bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial
Authors: Schneider Michael , Ammendolia Carlo , Murphy Donald , Glick Ronald , Piva Sara , Hile Elizabeth , Tudorascu Dana , Morton Sally C 
Published: May 2014

Abstract
Background
Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis.

Methods/design
This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome.

Discussion
Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms.

Trial registration
ClinicalTrials.gov identifier: NCT01943435
Determinants of postnatal care uptake in Bikita district, Zimbabwe
Authors: Pomerai K.W. , Shambira G. , Mudyiradima R.F. 
Published: May 2014

Introduction: The postnatal period is a good opportunity to detect medical problems of the mother and neonate and reduce morbidity and mortality. This study was conducted to determine factors associated with low postnatal care uptake in Bikita. Methods: A 1:1 unmatched case-control study was conducted. Random sampling was used to select cases and controls from antenatal care and postnatal care registers at health centres. An interviewer-administered questionnaire using constructs of the Health Belief Model was used. A focus group discussion was conducted with women who had come for antenatal and postnatal care. Results: A total of 150 cases and 150 controls were recruited. Independent factors associated with non-uptake of postnatal care uptake were: practising seclusion until umbilical cord fell off (adjusted odds ratio (AOR) 3.43; 95% confidence interval (CI): 1.73–6.81); residing in village/resettlement (AOR 3.71; 95% CI: 1.30–9.90); delivering at home (AOR 6.0; 95% CI: 3.50–12.71); and staying more than 5 km from health centre (AOR 1.73; 95% CI: 1.03–2.89). Factors associated with postnatal care uptake were secondary/tertiary level of education (AOR 0.25; 95% CI: 0.11–0.73) and ability of mother to attend postnatal care within 48 hours after at-home delivery (AOR 0.60; 95% CI: 0.21–0.96). Discussion and Conclusion: Factors associated with reduced likelihood of the 10-day postnatal care uptake in Bikita district were: practising seclusion until umbilical cord fell off; residing in a village or resettlement; delivering at home; and living more than 5 km from the nearest health centre. Outreach services have been launched for postnatal care and to ensure that village health workers are trained in basic postnatal care.
Do insulin secretagogues remain essential in managing type 2 diabetes?
Authors: Gostling Charles 
Published: May 2014

A strong case has been made for the use of the insulin-sensitizing agents, metformin and the thiazolidinediones (also known as glitazones) in the management of type 2 diabetes. Not only do they improve glycaemic control, but they may also reduce the risk of cardiovascular disease. Oral drugs promoting insulin secretion from the β-cells in the pancreas (insulin secretagogues), and in particular the sulphonylureas, have acquired an unfashionable status although they are cost effective and, in general, are well tolerated and safe. There is strong evidence for the benefits of sulphonylurea drugs in reducing the risk of microvascular disease in type 2 diabetes (in particular retinal and renal disease). Additionally, improved glycaemic control using these agents may reduce the risk for myocardial infarction. Current guidance for the management of type 2 diabetes suggests a stepped approach using lifestyle interventions, insulin-sensitizing agents and insulin secretagogues before progressing to insulin therapy if treatment targets are not achieved using maximally tolerated oral hypoglycaemic therapy. This article considers the role of insulin secretagogues, and in particular sulphonylureas, in managing type 2 diabetes. Attention is given to their relative strengths and weaknesses, as well as to how they might be used in combination with other agents.
Extent of heart failure self-care as an endpoint to patient education: A literature review
Authors: Cameron Jan , Worrall-Carteris Linda , Driscoll Andrea , New Gishel , Stewart Simon 
Published: May 2014

Background: In western countries the number of chronic heart failure (CHF) management programs has escalated in recent times. One key component of them is to teach self-care behaviours that enable affected individuals to monitor themselves and engage in lifestyles that improve their health status. Aim: The aim of this article is to describe CHF self-care management and to review the literature which examines the effectiveness of patient education on patients’ performance of self-care behaviours. Design/method: Bibliographical databases were searched for papers published in English between 1982 to 2006. The search used the key words: heart failure, education, self-care and measures. Only randomized controlled trials (RCTs) were selected. Results: Ten randomized controlled trials were selected that used education as an inter vention and, in total, 1064 patients with CHF participated in these studies. The studies were heterogenous as to the sample population, the health outcomes measured, the education interventions, the expertise of the educator, and the length of time that was spent on teaching patients. No consistent patterns of implementation and specific evaluation of its impact were found, although three respective groups of investigators reported significant differences in recurrent hospitalisation rates and mortality rates which were relative to usual care. Conclusions: Teaching patients appropriate CHF self-care behaviours can significantly improve their health outcomes. Improvements in self-care were demonstrated in seven studies but only three had used validated instruments to measure such changes. This suggests that no firm conclusions can be drawn about changes in self-care practices.
Nurse-facilitated suspected arrhythmia clinic: auditing the initial 12 months’ experience
Authors: Lapper Andrew , Smallwood Andrew 
Published: May 2014

Objective: Specialist nursing services focused on delivering care to patients with a suspected arrhythmia are evolving. An audit was undertaken to characterize the population of patients referred to a nurse-facilitated suspected arrhythmia outpatient clinic during the fi rst year of its operation, to assess effectiveness of the clinic in identifying those requiring further treatment, organizational implications of such a clinic and to form a baseline against which future audits can be compared. Methods: Retrospective data were collected from all patients newly referred and assessed in a nurse-facilitated suspected arrhythmia from July 2006 to July 2007. Results: 192 patients were referred to this clinic. New referrals were predominantly female (60%); an age range of 19–91 years and were largely Caucasian (88%). The most common symptom prompting referral was palpitations (71%). Depending on clinical history, 82% of referred patients had cardiac monitoring. Following investigation atrial fi brillation (persistent or paroxysmal) was identifi ed in 26% of the referred patients and signifi cant paroxysmal supra-ventricular tachycardia in 5%. The remainder demonstrated atrial ectopy (17%), ventricular ectopy (13%), other arrhythmias (1%), with no arrhythmias identifi ed in 38% of the cohort. Conclusions: This audit demonstrates that a nurse-facilitated suspected arrhythmia clinic is an effective way of identifying patients with suspected heart rhythm abnormalities. From an organizational standpoint this clinic helps to reduce the burden on general cardiology clinics and helps meet NHS targets. A clear need for further published evidence is highlighted.
Principles of good care in the dying stage of heart failure
Authors: Flynn Maria , Connolly Michael , Booth Katie 
Published: May 2014

This paper is the second of two that consider the broad philosophy and principles of supportive and palliative care as applied to patients living and dying with heart failure. Care of the dying patient is an important and integral part of health care but the disease trajectory of heart failure presents challenges in the diagnosis and management of the dying stage. There are national frameworks to guide best practice in the care of the dying and it is widely recognized that the practice of intensive supportive and palliative care can facilitate a ‘good death’. Excellent interpersonal and communications skills are necessary to help patients and their families deal with the psychological and emotional aspects of dying. This paper discusses the care and management of dying in heart failure and considers the nature and practice of psychological support for patients and their families. The implications of patients dying with ICDs and pacemakers are highlighted. The use of the Liverpool Care Pathway in caring for a dying patient and their family is also discussed.
Heart disease and poverty: The risk factor that dare not speak its name?
Authors: Jones Chris , Pierce-Hayes Ian 
Published: May 2014

Coronary artery disease continues to make a deep impression on the UK population in terms of both mortality and morbidity. Considerable public policy is aimed at reducing the impact of this disease, through modification of the risk factors thought to contribute to its development. We seek to argue that there is a risk factor for coronary artery disease which is commonly ignored by both public and professionals, despite a strong body of evidence pointing to a major role in the aetiology of the condition. This risk factor, namely poverty, contributes to many of the other recognized risk factors such as poor diet, smoking, family history and obesity. One possible reason for the relative down-grading of poverty is that, whereas matters of lifestyle point to the patient’s responsibility in preventing disease, poverty presents more difficult social problems in its prevention.
Homocysteine and CVD risk: Is it relevant or redundant?
Authors: Windrum Kathrine 
Published: May 2014

Homocysteine is an amino acid produced in the body as part of protein synthesis for key functions. High levels of homocysteine in the blood have been linked with cardiovascular disease (CVD) as well as other health problems. B vitamins play a role in the conversion of homocysteine to other amino acids in the body, and so since the mid-1990s research has been ongoing into whether supplementation with B vitamins and folic acid, with the specific aim of lowering homocysteine levels, could have a role in primary or secondary prevention of CVD. This article reviews the metabolism and pathophysiology of homocysteine, the origin of the ‘homocysteine hypothesis’ and outlines the results of key observational and interventional studies.
Atrial fibrillation—so what? Changing clinical practice
Authors: Bennett Michelle 
Published: May 2014

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, if left untreated it is a significant risk factor for stroke and other morbidities. Approximately 12 500 strokes each year are sttributable to AF and the annual cost to the NHS and personal social services budget is estimated to be around £148 million. The SAFE study identified that when GPs record manual pulses during routine consultations the incidence of AF diagnosis is significantly increased, ultimately leading to a reduction in the incidence of stroke. On 1 May 2007 the Wrexham primary care AF model pilot was launched. Working in partnership across organizational boundaries, changes were made to existing templates in some GP surgeries. A manual pulse check was added to all chronic disease management templates, and a stroke risk stratification tool was added to AF templates to ensure patients are correctly stratified for appropriate use of a thromboprophylactic agent, which in turn would reduce the incidence of stroke. Seven new AF patients were found by opportunistic checks during the pilot and 68 patients found to be on inappropriate or no thromboprophylaxis, which prompted further review by the GPs.
Cardiac resynchronization therapy: Biventricular pacing for heart failure
Authors: O’Donovan Kate 
Published: May 2014

Heart failure is a chronic progressive syndrome, which impairs quality of life and is associated with frequent hospitalizations and a high mortality rate despite optimal medical therapy. Ventricular dyssynchrony is characteristic of systolic heart failure in some of the patients and is recognized as an interventricular conduction abnormality on the ECG, commonly in the form of left bundle branch block. This contributes to abnormal ventricular contraction pattern, which further reduces cardiac output and exacerbates symptoms. Data from clinical trials have demonstrated that by pacing the right and left ventricle simultaneously, as in cardiac resynchronization therapy, ventricular contraction improves with a resultant reduction in symptoms and an improvement in cardiac output and quality of life in the majority of patients. This article provides an overview of ventricular dyssynchrony and the effect cardiac resynchronization therapy has on ventricular function and on quality of life and symptoms.
Improving sleep quality for patients after cardiac surgery
Authors: Conway Aaron , Nebauer Monica , Schulz Paula 
Published: May 2014

Research has consistently described that patients after cardiac surgery experience disturbed sleep yet there has been limited investigation into methods to improve this experience. Complementary therapies may be a method of addressing this issue. Aim: To determine if using progressive muscle relaxation improves self-rated sleep quality for patients following cardiac surgery. Methods and Results: Thirty-five participants’ quantitative data on sleep quality were obtained via questionnaire during their first postoperative week after cardiac surgery. Qualitative data were obtained through written responses to open-ended questions. No significant differences in sleep quality scores were found between pre and post-intervention of progressive muscle relaxation using the Wilcoxon Signed Ranks Test. However, the qualitative analysis discovered the intervention aided some participants in initiating their sleep by diversion of thought, inducing relaxation or alleviating pain and anxiety. Conclusions: Qualitative findings suggest that progressive muscle relaxation may help patients who have undergone cardiac surgery initiate their sleep.
Effectiveness of a one-stop nursefacilitated clinic in managing patients with palpitations
Authors: Smallwood Andrew , Lapper Andrew 
Published: May 2014

Objective: The purpose of this study was to evaluate the effectiveness of a ‘one-stop’ nurse-facilitated suspected arrhythmia clinic using a quantitative methodology. This was achieved by determining the frequency and reasons for re-referral of patients to a local hospital who were previously found not to have a significant arrhythmia after attending the nurse-facilitated clinic. Method: All new referrals to a nurse-facilitated suspected arrhythmia clinic from July 2007 to July 2008, who were not positively diagnosed as having a significant arrhythmia, were subject to an electronic search of the trust’s patient management system. Patients identified as having been re-referred into hospital had their medical notes examined to determine if the reason for referral was due to a suspected or proven arrhythmia. Results: 302 patients were referred to the nurse-facilitated suspected arrhythmia clinic from July 2007 to July 2008. 58% (n=175) had no significant arrhythmia detected. This cohort included patients with atrial and ventricular ectopy (20%), sinus rhythm with pauses (1%), no arrhythmias detected (38%) and not recorded (1%). 5% (n=8) were re-referred back into the hospital system with a further suspected arrhythmia and 1% (n=2) diagnosed with an arrhythmia. Conclusions: These findings suggest that a ‘one-stop’ nursefacilitated suspected arrhythmia clinic is effective at identifying people with a significant arrhythmia and can safely refer back to a general practitioner or on to cardiology services. This article adds detail and outcome data to previously published articles about this aspect of nurse-facilitated care.
Consent and mental capacity issuesn heart failure
Authors: Jones Chris , Lackey Joanne , Williams Barry 
Published: May 2014

The physical effects of heart failure have been widely researched and reported. Hitherto the psychological manifestations of this condition have received less attention. However, there is a growing body of evidence that points to the serious effect that heart failure has on intellectual performance. Heart failure causes patients problems in memory, attention and expression. Even though evidence relating to cognitive dysfunction has accumulated there is still little consideration in the literature to the implication of this decline for capacity or consent issues. Indeed many research papers that investigate the phenomenon treat the question of gaining consent in a way that is, arguably, superficial. This article aims to describe the phenomenon in heart failure, discuss the possible causes of the process and consider the relevance of the Mental Capacity Act 2005 in defining patients’ capacity to make judgements regarding care.
In-hospital resuscitation: 2010 guidelines in practice
Authors: Bowden Tracey 
Published: May 2014

This article outlines the key changes in practice arising from the updated 2010 resuscitation guidelines in relation to in-hospital resuscitation, including prevention of cardiac arrest. It is useful for any health-care professionals with a responsibility to provide direct care to patients within acute and critical care environments to have knowledge of the advanced life support algorithm to enable them to anticipate the needs of the team and be effective participants. One of the main themes of the updated guidelines is to ensure that continuous, effective chest compressions are maintained throughout the resuscitation attempt and interruptions are kept to a minimum.
Using patient experiences to develop a pre genetic service around family needs
Authors: Oliver J , Goodfellow J , Smyth L , Bourne R , Brennan P , Farrer M 
Published: May 2014

Objective: A genetics service wanted to gain an insight into the experiences of families with an inherited cardiac condition in order to design a new pilot service around family needs. Design: A focus group was held to understand from a family perspective what was important within the service. Interventions: Five families that had already been through the service were invited to share their experiences. Results: Three families attended. The facilitators noted the main points of what was discussed. The common themes were the time taken from the diagnosis or death of the family member to getting help and support. The lack of awareness of where to get the help required. Families felt unsupported after a sudden death. Conclusions: The families welcomed the opportunity to share their stories and the chance to improve the service for future users. An action plan was devised to include what they saw was important in a service.
Managing the risk of cardiac arrhythmias in patients with worsening renal function
Authors: Elliott Kay , Bolton Amanda 
Published: May 2014

This article explores key issues for management of patients with worsening renal function and cardiac arrhythmias, to enable clinicians to provide relevant support and monitoring for these relatively high-risk patients. The implications for arrhythmia inherent to renal failure, haemodialysis and peritoneal dialysis are reviewed, as is the higher prevalence of atrial fibrillation (AF) in those with renal failure—medication and treatment options are outlined. Recommendations are given around dialysis in terms of managing fluid volumes to reduce potential complications of dialysis such as left ventricular hypertrophy, heart failure and hyper/hypotension. In terms of ICD implantation the current evidence is reviewed, along with the role of the nurse in helping patients understand the risk versus benefit of device therapy. The opportunity to work collaboratively across specialisms is recommended and discussed; this may take the form of shared decision making, agreement of optimum follow-up/ monitoring schedules and provision of education.
An introduction to fractional flow reserve
Authors: Ruchat Gillian , Bergeron Marie-Paule , Colet Julieta , Dondenaz Ellsabeth , Muller Ollvier 
Published: May 2014

Fractional flow reserve (FFR) is an index derived from coronary pressure measurements to assess the functional significance of a coronary stenosis. It is performed during coronary angiography for patients with stable angina when a moderate coronary stenosis is found. The coronary pressures are measured during maximal hyperaemia, which is provoked by administering a hyperaemic drug. If the fractional flow reserve indicates that a patient does not have a haemodynamically significant stenosis there are no benefits gained from percutaneous coronary intervention (PCI). This review discusses the principles of FFR with the aim of assisting cardiac nurses involved in the procedure by explaining nursing intervention for patient care. It also aims to help all cardiac nurses understand FFR so they can provide preprocedural explanations to patients and understand decisions made after the procedure.
The patient pathway for mitral valve surgery
Authors: Bartley Tara 
Published: May 2014

Mitral valve disease can present as mitral regurgitation or mitral stenosis, causing the valve to leak or to narrow. In extreme cases the papillary muscle can rupture and the patient presents as an acute emergency. Patients with mitral disease will develop congestive heart failure and associated arrhythmias. The condition requires pharmacological intervention for symptom control and careful monitoring to assess when surgical intervention is indicated. Decisions regarding appropriate timing of surgical intervention should be made following discussion among the whole multidisciplinary team and patients should have the opportunity to learn about all their surgical options. Once a decision to operate (whether repair or replacement) has been made, the patient embarks on a process of preoperative screening and assessment, which is outlined in this article together with postoperative care.