An online survey of Australian physicians reported practice with the off-label use of nebulised frusemide

Background: Off-label prescribing is common in palliative care. Despite inconsistent reports of the benefit of nebulised frusemide for breathlessness, its use continues to be reported. Methods. An online survey was emailed to 249 members of the Australian and New Zealand Society of Palliative Medicine to estimate the use of nebulised frusemide for breathlessness by Australian physicians involved in palliative care in the previous 12 months. Results: There were 52/249 (21%) respondents to the survey. The majority (44/52; 85%) had not prescribed nebulised frusemide in the previous 12 months. The most common (18/44; 43%) reason for not prescribing nebulised frusemide was a belief that there was not enough evidence to support its use. Whilst only a few respondents (8/52; 15%) reported having used nebulised frusemide, all that had used it thought there was at least some benefit in relieving breathlessness. Conclusion: This report adds to the series of case studies reporting some benefit from nebulised frusemide in relieving breathlessnes. © 2012 Newton et al.; licensee BioMed Central Ltd

Barriers and facilitators to self-care in chronic heart failure: A meta-synthesis of qualitative studies

Chronic heart failure (CHF) is a costly condition that places large demands on self-care. Failure to adhere with self-care recommendations is common and associated with frequent hospitalization. Understanding the factors that enable or inhibit self-care is essential in developing effective health care interventions. This qualitative review was conducted to address the research question, "What are the barriers and facilitators to self-care among patients with CHF?" Electronic databases including Medline, EMBASE, CINAHL, Web of Science, Scopus and Google scholar were searched. Articles were included if they were peer reviewed (1995 to 2012), in English language and investigated at least one contextual or individual factor impacting on self-care in CHF patients > 18years. The criteria defined by Kuper et al. including clarity and appropriateness of sampling, data collection and data analysis were used to appraise the quality of articles. Twenty-three articles met the inclusion criteria. Factors impacting on self-care included: factors related to symptoms of CHF and the self-care process; factors related to personal characteristics; environmental and health care system factors. Important factors such as socioeconomic situation and education level have not been explored extensively and there is minimal data on the influence of age, gender, selfconfidence and duration of disease. Although there is an emerging literature, further research is required to address the barriers and facilitators of self-care in patients with CHF in order to provide an appropriate guide for intervention strategies to improve self-care in CHF. © 2013 Siabani et al

The feminization of aging: How will this impact on health outcomes and services?

We conducted an integrative review to identify issues and challenges that face aging women and to distinguish areas for future research. We found that many older women continue to face inequities related to health and often are invisible within the discourse of aging policy. In this article we argue for a greater focus on the unique needs of women, a gendered approach to policy and intervention development, and promotion of the health of women across the life span. Policymakers, health care workers, and researchers need to consider the perspective of gender as well as age when implementing and evaluating effective interventions. © Taylor & Francis Group, LLC

Non-pharmacological management interventions for COPD: An overview of Cochrane systematic reviews

© 2013 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. This is the protocol for a review and there is no abstract. The objectives are as follows: To a) summarise the evidence, b) identify gaps in the evidence base and c) describe elements of non-pharmacological, non-surgical and non-device interventions for the management of COPD using a standardised taxonomy for disease management adapted from the American Heart Association (Krumholz 2006)

The SNAPSHOT ACS study: getting the big picture on acute coronary syndrome

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The nurse educator role in the acute care setting in Australia: Important but poorly described

Objective The purpose of this paper is to describe the nurse educator role in the acute care setting in Australia. Method A literature review using Ganong's (1987) method of analysis was undertaken. Computerised databases were searched for articles published in English between 2000 and 2008 using the key words: 'education', 'nursing', 'nurse-educator', 'teaching methods', 'clinical', 'outcomes health care' and 'Australia'. Information was summarised to identify issues impacting on the nurse educator role using a standardised data extraction tool. Results The search strategies generated 152 articles and reports. The review identified that the nurse educator role is fundamental in supporting clinical practice and integral to developing a skilled and competent health workforce. Conclusion Confusion in nursing roles and role ambiguity contribute to the challenges for nurse educators in acute care. The absence of a national, standardised approach to role description and scope of practice in Australia may adversely impact role enactment. Further discussion and debate of the nurse educator role in Australia is warranted