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

Adherence to adjuvant therapy in post-menopausal breast cancer patients: A review

This is the post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2012 John Wiley & Sons, IncThis review aimed to address the concept of adherence to adjuvant therapy in post-menopausal women. Thirteen studies were included in the review. Study quality was assessed using Critical Appraisal Skills Programme and CONSORT tools. Adherence to adjuvant medication was assessed using a variety of methods. Estimates of adherence rates to adjuvant therapies indicated that of the post-menopausal women prescribed adjuvant therapy, between 15% and 55% were adherent to tamoxifen from 1 to 5 years of follow-up, albeit two studies proposed adherence rates greater than 85%; these data may be flawed due to the methods of data collection. Between 31% and 73% of women were adherent to anastrozole, letrozole or exemestane from 1 year of treatment. These estimates of adherence are based on a variety of reported records including self-report. Current evidence on the assessment of adherence to adjuvant therapies in post-menopausal women indicate that the adherence rates of medication maybe suboptimal and therefore therapeutic efficacy is questionable and may increase the risk of cancer recurrence and reduce disease survival rates. Concerted research is needed to investigate adherence rates, examine patient health beliefs in the medication management of post-menopausal breast cancer patients and also develop new measures to assess adherence with medication

A review of interventions used to improve adherence with medication in older

Background: Medication mismanagement is a continuous problem particularly in older people. Numerous interventions have been developed and tested in an attempt to improve adherence with medication in this client group. Objectives: This review aimed to examine the simple to complex interventions that have been used to assess and improve adherence with medication in older people. Design: An extensive review of the literature was performed and 20 relevant research papers and one report were chosen. Findings: Research papers were evaluated according to design, RCTs were analysed using the JADAD scoring system, systematic reviews and reviews of the literature were reviewed using the Critical Appraisal Skills Programme and subjected to a narrative analysis. This process assisted the development to emerging themes. Four themes were developed: patient barriers, health professional involvement, and health related outcomes and formation giving. Conclusions: The salient findings of the review infer that there is no clear definition of non–adherent behavior. Quantitative interventions fail to assess patient choice in relation to medication taking. Pharmacist-driven interventions are resource intensive. Health care outcomes and clinical effectiveness are seldom addressed in interventions. Among the many difficulties encountered when attempting to use interventions to promote adherence with medication in older people is their perceptions and beliefs, the appropriateness of the medicines prescribed as well as the impact of lifestyle patterns; smoking, alcohol and diet. Many intervention studies are of poor quality and do not include a theoretical framework to underpin the interventions being used. More focused research is needed to improve understanding of the theoretical knowledge that underpins the complexities of adherence with medication in older people. In-depth qualitative studies can be used to develop such theory. In addition, the quality of intervention research can be improved by the inclusion of a research framework such as the Medical Research Council model

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

Topical diclofenac: Clinical effectiveness and current uses in osteoarthritis of the knee and soft tissue injuries

Background: Diclofenac is a commonly used non-steroidal anti-inflammatory drug (NSAID) for symptom control in osteoarthritis (OA) of the knee and soft tissue injuries. Although treatment with oral diclofenac is associated with serious adverse effects involving both the gastrointestinal and renal systems, these adverse effects are thought to be limited with topical diclofenac formulations without loss of efficacy. Objective: The aim of this review is to explore the available evidence in relation to the pharmacokinetics, efficacy and reported adverse effects of the topical diclofenac formulations available. Results/conclusions: In the majority of studies examined, topical diclofenac formulations with sodium lotion, lecithin or epolamine gel, patch or plaster were either superior or equivalent to oral diclofenac formulations or placebo. Topical diclofenac significantly reduced pain and morning stiffness and improved physical function and patient global assessment without major adverse effects reported in patients with OA of the knee; and provided significant pain relief in patients with sports and soft tissue injuries involving the ankle, knee or shoulder. In the majority of studies, the predominant adverse effect involved pruritus or rash at the site of application, or nausea. The principle outcome of these studies is that topical diclofenac is a safe and practical alternative as a method of treatment in OA of the knee or as an alternative treatment for sports and soft tissue injury

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

Mode competition in a system of two parametrically driven pendulums with nonlinear coupling

This paper is part three in a series on the dynamics of two coupled, parametrically driven pendulums. In the previous parts Banning and van der Weele (1995) and Banning et al. (1997) studied the case of linear coupling; the present paper deals with the changes brought on by the inclusion of a nonlinear (third-order) term in the coupling. Special attention will be given to the phenomenon of mode competition.\ud \ud The nonlinear coupling is seen to introduce a new kind of threshold into the system, namely a lower limit to the frequency at which certain motions can exist. Another consequence is that the mode interaction between 1¿ and 2ß (two of the normal motions of the system) is less degenerate, causing the intermediary mixed motion known as MP to manifest itself more strongly