The influence of ethnicity and gender on navigating an acute coronary syndrome event

BACKGROUND

Ethnicity and gender may influence acute coronary syndrome patients recognizing symptoms and making the decision to seek care.

OBJECTIVE

To examine these potential differences in European (Caucasian), Chinese and South Asian acute coronary syndrome patients.

METHODS

In-depth interviews were conducted with 20 European (Caucasian: 10 men/10 women), 18 Chinese (10 men/eight women) and 19 South Asian (10 men/nine women) participants who were purposively sampled from those participating in a large cohort study focused on acute coronary syndrome. Analysis of transcribed interviews was undertaken using constant comparative methods.

RESULTS

Participants followed the process of: having symptoms; waiting/denying; justifying; disclosing/ discovering; acquiescing; taking action. The core category was 'navigating the experience'. Certain elements of this process were in the forefront, depending on participants' ethnicity and/or gender. For example, concerns regarding language barriers and being a burden to others varied by ethnicity. Women's tendency to feel responsibility to their home and family negatively impacted the timeliness in their decisions to seek care. Men tended to disclose their symptoms to receive help, whereas women often waited for their symptoms to be discovered by others. Finally, the thinking that symptoms were 'not-urgent' or something over which they had no control and concern regarding potential costs to others were more prominent for Chinese and South Asian participants.

CONCLUSION

Ethnic- and gender-based differences suggest that education and support, regarding navigation of acute coronary syndrome and access to care, be specifically targeted to ethnic communities.

Understanding nursing on an acute stroke unit: perceptions of space, time and interprofessional practice

AIM

This paper is a report of a study conducted to uncover nurses' perceptions of the contexts of caring for acute stroke survivors.

BACKGROUND

Nurses coordinate and organize care and continue the rehabilitative role of physiotherapists, occupational therapists and social workers during evenings and at weekends. Healthcare professionals view the nursing role as essential, but are uncertain about its nature.

METHOD

Ethnographic fieldwork was carried out in 2006 on a stroke unit in Canada. Interviews with nine healthcare professionals, including nurses, complemented observations of 20 healthcare professionals during patient care, team meetings and daily interactions. Analysis methods included ethnographic coding of field notes and interview transcripts.

FINDINGS

Three local domains frame how nurses understand challenges in organizing stroke care: 1) space, 2) time and 3) interprofessional practice. Structural factors force nurses to work in exceptionally close quarters. Time constraints compel them to find novel ways of providing care. Moreover, sharing of information with other members of the team enhances relationships and improves 'interprofessional collaboration'. The nurses believed that an interprofessional atmosphere is fundamental for collaborative stroke practice, despite working in a multiprofessional environment.

CONCLUSION

Understanding how care providers conceive of and respond to space, time and interprofessionalism has the potential to improve acute stroke care. Future research focusing on nurses and other professionals as members of interprofessional teams could help inform stroke care to enhance poststroke outcomes.

Comparison of i.v. cannula and Stevens' cannula for sub-Tenon's block

BACKGROUND

Sub-Tenon's local anaesthesia (STLA) is growing in popularity for ophthalmic surgery, and is widely regarded as safer than the alternative sharp needle techniques. Although safe, STLA is not devoid of risk. Therefore, the effectiveness of a plastic i.v. cannula was compared with the traditional metal Stevens' cannula for delivering STLA.

METHODS

In a randomized, controlled trial, the efficacy of STLA administered by either a Stevens' sub-Tenon's metal cannula or a standard 20 G Optiva i.v. plastic cannula was compared; 120 patients, undergoing cataract surgery, were randomly allocated to one of the two groups. After STLA, the primary outcome measure, kinesia of the globe, was recorded at 5 and 10 min.

RESULTS

There was no significant difference in the mean total ocular movement scores after STLA performed by either the 20 G i.v. cannula or standard 19 G sub-Tenon's cannula (P = 0.10). There was also no significant difference in any of the secondary outcome measures.

CONCLUSIONS

A 20 G Optiva i.v. cannula and the Stevens' sub-Tenon's cannula were equally effective at providing STLA.

Medical innovation, unmet medical needs, and the drug pipeline

This paper outlines and illustrates the working of a theoretical approach from the social sciences for analyzing medical innovation, unmet medical need, and the drug pipeline. Using the social history of three drugs made from recombinant DNA (insulin, human growth hormone, and tissue-plasminogen activator) the paper shows how drugs can be both technically and organizationally efficient while the needs they satisfy can be created or identified. The paper posits that drugs that require more organizational efficiency tend to satisfy identified, rather then created needs. Key words: Recombinant DNA, technical efficiency, organizational efficiency, anthropology.

Rectus muscle trauma complicating sub-Tenon's local anaesthesia

PURPOSE

To describe three cases of rectus muscle trauma in patients undergoing phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia via the inferonasal quadrant.

METHODS

Retrospective review was carried out of 3 cases from 1080 patients who underwent phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia in our unit over a 3 year period up to April 2000.

RESULTS

Two patients complained postoperatively of vertical diplopia and were shown to have restriction of elevation of the eye, which was found at surgical exploration to be due to inferior rectus muscle restriction. One patient had post-operative horizontal diplopia due restriction of abduction and exploration of the medial rectus muscle was planned.

CONCLUSION

Rectus muscle trauma is proposed as a complication of sub-Tenon's local anaesthesia and caution is advised to operators to clearly identify the sub-Tenon's space for injection of local anaesthetic.

Management of acute pain

This review discusses the inadequacies of postoperative pain management in the UK and recommendations to improve its quality. Advanced pain-relieving techniques are available; in this article we discuss the practical considerations of delivering these successfully to patients through the introduction of acute pain teams, and especially through extension of the nurses' role.

Paediatric blood pressure and anaesthesia

One percent of children have appreciably and consistently raised arterial blood pressure. A 7-year-old girl admitted for routine tonsillectomy, had unrecognised hypertension which put her at increased risk. Should anaesthetic practice take more note of paediatric blood pressures?