Nurse-led interventions to manage hypertension in general practice: A systematic review and meta-analysis

To evaluate the impact of general practice nurse-led interventions for blood pressure control and cardiovascular disease risk factor reduction in patients with hypertension. Systematic review and meta-analysis of randomized control trials. CINAHL, Medline and Scopus databases were searched to identify peer-reviewed studies published between 2000 and 2021. A systematic review of randomized control trials was conducted using a structured search strategy. The Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to appraise study quality. Meta-analysis and narrative synthesis were performed to determine the effectiveness of the included interventions. Eleven trials comprising of 4454 participants were included in the review. Meta-analysis showed significant reductions in both systolic and diastolic blood pressure in trials with 6 months or less follow-up. Improvements were also demonstrated in reducing blood lipids, physical activity, general lifestyle measures and medication adherence. Evidence for dietary improvements and reduction in alcohol and smoking rates was inconclusive. Nurse-led interventions for patients with hypertension are heterogeneous in terms of the nature of the intervention and outcomes measured. However, nurse-led interventions in general practice demonstrate significant potential to improve blood pressure and support cardiovascular disease risk factor reduction. Future research should be directed towards elucidating the successful elements of these interventions, evaluating cost-effectiveness and exploring translation into usual care. This review provides evidence that nurses in general practice could enhance current hypertension management through nurse-led interventions.

An Environmental Scan of the Role of Nurses in Preventing Fetal Alcohol Spectrum Disorders

Nurses are in an ideal position to talk to their patients of reproductive age about alcohol use and encourage the prevention of alcohol-exposed pregnancies. Effective conversations can be efficiently included in the clinical encounter to identify alcohol misuse and offer appropriate follow-up. This report presents results of an environmental scan of resources relevant to nursing professionals and nurses' role in addressing alcohol misuse. Gaps in nursing education and practice guidelines with regard to defining the nursing role in preventing alcohol-exposed pregnancies were revealed. Findings identified a need to promote adoption among nurses of evidence-based preventive practices to prevent alcohol misuse.

Rethinking the Well Woman Visit: A Scoping Review to Identify Eight Priority Areas for Well Woman Care in the Era of the Affordable Care Act

PURPOSE

The annual pap smear for cervical cancer screening, once a mainstay of the well woman visit (WWV), is no longer recommended for most low-risk women. This change has led many women and their health care providers to wonder if they should abandon this annual preventive health visit altogether. Changing guidelines coinciding with expanded WWV coverage for millions of American women under the Patient Protection and Affordable Care Act have created confusion for health care consumers and care givers alike. Is there evidence to support continued routine preventive health visits for women and, if so, what would ideally constitute the WWV of today?

METHODS

A scoping review of the literature was undertaken to appraise the current state of evidence regarding a wide range of possible elements to identify priority areas for the WWV.

FINDINGS

A population health perspective taking into consideration the reproductive health needs of women as well as the preventable and modifiable leading causes of death and disability was used to identify eight domains for the WWV of today: 1) reproductive life planning and sexual health, 2) cardiovascular disease and stroke, 3) prevention, screening, and early detection of cancers, 4) unintended injury, 5) anxiety, depression, substance abuse, and suicidal intent, 6) intimate partner violence, assault, and homicide, 7) lower respiratory disease, and 8) arthritis and other musculoskeletal problems.

CONCLUSIONS

The WWV remains a very important opportunity for prevention, health education, screening, and early detection and should not be abandoned.

Characteristics of drug demand reduction structures in Britain and Iran

Administrative structure of drug demand reduction and the way in which involved organizations interact with each other has been neglected by researchers, policy makers, and administrators at the national level and even in international institutions in this field. Studying such structures in different countries can reveal their attributes and features. In this study, key experts from the addictive behavior department of St George's University of London and a group of Iranian specialists in the field of drug demand reduction first wrote on a sheet the name of organizations that are in charge of drug demand reduction. Then, via teamwork, they drew the connections between the organizations and compared the two charts to assess the relations between the member organizations. In total, 17 features of efficient structure were obtained as follow: multi-institutional nature, collaborative inter-institutional activities, clear and relevant inter-institutional and intra-institutional job description, the ability to share the experiences, virtual institutions activity, community-based associations activity, mutual relationships, the existence of feedback sys-tems, evaluation, changeability, the ability to collect data rapidly, being rooted in community, flexibility at the local and regional levels, connection with research centers, updated policymaking, empowering the local level, and seeking the maximum benefit and the minimum resources. Recognizing the characteristics of substance related organizations in various countries could help policy makers to improve drug demand reduction structures and to manage the wide-spread use of psychoactive substances more effectively.