Nursing Times open learning programme. R5: using research. Part (i): The route from research to practice (continuing education credit).
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Biomedical subjects
Publications and source records attributed to K Robinson.
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The electrocardiogram in patients with acute inferior myocardial infarction frequently displays ST depression in non-infarct leads. The significance of this finding is uncertain. The relationship between ST depression, ST elevation and arteriographic severity of coronary artery disease was explored. 22 patients with acute inferior myocardial infarction, receiving thrombolysis and undergoing acute (within seven hours of the onset of chest pain) coronary angiography were studied prospectively. The electrocardiographic ST segment elevation in the inferior leads and ST segment depression in the lateral and in the anterior precordial leads were measured. In each group of leads, the maximum value of ST deviation in any lead as well as the sum of the values for ST deviation in the individual leads was determined. Gensini scores of total coronary artery disease and component scores for the major coronary arteries were determined from the coronary arteriogram. There was a strong correlation of maximum inferior ST elevation with both maximum lateral ST depression (r = 0.96, p < 0.001) and with maximum anterior precordial ST depression (r = 0.78, p < 0.001). The corresponding correlations for sum of ST deviations were r = 0.91, p < 0.001 and r = 0.79, p < 0.001 respectively. There was no relationship between Gensini scores of coronary artery disease and measures of electrocardiographic ST segment depression or elevation. Electrocardiographic ST depression in non-infarct leads in patients with inferior myocardial infarction, does not provide information regarding the degree of coronary artery disease. The ST depression in both lateral and anterior precordial leads correlates with and is a reflection of inferior ST elevation.
Vascular disease is a major cause of morbidity and mortality in end stage renal failure patients and cannot be explained entirely by the prevalence of traditional risk factors for atherosclerosis. A high plasma homocysteine concentration, which is a risk factor for vascular disease is found in patients with end stage renal disease. The exact cause for the hyperhomocysteinaemia seen in these patients is unknown, but is probably related to altered renal metabolism of homocysteine. High homocysteine concentrations may also be attributable to a deficiency of folate, vitamin B6 or vitamin B12 although, because of supplementation, these vitamins may be present in high concentrations in renal patients. The occurrence of hyperhomocysteinaemia despite high plasma vitamin concentration could be due to altered metabolism or inhibition of intracellular vitamin activity. A number of studies have now established hyperhomocystinaemia to be an independent risk factor for atherosclerosis in patients with end-stage renal disease. Plasma homocysteine concentrations can be reduced by administration of folic acid either alone or combined with vitamin B12 or vitamin B6. The effects of such reduction on vascular risk in renal failure patients needs further study.
This paper examines factors that facilitate or impede the implementation of heart health activities in Ontario public health departments using survey (n = 262) and depth interview (n = 56) data from Canadian Heart Health Initiative-Ontario Project (CHHIOP). The data were consistent in revealing factors related to leadership, staffing, resources, internal organization, and characteristics of the surrounding community as the primary facilitators or barriers. Diversity within these common themes reflected variation due to external factors in the communities served by the health unit and factors internal to the health unit itself. The findings advance knowledge of the factors that influence predisposition and capacity to undertake community-based heart health promotion in public health departments, and they underscore the challenge of achieving integrated programs among partner agencies.