Socioeconomic status and cardiovascular disease: risks and implications for care.

Socioeconomic status (SES) refers to an individual's social position relative to other members of a society. Low SES is associated with large increases in cardiovascular disease (CVD) risk in men and women. The inverse association between SES and CVD risk in high-income countries is the result of the high prevalence and compounding effects of multiple behavioral and psychosocial risk factors in people of low SES.

What is the strength of evidence for heart failure disease-management programs?

Heart failure (HF) disease-management programs are increasingly common. However, some large and recent trials of programs have not reported positive findings. There have also been parallel recent advances in reporting standards and theory around complex nonpharmacological interventions.

Patient and informal caregivers' knowledge of heart failure: necessary but insufficient for effective self-care.

Aims: Self-care of heart failure (HF) is a process that is important, complex, and challenging. Little is understood of the contextual factors influencing self-care. We aimed to examine the individual and contextual factors perceived by patients and their informal caregivers' to influence their willingness and capacity to undertake effective HF self-care.

A systematic review of the effectiveness of cutaneous warming systems to prevent hypothermia.

Aims: To retrieve and critique recent randomised trials of cutaneous warming systems used to prevent hypothermia in surgical patients during the intraoperative period and to identify gaps in current evidence and make recommendations for future trials.

Background: Hypothermia affects up to 70% of anaesthetised surgical patients and is associated with several significant negative health outcomes.

Design: Systematic review using integrative methods.

The potential of nursing to reduce the burden of heart failure in rural Canada: what strategies should nurses prioritize?

Chronic heart failure (CHF) is an increasingly common condition in high-income countries that has a large and negative impact on life quality and expectancy, and is associated with high financial costs. In Canada, CHF has an especially large impact on rural settings because of the higher proportion of older adults (aged >65 years) in these settings, and because care and outcomes tend to be more adverse in rural parts of the country compared to urban settings. Much can be done to reduce these burdens in terms of pharmacological, behavioural and health service strategies.

Complex critical realism: tenets and application in nursing research.

Aim: To outline the main tenets of critical realism (CR), its use, and future application in nursing.

Background: Little work has been done to discuss how CR can be applied to nursing research.

Findings: The tenets of CR include recognition of reality independent of human perceptions, a generative view of causation in open systems, and a focus on explanations and methodological eclecticism using a postdisciplinary approach.

Patients' experiences of disruptions associated with post-stroke dysarthria.

Background: Post-stroke dysarthria rehabilitation should consider social participation for people with dysarthria, but before this approach can be adopted, an understanding of the psychosocial impact of dysarthria is required. Despite the prevalence of dysarthria as a result of stroke, there is a paucity of research into this communication disorder, particularly studies that address the experiences of individuals. The available literature focuses mainly on the perceptions of others or includes groups of mixed aetiologies.

The complex nature of informal care in home-based heart failure management.

Aim: This paper is a report of a study to examine the complexities of informal caregiving for people with chronic heart failure.

Background: Little is known of the activities involved and underlying informal care. Heart failure is a common and burdensome condition in which carers play an important management role.

Waiting for treatment for chronic pain - a survey of existing benchmarks: toward establishing evidence-based benchmarks for medically acceptable waiting times.

As medical costs escalate, health care resources must be prioritized. In this context, there is an increasing need for benchmarks and best practices in wait time management. In December 2005, the Canadian Pain Society struck a Task Force to identify benchmarks for acceptable wait times for treatment of chronic pain.

A critical realist approach to understanding and evaluating heart health programmes.

Secondary prevention programmes for Coronary Heart Disease (CHD) aim to reduce cardiovascular risks and promote health in people with heart disease. Though programmes have been associated with health improvements in study populations, access to programmes remains low, and quality and effectiveness is highly variable. Current guidelines propose significant modifications to programmes, but existing research provides little insight into why programme effectiveness varies so much.

A systematic review of the effect of waiting for treatment for chronic pain.

In many countries timely access to care is a growing problem. As medical costs escalate health care resources must be prioritized. In this context there is an increasing need for benchmarks and best practices in wait-time management.

Secondary prevention programmes for coronary heart disease: a meta-regression showing the merits of shorter, generalist, primary care-based interventions.

Background: The aim of this study was to determine which programme characteristics influence the effectiveness of secondary prevention programmes for Coronary Heart Disease.

Design: The study follows a meta-regression design.

Methods: We conducted a meta-regression within a systematic review of randomized trials comparing secondary prevention programmes versus usual care.

A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed.

Objectives: The aim of this study was to determine the effect of exercise training and type of exercise (aerobic vs. strength vs. combined training) on left ventricular (LV) remodeling in heart failure (HF).

A randomized, double-blind, 8-week crossover study of once-daily controlled-release tramadol versus immediate-release tramadol taken as needed for chronic noncancer pain.

Objective: The purpose of this study was to evaluate the efficacy of controlled-release (CR) tramadol and immediate-release (IR) tramadol in patients with moderate or greater intensity chronic noncancer pain.

Methods: A total of 122 patients underwent washout from all opioids 2 to 7 days before randomization to 1 of 2 groups: active CR tramadol 200 mg every morning plus placebo IR tramadol 50 mg every 4 to 6 hours PRN rescue, or placebo CR tramadol 200 mg every morning plus active IR tramadol 50 mg every 4 to 6 hours PRN rescue. After 2 weeks, the doses were increased to CR tramadol 400 mg or placebo and IR tramadol 100 mg every 4 to 6 hours PRN or placebo, as rescue.

Chronic pain in Canada: have we improved our management of chronic noncancer pain?

Background: Chronic noncancer pain (CNCP) is a global issue, not only affecting individual suffering, but also impacting the delivery of health care and the strength of local economies.

Objectives: The current study (the Canadian Chronic Pain Study II [CCPSII]) was designed to assess any changes in the prevalence and treatment of CNCP, as well as in attitudes toward the use of strong analgesics, compared with a 2001 study (the CCPSI), and to provide a snapshot of the current standards of care for pain management in Canada.

Methods: Standard, computer-assisted telephone interview survey methodology was applied in two segments, ie, a general population survey and a survey targeting randomly selected primary care physicians (PCPs) who treat moderate to severe CNCP.

A case series of patients using medicinal marihuana for management of chronic pain under the Canadian Marihuana Medical Access Regulations.

The Canadian Marihuana Medical Access Regulations (MMAR) program allows Health Canada to grant access to marihuana for medical use to those who are suffering from grave and debilitating illnesses. This is a report on a case series of 30 patients followed at a tertiary care pain management center in Nova Scotia who have used medicinal marihuana for 1-5 years under the MMAR program. Patients completed a follow-up questionnaire containing demographic and dosing information, a series of 11-point numerical symptom relief rating scales, a side effect checklist, and a subjective measure of improvement in function.

A qualitative study of the contribution of pharmacists to heart failure management in Scotland.

Study Objectives: (1) To identify the medication management needs of chronic heart failure (CHF) patients and their caregivers; (2) To examine the perceived support for medication management available to these people from health professionals; (3) To identify the actual and potential perceived contribution of pharmacists to medication management.

Setting: A mixed urban/ rural region in the west of Scotland.

Design: Semi-structured qualitative research interviews.

A realist study of the mechanisms of cardiac rehabilitation.

Aim: The aim of this paper is to report patients' experiences of cardiac rehabilitation and perceptions of the mechanisms and contexts influencing its long-term effectiveness.

Background: Cardiac rehabilitation programmes for the secondary prevention of coronary heart disease are common. The effects of these programmes, however, can be inconsistent and little is known of the personal and contextual factors that influence service effectiveness.

Meta-analysis: secondary prevention programs for patients with coronary artery disease.

Background: Although supervised exercise programs reduce mortality in survivors of myocardial infarction, the effects of other types of cardiac secondary prevention programs are unknown.

Purpose: To determine the effectiveness of secondary cardiac prevention programs with and without exercise components.

Data Sources: The authors searched MEDLINE (1966-2004), the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, SIGLE, and the Cochrane Effective Practice and Organization of Care Study Registry.