bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel agents in development for advanced non-small cell lung cancer
Authors: Stinchcombe Thomas E.
Published: May 2014

The identification of EGFR mutations and ALK rearrangements in nonsmall cell lung cancer (NSCLC) has led to the rapid development of targeted therapies and significant changes in the treatment paradigm. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and crizotinib are now standard therapies for patients with the appropriate molecular alteration. Current investigations are determining the mechanisms of resistance to targeted therapies and developing novel agents to combat resistance. For patients with KRAS mutant NSCLC, a phase III trial of the MEK inhibitor, selumetinib, has been initiated. For patients without a defined mutation or a mutation without a known targeted therapy, immunotherapy, ganetespib, nintedanib and MET inhibitors in combination with EGFR TKIs are in development. Preliminary results of phase III trials raise doubts about the future development of dacomitinib as a second-line agent.
Translocation t(2;11) in CLL cells results in CXCR4/MAML2 fusion oncogene
Authors: Acunzo Mario , Romano Giulia , Wernicke Dorothee , Balatti Veronica , Rassenti Laura Z. , dell’Aquila Marie , Kipps Thomas J. , Pekarsky Yuri , Croce Carlo M.
Published: May 2014

Key Points

A new translocation t(2;11)(q22.1;q21) that involves CXCR4 and MAML2 has been described and characterized in CLL.
Long-axis rotation: a missing degree of freedom in avian bipedal locomotion
Authors: Kambic Robert E. , Roberts Thomas J. , Gatesy Stephen M.
Published: May 2014

Ground-dwelling birds are typically characterized as erect bipeds having hind limbs that operate parasagittally. Consequently, most previous research has emphasized flexion/extension angles and moments as calculated from a lateral perspective. Three-dimensional motion analyses have documented non-planar limb movements, but the skeletal kinematics underlying changes in foot orientation and transverse position remain unclear. In particular, long-axis rotation of the proximal limb segments is extremely difficult to measure with topical markers. Here we present six degree of freedom skeletal kinematic data from maneuvering guineafowl acquired by marker-based XROMM (X-ray Reconstruction of Moving Morphology). Translations and rotations of the hips, knees, ankles, and pelvis were derived from animated bone models using explicit joint coordinate systems. We distinguished sidesteps, sidestep yaws, crossover yaws, sidestep turns, and crossover turns, but birds often performed a sequence of blended partial maneuvers. Long-axis rotation of the femur (up to 38°) modulated the foot's transverse position. Long-axis rotation of the tibiotarsus (up to 65°) also affected medio-lateral positioning, but primarily served to either reorient a swing phase foot or yaw the body about a stance phase foot. Tarsometatarsal long-axis rotation was minimal, as was hip, knee, and ankle abduction/adduction. Despite having superficially hinge-like joints, birds coordinate substantial long-axis rotations of the hips and knees to execute complex 3-D maneuvers while striking a diversity of non-planar poses.
Ambient noise causes independent changes in distinct spectro-temporal features of echolocation calls in horseshoe bats
Authors: Hage Steffen R. , Jiang Tinglei , Berquist Sean , Feng Jiang , Metzner Walter
Published: May 2014

One of the most efficient mechanisms to optimize signal-to-noise ratios is the Lombard effect - an involuntary rise in call amplitude due to ambient noise. It is often accompanied by changes in the spectro-temporal composition of calls. We examined the effects of broadband-filtered noise on the spectro-temporal composition of horseshoe bat echolocation calls, which consist of a constant-frequency component and an initial and terminal frequency-modulated portion. We find that the frequency-modulated components became larger for almost all noise conditions, whereas the bandwidth of the constant-frequency component increased only when broadband-filtered noise was centered on or above the calls' dominant or fundamental frequency. This indicates that ambient noise modifies the associated acoustic parameters of the Lombard-effect, such as spectro-temporal features, independently and could significantly affect the bat's ability to detect and locate targets. Our findings may be of significance in evaluating the impact of environmental noise on echolocation behavior in bats.
Structure of Stable Telluradiphosphirane Bearing Bulky Ferrocenyl Ligands
Authors: Sasamori Takahiro , Suzuki Yuko , Sakagami Michiyasu , Miyake Hideaki , Tokitoh Norihiro
Published: May 2014

Chalcogenation reactions of 1,2-bis(ferrocenyl)diphosphene, Fc*P=PFc* (Fc*: 2,5-bis(3,5-di-t-butylphenyl)ferrocenyl), with elemental sulfur (S8) and tellurium afforded the corresponding thia- and telluradiphosphirane derivatives as stable crystalline compounds, respectively. The sterically demanding ferrocenyl group would afford sufficient crystallinity and stability to the heterocyclic compounds; the structures of these three-membered ring heterocycles were revealed by X-ray crystallographic analysis.
AUDIT COMMITTEE’S ROLE IN ENHANCING ACCOUNTABILITY OF THE ALBANIAN, PUBLIC SECTOR
Authors: Bello Holtjana
Published: May 2014

The main question around which this paper is based is whether the public sector in Albania needs to establish the Audit Committees as a demand for enhanced quality of services and accountability over the use of public funds is increasing. This paper analyzes the role of public sector Audit Committees in common law practices established to advise management on the adequacy of structures and processes that ensure the integrity of the accounting, auditing, risk management internal controls, and financial reporting. This paper founds out that Audit Committees are not best practices established in every country considering the fact that this practice is appropriate to the private sector corporate governance. However, it reveals that lack of such committees put into question the achievement of good governance objectives. Therefore, this document recommends the establishment of the Audit Committees across the public sector as a practice strongly recommended in the central government bodies within United Kingdom. Such Committees will advise the head of public organizations on risk exposure, corporate governance and control issues, and will enhance and improve the professionalism of internal auditors who still in Albania are adopting and relying on a traditional financial internal audit approach.
ISSUES OF CIVIL REGULATION CALCULATIONS IN AGRICULTURE
Authors: Umarov Ulash
Published: May 2014

One of the main sources of providing economic growth of agriculture and maintenance welfare life of population of Uzbekistan is required to develop step-by-step legislation. It regulates legal relations linked with calculations in agriculture and constantly its legal basis by virtue of theory, studies and principles of civil law according to the frames of reforms. The main goal of providing social-economic reforms in agriculture of Uzbekistan is to hardly continue maintaining successful life of country, and apropos of this increasing the size of producing in agriculture which based on competitive market, widening new range of production. Uninterruptedly continuing the strategy of economic reforms directed to provide successfully execution of governmental programs which aimed to develop diversified farm enterprise – studying legal problems of civil legal regulation of social-economic and investments relations play the main role based on calculations of current industry.
PROSPECTS OF FORMATION FINANCIAL-INDUSTRIAL GROUPS IN UZBEKISTAN
Authors: Ataniyazov Jasurbek
Published: May 2014

In this article, we evaluated the possibilities of the formation of financial-industrial groups, with participation of commercial banks and revealed features and prospects of formation financial-industrial groups in Uzbekistan. For the implementation of investment potential and development of financial-industrial integration, crucial are relations between the credit-financial institutions, mainly the commercial banks, and the industrial enterprises. The financial-industrial groups can play important role in spurring the investments in the real sector of the economy. The financial-industrial can become a basis for improved stability of national economy and for creation of favourable conditions in the development of the real sector.
Knowledge as power
Authors: Lugina Helen
Published: May 2014

As we launch this first issue of African Journal of Midwifery and Women's Health (AJM), we must think critically about our mission and the tools that can enhance fulfillment of this mission. The complexity of midwifery and women's health in Africa will be reflected in the journal, which will provide a forum for topical debates on clinical and professional issues. Research and education will be integral to each issue, encouraging advanced skills, knowledge transfer and academic discussions. Dissemination of information and utilization of knowledge will provide powerful tools in midwifery and women's health, to promote our professional image as well as improving health care delivery for women, children and their families.
Mothers’ perceptions of midwives’ labour and delivery support
Authors: Eustace Rosemary W , Lugina Helen Igobeko
Published: May 2014

Understanding what mothers perceive of their labour care and support is important for facilitating positive maternal and fetal outcomes across cultures. This cross-sectional study explored Tanzanian mothers' perceptions of midwives' caring and supportive behaviours during labour within the context of the midwife–woman interactions across two different birth settings. The study surveyed a convenience sample of 60 postpartum women and observed 37 midwife–woman interactions. In addition, focus group discussions were conducted to understand the women's perceptions of nursing, caring and supportive behaviour. The findings from the survey and observational data revealed that mothers from the private hospital reported more caring and supportive behaviours than mothers in the public hospital. These findings have implications for midwifery intervention related to the provision of effective caring and supportive care during labour and delivery across different birth settings.
A comparative analysis of pain management by midwives
Authors: Ziyane Isabella S , Sikhondze Nomvuselelo
Published: May 2014

The study was set up to investigate the management of labour pain by midwives and traditional birth attendants. A qualitative research methodology was used to seek the views of 50 midwives and 60 traditional birth attendants on pain management during labour.

Data were analyzed manually using themes that emerged from the study. The results revealed that pain was generally regarded as a normal physiological response to labour and was given little attention. Midwives identified pharmacological and nonpharmacological methods of relieving pain. Traditional birth attendants identified the use of herbs, baths, adopting the most comfortable position, as well as being with a companion as the ideal methods of pain management. Challenges experienced by midwives were lack of resources to effectively deliver quality care and poor referral system, socio-cultural issues and absence of a policy guideline to safeguard practice. Traditional birth attendants experienced challenges relating to poor recognition by the modern health care sector and poor referral system to modern maternity care facilities.

Recommendations were made to educational institutions to stream line their curriculum to take into consideration sociocultural aspects of childbearing. A recommendation related to policy makers was to design institutional guidelines, which set out a national strategy for safe motherhood and maternity care.
Increase in maternity assistants to ease the shortage of midwives
Authors: Bainbridge Jane
Published: May 2014

A serious shortage of midwives could lead to the use of even more maternity assistants to ease the burden of trained midwives in New Zealand, but is the health and wellbeing of mothers and babies at risk?
Philippines: raising the professional status of midwives
Authors: Daniel Lincia
Published: May 2014

Due to an alarming shortage of doctors and nurses in the Philippines, midwives are taking on extra duties such as inserting immunizing mothers and their children as well as delivering babies.
Africa Midwives Research Network sixth biennial conference
Authors: Ryan Maureen
Published: May 2014

A midwife from the developed world gives her impressions of the Africa Midwives Research Network conference and the important themes that were highlighted at this special event.
Does maternal age affect pregnancy outcome?: a study in Tanzania
Authors: Muganyizi Projestine S , Kidanto Hussein L , Massawe Siriel , Moshiro Candida
Published: May 2014

The objective was to estimate the effect of teenage and elderly maternal age on the incidence of labour interventions and perinatal outcome in Muhimbili National hospital, Tanzania. Included were all nulliparous mothers aged 12–50 years (n=43 167) who gave birth to singleton babies at the hospital during 1999–2005.

Recorded data from the electronic database was analyzed. Bivariate and multiple logistic regression analyses were performed to estimate the effect of teenage (12–19 years) and elderly age (35–50 years) on pregnancy risk factors and as outcome variables with reference to the traditional low risk age group (20–34 years).

Overall teenagers had the lowest incidence of risk factors. Compared to the low risk age group mothers teenagers were at increased risk for low birth weight (OR 1.4; 95% CI 1.11–1.68) but lower odds for blood loss, caesarean delivery and use of oxytocin. Elderly mothers had higher risk for low birth weight (OR 1.4; 95% CI 1.12–1.78) and caesarean delivery (OR 2.69; 95% CI 2.20–3.30). The elderly age mothers also had significantly more blood loss in excess of 500ml which was a result of the high caesarean section rate.

Teenagers, unlike the elderly mothers group, have no increased risks for labour and delivery complications that demand higher level facilities with comprehensive obstetric care services.
Incubators reduce depression
Authors: Bainbridge Jane
Published: May 2014

Researchers have discovered that having a tricky start in life could be the making of sick or preterm babies as they are less likely to suffer from depression than their healthier counterparts as adults.
Theory and practice: is the gap growing wider?
Authors: Lugina Helen
Published: May 2014

As a former educator, and a person who is currently working in health workforce issues at a regional level, the issue of how well theory and practice are linked comes to my mind all the time and it is a consistent informal, as well as anecdotal, observation I make and hear from fellow nurses and midwives. In fact, apart from the empirical research on the issue, most of which has been done in the western world, colleagues from both the West and the African region attest to the existence of the gap. Closing the gap is a challenge that needs careful exploration of the factors and the models that would work in various settings, given the varied resources available.
Factors that influence sexual behaviour in young women
Authors: Kazembe Abigail
Published: May 2014

This study investigated factors that influence the sexual behaviour of adolescent girls attending community secondary schools in Malawi. In-depth interviews with 22 sexually active and 17 abstinent girls were conducted. Grounded theory method guided data collection and analysis. ATLAS.ti 5.0 GmbH Berlin was used to analyze data. The following themes emerged as factors that informed sexual decisions of female adolescents: future-oriented goals, religious values, fear of consequences of sexual activity, cultural values, sexual desire, romantic interpersonal relationships, material gain, and parental and peer influence. The findings indicate the need for including sociocultural, psychological, as well as biological factors in designing HIV prevention interventions for young people.
Clinical competence of nursing graduates in Kenya
Authors: Chege Margaret Njambi , Kabiru Ephantus W , Karani Anna , Derese Ansellme
Published: May 2014

The objective was to compare the clinical competence of nurse graduates of two curricula tracts. At the time of the study Kenya Medical Training College (KMTC) had an innovative skillslab-integrated curriculum for Kenya registered community health nurses trained in Nairobi and a traditional lecture-based curriculum for those trained elsewhere.

288 nurse graduates were recruited for the study. Two clinical skills were randomly selected for evidence-based performance. Indicators of competence were identified through Delphi study. Approval to conduct the study was obtained from Ministries of Health and Education and joint University of Nairobi, Kenyatta National Hospital Ethics and Research Committee. Data were collected through evidence-based performance, in-depth interviews and focus group discussions (FGDs). Data input and analysis were done using Excel Version 2003-97.

There was significant difference (_2=65.988, p<0.001) in performance between graduates of the two methodologies. Those of the skillslab-based curriculum were described as critical thinkers. Those of the control group were described as better ward managers.

The skillslab graduates consistently scored higher in all indicators of competence and across the components of nursing expertise.
Preference for the male child and desired family size in Nigeria
Authors: Olaogun Adenike , Ayoola Adejoke , Ogunfowokan Adesola , Ewere Vivian
Published: May 2014

Sex preference continues to be a challenge, particularly in patriarchal societies. This article report on a survey among undergraduate students where over 50% indicated that they want a male child as the first child. Of those who stated a preference for a male child first, 89% want between three and six children. Of the respondents who want a female child first, 94% want four children or less. Among all the respondents, sex preference of the first child had a significant influence on the number of children desired. Preference for a male child as the first child is still strong among the young adults (χ2=38.64; Fisher's exact P=0.001). This has implications on reproductive behaviours of both men and women. There is need for nurses and midwives to be creative in family life education programmes that will deemphasize sex preference.
Obstetric fistulae in the developing world
Authors: Elneil Sohier
Published: May 2014

Obstetric fistulae is a problem commonly encountered in the developing world, that affects women of childbearing age during pregnancy and the labour process, resulting in debilitating urinary and/or faecal incontinence. Historically this predicament was also suffered by the developed world until the middle of the last century. Thus, this is not a new world crisis, but simply one of economic and health development. In the last two decades, new global initiatives have been instituted in the developing world to improve training and education in preventative and curative fistulae treatment by developing a unified classification and using evidence-based learning as a tool. This modern approach to the management of a devastating condition can only serve to achieve the World Health Organization objective of ‘health security for women throughout their life span’.
Misoprostol for safe motherhood: one tablet, two life-saving indications
Authors: Grossman Amy , Graves Alisha , Rwamushaija Emmanuel , Park Calandra
Published: May 2014

Misoprostol is a safe, acceptable, feasible, and effective alternative for both postpartum hemorrhage (PPH) and the treatment of incomplete abortion and miscarriage when no other interventions are available, which is often the case in resource-challenged regions. This article reviews the use of misoprostol for these two leading causes of maternal death globally and presents data on the implementation of misoprostol for PPH in Zanzibar as a case study. An evaluation was conducted to assess the uptake of misoprostol in public facilities in Zanzibar through a record review at nine facilities on various indicators from April 2008 to March 2009. For comparison, pre-intervention data were also collected from the same nine facilities for the 12 months preceding the PPH management trainings in April 2008.

Following the introduction of misoprostol for PPH, the need for additional interventions among PPH cases significantly declined. The post-intervention period showed significantly fewer blood transfusions, PPH referrals, and PPH-related maternal deaths. Among PPH cases, the need for blood transfusion decreased from 30 (19.2%) in the pre-intervention period to 7 (2.4%) in the postintervention period. Rates of PPH-related referrals and maternal deaths also declined from 7.7% pre-intervention to 3.1% postintervention (P<0.05).

Misoprostol has the potential to make an immediate impact on the number of maternal deaths resulting from PPH and treatment of incomplete abortion and miscarriage.
Indwelling catheters: women's knowledge of care and complications
Authors: Gundani Helen Vupenyu , Mutsingwa Sandra
Published: May 2014

Catheterization is a procedure that can subject women to provider-induced urinary tract infections (UTIs) and nosocomial infections. A descriptive study was conducted of women admitted to Parirenyatwa Referral Hospital in Harare, Zimbabwe. The main objective was to explore the women's knowledge of catheter care and complications of catheterization. A convenience sample of 20 admitted women was recruited. Face-to-face interviews were conducted to collect data, which were recorded, grouped, and analyzed using descriptive statistics in the form of frequencies, percentages, and tables. The study findings illustrate that in general the women had little knowledge about factors that influence catheterization. Also, most health-care practitioners did not know that indwelling urinary catheters (IUCs) cause most nosocomial infections. Health education sessions should be extended to patients/clients and communities to inform them about catheter care and the complications that can arise from catheterization.
From the global frontline to the UN: We need more trained midwives
Authors: Shepherd Joan
Published: May 2014

A special high-level event was held at the UN General Assembly on 20 September, as part of a campaign backed by Save the Children and more than 300 organizations around the world to encourage governments to invest in midwives and health workers. Dr Joan Shepherd reports on developments.
Quality assurance through the external examiner system
Authors: Mogobe Keitshokile Dintle
Published: May 2014

This paper focuses on the findings of an external examiner in five universities, in different countries in Southern Africa over nine years. The aim is to share information with fellow nurse academics who are concerned with issues of quality in nursing education, so that they could appreciate the challenges associated with the process with a view to improving the system. Participant observation and documentary analysis were used to collect data during the period.

The findings are presented through the steps of the external examining process: recruitment and appointments, signing of contracts, review of curriculum materials and examination questions, onsite visits and reviews of students’ scripts, external examiners’ meetings and report writing. The benefits for both the host institution and the external examiners are discussed. The following challenges were found: time and financial constraints, absence of written terms of reference, lack of induction sessions for new external examiners, lack of templates for report writing and stipulated dates for submission of reports.

The following were recommended given the findings of this study: timely appointment of external examiners, establishing a regional register of external examiners, producing a handbook for first time examiners and induction of new external examiners, comprehensive involvement of the external examiner, establishing a mechanism for effective monitoring and implementation of external examiner's recommendations and panel discussions.
Women’s experiences of breastfeeding: A narrative review of qualitative studies
Authors: Afoakwah Georgina , Smyth Rebecca , Lavender Dame Tina
Published: May 2014

Globally, breastfeeding remains the primary method of infant feeding. Despite the indisputable benefits of breastfeeding, studies have identified both positive and negative aspects of women’s experiences. This article aims to enhance our understanding of these breastfeeding experiences. Methods: Using a narrative review approach, 26 papers using different qualitative approaches were synthesized in order to consider the findings of real-life experiences of breastfeeding women. Selected qualitative studies described women’s experiences of breastfeeding across international regions. This was intended to provide a critical review of the existing evidence and contribute to improving the knowledge of breastfeeding practice. Results: The inclusive studies yielded five main themes. The essence of breastfeeding was described in relation to a symbol of motherhood, feeling connected between the mother and baby, the dilemma of mother’s expectations versus reality of breastfeeding, and mothers’ need for consistent reassurance and support, and lastly social-cultural construct of breastfeeding. Conclusion: The findings identify the wider importance of breastfeeding experience that goes beyond simply providing the baby with nutrition.
Health-Care Providers' Perceptions of Intravaginal Rings for HIV Prevention in Nairobi, Kenya
Authors: Wakasiaka Sabina , Smith Donna Jo , My Hoang Tina Dan , Jaoko Walter , Anzala Omu , Priddy Frances H
Published: May 2014

Background: Health-care providers form the backbone of health information and service delivery in many African communities. This study investigated health-care providers' (HCPs) attitudes towards a novel method of HIV prevention for women—a microbicide-embedded intravaginal ring (IVR). Methods: Qualitative interviews were conducted, covering initial attitudes towards IVRs, potential use among female sex workers, herbal practices for sexually transmitted infection (STI) management and the ways in which populations can access the rings should they become available. Twenty HCPs were interviewed in Mukuru and Kibera, which are informal settlements in Nairobi, Kenya, with high HIV prevalence, unemployment and commercial sex work. Results: The majority of HCPs had positive attitudes towards IVRs as a method of HIV prevention in this environment. HCPs liked that IVRs are female controlled and can be used covertly. Overall, HCPs reported a willingness to participate in the distribution of IVRs, and favoured distribution through health facilities at no cost. Conclusion: Findings from this study demonstrate that HCPs are willing to serve as the primary source of IVR information in target communities. However, they require adequate knowledge regarding microbicides and IVRs before these products reach the market.
Report on health screening of blood pressure, blood sugar and body mass index in hospital staff in Cameroon, Africa
Authors: Gobte Nkwan Jacob , Meyer Dorothy J , Njecko Boniface Takwe
Published: May 2014

Introduction:

In Africa, there is increasing attention on non-communicable diseases in response to a shifting of disease burden from infectious diseases to chronic illnesses, especially hypertension, diabetes and obesity. As part of the World Health Week, health screening was offered to all staff at Banso Baptist hospital to promote their awareness of their personal health and obtain a baseline assessment of the general health of the staff.

Methods:

A health screening was held for all hospital staff which included measurements of blood pressure, blood sugar and body mass index. Demographic data were collected and limited to age, gender and staff position/activity.

Results:

Almost 60% of the staff participated in the screening with 5.8% having an elevated blood pressure and 2.8% an elevated blood sugar. the percent of overweight/obesity was 55.9% with women significantly more obese than men (p=0.0001).

Discussion:

Overweight and obesity were higher in the staff than expected with the women's percentage concerning. without interventions, there is the potential of increasing numbers of staff eventually developing hypertension, diabetes and other chronic illnesses. Prevention efforts have the potential to maintain staff wellness and productivity as well as preventing chronic illnesses.
Nurse-led clinics on the march: Ensuring effectiveness
Authors: Hatchett Richard
Published: May 2014

Nurse-led clinics in cardiac nursing have grown rapidly in number over recent years. As this growth continues, or ultimately slows, practitioners need to ensure a patient-focused and measurably effective service. This can be achieved through self-assessment of current practice skills and limitations, a consideration of appropriate professional development and the incorporation of a process of audit and evaluation within the service.
Cardiac nursing in Hong Kong: An overseas perspective
Authors: Thompson David R , Yu Doris SF , Chair Sek Ying
Published: May 2014

Cardiac nursing in Hong Kong is well established and highly regarded. There is, however, a need for cardiac nurses to extend and expand their knowledge and skills base to fulfil ever more complex and challenging roles in acute care, rehabilitation and secondary prevention. With the advent of advanced and specialist nursing roles even more emphasis is being placed on the importance of education, training and research. This will not only enhance the professional recognition and status of cardiac nurses but, more importantly, ensure that they are equipped to better serve the patients and their families in hospital and in the community.
We want you: Specialist nurses needed for palliative care in heart failure
Authors: Hanratty Barbara , Mair Frances
Published: May 2014

Heart failure can be considered a terminal condition with high levels of mortality, yet palliative care support remains inadequate. Hear t failure patients are disadvantaged in almost ever y aspect of end-of-life care compared with those individuals suffering from cancer. This paper reviews the current situation and highlights some of the specific difficulties experienced by both those suffering from hear t failure and those providing terminal care for them. Communication issues, access to support ser vices and making a prognosis. will be discussed in particular. There is scope for improvement in care provision. In this paper it is argued that there are a range of approaches that could be adopted to improve the care delivered to patients suffering from terminal hear t failure and that specialist cardiac nurses are well placed to act as champions for individuals with this condition.
Why do women attend and continue cardiac rehabilitation?
Authors: Higginson Ray
Published: May 2014

Cardiac rehabilitation is a multidisciplinary intervention, designed to improve the life of the post-myocardial infarction (MI) patient and reduce his/her morbidity and mortality. Although the benefits apply equally to women and men, research shows that patient nonattendance particularly among the elderly female population is an important problem.

This qualitative study (which forms par t of a much larger doctoral study) explores some of the factors that influence women's decisions to attend cardiac rehabilitation after an MI. Using a feminist grounded theory research approach, ten female post-MI patients were inter viewed about their cardiac rehabilitation.

Preliminary analysis suggests that women choosing to attend claim that it increases their self-confidence, understanding of their condition and feeling of empowerment. They perceive themselves to be ‘restored’ to a functional level they had had before their MI.

Information gained from this study could be used to inform the development of gender-specific cardiac rehabilitation programmes.
The challenges of health promotion
Authors: Johnson Kate
Published: May 2014

Last month saw the publication of Promoting Health (Department of Health (DH), 2006a). Its aim is to support everyone in making healthier choices for themselves and others. Many cardiac nurses may argue that they already do this, particularly those involved in cardiac rehabilitation or in specialist roles. The factors included in the benchmark are: empowerment and informed choice, education for practitioners, assessment of health promotion needs, opportunities to promote health, engagement, partnership, access and accessibility, and outcome.
The treatment and psychology of erectile dysfunction in coronary heart disease
Authors: Foren Jenny , Cumisky Sue
Published: May 2014

It is reported that erectile dysfunction affects 100 million men worldwide and is common among older age groups. Erectile dsfunction and coronary hear t disease (CHD) share the same risk factors. They may develop independently but often develop together. The ability to have an erection is integral to a man's perception of his wel -being. Evidence suggests that only a small proportion of people will ask for help. This highlights the importance of feeling comfortable enough to raise and discuss sexual matters. Erectile dysfunction in patients with CHD may have psychological origins owing to a fear of serious cardiac incident, but may also have physiological causes owing to a disease process/arterial damage, or it may be a combination of both. In most cases there will be a variety of treatment options which are available.
Becoming a cardiomyopathy nurse specialist
Authors: Cruickshank Stephanie
Published: May 2014

Stephanie Cruickshank describes how her involvement with the Cardiomyopathy Association (CMA) as a supporter led to her present role as a CMA-funded cardiomyopathy nurse specialist.
A cross-continent view of adult congenital heart disease
Authors: Hatchett Richard
Published: May 2014

Advances in paediatric cardiology and cardiac surgery mean that the majority of patients with congenital heart defects will survive childhood. Figures are hard to obtain, but such people represent a growing population who will ultimately make their way to adult cardiac services. In the United Kingdom (UK) there are an estimated 150 000 adults with congenital heart disease.
Understanding calcium channel blockers in hypertension, angina and supraventricular tachycardia
Authors: Sargent Andrew
Published: May 2014

This drug focus article will examine the class of drugs that selectively block the calcium channels of the plasma membrane of the myocardium, smooth muscle cells and specialized cells of the cardiac conduction system. By controlling the influx of calcium a number of important therapeutic benefits can be achieved in the management of angina, hyper tension and hear t rate control. This article will examine the action of these drugs and will explain some of the important indications and adverse effects associated with them. From this, the reader will gain an important understanding of how these drugs are used in clinical practice.
A practical guide to ECGs
Authors: Gibson Tracey
Published: May 2014

Electrocardiography is a fundamental component of cardiovascular assessment for most cardiac nurses. It is an essential tool for investigating cardiac arrhythmias and coronary heart disease. In my experience, novice cardiac nurses are often both enthusiastic and apprehensive about learning this skill.
The sour taste of cherry-picking
Authors: Cosgrave Rebecca
Published: May 2014

No one could have missed the news this week that β-blockers are to be phased out in the treatment of hypertension. The update of Hypertension: Management of Hypertension in Adults in Primary Care (National Institute of Health and Clinical Excellence (NICE), 2006) comes just two years after the original guidelines were published, and signify major changes in the treatment of high blood pressure.
Research is at risk of suffocation
Authors: Wrigley Martha J
Published: May 2014

I was interested to read Caroline Shuldham’s commentary in your July issue regarding the need for nurses to be more involved in research. I applaude and echo her sentiments about the risks of seeing research as an academic exercise rather than, as I view it, a journey of discovery. A journey which can help to change personal views and develop knowledge, while enhancing global nursing and medical practice.
Becoming a pulmonary endarterectomy nurse specialist
Authors: Rootes Maureen
Published: May 2014

Maureen Rootes discusses how the service for patients with pulmonary hypertension has developed and how her recognition of patients’ needs led to her present role.
Psychological support is vital
Authors: Johnson Kate
Published: May 2014

My attention has recently been drawn to the report on The State of Ageing and Health in Europe (International Longevity Centre (ILC)-UK and The Merck Company Foundation (MCF), 2006) which was launched at the end of June this year. Many of the findings within the report, in relation to morbidity and mortality statistics, are not particularly surprising. Neither is the fact that there continue to be inequalities in health status and life expectancy for groups such as minority ethnic groups, those that are socially isolated, disabled older people and older women. It is disappointing though, considering how long these inequalities have been recognized, but at least the report highlighted that steps had been taken in some countries to address this. What did, however, hit home for me was the statement that ‘only cardiovascular disease has a greater toll on morbidity and mortality than depression’ (ILC-UK and MCF, 2006: 6) with depression as the major cause of suicide in European older people. Rates of both suicide and self-harm are approximately 26% higher in people over 65 years than in people aged between 25 and 64 years, and in 90% of the European Union countries the suicide rate is highest in those aged over 75 years. The risk for depression was found to be greater in older women and those with lower socioeconomic status.
Physical activity and cardiovascular disease
Authors: Wrigley Martha , Pakrashi Tapesh
Published: May 2014

This paper will discuss the role of physical activity in the development of cardiovascular disease as well as the general health benefits it can provide for adults who are not known to have coronary hear t disease (CHD). A historical introduction is given and physical inactivity as a risk factor associated with coronary hear t disease is examined. The benefits of physical activity along with consideration of levels of activity and CHD in the current population and government recommendations will be discussed, as is the role of nurses in encouraging enhanced levels of activity.
Understanding ICDs
Authors: McNaughton Amanda
Published: May 2014

With the increase in services for patients requiring an implantable cardioverter defibrillator (ICD) it is fundamental that cardiac practitioners have a good textbook to support their practice.
Becoming a cardiovascular advanced nurse specialist
Authors: Tabbernor Lynne
Published: May 2014

Lynne Tabbernor describes the route to her role and the part she played in the introduction of an innovative nurse-led service for people with atrial fibrillation.
Delays are putting people at greater risk of developing heart disease
Authors: Neal Phaedra
Published: May 2014

Phaedra Neal expresses concern at the Department of Health’s unwillingness to adopt the recommendations for cholesterol levels as set out in the Joint British Societies’ guidelines
Interpreting arterial blood gas results
Authors: Hatchettis Richard
Published: May 2014

The interpretation of arterial blood samples is now a common requirement of the cardiac nurse, usually working in acute areas. It assists in providing a more detailed assessment of the consequences of a compromised cardiac function at the level of oxygen delivery to the tissues themselves. This also allows the effects of interventions to improve cardiac status to be assessed, perhaps the administration of oxygen therapy, intravenous fluids, inotropes or mechanical assist devices. Arterial blood analysis also provides further information such as the acid-base balance of the patient, and this will be discussed below.
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 593
Research Roundup
Authors: Astin Felicity
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 round-up 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.
Marfan’s syndrome: Biological basis and genetics
Authors: Bentley Peter
Published: May 2014

This article discusses the biological basis of Marfan’s syndrome, a dominantly inherited genetic disorder which leads to abnormalities of the connective tissues. Genetics and its impact in Marfan’s syndrome will be reviewed. The features of the disease will be discussed, focusing mainly on changes in the heart and aorta, the skeleton and eyes. Diagnosis of Marfan’s syndrome will be discussed using the Ghent criteria. The implications of the condition in pregnancy and importance of a high standard of ante-natal care are considered. The role of health professionals in supporting those affected by Marfan’s syndrome is discussed. This also encompasses the importance of health promotion.
Research Round-Up
Authors: Astin Felicity
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 round-up 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.
It’s time to pass on the baton
Authors: Johnson Kate
Published: May 2014

On the 20th April we will be holding the first national cardiac awards at the Café Royal in London. These awards, held in association with the British Association for Nursing in Cardiovascular Care (BANCC), are an opportunity for us to celebrate and recognize some of the amazing work that is currently happening in the cardiac nursing field across the UK. As I write this we are currently in the process of judging the nominations and although it is a hard task, it is very encouraging to read about the different innovations that are being carried out by teams and/or individuals. Over the next few months we will be printing details of these.
Aortic stenosis part one: History, presentation, pathophysiology, examination
Authors: Potts Katherine
Published: May 2014

This is the first of two articles that will examine the common valvular heart disease condition, aortic stenosis. Aortic stenosis is caused by the calcification of the aortic valve. This first article will explore the pathophysiology and causes of aortic stenosis, focusing on degenerative aortic stenosis. The common patient presentations, including the history and clinical examination findings, will be discussed. The second article will focus on the common diagnostic tests that are used in confirmation of the diagnosis as well as assessing the severity of the disease and how these tests can guide further patient management.
Ashford and St Peter’s Hospitals NHS Trust cardiology study day
Authors: Wrigley Martha J , Hamper Caroline , Ramsay Heather
Published: May 2014

Putting together a study day can be hard work. Martha J Wrigley, Caroline Hamper, and Heather Ramsay, give us an over view of the proceedings at their annual study day, held in April this year. They also give an insight into how they planned and prepared the day.
Aortic stenosis part two: Diagnostic testing, evaluation and management
Authors: Potts Katherine , Hill Samantha
Published: May 2014

This is the second of two articles that will examine the common valvular heart disease condition–aortic stenosis. The first article explored the pathophysiology, causes, history and clinical examination of this condition. This article will focus on the common diagnostic tests that are used to confirm the diagnosis, including the assessment of the severity of the disease and how these tests guide further patient management. The valvular heart disease guidelines from the European Society of Cardiology (Vahanian et al, 2007) and the American Heart Association /American College of Cardiology (Bonow et al, 2006) will be used as evidence. The diagnostic tests that will be explored are the electrocardiogram, chest X-ray, echocardiography, exercise testing, angiography and medical therapy.
A guide to coronary care
Authors: Tagney Jenny
Published: May 2014

The first edition of this established reference text Comprehensive Coronary Care was published in 1989.This fourth edition, with foreword by Professor Roger Boyle CBE, National Director for Heart Disease and Stroke, comes nearly 20 years after the idea for the first edition was conceived by Jowett and Thompson while working together on a coronary care unit (CCU) in Leicester, UK.
Research Round-Up
Authors: MacInnes Julie
Published: May 2014

Home-based cardiac rehabilitation following myocardial infarction (MI) using ‘the heart manual’ has been an established method of care delivery for a number of years. However, up until now there has been little research into its effectiveness compared to more traditional hospital-based programmes.
ECG of the month
Authors: Whitbread Mark
Published: May 2014

Mark Whitbread presents an ECG for you to analyse. The answer and management plan are given on page 440
Research Round-Up
Authors: Linden Belinda
Published: May 2014

Work stress may increase cardiovascular risk either indirectly, by inducing unhealthy lifestyles, or directly, by affecting the autonomic nervous system. In this Italian study, Lucini and colleagues hypothesize that before any obvious sign of cardiovascular disease, work-related stress is accompanied by alterations of heart rate variability. Their study tested the theory that stress at work could induce alterations in heart rate variability and that implementing an on-site stress management programme based on cognitive restructuring (a technique in which the person identifies negative beliefs and replaces them with rational statements) and relaxation which could combat the symptoms of stress and help revert the heart rate variability and lower blood pressure.
Angiotensin receptor blockers in hypertension and heart failure
Authors: Walthall Helen
Published: May 2014

Biological studies have shown that angiotensin receptor blockers (ARBs) are effective in blocking the renin-angiotensin system through the blockade of angiotensin I receptors that are present in blood vessels. The clinical application of these findings is still in its relative infancy, however, studies have shown the effectiveness of ARBs in the management of hypertension, and more recently in diabetes. This paper will present the pharmacology of ARBs and related pharmacological properties, and the evidence for ARBs’ clinical application in the treatment of hypertension and heart failure.
Addressing the educational needs of arrhythmia nurses
Authors: Hatchett Richard , Yaldren Jo
Published: May 2014

Richard Hatchett and Jo Yaldren reflect on the progress made in professional development in the field of rhythm management