Implementation of a chest pain management service improves patient care and reduces length of stay

Objective Chest pain is one of the most common complaints in patients presenting to an emergency department. Delays in management due to a lack of readily available objective tests to risk stratify patients with possible acute coronary syndromes can lead to an unnecessarily lengthy admission placing pressure on hospital beds or inappropriate discharge. The need for a co-ordinated system of clinical management based on enhanced communication between departments, timely and appropriate triage, clinical investigation, diagnosis, and treatment was identified. Methods An evidence-based Chest Pain Management Service and clinical pathway were developed and implemented, including the introduction of after-hours exercise stress testing. Results Between November 2005 and March 2013, 5662 patients were managed according to a Chest Pain Management pathway resulting in a reduction of 5181 admission nights by more timely identification of patients at low risk who could then be discharged. In addition, 1360 days were avoided in high-risk patients who received earlier diagnosis and treatment. Conclusions The creation of a Chest Pain Management pathway and the extended exercise stress testing service resulted in earlier discharge for low-risk patients; and timely treatment for patients with positive and equivocal exercise stress test results. This service demonstrated a significant saving in overnight admissions.

We know this: How to apply what you already know to treat alcohol and other drug problems

Background Implementing effective AOD supports and treatments into our daily practice can occur via a range of strategies. While specialist treatments exclusively targeting pathways toward substance reduction are an option, it is often not within the scope of many psychologists working in generalist or tertiary mental health settings. Regardless of the perceived barriers for integrating AOD practice into our work, there are key principles and approaches that can be adopted to improve the outcomes for many clients. Aim Irrespective of the client’s perceived need to address AOD issues, significant substance use will impact on the development, prognosis and treatment of most mental health conditions. Embedding AOD practice across our clinical work requires an openness to consider evidence-based approaches for all levels of substance use. Method This presentation will outline a series of approaches that all practitioners can adopt, based on the principles of harm reduction and empowerment of client’s choice. An emphasis will be made toward outlining approaches that are consistent with best practice, easily accessible and do not require extensive resources to embed. Conclusion Applying effective AOD treatments as a standard treatment component is achievable for all practitioners and is essential for achieving better outcomes for a high proportion of the community accessing treatment from psychologists.

Consensus statement on the investigation and management of non-radiographic axial spondyloarthritis (nr-axSpA)

Aim Non-radiographic axial spondyloarthritis (nr-axSpA) is axial inflammatory arthritis where plain radiographic damage is not evident. An unknown proportion of these patients will progress to ankylosing spondylitis (AS). The increasing recognition of nr-axSpA has been greatly assisted by the widespread use of magnetic resonance imaging. The aim of this article was to construct a set of consensus statements based on a literature review to guide investigation and promote best management of nr-axSpA. Methods A literature review using Medline was conducted covering the major investigation modalities and treatment options available. A group of rheumatologists and a radiologist with expertise in investigation and management of SpA reviewed the literature and formulated a set of consensus statements. The Grade system encompassing the level of evidence and strength of recommendation was used. The opinion of a patient with nr-axSpA and a nurse experienced in the care of SpA patients was also sought and included. Results The literature review found few studies specifically addressing nr-axSpA, or if these patients were included, their results were often not separately reported. Fourteen consensus statements covering investigation and management of nr-axSpA were formulated. The level of agreement was high and ranged from 8.1 to 9.8. Treatment recommendations vary little with established AS, but this is primarily due to the lack of available evidence on the specific treatment of nr-axSpA. Conclusion The consensus statements aim to improve the diagnosis and management of nr-axSpA. We aim to raise awareness of this condition by the public and doctors and promote appropriate investigation and management.

Identity, image, and sexuality in young adults with cancer

The impact of disease and treatment on a young adult's self-image and sexuality has been largely overlooked. This is surprising given that establishing social and romantic relationships is a normal occurrence in young adulthood. This article describes three female patients' cancer journeys and demonstrates how their experiences have impacted their psychosocial function and self-regard. The themes of body image, self-esteem, and identity formation are explored, in relation to implications for relationship-building and moving beyond a cancer diagnosis. This article has been written by young cancer survivors, Danielle Tindle, Kelly Denver, and Faye Lilley, in an effort to elucidate the ongoing struggle to reconcile cancer into a normal young adult's life.

The impact of safety measures on the re-offence and crash rates of drink-driving offenders in Victoria

Alcohol is a major factor in road deaths and serious injuries. In Victoria, between 2008 and 2013, 30% of drivers killed were involved in alcohol-related crashes. From the early 1980s Victoria progressively introduced a series of measures, such as driver licence cancellation and alcohol interlocks, to reduce the level of drink-driving on Victoria's roads. This project tracked drink-driving offenders to measure and understand their re-offence and road trauma involvement levels during and after periods of licensing and driving interventions. The methodology controlled for exposure by aggregating crashes and traffic violations within relevant categories (e.g. licence cancelled/relicensed/relicensing not sought) and calculated as rates 'per thousand person-years'. Inferential statistical techniques were used to compare crash and offence rates between control and treatment groups across three distinct time periods, which coincided with the introduction of new interventions. This paper focuses on the extent to which the Victorian drink-driving measures have been successful in reducing re-offending and road trauma involvement during and after periods of licence interventions. It was found that a licence cancellation/ban is an effective drink-driving countermeasure as it reduced drink-driving offending and drink-driving crashes. Interlocks also had a positive effect on drink-driving offences as they were reduced during the interlock period as well as for the entire intervention period. Possible drink-driving policy implications are briefly discussed.

Chemotherapy-induced nausea and vomiting: A narrative review to inform dietetics practice

Chemotherapy-induced nausea and vomiting (CINV) are common nutrition-impact symptoms experienced by cancer patients. They exert a detrimental effect on dietary intake, risk of malnutrition and quality of life. While CINV are primarily managed with medication, dietitians play an important role in the management of CINV-related complications such as reduced dietary intake. This review discusses the burden of nausea and vomiting which cancer patients can experience, including its effect on quality of life, nutrition status, and treatment outcomes. Implications for dietetic practice include the need to explore the nature of reported symptoms, identify predisposing risk factors, and to consider the use of a variety of interventions that are individualised to the patient’s symptoms. There are little clinical data regarding effective dietetic interventions for nausea and vomiting. In summary, this review discusses dietetic-related issues surrounding CINV including the pathophysiology, risk factors, prevalence, and both pharmacological and dietetic treatment options.

Cardiovascular diseases and vulnerable plaques: data, modeling, predictions and clinical applications PREFACE

Introduction Two symposia on “cardiovascular diseases and vulnerable plaques” Cardiovascular disease (CVD) is the leading cause of death worldwide. Huge effort has been made in many disciplines including medical imaging, computational modeling, bio- mechanics, bioengineering, medical devices, animal and clinical studies, population studies as well as genomic, molecular, cellular and organ-level studies seeking improved methods for early detection, diagnosis, prevention and treatment of these diseases [1-14]. However, the mechanisms governing the initiation, progression and the occurrence of final acute clinical CVD events are still poorly understood. A large number of victims of these dis- eases who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs [8,9]. Most cardiovascular diseases are associated with vulnerable plaques. A grand challenge here is to develop new imaging techniques, predictive methods and patient screening tools to identify vulnerable plaques and patients who are more vulnerable to plaque rupture and associated clinical events such as stroke and heart attack, and recommend proper treatment plans to prevent those clinical events from happening. Articles in this special issue came from two symposia held recently focusing on “Cardio-vascular Diseases and Vulnerable Plaques: Data, Modeling, Predictions and Clinical Applications.” One was held at Worcester Polytechnic Institute (WPI), Worcester, MA, USA, July 13-14, 2014, right after the 7th World Congress of Biomechanics. This symposium was endorsed by the World Council of Biomechanics, and partially supported by a grant from NIH-National Institute of Biomedical Image and Bioengineering. The other was held at Southeast University (SEU), Nanjing, China, April 18-20, 2014.

Lebanese Plants and Plant-Derived Compounds Against Colon Cancer

Colorectal cancer (CRC) is a major health concern and demands long-term efforts in developing strategies for screening and prevention. CRC has become a preventable disease as a consequence of a better understanding of colorectal carcinogenesis. However, current therapy is unsatisfactory and necessitates the exploration of other approaches for the prevention and treatment of cancer. Plant based products have been recognized as preventive with regard to the development of colon cancer. Therefore, the potential chemopreventive use and mechanism of action of Lebanese natural product were evaluated. Towards this aim the antitumor activity of Onopordum cynarocephalum and Centaurea ainetensis has been studied using in vitro and in vivo models. In vitro, both crude extracts were non cytotoxic to normal intestinal cells and inhibited the proliferation of colon cancer cells in a dose-dependent manner. In vivo, both crude extracts reduced the number of tumors by an average of 65% at weeks 20 (adenomas stage) and 30 (adenocarcinomas stage). The activity of the C. ainetensis extract was attributed to Salograviolide A, a guaianolide-type sesquiterpene lactone, which was isolated and identified through bio-guided fractionation. The mechanism of action of thymoquinone (TQ), the active component of Nigella sativa, was established in colon cancer cells using in vitro models. By the use of N-acetyl cysteine, a radical scavenger, the direct involvement of reactive oxygen species in TQ-induced apoptotic cells was established. The analytical detection of TQ from spiked serum and its protein binding were evaluated. The average recovery of TQ from spiked serum subjected to several extraction procedures was 2.5% proving the inability of conventional methods to analyze TQ from serum. This has been explained by the extensive binding (>98%) of TQ to serum and major serum components such as bovine serum albumin (BSA) and alpha-1-acid glycoprotein (AGP). Using mass spectrometry analysis, TQ was confirmed to bind covalently to the free cysteine in position 34 and 147 of the amino acid sequence of BSA and AGP, respectively. The results of this work put at the disposal for future development new plants with anti-cancer activities and enhance the understanding of the pharmaceutical properties of TQ, a prerequisite for its future clinical development.

Phantom limb pain: A nursing perspective

Phantom limb pain (PLP) is a neuropathic pain condition occurring after amputation of a limb. PLP affects amputees’ quality of life and results in loss of productivity and psychological distress. The origin of pain from a non-existing limb creates a challenging situation for both patients and nurses. It is imperative to provide patients and nurses with the knowledge that PLP is a real phenomenon that requires care and treatment. This knowledge will lead to reduced problems for patients by allowing them to talk about PLP and ask for help when needed. Understanding of this phenomenon will enable nurses to appreciate the unique features of this form of neuropathic pain and apply appropriate techniques to promote effective pain management. Performing accurate and frequent assessments to understand the unique characteristics of PLP, displaying a non-judgemental attitude towards patients and teaching throughout the peri-operative process are significant nursing interventions.

Pheromone-mediated mass trapping and population diversion as strategies for suppressing Carpophilus spp. (Coleoptera: Nitidulidae) in Australian stone fruit orchards

1 Five experiments were conducted during 1995-99 in stone fruit orchards on the Central Coast and in inland New South Wales, Australia, on the use of synthetic aggregation pheromones and a coattractant to suppress populations of the ripening fruit pests Carpophilus spp. (Coleoptera: Nitidulidae). 2 Perimeter-based suppression traps baited with pheromone and coattractant placed at 3m intervals around small fruit blocks, caught large numbers of Carpophilus spp. Very small populations of Carpophilus spp. occurred within blocks, and fruit damage was minimal. 3 Carpophilus spp. populations in stone fruit blocks 15-370m from suppression traps were also small and non-damaging, indicating a large zone of pheromone attractivity. 4 Pheromone/coattractant-baited suppression traps appeared to divert Carpophilus spp. from nearby (130 m) ripening stone fruit. Ten metal drums containing decomposing fruit, baited with pheromone and treated with insecticide, attracted Carpophilus spp. and appeared to reduce populations and damage to ripening fruit at distances of 200-500 m. Populations and damage were significantly greater within 200m of the drums and may have been caused by ineffective poisoning or poor quality/overcrowding of fruit resources in the drums. 5 Suppression of Carpophilus spp. populations using synthetic aggregation pheromones and a coattractant appears to be a realistic management option in stone fruit orchards. Pheromone-mediated diversion of beetle populations from ripening fruit may be more practical than perimeter trapping, but more research is needed on the effective range of Carpophilus pheromones and the relative merits of trapping compared to attraction to insecticide-treated areas.

Pheromone-trapping of Carpophilus spp. (Coleoptera: Nitidulidae) in stone fruit orchards near Gosford, New South Wales: Fauna, seasonality and effect of insecticides

Traps baited with synthetic aggregation pheromones of Carpophilus hemipterus (L.), Carpophilus mutilatus Erichson and Carpophilus davidsoni Dobson and fermenting bread dough were used to identify the fauna and monitor the seasonal abundance of Carpophilus spp. in insecticide treated peach and nectarine orchards in the Gosford area of coastal New South Wales. In four orchards 67 178 beetles were trapped during 1994–1995, with C. davidsoni (82%) and Carpophilus gaveni (Dobson) (12.2%) dominating catches. Five species (C. hemipterus, C. mutilatus, Carpophilus marginellus Motschulsky, Carpophilus humeralis (F.) and an unidentified species) each accounted for 0.2–3.2% of trapped beetles. Carpophilus davidsoni was most abundant during late September–early October but numbers declined rapidly during October, usually before insecticides were applied. Spring populations of Carpophilus spp. were very large in 1994–1995 (1843–2588 per trap per week). However, despite a preharvest population decline of approximately 95% and 2–11 applications of insecticide, 14–545 beetles per trap per week (above the arbitrary fruit damage threshold of 10 beetles per trap per week) were recorded during the harvest period and fruit damage occurred at three of the four orchards. Lower preharvest populations in 1995–1996 (< 600 per trap per week) and up to six applications of insecticide resulted in < 10 beetles per trap per week during most of the harvest period and minimal or no fruit damage. The implications of these results for the integrated management of Carpophilus spp. in coastal and inland areas of southeastern Australia are discussed.

Trap Design Effect on the Capture of Carpophilus spp. (Coleoptera: Nitidulidae) Using Synthetic Aggregation Pheromones and a Coattractant

In a series of experiments conducted in stone fruit orchards in southern Australia, water-based funnel-type traps baited with synthetic aggregation pheromone and fermenting bread dough, trapped 3- to 7-fold as many Carpophihus beetles (primarily C. dauidsoni) than wind-oriented pipe traps or dry funnel traps. The efficacy of dry funnel traps but not pipe traps, appeared to be improved by using water-filled collecting bottles. The potential for using water-based funnel traps in population suppression of Carpophilus spp. in stone fruit orchards through mass trapping is discussed.

Social skills, expectancies, and drinking in adolescents

Research in the field of teenage drinking behavior has shown relationships between both social skills and drinking and alcohol expectancies and drinking. The present research investigated the comparative power of both of these sets of variables in predicting teenage drinking behavior, as well as looking at the contribution of more global cognitive structures. It was hypothesised that adolescents with high alcohol involvement would be discriminated from those with low involvement on the basis of social skills, cognitive structures, and alcohol expectancies. Seven hundred thirty-two adolescents participated in the study. Results indicated that adolescent alcohol involvement was associated with social skills deficits, positive alcohol expectancies, and negative cognitive structures concerning parents and teachers. The results revealed that, although the bulk of the variance in drinking behavior was explained by the independent effects of social skills and expectancies, the interaction of the two constructs explained an additional and significant proportion of the variance. Implications for preventive and treatment programs are discussed.

Review of Nezara viridula (L.) management strategies and potential for IPM in field crops with emphasis on Australia

Nezara viridula (L.) is a cosmopolitan, polyphagous heteropteran that causes economic damage to many crop species. At present, control of N. viridula in Australia and other countries relies heavily upon insecticides, most of which are disruptive to beneficial insects, constituting a constraint on integrated pest management (IPM). Much research has been conducted into non-chemical control methods for N. viridula. This paper reviews the potential for and limitations of sterile insect technique, classical, inundative and conservation biological control, and trap cropping. None of these techniques appear to be adequate for control of N. viridula when used alone but there is scope for these non-chemical approaches to be adopted for use in integrated management of this pest. A proposal is given for one such integrated approach for future development. It includes biopesticides, trap crops and carefully targeted habitat manipulation to enhance arthropod natural enemies as well as area-wide management and grower education.

Floating row covers and pyriproxyfen help control silverleaf whitefly Bemisia tabaci (Gennadius) Biotype B (Homoptera: Aleyrodidae) in zucchini

In zucchini, the use of row covers until flowering and the insect growth regulator (IGR) pyriproxyfen are effective methods of reducing the number of insects, especially silverleaf whitefly (Bemisia tabaci (Gennadius) Biotype B), on plants. We compared floating row covers (FRCs) up until flowering with silverleaf whitefly (SLW) introduced (FRC + SLW), or not introduced (FRC-only), or with introduction of SLW in open plots (SLW-only), or with introduction of SLW in open plots with IGR (SLW + IGR). FRC increased temperature and humidity compared with the uncovered treatments. Average fruit weight was less (P < 0.01) for the FRC + SLW treatment compared with the other treatments and the percentage of marketable fruit was less for the FRC + SLW than for the other three treatments. This result indicates that the use of either row covers or IGR controls whiteflies, reduces fruit damage and increases the size, weight, and quality of fruit, and may also control other sap-sucking insects. However, if SLW are already present on plants, the use of FRC may reduce predation and favour build up of SLW. Thus, FRC and IGR, if used judiciously, may provide an effective alternative to broad-spectrum pesticides in small-scale cucurbit production.