Care for the Carers: A Self-management program for carers of people with vision impairment

Care for the Carers is a self-management program for carers of people with a vision impairment. The Care for the Carers manual includes all the materials necessary for a health professional to initiate and facilitate a six-session course for carers of people with a vision impairment. Step-by-step instructions for establishing the course and recruiting participants are also provided. The program is underpinned by the principles of self-management. The Care for the Carers program grew out of a series of workshops for carers developed for ABWA by Susan Douglas and Lisa Viska. The Care for the Carers self-management program builds upon these workshops and embeds the principles of self-management in a structured program tailored for carers of people with vision loss. This protocol aims to provide people in a care giving role with the opportunity to gain more knowledge about their partner’s or family member’s vision loss, with practical strategies to assist their partner or family member to manage their vision loss and also with skills and strategies to enhance their self-care. The Care for the Carers program comprised one component of the Vision Self-management in Practice Project, a collaborative project between the Centre for Research into Disability and Society of Curtin University and the Association for the Blind of Western Australia. The project aimed to develop and evaluate new self-management interventions, to provide health professionals with the knowledge and skills to facilitate self-management programs, and to develop organisational capacity to electronically record and monitor participant outcomes over time. The Care for the Carers component specifically aimed to empower people in a caring role, by providing them with information, strategies and skills, so as to increase their confidence in managing their caring role

771-3 Direct Characterization of F1ecalnide Binding Rates from Use-Dependent Conduction Delay In Canine Purkinje Fibers

To quantitatively characterize flecainide-induced channel blockade from usedependent conduction delay (CD), 12 canine purkinje fibers were studied using a dual microelectrode technique. During 60 sec of pacing at interstimulus intervals (ISI) of 1.25–0.4 sec with 2μM flecainide (FLEC), incremental CD followed a monoexponential time course, the rates of which were linearly related to the interpulse recovery interval (tr=ISI — action potential duration). Steady state block was an exponential function of the recovery rates. Use-dependent block derived from incremental CD and decremental squared conduction velocity (θ2) was characterized by the forward (k) and reverse (I) rate constants for the activated (a) and resting (r) states:ka (× 106) (mol-1 s-1)la (s-1)kr (× 102) (mol-1 s-1)Ir (s-1)CD7.0±2.612.0±4.40.6±1.74.01±1.63θ210.0±3.414.7±2.52.8±5.73.66±1.40Vmax(prox)6.8±2.315.9±5.05.1±10.34.22±1.11These rates reflect marked open state Na+ channel block and closed channel trapping at resting membrane potentials with FLEC. The addition of 1μM isoproterenol (ISO) to FLEC-superfused fibers reversed the FLEC-induced reduction of θ2 from 1.79±0.7 to 1.89±0.89 (m/s)2 (p=0.017) without changing V˙max. The rate constants for FLEC binding and unbinding were not altered by ISO. Thus FLEC's apparent binding rates can be quantified from its use-{jependent effects on conduction. Both ISO's selective reversal of FLEC effect on θ2 but not V˙max and the absence of changes in the rate constants suggest that the modulation of FLEC effect is due to an alteration in passive membrane properties. These characterizations will facilitate subsequent comparisons of FLEC interactions in pathologic and hyperadrenergic states in vivo

Ablation vs drug use for atrial fibrillation

The relative merits of rate and rhythm control in the treatment of patients with atrial fibrillation (AF) have been compared in several major clinical trials, none of which demonstrated a significant difference in all-cause mortality. Yet, there is clear evidence that restoration and maintenance of sinus rhythm is associated with beneficial reverse atrial and ventricular remodelling. In addition, patients may feel better if AF is resolved, and data from some post hoc analyses suggest a possible mortality benefit. These apparently contradictory findings may reflect the high risk of serious adverse events associated with currently available antiarrhythmic drugs (AAD), counterbalancing their beneficial effect in restoring sinus rhythm. Catheter ablation offers an alternative means of restoring sinus rhythm in patients with AF and several clinical trials have indicated superior outcomes in certain subgroups after ablation with or without AAD vs. antiarrhythmic therapy alone. This study reviews the relative advantages and actual use of catheter ablation and other therapeutic options in the treatment of AF, with or without concomitant heart failure or structural heart disease. Catheter ablation is recognized in the latest ACC/AHA/ESC guidelines as a valid second-line option in patients who have failed or were intolerant of first-line antiarrhythmic therapy. In the absence of new antiarrhythmics with an improved benefit/risk profile, it could become a first-line strategy for certain patient populations. The ongoing CABANA trial should confirm its impact on overall survival relative to that of pharmacological rate or rhythm control

Predatory senescence in ageing wolves

It is well established that ageing handicaps the ability of prey to escape predators, yet surprisingly little is known about how ageing affects the ability of predators to catch prey. Research into long-lived predators has assumed that adults have uniform impacts on prey regardless of age. Here we use longitudinal data from repeated observations of individually-known wolves (Canis lupus) hunting elk (Cervus elaphus) in Yellowstone National Park to demonstrate that adult predatory performance declines with age and that an increasing ratio of senescent individuals in the wolf population depresses the rate of prey offtake. Because this ratio fluctuates independently of population size, predatory senescence may cause wolf populations of equal size but different age structure to have different impacts on prey populations. These findings suggest that predatory senescence is an important, though overlooked, factor affecting predator-prey dynamics. Supplemental table S! (15 pp.) attached below

Catheter-based intervention for pulmonary vein stenosis due to fibrosing mediastinitis: The Mayo Clinic experience

AbstractIntroductionFibrosing mediastinitis (FM) is a rare but fatal disease characterized by an excessive fibrotic reaction in the mediastinum, which can lead to life-threatening stenosis of the pulmonary veins (PV). Catheter-based intervention is currently the only viable option for therapy. However, the current literature on how best to manage these difficult cases, especially in regards to sequential interventions and their potential complications is very limited.MethodsWe searched through a database of all patients who have undergone PV interventions at the Earl H. Wood Cardiac Catheterization Laboratory in Mayo Clinic, Rochester. From this collection, we selected patients that underwent PV intervention to relieve stenosis secondary to FM.ResultsEight patients were identified, with a mean age of 41years (24–59years). Five were men, and three were women. Three patients underwent balloon angioplasty alone, and five patients had stents placed. The majority of patients had acute hemodynamic and symptomatic improvement. More than one intervention was required in five patients, four patients had at least one episode of restenosis, and four patients died within four weeks of their first PV intervention.ConclusionsWe describe the largest reported case series of catheter-based intervention for PV stenosis in FM. Although catheter-based therapy improved hemodynamics, short-term vascular patency, and patient symptoms, the rate of life-threatening complications, restenosis, and mortality associated with these interventions was found to be high. Despite these associated risks, catheter-based intervention is the only palliative option available to improve quality of life in severely symptomatic patients with PV stenosis and FM. Patients with PV stenosis and FM (especially those with bilateral disease) have an overall poor prognosis in spite of undergoing these interventions due to the progressive and recalcitrant nature of the disease. This underscores the need for further innovative approaches to manage this disease

A self-controlled case series to assess the effectiveness of beta blockers for heart failure in reducing hospitalisations in the elderly

Background: To determine the suitability of using the self-controlled case series design to assess improvements in health outcomes using the effectiveness of beta blockers for heart failure in reducing hospitalisations as the example. Methods: The Australian Government Department of Veterans' Affairs administrative claims database was used to undertake a self-controlled case-series in elderly patients aged 65 years or over to compare the risk of a heart failure hospitalisation during periods of being exposed and unexposed to a beta blocker. Two studies, the first using a one year period and the second using a four year period were undertaken to determine if the estimates varied due to changes in severity of heart failure over time. Results: In the one year period, 3,450 patients and in the four year period, 12, 682 patients had at least one hospitalisation for heart failure. The one year period showed a non-significant decrease in hospitalisations for heart failure 4-8 months after starting beta-blockers, (RR, 0.76; 95% CI (0.57-1.02)) and a significant decrease in the 8-12 months post-initiation of a beta blocker for heart failure (RR, 0.62; 95% CI (0.39, 0.99)). For the four year study there was an increased risk of hospitalisation less than eight months post-initiation and significant but smaller decrease in the 8-12 month window (RR, 0.90; 95% CI (0.82, 0.98)). Conclusions: The results of the one year observation period are similar to those observed in randomised clinical trials indicating that the self-controlled case-series method can be successfully applied to assess health outcomes. However, the result appears sensitive to the study periods used and further research to understand the appropriate applications of this method in pharmacoepidemiology is still required. The results also illustrate the benefits of extending beta blocker utilisation to the older age group of heart failure patients in which their use is common but the evidence is sparse.Emmae N Ramsay, Elizabeth E Roughead, Ben Ewald, Nicole L Pratt and Philip Rya