Hormone replacement therapy for women with type 1 diabetes mellitus

Background: There is conflicting information about the impact of the menopause on glycaemic control amongst women with type 1 diabetes. Some menopausal women with type 1 diabetes are treated with hormone replacement therapy (HRT) but the effects of this treatment have, to date, not been established.Objectives: To assess the effects of HRT for women with type 1 diabetes mellitus.Search methods: We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsycINFO from their inception to June 2012. The last search was run for all databases on 18 June 2012.Selection criteria: We selected randomised controlled trials or controlled clinical trials that involved peri‐ or postmenopausal women with type 1 diabetes undergoing HRT as an intervention.Data collection and analysis: Two researchers independently applied the inclusion criteria to the identified studies and assessed risk of bias. Disagreements were resolved by discussion or by intervention by a third party. Descriptive analysis was conducted for the review.Main results: Ninety‐two publications were screened. No studies met the inclusion criteria exclusively but one study that included both type 1 and type 2 diabetes participants was considered. This randomised clinical trial (RCT) compared HRT (N = 27) with placebo (N = 29) over 12 months. The outcome measures were cardiovascular risk factors, including lipid profile, glycaemic control, blood pressure and body weight. No significant differences between placebo and HTR were detected. Patient‐important outcomes like all‐cause mortality, cardiovascular disease, diabetic complications or health‐related quality of life were not investigated.Authors' conclusions: There is a lack of evidence around the use of HRT in women with type 1 diabetes. The one study that has been undertaken in this area is underpowered. More RCTs are required in the area to examine the impact of HRT on glycaemic control and cardiovascular outcomes.https://doi.org/10.1002/14651858.CD008613.pub2pubpub

Positioning and spinal bracing for pain relief in metastatic spinal cord compression in adults.

Background: This is an updated version of the original Cochrane review published in Issue 3 (Lee 2012) on patient positioning (mobilisation) and bracing for pain relief and spinal stability in adults with metastatic spinal cord compression. Many patients with metastatic spinal cord compression (MSCC) have spinal instability, but their clinician has determined that due to their advanced disease they are unsuitable for surgical internal fixation. Mobilising may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (whether a patient should be managed with bed rest or allowed to mobilise) and whether spinal bracing is helpful, is contradictory. Objectives: To investigate the correct positioning and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC. Search methods: For this update, we searched for relevant studies from February 2012 to 31 March 2015. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In Process, EMBASE, AMED, CINAHL, TRIP, SIGN, NICE, UK Clinical Research Network, National Guideline Clearinghouse and PEDro database. We also searched the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov, UK Clinical Trials Gateway (UKCTG), WHO International Clinical Trials Registry Platform (ICTRP) and Australia New Zealand Clinical Trials Registry (ANZCTR). For the original version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse, and PEDro database, in February 2012. Selection criteria: We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning (mobilisation) and bracing. Data collection and analysis: Two review authors independently assessed each possible study for inclusion and quality. Main results: For the original version of the review, we screened 1611 potentially relevant studies. No studies met the inclusion criteria. Many papers identified the importance of mobilisation, but no RCTs of bed rest versus mobilisation have been undertaken. We identified no RCTs of bracing in MSCC. For this update, we identified 347 potential titles. We screened 300 titles and abstracts after removal of duplicates. We did not identify any additional studies for inclusion. Authors' conclusions: Since publication of the original version of this review, no new studies were found and our conclusions remain unchanged. There is a lack of evidence‐based guidance around how to correctly position and when to mobilise patients with MSCC or if spinal bracing is an effective technique for reducing pain or improving quality of life. RCTs are required in this important area

International nurse education leaders' experiences of responding to the COVID-19 pandemic:A qualitative study

AIMS: To explore the experiences of strategic leads for nurse education as they sought to respond to the COVID‐19 pandemic. DESIGN: We utilised a qualitative interpretative approach to explore education leaders’ experiences of leading during the early months of the pandemic. METHODS: Nineteen leaders with significant strategic responsibility for nurse education in Australia, Canada, New Zealand, Singapore and the United Kingdom were identified via purposive sampling and agreed to participate. Interviews were held between May and July 2020. RESULTS: Four overarching themes arose from the analysis: (1) Crisis driven adaptability & flexibility; (2) Responsive, complex and changing communication; (3) Making decisions for student and staff safety; (4) Looking to the future; stronger partnerships. CONCLUSION: Internationally, while nursing education leaders faced different problems, they shared a common goal amidst the crisis to remain student‐centred. They demonstrated they were able to face major challenges, respond to large scale logistical problems and make decisions under significant and ongoing pressure. IMPACT: In responding to the pandemic, nurse leaders shared knowledge and offered mutual support. This bodes well for future collaboration. The move to online learning accelerated an existing trend and it seems likely that this will continue. Given the pressures they experienced over an extended period, the sector may wish to consider how it prepares and supports existing and future leaders

Patient positioning and braces for pain relief and spinal stability in metastatic cord compression in adults.

The purpose of this review is to investigate the correct positions for patients with MSCC and examine the effects of spinal bracing to relieve pain or vertebral collapse under physiological load, or both, in patients with MSCC

Re-imagining Navan Fort : new light on the evolution of a major ceremonial centre in Northern Europe

Peer reviewedPublisher PD

Breast cancer screening in women with learning disabilities: current knowledge and considerations

This paper looks at what has been written about breast screening in women with learning disabilities. Breast screening checks for lumps in your breast that might be cancer. Breast screening is done in a special clinic and machines are used to take a picture (like an X-ray) of the breast.The researchers read all the work they could find that had been written on breast screening in women with learning disabilities. They found that:?Fewer women with learning disabilities have breast cancer than other women;?Women with learning disabilities do not go for breast screening as often as other women;?Doctors and other health professionals need to know women with learning disabilities can get breast cancer.SummaryAs people with learning disabilities now live longer, they will experience the same age-related illnesses as the general population and cancer is a prime example of this. In women, cancer screening is used to detect early on-set of cancer of the breast and abnormalities of the cervix which might, if left untreated, develop into cancer. Disappointingly, the literature on cancer screening in women with learning disabilities consistently reports that cancer screening up-take is lower in this population compared to women in the general population. This paper presents a review of 35 articles relating to breast cancer, breast cancer screening and breast awareness in women with learning disabilities. Relevant papers and book chapters were located by searching a number of databases and undertaking hand searches, and includes publications from 1997 to 2007. The studies located ranged from localised health initiatives to improve breast awareness and breast screening up-take, to population studies. Although more is being published on cancer in people with learning disabilities there is still a paucity of literature on breast screening amongst women with learning disabilities. This review therefore, up-dates current knowledge on breast cancer incidence and breast awareness whilst critically reviewing studies specifically focusing on breast screening in women with learning disabilities

The frequency and cause of anxiety and depression amongst patients with malignant brain tumours between surgery and radiotherapy.

Introduction Between surgery and radiotherapy patients with a malignant glioma may encounter a number of psychosocial issues that could invoke an anxious or depressive response. This study explored the frequency, severity and cause of anxiety and depression in patients with presumed malignant brain tumours in the period between their surgery and radiotherapy. Methods A prospective study of 51 patients used mixed methods to measure anxiety and depression at three time points; post surgery, three weeks post surgery and pre radiotherapy. Analysis was undertaken using statistical and content analysis of the Hospital Anxiety and Depression (HAD) scores and unstructured interviews respectively. Results Analysis of HAD scores indicated a heightened level of anxiety in patients pre radiotherapy. This anxiety is more prevalent in younger patients and is not related to the patients change in functional state. Five patients had a significant depression at one or more time points between surgery and radiotherapy. Four of the five patients who reported scores consistent with depression had past histories of depression. Content analysis of unstructured interviews indicated that the HAD scores underestimated the presence of anxiety and depression amongst this group of patients. Conclusion Anxiety was more common in younger patients. Anxiety was slightly more frequent pre-radiotherapy. A past medical history of depression is a predictor of significant depression in the post-operative period. The HAD scale although useful is not an adequate measurement tool for detecting anxiety and depression amongst all patients and health care professionals should adopt other means to monitor for these signs and symptoms

Acute effects of weight training on glycaemia in type 1 diabetes

Exercise is regarded as a potential strategy to assist in the management of blood glucose in people with type 1 diabetes. However, currently there is little evidence-based information detailing the acute effects weight training has on glycaemia in type 1 diabetes. The aim of this review is to identify studies investigating the acute effects of weight training on blood glucose levels in type 1 diabetes.A search of Cumulative Index to Nursing and Allied Health Literature, Cochrane, Medline and SPORTDiscus databases was conducted. A systematic review of these studies was undertaken to address the issue.After fulfilling the inclusion criteria, eight articles were retrieved. The individual studies reported comparatively different results.Study findings from this review are inconclusive regarding the acute glycaemic response to weight training exercise. Analyses of the intervention studies highlight that weight training may increase, minimally affect or decrease post-exercise glycaemia in type 1 diabetes. It is likely that the heterogeneity regarding the weight training methods used among the studies, as well as the pre/post-exercise insulin and carbohydrate intake of the study participants have impacted on the findings.There remains a gap in the evidence base to inform health care professionals of the likely acute glycaemic response to weight training exercise. Problems in managing patient glycaemia may arise due to erroneous insulin and carbohydrate alterations based on unfounded and anecdotal-based guidance. The studies highlighted in this review have reported some of the potential effects that weight training may have on glycaemia