Heart failure nursing in Australia: Challenges, strengths, and opportunities

Australia has a land mass similar to the United States of America, supporting a population of just over 20 million, which is distributed predominantly across the coastal perimeter. The Australian society is rich in cultural diversity fostered by decades of migration. Both these factors present challenges for health care. First, because resources are scare in rural and remote regions, health outcomes are poorer in these regions, especially among indigenous populations. Second, the cultural diversity of Australians is a challenge to providing evidence-based treatment recommendations. In Australia, in parallel with international trends, there is a strong association between socioeconomic status, chronic conditions, and health outcomes

The role of b-type natriuretic peptide in heart failure management

Summary. Heart failure is a complex clinical syndrome that manifests itself with signs and symptoms which are neither sensitive nor specific for the diagnosis of heart failure. Natriuretic peptides and in particular b-type natriuretic peptide (and nt-proBNP) are widely used in clinical practice around the world as a maker of heart failure. BNP is primarly released from the left ventricle in response to pressure and volume overload. The strongest evidence for the use of BNP is to rule in or rule out heart failure as cause of breathlessness in people who present to the emergency room. There is enthusiasm for use of BNP as a market of heart failure severity as well as a predictor of outcomes in people with heart failure and trials are ongoing. Nesiritide, a recombinant form of BNP is currently being tested as a possible treatment in people with acutely decompensated heart failure

Measurement of local convective heat transfer coefficients from a smooth and roughened NACA-0012 airfoil: Flight test data

Wind tunnels typically have higher free stream turbulence levels than are found in flight. Turbulence intensity was measured to be 0.5 percent in the NASA Lewis Icing Research Tunnel (IRT) with the cloud making sprays off and around 2 percent with cloud making equipment on. Turbulence intensity for flight conditions was found to be too low to make meaningful measurements for smooth air. This difference between free stream and wing tunnel conditions has raised questions as to the validity of results obtained in the IRT. One objective of these tests was to determine the effect of free stream turbulence on convective heat transfer for the NASA Lewis LEWICE ice growth prediction code. These tests provide in-flight heat transfer data for a NASA-0012 airfoil with a 533 cm chord. Future tests will measure heat transfer data from the same airfoil in the Lewis Icing Research Tunnel. Roughness was obtained by the attachment of small, 2 mm diameter hemispheres of uniform size to the airfoil in three different patterns. Heat transfer measurements were recorded in flight on the NASA Lewis Twin Otter Icing Research Aircraft. Measurements were taken for the smooth and roughened surfaces at various aircraft speeds and angles of attack up to four degrees. Results are presented as Frossling number versus position on the airfoil for various roughnesses and angles of attack

A method of evaluating efficiency during space-suited work in a neutral buoyancy environment

The purpose was to investigate efficiency as related to the work transmission and the metabolic cost of various extravehicular activity (EVA) tasks during simulated microgravity (whole body water immersion) using three space suits. Two new prototype space station suits, AX-5 and MKIII, are pressurized at 57.2 kPa and were tested concurrently with the operationally used 29.6 kPa shuttle suit. Four male astronauts were asked to perform a fatigue trial on four upper extremity exercises during which metabolic rate and work output were measured and efficiency was calculated in each suit. The activities were selected to simulate actual EVA tasks. The test article was an underwater dynamometry system to which the astronauts were secured by foot restraints. All metabolic data was acquired, calculated, and stored using a computerized indirect calorimetry system connected to the suit ventilation/gas supply control console. During the efficiency testing, steady state metabolic rate could be evaluated as well as work transmitted to the dynamometer. Mechanical efficiency could then be calculated for each astronaut in each suit performing each movement

An online survey of Australian physicians reported practice with the off-label use of nebulised frusemide

BACKGROUND: Off-label prescribing is common in palliative care. Despite inconsistent reports of the benefit of nebulised frusemide for breathlessness, its use continues to be reported. METHODS: An online survey was emailed to 249 members of the Australian and New Zealand Society of Palliative Medicine to estimate the use of nebulised frusemide for breathlessness by Australian physicians involved in palliative care in the previous 12 months. RESULTS: There were 52/249 (21%) respondents to the survey. The majority (44/52; 85%) had not prescribed nebulised frusemide in the previous 12 months. The most common (18/44; 43%) reason for not prescribing nebulised frusemide was a belief that there was not enough evidence to support its use. Whilst only a few respondents (8/52; 15%) reported having used nebulised frusemide, all that had used it thought there was at least some benefit in relieving breathlessness. CONCLUSION: This report adds to the series of case studies reporting some benefit from nebulised frusemide in relieving breathlessnes

End stage heart failure patients: Palliative care in general practice

Background. Chronic heart failure is common, particularly in older individuals, and comorbidities are frequent. Patients with end stage heart failure can be highly symptomatic and require careful monitoring and treatment adjustment to improve symptoms. Objective. This article summarises the fundamentals of implementing palliative care in general practice and provides guidelines on caring patients with chronic heart failure at the end of life. Discussion. The high mortality in chronic heart failure underscores the importance of effective communication, symptom management and advance care planning. The unpredictability and uncertainty around the timing of death mean that individuals, and their families, may be less likely to have an understanding of their prognosis or have access to supportive and palliative care. Ideally, patients with symptomatic chronic heart failure should be managed in collaboration with a multidisciplinary heart failure program. Symptom management can be achieved by additive therapies and access to specialist palliative care services should be considered when the symptom burden is high

Selected Precision Agriculture studies in oil palm: a 10-year summary

Precision Agriculture (PA) embodies a holistic field management strategy that allows adjustment of crop input use and cultivation methods, including seed, fertilizer, pesticide and water application, variety selection, planting, tillage and harvesting, to match varying soil, crop and other field attributes. PA involves mapping and analyzing field variability, and linking such variability to management actions. This contrasts with conventional agriculture that is based on uniform treatment(s) across a field. Oil palm is an excellent candidate for PA implementation simply because it consumes a large amount of chemical and physical inputs. However, a major constraint in implementing PA strategies on a detailed scale for oil palm is the typically large plantation size. The agronomic challenge of increasing oil palm yield productivity hinges on three primary issues: 1) fertilization, 2) cropping practices such as planting density, ground cover, pruning and drainage, and 3) pest and disease management. This paper presents a 10-year Abstract of selected PA studies carried out in Malaysian and Indonesian oil palm plantations. These studies are: spatial variability of soil fertility across topography, removal of spatial effects to improve interpretation of data from fertilizer trials, development of a non-destructive oil yield and oil quality estimation protocol, stand density assessment using remote sensing, spatial variability of soil organic carbon across different crop ages, spatial variability of orange spotting disease, discriminating between potassium deficiency and orange spotting disease symptoms using remote sensing, estimating fresh fruit bunch yields using remote sensing, and estimating palm oil quality and yield using proximal sensing

Nebulized Furosemide for the Management of Dyspnea: Does the Evidence Support Its Use?

Dyspnea is a common and distressing symptom associated with multiple chronic illness and high levels of burden for individuals, their families and health care systems. The subjective nature dyspnea and a poor understanding of pathophysiological mechanisms challenge the clinician in developing management plans. Nebulized furosemide has been identified as a novel approach to dyspnea management. This review summarizes published studies, both clinical and experimental, reporting the use of nebulized furosemide. The search criteria yielded 42 articles published in the period 1988 to 2004. Although nebulized furosemide appeared to have a positive influence on dyspnea and physiological measurements, caution must be taken with the results primarily coming from small-scale clinical trials or observation trials. Despite the limitations of the studies reported, given the range of conditions reporting effectiveness of nebulized furosemide, further investigation of this potential novel treatment of dyspnea is warranted

A review of the six-minute walk test: Its implication as a self-administered assessment tool

Promoting self-management and monitoring physical activity are important strategies in chronic heart disease (CHD) management. The six-minute walk test (6MWT) is a commonly used sub-maximal exercise test for measuring physical functional capacity. The aim of this paper is to review the current literature on 6MWT relating to methodological issues as well as exploring the potential of the protocol to be adopted as a self-administered exercise test. The Medline, CINAHL, Science Direct and the World Wide Web using the search engine Google, were searched for articles describing the administration, reliability and validity of the 6MWT. Findings of the integrative literature review the 6MWT is a simple, safe tool. To date, the capacity for self-administration of the 6MWT has not been investigated. Adapting the 6MWT as a patient-reported outcome measure may enhance the capacity, not only for clinicians to monitor functional status, but also promote self-management by enabling individuals to monitor changes in their functional capacity

Improving physical and mental health in patients with prostate cancer undergoing androgen deprivation therapy: strategies to promote and improve physical activity quality and quantity.

Objective: Prostate cancer continues to be one of the highest-incident cancers among men. Reducing serum testosterone with androgen deprivation therapy (ADT) is a common effective treatment. While well-demonstrated for cancer suppression, there are numerous adverse effects caused by ADT that can contribute to short- and long-term prognosis. Increased levels of physical activity (PA) during treatment may reduce these side effects. However, uptake of PA is low. The purpose of this review is to identify and evaluate the current literature on strategies to promote and increase the levels of PA in patients with prostate cancer undergoing ADT. Data Sources: Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and grey literature were searched using Google Scholar up until April 2020. Conclusion: At present the most appropriate modes and dosages of PA for specific ADT toxicities is not known. It is established that some PA in the form of exercise, whether aerobic or resistance, is better than being sedentary for improvements in physical health, but beyond this prescription specifics have not been established. Further research is required to understand the impact of PA on the mental and physical health of men with prostate cancer undergoing ADT. Implications for Nursing Practice: Being physically active and avoiding sedentary behaviour is important for men with prostate cancer undergoing ADT, especially the implementation of strength training. PA in the form of exercise can assist in reducing the adverse physical side effects in the short- and long-term, with limited understanding of the effects on mental health. PA improves mental health outcomes across populations, which may also translate to men with prostate cancer, although further research is required. An important strategy to improve PA within the prostate cancer population is to provide an early referral to an exercise professional, such as an accredited exercise physiologist/clinical exercise physiologist or physical therapist/physiotherapist, and is supported by research as best practice for people affected by cancer undergoing active treatment