The Patient Experience After Spontaneous Coronary Artery Dissection.

OBJECTIVE: There is considerable burden of anxiety, depression, and post-traumatic stress disorder in patients with spontaneous coronary artery dissection (SCAD), yet research is limited on the experience and impact of SCAD from the patient perspective. This literature review sought to describe the current state of the literature on the patient experience of SCAD and consequences for patients following a SCAD event from the patient perspective. To better understand how people's experiences of SCAD affect their wellbeing, quality of life, lifestyles, and identity, and what would be useful from the patient perspective, an integrative review was performed. METHODS: An integrative literature review was conducted to understand the experience of SCAD and the post-event implications. Five databases were searched. Search terms included 'spontaneous coronary artery dissection', 'SCAD', 'patient', 'experience', 'perspective', and 'opinion'. English-language, peer-reviewed primary research in people with a diagnosis of SCAD that reflected the patient experience was included. Data indicating the SCAD experience including distress prevalence were extracted into an Excel spreadsheet, and narrative synthesis of included studies followed. FINDINGS: From 325 identified studies, five were included for review, yielding a combined sample of 447 participants. Patients with SCAD reported a lack of information about SCAD and the recovery process, and use of the internet for obtaining information. Patients with SCAD reported challenges in recovery including anxiety associated with fear of recurrence and uncertainty, and a need for greater support. A wide range of negative emotions was reported during and after the SCAD event. Participants reported participating in support groups, with mixed reviews of their appropriateness and effectiveness.

Making acute hospital exercises more realistic without impacting on healthcare delivery.

Exercises can suffer from a lack of realism that reduces the value of the exercise in terms of the positive experience of the participant and the possibility that outcomes are based on artificialities created by the exercise environment. It is important to minimise these so that participants actively engage and recommendations are based on robust observations. Field exercises provide the most realistic format in which to exercise but are disruptive to normal working and expensive. In a health environment, anything but the most minimal disruption to normal service would be considered unacceptable. This paper describes a possible alternative that combines different exercise formats with a simple, but well thought-out, patient simulation tool to explore the health response to two different mass casualty events. Key outcomes from these exercises are discussed to demonstrate the potential of this system when applied to the health community.

Comparative analysis of showering protocols for mass-casualty decontamination.

A well-established provision for mass-casualty decontamination that incorporates the use of mobile showering units has been developed in the UK. The effectiveness of such decontamination procedures will be critical in minimizing or preventing the contamination of emergency responders and hospital infrastructure. The purpose of this study was to evaluate three empirical strategies designed to optimize existing decontamination procedures: (1) instructions in the form of a pictorial aid prior to decontamination; (2) provision of a washcloth within the showering facility; and (3) an extended showering period. The study was a three-factor, between-participants (or "independent") design with 90 volunteers. The three factors each had two levels: use of washcloths (washcloth/no washcloth), washing instructions (instructions/no instructions), and shower cycle duration (three minutes/six minutes). The effectiveness of these strategies was quantified by whole-body fluorescence imaging following application of a red fluorophore to multiple, discrete areas of the skin. All five showering procedures were relatively effective in removing the fluorophore "contaminant", but the use of a cloth (in the absence of instructions) led to a significant ( appox. 20%) improvement in the effectiveness of decontamination over the standard protocol (p <0.05). Current mass-casualty decontamination effectiveness, especially in children, can be optimized by the provision of a washcloth. This simple but effective approach indicates the value of performing controlled volunteer trials for optimizing existing decontamination procedures.

Characterization of ZnE (E = S, Se, or Te) materials synthesized using silylated chalcogen reagents in mesoporous MCM-41.

The binary materials ZnS, ZnSe, and ZnTe have been successfully prepared within the mesoporous framework of MCM-41 at room temperature through the use of silylated chalcogen reagents. Postsynthesis grafting of ethylenediamine facilitates the complexation of anhydrous zinc acetate to the pore surface via a ligand exchange process between monodentate 3,5-lutidine ligands and the anchored chelating moiety. Coordinated zinc acetate readily reacts with E(SiMe(3))(2) (E = S, Se, or Te), thereby encapsulating zinc chalcogenides in the mesoporous channels. ZnE-MCM-41 materials have been characterized by EDX analysis, nitrogen sorption analysis, and Raman, UV-vis, and solid-state NMR spectroscopy. The observed blue shift in the absorption maximum is in agreement with the expected quantum confinement of these materials given the nanometer dimensions of the mesoporous architecture of the silicate host.

Investigations of the adsorption of n-pentane in several representative zeolites.

We have examined the adsorption of n-pentane in several representative zeolites such as silicalite (MFI), ferrierite (FER), zeolite L (LTL), and faujasite zeolites with FAU structure including siliceous Y (Si-Y) and Na-Y by using FT-Raman spectroscopy in combination with thermogravimetric analysis (TGA) with particular attention being paid to the conformational and dynamic behavior of the guest molecule. The results indicate that the framework topology mainly dictates the conformation of n-pentane in a zeolite. For the zeolites with channel systems such as silicalite, ferrierite, and zeolite L, the population of the all-trans conformer increases upon loading, given that the geometry of the isomer fits better in the channel. When n-pentane is adsorbed in zeolites with a large cavity, such as Si-Y and Na-Y, the distribution of the all-trans (TT) and trans-gauche (TG) conformers is similar to that of pure liquid, suggesting that the large supercage in the framework imposes minimal effect on the conformational equilibrium. The dynamics of the guest molecule is, however, influenced significantly by the existence of cations. Adsorption of n-pentane in a siliceous framework such as silicalite and Si-Y results in extensive molecular motion at room temperature, the degree of which decreases with decreasing temperature. In zeolites ferrierite, L, and Na-Y, the presence of cations in the framework markedly hinders the overall molecular motion. The cations clearly play a role in the observed static disorder of the guest molecule in zeolite L. Important information regarding the location of the n-pentane molecules within silicalite and ferrierite is also obtained.