Examining the effectiveness of the nurse consultant role

The role of nurse consultant aims to strengthen leadership and to help retain experienced and expert nurses in clinical practice. This article suggests that the consultant role is an example of how a redesigned nursing role can benefit patient care and service provision.     

Ganglioglioma with anaplastic recurrence of the neuronal element following radiotherapy

Gangliogliomas are rare tumours in adults representing between 0.5% and 1% of all neuroepithelial tumours. They are of mixed cellularity comprised both of a neuronal and a glial population. Although malignant transformation is rare, and this mostly occurs in the glial element, we present a case of malignant neuroblastomatous transformation of a ganglioglioma. This is only the second ever case to our knowledge in the literature reporting the participation of the neuronal element in the malignant transformation of a ganglioglioma. In contrast with the previous published case, our patient has received post-operative therapeutic radiotherapy. The related literature is reviewed and the oncogenic role of therapeutic irradiation is discussed.     

Delays in auditory-cued step initiation are related to increased volume of white matter hyperintensities in older adults

An increased volume of white matter hyperintensities (WMH) on MRI has been associated with mobility impairments in older adults. The objective of this preliminary study was to investigate the relationship between the volume of WMH and the delays in auditory-cued step initiation. Eight subjects aged 75–83 years participated. The WMH volume in the corticospinal tracts and anterior thalamic radiations were summed. Subjects performed an auditory-cued stepping task that included two simple reaction time (SRT) trials and three choice reaction time (CRT) trials. SRT trials required subjects to step as quickly as possible with the right foot from a symmetric standing position to a single target position in response to an auditory stimulus. For the CRT trials, subjects stepped as quickly as possible to one of two possible locations, depending on the auditory stimulus. The time from the stimulus onset to the reaction time of the anticipatory postural adjustment (APA_RT) and liftoff (LO) of the right foot was computed for each stimulus. The mean APA_RT and LO were greater for the CRT steps compared with the SRT steps to the same location. Increases in WMH were significantly associated with larger APA_RT and LO during both SRT and CRT for both target locations. These data suggest that increased volume of WMH is associated with greater central processing time during voluntary step initiation, and highlight a possible mechanism that can help to explain how damage to white matter tracts affects mobility in older adults.     

Planning locally relevant Internet programs for secondary prevention of cardiovascular disease

Background

Although the Internet has been shown to be an effective tool for supporting behavioural change in other chronic diseases, less in known about the efficacy of, or need for, Internet-based interventions in the prevention of coronary heart disease (CHD).

Aims

We investigated computer literacy, consumer need and perceived usefulness of the Internet as a secondary prevention tool in people with CHD.

Methods

A two-step mixed-method process was used that included a survey and two focus groups. The 12-item survey explored participants' access and confidence using the Internet. For the focus groups, we used standard methodology.

Results

We recruited 66 (88% response rate) consecutive cardiac patients; age 36–73 years (mean 64 ± 13), mostly male (85%), whose primary language was predominantly English (67%). Seventy percent had a home computer with Internet access but only 20% reported researching their heart-health online. There was polarity between those with and without Internet access. Further, we found less women than men could complete online forms (p = 0.03) and that participants aged over 65 years were less likely to access the Internet (p < 0.01) and had lower confidence (p < 0.01) than younger counterparts. Focus groups revealed challenges of an online secondary prevention service, but participants valued relevant, practical advice and placed strong emphasis on simple web design.

Conclusion

Using a mixed-methods process we collected locally sensitive information about Internet usage and recommendations for future online health-management strategies. Some patients have more confidence using the Internet, therefore a range of multi-technological secondary prevention interventions should be considered based on individual need.