A comparison of two differing doses of promethazine for the treatment of postoperative nausea and vomiting.

PURPOSE: To compare the use of promethazine 6.25 mg intravenous (IV) (experimental group) with promethazine 12.5 mg IV (control group) among adult ambulatory surgery patients to control established postoperative nausea or vomiting (PONV). DESIGN/METHODS: In a double-blind, randomized controlled trial (n = 120), 59 subjects received promethazine 6.25 mg and 61 subjects received promethazine 12.5 mg to treat PONV. Study doses were administered postoperatively if the subject reported/exhibited nausea and/or vomiting. Outcomes for experimental and control groups were compared on the basis of relief of PONV and sedation levels. FINDINGS: Ninety-seven percent of subjects reported total relief of nausea with a single administration of promethazine at either dose. Sedation levels differed between groups at 30 minutes post-medication administration and at the time of discharge to home. CONCLUSIONS: Promethazine 6.25 mg is as effective in controlling PONV as promethazine 12.5 mg, while resulting in less sedation.

Effect of concord grape juice on chemotherapy-induced nausea and vomiting: results of a pilot study.

PURPOSE/OBJECTIVES: To determine the feasibility of administering a flavonoid-rich adjunctive treatment (Concord grape juice) for the management of chemotherapy-induced nausea and vomiting (CINV); to evaluate the usefulness of existing measures for assessing CINV frequency and severity, quality of life, control over life events, and psychological state; to identify any actual or potential adverse events associated with frequent grape juice intake; and to provide preliminary data concerning the effect of Concord grape juice on CINV, quality of life, perceived control over life events, and psychological state. DESIGN: Double-blind, randomized clinical trial. SETTING: A cancer center in an academic health science center in the northeastern United States. SAMPLE: 77 adult patients with cancer receiving moderately or highly emetogenic chemotherapy agents. METHODS: Participants drank 4 oz. of grape juice or placebo prior to meals for one week following each of four chemotherapy treatment cycles. They recorded frequency, duration, and distress of nausea, vomiting, and retching daily, beginning the evening of chemotherapy administration and continuing for seven days. Data were analyzed with generalized estimating equations methodology to model differences between groups over time. MAIN RESEARCH VARIABLES: Nausea and vomiting frequency, duration, and distress; quality of life; control over decision making; and psychological state. FINDINGS: Nausea and vomiting frequency, duration, and distress were lower for experimental group members, although a high attrition rate (50%) resulted in insufficient power to detect statistically significant differences over time. Greater levels of anxiety, depression, and hostility at baseline were related to nausea and vomiting, quality of life, and perceived control over decision making. CONCLUSIONS: The effect of grape juice flavonoids on CINV should be investigated further with a larger sample to determine whether preliminary findings are supported. Alterations to the study protocol will be necessary to decrease attrition. IMPLICATIONS FOR NURSING: Flavonoid-rich fruits and vegetables may provide additional protection against CINV. If the compounds work, they would offer a low-cost, readily available adjunctive treatment for the management of CINV.

Implementing an oral health program in a group prenatal practice.

The Rochester Adolescent Maternity Program (RAMP) has incorporated evidence-based oral health guidelines into its prenatal care. These guidelines focus on tracking oral health services, screening and triaging prenatal patients, and providing patient and staff with the education needed to decrease oral health risks to mother, fetus, and baby. The RAMP process serves as a model for promoting quality oral health practices in pregnant teenagers and their babies.

Comparison of home health care physical therapy outcomes following total knee replacement with and without subacute rehabilitation.

PURPOSE: Few studies have examined the rehabilitation progression of patients managed through home health care physical therapy services following total knee replacement surgery. This study compares the episodes of care and functional outcomes of patients sent directly home to those discharged to a subacute rehabilitation setting prior to home health care. METHODS: Prospective data were collected from 212 consecutive home health care patients referred for physical therapy following total knee replacement surgery. Data routinely recorded by the physical therapist at each home visit related to ambulatory progression and physical status was used in analysis. RESULTS: Patients admitted to the subacute facilities on hospital discharge were older and less likely to have a caregiver in or near the home. Equivalent physical therapy outcomes were seen regardless of hospital discharge disposition, although patients admitted to subacute rehabilitation settings required an additional 12.4 days. Younger patients admitted to subacute rehabilitation settings demonstrated less desirable outcomes at time of initial home visit, although these differences disappeared by time of discharge from home health care. CONCLUSIONS: Findings suggest that direct discharge home following total knee replacement surgery is a viable option for many patients. The application of evidence to physical therapy practice can promote more informed decision-making and foster the use of best practice in the home health care setting.