Recent Submissions

  • Group psychological intervention for emotional distress in haematopoietic stem cell transplantation: A feasibility randomised clinical trial

    das Nair, Roshan (2023)
    PURPOSE: Haematopoietic stem cell transplantation (HSCT) is an intensive procedure associated with elevated psychological distress, particularly during the initial stages. Based on self-regulatory theory, a prophylactic group intervention was developed to mitigate this distress by targeting perceptions of HSCT and coping. This study evaluated the feasibility of delivering the intervention and of conducting a randomised clinical trial to assess efficacy. METHODS: Adults from consecutive referrals at two transplant centres were randomised to the intervention or to treatment as usual at each site. Psychological distress (primary outcome), HSCT perceptions, and coping were assessed at baseline, on transplant day, and two and four weeks after transplantation. RESULTS: Of 99 eligible patients, 45 consented. Main barriers to consent were insufficient time prior to transplantation, competing priorities, being unwell, and travel distance. Of 21 participants randomised to the intervention, five attended. Main barriers to attendance included insufficient time prior to transplantation and having competing priorities. Groups could not be held sufficiently frequently to enable attendance prior to transplantation, as randomising participants to the control group limited accrual. Anxiety peaked two weeks following transplantation. Depression increased throughout the acute phase. Clinical levels of distress were observed in 42% of patients during HSCT. Intervention effects were small but sample sizes for a full trial appeared feasible. CONCLUSIONS: Multimodal prehabilitation is required but there are specific barriers to delivering a group-based intervention and conducting a trial. Group prehabilitation requires customisation and better integration with routine care, such as patient screening, personalisation, and options for remote delivery.
  • Positive naproxen test in psychogenic fever

    Katshu, Mohammad Z. (2021)
    Pyrexia of unknown origin (PUO) broadly includes any febrile illness lasting ≥ 3 weeks with a temperature > 38.3°C (100.9°F) on at least 2 occasions in the absence of a known immunocompromised state and an uncertain diagnosis after a thorough assessment including history taking, physical examination, and appropriate investigations.1 PUO can be due to infectious, inflammatory, neoplastic, or other miscellaneous causes. Treatment with naproxen has been shown to result in lysis of fever within 24 hours in patients with PUO due to noninfectious causes, while patients with infectious conditions show little response.2,3 Hence, the naproxen test has been proposed as a useful diagnostic tool to differentiate PUO of infectious from noninfectious, especially neoplastic, etiology. However, the low sensitivity and specificity of the naproxen test has limited its wider acceptability.4 Psychogenic fever, also known as functional hyperthermia, is an underrecognized potential etiology of PUO.5 Here, we report a case of PUO, in the context of acute stress and depression, with a positive naproxen test.
  • Audit of blood borne virus screening, referral, and hepatitis B vaccination in a high secure hospital

    Holdcroft, Jason; D'Silva, Karen (2021)
    Blood borne virus (BBV) infections are a significant risk for patients and staff in secure settings. Hospital policy is that all newly admitted patients will be offered screening for hepatitis B & C and HIV. All admissions between 2016 and 2019 were audited for BBC screening and follow-up of positive results. 'Where appropriate', patients should be offered hepatitis B vaccination, and the offer/delivery of this was audited. Nearly all new admissions were screened for BBC in this period. The offer and provision of hepatitis B vaccination was inconsistent throughout the Hospital.
  • Feasibility and acceptability of a nutritional intervention testing the effects of nitrate-rich beetroot juice and folic acid on blood pressure in Tanzanian adults with elevated blood pressure

    Stephan, Blossom C. M. (2020)
    Sub-Saharan African countries are experiencing an alarming increase in hypertension prevalence. This study evaluated the feasibility and acceptability of nitrate-rich beetroot and folate supplementation, alone or combined, for the reduction of blood pressure (BP) in Tanzanian adults with elevated BP. This was a three-arm double-blind, placebo-controlled, parallel randomised clinical trial. Forty-eight participants were randomised to one of three groups to follow a specific 60-day intervention which included a: (1) combined intervention (beetroot juice + folate), (2) single intervention (beetroot juice + placebo), and (3) control group (nitrate-depleted beetroot juice + placebo). Forty-seven participants (age: 50-70 years) completed the study. The acceptability of the interventions was high. Self-reported compliance to the interventions was more than 90% which was confirmed by the significant increase in nitrate and folate concentrations in plasma and saliva samples in the treatment arms. This study provides important information for the design of high-nitrate interventions to reduce BP in Sub-Saharan African countries.
  • A service improvement report of blood-borne virus screening in a high secure mental hospital

    Strazds, Pixy; Abdelrazek, Tarek (2019)
    Background:Patients in a high secure hospital are a high-risk population for exposure to blood-borne viruses (BBV) because of previous lifestyles.Objective:This service improvement study intends to improve patients care by the Infection Prevention and Control Team (IPCT) coordinating the BBV screening and vaccination programme within the hospital.Methods:A retrospective review of patients? notes in 2007 and 2016 was used.Results:The results show an increase in screening offered and screening undertaken from 2007 to 2016. It also identifies an increase in hepatitis B vaccination programmes completed.Discussion:The expansion of the IPC and Physical Healthcare Team appear to be associated with the increase of screening and vaccination rates.
  • Regional haemodynamic responses to pituitary adenylate cyclase-activating polypeptide and vasoactive intestinal polypeptide in conscious rats

    Rakhit, Tuhina (1994)
    1. Regional haemodynamic responses to the homologous peptides, pituitary adenylate cyclase-activating peptide (1-27) (PACAP27) and vasoactive intestinal polypeptide (VIP) were assessed by giving 20 min infusions (1.5-15 nmol kg-1 h-1) in conscious, chronically-instrumented, Long Evans rats. 2. PACAP27 caused dose-dependent depressor and tachycardic effects associated with renal, mesenteric and hindquarters vasodilatations, although only in the latter vascular bed was there a sustained increase in flow. 3. VIP caused dose-dependent depressor and tachycardic effects that were not significantly different from those caused by equimolar doses of PACAP27. However, the hindquarters vasodilator effects of VIP (at 7.5 and 15 nmol kg-1 h-1) were greater than those of PACAP27 (at the same doses), and accompanied by reductions in renal and mesenteric flows and conductances. 4. In the presence of the nitric oxide (NO) synthase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME; 11 mumol kg-1 h-1), there was significant inhibition of the hindquarters vasodilator effects of PACAP27 and VIP (at 7.5 and 15 nmol kg-1 h-1). Under these circumstances the renal and mesenteric vasoconstrictor effects of VIP were abolished. 5. The beta 2-adrenoceptor antagonist, ICI 118551 (670 nmol kg-1 bolus, 335 nmol kg-1 h-1 infusion), reduced the matched hindquarters vasodilator responses to PACAP27 (15 nmol kg-1 h-1) and VIP (7.5 nmol kg-1 h-1), and also abolished the renal vasoconstrictor effects of VIP. 6. The AT1-receptor antagonist, losartan potassium (20 mumol kg-1), had no significant effect on the haemodynamic response to PACAP27 (15 nmol kg-1 h-1), but augmented the hypotensive action of VIP (7.5 nmol kg-1 h-1). This influence of losartan was associated with conversion of the renal and mesenteric vasoconstrictor effect of VIP to vasodilatation. 7. Our findings show that similar changes in mean systemic arterial blood pressure in response to PACAP27 and VIP conceal substantial differences in their regional haemodynamic actions. Although the hindquarters vasodilator effects of both peptides involve NO- and Beta2-adrenoceptor-mediated mechanisms,it appears that activation of the renin-angiotensin system contributes significantly to the haemodynamic effects of VIP, but not to those of PACAP27.
  • Perceptions of hematopoietic stem cell transplantation and coping predict emotional distress during the acute phase after transplantation

    Baliousis, Michael (2017)
    PURPOSE/OBJECTIVES: To test whether a widely used model of adjustment to illness, the self-regulatory model, explains the patterns of distress during acute hematopoietic stem cell transplantation (HSCT). According to the model, perceptions of HSCT, coping, and coping appraisals are associated with distress.. DESIGN: Longitudinal, correlational.. SETTING: The Centre for Clinical Haematology at Nottingham City Hospital and the Department of Haematology at Royal Hallamshire Hospital in Sheffield, both in the United Kingdom.. SAMPLE: 45 patients receiving mostly autologous transplantations for a hematologic malignancy.. METHODS: Patients were assessed at baseline, on transplantation day, and two and four weeks after transplantation using three questionnaires. MAIN RESEARCH VARIABLES: Psychological distress, including depression, anxiety, stress, and overall distress (DASS-21); use of different coping styles (Brief COPE); and perceptions of HSCT and coping appraisals (Brief IPQ).. FINDINGS: As suggested by the self-regulatory model, greater distress was associated with negative perceptions of HSCT, controlling for the effects of confounding variables. Mixed support was found for the model's predictions about the impact of coping styles on distress. Use of active and avoidant coping styles was associated with more distress during the acute phase after HSCT.. CONCLUSIONS: Negative perceptions of HSCT and coping contribute to psychological distress during the acute phase after HSCT and suggest the basis for intervention.. IMPLICATIONS FOR NURSING: Eliciting and discussing patients' negative perceptions of HSCT beforehand and supporting helpful coping may be important ways to reduce distress during HSCT.
  • Massive splenomegaly in rural Malawi: New wine, old wineskins and the importance of collaboration

    White, Charlotte (2014)
    During a voluntary placement in rural Malawi, we assessed a 21-year-old man who presented with dyspnoea and lethargy secondary to a chronic refractory anaemia associated with massive splenomegaly. He was initially treated at the rural hospital for a presumptive diagnosis of hyper-reactive malarial syndrome (HMS) with long-term malarial prophylaxis. There was inadequate provision of blood products and the availability of suitable donors was limited by the high local prevalence of blood-borne viruses. He was transferred to the district hospital for further investigations after transfusion of three units of blood. Unfortunately, he self-discharged without receiving appropriate investigations and medical treatment. Subsequently, his family sought help from the local traditional healer who performed scarification to attempt to treat him. Further efforts to emphasise the importance of hospital-based care proved unsuccessful, and sadly this man died at his family home 3 months after his initial presentation.; 2014 BMJ Publishing Group Ltd.