Transcatheter closure of interatrial communications for secondary prevention of paradoxical embolism: single-center experience

BACKGROUND: Patients with a patent foramen ovale (PFO) after cerebral, coronary, or systemic embolic events of presumed paradoxical origin are at risk for recurrent thromboembolism. We report our single-center experience of interventional closure of interatrial communications for secondary prevention of presumed paradoxical embolism. Methods and Results- Since 1997, percutaneous closure of interatrial communications was performed at our institution in 66 patients (mean age 47.8+/-12.7 years; 31 males) with a PFO or an atrial septal defect and at least 1 documented presumed paradoxical thromboembolic event. Fifty-eight patients had cerebral embolism, 10 had coronary embolism, and 3 had peripheral embolism. Several patients experienced multilocal arterial embolism. Fifty-four patients had a PFO, 33 of them with an atrial septal aneurysm, and 12 had an atrial septal defect. The implantation procedure was successful and without complication in all patients. After 3 months, only 2 patients showed a residual shunt, which disappeared in both cases after 12 months. In 112.2 patient-years of follow-up (range, 5 weeks to 3.5 years), we have not seen any recurrent thromboembolic event. CONCLUSIONS: Interventional closure of interatrial communications is a safe and effective therapeutic option for the secondary prevention of presumed paradoxical embolism. To further evaluate this strategy, randomized trials comparing interventional closure with anticoagulation have been initiated by us and others.     

Recollections of Nursing and Health Care in the Soviet Union

I led a party of British nurses on an Interchange of London study tour of Moscow and Leningrad early in 1986. The limitations inherent in a short tour, in which the visits were strictly organized by our hosts, are appreciated, but the party was able to visit examples of the three main institutions of care in which Soviet nurses work and to spend two evenings in informal discussion with nursing personnel. The interpretation of findings is my own and does not necessarily assume complete objectivity. Nevertheless, I have attempted to discuss data dispassionately and feel that information obtained is relevant and interesting in its own right. I have no doubt that we were shown the very best of Soviet nursing and health care, and no claims are made as to how representative the particular polyclinic, ambulance center, and hospital visited are of those in the USSR as a whole.     

The changing academic role of the nurse teacher in the United Kingdom

This paper presents findings from a national study conducted over a 3-year period (1991–94) which examined the changing role of the nurse teacher The study used multiple methods to collect data from a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers) This paper presents the findings relating to the development of the nurse teacher's academic role following the introduction of Project 2000 The issues presented and discussed include specialization within the nurse teacher's role, the nature of this specialization and the development of academic credibility and scholarship The implications of these changes in terms of the development of nursing as an academic subject area and the opportunity to contribute to the establishment of research based practice are explored     

Theoretical and practical considerations on the use of reassurance in the nursing management of anxious patients

This paper analyses the concept of reassurance in health care, arguing that it entails giving information predicting a safe outcome, plus the use of personal support to help patients feel secure The literature on anxiety management interventions is reviewed and selected findings are presented from a survey of reassurance in nursing practice based on 351 critical incidents reported by 253 nurses and 51 patients The survey concludes that reassuring strategies are indicated where patients'fears are judged to be unrealistic or excessive Accurate assessment is vital and must take into account coping styles Reassurance may also be indicated as a measure of last resort when working with cognitively impaired patients Personal support interventions are particularly valued by hospitalized patients who appear to observe individual nurses in order to assess their levels of competence and caring before requesting help     

The report of the clinical standards advisory group: standards of care for people with schizophrenia in the UK and implications for mental health nursing

The report of the clinical standards advisory group: standards of care for people with schizophrenia in the UK and implications for mental health nursing
The Clinical Standards Advisory Group Schizophrenia Committee has spent two years (1993–1995) developing a standards protocol to assist all Purchasers and Providers with the task of producing optimum services for people with schizophrenia and other serious and enduring mental illnesses. This work has been underpinned by research that included visits to a representative sample of services throughout the UK. The report of this initiative, which was published in the summer of 1995, has many implications for mental health nursing. These include the continuing necessity to focus on serious mental illness; more effort to develop multidisciplinary working and the use of the Care Programme Approach; an increased focus on relevant training in case management and psychosocial interventions; the need to recognize physical health problems; the importance of medication management; and, as the Review of Mental Health Nursing emphasized, the issue of leadership should be targeted as a priority for action.     

Assessing altered body image

Assessing altered body image.
Like pain, altered body image remains highly personal, abstract and difficult to describe. It has taken nearly a century to define the concept of body image, and to construe a reasonable working definition of altered body image (ABI). During this time, the assessment of body image has focused upon the researcher and his/her needs, rather than the professional nurse, who must arrive at a practical means to understanding patients' distress, and identify possible solutions. In this paper the author suggests parameters for the assessment of ABI in the practical arena, based both upon ongoing asthma care research and the experience of practitioners developing body image counsellor roles. It is suggested that altered body image should be assessed as part of an integrated approach, and that the complicated risk or cathexis scales developed for psychological research have limited use within the clinical setting.     

Patient Advice and Liaison Services: strengthening the voices of individual service users in health-care organizations

OBJECTIVE: To explore the roles of Patient Advice and Liaison Services (PALS) in their interactions with service users. CONTEXT: Every National Health Service health-care provider in England now has a PALS, which provides service users with information and help in resolving concerns and dissatisfactions with health care. DESIGN: Longitudinal qualitative study, 2002-4. This paper draws on data from 27 semi-structured interviews. SETTING AND PARTICIPANTS: PALS personnel working in six case study PALS in London. FINDINGS: PALS personnel adopt seven roles in order to support their clients in sorting out problems with health care: information provider; listener; messenger (passing on information from service users to staff); go-between (passing information forward and back); supporter (helping service users to present their own views); mediator (when two or more parties are in dispute); resource mobilizer (when the support of senior staff or other agencies is necessary to resolve a problem). CONCLUSIONS: Though these are not new functions, PALS is a universal service which is better placed than front-line health-care staff to offer such support, and increases choice for service users looking for sources of information and advice.     

Utilization of nursing research in practice and application strategies to raise research awareness amongst nurse practitioners: a model for success

This paper describes the views of nurse practitioners regarding the utilization of nursing research in practice and puts forward four major strategies to raise research awareness amongst students and qualified nursing staff. The aims of the study were to describe the extent to which nursing research was being used in practice and secondly the degree of nurses' awareness of current research findings relevant to their daily work. Attention also focused on strategies needed to improve research awareness amongst nurse practitioners. The study was centred on two large district general hospitals, chosen to provide contrasts. Data were collected at two points in time, over a 2½-year period, using in-depth individual and group interviews. The results of the study showed that research awareness amongst many nurses and research utilization in several practice areas were poor despite availability of a number of relevant and well-established nursing research findings. It also showed that resistance to applying nursing research to practice was often high, particularly amongst more senior nursing staff. However, it could be changed if researchers, nursing lecturers and nurse practitioners work jointly together towards promoting nursing research in practice and using: facilitation, support and encouragement; role modelling; consistency; and application in clinical practice.