Introduction of oral vitamin D supplementation and the rise of the allergy pandemic

The history of the allergy pandemic is well documented, enabling us to put the vitamin D hypothesis into its historical context. The purpose of this study is to compare the prevalence of rickets, vitamin D supply, and allergy prevalence at 50-year intervals by means of a retrospective analysis of the literature since 1880

A systematic review on the effectiveness of nurse-led cardiac clinics for adult patients with coronary heart disease

AimNurse-led clinics offer the possibility of patient education, support and continuity of care for patients with Coronary Heart Disease (CHD) to address and reduce risk factors. The objective of this review is to present the best available evidence related to nurse-led cardiac clinics for adults with CHD by updating an existing systematic review.MethodsTwenty databases for published literature and 11 databases or websites for unpublished literature were searched for the period September 2002 to March 2008. Additionally, reference lists of retrieved articles were reviewed and relevant journals were hand searched. Assessment for methodological quality, data extraction and synthesis was undertaken using a systematic review management tool (JBI-SUMARI).ResultsSeven RCTs formed the basis for this systematic review, however, in many cases meta-analysis was not possible because of a lack of relevant data. The major nurse-led intervention applied in the clinics consisted of health promotion through educating and counselling the patients. There were no harmful effects on patients with CHD identified when exposed to a nurse-led clinic. Few risk factors were significantly reduced by attending nurse-led clinic, but particular in the long-term no success in risk factor reduction was achieved. Difficulties were obvious in modifying behaviour changes concerning smoking cessation and diet adherence. Nurse-led clinics may positively influence perceived quality of life and general health status, especially physical functioning.ConclusionThe results indicated that care was equivalent to non-nurse led clinics, and there was no greater risk of poorer outcomes in the nurse-led clinics. The effectiveness of clinics might be dependent on the intensity of the nursing support. The combination of counselling and regular assessment of risk factors and health status delivered at nurse-led clinics is supported by the available research, and given that outcomes were in general equivalent between nurse-led and other clinics, further research should investigate the cost effectiveness of the different models of care.Implication for practiceBefore establishing a nurse-led clinic appropriate qualification and responsibilities, as well as the particular structure of the health care system and funding possibilities have to be considered.Implication for researchAdditional research on the effectiveness of selected interventions in nurse-led clinics is necessary. A systematic review on cost-effectiveness should be undertaken.V. Schadewaldt and T. Schultzhttp://connect.jbiconnectplus.org/JBIReviewsLibrary.asp

Nurse-led clinics as an effective service for cardiac patients: results from a systematic review

AIM: The article summarises results of a systematic review on the effectiveness of nurse-led clinics for patients with coronary heart disease. The objective was to present the best available evidence related to effective interventions in nurse-led cardiac clinics including patient education, risk factor assessment and continuity of care. METHODS: Following the principles of the Cochrane Collaboration for systematic reviews on effectiveness, this is an update to a previously published review. Thirty databases, relevant journals and hand searching of reference lists were the basis for a comprehensive literature search for the period September 2002 to March 2008. Assessment of methodological quality, data extraction and synthesis was undertaken using a systematic review management tool (JBI-SUMARI). When possible, data was pooled in a meta-analysis. RESULTS: The systematic review is based on seven randomised controlled trials. Inconsistencies of interventions executed in nurse-led clinics and various effects on the outcomes make a comparison difficult. The major nurse-led intervention applied in the clinics consisted of health education, counselling behaviour change and promotion of a healthy lifestyle. There were no harmful effects on patients with coronary heart disease identified when exposed to a nurse-led clinic. A few risk factors were significantly reduced in the short term by attending nurse-led clinics, but long-term changes were less apparent. The success of modifying behaviour such as smoking cessation and diet adherence was limited. However, nurse-led clinics may positively influence perceived quality of life and general health status. CONCLUSION: The results indicated that care was equivalent to non-nurse-managed clinics, and there was no greater risk of poorer outcomes in the nurse-led clinics. The effectiveness of clinics might be dependent on the intensity of the nursing support. Before establishing a nurse-led clinic appropriate qualification and responsibilities, as well as the particular structure of the healthcare system and funding possibilities have to be considered. The combination of counselling and regular assessment of risk factors and health status delivered at nurse-led clinics is supported by the available research, and given that outcomes were in general equivalent between nurse-led and other clinics, further research should investigate the cost-effectiveness of the different models of care.Verena Schadewaldt and Tim Schult