Efficacy and safety of cryotherapy vs. trichloroacetic acid in the treatment of solar lentigo

Background Solar lentigines are common sun‐induced benign melanocytic proliferation that presents a significant cosmetic worrying for many middle‐aged and elderly patients. Although the newer photoselective lasers have become the mainstay of treatment, cryotherapy and trichloroacetic acid (TCA) solution are inexpensive alternatives in the treatment of solar lentigines. The purpose of this study was to assess the efficacy of cryotherapy compared with TCA 33% on solar lentigines of the back of the hands (SLBH) in patients presenting to dermatologic clinic of our hospital. Methods Each hand of 25 women with SLBH was treated randomly with either cryotherapy or TCA 33% solution. Photographs of the hands were taken prior to and 2 months following the treatment. The response and side‐ effect rate were compared. Results Cryotherapy was more likely to produce substantial lightening of the solar lentigines than TCA 33% solution (P = 0.025) but more painful and took more time to heal. Post‐inflammatory hyperpigmentation (PIH) was almost equal in two types of treatment (P > 0.05). Statistically, the better results were seen in fairer Fitzpatrick's skin types (P = 0.00). Conclusion Cryotherapy shows better results than TCA 33% solution in the treatment of SLBH particularly in lower Fitzpatrick skin types. PIH is the major complication of each type of treatments particularly in darker Fitzpatrick skin types. Generally, the major criterion for treatment of SLBH with cryotherapy or TCA is Fitzpatrick's skin type of patients.     

Subcision in acne scar with and without subdermal implant: a clinical trial

Background Subcision is a procedure that has been reported to be beneficial in treatment of acne scars. Objective This stady aims to assess the efficacy of subcision in the treatment of rolling acne scars and evaluate a novel subdermal filler ‘absorbable plain catgut suture’ with subcision. Methods Twenty‐two patients with rolling acne scars underwent subcision, 20 of whom completed treatment and follow‐up period. One side of the face underwent subcision and another side subcision with subdermal implant. The patients and investigators’ assessment of improvement were both recorded. Results Subcision showed mild improvement in about 60% of patient and moderate improvement in about 40% of them. The rate of response showed no significant difference with the use of subdermal implant. The side‐effects of local oedema, bruising and infection were all transient. Conclusions Subcision seems to be a safe method to correct the rolling acne scars with long‐term improvement. However, the subdermal implant led to no significant superior results.     

Women''s expectations and experiences of childbirth

OBJECTIVE: to explore, describe and understand the expectations during pregnancy and subsequent experiences of childbirth in primiparae. DESIGN: a qualitative study using a phenomenological approach. Data were collected using unstructured, tape-recorded interviews in late pregnancy and at two weeks post birth. SETTING: the north of England. PARTICIPANTS: eight pregnant women, expecting their first baby. FINDINGS: the women all wanted to take an active part in their labour and the feeling of being 'in control' was the main finding and the 'essence' of this study. This was achieved through support from partners, the positive attitudes of the midwives caring for them during pregnancy and labour, information giving during pregnancy and labour and being able to make and be included in decision making during labour. IMPLICATIONS FOR PRACTICE: if women are to be empowered by making choices for childbirth and feeling 'in control', then it is important for midwives to explore and discover the wishes and feelings of women in their care so that realistic expectations can be promoted and then hopefully fulfilled.     

Access to Health Care

Purpose: To describe and analyze conceptual and operational definitions of health care access for future nursing theory, practice, and policy. Access to health care is a major health policy concern. However, the elements of access to care are not well understood. As a result, how access is addressed is often inconsistent and unclear.
Organizing construct: Walker and Avant's framework for concept analysis.
Sources: Published literature in nursing and health services from the 1960s to the 1990s. The analysis was done in 1997 for this integrative review of nursing and nonnursing literature.
Methods: Integrative literature review in 1997.
Findings: Access is a complex idea defined in many ways. One of the most comprehensive definitions of access is by the World Health Organization (WHO). Multidementional barriers and facilitators to access vary by community and country.
Conclusions: Societies may define access differently at different stages of development. Scales to measure some dimensions of access are available; however, newer and better measures are needed and are being developed and tested. Data on each of the dimensions are needed for comprehensive assessment of access to health care in all countries at all stages of development.     

Chronic treatment of cycling rhesus monkeys with low doses of the antiprogestin ZK 137 316: morphometric assessment of the uterus and oviduct

The long-term effects of the antiprogestin ZK 137 316 on reproductive tract morphology in rhesus macaques were investigated. The monkeys were injected daily (i.m.) for five menstrual cycles with vehicle or 0.01, 0.03 or 0.1 mg ZK 137 316/kg body weight. Reproductive tracts (n = 3/ group) were collected during the mid-luteal phase (day 8) of the fifth cycle in the control, 0.01 and 0.03 mg/kg groups, or 6-7 days after the oestradiol peak in the 0.1 mg/kg group. ZK 137 316 treatment resulted in a dose-dependent atrophy of the endometrium, marked by reduced mitotic activity in the glands, compaction of the stroma, degradation of spiral arteries and dilation of veins. There was no effect of ZK 137 316 on myometrial or oviductal weight. Treatment with 0.1 and 0.03 mg/kg, but not 0.01 mg/kg resulted in fully ciliated and secretory oviducts, indicating a dose-dependent blockade of progesterone antagonism of oestrogen-dependent oviductal differentiation. In the endometrium, the suppressive action of progesterone on oestrogen and progestin receptors was also blocked by ZK 137 316 in a dose-dependent manner. However, endometrial atrophy appeared due to inhibition of progesterone action together with a blockade of oestrogen-dependent proliferation. The profoundly suppressed endometrium produced by chronic low-dose ZK 137 316 treatment is unlikely to support implantation. Such treatment may therefore provide a novel contraceptive modality.      

Use of Routine Interventions in Vaginal Labor and Birth: Findings from the Maternity Experiences Survey

ABSTRACT: Background: Intervention rates in maternity practices vary considerably across Canadian provinces and territories. The objective of this study was to describe the use of routine interventions and practices in labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Rates of interventions and practices are considered in the light of current evidence and both Canadian and international recommendations. Methods: A sample of 8,244 estimated eligible women was identified from a randomly selected sample of recently born infants drawn from the May 2006 Canadian Census and stratified primarily by province and territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer‐assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews averaged 45 minutes long and were completed when infants were between 5 and 10 months old (9–14 mo in the territories). Completed responses were obtained from 6,421 women (78%). Results: Women frequently reported electronic fetal monitoring, a health care practitioner starting or speeding up their labor (or trying to do so), epidural anesthesia, episiotomy, and a supine position for birth. Some women also reported pubic or perineal shaves, enemas, and pushing on the top of their abdomen. Conclusions: Several practices and interventions were commonly reported in labor and birth in Canada, although evidence and Canadian and international guidelines recommend against their routine use. Practices not recommended for use at all, such as shaving, were also reported. (BIRTH 36:1 March 2009)     

Enhancing the nurses' role in healthcare delivery through strategic management: recognizing its importance or not?

Aims  To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nurses' vocabulary.
Background  Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role.
Methods  A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100.
Results  Less than 10% of journal titles contained the word strategy . What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident.
Conclusion  The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent.
Implications for nursing management  Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.