Managing Patients With Heart Failure: A Qualitative Study of Multidisciplinary Teams With Specialist Heart Failure Nurses

PURPOSE The purpose of this study was to explore the perceptions and experiences of health care clinicians working in multidisciplinary teams that include specialist heart failure nurses when caring for the management of heart failure patients. METHODS We used a qualitative in-depth interview study nested in a broader ethnographic study of unplanned admissions in heart failure patients (HoldFAST). We interviewed 24 health care clinicians across primary, secondary, and community care in 3 locations in the Midlands, South Central, and South West of England. RESULTS Within a framework of the role and contribution of the heart failure specialist nurse, our study identified 2 thematic areas that the clinicians agreed still represent particular challenges when working with heart failure patients. The first was communication with patients, in particular explaining the diagnosis and helping patients to understand the condition. The participants recognized that such communication was most effective when they had a long-term relationship with patients and families and that the specialist nurse played an important part in achieving this relationship. The second was communication within the team. Multidisciplinary input was especially needed because of the complexity of many patients and issues around medications, and the participants believed the specialist nurse may facilitate team communication. CONCLUSIONS The study highlights the role of specialist heart failure nurses in delivering education tailored to patients and facilitating better liaison among all clinicians, particularly when dealing with the management of comorbidities and drug regimens. The way in which specialist nurses were able to be caseworkers for their patients was perceived as a method of ensuring coordination and continuity of care

"Every structure we're taught goes out the window": General practitioners' experiences of providing help for patients with emotional concerns'

Up to 40% of general practitioners (GP) consultations contain an emotional component. General practitioners (GPs) have to provide care with limited time and resources. This qualitative study aimed to explore how GPs care for patients experiencing emotional concerns within the constraints of busy clinical practice. Seven GPs participated in three focus groups. Groups were recorded, transcribed and analysed thematically. Three themes were identified. (a) Collaboratively negotiated diagnosis: How patients' emotional concerns are understood and managed is the result of a negotiation between patient and GP belief models and the availability of treatments including talking therapy. (b) Doctor as drug: Not only is a continuous relationship between GPs and patients therapeutic in its own right, it is also necessary to effectively diagnose and engage patients in treatment as patients may experience stigma regarding emotional concerns. (c) Personal responsibility and institutional pressure: GPs feel personally responsible for supporting patients through their care journey, however, they face barriers due to lack of time and pressure from guidelines. GPs are forced to prioritise high-risk patients and experience an emotional toll. In conclusion, guidelines focus on diagnosis and a stepped-care model, however, this assumes diagnosis is relatively straightforward. GPs and patients have different models of psychological distress. This and the experience of stigma mean that establishing rapport is an important step before the GP and patient negotiate openly and develop a shared understanding of the problem. This takes time and emotional resources to do well. Longer consultations, continuity of care and formal supervision for GPs could enable them to better support patients

Varadia, a new helicarionoidean semi-slug genus from India’s Western ghats (Stylommatophora: Helicarionoidea)

We here describe a new Indian helicarionoidean genus, Varadia Bhosale & Raheem gen. nov., containing the single species Varadia amboliensis Bhosale, Thackeray, Muley & Raheem gen. et sp. nov. This new semi-slug is endemic to the northern and central Western Ghats and is primarily a forest living species. We describe and figure the shell, reproductive system, radula, spermatophore and external morphology of this new species, and detail its known distribution. We explore its relationships to other helicarionoideans using phylogenetic analyses of DNA sequence data for part of the ribosomal RNA gene cluster and discuss the morphology of the new genus in relation to other, primarily South Indian, helicarionoidean taxa. Based on characters of the reproductive system, particularly the male genitalia and the gametolytic sac, we provisionally place Varadia gen. nov. in the Macrochlamydinae (Ariophantidae). This is consistent with the results of our molecular phylogenetic analyses. The combination of large size, broad, densely tuberculated shell lobes and a shell with ca 4 whorls and a disproportionately large body whorl makes V. amboliensis gen. et sp. nov. unique among the helicarionoidean taxa of the Western Ghats. The new semi-slug is also highly distinctive in the morphology of its male genitalia

Varadia, a new helicarionoidean semi-slug genus from India’s Western ghats (Stylommatophora: Helicarionoidea)

We here describe a new Indian helicarionoidean genus, Varadia Bhosale & Raheem gen. nov., containing the single species Varadia amboliensis Bhosale, Thackeray, Muley & Raheem gen. et sp. nov. This new semi-slug is endemic to the northern and central Western Ghats and is primarily a forest living species. We describe and figure the shell, reproductive system, radula, spermatophore and external morphology of this new species, and detail its known distribution. We explore its relationships to other helicarionoideans using phylogenetic analyses of DNA sequence data for part of the ribosomal RNA gene cluster and discuss the morphology of the new genus in relation to other, primarily South Indian, helicarionoidean taxa. Based on characters of the reproductive system, particularly the male genitalia and the gametolytic sac, we provisionally place Varadia gen. nov. in the Macrochlamydinae (Ariophantidae). This is consistent with the results of our molecular phylogenetic analyses. The combination of large size, broad, densely tuberculated shell lobes and a shell with ca 4 whorls and a disproportionately large body whorl makes V. amboliensis gen. et sp. nov. unique among the helicarionoidean taxa of the Western Ghats. The new semi-slug is also highly distinctive in the morphology of its male genitalia

Comorbidity, limitations in activities and pain in patients with osteoarthritis of the hip or knee

BACKGROUND: This study aims to contribute to the knowledge of the influence of comorbidity in OA. The objectives of the study were (i) to describe the prevalence of comorbidity and (ii) to describe the relationship between comorbidity (morbidity count, severity and the presence of specific diseases) and limitations in activities and pain in elderly patients with knee or hip OA using a comprehensive inventory of comorbidity. METHODS: A cross-sectional cohort study was conducted, in which 288 elderly patients with hip or knee osteoarthritis were included. Apart from demographic and clinical data, information about comorbidity, limitations in activities (WOMAC, SF-36 and timed walking test) and pain (VAS) was collected by questionnaires and tests. Statistical analyses included descriptive statistics, multivariate regression techniques, t-tests and one-way ANOVA. RESULTS: Almost all patients suffered from at least one comorbid disease, with cardiac diseases, diseases of eye, ear, nose, throat and larynx, other urogenital diseases and endocrine/metabolic diseases being most prevalent. Morbidity count and severity index were associated with more limitations in activities and with more pain. The presence of most of the moderate or severe diseases and obesity was associated with limitations in activities or with pain. CONCLUSION: The results of this study emphasize the importance of comorbidity in the rehabilitation of elderly patients with osteoarthritis of the hip or knee. Clinical practitioners should be aware of the relationship of comorbidity with functional problems in OA patients. (aut. ref.

Rescue of Photoreceptor Degeneration by Curcumin in Transgenic Rats with P23H Rhodopsin Mutation

The P23H mutation in the rhodopsin gene causes rhodopsin misfolding, altered trafficking and formation of insoluble aggregates leading to photoreceptor degeneration and autosomal dominant retinitis pigmentosa (RP). There are no effective therapies to treat this condition. Compounds that enhance dissociation of protein aggregates may be of value in developing new treatments for such diseases. Anti-protein aggregating activity of curcumin has been reported earlier. In this study we present that treatment of COS-7 cells expressing mutant rhodopsin with curcumin results in dissociation of mutant protein aggregates and decreases endoplasmic reticulum stress. Furthermore we demonstrate that administration of curcumin to P23H-rhodopsin transgenic rats improves retinal morphology, physiology, gene expression and localization of rhodopsin. Our findings indicate that supplementation of curcumin improves retinal structure and function in P23H-rhodopsin transgenic rats. This data also suggest that curcumin may serve as a potential therapeutic agent in treating RP due to the P23H rhodopsin mutation and perhaps other degenerative diseases caused by protein trafficking defects