Improving care for cardiac patients with heart arrhythmias.

Sue Armstrong, Advanced Clinical Practitioner, University Hospitals of Leicester NHS Trust (suzanne.armstrong@uhl-tr.nhs.uk), won a Bronze Award in the Cardiovascular Nurse of the Year Category in the BJN Awards 2023.

Long-term results of aortic valve-sparing operations in patients with Marfan syndrome.

OBJECTIVE: The appropriateness of aortic valve-sparing operations in patients with Marfan syndrome has been questioned. This study examines the long-term results of these operations in patients with Marfan syndrome. METHODS: From 1988 to 2006, 103 consecutive patients with Marfan syndrome (mean age, 37 +/- 12 years) and aortic root aneurysm had aortic valve-sparing operations. Emergency surgery was performed in 11 patients: 8 for acute type A aortic dissection and 3 for unexplained persistent chest pain. Fourteen patients also had mitral valve surgery. The technique of aortic valve reimplantation was used in 77 patients, and aortic root remodeling was used in 26 patients. Patients were followed prospectively and underwent annual echocardiographic studies. The mean follow-up was 7.3 +/- 4.2 years and 100% complete. RESULTS: There was 1 operative death and 5 late deaths. Four of the 6 deaths were due to complications of aortic dissections. The patients' survival at 15 years was 87.2% compared with 95.6% for the general population of Ontario matched for age and sex. Seven patients had important aortic insufficiency: 4 mild to moderate, 2 moderate, and 1 moderate to severe. Freedom from greater than mild aortic insufficiency at 15 years was 79.2%. Three patients, all after aortic root remodeling, had aortic valve replacement, 2 for aortic insufficiency and 1 for endocarditis. At the most recent follow-up, 97 patients were alive: 86 were in functional class I, and 11 were in functional class II. CONCLUSIONS: Aortic valve-sparing operations provided excellent clinical outcomes in this series of patients with Marfan syndrome. Postoperatively, complications of aortic dissections were the leading cause of death.

Gender-sensitive mental health care.

OBJECTIVE: The aim of this paper is to examine aspects of mental health and mental health care through a gender lens. CONCLUSION: Gender differences have an impact on mental health and the experience and course of women's mental illness. Comprehensive gender-sensitive mental health care requires the planning, delivery, monitoring and quality improvement initiatives of mental health care to be informed by a knowledge and understanding of gender differences in women and men and their inter-relationship with respect to childhood and adult life experiences (e.g. violence and abuse); day-to-day social, cultural, and family realities; expression and experience of mental ill health and treatment needs and responses.

Results of valve preservation and repair for bicuspid aortic valve insufficiency.

BACKGROUND AND AIM OF THE STUDY: There is increasing interest in aortic valve-sparing and repair techniques for the treatment of aortic insufficiency (AI) and/or root aneurysm. The results of bicuspid aortic valve (BAV) repair at the authors' institution were evaluated. An attempt was made to assess the mode of failure and to identify surgical methods that provide durable repair results. METHODS: Aortic valve repair for BAV was performed in 71 patients (62 men, nine women; mean age 41.5 +/- 13.2 years) between 1993 and 2005. Repair techniques included cusp free margin plication (n = 47), subcommissural annuloplasty (n = 27), free margin reinforcement (n = 10), and cusp triangular resection (n = 7). Thirteen patients had remodeling of one or both aortic sinuses, and 16 had reimplantation of the aortic valve. The ascending aorta and arch were replaced in 29 and five patients, respectively. Concomitant mitral and coronary bypass surgeries were performed in 10 and three patients, respectively. RESULTS: There were no operative deaths. Early postoperative echocardiography revealed no or trace AI in 54 patients and mild AI in 17. There was only one late death which was non-cardiac-related. Eight-year freedom from endocarditis, thromboembolism and anticoagulation-related hemorrhage was 90%, 100% and 100%, respectively. Eight-year freedom from AI grade > or =3+ (moderate) and aortic valve replacement were 44% and 82%, respectively. At the latest follow up, 89% of patients were in NYHA functional class I. Patients who underwent aortic valve-sparing procedures had more stable valve function than those who had cusp repair and subcommissural plication. CONCLUSION: BAV repair is a safe procedure with good early functional results. However, recurrent AI remains a problem at five to eight years of follow up. Since dilation of the aortic root is a common cause of AI and a common feature of patients with BAV, aortic valve-sparing reimplantation operations should provide better long-term outcomes.

Prevenci'on de la mortalidad materna / editado por Erica Royston y Sue Armstrong / Preventing maternal deaths

Esta obra se propone examinar los numerosos y complejos factores que explican el enorme número de defunciones maternas evitables que siguen produciéndose año tras año. En base a más de 400 referencias bibliográficas, se documenta la gama de problemas - desde el fatalismo individual hasta los puntos flacos de los servicios sanitarios, pasando por las costumbres sociales - que es preciso entender para satisfacer las especiales necesidades de salud de la mujer, por tanto tiempo desatendidas. El libro comienza con una exposición de los problemas metodológicos en el acopio y la notificación de los datos que ayuda a entender por qué la mayoría de las tasas oficiales de mortalidad materna constituyen subestimaciones. En el segundo capítulo se revelan las dimensiones del problema mediante una revisión de la información disponible sobre tasas y riesgos vinculados con el embarazo y el parto en Africa, Asia, América Latina y los países desarrollados. Una vez definida la magnitud del problema, se examinan las causas y la prevención. Se describen primero las principales enfermedades y complicaciones del embarazo, las causas más importantes, los tipos de mujeres más vulnerables y las medidas preventivas pertinentes. El siguiente capítulo se ocupa de las defunciones causadas por los abortos; se examina el contexto social del aborto y su situación jurídica, y se demuestran sus consecuencias sanitarias en distintas partes del mundo. Asimismo, se evalúan los costos de los servicios sanitarios que tratan las complicaciones de los abortos ilegales. Otros capítulos abordan las complicaciones, a veces permanentes, del embarazo y el parto; las deficiencias logísticas que ocasionan defunciones maternas; y las modificaciones concretas que es preciso introducir en los servicios sanitarios y de planificación familiar a fin de prevenir esas muertes

Prevención de la mortalidad materna / Prevención de la mortalidad materna / Preventing maternal deaths

Hay en todo el mundo muchos miles de mujeres que viven el parto no como el acontecimiento gozoso que debería ser, sino como un momento de sufrimiento que puede incluso conducir a la muerte. En los pasíses en desarrollo en particular, la mortalidad y las lesiones maternas constituyen una tragedia de grandes proporciones. Sin embago, hasta hace muy poco tiempo los encargados de fijar las prioridades sanitarias nacionales e internacionales en gran medida pasaban por alto el problema, porque sus principales víctimas a menudo eran pobres y analfabetas y carecían de fuerza política

En los últimos años, se ha empezado a reconocer más generalmente el sufrimiento asociado al embarazo y el parto, así como el hecho de importancia capital de que gran parte de ese sufrimiento puede evitarse. En este libro se presenta un panorama general de este importante problema de salud pública y se resaltan las necesidades especiales de la mujer, durante largo tiempo desatendidas. Se desea así alentar las discusiones sobre el tema y promover en las políticas de salud pública los cambios necesarios para que la procreación sea menos peligrosa. Ya disponemos de la experiencia y los conocimientos técnicos para conseguirlo; ahora hacen falta voluntad política y el apoyo del público en general

La Prévention des décès maternels / [rédigé par] Erica Royston & Sue Armstrong / Preventing maternal deaths

La prévention des décès maternels explore les facteurs nombreux et complexes qui sont à l'origine du nombre considérable des décès maternels qui peuvent être prévenus et continuent pourtant de se produire chaque année. Sur la base de plus de 400 références à la littérature, cet ouvrage expose la gamme des problèmes - du fatalisme aux lacunes des services de santé en passant par les coutumes sociales - qu'il importe de comprendre pour apporter l'attention voulue aux besoins particuliers et si longtemps négligés des femmes en matière de santé. L'ouvrage commence par une étude des problèmes de méthodologie qui se posent au niveau de la collecte et de la notification des données et permettent de comprendre pourquoi la plupart des statistiques officielles sur la mortalité maternelle sont des sous-estimations. Le deuxième chapitre illustre les dimensions du problème par un bilan des données disponibles sur les taux de décès et les risques associés à la maternité en Afrique, en Asie, en Amérique latine et dans les pays développés. De nombreuses études de cas et des exemples tirés de recherches sur le terrain servent à explorer les différents facteurs d'ordre social, culturel et politique qui ensemble, déterminent le statut de la femme, sa santé, sa fécondité et son attitude à l'égard de la santé. Une fois cernées les dimensions du problème, l'ouvrage aborde les causes et la prévention. Il présente d'abord les principales maladies et complications de la grossesse, leurs causes premières, les types de femmes les plus exposées et les mesures préventives qui s'imposent. Les décès consécutifs à l'avortement sont examinés dans le chapitre suivant, de même que le contexte social de l'avortement, son statut juridique et ses conséquences pour la santé dans différentes parties du monde. Le coût que représente pour les services de santé le traitement des complications des avortements illicites est également analysé. D'autres chapitres sont axés sur les complications, parfois à vie, de la grossesse et de l'accouchement, sur les causes logistiques de la mortalité maternelle dans la mesure où elles tiennent aux faiblesses et aux lacunes des services de santé et sur les modifications qu'il faudrait apporter aux services de santé et de planification familiale pour prévenir la mortalité maternelle. L'ouvrage se termine par un appel à l'action en soulignant que des mesures préventives simples et peu coûteuses peuvent avoir un impact majeur sur les décès et les souffrances si longtemps considérés comme indissociables de la maternité

Preventing maternal deaths / edited by Erica Royston & Sue Armstrong / Prevención de la mortalidad materna / La Prévention des décès maternels

Explores the many complex factors responsible for the huge number of preventable maternal deaths that continue to occur each year. Utilizing more than 400 references to the literature, the book documents the range of problems from personal fatalism, through social customs, to the shortcomings of the health services that must be understood if the special and long-neglected health needs of women are to receive appropriate attention. The book opens with a discussion of methodological problems in data collection and reporting that help explain why most official maternal mortality rates are underestimates. The second chapter illustrates the dimensions of the problem through a review of available data on death rates and risks associated with childbearing in Africa, Asia, Latin America, and the developed countries. Numerous case histories and examples from field research are then used to explore the various social, cultural, and political factors which together determine the status of women, their health, fertility, and health-seeking behaviour. Factors discussed range from son preference and rules of inheritance to the link between women's perceptions of the health services and the reasons why these services so often fail to meet their needs. Having characterized the dimensions of the problem, the book turns to questions of causes and prevention. Readers are first introduced to the main diseases and complications of pregnancy, their chief cause, the types of women most likely to be affected, and relevant preventive actions. Deaths due to abortion are considered in the next chapter, which examines the social context of abortion, discusses its legal status, and documents health consequences in different parts of the world. The costs to the health services of dealing with the complications of illegal abortions are also critically assessed. Other chapters concentrate on the complications, sometimes life-long, of pregnancy and labour, the logistic causes of maternal death as these relate to weaknesses and failures in the health services, and the specific changes in health care and family planning services needed to prevent maternal deaths. The book concludes with a call to action, underscoring the capacity of simple, inexpensive preventive measures to have a major impact on the death and suffering so long condoned as part of motherhood