bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of self‐expanding covered stent and negative pressure wound therapy to manage late rectal perforation after injury from an improvised explosive device: a case report
Authors: Ozer M Tahir , Coskun Ali K , Sinan Huseyin , Saydam Mehmet , Akay Emin O , Peker Subutay , Ogunc Gokhan , Demirbas Sezai , Peker Yusuf
Published: May 2014

Blast injuries, caused by explosions accompanied by high‐pressure waves, produce tissue damage in the acute period, followed in the later period by circulatory disorders due to vascular endothelial damage and related tissue necrosis. Blunt rectal perforation is rare and difficult to diagnose. In the acute period following blast pelvic injuries, the main objectives are to stop bleeding, minimise contamination and preserve the patient's life. The patient in this report had major vascular injuries, severe pelvic injury and, in the later period, rectal perforation because of vascular endothelial damage caused by the blast effect. Our aim was to treat the patient conservatively because of his poor general condition. We placed a self‐expanding covered stent (SECS) into the rectum and then applied negative pressure wound therapy (NPWT; V.A.C.® Therapy, KCI) to the pelvic region and perirectal area. At the end of the treatment, the rectal perforation was closed, and the patient was discharged with healing. In this article, we discuss the novel use of an SECS with NPWT and review related literature.
Attitudes towards young people who self‐harm: age, an influencing factor
Authors: Cleaver Karen , Meerabeau Liz , Maras Pam
Published: May 2014

Aim

To determine the attitudes of emergency care staff towards young people (aged 12–18 years) who self‐harm and to gain an understanding of the basis of attitudes that exist.

Background

Young people frequently attend emergency services following self‐harm; it is unclear whether being a young person influences attitudes held.

Design

Mixed methods using a triangulation convergent design.

Methods

Survey of 143 staff members from four accident & emergency departments and one ambulance service. Semi‐structured interviews with seven children's A&E nurses and five ambulance personnel from the same locality. Data were collected during 2010.

Results/Findings

Pearson's product moment correlation coefficient confirmed a strong positive correlation between scores on the two scales used to measure attitudes; paired samples t‐test revealed a statistically significant difference in scores across the scales; practitioners held more positive attitudes towards young people who self‐harmed than young people per se. Both data sets confirmed the presence of ambivalence and ambiguity in attitudes held. The qualitative data revealed that because of their age and immaturity young people were not held responsible for their self‐harming behaviours. Being young did though influence subsequent admission, with particular difficulty in securing admission for those aged 16–17 reported.

Conclusion

Age is a factor in shaping practitioners' attitudes; age also directs and influences a young person's journey through emergency care, although due to ambiguity there is inconsistency in determining where those aged 16–17 years of age fit.
Predictors and Consequences of Gang Membership: Comparing Gang Members, Gang Leaders, and Non–Gang‐Affiliated Adjudicated Youth
Authors: Dmitrieva Julia , Gibson Lauren , Steinberg Laurence , Piquero Alex , Fagan Jeffrey
Published: May 2014

This 7‐year study of 1,170 male adjudicated youth examined how self‐esteem, psychopathy, and psychosocial maturity relate to gang status (low‐level member, leader, and non‐gang member). Low temperance, perspective, and responsibility predicted being a low‐level gang member, whereas only lower temperance predicted being a gang leader. Low self‐esteem predicted gang membership (low‐level and high‐level) at a younger age (i.e., during adolescence). However,higherself‐esteem and grandiose‐manipulative traits predicted being a gang leader during young adulthood. Over time, low‐level members became more psychopathic and less psychosocially mature. Gang leaders also became more psychopathic and undercontrolled (as indicated by lower temperance); however, their perspective and responsibility aspects of psychosocial maturity were not affected.
The Developmental Dynamics of Joining a Gang in Adolescence: Patterns and Predictors of Gang Membership
Authors: Gilman Amanda B. , Hill Karl G. , Hawkins J. David , Howell James C. , Kosterman Rick
Published: May 2014

Researchers have examined the predictors of adolescent gang membership, finding significant factors in the neighborhood, family, school, peers, and individual domains. However, little is known about whether risk and protective factors differ in predictive salience at different developmental periods. The present study examines predictors of joining a gang, tests whether these factors have different effects at different ages, and whether they differ by gender using theSeattleSocialDevelopmentProject (SSDP) sample (n = 808). By age 19, 173 participants had joined a gang. Using survival analysis, results showed that unique predictors of gang membership onset included living with a gang member, antisocial neighborhood, and antisocial peer influences in the previous year. No time or gender interactions with predictors were statistically significant.
Youth Gangs and Adolescent Development: New Findings, New Challenges, and New Directions: Introduction to the Special Section
Authors: Boxer Paul
Published: May 2014

Street gangs with youth membership have been present in American society for decades, and there is growing acknowledgment through local and national observations that contemporary gang activity is more entrenched and more widespread than in years past. Although there is a wealth of data on youth gangs available from criminological research, there is a relatively small empirical and theoretical developmental literature on youth gangs. Indeed, only a handful of studies have addressed critical developmental issues on youth gangs. This special section presents five new studies approaching the study of youth gangs from a broad developmental perspective, underscoring the need for ongoing inquiry linking the heretofore separate literatures on youth gangs and antisocial peer influence from criminology and developmental science.
Regular physical activity reduces the effects of Achilles tendon vibration on postural control for older women
Authors: Maitre J. , Serres I. , Lhuisset L. , Bois J. , Gasnier Y. , Paillard T.
Published: May 2014

The aim was to determine in what extent physical activity influences postural control when visual, vestibular, and/or proprioceptive systems are disrupted. Two groups of healthy older women: an active group (74.0 ± 3.8 years) who practiced physical activities and a sedentary group (74.7 ± 6.3 years) who did not, underwent 12 postural conditions consisted in altering information emanating from sensory systems by means of sensory manipulations (i.e., eyes closed, cervical collar, tendon vibration, electromyostimulation, galvanic vestibular stimulation, foam surface). The center of foot pressure velocity was recorded on a force platform. Results indicate that the sensory manipulations altered postural control. The sedentary group was more disturbed than the active group by the use of tendon vibration. There was no clear difference between the two groups in the other conditions. This study suggests that the practice of physical activities is beneficial as a means of limiting the effects of tendon vibration on postural control through a better use of the not manipulated sensory systems and/or a more efficient reweighting to proprioceptive information from regions unaffected by the tendon vibration.
Headaches in pregnancy
Authors: Revell Kirsty , Morrish Paul
Published: May 2014

Key content

Headaches in pregnancy and the postnatal period are common and usually benign but can herald intracranial catastrophe.

Assessment of headache in pregnancy is an essential skill for obstetricians and general practitioners.

Pregnancy can alter migraine aura and may trigger attacks of aura without a headache.

Headache may be the only symptom of cerebral venous thrombosis. If cerebral venous thrombosis is suspected, expert opinion should be sought and urgent brain imaging considered.

Neurological conditions were the third most common cause of death and ahead of sepsis in the Confidential Enquiries into Maternal Deaths in the United Kingdom 2006–2008 report (when considering direct and indirect causes).

Learning objectives

To revise the ‘red flag’ features and the differential diagnosis of headache in pregnancy.

To recognise when referral to a neurologist and urgent brain imaging is indicated.

To review the management of common causes of headache in pregnancy.

Ethical issues

Should obstetricians ever manage a neurological problem in pregnancy without neurological advice?
A guide to hunting periodic three-body orbits
Authors: Šuvakov Milovan , Dmitrašinović V.
Published: May 2014

The recent discovery of thirteen new and distinct three-body periodic planar orbits suggests that many more such orbits remain undiscovered. Searches in two-dimensional subspaces of the full four-dimensional space of initial conditions require computing resources that are available to many students, and the required level of computational and numerical expertise is also at the advanced undergraduate level. We discuss the methods for solving the planar three-body equations of motion, as well as some basic strategies and tactics for searches of periodic orbits. Our discussion should allow interested undergraduates to start their own searches. Users can submit new three-body orbits to a wiki-based website.
Inevitable inequality?
Authors: Deaton Angus
Published: May 2014

The world is unequal in many dimensions; even life itself is unequally distributed. In the United States and other wealthy nations, only 2 to 6 children out of every 1000 die before age 1, yet there are 25 countries where more than 60 out of 1000 do so. There are 10 countries, all in Africa, where per-capita gross domestic product (GDP) is less than 10% of U.S per-capita GDP. These gaps are a legacy of the Great Divergence that began 250 years ago, in which sustained progress in health and wealth in Europe spread gradually to the rest of the world. Will such gaps continue to be an inevitable consequence of progress?
Draft Genome Sequence of
Cupriavidus
sp. Strain SK-4, a di-
ortho
-Substituted Biphenyl-Utilizing Bacterium Isolated from Polychlorinated Biphenyl-Contaminated Sludge
Authors: Vilo Claudia , Benedik Michael J. , Ilori Matthew , Dong Qunfeng
Published: May 2014

Cupriavidus
sp. strain SK-4 is a bacterium capable of growing aerobically on monochlorobiphenyls and dichlorobiphenyls as the sole carbon sources for growth. Here, we report its draft genome sequence with the aim of facilitating an understanding of polychlorinated biphenyl biodegradation mechanisms.
Complete Genome Sequences of Two Escherichia coli O145:H28 Outbreak Strains of Food Origin
Authors: Cooper Kerry K. , Mandrell Robert E. , Louie Jacqueline W. , Korlach Jonas , Clark Tyson A. , Parker Craig T. , Huynh Steven , Chain Patrick S. G. , Ahmed Sanaa , Carter Michelle Qiu
Published: May 2014

Escherichia coli
O145:H28 strain RM12581 was isolated from bagged romaine lettuce during a 2010 U.S. lettuce-associated outbreak.
E. coli
O145:H28 strain RM12761 was isolated from ice cream during a 2007 ice cream-associated outbreak in Belgium. Here we report the complete genome sequences and annotation of both strains.
Anion receptors containing coordinatively unsaturated metal ions: copper(II) complexes with cyclam derivatives
Authors: Boiocchi Massimo , Broglia Arturo , Fabbrizzi Luigi , Fusco Nadia , Mangano Carlo
Published: May 2014

The two coordinatively unsaturated complexes [Cu(cyclam)]2+ (cyclam: 1,4,8,11-tetraazacyclotetradecane, 1) and [Cu(Bn4cyclam)]2+ (Bn4cyclam: 1,4,8,11-tetrabenzyl-1,4,8,11-tetraazacyclotetradecane, 2) in an MeCN solution uptake an anion X− (halide, pseudohalide) to give square pyramidal ternary complexes, whose stability has been determined through spectrophotometric titration experiments. The formation of a five-cordinate complex is favored by the trans-I configuration of the [Cu(Bn4cyclam)]2+ receptor, but it is contrasted by the severe steric repulsions exerted by the benzyl substituents on the macrocyclic framework. No significant repulsive effects have been observed in anion binding to the [Cu(cyclam)]2+ receptor, exhibiting a trans-III configuration. The existence of a linear relationship between the magnitude of the red shift experienced by the d−d absorption band on anion binding and log K values is discussed.
Infinite partition monoids
Authors: East James
Published: May 2014

Let 𝒫Xand 𝒮Xbe the partition monoid and symmetric group on an infinite set X. We show that 𝒫Xmay be generated by 𝒮Xtogether with two (but no fewer) additional partitions, and we classify the pairs α, β ∈ 𝒫Xfor which 𝒫Xis generated by 𝒮X∪ {α, β}. We also show that 𝒫Xmay be generated by the set ℰXof all idempotent partitions together with two (but no fewer) additional partitions. In fact, 𝒫Xis generated by ℰX∪ {α, β} if and only if it is generated by ℰX∪ 𝒮X∪ {α, β}. We also classify the pairs α, β ∈ 𝒫Xfor which 𝒫Xis generated by ℰX∪ {α, β}. Among other results, we show that any countable subset of 𝒫Xis contained in a 4-generated subsemigroup of 𝒫X, and that the length function on 𝒫Xis bounded with respect to any generating set.
On coideal subalgebras of abelian cocentral extensions and a generalization of Wall's conjecture
Authors: Burciu Sebastian
Published: May 2014

It is shown that any coideal subalgebra of a finite-dimensional Hopf algebra is a cyclic module over the dual Hopf algebra. Using this we describe all coideal subalgebras of a cocentral abelian extension of Hopf algebras extending some results from [R. Guralnick and F. Xu, On a subfactor generalization of Wall's conjecture, J. Algebra 332 (2011) 457–468].
Endothelial Cell–Specific Expression of Roundabout 4 Is Regulated by Differential DNA Methylation of the Proximal Promoter
Authors: Okada Yoshiaki , Funahashi Nobuaki , Tanaka Toru , Nishiyama Yuji , Yuan Lei , Shirakura Keisuke , Turjman Alexis S. , Kano Yoshihiro , Naruse Hiroki , Suzuki Ayano , Sakai Miki , Zhixia Jiang , Kitajima Kenji , Ishimoto Kenji , Hino Nobumasa , Kondoh Masuo , Mukai Yohei , Nakagawa Shinsaku , García-Cardeña Guillermo , Aird William C. , Doi Takefumi
Published: May 2014

Objective—

The molecular basis of endothelial cell (EC)–specific gene expression is poorly understood. Roundabout 4 (Robo4) is expressed exclusively in ECs. We previously reported that the 3-kb 5′-flanking region of the human Robo4 gene contains information for lineage-specific expression in the ECs. Our studies implicated a critical role for GA-binding protein and specificity protein 1 (SP1) in mediating overall expression levels. However, these transcription factors are also expressed in non-ECs. In this study, we tested the hypothesis that epigenetic mechanisms contribute to EC-specific Robo4 gene expression.

Methods and Results—

Bisulfite sequencing analysis indicated that the proximal promoter of Robo4 is methylated in non-ECs but not in ECs. Treatment with the DNA methyltransferase inhibitor 5-aza-2′-deoxycytidine increased Robo4 gene expression in non-ECs but not in ECs. Proximal promoter methylation significantly decreased the promoter activity in ECs. Electrophoretic mobility shift assays showed that DNA methylation of the proximal promoter inhibited SP1 binding to the −42 SP1 site. In DNase hypersensitivity assays, chromatin condensation of the Robo4 promoter was observed in some but not all nonexpressing cell types. In Hprt (hypoxanthine phosphoribosyltransferase)-targeted mice, a 0.3-kb proximal promoter directed cell-type–specific expression in the endothelium. Bisulfite sequencing analysis using embryonic stem cell–derived mesodermal cells and ECs indicated that the EC-specific methylation pattern of the promoter is determined by demethylation during differentiation and that binding of GA-binding protein and SP1 to the proximal promoter is not essential for demethylation.

Conclusions—

The EC-specific DNA methylation pattern of the Robo4 proximal promoter is determined during cell differentiation and contributes to regulation of EC-specific Robo4 gene expression.
Revision of the Afrotropical species of Gonatopus group 3 (Hymenoptera: Dryinidae), with description of a new species from Ghana
Authors: GUGLIELMINO ADALGISA , OLMI MASSIMO
Published: May 2014

The Afrotropical species of Gonatopus Ljungh, 1810 group 3 are revised. A new species is described from Ghana, Eastern Region: G. schwarzorum Guglielmino & Olmi, sp. nov. A new key to the females of the Afrotropical species of Gonatopus group 3 is presented.
International Comparative Study of Learning Outcomes of the RF and the EU School-Level Students as a Subject for Pedagogic Research
Authors: ������  , Firago Asya
Published: May 2014

Goals of the International program on learning outcomes assessment � Programme for International Student Assessment (PISA) � are discussed,

outcomes of PISA-2012 are provided, which reveals that Russian school students are behind their European peers in the skill to put the acquired knowledge

into practice. As is expected, implementation of the Russian Federation Government Program on �The Advancement of Education� for 2013�2020

would improve performance indicators of the RF school-level students regarding the results of further international comparative studies of basic education

quality. To achieve the said goal transferring commonly recognized European education values and goals to the realities of this country could be of

considerable use. Regulatory documents of the European Union on school education are analyzed and translated in Russian; priority tasks of European

states in the area of school-level education improvement are outlined as aimed at developing core competencies of school-level students. Eight core

competences as identified by the EU educational authorities are mentioned. To improve the RF school-level students core competences it is necessary to

re-arrange educational processes in such a way, that active personal communications come to play the crucial part. Importance of competency-building

approach in school education is outlined.
Guidance Aspects on Using Technological Approach to Nurture Professionally Significant Qualities in Prospective Teachers
Authors: Солодовникова  , Solodovnikova E.
Published: May 2014

The pattern for nurturing professionally significant qualities in prospective teachers on the premises of pedagogical institutions is presented. A specific

case is used to demonstrate how to implement technological approach in nurturing professionally significant qualities; also described are curricula for

two elective courses, namely, «Modern Educational Technologies in Teaching Mathematics» and «Learn How to Use the Educational Standard».
A support programme for mothers with perinatal loss in South Africa
Authors: Modiba Lebitsi
Published: May 2014

Although the general topic of death is receiving increasing attention from the medical community, little is known about the impact that pregnancy loss has on the lives experiencing it. The purpose of this study is to develop a support programme for mothers with pregnancy loss.

This research is a qualitative research design that is exploratory, descriptive and contextual in nature.

The support programme was formulated from the information gathered from phases I; II; and III. The support programme was validated and recommendations were made by experts.

Phase I phenomenological interviews were conducted with ten mothers on how they experienced pregnancy loss and care.

Phase II the focused semi-structured individual interviews were conducted with seven medical doctors and ten midwives on their experience. Phase I and II were not in this study but phase I was published in Health SA research journal: June 2007. Phase II submitted for accreditation in the same journal.
Knowledge and timing of antenatal care: women with medical conditions
Authors: Ngoma Catherine Mubita , Mwiinga Chimuka
Published: May 2014

Improving maternal health is one of the United Nations Millennium Development Goals. One way to improve maternal health is through provision and use of antenatal care services. Inadequate antenatal care may predispose a pregnant woman and her unborn child to complications especially in a woman with medical and obstetrical problems. Good quality antenatal care improves pregnancy outcomes.

The purpose of the study was to determine knowledge and timing of the onset of antenatal care among pregnant women with medical and/or obstetrical conditions. This is an exploratory cross-sectional study which used both qualitative and quantitative approach. The study took a convenience sample of 100 antenatal women with medical and obstetrical conditions who booked for antenatal care at two government health centres. The findings from the survey revealed that pregnant women with prior and current medical and obstetrical conditions booked late for antenatal care. The main reasons for late antenatal were socio-cultural issues and misinformation by the midwives. Midwives and the Government need to intensify the education of women on the importance of booking early for antenatal care. There is also need for retraining of midwives in clinical care protocols and procedures.
Improving the health workforce in Africa: the weak link
Authors: Nyoni Jennifer
Published: May 2014

The article discusses the health workforce challenges in Africa focussing generally on the 46 countries of the WHO Africa region but within the context of the global shortages that has reached crisis levels. The momentum gained in advocating to reverse the crisis; the key issues and challenges being faced; the global, regional and sub-regional high level commitments on what needs to be done. Some of the reasons why these commitments are not yet bearing evident fruit in countries is also discussed. An argument is made that while recognizing that the issues are complex and require multiple actions, one of the major weak links identified in this chain is the weak human resources function in the ministries of health. The strengthened function should include coordinating and following up the pledges and commitments made for the health workforce in a sustained and strategic manner. The main outcome would be effective health services for the populations being served.
Women's knowledge, practices and attitudes to breast self-examination
Authors: Oluwatosin O Abimbola
Published: May 2014

This is an interventional study that used a pre-test, post-test control group design to measure the effect of a nurse-led culture based intervention on rural women's knowledge, attitude and practice of breast self-examination (BSE) in Ibadan, Nigeria. Preintervention reports showed that most of the participants were not informed about timing of BSE. However post-intervention data indicated that 95 (44.8%) in the experimental group and only two participants in the control indicated correctly the timing for BSE. There was a significant increase in mean knowledge score of early detection measures from 24.95 SD (2.4) to 29.60 (4.3) p= 0.000000 in the experimental group. In the control group the pre-intervention score was 24.69 SD (2.3) and post intervention 24.68 SD p= 0.63. The findings of this study suggested that the nurse-led culture based intervention significantly improved both knowledge and self-reported practice of breast self-examination among the women.
Women's knowledge of vesico vaginal fistula in Kenya
Authors: Kavai Miriam Musimbi , Chepchirchir Angeline , Kayugira Rogers
Published: May 2014

The predominant cause of vesico vaginal fistula (VVF) in developing countries is prolonged labour accounting for 90%of the cases and the mainstay in management is prevention. A cross-sectional descriptive study was carried out at Kiambu District Hospital among women attending antenatal care (ANC) where the main objective was to determine their level of knowledge of VVF and sources of information.

A total of 137 women were recruited through systematic sampling. Interviews and focus group discussions were conducted to collect data.

Data were analysed and presented using descriptive statistics in the form of percentages and tables.

Results showed that most ANC clients have little or no information about VVF.

It is recommended that health education offered in ANC facilities should incorporate facts on VVF and its prevention.
Understanding a systematic review
Authors: MacInnes Douglas
Published: May 2014

This is the first in a series about how to read research. This article gives an overview of the process of performing a systematic review, how it is communicated and what to consider when making judgments about the information it contains.
A community participatory process for peer group HIV prevention
Authors: Chirwa Ellen Mbweza , Norr Kathleen , Malata Address , Mambulasa Janet
Published: May 2014

A peer group HIV intervention programme was developed using a qualitative community-based participatory action research approach. Twenty-eight community leaders and 11 selected couples in two districts of Malawi were interviewed using individual formal interviews and focus group discussions between september 2007 and april 2008. Data was analysed using a modified constant comparison method. The study has developed HIV prevention interventions through a participatory process focusing on couple acceptability, intervention delivery methods and outcomes of participatory research. The results show that the peer education sessions should involve both men and women so that they learn together. Strategies on the spread of HIV, fidelity, HIV prevention communication, alcohol abuse, educating children on HIV prevention, sexual satisfaction, and condom use should be included in the intervention. Partnerships between researchers and communities are crucial for conducting successful community-based participatory research.
Quality assessment of focused antenatal care services in Malawi
Authors: Lungu Florence , Malata Address , Chirwa Ellen , Mbendera Ida
Published: May 2014

The aim of this study was to explore the quality of focused antenatal care (FANC) services provided to pregnant women at Bwaila Maternity hospital in Lilongwe district, Malawi. The study design was descriptive using a convenience sample of 369 antenatal mothers. A structured questionnaire was administered to pregnant women attending the antenatal care clinic to assess the quality and content of FANC services. The findings indicate that overall, the structure for providing FANC services scored above World Health Organization (WHO) standards (at 87%) while the process of delivery of services in terms of performance scored below standard (at 60%). On the outcomes, the maternal and neonatal mortality ratios were 206 per 100 000 and 19 per 1000 live births respectively. Community mobilization, training of health care providers and consistent supply of material resources necessary for providing FANC is recommended in order to further improve neonatal and maternal outcomes.
Developing a continuing professional development programme to improve nursing practice in Lesotho
Authors: Moetsana-Poka Flavia , Lehana Tjoetso , Lebaka Makholu , McCarthy Carey F
Published: May 2014

Introduction

In 2010, the Lesotho government required professional regulatory bodies to enforce continuing professional development (CPD) amongst their members. The Lesotho Nursing Council (LNC) sought financial and technical support from the African Health Profession Regulatory Collaborative (ARC) to develop a national CPD programme.

Methods

The LNC and other national nursing and midwifery leadership collaborated on a step-by-step process of designing a CPD framework, engaging key stakeholders, and pilot testing CPD implementation, the Lesotho nursing leaders drafted a nursing and midwifery CPD framework.

Conclusions

The Lesotho nursing leaders developed the first health professional CPD programme in the country. Development of a CPD programme in Lesotho has reconciled nursing practice with the legislative standards governing the workforce.
Is hospital really the best place for patients with endocarditis?
Authors: Siefers Rhian , Massey Debbie
Published: May 2014

Despite developments in antibiotics and surgery, the treatment regimen for infective endocarditis continues to involve long courses of intravenous antibiotics. Because of the appreciable morbidity and mortality associated with this condition, attention has been focused on potential complications, and little consideration has been given to whether it is best to manage these patients in hospital or at home.
Nurses need to get involved in research
Authors: Shuldham Caroline
Published: May 2014

Caroline Shuldham discusses the important part research plays in improving the health and treatment of patients and argues that nurses need to get more involved.
Radiation dose from cardiac investigations: A survey of cardiac nurses’ knowledge
Authors: Stanbridge Katherine , Latus Kate , Robinson Clare , Reyes Eliana , Nicol Edward
Published: May 2014

Objectives. This survey aimed to highlight the level of knowledge cardiac nurses have concerning ionizing radiation doses received by patients, and the theoretical increased risk of malignancy, when undergoing specific cardiac investigations. Methods. In total 23 cardiac nurses were asked specific questions concerning ionizing radiation doses and the risk of subsequent malignancy. This was part of a wider multidisciplinary survey carried out at the British Cardiac Society annual scientific conference. All individuals were inter viewed by a nuclear medicine practitioner in isolation to prevent bias arising from participant collaboration and also to prevent individuals looking up the answers.

Results. The majority of those questioned did not know the correct ionizing radiation doses for specific cardiac investigations. None knew the exact background radiation dose of the UK in one year. Between 4–12 % of the participants correctly identified the theoretical risk of malignancy at 20 years for patients undergoing diagnostic coronary angiography, myocardial perfusion scintigraphy or computerized tomography coronary angiography.

Conclusions. Of those questioned, most did not know the ionizing radiation doses associated with common cardiac diagnostic tests. This is of concern because some nurses, with established and developing roles, have the authority to order these investigations. We conclude from this paper that the nurses, especially those with responsibility for requesting investigations involving ionizing radiation, need to develop their knowledge of this to support their roles. This will allow them to explain the risks and benefits of procedures competently and enable patients to make a fully informed decision about their future care. We also recommend further study of this subject in order to establish whether this is a common feature of other centers.
Multi-skilling the non-medical catheter laboratory workforce
Authors: Arnold Allyson
Published: May 2014

Allyson Arnold discusses the changing nature of demands on the cardiac catheter laboratory team and new initiatives to equip non-medical staff to work across disciplines and provide improved patient care
Integrating palliative care recommendations into clinical practice for chronic heart failure
Authors: Millerick Yvonne
Published: May 2014

Although advances in medical management of chronic hear t failure have improved symptoms and prognosis for some patients, the fact remains that for many the chronic nature of the disease continues to adversely impact on quality of life and inevitably leads to death. Even with this poor prognosis, the majority of patients and carers with advanced hear t failure are still unaware that they are living with a life-threatening illness and are often denied the opportunity to discuss care priorities at the end of life. Key policy initiatives throughout the UK recommend integrating palliative care into mainstream health care for patients and carers living with life-limiting chronic disease such as hear t failure. Regardless of these initiatives a palliative care approach featuring end-of-life care for such patients is exceptional. This artice describes a model of care that encourages a professional inclusive approach to the identification of high-risk chronic hear t failure patients and also offers specific guidance to support hear t failure professionals with the translation of national recommendations into everyday clinical practice.
A family perspective on hypertrophic cardiomyopathy
Authors: Williams Amy
Published: May 2014

Amy Williams, who was diagnosed with hypertrophic cardiomyopathy as a child and is also a trustee of the Cardiomyopathy Association and daughter of founder Carolyn Biro, talks about her experiences
Acute kidney injury and its impact on the cardiac patient
Authors: Byrne Gobnait , Murphy Fiona
Published: May 2014

The term acute kidney injury (AKI) is now used to represent acute renal failure. AKI is a complex disorder and is classified into three stages, one to three. The causes of AKI may be subdivided into prerenal, intrinsic and post-renal. Many patients develop AKI after cardiac surgery. Radiopaque contrast media, which is used in coronary angiography, is a common cause of AKI. The first priority in the management of AKI is to identify the condition promptly, treat the cause and treat the symptoms. Nurses need to monitor the signs and symptoms of AKI and treat hyperkalaemia and fluid overload appropriately. Some patients may require renal replacement therapy. The Renal Association in the UK has recently published guidelines on the diagnosis and management of AKI and this article will refer to these guidelines.
The role of cholesterol in the development of cardiovascular disease
Authors: Stokes Gill
Published: May 2014

Serum low-density lipoprotein cholesterol (LDL-c) is positively associated with the risk of cardiovascular disease (CVD) while high-density lipoprotein cholesterol (HDL-c) is inversely related to CVD risk. This article sets out to explore the role of lipids in the development of CVD and the identification and subsequent management of abnormal lipids (dyslipidaemia)—including individuals with inherited disorders such as familial hypercholesterolaemia (FH) and familial combined hyperlipidaemia (FCH)—through lifestyle, diet and drug therapy.
Breathlessness in end-stage heart failure
Authors: MacCallum Annie , Hughes Suzy
Published: May 2014

Breathlessness is a common and distressing symptom in end-stage heart failure, impacting adversely on quality of life for both the patient and the carer. Breathlessness is recognized as being a multi-factorial subjective experience. Research into effective therapies is surprisingly sparse, although this is a common feature in the end stages of a number of diseases. A complex holistic assessment must first exclude a treatable underlying cause and ensure that medications have been optimized.

A variety of both pharmacological and non-pharmacological therapies are available for breathlessness. Treatment is likely to require an approach incorporating both and addressing identified physical, social, psychological and spiritual needs to provide optimum relief. A skilled and experienced specialist cardiac nurse is ideally placed both to assess the breathlessness and to support the patient in finding effective therapies at the end of life.
An introduction to aortic regurgitation
Authors: Potts Katherine , Pritchard Deborah
Published: May 2014

The valvular heart disease condition, aortic regurgitation, occurs as a result of an abnormality of the aortic valve or the aortic root, or a disease process that may affect both the valve and the aortic root. Aortic regurgitation can occur as either an acute severe problem or presentation or as a chronic problem and presentation.

This article considers the pathophysiology and causes, progression and natural history of the disease process, clinical presentation and findings on examination and the diagnostic tests. Diagnostic tests per formed to confirm the diagnosis will be explored, including echocardiography, exercise tolerance testing, chest X-ray, and electrocardiogram. The role of medical therapy and surgical aortic valve replacement is also discussed.
Intermittent claudication and peripheral arterial disease: Implications for cardiac nurses
Authors: Palfreyman Simon , Fenwick Nikki , Trender Hazel
Published: May 2014

Intermittent claudication (IC) is a cramping pain that can be felt in the calf, thigh or buttock and occurs during walking or other exercise. It is a result of inadequate blood supply to the legs caused by atherosclerosis in the arteries and is a symptom of peripheral arterial disease. The risk factors mirror those for cardiovascular disease. People with IC also usually have systemic atherosclerosis and are at an increased risk of stroke and myocardial infarction. This article discusses the assessment and treatments for people with IC. It also highlights the similarity and differences between patients with IC and those with cardiovascular disease.
A journey through heart surgery, seen through the eyes of a medical student
Authors: Williams Rebecca , Papaspyros Sotiris C
Published: May 2014

Coronary artery disease affects a large number of people worldwide and has detrimental impact on quality of life and prognosis. Increasing incidence of obesity and unhealthy lifestyles indicate that it will continue to play a significant role in the health service.

The latest European coronary revascularization guidelines were published in October 2010. Seven clinical cardiologists, seven interventional cardiologists and seven cardiothoracic surgeons were the authors. This balance in the contribution of clinical specialties is reflected in the composition of the ‘heart team’.

In this article we review the pathway of care for a virtual patient. We aim to demonstrate the decision-making process and steps taken before, during and after a heart operation. Viewing coronary disease from this perspective will hopefully delineate how all aspects of patient care are provided as a collaborative effort from all members of the health-care team and highlight areas of improvement
Service evaluation of an adult congenital heart disease healthy lifestyle group
Authors: Kendall Lynne , Quirk Jo
Published: May 2014

Advances in the last few decades in surgical management, and more recently interventional catheterization, in childhood mean that more than 85% of children with congenital heart defects will now survive into adulthood. In the UK and worldwide there are now more adults than children with congenital heart disease. Many are very well, maintaining a good quality of life; however, few are fully repaired or ‘cured’ with many of the interventions being palliative. Many will require several, repeat medical and/or surgical interventions. Thus most adult congenital patients have complex health needs and require life-long specialized care. There is increasing evidence that a reduced exercise capacity in people with a broad range of congenital cardiac conditions, including asymptomatic patients with simple lesions, is a common finding.

This article will use a service evaluation to illustrate how an interdisciplinary approach was used in the exercise and lifestyle management of adult patients with congenital heart disease.
Cardiogenic shock complicating myocardial infarction: An overview
Authors: O'Donovan Kate
Published: May 2014

Cardiogenic shock is a devastating complication associated with myocardial infarction. Although advances in treatment strategies have declined the incidence of cardiogenic shock the mortality is approximately 50%. Evidence has demonstrated the benefit in early revascularization in preventing and treating cardiogenic shock with IABP serving as a bridge to this treatment option. This article considers the management of cardiogenic shock resulting from acute myocardial infarction seriously impairing left-ventricular pump function.
Osteoporosis and heart failure
Authors: Whittingham Katharine , Pinnock David
Published: May 2014

Over recent years there has been an increased interest in osteoporosis as a comorbidity with heart failure, as it is also associated with lifestyle factors relating to cardiovascular disease. There is clear evidence of a correlation between fracture risk and heart failure. Heart failure patients are a vulnerable population for developing osteoporosis; they are predominantly older people, often with existing comorbidities (for example diabetes and renal impairment) and have reduced exercise capacity as a result of the condition. Additionally there are the physiological and pharmacological implications of the condition including high levels of aldosterone and the effects of loop diuretics on calcium levels. It is therefore important that this increased risk is recognised and patients assessed accordingly.

The review article outlines the pathophysiology of osteoporosis, identifies the prevalence of the condition in male and female heart failure populations, indicates the typology of heart failure patients likely to develop this problem, and concludes with recommendations for nurses working with patients whose risk should be assessed.
Chest pain presentation in women and the psychological impact
Authors: Ingram Shirley
Published: May 2014

Cardiovascular disease remains the biggest global killer of women accounting for 47% of total female mortality yet many women remain unaware of this citing cancer as the major health threat. Chest pain is synonymous with the presentation of cardiac disease and impending acute coronary syndrome (ACS) however it is often not the main presenting symptom in many women and ACS symptoms as presented by women are often described as ‘atypical’. Psychological reactions such as anxiety are common following an acute cardiac event with younger women at greater risk. This article describes the neurobiology of chest pain, the differences in presentation with ACS by women and the nursing assessment and management of anxiety. A case study is used to illustrate the issues.
Denial of heart disease, delays seeking help and lifestyle changes
Authors: Snowden Austyn , Marland Glenn , Murray Esther , McCaig Marie
Published: May 2014

This article examines the psychological and physical impact of denial of illness related to heart disease. The most obvious sequelae entail avoidance of help-seeking behaviour and the maintenance of risk-taking behaviour such as poor diet, lack of exercise and smoking. A definition of denial is presented, followed by a description of the perceived benefits and risks of this strategy. That is, denial can be viewed as an adaptive response, and as such has a place in the human array of stress responses. The purpose of this is to show that any change in behaviour needs to be considered in relation to the losses incurred by curtailing that behaviour. The reason it is important to understand these individual perceptions is that in order to move into constructive dialogue the nurse has to recognize the function and value of denial to the individual concerned. Techniques are discussed using a case study method.
Comparison of short- and long-term haemostatic compression after transradial procedures
Authors: Schwaim Torsten , Brudin Lars , Qvist Jeanette , Peterssen Iren , Carlsson Jörg
Published: May 2014

Background: Rates of transradial coronary procedures are increasing due to substantial benefits compared with the transfemoral approach. There is no standard in type or length of compression of the puncture site. The aim of the study was to compare two different schemes of haemostatic compression using the TR Band with regard to bleeding complications, vessel occlusion and early patient discharge.

Methods: We compared two successive all-comer groups (n=331 and n=324) of patients after transradial coronary procedures between 1 October 2010 and 31 March 2011. The first group underwent compression of the puncture site for 1 hour before pressure was gradually released whereas pressure was maintained for 4 hours in the second group.

Results: No major access site complications occurred in either group. The rate of minor bleeding was higher after short compression compared with prolonged compression (34 (10.3%) vs 16 (4.9%), P=0.015). Short compression, female sex and use of tirofiban were associated with bleeding complications. Rates of patent pulse of the radial artery and oxygen saturation of the ipsilateral thumb were high, without any difference between the two groups. Discharge of elective outpatients was postponed by 3 hours using the longer compression scheme.

Conclusions: Maintenance of high compression pressure over 4 hours leads to a lower frequency of bleeding.
Chest pain with unobstructed coronary arteries and cardiac syndrome X
Authors: Webb Carolyn M , Collins Peter
Published: May 2014

The diagnosis of chest pain with unobstructed coronary arteries is found in one third of patients undergoing investigation of chest pain using coronary angiography. Symptoms are often debilitating and sufferers often have a poor quality of life, with frequent and costly demand on health-care services. Although patients with chest pain and unobstructed coronary arteries do not have increased cardiovascular mortality, morbidity is high. The pathophysiology is complex and management often needs to look beyond drug therapies.
Deactivation of ICDs in end-of-life care: A Welsh perspective
Authors: Churchouse Wendy , Seaman Slwan , Rees Paul , Cawsey-Williams Jo , Roberts Kathryn , Anderson Mark
Published: May 2014

An implantable cardioverter defibrillator (ICD) is a small cardiac implant that monitors, detects and treats life-threatening arrhythmias. If a patient has advanced or terminal disease requiring end-of-life care, it is questionable whether life-sustaining treatments such as defibrillation are appropriate. In such situations it is important that patients and their relatives are given the opportunity to discuss elective deactivation of their ICDs.

While deactivation is a simple procedure, from a psychological perspective it is sometimes thwarted with challenges for the patient, relatives and health-care professionals. Furthermore, deactivation of an ICD is often left until the last days of life, which can cause unnecessary distress for all concerned. The evidence, the views of patients, relatives and health-care professionals will be explored, along with a description of the development of the All-Wales ICD deactivation pathway.
Rivaroxaban: a novel anticoagulant
Authors: Haalstrup Margaret , Williams Helen
Published: May 2014

Rivaroxaban is an oral anticoagulant licensed for the treatment of acute deep vein thrombosis (DVT), and prevention of recurrent DVT and pulmonary embolism (PE) following an acute DVT in adults. It is also licensed for the prevention of stroke and systemic embolism in adult patients with additional risk factors with non-valvular atrial fibrillation. In addition, rivaroxaban has been licensed in the UK for the prevention of venous thromboembolism (VTE) in adult patients undergoing hip or knee replacement surgery. The National Institute for Health and Excellence (NICE) has approved rivaroxaban as a treatment option for all its licensed indications ( NICE 2012a , b , c ). Rivaroxaban is a highly selective direct factor Xa inhibitor with oral bioavailability. Inhibition of factor Xa interrupts the intrinsic and extrinsic pathway of the blood coagulation cascade, inhibiting both thrombin formation and development of thrombi. Rivaroxaban does not inhibit thrombin (activated Factor II) and has effects on platelets have been demonstrated (Bayer, 2012). Rivaroxaban is administered as a fixed dose regimen, and unlike vitamin K antagonists such as warfarin it does not require regular laboratory monitoring and has no known food, with few drug interactions.