A prospective clinical study of cerebral microemboli and neuropsychological outcome comparing vent-line and auto-venting arterial line filters: both filters are equally safe.

Introduction: Microemboli are the main implicated cause of neuropsychological (NP) impairment after cardiac surgery. This prospective clinical trial compared the effect of an auto-venting arterial line filter on intraoperative cerebral microemboli and NP outcome compared to an arterial line filter with a vent line, in patients undergoing elective coronary artery bypass graft (CABG) surgery.

Methods: One hundred and ten patients received either an Avecor Affinity (n =73) or Pall AV-6 (n =37) control filter.

Leucocyte-depleting arterial line filtration does not reduce myocardial injury assessed by Troponin T during routine coronary artery bypass grafting using crossclamp fibrillation.

Introduction: Leucocyte filtration can reduce inflammation and end-organ damage. The aim of this study was to test the cardioprotective effect of systemic leucocyte filtration during cardiopulmonary bypass (CPB) for coronary revascularization.

Methods: Sixty patients scheduled for elective coronary artery bypass grafting were prospectively randomised to receive either a test leucocyte-depleting (LD) filter or a control standard arterial line filter in the CPB circuit.

The design and evaluation of psychoeducational/self-management interventions.

A large number of interventions have been developed with the aim of improving patient self-management of arthritis. These interventions are complex, usually including multiple components, and have certain key features including participants' awareness of the arms of the study and their often having clear preferences for one or other arm. Because of these and other differences the randomized controlled trial is not necessarily ideal for studies of self-management interventions.

Class, cohort, and consumption: the British experience of the third age.

Objective: This study examines the relative effect of historical and social class location on engagement in consumerism within two different cohorts of retired people in the United Kingdom.

Methods: With use of self-reported data from the retired members of a nationally representative survey, an index of consumption was constructed. Its internal reliability was analysed and analyses of variance performed to examine the impact of class of origin, cohort, and class at exit on levels of self-reported "consumerism.

Negotiating mothering against the odds: gastrostomy tube feeding, stigma, governmentality and disabled children.

Using the findings of a small-scale qualitative investigation based on in-depth interviews with mothers attending a tertiary paediatric referral centre in London, this paper explores professional and parental discourses in relation to gastrostomy tube feeding and disabled children. Detailed accounts are given of women's struggles to negotiate their identities, and those of their children, within dominant discourses of mothering and child-centredness. Constructions of feeding practices as coercive conflict with normative expectations of 'good mothering' and the 'idealised autonomous' child.

Self-management interventions for chronic illness.

An increasing number of interventions have been developed for patients to better manage their chronic illnesses. They are characterised by substantial responsibility taken by patients, and are commonly referred to as self-management interventions. We examine the background, content, and efficacy of such interventions for type 2 diabetes, arthritis, and asthma.

'It's difficult being a dentist': stress and health in the general dental practitioner.

Objective: The aim of the study was to investigate overall stress, work-stress and health in general dental practitioners (GDPs).

Design, Setting And Subjects: A nationwide anonymous cross-sectional survey was undertaken using stratified random sampling of 2,441 GDPs in the UK.Main outcome measures Measures included perceived stress, Work Stress Inventory for Dentists, job dissatisfaction, measures of health symptoms and health behaviour, dental and demographic information.

Neuropsychological performance after kidney transplantation: a comparison between transplant types and in relation to dialysis and normative data.

Background: Neuropsychological (NP) performance after kidney transplantation (TX) has received little attention. This study compared NP functioning between dialysis and transplant patients and between living-related donor (LRD) and cadaver (CAD) transplant recipients. The association between immunosuppressive medication and NP outcomes was also examined.

Engaging patients in managing their cardiovascular health.

Psychological factors play a major part in the impact, course, and treatment of cardiovascular disease. Patients' cognitions and emotions feed into their responses to their illness and its treatments and can, for example, affect the likelihood of attendance at cardiac rehabilitation programmes. It is important to view the rehabilitation process from the perspective of the patient and to examine and assess patients' beliefs.

The effect of leucocyte-depleting arterial line filters on cerebral microemboli and neuropsychological outcome following coronary artery bypass surgery.

Objectives: A randomised clinical trial sought evidence as to whether leucocyte-depleting (LD) arterial line filters added a further degree of neuroprotection in patients undergoing elective coronary artery bypass graft (CABG) surgery.

Methods: One hundred and ninety-two patients were randomised to the use of a Pall Leukoguard-6 LD filter or either an Avecor Affinity or Pall Autovent-6 control filter. Cerebral microemboli during surgery were recorded by transcranial Doppler (TCD) monitor over the right middle cerebral artery.

Cognitive change 5 years after coronary artery bypass surgery.

A longitudinal study of cognitive function after coronary artery bypass surgery examined 107 participants using 11 tests, preoperatively and at 6 days, 8 weeks, and 5 years after surgery. The overall neuropsychological (NP) change score declined at 6 days, showed some recovery at 8 weeks, and declined again at 5 years. The number of microemboli recorded during surgery, postoperative short-term cognitive change, and degree of recovery at 8 weeks were identified as predictors of change in NP score to 5 years.

Acute neuropsychological changes in hemodialysis and peritoneal dialysis patients.

This study examined the impact of different dialysis treatments on the neuropsychological (NP) functioning of 145 end-stage renal disease patients. Hemodialysis (HD) and peritoneal dialysis (PD) patients were administered an NP test battery and measures of mood on 2 consecutive days (pre- and 24 hr postdialysis). Biochemistry was assessed at each session.

The psychological perspective: a professional view.

Psychological issues surrounding the care of patients with cardiovascular disease are many and diverse. This paper discusses three main areas: cognitions, emotions, and social support. The examples given relate primarily to post-myocardial infarction patients but the concepts discussed are relevant to other aspects of cardiovascular disease.