Experiences of UK patients with hepatitis C virus infection accessing phlebotomy: A qualitative analysis.

This study provides an understanding of the experiences and perceptions of phlebotomy in people with infection who have venous damage related to injecting drug use with the aim of improving their care. Narrative interviews were conducted with 10 attendees of a phlebotomy service within an acute Trust in the south-west of England. The participants had hepatitis C infection and poor venous access due to current or former drug use. Interview audiotapes were analyzed, and the themes - conflict, emotional responses, the patient as expert, and offering solutions - were identified. In the context of this study, we discuss the difficulties associated with phlebotomy, which might explain why individuals with hepatitis C infection and venous damage disengage from health services and are less likely to undertake antiviral treatment. This research adds to the literature on phlebotomy for vulnerable groups, and recommends hepatitis C virus clinics within drug agencies, the need to review training and policy, and the development of "phlebotomy passports" to enable continuity of care between services.

Nursing care for end-stage liver disease.

Nurses are seeing more and more patients with liver disease, many of whom are under 65. Most common causes are avoidable and, as liver disease may take up to 30 years to develop, identifying those at risk is key. Patients with liver disease often have a fluctuating course of complications that needs a team approach to care. Improving end-of-life care can also reduce the number of these patients who die in hospital. This article, the first in a two-part series, explores some common complications of liver disease and best practice for nurses treating patients with end-stage liver disease.

Distribution of pH changes in mouse neonatal hypoxic-ischaemic insult.

We assessed the distribution in brain pH after neonatal hypoxic-ischaemic insult and its correlation with local injury. Postnatal day 7 mice were injected with neutral red and underwent left carotid occlusion and exposure to 8% oxygen. Images captured from the cut surface of snap-frozen brain were used to calculate the pH from the blue-green absorbance ratios. Carotid occlusion alone had no effect, but combined with hypoxia caused rapid, biphasic pH decline, with the first plateau at 15-30 min, and the second at 60-90 min. The ipsilateral dorsal cortex, hippocampus, striatum and thalamus were most affected. Contralateral pH initially showed only 30% of the ipsilateral decline, becoming more acidotic with increasing duration. Systemic blood analysis revealed, compared with hypoxia alone, that combined insult caused a 63% decrease in blood glucose (1.3 ± 0.2 mM), a 2-fold increase in circulating lactate (17.7 ± 2.9 mM), a reduction in CO(2) to 1.9 ± 0.1 kPa and a drop in pH (7.26 ± 0.06). Re-oxygenation resulted in the normalisation of systemic changes, as well as a global alkaline rebound in brain pH at 4-6 h. A topographic comparison of brain injury showed only a partial correlation with pH changes, with the severest injury occurring in the ipsilateral hippocampus and sparing acidic parts of the contralateral cortex.

An ecosystem approach to combat desertification on the Colorado Plateau.

Desertification of shrub and grassland into pinyon-juniper woodland is occurring over much of the Colorado Plateau in the southwestern United States. As trees invade, they out-compete shrubs and grasses, increasing erosion rates and reducing infiltration of moisture into the soil. This has caused habitat problems for wildlife, and reduced forage for livestock. These impacts also affect the human communities that rely on ranching and tourism related to hunting. Past land use and management practices including heavy livestock grazing, fire suppression and introduction of exotic annual plants are believed to have led to current conditions. The Montrose office of the Bureau of Land Management has implemented an ecosystem-based program to reverse the desertification process on public land. The program is centered on detailed landscape objectives describing the desired vegetation mosaic on 360,000 ha of public land. The objectives outline proportions of plant seral stages and arrays of patch sizes for each planning unit. These objectives are based on priority management issues and the need to replicate a natural vegetation mosaic. Where the existing mosaic does not meet objectives, mechanical vegetation treatments and prescribed fire are used to create early and mid-seral patches on the ground. This restored vegetation pattern and type should be sustained over time through a natural fire regime and improved livestock management. Because many uncertainties exist, an adaptive management process is being used that allows mosaic objectives to be changed or processes modified where monitoring or scientific research indicate a need.