A pivotal role in international rescue

As more British people travel abroad, international co-operation between health-care services has evolved. One of the key professionals involved in repatriating British travellers who are ill or injured are in-flight nurses, who need to have a wide range of nursing knowledge as well as good communication skills. In-flight nurses are generally in sole charge of a patient and they need to be able to deal independently and confidently with foreign health systems and officials, and be prepared to travel to dangerous areas such as war zones.     

Opportunistic case finding pivotal in diagnosing COPD

The principle of COPD diagnosis is based on establishing the presence of obstructive post-bronchodilator spirometry in an at-risk individual with appropriate symptoms. Most individuals diagnosed with COPD have substantial cigarette smoke exposure, more than 10 and usually 20 pack years. Patients with COPD usually have symptoms of cough and phlegm, exertional breathlessness, wheezing, recurrent winter bronchitis or a combination of these symptoms. A current or ex-smoker, aged over 35, with respiratory symptoms should undergo spirometry testing. The hallmark of COPD is the presence of airflow obstruction after administration of a bronchodilator. However, while normal spirometry excludes COPD, obstructive spirometry is also seen in asthma and bronchiectasis emphasising the importance of clinical features. A significant change introduced in the 2010 NICE guideline is the new grading of COPD severity. A system based on FEV alone oversimplifies disease severity and full clinical assessment should include symptoms, frequency of exacerbations and impact of disease on functioning and health status. The most important single intervention is smoking cessation as this is proven to reduce decline in FEV1 and reduce mortality. All patients should also receive influenza and pneumococcal vaccination, weight management, pulmonary rehabilitation (if breathless) and short-acting bronchodilators. The evidence base for rehabilitation is very strong with positive effects shown on breathlessness, exercise capacity, activity level, exacerbation rate, leg muscle strength and quality of life.     

HA-1A in septic patients with ARDS: Results from the pivotal trial

Objective To evaluate the effects of HA-1A, a human monoclonal antiendotoxin antibody, in septic patients with ARDS.Design Substudy of a multicenter, double-blinded, placebo-controlled trial of HA-1A in septic patients.Patients 63 septic patients with ARDS at the time of study entry.Intervention A single intravenous injection of HA-1A (100 mg) or placebo.Results A quantitative radiographic score, the PaO₂/FIO₂ ratio and an index of the severity of ARDS did not show a significant difference between the treatment and placebo groups at 3, 5 and 7 days after treatment. The duration of endotracheal intubation did not differ between the two groups. 15 of 30 HA-1A treated patients (50%) and 23 of 33 placebo-treated patients (69.7%) died within 28 days. The daily mortality was always lower in the HA-1A group, but this difference was not statistically significant at 28 days. The 28-day survival curves for the two treatment groups adjusted by covariate analysis were not significantly different (p=0.07). Using logistic regression, a significant independent effect of HA-1A treatment was detected upon the early survival rate at 7 days (p=0.03) but not at 14 and 28 days.Conclusion A single injection of HA-1A in septic patients with ARDS did not reverse acute respiratory failure or improve long-term survival.This study was supported by a grant from Centocor Inc., Malvern, PA, USA     

Pulmonary artery: A pivotal site for catheter ablation in idiopathic RVOT ventricular arrhythmias

In patients without associated myocardial diseases, characterized by left bundle branch block and inferior axis morphologies, repetitive idiopathic right ventricular tachycardias and ventricular premature contractions typically arise from right ventricular outflow tract (RVOT). Accumulated evidences have shown that radiofrequency catheter ablation is a useful treatment for patients with RVOT ventricular arrhythmias (VAs). Interestingly, several medical centers have shown that pulmonary artery (PA) is a potential novel site for catheter ablation in RVOT‐like VAs, particularly in patients where termination of RVOT VAs at the usual site fails. In this review, we comprehensively demonstrated that RVOT VAs were successfully terminated at the site of PA, analyzed the characteristics of surface electrocardiogram and endocardial potentials, and explored the underlying mechanisms for these cases.     

Sustaining the pivotal organizational outcome: magnet recognition

parsons m.l. & cornett p.a. (2011) Journal of Nursing Management 19, 277–286
Sustaining the pivotal organizational outcome: magnet recognition Aim To identify the facilitators and barriers for health-care organizations to sustain Magnet Recognition, the exemplar of a professional practice environment and quality care. Background Recognition as a Magnet Hospital is the gold standard for acknowledging excellence in nursing. However, limited evidence exists to inform nursing management practices for sustainability. Method This qualitative study was conducted using a national convenience sample of 15 Chief Nursing Officers of Magnet Recognized hospitals in the USA. Results Key macrosystem facilitators included executive management and leadership themes about quality, people, education, and the nurse executive’s commitment and intent. Barriers were executive management turnover and financial challenges. Infrastructure supports and resources for empowerment and quality and unit leadership practices were found to be essential for quality outcomes. The key theme at the microsystem level was moving nursing practice to managing outcomes from tasks; barriers were challenges with unit management turnover and development. Conclusions Multiple factors at system levels were found to contribute to sustainability. Further research is needed on the concept of sustainability. Implications for nursing management The findings contribute to executives’ armamentarium to inform management practice for the design of evidenced based organizational systems and programs for nursing excellence.