Patient Experience of Informed Consent for Diagnostic Coronary Angiogram and Follow-On Treatments

Background/Aims Coronary angiography requires a complex informed consent process as a legal and ethical requirement before treatment. This process may allow percutaneous coronary intervention to be completed as a continuation of a coronary angiography. Patients routinely consent to both interventions, but over one-quarter will only receive the diagnostic angiogram. This study explored views and understandings of the informed consent process, and associations with demographic characteristics, among patients who consented to coronary angiography and same-setting percutaneous coronary intervention, but were found to be ineligible for the latter. Methods A descriptive cross-sectional survey design was used to explore patients' views. A total of 62 participants (73% male, mean age 68.4 years) completed a 36-item survey the day after undergoing diagnostic coronary angiography. Results Female participants reported greater difficulty in recalling treatment information (P<0.03), found discussions about alternative treatments more confusing (P<0.02), and the disclosure of comprehensive risk information more of a deterrent to consent for treatment (P<0.02) compared to men. Higher levels of education were associated with greater preference for information and involvement in treatment decisions (P<0.002). Conclusions Patients who give informed consent for diagnostic coronary angiography with or without a same-setting percutaneous coronary intervention need clear comprehensive information regarding alternative options. By recognising the patient's need for information, nurses can provide an individualised explanation and reinforcement of the information provided during informed consent

Students With Emotional–Behavioral Disorders as Cross-Age Tutors: A Synthesis of the Literature

The purpose of this quantitative synthesis was to evaluate the effectiveness and related outcomes of the cross-age tutoring model when students with or at risk for emotional–behavioral disorders (EBD) serve as tutors. Research questions were posed to identify the shared and unique components (e.g., dosage, tutor training) of the cross-age tutoring model; the extent to which students with EBD can effectively serve as cross-age tutors (i.e., fidelity of implementation and tutees’ improvement); the extent to which the model was effective in promoting desired academic and/or social–emotional–behavioral outcomes for tutees and tutors with EBD; the generalization, maintenance, and social validity of the effects; and the overall methodological quality and rigor of the included studies. Findings showed common training and instructional components across interventions and that tutors with EBD can implement cross-age tutoring procedures with fidelity. The cross-age model was shown to be effective in promoting academic and social–behavioral skills for the tutees as well as the tutors. Evidence for effectiveness in improving self-concept and attitude of the tutor with EBD was inconsistent. Implications and future research considerations are discussed

Sleep Disturbance, Symptoms, Psychological Distress, and Health-Related Quality of Life in Pulmonary Arterial Hypertension

Background: Pulmonary arterial hypertension (PAH) is a devastating disease characterized by elevated pulmonary pressures that lead to right heart failure and premature mortality. Patients experience multiple symptoms including dyspnea, fatigue and chest pain, but little is known about sleep disturbance, PAH symptoms, psychological distress and health-related quality of life (HRQOL) in PAH. Aim: The purpose of this study was to describe the occurrence of sleep disturbance and compare PAH symptoms, psychological distress, and HRQOL across severity of sleep disturbance. Methods: One hundred and ninety-one participants completed a socio-demographic and clinical data form, PAH Symptom Severity Scale, Profile of Mood States (POMS) short form and the Medical Outcomes Short Form-36 (SF-36). Descriptive statistics were used to describe sleep disturbances; analysis of variance models were used to quantify differences in PAH symptoms, psychological distress and HRQOL by sleep disturbance groups. Results: The majority of participants (n=162, 85%) were women with a mean age of 53 years. Sixty-five (34%) reported no sleep disturbance; 54 (28%) mild sleep disturbance; 41 (22%) moderate sleep disturbance; and 31 (16%) severe sleep disturbance. Those reporting higher sleep disturbance severity reported worse PAH symptoms, psychological distress, and HRQOL. Conclusions: Sleep disturbance is a significant finding in PAH. Increasing levels of sleep disturbance are associated with worse PAH symptoms, psychological states, and health-related quality of life. Interventions that decrease sleep disturbances may improve symptoms and HRQOL

Patient experience of informed consent for diagnostic coronary angiogram and follow-on treatments

Background/Aims Coronary angiography requires a complex informed consent process as a legal and ethical requirement before treatment. This process may allow percutaneous coronary intervention to be completed as a continuation of a coronary angiography. Patients routinely consent to both interventions, but over one-quarter will only receive the diagnostic angiogram. This study explored views and understandings of the informed consent process, and associations with demographic characteristics, among patients who consented to coronary angiography and same-setting percutaneous coronary intervention, but were found to be ineligible for the latter. Methods A descriptive cross-sectional survey design was used to explore patients' views. A total of 62 participants (73% male, mean age 68.4 years) completed a 36-item survey the day after undergoing diagnostic coronary angiography. Results Female participants reported greater difficulty in recalling treatment information (P<0.03), found discussions about alternative treatments more confusing (P<0.02), and the disclosure of comprehensive risk information more of a deterrent to consent for treatment (P<0.02) compared to men. Higher levels of education were associated with greater preference for information and involvement in treatment decisions (P<0.002). Conclusions Patients who give informed consent for diagnostic coronary angiography with or without a same-setting percutaneous coronary intervention need clear comprehensive information regarding alternative options. By recognising the patient's need for information, nurses can provide an individualised explanation and reinforcement of the information provided during informed consent

Spatial Environmental Modeling of Autoantibody Outcomes among an African American Population

In this study of autoimmunity among a population of Gullah African Americans in South Carolina, the links between environmental exposures and autoimmunity (presence of antinuclear antibodies (ANA)) have been assessed. The study population included patients with systemic lupus erythematosus (n = 10), their first degree relatives (n = 61), and unrelated controls (n = 9) where 47.5% (n = 38) were ANA positive. This paper presents the methodology used to model ANA status as a function of individual environmental influences, both self-reported and measured, while controlling for known autoimmunity risk factors. We have examined variable dimension reduction and selection methods in our approach. Following the dimension reduction and selection methods, we fit logistic spatial Bayesian models to explore the relationship between our outcome of interest and environmental exposures adjusting for personal variables. Our analysis also includes a validation “strip” where we have interpolated information from a specific geographic area for a subset of the study population that lives in that vicinity. Our results demonstrate that residential proximity to exposure site is important in this form of analysis. The use of a validation strip network demonstrated that even with small sample numbers some significant exposure-outcome relationships can be detected

Prospectus, March 2, 1983

PARKLAND AT NIGHT…; News Digest; Evening job is preference; Two from PC named to board; StuGo challenged; Nominate now; UI feature: Engineering; 32nd open house planned; Behind in payments? This may be helpful; People want more than transportation; Auto mechanics must change with the times; Yesteryear: new car less than $900; Women\u27s History Week; Attending evening classes requires dedication; Parts available; \u2783-\u2784 aid forms ready; Parkland P.M.; Pick a winner; Rolling Stones as vital as ever; Reputations are staked on Oscar predictions; Classified; C-U happenings; Skylines; \u27Roughing it\u27 isn\u27t what it used to be; \u27Worst thing that\u27s happened to college football...\u27: take the money and run; Track wins 15 of 17 in regional; Sport shorts; Globetrotters: comedy and skill; Record now 25-1 for PC womenhttps://spark.parkland.edu/prospectus_1983/1023/thumbnail.jp

A core curriculum for the continuing professional development of nurses: Developed by the Education Committee on behalf of the Council on Cardiovascular Nursing and Allied Professions of the ESC

Background: The European Society of Cardiology and the Council on Cardiovascular Nursing and Allied Professions share a vision; to decrease the burden of cardiovascular disease in Europe. Nurses represent the largest sector of the health professional workforce and have a significant contribution to make, which has not yet been fully realised. Recent evidence highlights an association between the level of nurse education and inpatient mortality making this an important topic, particularly as the provision of nurse education in Europe is variable. Aim: To develop a core curriculum to inform the education of nurses following initial qualification for work in cardiovascular settings. Method: A syllabus was developed using published literature, policy documents and existing curricula with expert input from service users, specialist nurses, cardiologists, educationalists and academics. The syllabus formed the framework for the development of the core curriculum. Results: Eight key themes characterise the core curriculum which are presented together with an account of the development process. While the curriculum is not intended to cover all aspects of the highly complex role of the cardiovascular nurse, the themes do exemplify the science and art of nursing and are transferable across different levels of clinical practice and settings. The curriculum functions both as a ‘map’, which identifies key themes to include in nurse education, and as a ‘tool’ to inform educational provision that bridges’ the gap between initial nurse education and advanced specialist practice. Content can be adapted for use to fit the national context and reflects the specific needs, health priorities, legislative and regulatory standards that govern safe nursing practice across different countries. Conclusion: The core curriculum can be used as a learning framework to guide nurse education, in particular the continuing professional education of post-qualifying nurses working in cardiovascular settings. This represents a significant step towards streamlining cardiovascular nurse education in Europ

Future directions in research on beaked whales

Until the 1990s, beaked whales were one of the least understood groups of large mammals. Information on northern bottlenose whales (Hyperoodon ampullatus) and Baird’s beaked whales (Berardius bairdii) was available from data collected during whaling, however, little information existed on the smaller species other than occasional data gleaned from beach-cast animals. Recent research advances have been plentiful. Increasing global survey effort, together with morphometric and genetic analyses have shown at least 22 species in this group. Longitudinal field studies of at least four species (H. ampullatus, B. bairdii, Ziphius cavirostris, Mesoplodon densirostris) have become established over the last three decades. Several long-term studies support photo-identification catalogs providing insights into life history, social structure and population size. Tag-based efforts looking at diving, movements and acoustics have provided detail on individual behavior as well as population structure and ranges. Passive acoustic monitoring has allowed long-term and seasonal monitoring of populations. Genetic studies have uncovered cryptic species and revealed contrasting patterns of genetic diversity and connectivity amongst the few species examined. Conservation concern for these species was sparked by mass strandings coincident with military mid-frequency sonar use. Fat and gas emboli have been symptomatic indicators of mortalities related to sonar exposure, suggesting that their vulnerability stems from the physiological exertion of extreme diving for medium-sized whales. Behavioral response experiments have now shown that beaked whales appear to cease foraging and delay their return to foraging and/or leave the area in association with exposure to mid-frequency signals at low acoustic levels. Future priorities for these species will be to (1) continue field-studies to better understand smaller-scale habitat use, vital rates and social structure; (2) develop better detection methods for larger-scale survey work; (3) improve methodology for monitoring energetics, individual body condition and health; (4) develop tools to better understand physiology; (5) use recent genetic advances with improved sample databanks to re-examine global and local beaked whale relationships; (6) further quantify anthropogenic impacts (both sonar and other noise) and their population consequences (7) apply acquired data for realistic mitigation of sonar and other anthropogenic impacts for beaked whale conservation.Publisher PDFPeer reviewe

Non-pharmacological interventions to reduce psychological distress in patients undergoing diagnostic cardiac catheterization: a rapid review

Abstract Background: Cardiac catheterization is the standard procedure for the diagnosis of coronary heart disease. The threat physically and emotionally from this procedure can effect the patient’s perception of their health. The heightened psychological distress associated with this diagnostic procedure can cause adverse patient outcomes. Non-pharmacologic interventions have been implemented to reduce psychological distress associated with cardiac catheterization. Aims: The objective of this rapid review is to assess the efficacy of non-pharmacologic interventions (procedural education, relaxation techniques, psychological preparation) on psychological distress experienced by patients as they undergo a cardiac catheterization. Methods: Published, peer-reviewed, English-language intervention studies from 1981 to 2014 were identified in a search of CINAHL, Medline, and Cochrane Library. Eligible studies included adults undergoing cardiac catheterization. Studies included in this review used experimental and quasi-experimental designs and assessed at least one primary outcome: anxiety, depression, and pain to test non-pharmacologic interventions pre and post-cardiac catheterization. Researchers independently extracted data from included studies and completed a quality assessment using a published tool. Data was synthesised as a narrative. Results: There were 29 eligible experimental and quasi-experimental studies that tested the 3 interventions (n=2504). Findings suggest that non-pharmacologic interventions were able to effectively reduce psychological distress in some patients undergoing cardiac catheterization. Conclusion: Evidence is stronger in recent studies that non-pharmacologic interventions of procedural education and psychological preparation can reduce psychological distress in patients undergoing cardiac catheterization. Further research is needed to define the various relaxation techniques that can be effectively implemented for patients undergoing cardiac catheterization

Biogeography in the deep : hierarchical population genomic structure of two beaked whale species

Funding for this research was provided by the Office of Naval Research, Award numbers N000141613017 and N000142112712. ABO was supported by a partial studentship from the University of St Andrews, School of Biology; OEG by the Marine Alliance for Science and Technology for Scotland (Scottish Funding Council grant HR09011); ELC by a Rutherford Discovery Fellowship from the Royal Society of New Zealand Te Aparangi; NAS by a Ramon y Cajal Fellowship from the Spanish Ministry of Innovation; MLM by the European Union’s Horizon 2020 Research and Innovation Programme (Marie Skłodowska-Curie grant 801199); CR by the Marine Institute (Cetaceans on the Frontier) and the Irish Research Council; and MTO by the Hartmann Foundation.The deep sea is the largest ecosystem on Earth, yet little is known about the processes driving patterns of genetic diversity in its inhabitants. Here, we investigated the macro- and microevolutionary processes shaping genomic population structure and diversity in two poorly understood, globally distributed, deep-sea predators: Cuvier’s beaked whale (Ziphius cavirostris) and Blainville’s beaked whale (Mesoplodon densirostris). We used double-digest restriction associated DNA (ddRAD) and whole mitochondrial genome (mitogenome) sequencing to characterise genetic patterns using phylogenetic trees, cluster analysis, isolation-by-distance, genetic diversity and differentiation statistics. Single nucleotide polymorphisms (SNPs; Blainville’s n = 43 samples, SNPs=13988; Cuvier’s n = 123, SNPs= 30479) and mitogenomes (Blainville’s n = 27; Cuvier’s n = 35) revealed substantial hierarchical structure at a global scale. Both species display significant genetic structure between the Atlantic, Indo-Pacific and in Cuvier’s, the Mediterranean Sea. Within major ocean basins, clear differentiation is found between genetic clusters on the east and west sides of the North Atlantic, and some distinct patterns of structure in the Indo-Pacific and Southern Hemisphere. We infer that macroevolutionary processes shaping patterns of genetic diversity include biogeographical barriers, highlighting the importance of such barriers even to highly mobile, deep-diving taxa. The barriers likely differ between the species due to their thermal tolerances and evolutionary histories. On a microevolutionary scale, it seems likely that the balance between resident populations displaying site fidelity, and transient individuals facilitating gene flow, shapes patterns of connectivity and genetic drift in beaked whales. Based on these results, we propose management units to facilitate improved conservation measures for these elusive species.Publisher PDFPeer reviewe