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The latest evidence for practice

Choice picks from the research journals, with some choice comment …

Una Adderley
Specialist Nurse
Team Leader

Postmenopausal hot flushes
Approximately 75% of postmenopausal women suffer from vasomotor symptoms, such as night sweats and hot flushes. Although these symptoms are not indicators of serious illness, they can cause much discomfort and often prompt women to seek medical advice.

Until recently, hormone replacement therapy (HRT) was the usual treatment offered for menopausal symptoms. However, the small but statistically significant link between HRT and serious conditions, such as myocardial infarction and breast cancer, appears to have discouraged uptake of HRT.

Although alternative approaches, such as lifestyle changes and natural phyto-oestrogens, may be effective for some sufferers, they may not work as well in women with severe vasomotor symptoms. Such women may still require HRT at a dose that will be effective, while minimising risks.

This American randomised, controlled trial sought to discover whether the lowest available strength transdermal oestrogen hormone replacement therapy (microdose 17β-oestradiol) was effective in reducing the frequency and severity of hot flushes in symptomatic postmenopausal women.

A total of 425 healthy postmenopausal women with symptoms of hot flushes were randomly allocated to one of three groups.  The first group received a low-dose patch; the second group received a microdose patch; while the third group received a placebo. The patches were changed weekly and the participants were followed for 12 weeks.

All three groups showed a gradual improvement in their symptoms; but at 12 weeks, the groups that had received low-dose and microdose patches experienced less frequent and less severe hot flushes.

A commentary notes that the results of this trial support the principle of "start low, titrate slow", as the microdose intervention appears to offer effective vasomotor relief that is comparable with low-dose preparations. l

Reference
Bachmann GA, Schaefers M, Uddin A, Utian WH. Lowest effective trandermal 17β-oestradiol dose for relief of hot flushes in postmenopausal women: a randomized controlled trial.  Obstet Gynacol 2007,110:771–9.

Commentary
Dorsen C. Evid Base Nurs 2008;11:53.

Does brisk walking improve cardiovascular risk factors?
Walking is an activity that is easy, accessible and sustainable for most of the population. There is evidence to suggest that regular brisk walking improves general health but the effect on cardiovascular risk factors was unknown. A meta-analysis sought randomised, controlled trials (RCTs) that had assessed the effects of walking on changes in cardiovascular risk factors in sedentary but otherwise healthy adults. Twenty-four RCTs met the inclusion criteria. On average, the walking programmes lasted for 35 weeks and walking was done 4.4 times a week for 38 minutes per session.

The results showed that brisk walking improved cardiovascular fitness, body composition and diastolic blood pressure. A commentary noted that although there were some methodological issues that limited the robustness of the results, this study supports the results of other studies suggesting that nurses should encourage walking, particularly among sedentary populations.

Reference
Murphy MH, Nevill AM, Murtagh EM, Holder RL. The effect of walking on fitness, fatness and resting blood pressure: a meta-analysis of randomised, controlled trials. Prev Med 2007;44:377–85.

Commentary
Maddison R. Evid Base Nurs 2008,11(1):15