Routine use of fluoroscopic guidance and up-front femoral angiography results in reduced femoral complications in patients undergoing coronary angiographic procedures: an observational study using an Interrupted Time-Series analysis.

Transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, however, femoral access remains necessary for numerous procedures, including complex high-risk interventions, structural procedures, and procedures involving mechanical circulatory support. Optimising the safety of this approach is crucial to minimize costly and potentially life-threatening complications. We initiated a quality improvement project recommending routine fluoroscopic guidance (femoral head), and upfront femoral angiography should be performed to assess for location and immediate complications. We assessed the effect of these measures on the rate of vascular complications. Data were collected prospectively on 4534 consecutive patients undergoing femoral coronary angiographic procedures from 2015 to 2017. The primary end-point was any access complication. Outcomes were compared pre and post introduction including the use of an Interrupted Time-Series (ITS) analysis. 1890 patients underwent angiography prior to the introduction of routine fluoroscopy and upfront femoral angiography and 2644 post. All operators adopted these approaches. Baseline characteristics, including large sheath use, anticoagulant use and PCI rates were similar between the 2 groups. Fluoroscopy-enabled punctures were made in the 'safe zone' in over 91% of cases and upfront femoral angiography resulted in management changes i.e. procedural abandonment prior to heparin administration in 21 patients (1.1%). ITS analysis demonstrated evidence of a reduction in femoral complication rates after the introduction of the intervention, which was over and above the existing trend before the introduction (40% decrease RR 0.58; 95% CI: 0.25-0.87; P < 0.01). Overall these quality improvement measures were associated with a significantly lower incidence of access site complications (0.9% vs. 2.0%, P < 0.001). Routine fluoroscopy guided vascular access and upfront femoral angiography prior to anticoagulation leads to lower vascular complication rates. Thus, study shows that femoral intervention can be performed safely with very low access-related complication rates when fluoroscopic guidance and upfront angiography is used to obtain femoral arterial access.

Intrauterine contraception insertion pain: nursing interventions to improve patient experience.

AIMS AND OBJECTIVES: To examine factors which contribute to the individual's experience of pain in relation to intrauterine contraception insertion and determine evidence-based nursing strategies to best assess and manage this pain. BACKGROUND: Nurses are increasingly involved in consultations regarding intrauterine contraception. However, concerns regarding painful or difficult insertion may inhibit uptake and discourage nurses from promoting or inserting intrauterine contraception. DESIGN: Integrative review. METHODS: Database searches of CINAHL, PubMed, Wiley Online Library and the Cochrane Collaboration for relevant literature. Eight papers met the inclusion criteria and were analysed using an integrative review process. RESULTS: Physical causes and pharmacological interventions for insertion pain have been thoroughly investigated. Absence of previous vaginal delivery and anxiety may increase the likelihood of procedural pain. The literature fails to conclusively determine any universally effective prophylactic analgesia. Cervical anaesthesia may be beneficial in some cases and oral analgesia may relieve postprocedural pain. Distraction in the form of conversation, music or television can be effective in reducing anxiety. CONCLUSIONS: A combination of physical, psychological and environmental factors contribute to the individual's pain experience. Nurses have the potential to make a significant impact on pain outcomes by demonstrating clinical expertise and creating a trustful environment. Giving reliable information, acknowledging the significance of anxiety and providing reassurance and distraction are effective pain reducing strategies. Research into nonpharmacological approaches is warranted, especially those which reduce anxiety. RELEVANCE TO CLINICAL PRACTICE: Increasing uptake of long-acting reversible contraception is a public health goal. Providing effective pain management strategies to improve patient experience may encourage more nurses to recommend, or enhance their scope of practice to include, intrauterine contraception insertion.

A multimodal, interdisciplinary programme for the management of cachexia and fatigue.

Fatigue and cachexia are common symptoms of advanced disease that have a significant impact on quality of life for palliative care clients. Management of cachexia and fatigue is often overlooked, but growing understanding of the multidimensional nature of fatigue and muscle wasting has led to interest in a model of care based on multimodal therapy that has been successfully implemented in specialized multidisciplinary hospital-based clinics in the oncology/palliative care setting. This article reports on an innovative incorporation of features of this model into a client-centred, interdisciplinary programme that aims to manage the effects of cachexia and fatigue and to improve quality of life for palliative care clients in their home setting. This Cachexia and Fatigue Management Programme (CFMP) involves the use of an anti-inflammatory agent, high protein intake, and an individually tailored resistance exercise regimen to counteract muscle wasting and fatigue. The article provides an overview of the role of multimodal therapies in the management of cachexia and fatigue before moving on to discuss the development of the CFMP, its features, and potential benefits for palliative care clients, caregivers, and health services.

Utility stress as a social determinant of health: exploring the links in a remote Aboriginal community.

ISSUE ADDRESSED: The implications of the high cost of water on the poverty and subsequent health of Aboriginal residents in a remote community in Australia. METHODS: During 2003, a focus group session was held with adults at Umoona Aboriginal community in South Australia. Participants were asked to comment on key issues of concern in the provision of the domestic water supply. RESULTS: The Umoona community members in Coober Pedy identified the high cost of water and electricity as key hardship factors. CONCLUSIONS: Plans under the National Water Initiative to move to full cost recovery for water and the privatisation of public utilities may result in increased hardship for low-income groups such as Aboriginal people. Utility stress (difficulties paying water, electricity, gas or telephone accounts by the due date) increases poverty and relative deprivation, both key factors in the social determinants of health. Increased community service obligations (CSO) and rebates need to be made available to all low-income groups in order to reduce the negative impact of poverty.