Supplemental oxygen and hyperbaric treatment at high altitude: Cardiac and respiratory response

Introduction: The most effective treatment for high altitude sickness is prompt descent. However, rapid descent is sometimes impossible and alternative solutions are desirable. Supplemental oxygen at ambient pressure and hyperbaric oxygen in a hyperbaric tent have both been demonstrated to improve symptoms and increase arterial oxygenation (SaO(2)) in those with high altitude sickness; however, their use in combination has not previously been described in a controlled study. Methods and Results: In this feasibility study, the SaO(2) of six healthy, well-acclimatized participants rose from 76.5 to 97.5% at 4900 m and 72.5 to 96.0% at 5700 m following the administration of oxygen via a nasal demand circuit (33 ml of oxygen per pulse) inside a hyperbaric tent (107 mmHg above ambient barometric pressure) (p

Promoting Health Behaviour Change in the Cardiac Patient

The importance of giving patients advice in relation to positive health behaviour change geared towards maximizing physical health must not be overlooked and is an important role of the cardiac nurse in contemporary health care. However, over-reliance on offering advice can often be counter-productive and less likely to achieve effective change. Patients are more likely to make positive health behaviour changes when they self-generate their own solutions to the health issues and problems that they face. In this article, the authors encourage cardiac nurses to embrace a less directive and more facilitative approach to patient health behaviour change in light of the mounting evidence that exists to the effectiveness of motivational interviewing techniques.

Using simulation to assess cardiac first-responder schemes exhibiting stochastic and spatial complexities

A Monte-Carlo simulation-based model has been constructed to assess a public health scheme involving mobile-volunteer cardiac First-Responders. The scheme being assessed aims to improve survival of Sudden-Cardiac-Arrest (SCA) patients, through reducing the time until administration of life-saving defibrillation treatment, with volunteers being paged to respond to possible SCA incidents alongside the Emergency Medical Services. The need for a model, for example, to assess the impact of the scheme in different geographical regions, was apparent upon collection of observational trial data (given it exhibited stochastic and spatial complexities). The simulation-based model developed has been validated and then used to assess the scheme's benefits in an alternative rural region (not a part of the original trial). These illustrative results conclude that the scheme may not be the most efficient use of National Health Service resources in this geographical region, thus demonstrating the importance and usefulness of simulation modelling in aiding decision making.

Assessing quality of life in cardiac rehabilitation: Choosing an appropriate tool

Quality of life is an important outcome for people undergoing cardiac rehabilitation. This paper discusses the difficulties with defining the concept of quality of life and how it might be distinct from the concept of health-related quality of life. Based on a review of the literature, a description is provided of health-related quality of life questionnaires that have been used in cardiac rehabilitation populations. Some criteria for choosing between these questionnaires are then discussed and, finally, a brief discussion is presented of the concept of response shift and how this might influence the assessment of health-related quality of life in a cardiac rehabilitation setting.