bluuebunny/crossref_metadata_2025 huggingface dataset:
The provision of culturally sensitive care to linguistically and culturally diverse groups
Authors: Gammon Brian , Gunarathne Ashan
Published: May 2014

Despite attempts to maximize access to and receipt of health care in the UK, minority ethnic groups experience significant problems with non-culturally sensitive health care. ‘Linguistically and culturally diverse’ (LCD) groups continue, therefore, to bear a disease burden which is unacceptably high. This is particularly evident in cerebrovascular disease (CVD). The origin of exclusionary practices is discussed as is the epidemiology of CVD among Indian, Pakistani and Bangladeshi populations resident in the UK. There then follows a discussion of barriers to health care access, beliefs concerning health, medicine, illness and disease among LCD groups as possible predictors of access to health care. The central contention is that health care provided to CVD patients is flawed and indeed may exacerbate poor health outcomes as a result of discriminatory practices. Given this, models of nursing assessment and care are discussed. Finally, specific suggestions to enable staff to provide culturally sensitive care are provided and conclusions stated.
Briefing practitioners on surgery
Authors: Green Sarah
Published: May 2014

This text, described as a ‘briefing’, provides a descriptive and informative guide to the process of cardiac surgery. The book is written by an anaesthetist and aimed at trainee anaesthetists and other clinicians involved in cardiac surgery such as trainee surgeons, perfusionists, anaesthetic support staff, ward, theatre and critical care practitioners and therapists involved in the care of cardiac surgical patients.
Changes in store for the new year
Authors: Tagney Jenny
Published: May 2014

As we draw to the end of another eventful year both in cardiac nursing and in the life of the British Journal of Cardiac Nursing, it falls to me to write the final editorial for 2007. Much remains topical, such as the petition by the British Heart Foundation and British Association for Cardiac Rehabilitation to ensure that these valuable, evidence-based services remain part of the expected care pathway. The plight of female heart failure patients in particular was raised again by Professor Martin Cowie and fellow researchers through a UK-wide survey, revealing that women were less likely to have an echo or receive beta-blockers, as reported by the BBC (2007) ahead of the study’s publication in Heart. If anyone is familiar with the survey and would like to consider writing a commentary or overview for BJCN—get in touch!
Something to celebrate
Authors: Johnson Kate
Published: May 2014

The latest progress report on the National Service Framework (NSF) for Coronary Heart Disease (Department of Health (DH), 2000) has recently been published (DH, 2007).While there are some similarities to the format of the 2005 report, this does not contain so much detail about all the standards, and focuses instead on celebrating some of the improvements and areas of good practice. There is a lot within it to feel pleased about: death rates are continuing to fall, waiting times for cardiac surgery are no longer than 3 months, the number of cardiologists has increased and new cardiac centres are opening, giving patients greater access to services on their doorstep than they had before. Unfortunately, what it does not mention is that although patients may get heart surgery quicker, in some places the waiting times for diagnostic cardiac angiography have increased. This is not necessarily because of a lack of facilities or staff but because of funding constraints. It is fantastic that targets are being met, but sadly we know that, in some cases, achieving them is one of the reasons why many NHS trusts are now in financial difficulties. I would hope, however, that the provision of new or improved cardiac centres and facilities country-wide may, at least, offer better employment opportunities for nurses, in particular those who are newly qualified.
Change your approach to ECG interpretation
Authors: Oldroyd Carol
Published: May 2014

Electrocardiograms (ECGs) are one of the most common investigations used in cardiovascular assessment. However, their interpretation can prove challenging to even the most experienced practitioner. Given the plethora of ECG interpretation books that are available on the market, it is always interesting when a text advocating a different approach is published. The authors of this text claim to deliver a new, easy to follow approach to ECG interpretation which is suitable for both the beginner and the more experienced reader. It is aimed at anyone involved in ECG interpretation including medical students, cardiac physiologists and student nurses.
Glycaemic control after myocardial infarction: The DIGAMI protocol
Authors: Davies Siân
Published: May 2014

The diabetes mellitus, insulin glucose infusion in acute myocardial infarction (DIGAMI) study (Malmberg et al, 1994; 1995; 1996; 1997) assessed the effects of intravenous insulin and glucose, followed by multi-dose subcutaneous insulin, on mortality after acute myocardial infarction (AMI) in patients with hyperglycaemia. The study suggested improved survival rates in those patients who had received insulin and glucose. These results prompted many clinicians to question and alter their practice. However, the study did cause some controversy. The suggested regimen was not without problems and the trial raised questions about the importance of chronic versus acute metabolic control. The subsequent DIGAMI 2 study (Malmberg et al, 2005) sought to answer queries raised by the original study but was also controversial. It is important to note, however, that the DIGAMI study did identify the benefit of strict glycaemic control in patients with AMI. It is essential that nurses are aware of this to enable them to improve patient outcomes.
Research Round-Up
Authors: Hachett Richard , Tagney Jenny
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the felid 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 7th annual spring meeting on cardiovascular nursing
Authors: Cosgrave Rebecca
Published: May 2014

A meeting of the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions, in collaboration with the British Association for Nursing in Cardiovascular Care and the Greater Manchester and Cheshire Cardiac Network, took place in Manchester on 23–24 March. Rebecca Cosgrave reports on some of the highlights.
Extubation after cardiac surgery: A practical guide
Authors: Lancasteris Leann
Published: May 2014

Extubation has become part of the everyday role of nurses working in intensive care or cardiac recovery units, who care for patients in the immediate postoperative phase. In this article Leann Lancaster gives a guide to performing the procedure and how to prepare the patient.
An introduction to heart failure and its management
Authors: Butler Jane
Published: May 2014

Heart failure is a common, clinical syndrome that results from any functional or structural cardiac disorder that impairs the pumping ability of the heart. According to the Department of Health patients with heart failure account for 5% of acute admissions to hospital. This group of patients have a poor quality of life, poor prognosis and high re-admission rates (35–43%). Common signs and symptoms include breathing difficulties, fatigue and swollen feet, ankles or legs. Diagnosis is made on the presence of symptoms of heart failure, objective evidence of cardiac dysfunction and often a clinical response to treatment. Once a diagnosis of heart failure is made there are many treatments available to help the heart function better.
The Tower Hamlets Primary Care Trust approach to nurse-led heart failure care
Authors: Ruddick Lynne , Mclver Penny
Published: May 2014

Over the last 30 years there has been a vast amount of therapeutic interest in heart failure, resulting in the development of a wealth of evidence-based strategies for its management. However, it is clear that, despite the availability of this evidence, heart failure patients are not receiving appropriate treatment, resulting in huge costs to both patients and the NHS. This article describes the introduction of a nurse-led heart failure service in Tower Hamlets Primary Care Trust. Its development was driven by public policy and the abundance of evidence-based guidelines for the effective management of heart failure across primary and secondary care. The service is in its infancy and will be required to adapt and innovate to ensure excellent care for heart failure patients.
Setting up a primary percutaneous coronary intervention service
Authors: Nicholas Marina
Published: May 2014

Primary percutaneous coronary intervention (PPCI) has been shown to be the most effective treatment in restoring the coronary blood flow of patients with an ST-segment elevation myocardial infarction (STEMI). PPCI has also been shown to have better long-term survival rates, result in fewer non-fatal re-infarctions and cause fewer haemorrhagic strokes compared to patients treated with thrombolysis. It is only in the last 3 years that the government has decided to pilot the feasibility and cost-effectiveness of developing a nationwide PPCI service.

This paper describes how a tertiary centre for cardiac services set up a 24-hour PPCI service and some of the problems that occurred. It also discusses the protocols and guidelines that were developed and issues around bed management and staffing levels. This paper also considers the educational needs of the staff, cost implications of this service and the impact this service had on the cardiac rehabilitation department.
Sharing the knowledge
Authors: Stuart-Jones Vicqui
Published: May 2014

Observant readers may have spotted that in this issue of the British Journal of Cardiac Nursing we have a special focus on PCI and the use of stents. I’m sure many of you will be attending the British Cardiovascular Intervention Society’s Advanced Angioplasty conference later this month. It remains a topical issue for another reason too, given the way the wind seems to be blowing for drug-eluting stents, and I would encourage those of you not yet aware of the current contention to read Jill Bishop’s comment piece. We also look at how nurses can improve patients’ knowledge of the procedure.
Patient education before undergoing percutaneous coronary intervention
Authors: Chair Sek Ying , Pang Anita Mei Hing
Published: May 2014

Aim: This study aimed to evaluate whether a preoperative education programme could improve patients’ knowledge level and satisfaction level related to the procedure of percutaneous coronary intervention (PCI).

Methods: The study used a pre- and post-intervention test design.A structured preoperative education programme was offered to 70 patients undergoing PCI at a private hospital in Hong Kong. Patients’ knowledge regarding PCI was assessed before the teaching programme on the admission day and the morning before the procedure. Patients’ satisfaction level was assessed before discharge from the intensive care unit.

Results: A statistically significant difference was found between the patients’ knowledge base before and after the teaching programme (t=28.9, P<0.001). Moreover, a patient satisfaction survey was developed and yielded very positive results.

Conclusions: With the younger age and increased educational level of cardiac patients in the last decade, the demand for in-depth and detailed information of the disease and treatment modalities are expected to increase. A preoperative teaching programme would increase patients’ knowledge of the PCI procedure and promote patient satisfaction regarding the care received.
Getting published in a peer reviewed journal
Authors: Albarran John , Pontin David
Published: May 2014

John Albarran and David Pontin offer advice on the steps to take from initial ideas through to drafting, revising and submitting a manuscript to increase the chances of acceptance and publication
Pocket reference
Authors: Neal Julia
Published: May 2014

There are few concise texts available in this area and this pocket-sized book has been written to provide a quick reference guide covering the essential elements of cardiac problems. It is aimed at nurses in all areas who care or cardiac patients in hospital and in the community and would also be useful for therapy staff working in these areas. All aspects of cardiac nursing are summarized, including assessment and some useful background in areas such as policy trends and pathophysiology and a helpful glossary is provided.
The therapeutic benefits of rosuvastatin
Authors: Hoey Sarah
Published: May 2014

Rosuvastatin, one of the drugs in the statin class of medicines, is licensed in the UK for primary hypercholesterolaemia in patients where non-pharmacological methods such as weight reduction and exercise have proved inadequate. It offers a second-line therapy for patients whose cholesterol has not been controlled on simvastatin or atorvastatin plus ezetimbe

This article discusses the pharmacological properties and prescribing considerations for the drug.
Nudges, or shock tactics?
Authors: Stuart-Jones Vicqui
Published: May 2014

Passing through a train station the other week I caught sight of a poster from one of the latest health advice campaigns. First, there were the TV ads which subtly reminded us how many units of alcohol are really in that standard size glass of wine, or that nice bottle of red. Subtle or not, it was aiming to shock the audience with the difference between what we ‘knew’ (one bottle is six glasses and one glass is one unit of alcohol…right?) and what the reality was.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 526.
The health professional’s role in helping patients understand the concept of cardiovascular risk
Authors: Kennedy Susan
Published: May 2014

This article, the second of two on cardiovascular risk estimation, discusses factors that health professionals should consider when communicating the results of a cardiovascular risk assessment to the individual. Risk communication is a two-way process requiring competence and caring in the health professional so that individuals understand and trust the information they receive. The various influences that can affect an individual’s perception of cardiovascular risk are described. The evidence for different approaches to presenting the level of risk is reviewed. People who attend for cardiovascular risk estimation need health professionals to effectively communicate the results so that the most benefit can be achieved through self care by making lifestyle changes, under taking CVD prevention therapies or monitoring.
A caring profession?
Authors: Tagney Jenny
Published: May 2014

The delivery of ‘High Quality Care for All’ (DH, 2008) has been a catalyst for some interesting reports commissioned by the Chief Nursing Officer (CNO) for England, Professor Dame Christine Beasley, from the National Nursing Research Unit (Kings College, London) to highlight the role of nursing in current and future health care delivery. ‘Nurses in Society: Starting the Debate’ (Maben and Griffiths, 2008) was prompted by a sense that nursing had lost its way and that there were unacceptable variations in the quality of care. The report reviews the many influences on nursing roles from sociological to educational and suggests a potential model for ‘the future registered nurse: practitioner, partner, leader’ (p15). It links well with a sister report also released in October ‘State of the Art Metrics: A Rapid Appraisal’ (Griffiths et al, 2008). This much-needed work on defining how to measure the nursing contribution to delivery and outcomes of care attempts to identify ways of incorporating more qualitative measures rather than the quantitative rates of infection, numbers of patients treated and the like.
Rehabilitation needs support on a national scale
Authors: Edwards Judith
Published: May 2014

Judith Edwards explains why cardiac rehabilitation services are increasingly under threat in the UK, and the campaign underway to tackle the issue
Straightforward waveforms
Authors: Corrigan Philomena
Published: May 2014

This is the 7th edition of a book with a practical, non-academic approach to the identification and treatment of cardiac arrhythmias.
Vascular access and cardiac complications after PCI: In- and out-of-hospital outcome issues
Authors: Higgins Monica , Theobald Karen , Peters Jaime
Published: May 2014

Background: Despite the rapid increase in percutaneous coronary intervention (PCI) rates, vascular complications remain a possible source of impaired outcomes for patients. Moreover, management of complications is an integral part of cardiac nurses’ roles and responsibilities.

Aim: The aim of this quality review was to highlight the in-hospital and out-of-hospital complications up to 12 months post-discharge following PCI.

Methods and Results: A review of prospectively-collected data from the Angioplasty Database run by the research institute of 1089 consecutive patients who had PCI procedures from 1 January 2005– 31 December 2006 was conducted. The in-hospital vascular complications included bleeding/ooze only (22.4%) and haematoma only (7.1%). The in-hospital cardiac outcomes included one death(0.09%) following PCI. In addition, a sample of 525 (52%) patients were followed up at 1 month and 12 months post-procedure. Vascular complications were 2.5% and 4% respectively. Cardiac complications included repeat angiogram (9.7%) and repeat PCI (3.6%).

Conclusions: Vascular outcomes pose ongoing problems for patients both in and out of hospital. The results suggest that cardiac nurses need to further improve monitoring of their patient outcomes following PCI.
Don’t be shy of sharing your work
Authors: Jones Ian
Published: May 2014

It is with some regret that I pen my final editorial as joint consultant editor of this journal. After a great deal of contemplation I have decided to step down and hand over the reins completely to Jenny and Vicqui. I have enjoyed my time as editor and feel that the journal continues to provide an excellent resource for cardiac nurses in the UK and the wider English-speaking world.
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 279
Contemplating progress in heart failure care
Authors: Riley Jillian
Published: May 2014

This month’s guest Editor, Jillian Riley, outlines some of the challenges relating to heart failure faced by nurses, patients and carers—and reflected in this issue.
Patient education around cardiac surgery
Authors: Goodman Helen
Published: May 2014

This article considers the content and format of patient education before cardiac surgery, with a review of the literature on patients’ needs at this time, and previous methods used. Patient education has long been an important part of nursing care. However, time pressure such as the 18-weeks target from GP referral to surgery and the need for more patients to be prepared in a shorter time frame should prompt nurses to review how information is presented and provide it in a timely and effective manner.

There is a need to ensure that a wide approach is taken to education including details of the operation and admission process but also the reason for the operation and the nature of heart disease. This should include addressing misconceptions and providing the opportunity for individual questions and concerns to be addressed.
Family history of premature coronary heart disease: Discussing the evidence
Authors: Wrigley Martha , Lathlean Judith
Published: May 2014

People with a premature family history of coronary heart disease have an increased cardiovascular risk. The National Service Framework for Coronary Heart Disease, and the current Joint British Societies Guidelines both stipulate that these people should be targeted for preventative health care measures. This article discusses the key studies associated with a positive premature family history of coronary heart disease. The historical evidence that supports the theory that family history is an independent risk factor for coronary heart disease are presented. The mechanism for this risk factor is explored and the preventive studies that have been conducted to address the problem are identified. The implications of the findings of these studies, on a population and individual level, are discussed.
Guidance on Risk Assessment and Stroke Prevention for AF
Authors: Tyndall Keith , Holding Shona
Published: May 2014

Keith Tyndall and Shona Holding explain how GRASP AF, a computer-based clinical tool, can be used in primary care to find those patients with an existing diagnosis of atrial fibrillation who are at high risk of stroke.
The modern matron in cardiac services
Authors: Furniss Sarah
Published: May 2014

Sarah Furniss looks back at her career path in acute cardiac care and considers the role of the modern matron and the impact it can have on the cardiac patient’s experience.
Central venous oxygen saturation monitoring
Authors: Ladewig Emma L , Lewis Peter A
Published: May 2014

It has been established that mixed venous oxygen saturation (Svo2) reflects the balance between systemic oxygen delivery and consumption. Literature indicates that it is a valuable clinical indicator and has good prognostic value early in patient course.

This article aims to establish the usefulness of Svo2 as a clinical indicator. A secondary aim was to determine whether central venous oxygen saturation (Scvo2) and Svo2 are interchangeable.

Of particular relevance to cardiac nurses is the link between decreased Svo2 and cardiac failure in patients with myocardial infarction, and with decline in myocardial function, clinical shock and arrhythmias.

While absolute values Scvo2 and Svo2 are not interchangeable, Scvo2 and Svo2 are equivalent in terms of clinical course. Additionally, Scvo2 monitoring is a safer and less costly alternative to Svo2 monitoring. It can be concluded that continuous Scvo2 monitoring should potentially be undertaken in patients at risk of haemodynamic instability.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 196
An evaluation of a primary and secondary care cardiac rehabilitation service pathway
Authors: Trotman-Beasty Anita , McKenna Jim , Ingle Lee
Published: May 2014

Background: The aim of the study was to assess the synergy between patient treatment pathways in two large primary care trusts (PCTs) and general practices for patients following myocardial infarction (MI) and after completing a 12-week cardiac rehabilitation (CR) hear t manual programme in Kingston-Upon-Hull and the East Riding of Yorkshire.

Methods: Of the 50 practice nurses randomly selected from local GP surgeries and invited to participate, 40 questionnaires were returned and two practice nurses volunteered to be inter viewed.

Results: Four key themes were identified: knowledge of the ‘heart manual programme’ (HMP); information received or used post-HMP; post-MI follow-up routines of practice nurses; the practice nurse: assessment.

Conclusions: It appears that current CR provision in Kingston-uponHull and the East Riding of Yorkshire may be fragmented and duplicative, leading to poor cost effectiveness as both primary and secondary care providers are working to conflicting government targets. The system fails to build on the strengths of the health professionals working within it. We recommend the development of an integrated, standardized care pathway that we hope will bring a ‘joined-up’ solution to a disjointed problem.
It’s all about awareness
Authors: Tagney Jenny
Published: May 2014

Did you know that the average wine drinker now consumes around 2000 calories in alcohol per month? In the recent Department of Health ‘Know your Limits’ campaign survey many women admitted that they did not know that a glass of white wine contains the same calories as a bag of crisps or that two large glasses of white wine put a woman over her daily recommended alcohol intake (DH, 2009). The leaflets that have been produced as part of the campaign aim to raise awareness of such simple facts, particularly in young people.
Treat Me Right! Better care through communication
Authors: Turner Nigel
Published: May 2014

Nigel Turner discusses a project in West London to improve standards of care for patients with learning disabilities by helping health professionals to better communicate with them
Not your usual coronary care patient
Authors: Sneddon Susan , Chalkley Sarah
Published: May 2014

Susan Sneddon describes her experiences as a brand new mother with acute heart problems, and how cooperation across specialisms ensured all her care needs were met
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 343
Chest X-ray case study 5
Authors: Ash-Miles Janice , Callaway Mark
Published: May 2014

Janice Ash-Miles and Mark Callaway present a chest X-ray for you to analyse. The answers and discussion are given on page 440
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer is given on page 449.
Spotting early signs of depression in patients with chronic heart failure
Authors: Kirk Mary , LeGeyt Paulette
Published: May 2014

Depression tends to be more common in patients with heart failure than in the general population. It is estimated to affect between 24% and 40% of patients with stable heart failure. Loss of a patient’s sense of self and a forced change in lifestyle can be difficult to accept and that in turn can lead to low mood and then depression. Other factors such as previous mental health issues and external stressors can influence the risk of depression.

Evidence suggests depressed patients are less likely to adhere to medication and lifestyle regimes thereby increasing the likelihood of deterioration in their cardiac condition. Fatigue and poor sleep patterns are symptoms associated with heart failure, but can also be attributable to depression. This could influence health professionals’ assessment and treatment of patient’s heart failure, while not addressing the underlying issue of depression.

This article looks at depression in heart failure patients and suggests ways in which health professionals can identify early those patients that have an increased risk of developing depression.
Modernising Nursing Careers and the cardiothoracic nurse
Authors: Bartley Tara
Published: May 2014

Tara Bartley outlines the implications of the Modernising Nursing Careers programme for nurses, particularly those pursuing a career path in cardiothoracic surgery
Highlighting patient eligibility for elective DC cardioversion: ‘Jump Start’ a software solution
Authors: Lapper Andrew , Caines Pauline , Puri Pranay , Shoker Bally , Smallwood Andrew
Published: May 2014

Atrial fibrillation (AF) is the most frequently encountered sustained cardiac arrhythmia in clinical practice. Medical treatment strategies focus on either heart rhythm control or heart rate control combined with antithrombotic prophylaxis or anticoagulation. If a rhythm control strategy is decided on then transthoracic elective direct current cardioversion is one option for selected patients. Preparing patients for elective direct current cardioversion can present an organizational challenge. This article describes the development and evaluation of a software-based solution to automatically highlight those patients that were eligible for this procedure based on the International Normalized Ratio (INR) blood results entered into the system. In the views of the users, this service development has succeeded in the aim of streamlining the potentially challenging aspect of elective direct current cardioversion anti-thrombotic prophylaxis.
SIGN guidance on management of diabetes
Authors: Linden Belinda
Published: May 2014

Belinda Linden presents an overview of recently-published guidance of relevance to cardiovascular nursing. This month we look at the Scottish clinical guidelines on management of diabetes
The role of prasugrel in prevention of CV events
Authors: Williams Helen
Published: May 2014

Prasugrel is a potent antiplatelet inhibitor with a rapid onset of activity and reduced inter-patient variability. Clinical trial data from TRITON TIMI-38 demonstrated significantly fewer cardiovascular events in patients presenting with acute coronary syndrome (ACS) and undergoing percutaneous coronary intervention (PCI) who were treated with prasugrel compared with clopidogrel (all patients also received low-dose aspirin). However, prasugrel is also associated with a significantly greater risk of bleeding, including major, life-threatening and fatal bleeds. As a result prasugrel is contraindicated in patients with prior stroke or transient ischaemic attack (TIA); and should only be used cautiously and at a lower maintenance dose in older patients (>75 years) and those of low bodyweight (<60kg). NICE guidance recommends that prasugrel is considered for patients presenting with ACS and scheduled for PCI in three specific groups: patients undergoing primary PCI following an ST-elevation myocardial infarction, patients that experienced re-infarction or stent thrombosis while taking aspirin and clopidogrel, and patients with diabetes mellitus. Since launch, the adoption of prasugrel into routine clinical practice has been slow, probably because clinicians are unsure of the benefit-to-risk ratio, particularly with respect to the risk of bleeding. Patients prescribed prasugrel should be carefully counselled on the importance of adherence to therapy for the prescribed period and should be encouraged to seek specialist advice should side effects or other issues arise during treatment.
Rheumatoid arthritis and risk factors for cardiovascular disease
Authors: Kumar Namita
Published: May 2014

The fact that patients with rheumatoid arthritis have an increased risk of cardiovacular disease is now without doubt. There are multiple risk factors that could be blamed for this increased incidence. The traditional risk factors well known to us all may be to blame in part but there are other, more novel, risk factors that are more relevant in rheumatoid arthritis.

This paper aims to discuss some of these less well-known risk factors for CVD particularly with regard to rheumatoid arthritis. Treatment strategies are also discussed.
Considering changes in cardiac nursing
Authors: Shuldham Caroline
Published: May 2014

Caroiine Shuldham talked to Lucy Jolin about her personal experiences of the past and present of nursing and thoughts on the future of cardiac care
Fibre: Understanding the true heart of the grain
Authors: Jefferson Angie
Published: May 2014

Fibre is essential to a healthy diet, and it has been suggested that consuming whole grains could have a role in prevention of cardiovascular disease. Angie Jefferson looks at some of the evidence
Peripheral cannulation: A practical guide
Authors: Bowden Tracey
Published: May 2014

Tracey Bowden describes a practical, step-by-step approach to inser tion of a peripheral cannula, which will assist practitioners to under take the procedure safely and competently
Leadership and management skills in health care
Authors: Ellis Peter , Abbott Jane
Published: May 2014

Peter Ellis and Jane Abbott explain some of the theories and concepts that new managers can draw on when leading a team. They then describe how the style of leadership can be adapted in relation to the situation and team where a new manager has to take the lead
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 192.
Myocarditis: Silent but deadly
Authors: O’Donovan Kate
Published: May 2014

Myocarditis simply means inflammation of the myocardium. Clinical presentation ranges from nonspecific symptoms to fulminant hear t failure or cardiogenic shock on presentation. There are several causes associated with the condition but viruses are considered a common cause. The majority of patients remain asymptomatic and maintain normal left ventricular function but there are some who progress to dilated cardiomyopathy requiring transplantation or they may die. There are no specific investigations for myocarditis, diagnosis is made on clinical suspicion supplemented with results from ECG, biomarkers, inflammatory markers and echocardiography. Endomyocardial biopsy remains the gold standard despite several recognized limitations. Treatment is supportive and aimed at preserving left-ventricular function and preventing progression to dilated cardiomyopathy.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer is given on page 254.
Appealing to NICE to rethink dronedarone
Authors: Lobban Trudie , Jerrome Jo
Published: May 2014

Trudie Lobban and Jo Jerrome outline the recent campaign by the Atrial Fibrillation Association to get NICE to reconsider its stance on a new antiarrhythmic drug.
ECG of the month
Authors: Regan Claire
Published: May 2014

Clare Regan presents an ECG for you to analyse. The answer is given on page 337
Natriuretic peptides: An overview for the clinician
Authors: Wilson David , Foley Paul W X
Published: May 2014

This article reviews the nature and function of natriuretic peptides and explores their role in the diagnosis, management and treatment of heart failure. It examines how major medical societies have incorporated natriuretic peptides into their guidelines and suggests how this may affect practice in British hospitals.
Gastrointestinal symptoms in end-stage heart failure
Authors: MacCallum Annie , Hughes Suzy
Published: May 2014

Gastro-intestinal (GI) symptoms in advanced heart failure can cause distress to both the patient and his/her carer. While GI symptoms are common at the end stages of many diseases, management must reflect the specific causes of these symptoms in the heart failure patient. Breathlessness, fatigue, limited mobility and depression—all symptoms associated with advancing heart failure—and the treatment of the heart failure itself can potentiate or exacerbate GI symptoms. Early assessment, recognition of the impact and pro-active management of GI symptoms is recommended. Cachexia is common at the advanced stages of many diseases and is associated with poor outcomes for heart failure patients. The mechanisms and suitable treatments for this remain a case for further investigation.
Supporting those who have lost family through SADS
Authors: Morris Angela
Published: May 2014

Angela Morris describes how losing her son to sudden arrhythmic death syndrome affected her, and how the support group she set up in the North West seeks to help families with similar bereavement.
Aquapheresis: a therapeutic option for fluid-overloaded patients
Authors: Wick Caroline , Bakhai Ameet
Published: May 2014

Heart failure is one of the most common causes of hospital emergency admissions (5%), re-admissions and bed day occupancy, and these rates are predicted to increase in the future. Of all heart failure admissions, 90% are due to fluid overload. Currently, loop diuretics are the ‘hallmark’ treatment, however some patients become resistant to diuretic therapy over time and diuretics have a high rate of adverse effects. Considering the large number of patients, increased morbidity, mortality rates and resource use, current management strategies are not optimal: new therapies are required and should be evaluated thoroughly. Aquapheresis (AQ) is a non-pharmacological procedure that removes excess water and sodium from the blood via a filter using a simplified ultrafiltration (UF) device.

This article discusses AQ as a treatment option. AQ is a relatively new therapy in the UK and has some advantages over conventional therapy. In particular, patients can be treated with AQ in a cardiology setting, this may allow rapid removal of excess fluid and earlier discharge. Close consultant supervision and input is required with dedicated nursing staff managing the patient. A formal UK health economic analysis is required. AQ provides a feasible, additional treatment option for patients with heart failure in the UK, which are significantly limited at present.
Catheter ablation for paroxysmal atrial fibrillation
Authors: Richards Gaynor
Published: May 2014

Atrial fibrillation (AF) is the most commonly occurring arrhythmia, with a characterised pattern of progression. The many different presentations of AF and approaches to its management refect the complex nature of this condition. This article describes the overall management of a patient with lone paroxysmal AF, with a focus on pharmacological therapy and catheter ablation. In order to understand the therapeutic strategies employed, an appreciation of the pathophysiological processes involved in the development and perpetuation of AF is required. Ultimately, the driving force for any management strategy adopted should be determined by the symptoms experienced by the patient, and the effect that the arrhythmia has on their quality of life.
Complications of stroke resulting from atrial fibrillation
Authors: Parmar Paresh , Tolhurst Rowan
Published: May 2014

Atrial fibrillation is the commonest cause of cardioembolic stroke, which accounts for approximately 20% of ischaemic stroke. Cardioembolic stroke has a higher risk of morbidity and mortality, resulting in greater disability, longer hospital stays, costlier rehabilitation, and complications that greatly affect the quality of life. Appropriate treatment with anticoagulants, in conjunction with the management of hypertension, diabetes and cholesterol, will reduce the risk of stroke. Complications of stroke include dysphagia, post-stroke seizures, dry mouth, depression and post-stroke pain. The treatment strategies involve medication, however this leads to polypharmacy which has can increases the risk of adverse drug reactions. Also, some patients are averse to taking multiple medications.
Circulatory shock part 2: Nursing management
Authors: Jones Ian , Rushton Melanie
Published: May 2014

In the second part of this series on circulatory shock, the authors provide a general overview of the acute nursing management of patients experiencing circulatory shock. The holistic dimension in the care of these patients is also considered.
Delirium in cardiac patients: A clinical review
Authors: Clegg Andrew , Young John , Siddiqi Najma
Published: May 2014

Delirium is a common but preventable clinical syndrome that is distressing for patients, relatives and staff. It occurs frequently on cardiac wards and is associated with important adverse health consequences. In cardiac surgery patients, important preoperative risk factors are presence of cognitive impairment, depressive symptoms, previous stroke or transient ischaemic attack and abnormal albumin.

Nursing staff are particularly well placed to facilitate the diagnosis of delirium, which should be suspected if a patient has a rapid onset of fluctuating confusion. The Delirium Observation Screening (DOS) tool has been developed for use by nursing staff during routine ward care to identify delirium.

The initial management of delirium involves identification and treatment of the potential cause, or combination of causes. People with delirium may have impaired capacity to consent and health-care professionals who care for people with delirium should therefore be familiar with the assessment of mental capacity.
Subcutaneous implantable defibrillators: An overview for nurses
Authors: Tagney Jenny , Horne Annie
Published: May 2014

The aim of this article is to describe new subcutaneous implantable cardioverter defibrillator (S-ICD) devices that are now available, considering appropriate patient criteria, limitations and possible future developments. It is aimed at nursing staff who may be responsible for the care of patients undergoing such device implants, to give them an understanding of this relatively new technology and how it differs from the traditional transvenous systems.
Myocardial infarction symptoms and appropriate action: awareness in people with diabetes
Authors: Wilson Valerie
Published: May 2014

Diabetes exerts its greatest toll on the vascular system, causing micro- and macrovascular complications of the heart and circulatory system. This article explores the awareness of a group of people with either type 1 or type 2 diabetes of symptomatic myocardial infarction, and what action they would take if they experienced any of these.

Aim: To explore awareness of potential myocardial infarction symptoms in a group of people with diabetes and to determine what action they would take.

Method: A convenience sample of 21 non-NHS participants with either type 1 or type 2 diabetes took part in two focus groups.

Results: Thematic data analysis identified the emergence of three main issues: recognising symptoms such as chest pain; not taking the symptoms of a potential myocardial infarction seriously; and reluctance to dial 999.

Conclusions: This small-scale focus group study indicates that not all people with diabetes might take symptoms of potential myocardial infarction seriously or seek emergency help.
Person-centred rehabilitation for hard-to-reach groups
Authors: Scott Janine , Price Lesley , Lindsay Grace
Published: May 2014

Nurses play a key role in leading and delivering cardiac rehabilitation within multidisciplinary teams, and continually face new challenges. However, one aspect of service delivery that remains a particular issue and challenge within many cardiac rehabilitation services is poor patient uptake of phase 3 cardiac rehabilitation programmes. Although there are a variety of factors that may affect uptake, it has been identified that despite efforts lack of equal access for sub groups of patients such as women, those from socio-economically deprived groups, ethnic minority groups and the elderly, remains an issue. This article provides a review of the literature exploring the existing issues affecting attendance within these groups, and offers some recommendations for local changes in service delivery to overcome some of the identified barriers to non- engagement or early drop out from programmes. The aim of the article is to discuss ways in which nurses can strengthen the person-centred approach to identify ways of improving uptake further in these hard-to-reach groups.
Ten tips for safer prescribing by non-medical prescribers
Authors: Petty Duncan Robert
Published: May 2014

This article explores 10 ideas for improving the safety of prescribing through better ways of working. Personal vigilance and care is required when prescribing to avoid errors resulting from poor prescribing decisions, for example, wrong drug, dose, route, frequency, and/or quantity. However, errors can also occur for other reasons, including poor patient communication, lack of monitoring, and poor interface communication, especially in primary and secondary care. Systems for reviewing and monitoring will help reduce errors, and the nonmedical prescriber must work with other prescribers to ensure these systems are in place. These top 10 tips ware not exhaustive, but if practiced will go a long way to improving patient safety.
Nursing assessment of the causes of chest pain
Authors: O'Donovan Kate
Published: May 2014

Chest pain is a common presenting complaint in healthcare. Causes of chest pain are multifactorial, but one of the greatest concerns is that the pain is cardiac in nature. A succinct, focused and targeted assessment can help confirm or rule our a cardiac cause as well as highlighting other potential causes. The assessment focuses on the quality, location, duration and characteristics, as well as the relieving factors, for a person with chest pain. Pain assessment tools aid in eliciting such information and serve to compliment the assessment process. Haemodynamic assessment aims to determine the stability of the patient and thus determine the need for subsequent nursing intervention and the timeliness of the assessment. It is beyond the scope of this paper to discuss investigations or the management of chest pain.
Tetralogy of Fallot, late outcomes and quality of life
Authors: Habibi Hajar , Jaikumar Juliet
Published: May 2014

Tetralogy of Fallot is a cyanotic congenital heart defect, which in the majority of cases is diagnosed in infancy and treated with surgical correction. In some cases tetralogy of Fallot is diagnosed and repaired in later life and adulthood. We report a case study of a 32-year-old female who underwent late surgical correction and had uncomplicated surgical and postoperative course with reported improved health-related quality of life post surgery. The help provided by the adult congenital heart disease nurse in this case demonstrates how important this role is. At first the patient was very anxious and unaware of the details of her disease; however, following support from the specialist nurses she went on to undergo several investigations and then surgery.
Being mindful of pulmonary arterial hypertension
Authors: Roberts-Collins Cara , Tagney Jenny , Tulloh Robert , Garratt Vanessa
Published: May 2014

Pulmonary arterial hypertension (PAH) is a chronic, debilitating disease. Distressing symptoms include severe breathlessness, fatigue, syncope, haemoptysis, abdominal distension, and chest pain. Treatment for PAH involves complex, time-consuming, painful and anxiety-provoking treatments, whilst facing an unpredictable future. It is therefore unsurprising that individuals living with PAH experience an increased prevalence of mental health problems, including increased levels of depression, anxiety, and panic. Functional disability has been shown to be higher in those with both chronic illness and co-morbid depression. Evidence in other chronic conditions, including heart failure, suggests significant improvements in both psychological and physical health following a mindfulness-based stress reduction (MBSR) intervention. Given the evidence, and the significant distress caused by PAH, any potential to improve psychological and physical wellbeing is appealing. This article discusses the psychological impact of living with PAH, and considers whether an MBSR intervention might be useful for patients with PAH, given the evidence based on other chronic health conditions.
Using a health information library to empower patients
Authors: Devalapalli Uma , Badhe Madhulika , Shotter Cas
Published: May 2014

The impact of health libraries on patient care has been studied in a number of settings and populations. This article describes a pilot study undertaken in an acute hospital Trust in England by health library staff and the lead specialist cardiac nurse to provide health information to in-patients with the aim of empowering them with evidence-based high quality health information. This article discussed this project and provides recommendation on how this service could be implemented and expanded.
Heart failure and the need for high-quality end-of-life care
Authors: Price Angeline , Jones Ian
Published: May 2014

This paper provides the reader with an overview of the disease trajectory associated with heart failure, exploring the need for adequate end-of-life care provision in this patient group. Barriers to providing successful end-of-life care are discussed. These include difficulties in handling patient denial, discussions about poor prognosis and dealing with patients’ emotional involvement. Staff education is needed as cardiac staff often lack the communication skills necessary to handle these issues. Recommendations are made that will aid the removal of these barriers and ultimately improve end-of-life care provision for this group.