Exploratory study of mental health consultation-liaison nursing in Australia.

Mental health nursing roles in Consultation-Liaison (CL) psychiatry and emergency departments are rapidly developing within Australia since the mainstreaming of mental health services within the general health-care system. Anecdotal evidence suggests that many of these positions have been initiated and developed in relative isolation and with little formalized support. Consequently, a comprehensive understanding of these roles and the nurses who occupy them is limited. A survey was developed and distributed to gather information on CL nurses in Australia. The survey was aimed at CL nurses working in a range of settings and included questions relating to demographics, qualifications, experience, clinical practice, organizational structure, education, clinical supervision, education and training and work satisfaction. This, the first of a two-part paper, will present the key findings relating to demographics and characteristics of the role. Overall, the findings demonstrated that the CL nurses who responded to the survey (n = 56) were experienced psychiatric/mental health nurses working primarily in general hospital wards and/or emergency departments; receive requests fo rconsultation from a range of health professionals but predominantly nurses; provide education to a range of staff groups; and use a range of titles to identify their role

Exploratory study of mental health consultation-liaison nursing in Australia.

Mental health Consultation-Liaison (CL) nursing continues to develop and gain recognition as a ubspecialty of mental health nursing. CL roles are particularly important given the significant number of people experiencing mental illness and other mental health problems within the general health-care settings. However, despite the potential value of these roles, the literature provides little information about these roles and about the nurses who work in these roles. This is the second part of a two-part paper describing a survey of CL nurses in Australia. Part 1 describes demographic data and characteristics of the CL role. Part 2 provides an exploration of the following factors: educational preparation, support, and work satisfaction. The findings identified specific educational needs in preparation and ongoing support for the role. However, overall the participants expressed a high level of satisfaction with their work. Given the current recruitment problems in mental health nursing, the promotion of the CL nursing role might enhance a more positive view of this branch of nursing

Irbesartan in Marfan syndrome (AIMS): a double-blind, placebo-controlled randomised trial

Background: Irbesartan, a long acting selective angiotensin-1 receptor inhibitor, in Marfan syndrome might reduce aortic dilatation, which is associated with dissection and rupture. We aimed to determine the effects of irbesartan on the rate of aortic dilatation in children and adults with Marfan syndrome. Methods: We did a placebo-controlled, double-blind randomised trial at 22 centres in the UK. Individuals aged 6–40 years with clinically confirmed Marfan syndrome were eligible for inclusion. Study participants were all given 75 mg open label irbesartan once daily, then randomly assigned to 150 mg of irbesartan (increased to 300 mg as tolerated) or matching placebo. Aortic diameter was measured by echocardiography at baseline and then annually. All images were analysed by a core laboratory blinded to treatment allocation. The primary endpoint was the rate of aortic root dilatation. This trial is registered with ISRCTN, number ISRCTN90011794. Findings: Between March 14, 2012, and May 1, 2015, 192 participants were recruited and randomly assigned to irbesartan (n=104) or placebo (n=88), and all were followed for up to 5 years. Median age at recruitment was 18 years (IQR 12–28), 99 (52%) were female, mean blood pressure was 110/65 mm Hg (SDs 16 and 12), and 108 (56%) were taking β blockers. Mean baseline aortic root diameter was 34·4 mm in the irbesartan group (SD 5·8) and placebo group (5·5). The mean rate of aortic root dilatation was 0·53 mm per year (95% CI 0·39 to 0·67) in the irbesartan group compared with 0·74 mm per year (0·60 to 0·89) in the placebo group, with a difference in means of −0·22 mm per year (−0·41 to −0·02, p=0·030). The rate of change in aortic Z score was also reduced by irbesartan (difference in means −0·10 per year, 95% CI −0·19 to −0·01, p=0·035). Irbesartan was well tolerated with no observed differences in rates of serious adverse events. Interpretation: Irbesartan is associated with a reduction in the rate of aortic dilatation in children and young adults with Marfan syndrome and could reduce the incidence of aortic complications