Arginine metabolism in Trichomonas vaginalis infected with Mycoplasma hominis

Both Mycoplasma hominis and Trichomonas vaginalis utilize arginine as an energy source via the arginine dihydrolase (ADH) pathway. It has been previously demonstrated that M. hominis forms a stable intracellular relationship with T. vaginalis; hence, in this study we examined the interaction of two localized ADH pathways by comparing T. vaginalis strain SS22 with the laboratory-generated T. vaginalis strain SS22-MOZ2 infected with M. hominis MOZ2. The presence of M. hominis resulted in an approximately 16-fold increase in intracellular ornithine and a threefold increase in putrescine, compared with control T. vaginalis cultures. No change in the activity of enzymes of the ADH pathway could be demonstrated in SS22-MOZ2 compared with the parent SS22, and the increased production of ornithine could be attributed to the presence of M. hominis. Using metabolic flow analysis it was determined that the elasticity of enzymes of the ADH pathway in SS22-MOZ2 was unchanged compared with the parent SS22; however, the elasticity of ornithine decarboxylase (ODC) in SS22 was small, and it was doubled in SS22-MOZ2 cells. The potential benefit of this relationship to both T. vaginalis and M. hominis is discussed

What have our patients learnt after being hospitalised for an acute myocardial infarction?

Background: Education for hospitalised patients is an important aspect of care for people who have an acute cardiovascular event. Objective: To investigate the cardiovascular risk factor behaviours of patients together with their acute coronary syndrome (ACS) knowledge, attitudes and beliefs following admission to hospital for an acute myocardial infarction. Methods: Patients diagnosed with an acute myocardial infarction participated in an observational study. Patients completed a questionnaire consisting of cardiovascular risk factor behaviour questions and the ACS Response Index prior to discharge and at follow-up 10 weeks later. Results: Of the 135 participants enrolled, 114 (84%) completed follow-up, 70% were males; mean age was 63 (±11.6) years. The median length of hospital stay was 3 days (IQR 1) and the time to follow-up after discharge was 10 weeks. Self-reported risk factor behaviours improved significantly for diet (p < 0.001) and smoking cessation (p = 0.023) following discharge. At discharge 39% of patients had inadequate knowledge of ACS symptoms. The ACS Response Index improved significantly after discharge for attitudes (p = 0.004) and beliefs (p = 0.008). Despite 85% of patients indicating they would attend cardiac rehabilitation only 30% had commenced a programme at follow-up. Conclusion: Patients reported implementing a number of healthy lifestyle changes following discharge including smoking cessation and healthy eating. Attitudes and beliefs regarding ACS showed a significant improvement following discharge. More than one third of patients had inadequate knowledge at discharge, suggesting current education practices may not be meeting the needs of patients with a myocardial infarction

Patient preferences for the delivery of cardiac rehabilitation

Objective: To elicit patients' preferences for cardiac rehabilitation(CR). Methods: A Discrete Choice Experiment was used to quantify patients' preferences for the delivery of CR. This survey-based method elicited the relative importance of different characteristics of a program. Results: 200 in-patients eligible to attend CR completed the survey. Over half of the patients strongly preferred a centre-based compared to a home-based program. Many but not all preferred a program starting within two rather than six weeks of discharge and exercise delivered in a group rather than individual setting, with exercise via the internet using telehealth strongly disliked. Some respondents preferred lifestyle information delivered one-to-one by a health professional, and there was an overall preference against delivery by smart phone Apps. Some preferred a program out of rather than within working hours and a shorter program (four weeks compared to eight weeks). Conclusions: This study provides further insight into patient preferences for a CR program. Although the strongest preferences were for centre-based programs with healthcare professionals facilitating exercise classes and one-on-one education, it is important to offer flexible delivery as one approach will not suit everyone

Efficacy of a Self-Care Manual for People with Chronic Heart Failure

Abstract Chronic Heart Failure (CHF) has become a major health problem reaching epidemic proportions and imposing a considerable burden on health care systems. Chronic Heart Failure Management Programs (CHF-MPs), which have been developed to optimise care delivery, have proven to be cost-effective in reducing recurrent hospitalisations, morbidity and mortality. These programs include patient education however educational strategies vary considerably. Further research is required to inform decisions regarding the most effective intervention for patient education. This program of research aimed firstly to investigate education for people with CHF including a comprehensive assessment of their learning style, learning needs and learning preferences. Secondly a self-care education manual was developed as the building block for an educational intervention. Finally further research was undertaken to investigate the effectiveness of this educational intervention. This research has been guided by the principles of andragogy underpinned by an education process involving fours steps: assessment, planning, implementation and evaluation. For the initial assessment a systematic review of randomised controlled trials that had implemented an educational intervention for CHF patients was completed to identify effective educational interventions - Educational interventions for patients with heart failure: a systematic review of randomised controlled trials. This systematic review of 19 studies found that studies used a variety of outcome measures to evaluate their effectiveness with 15 studies demonstrating a significant effect in at least one of their outcome measures. While a variety of different educational interventions were implemented it was difficult to establish the most effective strategy as studies varied considerably in delivery methods, duration and outcome measures. To complete the assessment phase of this research two studies were undertaken. The first study investigated the learning style and learning needs of 55 patients with CHF using a Heart Failure Learning Style and Needs Inventory - The Learning Style and Learning Needs of Heart Failure Patients (The Need2Know Study). This needs assessment indicated 64% of participants preferred multimodal learning, 18% preferred read/write, 11% preferred auditory, and 7% preferred kinesthetic. In relation to educational topics signs and symptoms was ranked as the most important topic to learn followed by prognosis, risk factors, and fourthly medications. The second study investigated the learning preferences of patients with CHF - The Learning for Heart Failure Patients (The L-HF patient study.) This study involved a purposive sample of 12 participants, diagnosed with CHF, who participated in semi-structured interviews. Four themes emerged; knowledge quest, barriers to learning, facilitators for learning and meeting educational needs. Patients advocated a design of educational resources which support ‘Read, Experience, Relationship and Record’. The next step, the planning of the intervention, involved developing a self-care manual for people with CHF– the ‘GO-Getting On with Heart Failure’ manual. The need for a comprehensive written manual was supported by patients identifying they preferred to read, record and refer back to written information. The content was designed according to the patients identified learning needs. Integrating these ‘need to know’ topics into the manual aimed to engage patients in their own learning. An educational intervention based on the self-care manual with the addition of a DVD was implemented and evaluated in two studies. Firstly a pilot study using a pre-test post-test design assessed changes in knowledge and self-care abilities of 38 patients diagnosed with CHF who participated in this educational intervention. Knowledge was evaluated with the Dutch Heart Failure Knowledge Scale (DHFKS) while self-care abilities were evaluated with the Self-Care Heart Failure Index (SCHFI). Results demonstrated a statistically significant difference in the pre and post scores for knowledge (

Education material for heart failure patients: what works and what does not?

Patient education is an important element of care, but evidence with regard to education material is not always apparent, as it is intertwined with educational strategies as components of heart failure management programs. Difficulties have arisen in determining the effectiveness of particular education strategies, as multiple strategies are commonly bundled together and packaged within research protocols. To further complicate this issue, the bundles are diverse, lack precision in describing their components, and report different outcomes. Despite these difficulties, clinicians can utilise a number of proven commonalities to deliver effective education: assessment of learning needs and style, verbal interaction with a healthcare professional, and a selection of multimedia patient education materials

Cardiac clinical skill assessments for registered nurses

This article outlines a framework of clinical skill assessments that identify the knowledge and skills required for safe and competent care of cardiac patients. This framework categorizes identified cardiac skills into a logical sequence for assessment, aims to standardize the assessment process, and allows transportability of clinical skills

A systematic review of the impact of nurse-initiated medications in the emergency department

Nurse-initiated medications are one of the most important strategies used to facilitate timely care for people who present to Emergency Departments (EDs). The purpose of this paper was to systematically review the evidence of nurse-initiated medications to guide future practice and research.A systematic review of the literature was conducted to locate published studies and Grey literature. All studies were assessed independently by two independent reviewers for relevance using titles and abstracts, eligibility dictated by the inclusion criteria, and methodological quality.Five experimental studies were included in this review: one randomised controlled trial and four quasi-experimental studies conducted in paediatric and adult EDs. The nurse-initiated medications were salbutamol for respiratory conditions and analgesia for painful conditions, which enabled patients to receive the medications quicker by half-an-hour compared to those who did not have nurse-initiated medications. The intervention had no effect on adverse events, doctor wait time and length of stay. Nurse-initiated analgesia was associated with increased likelihood of receiving analgesia, achieving clinically-relevant pain reduction, and better patient satisfaction.Nurse-initiated medications are safe and beneficial for ED patients. However, randomised controlled studies are required to strengthen the validity of results

Challenges in educating a patient with severe anxiety and depression

This case report aims to outline the psychological effect an arrhythmia can have on a patient and their spouse and how anxiety has a profoundly negative effect on how a patient learns. This case report also highlights the difficulties nurses perceive in attempting to educate and engage the patient and spouse, and the problems in balancing nursing care between technology (in this case the need for constant cardiac monitoring) and more focused on patient concerns (fear of dying and defibrillator discharging). As nursing care incorporates the use of more advanced technology, it is important to ensure care remains patient-focused not technology-focused. The impact of anxiety on cognition and patient learning cannot be underestimated