Primary angioplasty for heart attack: mismatch between expectations and reality?

AIM: This paper is a report of a study to explore patients' experiences of primary angioplasty and assess their illness perceptions during early recovery. BACKGROUND: Primary angioplasty is recognized as the gold standard treatment for patients with ST elevation myocardial infarction, yet little is known about patients' experiences of this treatment. Recent policy change has emphasized the need for clinical practice to be more patient-centred. One way to achieve this is to understand patients' experiences of treatment better. METHOD: A mixed methods exploratory study was carried out in 2006-2007 with a purposive sample of 29 patients. Data were collected 3-12 days after hospital discharge using (a) semi-structured interviews to explore participants' experiences and (b) The Illness Perception Questionnaire to evaluate illness perceptions. Interview data were analysed using the Framework approach. Questionnaire data were used to inform the qualitative findings. FINDINGS: Participants were very positive about their treatment but experienced considerable emotional shock, which was exacerbated by the speed with which events occurred. Patients' experiences were characterized by a mismatch between their expectations and reality. Questionnaire data supported the notion that they experienced difficulty in 'making sense' of their condition in a coherent way. They tended to see their condition as 'acute' rather than 'chronic' and their treatment as curative. CONCLUSION: Patient education should include focused discussions addressing the 'mismatches' that may occur between their expectations and reality. In this way, a more coherent understanding can be promoted, with greater awareness of heart disease as a long-term condition requiring ongoing self-management.

Effects of backpack carriage on gait parameters in children.

PURPOSE: Carrying a backpack over 2 shoulders is the most efficient means of carriage, but often backpacks are carried over 1 shoulder. Our purpose was to assess walking base of support, stride length, double support time, and velocity when backpacks were carried on 1 or 2 shoulders. METHODS: Thirty-two children (12-13 years) were assessed under 2 load conditions using the GAITRite system. RESULTS: No significant differences were found in base of support, stride length, or velocity when compared with the unloaded baseline walk. Double limb support significantly increased (p < 0.0001) with both load conditions when compared with the baseline, but not between 1-shoulder and 2-shoulders carriage. CONCLUSION: Little change in temporal-spatial gait parameters was noted during backpack use with loads limited to 15% body weight. Future studies need to examine the effects of the child's height, body mass index, and strength on safe backpack use.

The information needs of patients treated with primary angioplasty for heart attack: an exploratory study.

OBJECTIVE: As early recovery is a challenging period for cardiac patients who frequently have 'unmet' health information needs, the objective of this study was to explore the information needs of patients treated with primary angioplasty for heart attack. METHODS: Qualitative methodology using semi-structured interviews with 29 patients recruited from a specialist English Cardiology centre, 3-12 days after discharge from hospital. Framework analysis techniques were used to synthesise findings. RESULTS: Participants were generally satisfied with the way in which health information was provided. The need for more specific information about the risk of recurrence, the level of heart muscle damage, discharge medications, appropriate levels of physical activity and diet was highlighted. There was no clear preference for informant and preferences for the timing of information delivery varied considerably. CONCLUSION: Health information provision was satisfactory for most but could be improved by the closer matching of patients' preferences with provision. The shortened hospital stay, rapid throughput and emotional shock experienced by patients influenced their ability to absorb information making the optimum timing for health information delivery variable. PRACTICE IMPLICATIONS: Current guidelines about the provision of health information for patients recovering from heart attack may need to be reviewed to reflect the recent technological advances in treatment. One approach may be to better 'stage' information to reflect patients' priorities. Home visits by specialist nurses may need to be scheduled earlier to improve continuity of care and address information 'gaps'.

Invertebrate D2 type dopamine receptor exhibits age-based plasticity of expression in the mushroom bodies of the honeybee brain.

We have isolated a cDNA clone from the honeybee brain encoding a dopamine receptor, AmDop2, which is positively coupled to adenylyl cyclase. The transmembrane domains of this receptor are 88% identical to the orthologous Drosophila D2 dopamine receptor, DmDop2, though phylogenetic analysis and sequence homology both indicate that invertebrate and vertebrate D2 receptors are quite distinct. In situ hybridization to mRNA in whole-mount preparations of honeybee brains reveals gene expression in the mushroom bodies, a primary site of associative learning. Furthermore, two anatomically distinct cell types in the mushroom bodies exhibit differential regulation of AmDop2 expression. In all nonreproductive females (worker caste) and reproductive males (drones) the receptor gene is strongly and constitutively expressed in all mushroom body interneurons with small cell bodies. In contrast, the large cell-bodied interneurons exhibit dramatic plasticity of AmDop2 gene expression. In newly emerged worker bees (cell-cleaning specialists) and newly emerged drones, no AmDop2 transcript is observed in the large interneurons whereas this transcript is abundant in these cells in the oldest worker bees (resource foragers) and older drones. Differentiation of the mushroom body interneurons into two distinct classes (i.e., plastic or nonplastic with respect to AmDop2 gene expression) indicates that this receptor contributes to the differential regulation of distinct neural circuits. Moreover, the plasticity of expression observed in the large cells implicates this receptor in the behavioral maturation of the bee.