Paul Warner

Digoxin therapy in the elderly: pharmacokinetic considerations in nursing.

Digoxin is effective in controlling ventricular rhythm in atrial fibrillation and is used in heart failure when angiotensin converting enzyme inhibitors and diuretics are ineffective. Because use of more than 1 drug is often required with these conditions, pharmacokinetic considerations, including those related to complementary medicine, are important. Increased awareness of drug action in the elderly is important because there is often an increase in body fat and leaner muscle mass as well as changes in organ function, such as that of the kidney, which alters drug activity. Nurses have an important role to play in the safe administration of digoxin.

Opportunistic screening for cardiovascular problems in rural and remote health settings.

Background: Cardiovascular disease is the leading cause of death in Australia and the United States. It is not known if routine electrocardiogram (ECG) assessment at the community level could identify a significant proportion of people with clinically relevant ECG anomalies who could benefit from intervention. Purpose: This study aimed to elucidate the use of 3-lead ECG assessment by community nurses in rural and remote health settings. We report the findings obtained from 20-minute, lead II ECG recordings of 71 people who participated in a diabetes screening study. Results: Seven participants reported cardiac anomalies before screening. One or more ECG abnormalities were found in 45 participants. Of these, nine people who were otherwise asymptomatic showed abnormal ECG characteristics that warranted further investigation. Conclusion: Although further research is needed, incorporating routine 3-lead ECG testing in rural and remote communities may improve general health in the community by providing early recognition of cardiac anomalies in otherwise asymptomatic individuals who may be amenable to treatment. This study has implications for community nurses on two levels: opportunistic screening, monitoring and evaluation.

Use of heart rate variability infographies in identification of depression status complementing the Patient Health Questionnaire-9

Depression is a strong risk factor for chronic illness. It also increases the risk of morbidity and mortality associated with cardiovascular disease (CVD). Heart Rate Variability (HRV) analysis, which characterizes cardiovascular health and depression status can provide information on any pathophysiological effect of depression on CVD and also effect of CVD on depression. HRV measures provide additional information to the physician to improve the management of depression and prevent CVD-associated mortality. In this study time and frequency domain HRV measures were investigated for 67 cases with different levels of depression classified according to the Patient Health Questionnaire (PHQ-9). A new four-level depression range of PHQ-9 scores was then obtained by systematically modifying the standard ranges, to achieve the highest statistical HRV difference between the categories. In order to assist the assessment of depression, its progression and associated cardiovascular condition, an illustrative circular mapping of HRV measures was developed. This HRV infographic shows the normal range of HRV measures, and provides a simple graphical illustration for identifying abnormal HRV and stage of depression based on the modified PHQ-9 scale.

Twelve possible strategies for enhancing interprofessional socialisation in higher education: Findings from an interpretive phenomenological study

ABSTRACT The aim of this study was to investigate the interprofessional socialisation experiences of health professional educators (HPEs) across five health science faculties in Perth, Australia. Evidence supported the importance of educators teaching and learning together, although there was minimal evidence with regard to the type of support HPEs received or required in order to socialise interprofessionally within higher education. Interview participants comprised 26 HPEs from various health-related professions across Western Australia. An interpretive phenomenological framework was used to discover the phenomena of interprofessional socialisation. The examination of the data was undertaken via qualitative content analysis with the aid of NVivo 10 software. Content coding led to the development of categories, sub-categories, and then themes. Five themes were identified; however, only one of these themes, “interprofessional socialisation strategies within higher education,” is explored within this article. Based on the data within this theme, 12 possible socialisation strategies (formal and informal) were identified for HPEs, which could be implemented within health science faculties, taking into account the organisation’s culture and strategic intent towards interprofessional collaboration and education.

Prevalence and severity of ECG anomalies in a rural Australian population.

Aims: To determine the prevalence and severity of cardiac arrhythmias in a rural Australian population using ECG assessment. Study Design: This is a University-based research project. Comparative design with random samples used. Place and Duration of Study: School of Community Health, Charles Sturt University, Albury, NSW, Australia. Methodology: Five hundred and eight participants with or without a known history of cardiovascular disease were recruited via public media announcements indicating a health screening opportunity carried out at the local university. Their medical history was obtained and a 12-lead electrocardiography (ECG) was recorded. ECG recordings were classified into severity and prevalence determined in each category. The number of participants that had to be referred and had follow-up by the general practitioner was Original Research Article British Journal of Medicine & Medical Research, 4(7): 1558-1566, 2014 1559 determined. Results: Moderate to severe ECG anomalies, which included atrial fibrillation or left bundle branch block were identified in 58 (11.4%) of the participants. Forty (7.9%) individuals with ECG anomalies were referred to the general practitioner for further evaluation. Eight participants did not seek further advice. Twenty-two (68.8%) participants that made an appointment to see their general practitioner were either commenced on treatment, had their treatment changed or received surgery. A further 85 (16.7%) of individuals required regular follow-up in line with their ECG characteristics and other health information, presenting with non-clinical ECG changes that had the potential for adverse health outcomes in the future including long QT interval, right bundle branch block or left ventricular hypertrophy for instance. Conclusion: Our study has demonstrated that a substantial number of patients in this rural community have both ECG abnormalities and or cardiac arrhythmias that required regular review or commencement of treatment by their doctor.