Carvedilol: a countermeasure to heart failure.

Initially used primarily as an antihypertensive, the beta-blocker carvedilol is now being used to alleviate heart failure, significantly reducing hospitalizations and mortality. In this article, we discuss the pathophysiology of heart failure; carvedilol's action, long-term benefits, and administration; and potential short-term adverse effects.

Trends in needle and soil chemistry of Norway spruce and Scots pine stands in South Sweden 1985-1994.

The nutrient status of the trees and soil in 42 stands of Norway spruce (Picea abies (L.) Karst.) and Scots pine (Pinus sylvestris L.) in Scania, South Sweden was followed from 1985 to 1994. Samples from needles taken in winter 1985, 1987, 1990, and 1994, and soils in 1988 and 1993 were analyzed. Concentrations, as well as ratios to N, of K and Cu in needles of both species decreased by approximately 40% from 1985 to 1994. Soil analyses indicate ongoing soil acidification and leaching of mineral nutrients from the soil profile. Together with deposition data and corroboration from modeled scenarios, these data support the recent contention that one consequence of enhanced deposition of N and S will be the development of nutrient imbalances in trees growing in southern Sweden.

Effects of modified positioning and mobilization of back pain and delayed bleeding in patients who had received heparin and undergone angiography: a pilot study.

OBJECTIVE: To examine the effects that a modified positioning and mobilization routine had no back pain and delayed bleeding in patients who had received heparin and undergone cardiac angiography. DESIGN: An experimental research design was used. Each patient was assigned randomly to either the control group, which required 6 hours of bed rest after cardiac angiography, or the experimental group. The experimental group had modified positioning, in which the head of the bed was elevated to a maximum of 45 degrees, and modified mobilization, in which they were ambulated briefly at the bedside 4 hours after angiography. SETTING: Two cardiology units of a 700-bed urban teaching hospital in western Canada. SAMPLE: All patients admitted for nonemergent cardiac angiography were approached for consent, to attain a sample of 29 patients, and were randomly assigned to the experimental or the control group. METHOD: Each patient was randomly assigned before cardiac angiography. The assignment was confidential until the patient was admitted to the cardiac unit after angiography. A demographic tool and the McGill Present Pain Intensity Scale were used to collect data. Perception of pain was evaluated over four observation periods. A research assistant monitored sanguineous drainage on the dressing and hematoma to evaluate the presence of delayed bleeding. DATA ANALYSIS: Demographic information was analyzed primarily through descriptive statistics. Results were analyzed to compare back pain and delayed bleeding between the two groups. Wilcoxon scores and t tests both were used for analysis and correlated well with each other. RESULTS: The group with the modified positioning and mobilization routine experienced significantly less pain overall (p = 0.02), less pain at each interval, and significantly less pain intensity (p < 0.05). There was no difference in bleeding. One person in each group had an estimated blood loss of more than 100 ml through the pressure dressing. CONCLUSION: This pilot study supports our hypothesis that modifying the immobilization of patients after cardiac angiography is associated with a reduction in back pain and with no increase of delayed bleeding at the femoral access site. The results support the need for further investigation of ambulation interventions after cardiac angiography.

The effect of early ambulation on patient comfort and delayed bleeding after cardiac angiogram: a pilot study.

OBJECTIVE: To examine the effects of ambulation at 3 versus 6 hours on delayed bleeding, pain, and anxiety in patients after cardiac angiogram. DESIGN: Experimental, pretest posttest, random assignment. SETTING: Western Canadian University-affiliated tertiary care hospital. PATIENTS: Thirty-nine patients who underwent cardiac angiograms. OUTCOME MEASURES: Delayed bleeding, pain, and anxiety. INTERVENTION: The experimental group ambulated at 3 hours after cardiac angiogram; the control group ambulated at 6 hours. Delayed bleeding was evaluated by sanguinous drainage through a standard gauze pressure dressing and/or the presence of a palpable hematoma greater than 5 cm in width. Melzack's Present Pain Intensity Scale and Spielberger's State Anxiety Inventory were used to evaluate patient comfort at 2, 4, and 7 hours after angiogram and the next day. RESULTS: None of the patients experienced any delayed bleeding. Student's t test was used to compare pain levels and anxiety scores. In addition, repeated measures analysis of variance was applied to pain scores taken at 4 hours, 7 hours, and the next day. The 2-hour observation data were used as a covariate and a basis for comparison of pain at the next three observations. Patients ambulating early had significantly less pain overall (p < 0.005) and less back pain at 4 and 7 hours after angiogram (p < 0.05). There was no significant difference in the mean anxiety scores. CONCLUSION: The significant decrease in back pain of patients who ambulated earlier demonstrates the need to consider patient comfort as well as the potential risks and sequelae of delayed bleeding.