Where are we now? Research-mindedness in the 1990s

Summary

• ? Nurses taking a research course carried out a research project investigating colleagues' knowledge of and attitudes to research.
• ? Only a minority of the nurses studied read nursing journals regularly.
• ? Many reported negative attitudes to research articles.
• ? Observation in wards showed limited application of research in practice.
• ? Course members gained valuable knowledge of and insights into the research process through carrying out the project

     

Long‐Term Clinical Efficacy and Risk of Catheter Ablation for Atrial Fibrillation in Octogenarians

Background: Radiofrequency ablation is an effective treatment for atrial fibrillation (AF). With improved safety, the therapy has been offered to increasingly older populations. Arrhythmia mechanisms, medical comorbidities, and safety may vary in the very elderly population. Methods: Patients presenting for AF ablation were divided into two groups [≥80 years (n = 35), <80 years (n = 717)]. AF ablation consisted of pulmonary vein antral isolation with or without additional linear lesions. A successful outcome was defined as no further AF and off all antiarrhythmic medications >3 months following 1 + ablation procedures. Results: The type of AF was similar in both groups (paroxysmal: 46% in the older group vs 54% in the younger, P = 0.33). Older patients were more likely to have a higher CHADS2 score, coronary artery disease, and less likely to have had a prior ablation. The hospital stay on average was longer in the older cohort (2.9 ± 7.7 vs 2.1 ± 1.1 days, P = 0.001). There was no increased risk of peri‐procedural complications. One‐year survival free of AF or flutter was 78% in those >80 and 75% in those younger (P = 0.78). There was no difference between groups if the AF was paroxysmal (P = 0.44) or persistent/chronic (P = 0.74). Over a 3‐year follow‐up period, five patients died and four strokes occurred all in the younger cohort. Conclusion: Octogenarian patients, despite more coexistent cardiovascular diseases, have favorable outcomes after AF ablation measured by successful rhythm management. On an average their hospital stay is longer, but no significant increase in short‐ or long‐term complications was observed. These data support AF ablation in select octogenarians. (PACE 2010; 33:146–152)     

The in vitro properties of dermal papilla cell lines established from human hair follicles

The in vitro properties of cells cultured from the dermal papilla of human hair follicles were studied and compared with those of lines of dermal fibroblasts derived from the same material. In serial subcultures, the dermal papilla cells displayed a spread out, polygonal cellular morphology at stationary growth phases and a tendency to form multi-layered aggregates before reaching confluence. Aggregation was particularly marked when papilla cells were grown on collagen gels. In contrast, dermal fibroblasts grew as branching, parallel arrays of spindle-shaped cells which remained as monolayers until confluence. Compared with dermal fibroblasts, papilla cells also exhibited a shorter in vitro survival time. The properties of cultured human papilla cells are similar to those of rat vibrissa papilla cells.     

Percutaneous endoscopic gastrostomy feeding in AIDS*

Reduced energy intake is the most important reason for weight loss in advanced human immunodeficiency virus (HIV) infection. From January 1989 to August 1995 enteral feeding via a percutaneous endoscopic gastrostomy tube (PEG) was offered to all human immunodeficiency virus(HIV)/AIDS patients attending Fairfield Hospital, Melbourne who were unable to maintain 85% ideal body weight. A total of 71 patients received enteral feeding (1000–2000 kcal/day) for a median period of 161 days (range 4–644 days). Fifty-one (72%) patients gained 5.8 ± 4.4kg (range 0.4 - 19.2kg). Nine gained 10 kg or more. The median time to maximum weight was 74 days after PEG insertion. Those who gained weight had a longer median survival, but this difference was not statistically significant (210 vs 109 days, P=0.07). The only predictor of weight gain was a CD4 count greater than 100/μL. Patients who gained weight reported improved quality of life and increased independence. However, early complications, especially wound infection, were common. Although these data have been gathered retrospectively, our experience suggests that enteral feeding can maintain or improve nutritional status and may improve quality of life in advanced HIV infection.     

Investigating the influence of treatment philosophy on outcome of methadone maintenance

This study is based on a ‘natural experiment’ in which a cohort of heroin users was assessed at one unit, then referred on geographic grounds for treatment to one of two clinics—one orientated to long-term maintenance (Clinic 2, with 61 subjects), the other to time-limited treatment aimed at achieving abstinence from all drugs including methadone (Clinic 1, 141 subjects). The outcome measure was heroin use as measured by urine testing performed regularly at both clinics. Overall, 25% of urine tests from Clinic 1 were positive for heroin compared to 18% in Clinic 2. This difference reflected in part a high rate of heroin use during the period of mandatory withdrawal from treatment in Clinic 1. Statistical models were developed to identify factors associated with heroin use. There was a strong association between methadone dose and heroin use; relative to a daily dose of 40 mg, a dose of 80 mg/day of methadone was less likely to be associated with a heroin-positive urine (OR 0.55, 95% CI [0.45,0.68]). Average doses prescribed in Clinic 1 were lower, reflecting the clinic's orientation to abstinence. Adjusting for dose, and for the fact that certain individuals tend to use heroin heavily while others do not, there was no difference between the clinics in risk of heroin use during maintenance treatment. The higher rates of heroin use in the abstinence-orientated clinic were attributable to time-limited treatment and the use of lower doses of methadone. This finding confirms that in investigating the effects of treatment factors, the powerful influence of methadone dose needs to be taken into account.     

Attitudes towards gamete donation among couples undergoing in vitro fertilization

Summary. The attitudes of 234 anonymous couples undergoing in vitro fertilization toward sperm and oocyte donation were explored by questionnaire. All the questionnaires were returned of which 222 (95%) were complete and analysed. A high proportion of couples found the use of donor sperm acceptable for therapeutic, diagnostic and treatment purposes (77%, 90% and 97% respectively) and 72%, 84% and 90% respectively were willing to donate oocytes for these purposes. Of potential oocyte donors 41% would agree to nonanonymous donation, 12% would wish to meet the recipient couple and although only 4% wanted to choose the recipient, a quarter of the couples would prefer a relative or friend as the recipient. Provision of nonidentifying information about the donor to the recipient couple was acceptable to almost 70% whereas 40% found giving the same information to the child acceptable.     

Leading edge practitioners in community pharmacy: approaches to innovation

Despite the recommendations of the Nuffield (1986) and Pharmaceutical Care (1992) reports, implementation of the “wider role” in pharmacy practice has been piecemeal. While individual pharmacists have successfully introduced innovations in tasks and working methods, others have not. The paper explores the hypothesis that innovation is related to a set of (largely) generic characteristics possessed by those who promote professional change, together with enabling elements in the work environment. The hypothesis is explored by the identification of leading edge practitioners (LEPs) by key stakeholders in pharmaceutical service delivery and tested using critical incident analysis, an extended interview schedule and a psychometric test (KAI). LEPs were found to initiate more actions, to be more patient-centred, to be effective “soft” networkers, more focused on staff development and more effective influencers. There are wide implications for both providers and purchasers of pharmaceutical care, together with those who have a responsibility for training and development.     

Blood pressure during sustained inhibitory breathing in the natural environment

Previous studies reported that breathing frequency of laboratory dogs decreased preceding the onset of an avoidance task and that this decrease was accompanied by increases in blood pressure and decreases in heart rate. Low frequency/normal tidal volume breathing has also been observed in ambulatory humans, but the cardiovascular concomitants of this inhibitory breathing pattern remain to be determined. The present study recorded blood pressure and heart rate in humans during periods of inhibitory breathing in the natural environment. Systolic and mean pressure were higher during inhibitory breathing than at other times, but no differences in diastolic pressure or heart rate were observed. Inhibitory breathing was differentially associated with the workplace and with social situations. Thus, major components of a physiological pattern that predisposes laboratory animals to sodium-sensitive experimental hypertension have now been observed to covary in ambulatory humans. Whether inhibitory breathing in the natural environment is a correlate or a cause of elevated blood pressure remains to be determined.     

‘A thorny problem for feminism’: an analysis of the subjective work experiences of enrolled nurses

• ? Feminist methodology has been used in this study to investigate the subjective work experiences of 19 enrolled nurses.
• ? Reflexive conversational techniques enabled participants to relate autobiographical narratives examining their experiences of working in a nursing hierarchy.
• ? Two themes are reported: ‘nursing identity’ and ‘exploitation’. Through an analysis of these themes insight has been gained into the manner in which nurses inter-relate.
• ? The study demonstrates how the correlation between rank, status and expertise within the nursing hierarchy may have negative consequences for patient care.