Diclofenac solution (Pennsaid) in the management of osteoarthritis of the knee : Patient implications

Topical diclofenac sodium (pennsaid) is a non-steroidal-anti- inflammatory drug that is used to manage the recurrent pain and symptoms of osteoarthritis of the knee. Pennsaid is applied topically, absorbed cutaneously and concentrates locally at the site of application. Tugwell et al. [54] has shown that pennsaid is as efficacious as oral diclofenac as a mode of pain relief without systemic effects. The most common side effect induced by pennsaid is the development of dry skin at the site of application. This is caused by dimethyl sulfoxide which is the vehicle used in the pennsaid formulation. Dimethyl sulfoxide dissolves the natural oils in the skin causing dryness

The use of topical diclofenac in the pain management of osteoarthritis of the knee

Osteoarthritis (OA) is a common complaint that affects millions of people worldwide. As there is no cure for OA, drug treatment is the main form of management. This can be achieved through the use of analgesics and anti-inflammatory drugs such as the NSAID diclofenac sodium. The chronic use of diclofenac sodium can lead to adverse gastrointestinal problems. The use of a topical formulation of diclofenac sodium aims to reduce this problem. Evidence from four randomized controlled trails of the efficacy and safety of topical diclofenac sodium as a method of pain relief for the treatment of OA of the knee is presented and discussed. Findings imply that topical diclofenac sodium is an efficacious and safe method of pain control in patients with OA of the knee

Employment and breast cancer: A meta-ethnography

This article is available open access through the publisher’s website at the link below. Copyright @ 2011 Blackwell Publishing Ltd.The purpose of this synthesis is to examine the qualitative evidence on the lived experience of breast cancer survivors in relation to return to work. An in-depth search of the literature was undertaken from 1999 until July 2010. Ten relevant papers emerged that reflected the aims of the synthesis. A meta-ethnographic approach was used to synthesise papers. Four concepts emerged that reflected the return to work, these included influencing factors, sickness absence, work ability and work-related problems and experiences of return to work. Further synthesis of concepts led to the development of four final interpretations. These included breast cancer and employment, treatment-induced physical impairment, employer comprehension of breast cancer and fear of work-related failure. These interpretations indicate that employers need to be educated on the work capabilities of cancer survivors post treatment. Improved support facilities are needed for cancer survivors which are supported by European employment legislation and guidance offered by company occupational health departments. Moreover, health care professionals could become more involved in the education of breast cancer patients with regard to the timing of returning to work

Medication taking behaviour and hypertension: A review of the literature

Hypertension is a global illness and one that affects circa 20% of the population. Despite the effectiveness of treatment, adherence with medication is a key concern, particularly in the elderly. Over the last 30 years, a variety of measures have been employed to assess adherence and yet no one measure is deemed to be the gold standard. Evidence suggests that it may be more reliable to use a combination of methods. Two forms of nonadherence are noted; intentional and unintentional. These forms are significantly different with regard to underpinning characteristics and patient features. In order to improve adherence with antihypertensive medication a shared decision making approach should be adopted during patient consultation, which focuses on patients’ impressions of illness and underpinning health beliefs. This approach to consultation should be actively encouraged as part of the medication management of patients

A hermeneutic phenomenological study of community nurses' CPD

Continuing professional development (CPD) is a mandatory aspect of nurse registration. In the NHS, more demanding professional roles compel nurses to develop and update their knowledge and skills through CPD. Even though CPD is an essential component of nurse education, research investigating community practitioners’ views, experiences and perceptions of the link between reflection and CPD is limited. This phenomenological study explored community health practitioners’ experiences of CPD and perceptions of the link between CPD and reflection. Ten community practitioners who specialized in district or school nursing and health visiting were interviewed using an in-depth approach. Data was analysed using thematic networks as a tool (Attride-Stirling, 2001). Findings revealed that community practitioners viewed CPD positively, perceived the benefits as both professional and personal development. Development needs were identified through reflective practice and appraisal. Even though significant barriers were apparent, the organization provided opportunities to access formal and self-directed learning events. There is a need for organizations to invest in CPD of the workforce, consider cheaper alternatives for meeting CPD needs and for further research to assess the impact of CPD on clinical practice

Perceptions of Breast Cancer Screening in Older Chinese Women: A Meta-Ethnography

In Eastern Asia, as the incidence of breast cancer continues to increase yet compliance with breast cancer screening in older Chinese women who are at risk of early stage breast cancer is poor. This meta-ethnography explored breast cancer awareness, attitudes and breast screening behaviour in older Chinese women. Nine qualitative studies were appraised using CASP tools. Many Chinese women believed that illness is preordained, therefore mammography was a futile exercise. Older Chinese women held erroneous views of breast cancer, and believed that if they developed this form of cancer they would hide the disease from their family due to perceptions of bad luck and derision for both the cancer patient and their family. There is a great need for targeted breast health educational programmes for Chinese migrant women that educate women to participate in mammography and promote acculturation and health education. Future public health programmes need to target older Chinese women

A propensity matched comparison of return to work and quality of life after stenting or coronary artery bypass surgery

Objectives: We sought to determine (1) return to work (RTW) rates, (2) long-term employment (>12 months postprocedure), (3) time taken to RTW, and (4) quality of life (QoL), in patients treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Methods: Questionnaires regarding RTW were sent to 689 PCI and 169 CABG patients who underwent PCI or CABG at University Hospitals of Leicester Trust, UK, from May 2012 to May 2013. QoL was also measured using the European QoL 5-dimensions questionnaire (EQ-5D). Responses from patients employed preprocedure were analysed using multivariate logistic regression. Propensity score-matching was further used to compare similar patient populations receiving PCI or CABG. Results: The response rate was 38% (235 PCI and 88 CABG patients). 241 respondents (75%) were employed preprocedure. Of these 162 (93%) PCI and 51 (77%) CABG patients returned to work, whereas 147 (85%) PCI and 41 (62%) CABG patients were still employed at >12 months postprocedure. After propensity analysis, there was no significant difference between PCI and CABG patients in RTW, long-term employment, nor QoL. The median time taken to RTW was 6 weeks after PCI and 13 weeks after CABG (p=0.001). The effect remained significant after multivariate analysis (p=0.001) and propensity analysis (p=0.001). Conclusions: In this first propensity score-matched study comparing RTW and QoL after PCI or CABG strict propensity matching indicates that RTW or QoL, is similar for PCI or CABG, albeit the number of matched pairs was small. There are differences, however, in delay in RTW