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Oncology Nursing Forum 2002To provide a systematic review in relation to evidence-based practice for the management of sexual dysfunction in adults with cancer and to define the current state of... (Review)
Review
PURPOSE/OBJECTIVES
To provide a systematic review in relation to evidence-based practice for the management of sexual dysfunction in adults with cancer and to define the current state of knowledge about intervention for this symptom, the gaps and barriers in the current state of knowledge, and recommendations for public education and future research direction.
DATA SOURCES
Articles published from 1980-2000, books, and practice standards.
DATA SYNTHESIS
Few tested interventions are available to treat sexual dysfunction in patients with cancer. Those dysfunctions investigated include hot flashes, vaginal dryness, bladder control, and sexual functioning in two breast cancer populations, and psychosocial issues in a remaining few. Many diverse interventions have been reported based on expert opinion and case study.
CONCLUSIONS
Although an abundance of literature exists related to the provision of interventions for sexual dysfunction in patients with cancer, few results are from randomized controlled clinical trials. Sexual dysfunction has been addressed extensively in the literature in relation to patients with cancer, but information is needed to ascertain the best assessment strategy and the best intervention, along with appropriate outcome criteria and research design. Description and control of the disease and treatment variables as outcome moderators are needed.
IMPLICATIONS FOR NURSING PRACTICE
Reliable and valid interventions to promote sexual function are necessary as nurses intervene with patients and their partners. Practice guidelines are available but must begin to be based on research as well as expert opinion. As more research-based intervention information becomes available, clinicians will be able to provide care with greater confidence and certainty.
Topics: Evidence-Based Medicine; Humans; Medical Oncology; Neoplasms; Nursing Assessment; Oncology Nursing; Patient Education as Topic; Prevalence; Research Design; Self-Help Groups; Sex Counseling; Sexual Dysfunction, Physiological; Treatment Outcome
PubMed: 11817493
DOI: 10.1188/02.ONF.53-69 -
The Cochrane Database of Systematic... 2000Endometriosis is a major women's health-care problem. It causes pain and/or infertility, and affects millions of women worldwide. Endometriosis is defined according to... (Review)
Review
BACKGROUND
Endometriosis is a major women's health-care problem. It causes pain and/or infertility, and affects millions of women worldwide. Endometriosis is defined according to histological criteria by the presence of tissue resembling endometrium in sites outside the uterus, most commonly the ovaries and peritoneum. The aim of treatment has been to remove the deposits of ectopic endometrium that are thought to be responsible for the symptoms of endometriosis. This can be achieved surgically by destroying or removing the implants; medical therapies induce atrophy within the hormonally-dependent ectopic endometrium. The duration of hormonal treatment may be limited by unwanted side effects. There is some evidence, however, from epidemiological research that current use of the combined oral contraceptive pill (OCP) is associated with a reduced incidence of endometriosis. The combined pill has the great advantage over other hormonal treatments that it can be taken indefinitely.
OBJECTIVES
The aim of this review was to establish the role of modern oral contraceptives in the management of painful symptoms ascribed to endometriosis.
SEARCH STRATEGY
The search strategy of the Menstrual Disorders Group was utilised to identify all randomised trials of the use of oral contraceptives in the treatment of symptomatic endometriosis. In addition a search of the Cochrane Controlled Trials Register was undertaken together with approaches to pharmaceutical companies.
SELECTION CRITERIA
All truly randomised controlled trials of the use of oral contraceptive pills in the treatment of women of reproductive age with symptoms ascribed to the diagnosis of endometriosis made visually at a surgical procedure, were included.
DATA COLLECTION AND ANALYSIS
Study quality assessment and data extraction was carried out independently by two reviewers. One of the assessors was an expert in the content matter.
MAIN RESULTS
Only one study was identified which satisfied the inclusion criteria. The oral contraceptive used in a conventional manner was less effective than a GnRH analogue in the relief of dysmenorrhoea. No significant difference was noted between the effectiveness of the oral contraceptive pill and a GnRH analogue in the relief of dyspareunia or non-menstrual pain. Headaches and weight gain were more commonly associated with oral contraceptive usage than with GnRH analogue usage whereas hot flushes, insomnia and vaginal dryness were less common.
REVIEWER'S CONCLUSIONS
There is a paucity of data relating to the use of oral contraceptive preparations in the treatment of symptomtic endometriosis. The data such as it is supports the common practice of the use of the oral contraceptive pill as a first line therapy but further research is required to fully evaluate its role in the management of endometriosis.
Topics: Contraceptives, Oral; Endometriosis; Female; Humans; Pelvic Pain
PubMed: 10796731
DOI: 10.1002/14651858.CD001019 -
Canadian Family Physician Medecin de... Jun 1998To review the scientific literature on common alternative remedies for treatment of symptoms attributed to menopause and to contrast this with available lay literature. (Review)
Review
OBJECTIVE
To review the scientific literature on common alternative remedies for treatment of symptoms attributed to menopause and to contrast this with available lay literature.
QUALITY OF EVIDENCE
Scientific articles were identified by searching MEDLINE, CINAHL, and HEALTH databases from 1966 to mid-1997 for English-language articles. More than 200 references were reviewed; 85 were selected for citation based on specific reference to alternative medicine for symptoms commonly attributed to menopause (e.g., hot flashes), to the effects of changing estrogen levels (e.g., irregular menses, vaginal dryness), and to reported side effects of the treatments.
MAIN FINDINGS
The scientific literature was categorized under the headings nutritional supplements, herbal remedies, homeopathic remedies, and physical approaches. Some scientific evidence of the safety and efficacy of alternative treatments during menopause was uncovered, with the strongest evidence emerging in favour of phytoestrogens, which occur in high concentrations as isoflavones in soy products.
CONCLUSIONS
In available controlled studies, the strongest data support phytoestrogens for their role in diminishing menopausal symptoms related to estrogen deficiency and for possible protective effects on bones and the cardiovascular system. Randomized controlled trials, standardization of dosage, and accurate safety and efficacy labeling are required to ensure proper use of alternative remedies.
Topics: Complementary Therapies; Estrogens, Non-Steroidal; Evidence-Based Medicine; Food, Organic; Homeopathy; Humans; Isoflavones; Menopause; Phytoestrogens; Phytotherapy; Plant Preparations; Research Design; Treatment Outcome
PubMed: 9640524
DOI: No ID Found