bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Five-Degree-of-Freedom Parallel Manipulator and Its Kinematic Optimization
Authors: Song Yimin , Lian Binbin , Sun Tao , Dong Gang , Qi Yang , Gao Hao
Published: May 2014

Driven by requirements of five-axis numerical control (NC) machine for its executive mechanism, this paper creatively proposes a flow path to synthesize a novel class of n-degree-of-freedom (n-DoF, 4 ≤ n ≤ 6) parallel manipulators (PMs) resorting to four steps, and takes a patented 5-DoF PM, named T5, for example to demonstrate the flow path in depth. Comparing with existing five-axis executive mechanisms, this novel class of the PMs has some advantages of light end-effector, good static, dynamic performance, and so on. Upon the underlying architecture of T5, the kinematic analysis and optimal design are carried out for the first time, in which two essential procedures are involved, one is the kinematic performance index by means of the reciprocal product associated with the wrench screw and twist screw with specific physical meaning, the other is the design method adopted to perform the multi-objective dimensional synthesis using an artificial intelligence approach, that is nondominated sorting genetic algorithm II (NSGA-II). This paper is aimed at laying a solid theoretical and technical foundation for the prototype design and manufacture of T5 PM.
Is the mean free path the mean of a distribution?
Authors: Paik Steve T.
Published: May 2014

We bring attention to the fact that Maxwell's mean free path for a dilute hard-sphere gas in thermal equilibrium, (2σn)−1, which is ordinarily obtained by multiplying the average speed by the average time between collisions, is also the statistical mean of the distribution of free path lengths in such a gas.
Draft Genome Sequence of Potassium-Dependent Alkaliphilic
Bacillus
sp. Strain TS-2, Isolated from a Jumping Spider
Authors: Fujinami Shun , Takeda Kiyoko , Onodera Takefumi , Satoh Katsuya , Sano Motohiko , Narumi Issay , Ito Masahiro
Published: May 2014

The potassium-dependent alkaliphilic
Bacillus
sp. strain TS-2 was isolated from the mashed extract of a jumping spider, and its draft genome sequence was obtained. Comparative genomic analysis with a previously sequenced sodium-dependent alkaliphilic
Bacillus
species may reveal potassium-dependent alkaline adaptation mechanisms.
NSE characterization of some alternating groups
Authors: Ahanjideh Neda , Asadian Bahareh
Published: May 2014

Let p ≥ 5 be a prime and n ∈ {p, p + 1, p + 2}. Let G be a finite group and πe(G) be the set of element orders of G. Assume that k ∈ πe(G) and mk(G) is the number of elements of order k in G. Set nse (G) = {mk(G) : k ∈ πe(G)}. In this paper, we show that if nse (An) = nse (G), p ∈ π(G) and p2 ∤ |G|, then G ≅ An. As a consequence of our result, we show that if nse (An) = nse (G) and |G| = |An|, then G ≅ An.
CRYSTALLINE STRUCTURES AND α → β AND γ POLYMORPHS TRANSFORMATION INDUCED BY NANOCLAY IN PVDF-BASED NANOCOMPOSITE
Authors: ABOLHASANI MOHAMMAD MAHDI , NAEBE MINOO , JALALI-ARANI AZAM , GUO QIPENG
Published: May 2014

Poly(vinylidene fluoride) (PVDF) nanocomposites were prepared by melt-mixing. The dispersion of clay platelets and rheology of nanocomposites were analyzed using X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and rheometric mechanical spectrometer (RMS). The transformation of α to β and γ phase in PVDF was induced by the addition of nanoclay and subsequently the isothermal crystallization kinetics of neat PVDF and its nanocomposite have been investigated. The interaction between clay nanofillers and PVDF macromolecular chains induced the change of conformation from trans-gauche to all-trans crystal structure in PVDF segment. The isothermal crystallization of PVDF/clay nanocomposites was carried out by Differential Scanning Calorimetry (DSC) technique. The influence of clay platelets on nucleation crystallization rate and Avrami exponent were studied. PVDF/clay nanocomposite showed higher crystallization rate indicating that nanoclay has acted as an effective nucleation agent. This nucleation effect of nanoclay increased the Avrami exponent and decreased the degree of crystallinity.
Enhancement of ferroelectricity and large dielectric strength of Pb(Zr0.52Ti0.48)O3 thin films on SrTiO3 substrate with a SrRuO3 buffer
Authors: Tang Zhen-Hua , Xiong Ying , Tang Ming-Hua , Zhang Wanli , Zeng Jia , Zhou Yichun
Published: May 2014

Epitaxial PbZr 0.52 Ti 0.48 O 3 (PZT) films with perfectly c-axis oriented tetragonal phase were deposited on SrTiO 3 (STO) substrates using a SrRuO 3 (SRO) buffer layer by pulsed laser deposition (PLD) method. Ferroelectric behavior of PZT on STO substrates along with an improved remnant polarization (2P r ) of 118 μC/cm2 and a low coercive field (E c ) of 193 kV/cm at 15 V were observed at room temperature indicating that the SRO/STO substrates with small lattice misfit can make some contributions to enhance PZT film's ferroelectric properties. Moreover, the capacitance characteristics of the PZT thin films were detected, a large dielectric constant of 1476, the charging and discharging characteristics determine the large dielectric strength of the PZT thin film capacitors.
Factor XII Regulates the Pathological Process of Thrombus Formation on Ruptured Plaques
Authors: Kuijpers Marijke J.E. , van der Meijden Paola E.J. , Feijge Marion A.H. , Mattheij Nadine J.A. , May Frauke , Govers-Riemslag José , Meijers Joost C.M. , Heemskerk Johan W.M. , Renné Thomas , Cosemans Judith M.E.M.
Published: May 2014

Objective—

Atherothrombosis is the main cause of myocardial infarction and ischemic stroke. Although the extrinsic (tissue factor–factor VIIa [FVIIa]) pathway is considered as a major trigger of coagulation in atherothrombosis, the role of the intrinsic coagulation pathway via coagulation FXII herein is unknown. Here, we studied the roles of the extrinsic and intrinsic coagulation pathways in thrombus formation on atherosclerotic plaques both in vivo and ex vivo.

Approach and Results—

Plaque rupture after ultrasound treatment evoked immediate formation of subocclusive thrombi in the carotid arteries of
Apoe

−/−

mice, which became unstable in the presence of structurally different FXIIa inhibitors. In contrast, inhibition of FVIIa reduced thrombus size at a more initial stage without affecting embolization. Genetic deficiency in FXII (human and mouse) or FXI (mouse) reduced ex vivo whole-blood thrombus and fibrin formation on immobilized plaque homogenates. Localization studies by confocal microscopy indicated that FXIIa bound to thrombi and fibrin particularly in luminal-exposed thrombus areas.

Conclusions—

The FVIIa- and FXIIa-triggered coagulation pathways have distinct but complementary roles in atherothrombus formation. The tissue factor–FVIIa pathway contributes to initial thrombus buildup, whereas FXIIa bound to thrombi ensures thrombus stability.
“AND WHAT DOES ANYTHING AT ALL MATTER?”: Asceticism and the Hermeneutics of Comfort in Hopkins’s Terrible Sonnets
Authors: Yost Julia Dorothy
Published: May 2014

On one account, the life and work of Gerard Manley Hopkins reveal Catholic asceticism as a grim, life-denying regimen, a form of ethical extremism inimical to the poet’s psychological comfort and his creativity. In Hopkins’s latter years, runs the logic, stringent self-denial conduced to depression and to poetic chastening, with the so-called Terrible Sonnets exemplifying both. This essay, however, contends that Hopkins’s asceticism implemented a hermeneutic productive of both psychological recuperation and literary ingenuity. What Hopkins sought was “comfort” in an archaic sense of that word, as goal-oriented and ethical. Such comfort, as the set of objects and affects associated with asceticism, is thematized throughout the Terrible Sonnets. Tracing the theme will serve to draw out the recuperative hermeneutic of Hopkins’s asceticism, which redeems Hopkins’s life in Dublin and establishes the consistency of these late sonnets with his seemingly more characteristic earlier work.
Vanmanenia maculata, a new species of hillstream loach from the Chang-Jiang Basin, South China (Teleostei: Gastromyzontidae)
Authors: YI WEN-JING , ZHANG E , SHEN JIAN-ZHONG
Published: May 2014

Vanmanenia maculata, new species, is described from the middle and lower Chang-Jiang basin in Hubei, Hunan, and Jiangxi provinces, South China. This new species, along with V. caldwelli, V. stenosoma, and V. striata, is distinguished from all other Chinese species of the genus by lacking secondary rostral barbels. It is distinct from V. caldwelli and V. striata in anus placement, rostral lobule shape, and body coloration, and from V. stenosoma in having a larger scaleless area on the ventral surface of the body and a shallower caudal-peduncle. Vanmanenia polylepis should be removed from the synonymy of V. pingchowensis and regarded as valid.
Developing Subject Position of Learner�s Personality in the Framework of Higher Institution Educational System
Authors: ������  , Eremina I. , �����  , Karev B.
Published: May 2014

The paper specifies a course of higher education system development, which is especially favorable for bringing up learners as free, creative and intellectually-

enriched individuals. The mission of conditioning and enhancing the said qualities in the vocational-education space of higher educational

institutions assumes that subject position of each learner should be developed. Personal subject position implies ability to set up and then meet certain

objectives (tasks).

To develop a learner�s personality as that of a subject the authors suggest the following steps: to comprehend the problem; to formulate a hypothesis;

to draw out an algorithm to resolve the hypothesis; to implement the elaborated algorithm in a step-by-step fashion, while keeping the minutes of

observations and acknowledging research findings; hypothesis testing. Pedagogic conditions, favorable to nurturing higher institution learners� subject

position are described.

Educational practice case studies are presented, to demonstrate pedagogical techniques of conditioning students� subject position. Outcomes of experimental

program, where students tried to master techniques and procedures of research activities, meant to enhance their creative potential (and

their subject position as well), are examined. Special characteristics are suggested for monitoring dynamics of development higher-institution students�

subject position.
Procedure for Arranging Educational Activities in the Context of the Federal Law «On Education in the Russian Federation» Enactment
Authors: Фёклин  , Feklin Sergey
Published: May 2014

According to the Federal Law of December 29, 2012 № 273-FL «On Education in the Russian Federation» new procedures to regulate educational

activities arranging and conducting in accordance with educational programs of various levels and/or of various purposes or on correspondent type of

education, which are to be adopted by orders of the RF Ministry of Education and Science (hereinafter referred to as «procedures»), have come into effect

as from September 1, 2013. Standard provisions, which earlier regulated arranging and conducting educational activities by educational institutions of

various types and kinds, and the whole specter of other activities of these institutions, are gradually losing force.

When implementing new procedures, bodies of the RF executive authorities and local authorities, responsible for control and administration in the

sphere of education, as well as educational institutions and participants of educational relations may encounter considerable difficulties.

The author’s papers provide exhaustible and detailed answers to any questions, which may arose when implementing new procedures in the educational

sphere.
Challenges and Issues in Computer Aided Evaluation of Competences Maturity Degree of Graduating Students Focusing in Various Areas
Authors: Тигина  , Tigina Mariya
Published: May 2014

The paper considers the concept of competences and how to develop these in the course of mastering academic disciplines at universities. The need for

automated procedure of evaluating degree of competences maturity is emphasized as well as related tasks to be resolved to elaborate such a procedure.

Also discussed are current methods of students’ knowledge evaluation, and automated evaluation systems, operating on the basis of these methods.
ANALYSIS OF THE LABOUR MARKET IN THE REPUBLIC OF MACEDONIA ACCORDING TO THE LEVEL OF EDUCATION
Authors: Cabuleva Kostadinka , Miteva-Kacarski Emilija , Radosavlajevik-Bojceva Marina
Published: May 2014

The current educational system has to prepare the students for professions which should develop tomorrow. The key role of education at this moment in time ought to be the ability to predict the changes and to adapt to them successfully. The final resultant of the educational process is the acquisition of skills which will enable the pupils or students to adapt to the labour market quickly and easily. The connection of education with the labour market is the principal aim of the economy being based on knowledge.In this paper, we make an effort to create an analytic framework for the representation of the educational profiles at the labour market in the Republic of Macedonia. The data contained in the analysis points out to the fact that out of the total number of employees according to their education in the period of 2001-2012, the biggest per cent of employees belongs to the ones with secondary education (three-year and four-year secondary education). In 2001, this percentile participation was 49.6% whereas in 2012, this per cent increased to 53.6%. The second position is being taken up by the employees with primary and lower secondary education (25.42% in 2001). However, as a result of the fact the employment rate had been reducing year by year, in 2012, it was 18.53%. The employees with university education are taking up the third position. In 2001, the percentile participation of employees with university education was 10.53% whereas in 2012, it was 21.6%. This trend is due to the dispersed studies in a large number of towns in the Republic of Macedonia, which have led to increase in the number of graduates. Having in mind this analysis, the public educational institutions are facing the challenge to alter their current structure, to bring about a new structural change and to develop an organizational structure which will be compatible with the general changes at the labour market.
An African success story: an external evaluation of the AMRN
Authors: Maclean Gaynor D.
Published: May 2014

The paper provides a conference report from the Africa Midwives Research Network sixth biennial scientific conference held in Nairobi, Kenya in November 2007. The presentation was made by one of the external evaluators who undertook an independent evaluation of the Network on behalf of the Swedish International Development Cooperation Agency (Sida). The evaluation identified the lessons learned during the fourteen years of the Network's existence and concluded that AMRN has achieved much, particularly in the seven core countries at the heart of the organization. Valuable lessons have been learned concerning midwifery education and practice that should make childbirth safer and contribute appreciably to the achievement of the Millennium Development Goals. Further efforts are needed to disseminate research findings, expand opportunities for promoting evidence based practice and utilise evidence based advocacy strategies in working with governments to facilitate the development of ‘enabling environments’ essential to the functioning of skilled midwives.
Evidence-based measures for reducing maternal and child mortality
Authors: Ndikom Chizoma M , Fawole Adeniran O
Published: May 2014

Improving maternal and child health in developing countries are critical components of the millennium development goals. The indicators for measuring progress in most developing countries remain poor reflecting poor access to quality maternal and child health care among other factors. Cost-effective interventions to save women's and children's lives are known. Failure to implement these interventions contributes significantly to the poor health indices prevalent in developing countries. Initiatives for improving quality of maternal and child health care must incorporate affordable and cost-effective evidence-based treatment strategies that are applicable in developing countries.
Misconceptions about HIV infection faced by diagnosed Ghanaian women
Authors: Mwini-Nyaledzigbor PP , Wright SCD
Published: May 2014

Purpose: This article aims to explore the misconceptions that Ghanaian people have toward women diagnosed with HIV, as perceived by these women. Methods: A qualitative, explorative and contextual research design was used, with purposive and convenience sampling. Self-reported data were gathered using semi-structured interviews. Tesch hermeneutical analysis approach was used in analysing the data. Results: The main theme was ignorance, with sub-themes emerging from the data including: HIV-infection being punishment from God; HIV/AIDS being a ‘spoiled’ woman's disease (Muora); HIV-positive women can transmit the virus to people through sitting on chairs, touching their big toes or crossing urine voided by them. Conclusion: Misconceptions and beliefs about the mode of transmission of HIV is a social phenomenon that works against controlling the spread of the epidemic. Knowledge about HIV transmission needs to be tackled and explained according to socio-cultural beliefs and attitudes prevalent in Ghanaian societies.
Strengthening nursing and midwifery regulations and standards in Africa
Authors: Gross Jessica , Mccarthy Carey , Kelley Maureen
Published: May 2014

Health professional boards have a mandate to regulate the training, licensure and practice of health workers; however, regulatory bodies, professional associations and academic institutions have not been widely involved in efforts to advance health worker education and practice. The African Health Profession Regulatory Collaborative (ARC) for Nurses and Midwives is a four-year initiative aimed at strengthening regional standards, regulatory frameworks, organizational capacity, and nursing leadership, in the East, Central and Southern Africa (ESCA) region. ARC convenes regional meetings of nursing and midwifery leaders, awards grants to support national regulation improvement projects, and provides technical assistance to country teams to address identified regulatory issues. During year one, ARC convened three regional meetings, awarded five grants to support regulation improvement projects, and provided targeted technical assistance to eight country teams. As ARC continues to evaluate its proof of concept, key strengths that have emerged include an investment in health systems strengthening, strong country ownership, and the value of south-to-south collaboration. This article describes an approach to strengthening nursing and midwifery regulation through collaborative improvement cycles that could serve as a model for strengthening health workforce regulation among additional cadres and regions.
Social-cultural practices and beliefs influencing maternal mortality
Authors: Mboho Margaret , Furber Christine , Waterman Heather
Published: May 2014

This study aimed to explore how sociocultural practices and beliefs may influence maternal mortality in Nigeria by examining the cultural practices and popular traditional beliefs of the Ibibio and Annang ethnic groups of Akwa Ibom state. The research used semi-structured and unstructured in-depth face-to-face interviews and focus group discussions (FGDs) for data collection. Two sites in Akwa lbom state of Nigeria—Etinan and Oruk Anam—were selected for the study. Thirty women of childbearing age and 10 men were interviewed. Four focus group discussions were held with 5 mothers-in-law, 5 menopausal women and 10 midwives. Thirty five observation sessions were conducted with seven traditional birth attendants (TBAs). Thematic analysis of the data was undertaken. The computer software programme NVivo 8 was used to support management of data. The findings are presented in two themes: Childbearing as an inevitable burden or destiny and pregnancy, mystery, and superstition and the role of TBA. The supernatural belief system and religious prophecies served to potentially delay referral of childbearing women with complications to health care facilities placing women's lives at risk. It was therefore recommended that TBAs need to receive better training to make timely referrals to hospitals. Furthermore, they should be encouraged to develop better working relationships with midwives.
Male involvement in antenatal care redefined: A cross-sectional survey of married men in Lang'ata district, Kenya
Authors: Matiang'i Micah , Mojola Aloo , Githae Margret
Published: May 2014

Although the World Health Organization (WHO) has recognised the role of male involvement in maternal and child health (MNCH), its uptake is still low ( WHO, 2001 ; Ramirez-Ferrero et al, 2012 ). Kenya's division for reproductive health has embraced male involvement to improve the local maternal mortality ratio (MMR) of 488 per 100 000 live births ( Kenya National Bureau of Statistics, 2010 ). Unfortunately, single ‘facilitative’ roles of men, such as escorting a wife to a health facility, have been mistaken for male involvement. This cross-sectional survey involving 388 married men used an index of seven proxy indicators to define male involvement in antenatal care. The index was used to find out the determinants of male involvement in the cosmopolitan Lang'ata district in Kenya. Scores of four and above out of the seven proxy indicators depicted more involvement compared to scores below four. Overall, there was 40% male involvement, and higher education (odds ratio (OR) 1.5, 95% confidence interval (CI): 1.05–2.03, p <0.026), planned pregnancies (OR 0.60, 95%CI: 0.46–0.76, p <0.001), high income (OR 0.51, 0.31, 95% CI: 0.30–0.72; p <0.001, 0.023), joint couple counseling and formalised marriages were associated with high male involvement in antenatal care.
Breast gangrene in an HIV positive woman: A rare presentation
Authors: Mwashambwa Masumbuko , Rastagaev Alexender , Nashiru Ally , Ringo Tumaini
Published: May 2014

Introduction: Breast gangrene is a very rare surgical condition with relatively few published cases. Many factors have been attributed to the condition, of which Human Immunodeficiency Virus (HIV) is a rare cause. This paper presents a case of breast gangrene in an HIV-infected patient. Case report: A 54-year-old previously healthy widowed woman presented with gangrene of the right breast. She was HIV positive with CD4 count of 200 cells/mm3. A mastectomy was performed and the wound healed after 3 weeks. Conclusion: This case demonstrates a rare complication of HIV infection. Treatment should be started immediately and should include resuscitation, antibiotics, mastectomy or serial debridement. Additional anti-retroviral therapy should be administered according to standard guidelines.
Review of the Seychelles’ Nurses and Midwives Act
Authors: Agricole Winifred , Hoarau Marie Antoinette , Suzette Jeanne D'Arc , Sinon Elsia
Published: May 2014

The Nurses and Midwives Act of 1985 governs the nursing and midwifery profession in the Seychelles. A major review of this Act was initiated in February 2011, which aimed to produce a modern Act that would reflect the changing roles of the nursing and midwifery professions in the Seychelles. Methods: Comparative reviews were undertaken of existing national nursing and midwifery acts from the region and the world. Focus group discussions were held with policy makers, nurses, midwives, other health professions and health consumers. Results: The review of the Act produced a draft bill of key reforms, including identification of an extended scope of practice for nurses and midwives, establishment of a licence renewal process, a full-time registrar position for the nursing council, and provision of government funds for these activities on an annual basis. Conclusion: The review of the Act generated new ideas and revealed areas needing amendments so as to align with evolving regional and global trends in the nursing and midwifery professions.
The Joint British Societies’ guidelines on prevention of cardiovascular disease
Authors: Wood David
Published: May 2014

The aim of the new Joint British Societies’ guidelines (JBS 2) developed by the British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society and The Stroke Association is to promote a consistent multidisciplinary approach to the management of people with established atherosclerotic cardiovascular disease (CVD) and those at high risk of developing symptomatic atherosclerotic disease (British Cardiac Society et al, 2005).
The pathological origins of arrhythmias
Authors: Khan Ehsan
Published: May 2014

The pathology of arrhythmias are common in acute and critical care settings as well as in a number of other care settings. Unfortunately any single arrhythmia may be caused by a number of different mechanisms. Different pathologies give rise to different proarrhythmic or ‘arrhythmogenic’ mechanisms. These mechanisms may involve the presence of ischaemia, myocardial fibrosis, muscle stretch and genetic mutations. An understanding of these mechanisms will help the practitioner recognize situations where arrhythmias may occur, and enable the nurse to take pre-emptive action to retard or inhibit the development of the arrhythmia.
Continuous positive airway pressure ventilation. Part two: Indications and contraindications
Authors: Nehyba Katrine
Published: May 2014

Part one of this article described the principles and practice of continuous positive airway pressure (CPAP) therapy. Part two describes the indications, contraindications and precautions and reviews the use of CPAP or three different cardiac patient groups. For patients who have had cardiac surgery, CPAP does not have a place in routine post-operative care. For patients who are admitted with acute cardiogenic pulmonary oedema, CPAP can prevent intubation and improve mortality. For patients with sleep disordered breathing as a result of heart failure, nocturnal CPAP can provide symptomatic relief.
Factors affecting self-care in heart failure: A literature review
Authors: MacInnes Julie
Published: May 2014

The concept of self-care is now well established in government policy and guides the clinical management of patients with long-term conditions, including those with heart failure. Self-care is defined here as adherence to medication and recommended lifestyle advice (self-care maintenance), and recognising, monitoring and responding to symptoms (self-care management). In this literature review, the influence of biological, psychological and social factors on self-care in heart failure are considered. Levels of social support, the patient provider relationship, functional and cognitive ability, depression, personal beliefs, knowledge and psychological factors such as motivation and self-efficacy have all been shown to influence self-care in this patient group. The implications for practice in the light of this review are considered.
ECG of the month
Authors: Bowbrick Steve
Published: May 2014

Steve Bowbrick presents an ECG for you to analyse. The answer and management plan are given on page 372.
Focusing on the future of UK cardiac nursing
Authors: Stuart-Jones Vicqui
Published: May 2014

Vicqui Stuart-Jones reports on the proceedings from the British Association for Nursing in Cardiovascular Care’s annual conference, where delegates were presented with research findings, asked to consider how to improve access to rehabilitation, and treated to an impassioned debate…
Semi-skimmed but fully skilled
Authors: Tagney Jenny
Published: May 2014

Well, for the many of us that sought solace from the wild and wet conditions in the UK over the ‘summer’ by over-indulging in cream teas, this issue may bring an unwelcome potential threat to our attention—cholesterol! NICE has also been busy developing related clinical guidelines over the past few months too so it cannot have escaped your notice (NICE, 2008a; NICE, 2008b)! It is easy to see why GPs might find it difficult to keep up-to-date with recommendations as even the quick reference guides for both these new guidelines are quite sizable documents. All the more reason for cardiovascular nurses in every setting to be informed and able to explain such issues to patients.
Anaemia and the nurse-led clinic outside renal care
Authors: Momoh ibrahim , Hatchett Richard
Published: May 2014

Anaemia is a condition commonly encountered in many clinical specialities, including chronic heart disease, haemato-oncology, gastroenterology, gynaecology/obstetrics, renal disease and care of the elderly. In recent years, anaemia has emerged as a significant public health issue due to the appreciation that it has profound implications as a comorbid factor for other illnesses, while in itself presenting a serious health risk factor. This article explores the definition, classification and current treatment options for anaemia. It describes the move within a central London acute trust to a nurse-led service and the favourable patient satisfaction results that have emerged from an initial survey.
Research Roundup
Authors: Linden Belinda
Published: May 2014

An implantable cardioverter-defibrillator (ICD) can treat life-threatening arrhythmias. The generator is usually implanted in the pectoral region beneath the skin, with a transvenous lead from the device into the heart.
Health literacy and coronary heart disease: Implications for nurses
Authors: Kilonzo Brid , Hughes Michèle , O'Connell Rhona
Published: May 2014

Health literacy is an issue that can have considerable impact on patients with self-management regimes that require medication adherence and lifestyle changes. Patients with lower levels of health literacy ask fewer questions and consequently are more prone to errors. This can have major consequences for the patient, family and health-care providers.

This article provides a review of the key issues related to health literacy: how it is defined; the impact of health literacy on health outcomes; why it is a useful concept for cardiac nurses to be aware of and strategies nurses should consider to enhance patients’ health literacy. It is known that low levels of health literacy affect people's perception of their health. Poor health literacy affects all sectors of society. The tips included here could enhance cardiac nurses’ educative efforts, making each client ultimately more health-literate and efficient at self-care.
Nurse prescribing and the PCI specialist nurse role
Authors: Callaghan Sarah
Published: May 2014

Sarah Callaghan shares her experiences of incorporating prescribing in a specialist nurse role focused on care of patients undergoing percutaneous coronary intervention.
Pregnancy and heart disease: An overview
Authors: Brooks Ruth
Published: May 2014

Heart disease has been the overall leading cause of maternal death in the UK for the last six years of reporting. It is particularly concerning that half of those who died in the last three-year period had received substandard care. This article aims to provide readers with a broad overview of the haemodynamic changes of pregnancy and an awareness of the issues women with various cardiac conditions face in pregnancy. The early identification of women at risk is important to optimize the chances of a successful pregnancy. Preconception counselling and contraceptive advice should be offered to encourage informed decision-making and planned pregnancies. Follow-up during pregnancy should be tailored to the degree of assessed risk. There is very little evidence on which to base practice. Practitioners are therefore reliant on clinical experience, small case series and expert consensus. Management of women with pre-existing or acquired heart disease should therefore have input from a consultant with an interest in maternal cardiology and an expert multidisciplinary team.
Assessment of a patient presenting with suspected pulmonary embolism
Authors: Potts Katherine
Published: May 2014

Pulmonary embolism is a common cause of cardiovascular death with high mortality rates if left untreated. For this reason a prompt diagnosis needs to be made and this includes taking a comprehensive history using a standardised format. This article will first look at the pathophysiology of pulmonary embolism and then demonstrate the standardised format for history-taking with the use of a clinical case study exploring the presentation and management of a patient with suspected pulmonary embolism.
The existential significance of social support: patients’ experiences after MI
Authors: Delmar Charlotte , Jakobsen Christina , Forup Lisbeth , Pedersen Birthe D
Published: May 2014

This article presents findings from a study focusing on how myocardial infarction (MI) patients undergoing rehabilitation in an outpatient clinic view the role of family relationships in their daily lives.

With a relational, person-oriented perspective on patients’ suffering and coping, the aim is to explore the existential significance of social support.

The project design is qualitative, inspired by Ricoeur's reflective phenomenological approach, involving a naïve reading, a structural analysis, and a critical interpretation.

The study shows that the patients try to keep their worries to themselves and they avoid talking to their close family about everyday existential life phenomena such as anxiety, loneliness and the balance between security and insecurity.

Achieving harmony after MI involves a balance between feeling safe and insecure in order to satisfy the needs of their close family.

This places the cardiac nurse as a catalyst for existential communication between the patient and the close family.
The importance of structured history-taking for blackouts
Authors: Yaldren Jo , Wilson Claire , Robbins Lauren
Published: May 2014

In clinical practice some patients who present as ‘collapse, ?cause’ will have had an episode of transient loss of consciousness (TLoC). This article will examine the terms used relating to TLoC (referred to in the article by the lay term ‘blackout’), and explore the rationale relating to comprehensive and systematic history taking in this patient group.

Cardiac, neurological and psychogenic causes of blackout will also be considered.
Interventions to increase the uptake of cardiac rehabilitation: Systematic review
Authors: Dressler Corinna , Pattenden Jill , Atkin Karl , Lewin Robert J
Published: May 2014

Cardiac rehabilitation (CR) can significantly reduce mortality and morbidity, yet many patients fail to attend.

Aim: Evaluation of interventions designed to increase participation in CR with a secondary focus on under-represented groups.

Methods: Systematic review of six electronic databases including randomised controlled trials.

Results: Six studies were identified, four of which reported a significant increase in uptake. Two of these interventions used psychological theory-based letters, the third a liaison nurse, and the fourth used a social worker to encourage attendance. The other two studies used peer support or peer support in combination with a nurse. The latter targeted older, unpartnered adults and the study using social worker support targeted blue-collar workers. These were the only two studies addressing potentially under-represented groups. A lack of evidence in that area became apparent.

Conclusion: Conclusions must be limited due to the small number of studies. While the effect of peer support is unclear, the impact of additional health-care professional support appears promising. The low cost and risk of adapting invitation letters in line with psychological theory and the considerable health gain of increased participation suggest that CR clinicians should not wait before investigating this method.
Dabigatran for stroke prevention in atrial fbrillation
Authors: Williams Helen
Published: May 2014

Recently endorsed by the National Institute for Health and Clinical Excellence, dabigatran, a direct thrombin inhibitor, is licensed for the prevention of stroke in patients with atrial fibrillation and additional risk factors. There are some groups of patients unable to take warfarin where use is compelling. Patients unable to achieve adequate INR control on warfarin should also be considered for dabigatran therapy. Cost may delay the rollout of dabigatran into clinical practice. Key practical considerations for patients prescribed dabigatran are to assess and manage bleeding risk, which will change over time, renal monitoring and dose adjustment as the patient ages—the higher dose is contraindicated in the over-80 age group. Patient adherence will be a critical factor in determining the efficacy of dabigatran outside of clinical trial setting. Patients should be counselled on the reason for anticoagulant therapy, benefits and risks of therapy, and importance of compliance to the treatment to minimise their stroke risk.
NICE recommendations on the management of hypertension
Authors: Linden Belinda
Published: May 2014

Here, Belinda Linden reviews the key areas covered by the recent National Institute for Health and Care Excellence quality standard for the management of hypertension in adults
Revised national guidelines for antithrombotic therapy
Authors: Belinda Linden
Published: May 2014

Belinda Linden discusses key recommendations from the recently revised Scottish Intercollegiate Guidelines Network (SIGN) National Clinical Guideline 129, which updates health practitioners regarding indications and management of antithrombotic therapy
Nurses' perspectives on stroke care in London
Authors: Brooke Joanne , Walia Surinder
Published: May 2014

Aim:

This paper is a report of a study exploring nurses' perspectives on their developing roles in specialist stroke care in London.

Method:

Nine paired semi-structured interviews with nurses working across the stroke care pathway in London were completed in 2011, recorded and transcribed verbatim. The data were analysed using interpretative phenomenological analysis.

Results:

The emergent themes included receiving support from fellow nurses, good communication but minimal involvement with the multidisciplinary team, unclear career pathways, and a positive ethos among the nurses. The nurses' responses indicate that they remain passionate and caring. They expressed interest in being more closely involved with the decision-making process within the multidisciplinary team.

Conclusion:

An understanding of the complex nursing roles within the new London stroke care pathway has emerged. Clear pathways of progression from band 5 to band 6 are being developed.
BSH 2013: Making sense of acute heart failure
Authors: Larner Martin , Bailey Lisa , O'Donnell Richard , Hamlen Annalie , MacCallum Annie
Published: May 2014

Meeting report prepared by Martin Larner, Lisa Bailey, Richard O'Donnell, Heart Failure Nurse Specialists; Annalie Hamlen, Clinical Nurse Specialist Heart Failure/Telehealth, Gloucestershire Care Services NHS Trust; and Annie MacCallum, Head of Specialist Services, Gloucestershire Care Services NHS Trust.
Systematically assessing chest pain in cardiac patients
Authors: Al-Maqbali Mohammed
Published: May 2014

Chest pain is the most common presenting symptom of coronary heart disease. A structured nursing assessment of the patient's complaint of chest pain must therefore be carried out as it has potential high-risk factors that may require immediate intervention. An effective physical assessment strategy has a beneficial effect on patient management and can reduce mortality rates in coronary disease. An evaluation of the the patient's history can help guide the examining nurse towards accurate diagnoses and, subsequently, the adoption of appropriate treatment. This article presents the use of a systematic approach to the assessment of cardiac patients with chest pain. The combination of a full patient history with a thorough physical examination is the most powerful tool that can be employed, leading to accurate diagnoses.
Research Roundup
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail
Living with cardiomyopathy
Authors: Amiss Tina
Published: May 2014

Tina Amiss was diagnosed with dilated cardiomyopathy in her early 30s. Here she shares her experiences of learning to live with the condition and its effect on her family
Treating diabetic foot ulceration in the 21st century
Authors: FitzJohn Maria
Published: May 2014

This paper details the revolutionary approach taken by one team in treating foot ulcers caused by diabetes mellitus. This approach is a field worker led, community based clinic combining the advanced practitioner skills of a senior chiropodist, a tissue viability nurse and diabetes specialist health-visitor. Foot ulcers should not be treated lightly due to the fact that an ulcer can all too easily lead to a foot amputation unless appropriate intervention is taken. Traditionally, treatment has taken place within a hospital outpatient clinic. The community clinic described here, from conception to delivery, incorporates several innovations which make it both more effective and more economical to operate than the hospital based alternative. Healing rate results from 16 months of treatment have been very encouraging. It has taken on average six weeks to heal a grade one ulcer compared with, on average, twenty weeks of ineffectual treatment previously. Inevitably, mistakes were made, and these are recorded together with the lessons learnt. In conclusion, this new approach has significant benefits and illustrates a model of health care likely to become increasingly common in the twenty-first century.
Incontinence - Not just a problem of old age
Authors: Wells Mandy
Published: May 2014

Incontinence is a major health care problem for the younger adult. This paper examines the prevalence of incontinence, particularly in the younger female. Community health nurses need to be proactive in their identification of incontinence problems, particularly in women following childbirth where the incidence of incontinence is particularly high.

The use of pelvic floor re-education is discussed, and it is argued that studies relating to programmes such as this have suffered from a lack of rigor. It is therefore suggested that there is a need for well designed studies in the near future.

It is shown that appropriately educated community health nurses can prove effective in developing continence programmes, despite there being a debate about the effectiveness of health promotion programmes.
Interprofessional and multi-agency training and working
Authors: Leiba Tony
Published: May 2014

Interprofessional and multi-agency training and working is a highly complex business. Professionals who ignore the complexity of training do so at their peril. The challenges are evident in ideological differences, power and status relationships, different professional and organisational cultures, language differences and poor communications. By addressing these challenges, opportunities should be available for all participating professionals and agencies to influence the planning process to ensure the commitment of resources and personnel for interprofessional and multi-agency working.
Nurses and commissioning
Authors: Goodwin Shirley
Published: May 2014

Five years after the National Health Service (NHS) reforms separated purchasers from providers, most nurses working in community health and primary care have been profoundly affected, one way or the other, by the changes. A small but hopefully increasing number are involved directly as commissioners in what are now the new health authorities, and some exciting new roles for nurses are also developing through general practitioner (GP) fundholding and the total purchasing pilots.
Transitional arrangements and the community nurse
Authors: Castledine George
Published: May 2014

Last month, Margaret Wallace outlined the United Kingdom Central Council’s (UKCC’s) transitional arrangements for PREP in the British Journal of Community Health Nursing.
Intravenous antibiotics for infected leg ulcers: a district nurses’ role?
Authors: Ashworth Christine J.
Published: May 2014

Leg ulcers, particularly in the elderly, are a major health care problem for district nurses. This paper discusses the incidence of leg ulcers in the community, the cost to the National Health Service (NHS) and the cost to the clients affected.

The rationale for systemic antibiotic usage in the treatment of infected ulcers is discussed prior to closer examination of the efficacy of antibiotics administered intravenously, rather than orally. This paper will consider both the potential for – and the administration of – intravenous (IV) antibiotics by the district nurse in the patient’s home.
The effects of policy changes on community nurses
Authors: Wallace Ann
Published: May 2014

National Health Service (NHS) reforms have sought to refocus the purpose of health care by shifting the provision and commissioning of health services from the secondary to the primary care sector (Department of Health and Social Security (DHSS) 1987, the NHS and Community Care Act 1990, Department of Health (DoH) 1989, 1992a).

However, short termism in policy making has tended to create health care policies which are often unconnected and divergent in their implications (Williams et al 1993, Salter 1994). As a result, community nurses are having to manage such contradictions in a general management structure where access to professional leadership is increasingly elusive (Kitching 1993).

This paper explores some of the impact of these reforms on the organisation of patient care and examines the role of community nurses within a primary care led NHS.
GPs' perceptions of the practice nurse's role
Authors: Hawksley Barbara
Published: May 2014

An exploratory study was undertaken to gain insights into general practitioners’ (GPs’) perceptions of the practice nurse's role and the education and training needed to undertake the role. An interpretative methodology was used to facilitate the participation of the GPs. The information gained was then used to help providers focus activities effectively, to ensure purchasers greater access to appropriate education and training for practice nurses. Three main themes emerged: perceptions of role, education and training and working relationship. Respondents identified that special education and training is necessary to undertake the role of practice nurse, although the education and training considered appropriate was predominantly task orientated.
Measuring the workload of an integrated nursing team in general practice
Authors: Godfrey Emma , Rink Pit , Ross Fiona
Published: May 2014

This paper describes some of the issues involved in developing a methodology for determining nursing skills in an integrated general practice team. The authors’ approach developed a system of workload measurement, using audit instruments, which has enabled an analysis of workload across different professional groups of nurses. The instruments were enhanced and given face validity by qualitative data collected through interviews. This paper reviews some of the literature on measuring nursing activity and workload in primary care. It highlights some of the methodological issues, with reference to the findings from an analysis of activity and workload of an integrated nursing team in a fundholding general practice published last year in this journal (Rink et al 1996).