The experiences of Myocardial Infarction patients readmitted within six months of Primary Percutaneous Coronary Intervention

Aims and objectives: To explore the experiences of patients readmitted due to potential ischaemic heart disease symptoms within six months of primary percutaneous coronary intervention. Background: Following myocardial infarction and primary percutaneous coronary intervention, some patients experience potential ischaemic heart disease symptoms that may lead to readmission. Symptoms may be related to cardiac ischaemia, reduced psychological health or a comorbid condition. Design: A qualitative study involving semistructured, in-depth interviews conducted once, mean 196 (50–384) days following readmission (at least six months following original ST-elevation myocardial infarction and primary percutaneous coronary intervention). This is the qualitative part of a mixed methods study. Methods: Participants were purposefully selected, and concurrent sampling, data collection and data analysis were performed. Data were organised using framework analysis; constant comparative analysis involving deduction and induction led to identification of cogent themes and subthemes. Results: Twenty-five participants (14 men, 27–79 years) experienced 1–4 readmissions; discharge diagnoses were cardiac, psychological, indeterminate, pulmonary and gastric. Three main themes emerged: (1) anxiety, uncertainty and inability to determine cause of symptoms, (2) fear of experiencing further myocardial infarction and (3) insufficient opportunity to validate self-construction of illness. Conclusion: Fear of dying or experiencing a further myocardial infarction led to patients seeking help at the time of potential ischaemic heart disease symptoms. Participants were anxious and lacked understanding regarding symptom attribution at the time of readmission and generally following their heart attack. Additionally, original heart attack symptoms were used as a comparator for future symptoms. Participants reported feeling well immediately after primary percutaneous coronary intervention but later experiencing fatigue and debilitation often linked to potential ischaemic heart disease symptoms. Relevance to clinical practice: Increased education and information related to symptom attribution post-primary percutaneous coronary intervention and postreadmission are worthy of exploration and may lead to increased understanding and reassurance for this patient group

Status of national research bioethics committees in the WHO African region

BACKGROUND: The Regional Committee for Africa of the World Health Organization (WHO) in 2001 expressed concern that some health-related studies undertaken in the Region were not subjected to any form of ethics review. In 2003, the study reported in this paper was conducted to determine which Member country did not have a national research ethics committee (REC) with a view to guiding the WHO Regional Office in developing practical strategies for supporting those countries. METHODS: This is a descriptive study. The questionnaire was prepared and sent by diplomatic pouch to all the 46 Member States in the WHO African Region, through the WHO country representatives, for facilitation and follow up. The data were entered in Excel spreadsheet and subsequently exported to STATA for analysis. A Chi-Squared test (χ(2)) for independence was undertaken to test the relationship between presence/absence of Research Ethics Committee (REC) and selected individual socioeconomic and health variables. RESULTS: The main findings were as follows: the response rate was 61% (28/46); 64% (18/28) confirmed the existence of RECs; 36% (10/28) of the respondent countries did not have a REC (although 80% of them reported that they had in place an ad hoc ethical review mechanism); 85% (22/26) of the countries that responded to this question indicated that ethical approval of research proposals was, in principle, required; and although 59% of the countries that had a REC expected it to meet every month, only 44% of them reported that the REC actually met on a monthly basis. In the Chi-Squared test, only the average population in the group of countries with a REC was statistically different (at 5% level of significance) from that of the group of countries without a REC. CONCLUSION: In the current era of globalized biomedical research, good ethics stewardship demands that every country, irrespective of its level of economic development, should have in place a functional research ethics review system in order to protect the dignity, integrity and safety of its citizens who participate in research

Gothic visions of classical architecture in Hablot Knight Browne’s “dark” illustrations for the novels of Charles Dickens

In the early gothic literature of the eighteenth century danger lurked in the darkness beneath the pointed arches of gothic buildings. During the nineteenth century there was a progressive, although never complete, dislocation of gothic literary readings from gothic architecture. This article explores a phase in that development through discussion of a series of ‘dark’ illustrations produced by Hablot Knight Browne to illustrate novels by Charles Dickens. These show the way in which the rounded arches of neo-classical architecture were depicted in the mid-nineteenth century as locales of oppression and obscurity. Such depictions acted, in an age of political and moral reform, to critique the values of the system of power and authority that such architecture represented

Child welfare inequalities: new evidence, further questions

Research internationally has identified large differences in rates of child safeguarding interventions, recently characterized as child welfare inequalities, markers of social inequalities in childhood with parallels to inequalities in health and education. This paper reports a Nuffield Foundation-funded study to examine the role of deprivation in explaining differences in key children's services interventions between and within local authorities (LAs). The study involved an analysis of descriptive data on over 10% of children on child protection plans or in out-of-home care in 14 English LAs at 31 March 2012. The data demonstrate very large inequalities in rates of child welfare interventions within and between LAs, systematically related to levels of deprivation. There is evidence of a gradient in child welfare inequalities across the whole of society. There also appears to be an equivalent of the inverse care law for health: For any given level of deprivation in local neighbourhoods, LAs with lower overall levels of deprivation were intervening more often. The findings raise fundamental questions for research, policy and practice including whether the allocation of children's service resources sufficiently recognize the impact of deprivation on demand and how we judge whether a safeguarding system is effective at the population level. Publisher statement: This is the peer reviewed version of the following article: Bywaters, P. , Brady, G.M. , Sparks, T. and Bos, E. (2014) Child welfare inequalities: new evidence, further questions. Child & Family Social Work, volume 21, issue 3, which has been published in final form at http://dx.doi.org/10.1111/cfs.12154. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for self-archiving'

Time-scarcity, ready-meals, ill-health and the obesity epidemic

In this 3-part paper, we firstly review the interaction of time-scarcity with food-choices, specifically ready-meals, and potential health consequences from their consumption. Secondly we review declared nutrients, in relation to the standard 30% of Guideline Daily Amounts, concluding that popular ready-meals from major UK supermarkets are currently nutritionally haphazard. Thirdly, we present a simple scheme to establish standards for nutritional composition of ready-meals: unless otherwise specified, any meal (the smallest unit of nutrition) as recommended to be eaten or as offered should provide 30%+10% of GDA for energy and pro rata for key nutrients (e.g. sodium, sat fat, vitamin C)

Incremental Validity of Patients’ Self-Reported Anger Beyond Structured Professional Judgment Tools in the Prediction of Inpatient Aggression

Mental health inpatients’ self-reported violence risk predicts actual aggressive outcomes. Anger, for which there are well-evidenced interventions, commonly precedes inpatient aggression. We aimed to determine whether patients’ self-reported anger added incremental validity to violence prediction beyond routinely completed violence risk assessments. A correlational, pseudo-prospective study design was employed. N = 76 inpatients in secure hospitals completed self-report validated anger measures; routinely collected clinicians' ratings on structured professional judgment tools, and aggressive incident data for a 3-month follow-up period were extracted from clinical records. Thirty four (45%) participants were violent; self-reported anger and clinician-risk ratings were significantly positively correlated. Self-reported anger predicted aggressive outcomes but not incrementally beyond relevant risk assessment subscale and item scores. It may not be beneficial for all patients to self-report anger as part of continuous violence risk assessments, but those who score highly on anger-relevant items of risk assessment tools could be considered for further assessment to support risk-management interventions

Does anxiety predict the use of urgent care by people with long term conditions? A systematic review with meta-analysis.

Objective: The role of anxiety in the use of urgent care in people with long term conditions is not fully understood. A systematic review was conducted with meta-analysis to examine the relationship between anxiety and future use of urgent healthcare among individuals with one of four long term conditions: diabetes; coronary heart disease, chronic obstructive pulmonary disease and asthma. Methods: Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane Library were conducted These searches were supplemented by hand-searching bibliographies, citation tracing eligible studies and asking experts within the field about relevant studies. Studies were eligible for inclusion if they: a) used a standardised measure of anxiety, b) used prospective cohort design, c) included adult patients diagnosed with coronary heart disease (CHD), asthma, diabetes or chronic obstructive pulmonary disease (COPD), d) assessed urgent healthcare use prospectively. Data regarding participants, methodology, and association between anxiety and urgent care use was extracted from studies eligible for inclusion. Odds ratios were calculated for each study and pooled using random effects models. Results: 8 independent studies were identified for inclusion in the meta-analysis, with a total of 28,823 individual patients. Pooled effects indicate that anxiety is not associated with an increase in the use of urgent care (OR. =. 1.078, p. =. 0.476), regardless of the type of service, or type of medical condition. Conclusions: Anxiety is not associated with increased use of urgent care. This finding is in contrast to similar studies which have investigated the role of depression as a risk factor for use of urgent care

Caught between compassion and control: exploring the challenges associated with inpatient adolescent mental healthcare in an independent hospital

Aim. To extend our understanding of how healthcare assistants construct and managedemanding situations in a secure mental health setting and to explore the effects ontheir health and well-being, to provide recommendations for enhanced support.Background. Contemporary literature acknowledges high rates of occupationalstress and burnout among healthcare assistants, suggesting the context in whichthey work places them at elevated risk of physical harm and psychologicaldistress. Yet, there is a deficit of qualitative research exploring the experiences ofhealthcare assistants in adolescent inpatient facilities.Design. An exploratory multi-method qualitative approach was used to collectdata about the challenges faced by healthcare assistants working on secureadolescent mental health wards in an independent hospital during 2014.Method. Fifteen sets of data were collected. Ten participants completed diaryentries and five participants were also interviewed allowing for triangulation.Data were analysed using Interpretive Phenomenological Analysis.Findings. The findings illustrated how inpatient mental healthcare is a unique anddistinctive area of nursing, where disturbing behaviour is often normalized anddetached from the outside world. Healthcare assistants often experienced tensionbetween their personal moral code which orientate them towards empathy andsupport and the emotional detachment and control expected by the organization,contributing to burnout and moral distress.Conclusions. This study yielded insights into mental health nursing andspecifically the phenomenon of moral distress. Given the ever-increasing demandfor healthcare professionals, the effects of moral distress on both the lives ofhealthcare assistants and patient care, merits further study