The effect of education and training on the provision of intrapartum care by general practitioners

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Nurse-led interventions used to improve control of high blood pressure in people with diabetes: a systematic review and meta-analysis

Background: Previous reviews demonstrate uncertainty about the effectiveness of nurse‐led interventions in the management of hypertension. No specific reviews in diabetes have been identified. We have systematically reviewed the evidence for effectiveness of nurse‐led interventions for people with diabetes mellitus. Methods: In this systematic review and meta‐analysis, searches of Medline, Embase, CINAHL and the Cochrane Central Trials register were undertaken to identify studies comparing any intervention conducted by nurses in managing hypertension in diabetes with usual doctor‐led care. Additional citations were identified from papers retrieved and correspondence with authors. Outcome measures were absolute systolic and diastolic blood pressure, change in blood pressure, proportions achieving study target blood pressure and proportions prescribed anti‐hypertensive medication. Results: Eleven studies were identified. Interventions included adoption of treatment algorithms, nurse‐led clinics and nurse prescribing. Meta‐analysis showed greater reductions in blood pressure in favour of any nurse‐led interventions (systolic weighted mean difference −5.8 mmHg, 95% CI −9.6 to −2.0; diastolic weighted mean difference −4.2 mmHg, 95% CI −7.6 to −0.7) compared with usual doctor‐led care. No overall superiority in achievement of study targets or in the use of medication was evident for any nurse‐based interventions over doctor‐led care. Conclusions: There is some evidence for improved blood pressure outcomes with nurse‐led interventions for hypertension in people with diabetes compared with doctor‐led care. Nurse‐based interventions require an algorithm to structure care and there is some preliminary evidence for better outcomes with nurse prescribing. Further work is needed to elucidate which nurse‐led interventions are most effective

The impact of the voice in relation to psychosomatic well-being after education in female student teachers: a longitudinal, descriptive study.

Item does not contain fulltextOBJECTIVE: Voice handicap in relation to psychosomatic well-being after education in female student teachers. METHODS: A longitudinal survey among 90 female students using Voice Handicap Index and Symptom Check List-90 at the start and end of education. RESULTS: Student teachers in fourth grade showed lower VHI Total and lower SCL-90 Total scores compared to first grade. Students with higher VHI scores in fourth grade had higher risk on "Anxiety" (OR=1.8 to 4.8), "Agoraphobia" (OR=1.9 to 3.9) and "Insufficiency in thinking and acting" (OR=1.6 to 3.2). Students with respectively higher VHI-Total and VHI-Emotional subscale scores had higher risk on "Depression" (OR=1.7, resp. 3.9), "Interpersonal sensitivity and mistrust" (OR=1.6, resp. 3.2), "Hostility" (OR=1.7, resp. 2.1) and SCL-Total (OR=3.1 resp. 4.0). CONCLUSIONS: Student teachers at the end of education showed more well-being and were less vocally handicapped. A tendency for a positive relation between higher emotional voice handicap and more psychosomatic complaints was found. SUGGESTIONS: The VHI has proven to be useful and special attention to VHI Emotional scale is advised in screening. This study might have implications for the preventive care and a multi-dimensional approach with attention to physical, mental and social voice care in future teachers is suggested. In contrast to the group score comparisons a closer look at individual reports on specific VHI items in relation to SCL-90 may be fruitful to detect tendencies. Student teachers can benefit from interdisciplinary collaboration between a psychologist and voice therapist in reducing psychosocial risk factors.1 maart 201