bluuebunny/crossref_metadata_2025 huggingface dataset:
A commitment to women and the newborn
Authors: Lavender Tina
Published: May 2014

The International Confederation of Midwives (ICM) held its 28th Triennial Congress in Glasgow in the first week of June 2008. This was the largest ever gathering of midwives in the UK, with more than 2500 midwives and partners in maternity care from across the globe attending. The theme of the conference, ‘Midwifery: a worldwide commitment to women and the newborn’, presented an opportunity to celebrate midwifery achievements and strategize on what work is still to be conducted. Pivotal to plenary and concurrent sessions was the Millennium Development Goals (MDGs). Despite frustrations at the difficulties in achieving these goals, midwives demonstrated a passionate commitment to continue to work toward them.
Risk factors for intimate partner violence in kenya
Authors: Maina Geoffrey M
Published: May 2014

Intimate partner violence is a major public health issue worldwide. It transcends racial, religious and geographical boundaries and characteristically affects women more than men. Several factors are thought to contribute to perpetuation and propagation of partner violence such as socio-economic, cultural, interpersonal factors and religion. The aim of the study was to explore the risk factors to partner violence in Kenya.

Eleven health care providers working in an emergency department were selected to participate in the study. Individual in-depth interviews were conducted NVIVO software enabled exploration of the interviews to develops major themes and sub-themes. Various factors were identified as attributable to causation of partner violence among various communities in Kenya.
Community perceptions of the causes and prevention of maternal mortality
Authors: Adegooke Adetoro A , Ogundeji Martins O , Lawoyin Taiwo O , Campbell Malcolm , Thomson Ann M
Published: May 2014

The objective was to identify community members' perceptions of the causes and prevention of maternal mortality in Ibadan, North East Local Government Area of Oyo State, Nigeria.

Reported in this article are the results from a pilot study, carried out in 2005, of the views of 418 community men and women aged 15–49 years in Idi ape, Iwo Road and Okeadu areas of Ibadan North East. Data were collected over a two-week period using interviews with a structured questionnaire consisting of open-ended questions.

People's perceptions of the causes and prevention of maternal death varied widely. Both medical and non-medical factors were reported as being responsible. The perceived causes of maternal mortality ranged from medical/obstetrical to individual, health personnel, governmental and supernatural causes. Participants stated that to prevent maternal mortality in this setting, awareness creation of the causes of maternal mortality is crucial and that a lot of political will is needed from the government of Oyo State and Nigeria as a whole. The government should improve the provision of well-equipped health facilities staffed by qualified health professionals providing a free or subsidised service.

For a fuller understanding of maternal morbidity and mortality, it is important to consider factors outside the hospital and formal medical practice. These findings have important implications for the design and implementation of safe motherhood programmes and in formulation of safe motherhood policy in Nigeria.
Maternal and child health services in Nigeria: factors affecting choice
Authors: Okeh UM , Ugwu AC
Published: May 2014

This study examines factors affecting the choice of maternal and child health services in a remote part of Nigeria. A house-to-house survey of 329 women in Okpochiri-Ngbo in the South-Eastern part of Nigeria was carried out to determine the maternal factors associated with this choice. The variables examined included age, duration of marriage, education, occupation, income, parity and husband’s education. The analysis showed that distance from the health service, education of the mother and her age were the strongest determinants of the choice of MCH service used.
Knowledge and management of vulvovaginal candidiasis in Nigeria
Authors: Ogunfowokan Adesola A , Ibrahim Elizabeth M , Akintaju Oluwafunmilola M
Published: May 2014

This study explored female undergraduates' knowledge and experiences of vulvovaginal candidiasis (VVC), a yeast infection known to be prevelant among young women. A sample of 390 students from different courses–pharmacy, nursing science, management and accounting, and agricultural economics–at a university in southwestrn Nigeria, revealed that those taking health-related courses had poorer knowledge of VCC than the other students. Most of the students had experienced VCC at least once and the majority used treatments available over the counter and did not use the university health facility. It is recommended that health professionals are involved in educating undergraduates about how to reduce the incidence of infection.
Knowledge, attitudes and practices of HIV parent-to-child transmission
Authors: Mantula Fennie , Chaibva Cynthia Nombulelo , Chamisa Judith Audrey
Published: May 2014

This study aimed to determine knowledge, attitudes and practices related to a HIV prevention of parent-to-child transmission (PPTCT) programme among pregnant women who book for antenatal care. The intention was to develop new strategies toward improving the acceptance rate of the programme, which had a low uptake despite its availability, accessibility and affordability. A descriptive survey was used and 33 randomly selected pregnant mothers participated in a structured interview. Data are presented in tables and accompanied by a research-article and analysis of the participants’ answers. The study revealed that pregnant women are exposed to information on PPTCT. Negative attitudes of the community, spouses/partners and some pregnant women toward the programme contribute to practices of risky behaviour. Interventions to improve acceptance of the PPTCT programme should target the pregnant mothers, their partners and the community at large during the design, implementation and evaluation stages.
Afghanistan: the ‘worst’ place in the world for pregnant women
Authors: Bainbridge Jane
Published: May 2014

Maternal mortality rates in Afghanistan are estimated to be 1600 per 100 000 live births, earning the country a reputation as the ‘most dangerous place to be born’
Risk awareness among pregnant adolescent women in Zimbabwe
Authors: Gundani Helen Vupenyu , Gandanga Rowesai
Published: May 2014

This study aimed to establish the extent of knowledge of adolescent women relating to pregnancy-related complications. To establish this, a non-experimental descriptive survey was undertaken, and data were collected using a structured questionnaire. The setting of the study was a prenatal care clinic at Marondera Provincial hospital, Zimbabwe. Participants in the study included 66 adolescent pregnant women aged 13 to 19 years, who attended prenatal care at Marondera Provincial hospital. For the purpose of this study, the main outcome measures were selected indicators of adolescents' knowledge on pregnancy-related complications such as preterm delivery, preterm labour, obstructed labour, abortion, stillbirth, and anaemia. Knowledge of the influence of age factors was also analyzed utilizing descriptive statistics. Thirty-nine (59.1%) participants had no knowledge of the complications related to pregnancy, while 27 (40.1%) had some knowledge of the complications related to pregnancy. Only 1 participant (1.5%) knew that HIV/AIDS was related to pregnancy complications. Adolescent women married early and were susceptible to pregnancy-related complications. Age was associated with the frequency of occurrence of pregnancy-related complications in women. The older the woman was, the less susceptible she was to pregnancy-related complications. The adolescents had limited knowledge of pregnancy-related complications, although some of them had received some form of knowledge on the complications. However, before any interventions can be recommended, more research is needed.
Health Implications of harmful widowhood practices in Nigeria
Authors: Oludayo Owolabi Gbonjubola , Adenike Onibokun
Published: May 2014

This article outlines an exploratory survey to determine the existence and extent of harmful widowhood practices among widows and the subsequent health implications of such practices. A detailed questionnaire was administered to 210 widows with a response of 95.24%. Findings indicated that 83.5% and 56.5% of respondents were subjected to staying indoors and wearing of black dresses respectively. Similarly, widows were commonly subjected to confiscation of husband's goods and accused of having a hand in the husband's death, with a prevalence of 20% and 18% respectively. A significant relationship also exists between these harmful widowhood practices and the respondents' health. Of the respondents, 40.5% experienced absent-mindedness, while 56% had anxiety about children's future and 13.5% already had high blood pressure. Little or no help was received from the government or non-governmental organizations. There is a need for policies from all sectors of society to help ensure widows' welfare.
Breastfeeding and weaning in a village in the Niger Inland Delta, Mali
Authors: Sall M , Jacks B , Jacks G
Published: May 2014

The aim of the study was to investigate the breastfeeding and weaning customs and their influence on the survival of infants in the village of Niafunké, Mali. A questionnaire with 22 questions was put to 30 mothers, 15 traditional birth attendants, and 5 midwives. All the mothers used colostrum. However, before breastfeeding was initiated the children were given date juice, which constitutes a considerable infection risk. Weaning was started at the age of 6 to 9 months. The breastfeeding and weaning customs are largely satisfying; nevertheless, the child mortality before the age of 5 years was extremely high, at 56 children out of 131 born. The majority of these, 40, died during their first year of life. The infant mortality showed two periods of greatly elevated death rate: right after birth and during the period of weaning. The mortality after birth may depend on the lack of educated midwives as well as infections caused by water being given with the breast milk. The mortality at weaning obviously depends on poor hygienic conditions, possibly combined with a documented insufficient zinc intake weakening the immune system. Abrupt weaning practised when a new pregnancy is experienced is also a contributing factor. The breastfeeding may be interrupted over a single day, causing both physical and mental stress for the child. The mothers' information about breastfeeding and weaning comes from a number of sources: the parents, the traditional birth attendants, religious authorities, and the radio, which seems to have a good reach into the society.
Working conditions and perspectives among South African health workers
Authors: Taylor Lauren C. , Fair Cynthia D. , Nikodem Cheryl
Published: May 2014

Approximately one-third of women of childbearing age in south africa are infected with HIV/AIDS, placing great demands on nurses and midwives. Consequently, these health professionals are in an excellent position to note shifts in government policy and subsequent changes in working conditions and provisions of services which may affect the care they are able to provide. The current study assessed working conditions of 249 nurses and midwives in Cape Town and their perceptions of HIV-related initiatives of the current health administration. Results indicated a need for increased support for health professionals including better staffing, supervision and resources, and further evaluation of the implementation of policies from the health administration.
Using law to strengthen health professions: frameworks and practice
Authors: Verani André , Shayo Peter , Howse Genevieve
Published: May 2014

The lack of sufficient, high-quality health workers is one of the primary barriers to improving health in sub-Saharan Africa. An approach to address this challenge is for public health practitioners to increase their cooperation with public health lawyers, regulators and other policymakers in order to develop strengthened health workforce laws, regulations, and policies that are vigorously implemented and enforced. Conceptual frameworks can help clarify the meaning of health system governance and the pathways between law and health. International recommendations for policy interventions governing health workers provide countries with valuable guidance for domestic reforms. Monitoring and evaluation of legal, regulatory, and other policy interventions are required to ascertain their public health impact. At the intersection of law and public health, professionals from both fields can collaborate in concrete ways such as those discussed here to improve laws and policies governing health.
Waiting time and women's satisfaction at an antenatal clinic in Ghana
Authors: Donkor Ernestina Safoa , Obed Samuel A.
Published: May 2014

Waiting to receive care can be frustrating if it takes a long time. This quantitative, descriptive study was undertaken to investigate waiting time, factors contributing to long waiting hours and women's satisfaction at an antenatal clinic (ANC). Data were collected from 316 women drawn through a convenient sampling method from antenatal care units of a hospital in Ghana. The response rate was 96%. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). The findings indicate that the duration of time spent by women at antenatal clinic was 6.5 ± 2 hours. The unit at which most time was spent was waiting to see a doctor in the consulting room. About 68% (n = 216) rated the waiting time as too long and almost half (n = 145) (48%) expressed dissatisfaction at the time spent. These findings have implications for health personnel as we seek to encourage women to report regularly to an antenatal clinic to receive care in order to improve pregnancy outcomes.
Incorporating cultural beliefs in promoting exclusive breastfeeding
Authors: Reinsma Kathryn , Bolima Nancy , Fonteh Florence , Okwen Patrick , Yota Daniel , Montgomery Susanne
Published: May 2014

Introduction:

Since 2003, the World Health Organization has recommended exclusive breastfeeding for the first 6 months of life. In the Northwest region of Cameroon approximately 90% of women initiate breastfeeding, yet only 34% of these women exclusively breastfeed for the recommended six months.

Aim:

To determine influences on women's exclusive breastfeeding practices.

Methods:

Semi-structured interviews were conducted with six women and six men followed by focus group discussions with three groups of women and three groups of men in the Kumbo West Health District, Northwest region, Cameroon. All participants were selected using theoretical sampling to assure triangulation.

Results:

Three themes emerged that influence exclusive breastfeeding practices: woman's readiness to exclusively breastfeed; cultural influences towards exclusive breastfeeding; and perceived constraints to exclusive breastfeeding.

Conclusion:

These emergent themes were used to create a theoretical framework that is useful for developing a breastfeeding health education intervention in non-Western settings.
Factors affecting the choice for home deliveries in Malawi
Authors: Chanza Dorothy , Chirwa Ellen , Maluwa Alfred , Malata Address , Masache Gibson
Published: May 2014

In developing countries, a high rate of maternal and neonatal deaths have been associated with home births. This study explored factors that influence pregnant women to deliver at home in the Thekerani Area of Thyolo district in Malawi. The study design was descriptive and recruited a convenience sample of 253 mothers. Data were collected through face-to-face interviews using a structured questionnaire on women who were attending fewer than five postnatal and family planning clinics. The results identified four main factors that influenced home delivery; longwalking distance to a health facility (78%); lack of financial support while in hospital (52%); hostile behaviour of health personnel towards women in labour (40%) and traditional beliefs (31%). This study found that there is a need to: provide bicycle ambulances to each group village headman for easy transportation of pregnant women to health facilities, create awareness of birth preparedness and complications, upgrade existing primary health care centres to provide emergency obstetric and neonatal care services and empower the women financially through income generating activities.
Overview of maternal mortality in Eritrea, sub-Saharan Africa
Authors: Araya Winta , Johnson-Mallard Versie , Evans Mary E , Beckstead Jason W , McNerney Diane , Shelton Melissa Molinari , Jevitt Cecilia
Published: May 2014

The majority of maternal deaths occur in sub-Saharan Africa and reports show that the sub-Saharan region along with Asia contribute 87% of the world's maternal deaths ( United Nations (UN), 2010 ). The risk of dying for a woman in the reproductive age group in sub-Saharan Africa is 1 in 31, compared with 1 in 4300 in the developed countries ( Rogo et al, 2006 ). Equipping the public with the proper information as to why women die and what could have been done to save their lives is feasible even in developing regions ( World Health Organization (WHO), 2004 ). This article intends to provide a brief overview of issues related to maternal mortality, progress made towards mortality reduction, future trends and recommendations for the improvement of maternal health, with a focus to Eritrea, an east African nation.
Helping midwives in Ghana to reduce maternal mortality
Authors: Floyd Liz
Published: May 2014

This article describes work undertaken in Ghana with Kybele, a multidisciplinary humanitarian organisation. Kybele is dedicated to improving childbirth safety worldwide, by improving processes that will reduce maternal mortality. The role of the author, as the midwife team member, was to work alongside doctors and midwives in a busy maternity referral hospital in Accra, Ghana. Review of the history of maternal deaths, and observing and working alongside the midwives revealed a heavy workload, cramped and disorganised space, poor decision making and inadequate referral systems. This project provided opportunities for small group work, supported managers and targeted teaching to enable the Ghanaian midwives to share their beliefs about their role, understand the challenges and identify ways to improve standards of care for women. The midwives decided on four key areas for improvement: monitoring women using the partogram, improving professional accountability by introducing patient allocation, improving the labour ward environment and developing leadership skills. The partnership working style and ongoing support that are key features of the Kybele model will continue to assist the project and monitor progress.
Labour pain perception and use of non-pharmacologic labour support in newly delivered mothers in Ibadan, Nigeria
Authors: Oyetunde Modupe Olusola , Ojerinde Ogonna Eze
Published: May 2014

Background:

Pain is an unpleasant and highly personal experience that may be imperceptible to others. It is a common experience in labour and childbirth. Dealing with labour pain remains a concern to women in labour, as well as skilled birth attendants, especially in poor/low-resource settings where pain management protocol is nonexistent or where there may be sociocultural constraints of pain relief methods.

Aim:

To explore labour pain perception and the use of non-pharmacologic support during labour among newly delivered mothers.

Method:

A cross-sectional descriptive design was adopted in assessing 100 newly delivered mothers at University College Hospital and Jericho Nursing Home in Ibadan, Nigeria. Three hypotheses were generated and tested at alpha5%. These were that there is no significant difference between: provision of information and perception of pain during labour among newly delivered mothers; labour pain experience and choice for caesarean section in subsequent pregnancies; and back massage and pain reduction during labour.

Results:

About 96% of women indicated that they experienced pain during labour. All the respondents acknowledged that labour pain was a normal experience every woman should go through. However, some women (68%) indicated a need to relieve labour pain. About 60% preferred to be supported in labour, and non-pharmacological support, which was experienced by around 70%, was identified as mainly emotional (52%) and massage therapy (32%). There was low preference for spouses’ emotional support (37%). Caesarean section was not considered as an alternative to experiencing labour pain by 62% of respondents. There were significant associations between information and pain perception during labour (p=0.017); labour pain experience and choice of caesarean section in subsequent pregnancies (p=0.002); and back massage and pain reduction during labour (p=0.008).

Conclusion:

Labour pain is a serious issue that may break the tradition of and clamour for spontaneous vaginal delivery in the Nigerian setting. Information and support during labour helped women to cope. Assessment should be imbibed by nurses and midwives in labour wards for accurate diagnosis and management of pain in labour. Spousal support during labour should be encouraged.
Support during pregnancy, labour and childbirth by husbands in Zambia
Authors: Ngoma Catherine Mubita , Chongo Charity
Published: May 2014

Zambia has a very high maternal mortality ratio of 549 deaths per 100 000 live births ( Central Statistic Office (CSO), 2007 ). The high maternal mortality rate is attributed to many factors, and husbands’ support, such as provision of transport and deciding when to seek medical help, could be one of them. This study explores and describes husbands’ perceptions of what support they could or should provide during pregnancy and labour with the aim of encouraging their participation to improve maternal health. A cross-sectional descriptive study was conducted in Kantashi Township in Mufulira district which is in the northern part of the Copper belt province of Zambia. A probability sample of 385 married men aged between 20 and 59 years old participated in the study and were selected using systematic sampling method. The study revealed that 96.6% of the respondents reported that they did not accompany their wives to antenatal clinics. The support that men stated they would give to their wives during the antenatal period included emphasising behaviour according to professional advice given by health-care professionals (97.1%), not having extra marital relationships (97.1%), and encouraging their wives to maintain morale (96.6%). Fifty-three percent of the men stated that they would accompany their wives to a health facility for admission during labour.
Awareness and attitudes of women towards cervical cancer screening in Oyo state, Nigeria
Authors: Bammeke Olukemi A , Ndikom Chizoma M
Published: May 2014

Cervical cancer is one of the leading causes of cancer deaths among women especially in the developing world. This study examined the awareness and the attitude of women towards cervical cancer screening in Agbowo Primary Health Centre in Ibadan, Nigeria. Using a cross-sectional study design and convenient sampling, a questionnaire was administered to collect data from 100 women who utilised postnatal and immunization services in the health centre. The hypotheses were tested using Pearson product moment correlation at significance level of P<0.05.

The findings showed that the majority (52%) of the participants were aware of cervical cancer, 58% were aware of cervical cancer screening but only 5.0% had utilised cervical cancer screening services. There was significant positive relationship (r=0.369; P=0.001) between awareness and utilisation of cervical cancer screening services and educational background and utilisation of cervical cancer screening services (P=0.002) as well as economic status and use of the screening services (r=0.276; P=0.001). Attitude and uptake of cervical cancer screening services also showed a positive correlation (r=0.276; P<0.006). some of the factors that influenced uptake include lack of awareness about where to get screened, cost, attitude of health workers and delay in hospitals. The study has shown that cervical cancer screening uptake is still very poor, although, the awareness of cervical screening was fairly high. There is no doubt that education improve uptake of cervical cancer screening. There is still the need to create more awareness and make the services available so as to improve the uptake of cervical cancer screening.
Cardiac assessment part 1: Inspection, palpation, percussion
Authors: Massey Debbie
Published: May 2014

Over the last fifteen years numerous political drivers have paved the way for the development of new and innovative models of practice within cardiac care. Many of these require practitioners to perform detailed and comprehensive patient assessments. Within nursing, respiratory assessment is increasingly regarded as an essential element of the practitioner's profile. However, the assessment of other body systems has been adopted more slowly. This paper argues that cardiac assessment should be routinely incorporated into the practitioner's scope of practice and offers them an opportunity to develop and augment their knowledge and understanding of cardiac assessment. It suggests and introduces a systematic model that may be used in clinical practice.
CHD risk factors in UK Gujarati immigrants compared with their contemporaries in Gujarat, India
Authors: Patel JV , Karadia V , Sumara S , Hughes EA , Vyas A , James L , Patel D , Patel M , Yadav S , Reddy KS , Prabhakaran D
Published: May 2014

Background: South Asian immigrants in Britain have an excess risk of coronary heart disease (CHD). This study aimed to elucidate the impact of migration on CHD risk factors by comparing these in two groups of Gujarati people: migrants to Britain and those still living in Gujarat, India.

Methods: Metabolic factors during oral glucose tolerance test, lifestyle indices (physical activity and diet, determined by standardized questionnaires), and energy expenditure and metabolic parameters were evaluated in 242 randomly sampled Gujarati people aged between 25 and 79 years living in Sandwell, West Midlands and 295 age-, gender- and caste-matched subjects in Gujarat, India.

Results: Gujaratis in Sandwell had significantly higher dietary energy and fat intakes and their mean body mass index was 6.6 kg/m2 higher (95% CI, 4.5–7.4 kg/m2) than those of Gujaratis in India. Blood pressure, serum cholesterol and triglyceride values increased with migration; in all cases; these factors were ≥6.6– 13.1% higher in Sandwell Gujaratis (95% CI). Diabetes prevalence was high in both groups (15%), but insulin secretion was lower and diabetes was less frequently accompanied by excess metabolic risk factors in subjects in India.

Conclusions: The higher risk seen in Gujarati immigrants is probably related to an increased fat intake and obesity which are associated with migration. Ways of improving nutrition and identifying treating cardiovascular risk factors in this population are urgently required
Conducting a literature review: How to carry out bibliographical database searches
Authors: Lahlafi Alison
Published: May 2014

Alison Lahlafi presents a systematic guide to planning and carrying out a search for relevant material using electronic bibliographical databases in order to conduct a literature review
The pressure’s rising
Authors: Cosgrave Rebecca
Published: May 2014

While I was listening to the radio last week I came across the ‘Case Notes’ programme on BBC Radio 4 (27 February 2007). The subject matter was high blood pressure. More and more people seem to be being diagnosed with hypertension and many of these people are fairly young and seem to be living relatively healthy lives.
Trans-fatty acids: The hidden fat
Authors: Hamilton Rozi
Published: May 2014

Trans-fatty acids are formed during the process of hydrogenating oils. Hydrogenated oils are used by the food industry in a large number of of processed and pre-prepared foods. During this article there will be a discussion of the health risks associated with a diet rich in trans-fatty acids, looking in particular at the recent published evidence on the damaging effects of trans-fatty acids on the cardiovascular system. There will also be consideration of the government’s current stance on these. The extent of the food industry’s use of hydrogenation and the types of foods that contain trans fats are highlighted and suggestions are made about how cardiac nurses can educate their patients to avoid products that contain trans-fatty acids.
Strengthening leadership in nursing
Authors: Tagney Jenny
Published: May 2014

As a nurse consultant Jenny Tagney has striven to improve patient care in the areas of chest pain, heart failure and arrhythmias. She tells us how her role has enabled her to achieve change.
Learn all about cardiac pacemakers and defibrillators
Authors: Karrouze Andrew
Published: May 2014

The first chapter of this book discusses the basic principles of pacing and does it very well. It may be a little basic for the experienced practitioner but it is informative all the same. The electrocardiogram (ECG) diagrams are easy to understand in this section and I particularly enjoyed the ‘frequently asked questions’ at the end of the chapter.
The effect of cardiac rehabilitation on changing patients’ clinical outcomes
Authors: Ying Sek , Thompson David R , Tang Sui Wai , Leung Kei Pui
Published: May 2014

Aim: This study aimed to evaluate the effect of cardiac rehabilitation on changing patients’ exercise intensity and physiological outcomes.

Methods: The study used a pre- and post-inter vention test design to evaluate an 8-week cardiac rehabilitation programme. The focus of this programme was supervised exercise and the content includeddiet, physical activity, stress management and risk factor management. Patients attended three 2-hour sessions every week and these were supervised by a nurse specialist.

Results: After 8 weeks of cardiac rehabilitation, the patients’ exercise intensity, systolic and diastolic blood pressure, body mass index, total cholesterol, high-density lipoprotein cholesterol, lowdensity lipoprotein cholesterol, and triglycerides were all improved. However, except for the high density lipoprotein cholesterol levels, the improvements were not sustained at 3 months. Among behaviour changes, only the improved behaviour in smoking and exercise were maintained at 3 months.

Conclusions: The results of this study indicate that cardiac rehabilitation is effective in improving cardiac patient outcomes in the short term but that other approaches, such as motivational interviewing and counselling, and strategies such as unsupervised exercise programmes in community settings, may be needed to maintain the physiological improvements.
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 241
Preoperative evaluation of cardiac patients
Authors: Aps Chris
Published: May 2014

There are six stages of a cardiac surgical operation. Each has its own clinical significances and priorities(Table 1).
Ivabradine: A new treatment for chronic stable angina
Authors: Nixon Rhona , Kruszewski Kirsten , Bloe Charlie , Leslie Stephen J
Published: May 2014

Heart rate lowering is important in the treatment of symptomatic coronary artery disease (angina). A lower heart rate results in improved myocardial perfusion, reduced myocardial oxygen demand and therefore less myocardial ischaemia. This has traditionally been achieved with beta-blockers, or rate limiting calcium-channel antagonists. However, both these drugs are associated with significant side-effects in a proportion of patients. Ivabradine is a new drug which selectively and specifically inhibits the If channel in the sinoatrial node. It offers great promise in achieving heart rate reduction in patients in sinus rhythm without major side effects. Ivabradine has no negative inoptropic effects and does not appear to have any major side-effects. It has similar antianginal properties to both atenolol and amlodipine. Ivabradine represents a new approach to lowering heart rate in patients with chronic stable angina and potentially in unstable angina and chronic heart failure.
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 209
Ambulatory blood pressure monitoring in the community: Increasing access and choice
Authors: Nelson Sara , Vincent Louise
Published: May 2014

This paper will discuss how an ambulatory blood pressure service was redesigned and moved into the community offering patients greater choice and access to diagnostics in a timely fashion.

Waiting times were decreased for this particular diagnostic test from an average of 14 weeks to about 2 weeks. This has facilitated earlier diagnosis and treatment for the patients concerned and quicker reporting of the results to the General Practitioners (GPs). It has been well evaluated by both staff and users.
Philosophy and principles of supportive and palliative care in heart failure
Authors: Flynn Maria , Connolly Michael , Booth Katie
Published: May 2014

This paper is the first of two that consider the broad philosophy and principles of supportive and palliative care as applied to patients living and dying with heart failure.

It is widely recognized that in order to provide the best possible care to patients suffering heart failure there is a need to deliver supportive and palliative care. Although the prediction of life expectancy in end-stage heart failure is problematic, the provision of supportive and palliative care can do much to minimize distress for the patient, their family and carers.

Within the context of modern NHS services, this paper provides a broad outline of the philosophy and principles of supportive and palliative care and applies these to the care of patients with heart failure. Some common clinical symptoms at the end of life are discussed together with strategies for their palliative management.
Follow-up of patients after heart valve surgery: Setting up a nurse-led clinic
Authors: Anscombe Anna , Cadet Jane
Published: May 2014

Surgery remains the treatment of choice for most significant heart valve lesions. Although potentially life-threatening complications can develop long after surgery to replace diseased heart valves, many patients do not receive regular follow-up in specialist care. At present, there is no consensus on best practice regarding timing of follow-up appointments. This article relates the experience of setting up a nurse-led outpatients clinic for long-term follow-up of patients following valve surgery.
Renal replacement therapy and its impact on the cardiac patient
Authors: Byrne Gobnait , Murphy Fiona
Published: May 2014

Chronic kidney disease (CKD) is classified into five stages. This is the last in a series of four articles that have explored the interrelationship of cardiovascular disease (CVD) with acute kidney injury and CKD. Those patients at stage 5 CKD require renal replacement therapy (RRT) to survive, which includes haemodialysis, peritoneal dialysis, renal transplantation and conservative management (including patients who opt not to have dialysis treatment or those who choose to withdraw from same). There will be a discussion throughout this article of the continual inter face of CVD and RRT and the management of these patients.
Exploring the information needs of patients who have undergone PCI
Authors: Corones Katina , Coyer Fiona M , Theobald Karen A
Published: May 2014

In Australia percutaneous coronary intervention (PCI) rates have significantly increased over the last decade. However, often, in the hospital setting, there is little time for comprehensive patient education due to the urgency for coronary artery catheterisation, and short length of patient stay.

Aim: The purpose of this study was to explore the information needs of first-time PCI patients four to six weeks post-procedure.

Method and Results: This study was based on a naturalistic inquiry approach using semi-structured interviews with 10 participants and field notes as the methods of data collection. Data were analysed utilising Thomas’ (2003) five steps to a thematic analysis, incorporating a constant comparative approach. Four themes were identified: ‘Events leading up’; ‘Information prior’; ‘About the procedure’; and ‘Lifestyle’.

Conclusions: Findings highlighted the numerous educational needs of participants for PCI across the continuum of their clinical admission and discharge. Furthermore, the study uncovered the need for a tailored approach to PCI patient information delivery. Findings also demonstrated the need to further identify and trial different information delivery methods and timing of PCI education to patients and their families.
Permanent pacemakers: An overview
Authors: Davies Alan
Published: May 2014

Many patients in many different clinical areas have a permanent pacemaker (PPM) device implanted. Nurses are better equipped to deal with the unique needs of this patient group by understanding the different types of pacemaker device available, how these devices function, and how this impacts on the patient’s clinical care. An understanding of the pacemaker device also helps to identify or anticipate potential problems with the device, which may affect the patient’s health. Certain clinical tests and equipment may also affect the functioning of a pacemaker device and it is important that nurses are aware of these effects so that steps can be taken to prevent or reduce these effects, and deliver the best possible care to patients with a permanent pacemaker.
Public involvement in NHS research
Authors: Flynn Maria , Hunter Ruth
Published: May 2014

In part 4 of a series on practical aspects of research, Maria Flynn and Ruth Hunter discuss the role of patients and members of the public in health research and highlight what public involvement (PI) might mean for cardiac nurses engaged in research.
Drawing a pedigree for inherited cardiovascular conditions
Authors: Reye Paul
Published: May 2014

Paul Reye outlines the process of taking a family history in order to draw up up a pedigree diagram,and explores how the resulting tool can be used in diagnosis and to explain genetic risk
ABCDE: The assessment of the critically ill patient
Authors: Jevon Philip
Published: May 2014

Phil Jevon provides a reminder of the step-by-step approach to managing a deteriorating patient, in line with the Resuscitation Council guidelines
GP-led commissioning: Reinventing the wheel?
Authors: Nelson Sara
Published: May 2014

Sara Nelson outlines the background to the plans for GPs to take control of commissioning budgets, and considers the issues arising from the proposed change for primary care
Transcatheter aortic valve implantation for patients unsuitable for surgery
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 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.
Preventing Contrast-induced Nephropathy part 2: Preventive Strategies
Authors: O'Donovan Kate
Published: May 2014

Contrast agents play an important role in cardiology as part of diagnostic and interventional procedures. These contrast agents are known to be nephrotoxic, and damage to the kidneys can occur as a result of their use. This second article on contrast-induced nephropathy (CIN) discusses strategies that have been employed in acute care to identify those at high risk of CIN and then to reduce the risk of this occurring, particularly considering the role of the cardiac nurse.
Living with a ventricular assist device
Authors: O’Donovan Kate
Published: May 2014

The overall prevalence of heart failure is increasing which is placing a burden on the health-care system. Treatment strategies include pharmacological support and heart transplantation. Due to shortage in donor organs and ineligibility for transplant, ventricular assist devices (VADs) have proved an alternative in bridging the patient to transplantation or as destination therapy. Although these devices have been shown to decrease symptoms and prolong survival they are associated with a new way of living for the recipient and caregiver. Emotions from being overwhelmed to feelings of optimism are experienced. Nurses working with this population need to be aware of the emotional and physical impact living with a VAD has on the recipient and caregiver.
Evaluating a cardiac rehabilitation service
Authors: Meadows Steve , Jobson Simon , Kirk Mary
Published: May 2014

Cardiac rehabilitation programmes reduce cardiac-related morbidity. However, evidence suggests that cardiac rehabilitation services nationally are not equitable, with regional variation in the scope of service provision and patient outcome. With new commissioning groups being established, service providers have an opportunity to highlight gaps in the quality of their service. Commissioning groups now require evidence to demonstrate efficacy and cost effectiveness of services. Data collected during cardiac rehabilitation can be reviewed to provide such evidence. This article discusses the value of performing service evaluation for cardiac rehabilitation services as a means of improving service efficiency, patient care and to provide a foundation for evidence-based practice.
Tricyclic antidepressant self poisoning and admission for acute care
Authors: Marland Glenn , Snowden Austyn , McNay Lisa , McCaig Marie , Boyd Gary
Published: May 2014

Self-poisoning by ingestion of antidepressants is a common method of suicide. Although tricyclic antidepressants (TCAs) are no longer the first choice treatment for depression they are still commonly taken in overdose causing poisoning and admission to acute care. This article describes the mechanism of toxicity and the requisite physical care. It also suggests that it is important for nurses to maintain a positive, sensitive, and hopeful approach. A comprehensive approach to care is presented specifying the best evidence for physical and psychological care, and most importantly, a coherent combination of both.
How to identify and improve medication non-adherence in the cardiac patient
Authors: Auyeung Vivian , McRobbie Duncan
Published: May 2014

This article will introduce the perceptions and practicalities framework as a way to understand medication non-adherence in the cardiac patient. Practical recommendations on how to identify non-adherence are presented; interventions to improve non-adherence are drawn from the literature of pharmacy practice and health psychology. Interventions need to be matched according to whether the patient is intentionally or unintentionally not taking his/her medicines as prescribed. Patient-centred approaches, such as motivational interviewing, are encouraged as a way to communicate effectively with patients. Distinctions between methods used in research studies and those available in clinical practice are highlighted where appropriate.
Tai Chi beneficial for patients with heart failure
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 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.
The role of the dietitian in cardiac rehabilitation
Authors: Hornby Alison
Published: May 2014

Cardiac rehabilitation has evolved from an exercise and drug therapy focus to a more comprehensive, multidisciplinary model. Alison Hornby discusses the role of dietitians in CR and how they can support the work of cardiac specialist nurses and physical activity specialists.
Running an aortic valve surveillance programme
Authors: MacDonald Marwen , Fraser Audrey , Crawford Chiala , Farman Colin , Leslie Stephen J
Published: May 2014

Aortic stenosis is the most common form of valvular heart disease. It is a progressive condition and many patients ultimately require surgical intervention. It is often discovered at an early stage in the disease process and therefore long term surveillance of patients may be required. This paper describes the development of a non-doctor delivered aortic surveillance programme. The main elements of the echocardiography clinic and surveillance programme are described with the aim of helping other hospitals set up such a service
Cardiovascular risk and androgenic anabolic steroids
Authors: Sculthorpe Nicholas , Grace Fergal , Angell Peter , Baker Julien , George Keith
Published: May 2014

Although several drugs are purported to improve exercise performance, androgenic anabolic steroids (AAS) are the most widespread. Furthermore, unlike other drugs, their use has expanded beyond competition, to non-competitive and recreational athletes. Correspondingly health professionals are more likely to come into contact with users of AAS than with users of other performance-enhancing drugs. While there are numerous reports outlining serious cardiovascular consequences to high-dose AAS abuse, this evidence is often limited by difficulties in gaining access to users due to the legal status of AAS. Additionally the co-abuse of other substances (as additional muscle mass enhancers, or to mitigate possible side effects) is a further confounding factor. This review examines the evidence for AAS having a negative effect on the cardiac and vascular tissue and the corresponding risk of developing cardiovascular disease. Possible mechanisms of action by which AAS bring about these changes are also discussed.
Identifying patients with hypertension using ABPM
Authors: Fallon Noeleen , McKee Gabrielle , Finn Caroline , O'Mahony Rose , Flynn Nora , McGeary Patricia
Published: May 2014

The aim of this study was to assess the effectiveness of the systematic identification and sustained follow-up protocol of hypertensive patients using ambulatory blood pressure monitoring (ABPM) superimposed on Phase III cardiac rehabilitation (CR).

Methods:

Patients with elevated blood pressure (BP) (clinic measurement) on entry to CR had protocol cycles of ABPM, lifestyle education, medication changes and clinic BP monitoring, throughout CR and up to 6 months follow-up until BP control was achieved.

Results:

Initial assessment using clinic measurement identified 30% (129) patients with uncontrolled hypertension but following initial ABPM 62% (n=80) were normal with 38% (49) diagnosed as uncontrolled. These were followed-up using protocol cycles up to six times. Of those originally identified as hypertensive, 81% (104) achieved control.

Conclusion:

This systematic identification and sustained follow-up of hypertensive patients using ABPM in CR was a convenient, successful method in identifying and controlling a significant amount of uncontrolled hypertension.
Characteristics of qualitative research and its application
Authors: Astin Felicity , Long Andrew
Published: May 2014

This article explores the characteristics of qualitative research and its potential value for research in cardiac nursing, using short illustrative examples. It begins by clarifying the focus and world view of qualitative research, elaborating on its underlying methodology and methods. Insight is provided into the range of methods of data collection, sampling and data analysis. A short section is also provided on the importance of reflexivity in qualitative research and of providing insight into ‘how the study was done’ to enable the reader to evaluate the quality of the qualitative research study carried out.