Effectiveness of nurse prescribing: a review of the literature

Background. In the UK, the number of nurses able to prescribe medicines is rapidly increasing in line with Government policy directives. Whilst a number of research studies have been conducted on nurse prescribing, review and synthesis of the findings from these studies had not been undertaken. Aims and objectives. The literature review was conducted to identify key findings about the impact and effectiveness of nurse prescribing as well as under‐researched issues, in order to inform future research, education and practice in this area. Methods. A review of the literature on the first phase of nurse prescribing (1993–2002) in the UK was undertaken using electronic databases and specified search terms; some hand searching and identification of grey literature was also carried out. Results. Eighteen research‐based publications were included in the review. Findings indicate that patients are generally satisfied with district nurses’ and health visitors’ prescribing in the first phase of nurse prescribing. Nurses who prescribe are also generally satisfied with their role, although some concerns about the adequacy of their pharmacological knowledge have been raised. There is some variation in the prescribing patterns of district nurses’, health visitors’ and practice nurses, and the limitations of the original Nurse Prescribers’ Formulary (NPF) have been highlighted. Some preconditions for good nurse prescribing practice have begun to be identified. Some nurse prescribing outcomes – e.g. its impact on the prescribing practices of doctors, and the perspectives of certain patient groups – remain un‐evaluated. Research into the first phase of nurse prescribing is inevitably confined to those with a district nurse and/or health visitor qualification who were prescribing from the original NPF, thus limiting conclusions that can be drawn for the current policy context. Conclusions. The review highlights that nurse prescribing has generally been evaluated positively to date; however, there are both methodological weaknesses and under‐researched issues that point to the need for further research into this important policy initiative. Relevance to clinical practice. The review focuses on a clinical issue central to current and future forms of health care practice. Findings from the review highlight both the impact of nurse prescribing and the prerequisites that require consideration by those responsible for the development of nurse prescribing in clinical practice.     

The tympanic membrane thermometer in paediatrics: a review of the literature

This literature review looks at published works on the accuracy, reliability and sensitivity of the tympanic membrane thermometer in the paediatric population, particularly in relation to those who present in the Accident and Emergency department.Decisions that influence patient care outcomes are often based on information obtained from taking the child's temperature. Numerous studies have been conducted to examine temperature sites and instruments used. The most recent temperature measuring device to be used by nurses in assessing their patients is the tympanic membrane thermometer. The advantages of tympanic membrane temperature measurement include ease of use, rapid results and convenience for both nurse and child.However, inconsistent study reports have revealed some concerns about the use of the tympanic membrane thermometer as a routine measurement tool of body temperature in children. To meet the goal of accurate assessment of body temperature the practitioner must understand the principles behind the use of the tympanic membrane thermometer and thus use it appropriately.     

Ethical review of off-label drugs during the COVID-19 pandemic

High-quality scientific research is very important in attempting to effectively control the coronavirus disease 2019 (COVID-19) pandemic and ensure people’s health and safety. Chloroquine (CQ) and hydroxychloroquine (HCQ) have received much attention. This article comprehensively investigates the ethical review of off-label CQ and HCQ research during the COVID-19 pandemic with regard to strictly abiding by review standards, improving review efficiency, ensuring the rights and interests of subjects and that ethics committees conduct independent reviews, and achieving full ethics supervision of research conducted during an emergency. Research must be both rigorous and prudent to ensure the best outcome, with the maximization of benefits as the core principle. Standardization of the application, implementation and ethical review processes are needed to prevent unnecessary risk.     

Post-operative pain in children: a review of the literature

Summary

• ? Post-operative pain has been increasingly reported over the last 40 years.
• ? Literature reporting pain in children is increasing.
• ? Although methods of assessing pain in children have been developed over the last 15 years, difficulties still exist.
• ? The long-standing problems of managing pain persist because practice is often based on misconceptions rather than research.
• ? This failure to base practice on research is caused, in part, by the fact that neither medical nor nurse training recognizes pain as a specific subject area in its own right.
• ? Until training changes and practice improves, post-operative pain in children is likely to remain poorly recognized and undertreated.

     

Anti-epileptic drugs in the preventive treatment of migraine headache: a brief review

Anti-epileptic drugs are employed for the prophylactic treatment of migraine. Valproic acid and its sodium salt (divalproex) have been shown to be effective in preventing migraine in double-blind placebo-controlled studies. Gabapentin and lamotrigine have also been proposed for migraine prophylaxis, but more extensive studies are needed to confirm their efficacies. The main mechanism of action of anti-epileptic drugs in the inhibition of the sodium channel to induce a depolarization, preventing the high, frequent action potentials typically excited by convulsive attacks. Moreover, valproate and gabapentin increase brain concentrations of GABA and, probably, inhibit the degradation of GABA. Other proposed mechanisms of action for valproate are a direct effect on neuronal membranes and a reduction of excitatory transmission by aspartate. Valproate, at the recommended dose of 500 mg twice daily, is well tolerated. The more frequent unwanted effects associated with almost all drugs of this class are weight gain, drowsiness, dizziness and tremor. Topiramate has recently been proposed for the treatment of unresponsive, high frequency migraine, taking into account both the GABA and glutamatergic mechanisms of action. Received: 13 November 2000 / Accepted in revised form: 5 April 2001     

Parents with learning disabilities: a review of the literature

Parenting by learning disabled persons is a highly emotive issue, eliciting arguments from both extremes. Many of the arguments against such parenting have their basis in eugenic theory, whereas those in favour, often cite human rights declarations, and philosophies such as 'normalization'. This review of the literature describes the chronological development of theory on the subject, spanning 1900 to the present day. It has become clear that, whereas parents with learning difficulties may be more predisposed to having problems, they can indeed perform as adequate parents, given appropriate training and support. This paper traces the development of current theory, through an in-depth discussion of the available literature.     

Measurement of oral mucositis in children: a review of the literature

Goals of work The assessment of oral mucositis is important. There is a paucity of validated oral mucositis assessment instruments for use in children. This paper reviews the available mucositis measurement tools and their applicability to a paediatric population. Materials and methods Literature search of PUBMED™ and bibliography searches identified articles relevant to mucositis measurement tools and the measurement of mucositis in paediatrics. Results The relevant issues in the literature could be grouped into three categories: (1) development and evaluation of oral assessment tools, (2) oral assessment in the paediatric population, and (3) challenges to the assessment of oral mucositis in children. There were numerous validated mucositis assessment scales for use in adults. Only three of these scales have received limited evaluation for use in the paediatric population. The unique challenges presented by the paediatric population are excluded from much of the discussion in the literature. Conclusion The paper demonstrates the need to consider the issues specific to children. It must be determined whether previously developed tools are ideally suited for children enrolled on mucositis clinical trials.     

Cervical eosinophilic granuloma and torticollis: a case report and review of the literature

Eosinophilic granuloma (EG) is a benign and solitary bony lesion of unknown etiology, which typically affects children: 90% of patients are between the ages of 5 and 15 years. EG, a variant of histiocytosis X, is a rare disease causing destructive bony lesions of the cervical spine in children. This report describes the case of a 5-year-old boy with torticollis who presented to the Emergency Department and was found to have EG of C₆. He was successfully treated with anterior cervical corpectomy and fusion by using anterior plate and screws, with resolution of his symptoms.     

Dose-effect relationships of nonsteroidal anti-inflammatory drugs: a literature review

BACKGROUND: Many clinicians believe that higher doses of nonsteroidal anti-inflammatory drugs (NSAIDs) are more effective than lower doses for the treatment of rheumatoid arthritis (RA) and osteoarthritis (OA) but are associated with higher rates of adverse events (AEs). However, there is a lack of consensus on dose-effect relationships with the NSAIDs. OBJECTIVE: The purpose of this review was to investigate evidence for the relationship between NSAID dose, efficacy, and the occurrence of AEs from clinical trials of RA and OA of the hip and knee. METHODS: Relevant English-language publications were identified through a search of EMBASE, MEDLINE, and REFLINE using the terms aceclofenac, diclofenac, etodolac, ibuprofen, isoxicam, lornoxicam, meloxicam, nabumetone, naproxen, piroxicam, tenidap, tenoxicam, arthritis, OA (hip and knee), RA, rheumatic disorders, and musculoskeletal disorders for the period January 1970 to December 1997 (this review was conducted in 1998). Bibliographies of retrieved publications were reviewed for other potentially relevant articles. Selected publications were evaluated for quality (likelihood of bias) based on 4 factors (randomization procedure; completeness of patient and treatment information; standardization and completeness of outcome data; and reporting of attrition data). RESULTS: This review included 99 publications concerning clinical trials conducted in 24 countries and enrolling 28,239 patients. The majority of reports were published in the 1990s, particularly in the latter half of that decade. The average quality of the publications improved over time, with a significant increase in mean quality score from 5.43 in the 1970s to 9.21 during the last half of the 1990s (P < 0.05). Only 8 reports directly compared high and low doses of the same drug in relation to efficacy. CONCLUSIONS: Data on the relationship of NSAID dose to efficacy and the incidence of AEs were limited. There is a need for clinical trials directly addressing dose-effect relationships of NSAIDs, as well as reviews of more current literature and reports in languages other than English.