How effective are nasal steroids combined with nonsedating antihistamines for seasonal allergic rhinitis?

For treating seasonal allergic rhinitis, inhaled nasal corticosteroids are superior to nonsedating antihistamines (Grade of recommendation: A, based on a large meta-analysis of randomized controlled trials [RCTs]). Combining nasal steroids and nonsedating antihistamines yields no additional benefits (Grade of recommendation: A, based on several RCTs). Unless patient preference limits their use, nasal steroids should be first-line therapy

Should we treat elevated cholesterol in elderly patients?

HMG-CoA reductase inhibitors, or statins, have been shown to decrease all-cause mortality in individuals aged 65 and older with known coronary heart disease (CHD) and elevated cholesterol levels. (Grade of recommendation: A, based on randomized controlled trials.) The clinical benefit of statin use in older persons without known CHD, however, is uncertain. Decisions about testing for lipid levels and treatment should include discussions with the patient about the potential benefits and risks of treatment, taking into account the individual's overall risk of CHD. (Grade of recommendation: C, based on extrapolations from cohort studies.

What are the indications for urodynamic testing in older adults with incontinence?

Urodynamic testing is indicated for older adults with incontinence when the underlying cause remains unclear (Grade of Recommendation: B, based on multiple well designed, but inconsistent, randomized controlled trials [RCTs]). Simple cystometry -- specifically, measuring post void residual and bladder capacity -- is helpful in the evaluation of urinary incontinence when the cause has remained unclear. It may also offer benefit when surgery is under consideration, when there is a history of genitourinary surgery, or when a conservative therapeutic trial has not had an adequate response (Grade of Recommendation: C, based on a small number of RCTs, retrospective cohort studies and systemic reviews)

What are effective strategies for reducing the risk of steroid-induced osteoporosis?

Calcium, in combination with vitamin D, prevents bone loss and is recommended in all patients. (Grade of recommendation: A, based on systematic reviews of randomized controlled trials [RCTs]). Alendronate and risedronate prevent fractures and should be considered for all patients at increased risk of fracture (5 mg of prednisone or equivalent, daily for longer than 3 months). (Grade of recommendation: A, based on RCTs) Replacement of sex hormones in hypogonadal patients prevents bone loss and increases bone mineral density (BMD). (Grade of recommendation: A for women, based on RCTs; B for men, based on one randomized, crossover trial.) Calcitonin prevents bone loss for up to 1 year. (Grade of recommendation: A, based on systematic review.

A Practical Theory-Based Approach to Action-Research in Survivor Communities

This article draws on field reports and education theory to: 1. Describe a dynamic in communities living with repercussions of historic events; 2. Describe the potential of action research to overcome this dynamic; and 3. Interpret data from a recent action research initiative. Findings suggest these communities may be defined by their capacity to imagine a better future, that this capacity may be enhanced by action research initiatives, and that this capacity is measurable. These findings offer Extension professionals a quantifiable construct that will allow them to document community need, evaluate results, and generate support for action research initiatives

Multi-stakeholder process of co-designing small-scale fisheries policy in South Africa.

In 2005, a group of researchers, community-based organizations and lawyers got together with small-scale fishers to launch a class action law suit against the government of South Africa in its allocation system of Individual Transferable Quotas, on the ground that the system was unfair to small-scale fishing communities and threatened their right to practise their livelihoods. This effort resulted in the cabinet adoption of a new small-scale fisheries policy in 2014, with amendments being made to fisheries law (the Marine Living Resource Act 18 of 1998) to accommodate the issues and concerns of small-scale fisheries. Draft regulations and an implementation plan have recently been released, paving the way for the implementation of small-scale fisheries allocations in 2016. These legal and policy shifts are of great significance for small-scale fisheries, both in South Africa and elsewhere, and deserve careful examination. This paper discusses the processes leading to the development of a new small-scale fisheries policy and what has followed since. Specifically, the analysis focuses on a variety of collaborations between scholars from different disciplines; researchers from multiple fields; community practitioners representing diverse professional and community perspectives; and community organizations across local, state, national and international levels. The paper uses a model of change that crosses research and practitioner boundaries based on three key strategies: getting noticed; organizing at scale; and getting a seat at the negotiation table. It also considers the “transdisciplinary” process of involving all relevant actors in strategic, collective, reflection–action–reflection–action “from below”, which was crucial in the co-designing of this small-scale policy formulation in South Africa

A Practical Theory-Based Approach to Action-Research in Survivor Communities

This article draws on field reports and education theory to: 1. Describe a dynamic in communities living with repercussions of historic events; 2. Describe the potential of action research to overcome this dynamic; and 3. Interpret data from a recent action research initiative. Findings suggest these communities may be defined by their capacity to imagine a better future, that this capacity may be enhanced by action research initiatives, and that this capacity is measurable. These findings offer Extension professionals a quantifiable construct that will allow them to document community need, evaluate results, and generate support for action research initiatives