EBSCOhost Research Databases Research Articles

Evaluating the Association between Diabetes, Cognitive Decline and Dementia.

The aim of this article is to review the association between diabetes mellitus, cognitive decline and dementia, including the effects of cognitive decline and dementia on self management of diabetes. This is a literature review of primary research articles. A number of contemporary research articles that met the inclusion criteria were selected for this review paper. These articles were selected using a number of search strategies and electronic databases, such as EBSCOhost Research and SwetsWise databases. The duration of diabetes, glycated haemoglobin levels and glycaemic fluctuations were associated with cognitive decline and dementia. Similarly, hypoglycaemia was significantly related to increased risk of developing cognitive decline and dementia. Furthermore, cognitive decline and dementia were associated with poorer diabetes management. There is evidence of the association between diabetes, cognitive decline and dementia including the shared pathogenesis between diabetes and Alzheimer’s disease. In addition, the self management of diabetes is affected by dementia and cognitive decline. It could be suggested that the association between diabetes and dementia is bidirectional with the potential to proceed to a vicious cycle. Further studies are needed in order to fully establish the relationship between diabetes, cognitive decline and dementia. Patients who have diabetes and dementia could benefit from structured education strategies, which should involve empowerment programmes and lifestyle changes. The detection of cognitive decline should highlight the need for education strategies.

Evaluation of the role of enteral nutrition in managing patients with diabetes: a systematic review.

The aim of this systematic review is to evaluate the role of enteral nutrition in managing patients with diabetes on enteral feed. The prevalence of diabetes is on the increase in the UK and globally partly due to lack of physical activities, poor dietary regimes and genetic susceptibility. The development of diabetes often leads to complications such as stroke, which may require enteral nutritional support. The provision of enteral feeds comes with its complications including hyperglycaemia which if not managed can have profound consequences for the patients in terms of clinical outcomes. Therefore, it is essential to develop strategies for managing patients with diabetes on enteral feed with respect to the type and composition of the feed. This is a systematic review of published peer reviewed articles. EBSCOhost Research, PubMed and SwetsWise databases were searched. Reference lists of identified articles were reviewed. Randomised controlled trials comparing enteral nutrition diabetes specific formulas with standard formulas were included. The studies which compared diabetes specific formulas (DSF) with standard formulas showed that DSF was more effective in controlling glucose profiles including postprandial glucose, HbA1c and insulinemic response. The use of DSF appears to be effective in managing patients with diabetes on enteral feed compared with standard feed.

The role of acupoint stimulation as an adjunct therapy for lung cancer: a systematic review and meta-analysis

BackgroundLung cancer is the leading cause of death in cancer patients. Clinical studies showed that a variety of acupoint stimulations have been extensively used for lung cancer patients, including needle insertion, injection with herbal extraction, plaster application, and moxibustion. However, the role of acupoint stimulation in lung cancer treatment was not fully reviewed.MethodsIn the present study, we conducted a systematic review and meta-analysis on the role of acupoint stimulation in lung cancer treatment by electronic and manual searching in seven databases, including Ovid (Ovid MEDLINE, AMED, CAB s, EMBASE), EBSCOhost research databases (Academic Search premier, MEDLINE, CIHAHL Plus), PreQuest (British Nursing Index, ProQuest Medical Library, ProQuest Dissertations & Theses A&I, PsycINFO), and ISI web of knowledge (Web of Science, BIOSIS Citation Index, Biological s, Chinese Science Citation Database), CNKI, Wanfang Data, and CQVIP.ResultsOur study showed that acupoint stimulation has strong immunomodulatory effect for lung cancer patients as demonstrated by the significant increase of IL-2, T cell subtypes (CD3+ and CD4+, but not CD8+ cells), and natural killer cells. Further analysis revealed that acupoint stimulation remarkably alleviates the conventional therapy-induced bone marrow suppression (hemoglobin, platelet, and WBC reduction) in lung cancer patients, as well as decreases nausea and vomiting. The pooled studies also showed that acupoint stimulation can improve Karnofsky performance status, immediate tumor response, quality of life (EORCT-QLQ-C30), and pain control of cancer patients.ConclusionsAcupoint stimulation is found to be effective in lung cancer treatment, further confirmatory evaluation via large scale randomized trials is warranted.

Effectiveness of non-pharmacological interventions in relieving children's postoperative pain: a systematic review

Background Acute pain management in children during the postoperative period is challenging. Poor pain management causes physiological changes and impacts on various systems that contribute to physical and psychological adverse effects. Objectives To evaluate the best available evidence related to the use and effectiveness of non-pharmacological interventions as an adjunct therapy to pharmacological interventions and the perceptions and/or pain behaviours in infants, children and adolescents who had undergone a major surgery. Inclusion criteria Types of participants This systematic review considered studies whose participants were children aged 0-19 years who received non-pharmacological pain management interventions before or after receiving a major surgery. Types of intervention(s)/phenomena of interest Non-pharmacological pain management interventions before or after receiving a major surgery. Types of studies This review considered any randomized clinical trials and quasi-experimental design studies. Types of outcomes The outcome measure of interest was pain assessment using measurement scales with established validity and reliability. This review considered any randomized clinical trials and quasi-experimental design studies. Search strategy The search sought to identify both published and unpublished studies between January 1990 and December 2011. The databases searched for published studies included: PubMed, CINAHL, EMBASE, Science Direct, ProQuest Dissertations and Theses, Medical Library, Cochrane Database, Blackwell Synergy, [email protected], EBSCO Host Research Databases, Thai Thesis Database, Digital Library of Thailand Research Fund, and Research of National Research Council of Thailand. Methodological quality Two reviewers independently assessed the methodological quality of all the articles using a standardized critical appraisal checklist developed by the Joanna Briggs Institute. Data collection Data were extracted from studies using a standardized data extraction tool from the Joanna Briggs Institute. Data synthesis Statistical pooling of results in meta-analysis was not appropriate, so the findings were summarized in narrative form. Results Eight of the nine studies included in this review indicated a significant positive effect of non-pharmacological pain management. Four interventions improved postoperative pain in both school-age and adolescent patients using guided imagery, parent-child-nurse mutual participation, foot massage and play activities. Touching the forehead, shoulder and the skin above the wound alleviated postoperative pain in school-age patients. Fowler's position alleviated postoperative pain in infant patients. Conclusions A combination of pharmacological and non-pharmacological interventions is usually effective in postoperative pain management. No single pain relief intervention is effective across ages or types of pain; therefore, nurses should select an appropriate non-pharmacological intervention for each patient. Implications for practice A pre-operative preparation session should be conducted with school-age and adolescent patients. Guided imagery and parent-child-nurse mutual participation are effective interventions to be used in these sessions for management of postoperative pain relief. In the postoperative care period, especially the first three days after surgery, play activities as a distraction strategy have proven to be effective for relieving pain and enhancing coping behaviors among school-age and adolescent patients. Positioning the patient in the Fowler's position could be used to relieve pain in infant patients. In addition, touching the forehead, shoulder and skin above the operative wound could be used for school-age patients and foot massages could be used for both school-age and adolescent patients. Implications for research The studies identified in this review only focused on infants, school-age children and adolescents. Additional research is needed to fully understand postoperative pain management in children of all age groups. Other non-pharmacological interventions such as thermal regulation, presence of parents, helping in daily activities, and creating a comfortable environment could be included in further studies.

State of the Science: Does the Theory of Maternal Role Attainment Apply to African American Motherhood?

This article reviews the current state of knowledge of the theory of maternal role attainment (MRA) and its relevance in describing African American motherhood. EBSCOhost Research Databases that included PubMed, CINAHL plus, MEDLINE, PsycINFO, SCOPUS, and Web of Science were searched for journal articles that examined maternal identity and MRA. Keyword searches included maternal identity, maternal role attainment, becoming a mother, prenatal attachment, maternal-fetal attachment, and maternal-infant attachment. Inclusion criteria for this review were published journal articles of studies conducted in the United States, with a clear delineation of the theoretical framework of MRA. Journal articles that measured MRA among women with depression or medically fragile infants were excluded. Two hundred and twelve studies were reviewed; 25 studies, published between 1975 and 2007, met the inclusion criteria. Nine articles described the theory of MRA, 11 articles measured variables thought to influence MRA, and 6 articles described maternal-fetal attachment, a construct of MRA. Studies were reviewed, categorized, and analyzed to determine current knowledge of how the theory of MRA describes African American motherhood. Categories included studies describing the theoretical framework of maternal identity and MRA, studies measuring key variables thought to impact MRA, and studies measuring maternal-fetal attachment and maternal-infant attachment. The studies were limited by homogenous samples of upper-middle-class white women and low-income, single, African American adolescents. Study results of MRA cannot be generalized to African American women. Further research is essential to identify attributes influencing MRA, specifically among larger samples of African American women with demographics similar to that of the white populations that have been included in studies thus far.

Acute coronary syndrome in pregnant women

The purpose of this article is to review the available information on the pathophysiology, diagnosis, treatment and prognosis of acute coronary syndromes (ST-elevation myocardial infarction [STEMI] and non-ST-elevation myocardial infarction [NSTEMI]) during all stages of pregnancy. We searched the English-language literature indexed in MEDLINE, Scopus and EBSCO host research databases from 1980 through to August 2010 using the indexing terms ‘pregnancy’, ‘ante-,peri-, and postpartum’, ‘acute coronary syndrome’, ‘myocardial infarction’, ‘STEMI’ and ‘NSTEMI’. Symptomatic coronary artery disease is still infrequent in women of childbearing age, but the recent increase in its prevalence in pregnancy has been attributed to the modern trend of childbearing in older years because many young working women are postponing having children. Although rare, acute pregnancy-related MI is a devastating event that may claim the life of a mother and her fetus. The incidence of MI is estimated at 0.6–1 per 10,000 pregnancies. The case fatality rate has been reported to be 5–37%. Owing to the rarity of the event, information related to MI in pregnancy is derived from case reports and, therefore, is subject to considerable reporting bias. Treatment needs to be prompt and urgent because of the very high mortality rate. Current guidelines for the diagnosis and treatment of MI should be expanded to include pregnancy-related MI. Screening and management of cardiovascular risk factors should be achieved before pregnancy.

Burning mouth syndrome: Identification, diagnosis, and treatment

To provide an overview of burning mouth syndrome (BMS), describe the role of the clinician when a patient presents with the burning mouth complaint, offer guidance in differentiating the cause of the complaint, and identify potential treatment options for the patient suffering from BMS. A search of MD Consult, Medline, and EBSCO Host Research Databases with the terms "burning mouth" and "BMS." BMS is a common, chronic disorder of unknown etiology with no underlying or systemic causes or oral signs identified. It affects more than 1 million people in the United States, predominantly postmenopausal women. Despite the common nature of the disorder, it is often misunderstood. Palliative treatment, education, and support should be offered to the patient with idiopathic BMS. A variety of treatment options exist, including benzodiazepines, tricyclic antidepressants, anticonvulsants, alpha-lipoic acid, topical capsaicin, and cognitive therapy can be added to the medication regimen for greater benefit. The role of the clinician is to obtain a meticulous history and physical examination of the patient, order relevant diagnostic tests, and rule out treatable conditions that may be causing the burning mouth symptom. If secondary causes of BMS are ruled out, the clinician should present treatment options to the patient and consider referral to specialists as necessary. A combination of medications may be more effective than a single medication.

Clinical implications of cytokines in the critical-care unit

To understand the role of different cytokines in the pathophysiology and management of different acute cardiovascular disorders in critically ill patients, we reviewed most of the pertinent articles published on Medline, Scopus and EBSCO host research databases from 1985 to January 2009. We used the indexing terms ‘cytokines’, ‘cardiovascular’, ‘sepsis’, ‘critical care’, ‘myocardial dysfunction’, ‘shock’, ‘thromboembolism’, ‘inflammatory’ and ‘arrhythmias’. Myocardial dysfunction, dysrhythmic and thromboembolic disorders all appear associated with important fluctuations in cytokines. When and how to sample cytokine levels and the ways in which cytokines contribute to patient deterioration or improvement require further clinical studies. The measurement and interplay of several different cytokines may ultimately be of substantial clinical importance in the diagnosis, treatment and prognosis of patients with different acute cardiovascular disorders managed by critical-care physicians in intensive-care units. Although the role of cytokines in cardiovascular disorders is debatable, the clinical implication of cytokines in the critical-care unit is a new horizon that warrants more attention.

Impact of gender in patients with acute coronary syndrome

In this article, we review the impact of gender on the pathophysiology, management and outcomes after acute coronary syndrome (ACS). We searched the English-language literature indexed in MEDLINE, Scopus and EBSCOhost Research databases from 1988 through January 2009 using the indexing terms ‘gender’, ‘short- and long-term outcomes’ and ‘acute coronary syndrome’ and ‘myocardial infarction’. Data comparing gender differences in outcomes after ACS showed that females have a higher mortality rate than males. Observational studies showed that guideline-recommended management strategies are used significantly less frequently in females than males. The undertreatment and worse outcome of female patients with ACS are probably multifactorial and have been reported in different ethnicities and cultures. However, there are conflicting data regarding to the impact of gender on early versus long-term outcomes, the benefit of early intervention in low- and high-risk females and the influence of unmeasured selection biases in the use of therapies in the observational data. These gender discrepancy trends warrant close follow-up, as this might reflect changes in primary and secondary prevention in the community. Furthermore, gender discrepancy gives an indication of healthcare quality and whether care is given in an unbiased manner. All high-risk females, and males with ACS, should receive optimal medical management, coronary angiography and revascularization whenever indicated.

Physical Activity of Youth with Intellectual Disability: Review and Research Agenda

This review characterizes physical activity behavior in youth with intellectual disability (ID) and identifies limitations in the published research. Keyword searches were used to identify articles from MEDLINE, EBSCOhost Research Databases, Psych Articles, Health Source, and SPORT Discus, and ProQuest Dissertations and Theses up to June 2007. Data were extracted from each study using a template of key items that included participant population, study design, data source, and outcome measure. Nineteen manuscripts met the inclusion criteria. Findings were mixed, with various studies indicating that youth with ID have lower, similar, and higher physical activity levels than peers without disabilities. Only two studies provided enough information to determine that some youth with ID were meeting minimum physical activity standards. Significant methodological limitations prohibit clear conclusions regarding physical activity in youth with ID.

T-Wave Alternans and Sudden Cardiac Death

Sudden cardiac death (SCD) is the leading cause of mortality in patients with ischemic heart disease and left ventricular dysfunction. The majority of SCD are due to ventricular tachyarrhythmias. SCD strikes many asymptomatic patients and often is the first manifestation of heart disease. Thus, reliable determination of arrhythmic risk is warranted to guide preventive therapy. To highlight the prognostic value of microvolt-level electrical alternans of the T-wave (MTWA) in patients at risk for SCD, most of the pertinent published articles in the Medline, Scopus, and EBSCO Host research databases have been reviewed. MTWA has been proposed to be a strong and independent predictor of all-cause and arrhythmic mortality. The high predictive value of MTWA in patient with cardiomyopathy varies significantly depending on the population studied. Combining with other indices or having serial MTWA readings could overcome MTWA limitations. Redefining MTWA readings may expand its prognostic utility.

Detection of myocardial dysfunction in the presence of normal ejection fraction

Detection of subclinical myocardial involvement is of utmost importance in risk stratification and prognosis; the role of ejection fraction in the detection of subclinical disease may be unhelpful. Our aim was to evaluate the methodology and importance of early detection of myocardial involvement in the presence of normal ejection fraction. Most of the pertinent English and non-English articles published from 1980 to 2006 in Medline, Scopus, and EBSCO Host research databases have been reviewed. Serial assessment of systolic function with different techniques should be avoided, since imaging modalities and ejection fraction measurements are not interchangeable. Additional non-invasive tools still are needed for the identification of subclinical left ventricular dysfunction in certain diseases. The recognition of subclinical involvement will prompt initiation of specific therapy to prevent the development of overt left ventricular dysfunction. This also is needed for determining the best timing for intervention in asymptomatic patients with metabolic and valvular disorders.

Dysrhythmia and electrocardiographic changes in diabetes mellitus: pathophysiology and impact on the incidence of sudden cardiac death

The incidence of sudden cardiac death (SCD) is increasing in diabetes mellitus. Susceptibility to dysrhythmias and the reliability of an electrocardiogram in diabetic hearts are debatable issues. To highlight the underlying mechanism of dysrhythmia and electrocardiographic changes in diabetic patients and the impact on the incidence of SCD. Most the pertinent articles (English and non-English) published in Medline, Scopus and EBSCO Host research databases have been reviewed. In the absence of systematic reviews, susceptibility to dysrhythmias and electrical instability in diabetic patients are underestimated. This susceptibility has been found to be enhanced, unchanged or reduced in different studies. To find a link between SCD and diabetes, the published studies provide controversial results; however, the majority of studies with a long-term follow-up support this link. The role of hyperglycemia, autonomic neuropathy and anti-diabetic agents as predisposing factors deserve more attention to fortify the clinical judgment and decrease the incidence of SCD.