Joyce Anastasi

Abstract

The popularity and prevalence of herbal products and dietary supplements in the US has grown steadily. Patients are increasingly using them to prevent disease, complement conventional therapies, and promote well being and health. Nurse practitioners play a critical role in discussion, communication, and education of herbal supplement use. This article provides a review of commonly used herbal supplements regarding recent evidence for efficacy, possible drug interactions, and safety considerations.

Abstract

The incidence of cardiovascular disease (CVD) is increasing in HIV-infected people. Risk factors such as hyperlipidemia, impaired glucose tolerance, and insulin resistance have become common. CVD in HIV may also be related to nontraditional risk factors including accumulation of visceral fat, inflammation secondary to HIV, and effects of some antiretroviral drugs. This cross-sectional study described the CVD risk factors of 123 adults living with HIV and calculated the 10-year estimate for general cardiovascular risk score. Results showed that approximately 25% of the participants were considered to be at high risk for developing CVD in the next 10 years. Increased waist circumference and longer duration of smoking habit were associated with elevated general cardiovascular risk scores. Similar to the general population, most of the identified risks could be modified through lifestyle management.

Abstract

HIV infection has become a chronic illness with the availability of potent antiretroviral agents. Many of the agents used to manage HIV, however, have been associated with distressing symptoms such as nausea and vomiting posing challenges to maintain adherence to therapy and quality of life. This article highlights the mechanism, evaluation, and management of HIV-associated nausea and vomiting. Supportive symptom management information is also presented.

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Peripheral neuropathy is one of the most common neurological complications of human immunodeficiency virus (HIV) infection and continues to impact people living with HIV/AIDS. The pain associated with peripheral neuropathy can be severe and debilitating. Most pharmacological agents are inadequate in symptom management and are accompanied by adverse side-effects. Acupuncture and moxibustion offer treatment approaches that can reduce HIV symptoms and/or the side-effects of anti-retroviral therapy and improve patients' quality of life.

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Distal sensory peripheral neuropathy is a common neurological complication experienced by people living with the human immunodeficiency virus (HIV). Traditional Chinese medicine (TCM) may offer effective interventions in the management of its symptoms. To improve the quality and transparency of reporting acupuncture clinical trials, the Consolidated Standards of Reporting Trials (CONSORT) guidelines were developed in 1996 and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) recommendations were introduced in 2001. Incorporating international guidelines, this paper describes the development of a RCT including rationale, design, methods, procedures and logistics for a pilot study aimed at evaluating acupuncture and moxibustion for neuropathy associated with HIV. Using STRICTA guidelines as a template, aspects of clinical research design are explored to further optimise future studies of TCM.

Abstract

OBJECTIVES: To review the quality of adverse event reporting for published randomized controlled trials (RCTs) focusing on acupuncture for pain reduction. With the release of the Consolidated Standards of Reporting Trials (CONSORT) in 2001, the quality of published RCTs has improved. To improve reporting on adverse events, CONSORT expanded the section on harms (adverse events) in 2004. This paper evaluates whether the updated harms guidelines have been implemented in RCTs evaluating acupuncture for pain relief. METHODS: Systematic searches were conducted using the following databases: MEDLINE, Allied & Complementary Medicine, Cumulative Index to Nursing & Allied Health Literature, and All EBM Reviews. Each database was searched from 2005 through 2008, corresponding to the availability of the updated harms guideline. RESULTS: Ten studies met the inclusion criteria of this review. Six of the 10 studies mentioned or discussed adverse events. Four of the 6 studies did not detail how adverse events were collected. Only 2 studies discussed how adverse events were assessed. DISCUSSION: On the basis of our findings, acupuncture clinical trials for pain reduction have yet to comprehensively meet CONSORTs guidelines for adverse event reporting. Acupuncture is commonly used by patients experiencing pain and although typically viewed as a benign and minimally invasive therapy, serious adverse events have been reported in the literature. To effectively and comprehensively document and understand these events, routine reporting according to ONSORT s harms guidelines should become the norm. Both science and patients are served by accuately evaluating the safety of acupuncture for patient populations experiencing pain.

Abstract

Purpose: To discuss the etiology, clinical presentation, diagnosis, and management of endometriosis for the advanced practice nurse (APN) in primary care.Data sources: Selected research, clinical studies, clinical practice guidelines, and review articles.Conclusions: Commonly encountered by the APN in primary care, endometriosis is a chronic, progressive inflammatory disease characterized by endometrial lesions, cysts, fibrosis, or adhesions in the pelvic cavity, causing chronic pelvic pain and infertility in women of reproductive age. Because of its frequently normal physical examination findings, variable clinical presentations, and nonspecific, overlapping symptoms with other conditions, endometriosis can be difficult to diagnose. As there currently are no accurate noninvasive diagnostic tests specific for endometriosis, it is imperative for the APN to become knowledgeable about the etiology, clinical presentation, diagnosis, and current treatment options of this disease.Implications for practice: The APN in primary care plays an essential role in health promotion through disease management and infertility prevention by providing support and much needed information to the patient with endometriosis. APNs can also facilitate quality of care and manage treatments effectively to improve quality of life, reduce pain, and prevent further progression of disease. Practice recommendations include timely diagnosis, pain management, infertility counseling, patient education, and support for quality of life issues.

Abstract

The authors describe the development and incorporation of an integrative therapies subspecialty curriculum into a graduate nursing education program. Specialized education in integrative therapies prepares nursing students more thoroughly for primary care practice because many patients now use what is called complementary and alternative medicine in conjunction with standard medical care. Students learn to determine the safety, efficacy, and cultural significance of complementary and alternative medicine practices of their diverse patient population.