and six items make-up the OEs-HRT subscale. The two subscales and total instrument were found to have good internal reliabilities. Implications for HRT intervention using the developed tool are discussed.     

The pros and cons of hormone replacement therapy

Hormone replacement therapy (HRT) is used by over one million women in the UK. It was introduced 70 years ago and during this period many studies have produced evidence on both its harmful and beneficial effects. This article explains HRT and discusses the variety of other preparations available to control the effects of the menopause. The risks and benefits of HRT are gathered from current evidence.     

Indications for hormone replacement therapy

Postmenopausal primary ovarian insufficiency may lead to the clinical picture of the climacteric syndrome and to metabolic changes inducing specific diseases due to oestrogen deficiency. In symptomatic states of oestrogen deficiency, Hormone Replacement Therapy (HRT) is indicated for therapeutic reasons. If there is an increased risk for osteoporosis, for cardiovascular diseases or for Alzheimer's Disease, the preventive administration of HRT has to be discussed. In the combined presence of an increased metabolic risk and of subjective symptoms, HRT is still the best choice. Recent alternatives to classical HRT are Tibolone and, in the later postmenopause, Raloxifene. Incorrect media reports lead to insecurity and to concerns about the use of sexual steroids after menopause. HRT can be accompanied by a small weight increase of 200-500 g. However, more important in most women is the normal trend to weight gain in the 40s and 50s. HRT does not increase blood pressure. If there are some hints for an abnormal coagulation system in the personal or family history of a patient, thrombophilia should be excluded before the begin of HRT. The risk to have an endometrial carcinoma during HRT is not increased, but endometrial cancers are more frequent with unopposed estrogen administration. The incidence of breast cancer increases continuously with ageing. If 1000 women start HRT at the age of 50 and continue for five years, two more cases of breast cancer are diagnosed within the next 20 years. This small increase of morbidity is not accompanied by an increased mortality due to breast cancer: mortality does not change. The data available today show a clear decrease of total mortality up to the age of 75 years in women using oestrogens and speak in favour of HRT. If HRT is used for less than five years, cancer risk is not increased. The gain in Life Quality primes significantly. For the indication of long term HRT, the risks and benefits have to be evaluated individually.     

Cardioprotective benefits of hormone replacement therapy

PURPOSE: To examine the effect of hormone replacement therapy (HRT) on adverse cardiac events in postmenopausal women. DATA SOURCES: A systematic review of all available scientific literature (513 articles) on the cardioprotective benefits of HRT, including research reports, meta-analyses, and commentaries. CONCLUSIONS: Epidemiological studies have consistently suggested that HRT administered to postmenopausal women significantly lowers the risks of cardiovascular events. However, the claimed benefits might have been exaggerated. The results of the only large randomized clinical trial did not show similar benefits as those reported from observational studies. Research findings about cardiovascular protection of HRT remain inconclusive. IMPLICATIONS FOR PRACTICE: While waiting for more definitive data, it is appropriate to consider other options that have been proven safe and effective in the prevention of cardiovascular disease.     

Cerebral embolism and hormone replacement therapy

Few studies have focused on the relationship between hormone replacement therapy (HRT) for postmenopausal women or those with breast cancer and the occurrence of cerebral embolism. Results are conflicting as to whether there is a link between the two. We describe three patients who experienced cerebral embolism during HRT. A 73-year-old woman had a transient ischemic attack (TIA) 6 years prior to the present admission. She then took HRT oestrogen plus medroxyprogesterone acetate for about 6 years. The HRT had been prescribed by a gynaecologist for amelioration of postmenopausal symptoms. Six years after beginning HRT, she experienced sudden onset left hemiparesis due to cerebral embolism. Two other patients had been taking HRT for breast cancers. One, a 47-year-old woman, had taken medroxyprogesterone acetate for more than one year, for recurrence of breast cancer. She had developed sudden complete left hemiparesis due to an embolism at the carotid bifurcation. The other patient, a 72-year-old woman who was taking tamoxifen citrate for prevention of breast cancer relapse, experienced cerebral embolism just 2 months after beginning tamoxifen. The risk of cerebral embolism in those on HRT should be emphasized, along with the beneficial effects in terms of postmenopausal symptoms and prevention of breast cancer recurrence.     

The readability of online Canadian radiotherapy patient educational materials

Introduction/backgroundIt is not clear if online radiotherapy patient educational materials that are published by the Canadian Cancer Society (CCS) and the various provincial health authorities meet the appropriate readability levels. The aim of this study is to determine the readability of online Canadian radiotherapy patient educational materials.MethodsThe publicly available educational materials were acquired from the provincial health authorities' and the CCS's websites. Only English language materials were included. Documents which mainly contained instructions or were part of interactive modules were excluded. The materials were transferred to Microsoft Word documents and labelled by source and category. Editing was then performed and the readability scores were acquired for each document.ResultsA total of 67 documents were included and 4 were excluded. The overall mean Flesch-Kincaid Grade Level from all sources was 7.5 (range, 3.6–13.2; 95% confidence interval [CI] 7.1–7.9), while the overall mean Flesch Reading Ease from all sources was 64.0 (range, 44.2–78.1; 95% confidence interval [CI] 62.0–66.1). The mean Flesch-Kincaid Grade Level scores from all sources were higher than the grade 6 recommended reading level for patient educational materials. This difference was found to be statistically significant (p ≤ 0.05) for Alberta, New Brunswick, Quebec, and Nova Scotia.Discussion/conclusionsOverall, the readability levels of online Canadian radiotherapy patient educational materials exceed the recommended grade 6 readability for patient educational resources. It is hoped that the findings of this study would inform and guide the future development and distribution of materials that meet the appropriate readability standards.