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BACKGROUND: The New Zealand Cardiac Implanted Device Registry (Device) has recently been developed under the auspices of the New Zealand Branch of the Cardiac Society of Australia and New Zealand. This study describes the initial Device registry cohort of patients receiving a new pacemaker, their indications for pacing and their perioperative complications. METHODS: The Device Registry was used to audit patients receiving a first pacemaker between 1st January 2014 and 1st June 2015. RESULTS: We examined 1611 patients undergoing first pacemaker implantation. Patients were predominantly male (59%), and had a median age of 70 years. The most common symptom for pacemaker implantation was syncope (39%), followed by dizziness (30%) and dyspnoea (12%). The most common aetiology for a pacemaker was a conduction tissue disorder (35%), followed by sinus node dysfunction (22%). Atrioventricular (AV) block was the most common ECG abnormality, present in 44%. Dual chamber pacemakers were most common (62%), followed by single chamber ventricular pacemakers (34%), and cardiac resynchronisation therapy - pacemakers (CRT-P) (2%). Complications within 24hours of the implant procedure were reported in 64 patients (3.9%), none of which were fatal. The most common complication was the need for reoperation to manipulate a lead, occurring in 23 patients (1.4%). CONCLUSION: This is the first description of data entered into the Device registry. Patients receiving a pacemaker were younger than in European registries, and there was a low use of CRT-P devices compared to international rates. Complications rates were low and compare favourably to available international data.

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BACKGROUND: Heart failure is a growing health issue and is associated with significant mortality risk. Device therapy is efficacious in preventing sudden death in patients with heart failure; however, this evidence comes from rigorous clinical trials. It is unclear how device therapy is utilized in 'real-world' practice. The primary objective was to characterize patterns of device use in patients with heart failure at risk of sudden death and to identify barriers to guideline-driven prescription of implantable cardioverter-defibrillators. METHODS: We report a cross-sectional study of patients attending general cardiology clinic over a 3-month period. RESULTS: Of 1003 consecutive patients attending the cardiology clinic, 176 had heart failure. Of these, 66 were potentially eligible for device therapy, but only 16 of these had actually undergone device implantation. Potentially eligible non-recipients were older (P < 0.001), more likely to have ischaemic cardiomyopathy (P= 0.002), less likely to be prescribed spironolactone (P= 0.005) or warfarin (P= 0.02), and less likely to have a widened QRS > 120 ms (P= 0.005). There was a high prevalence of underuse of evidence-based pharmacotherapies among patients with heart failure. CONCLUSION: There is substantial underuse of device therapy in patients with heart failure. Strikingly, whereas patients with symptoms of heart failure were more likely to receive a device, those being managed for ischaemic heart disease were not. There is also a high prevalence of failure to prescribe evidence-based pharmacotherapy in a tertiary hospital general cardiology clinic. This may be explained in part by the lack of a patient database to record treatment contraindications and to alert clinicians to possible gaps in patient therapy.

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Although many nurses and families may develop a spiritual relationship, a review of the literature showed few studies and scant literature addressing this topic. Furthermore, no studies were identified that used methodologies that provide descriptions and understanding of the meaning of this phenomenon. This article describes the application of the phenomenological method in the investigation of the meaning of a spiritual relationship between families and their nurses in a hospice setting. The phenomenological method can be used to uncover the meaning of experience through respondents' descriptions. Transcripts of interviews in which 11 nurses and 12 families were asked to describe their hospice experience were analyzed using Giorgi's approach to Husserlian phenomenology. Descriptions of nurse-family relationships were identified and synthesized into five thematic structures of experience: nurses' ways of being; nurses' ways of doing; nurses' ways of knowing; ways of receiving and giving; and ways of welcoming a stranger. The thematic structures of experience were synthesized into and interpreted as a metaunity of meaning. Through reflection, the unity of meaning was intuited as "The Shining Stranger." Analysis of selected Eastern and Western religious literature provided exemplars and a characterization of the shining stranger. Implications of the application of the phenomenological method are discussed.

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The protonation constants and complex formation constants of ionomycin have been determined in 80% methanol/water (w/w) at 25.0 degrees C and mu = 0.050 (tetraethylammonium perchlorate). Potentiometric and spectrometric titration techniques give the following values for the mixed-mode protonation constants of ionomycin: log KH1 = 11.94 +/- 0.02 and log KH2 = 6.80 +/- 0.03. Comparison of these values with those for model compounds indicates that KH1 and KH2 refer to equilibria involving the beta-diketone and carboxylic acid moieties, respectively. Titrations of ionomycin with metal ion at fixed values of pH produced changes in the UV-visual absorbance spectra which were analyzed to give conditional complex formation constants, KMI'. The pH dependence of the values of KMI' indicated that 1:1 divalent metal ion-ionomycin (MI) complexes and protonated MHI+ complexes were formed in the pH range studied. The values of log KMI ranged from 5.30 +/- 0.11 for Sr2+ to 10.25 +/- 0.03 for Ni2+. The selectivity pattern and relative affinities (in parentheses) for the formation of the species MI are as follows: Ni2+ (2000) greater than Zn2+ (600) greater than CO2+ (440) greater than Mn2+ (47) greater than Mg2+ (1.00) greater than Ca2+ (0.21) greater than Sr2+ (0.022). Logarithmic values of KMHI, for the reaction MI + H+ in equilibrium MHI+, ranged from 5.9 (Ni2+) to 8.4 (Sr2+). Calculations using the values of the equilibrium constants determined indicate that an appreciable fraction of the complexed ionophore exists as the protonated complex, MHI+, in the pH range of 6.5-8.5.

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The purpose of this study was to uncover, through nurses' and families' descriptions of their hospice experience, the elements comprising the nurse-family spiritual relationship. Findings were synthesized into five themes: nurses' ways of being, nurses' ways of doing, nurses' ways of knowing, ways of receiving and giving, and ways of welcoming a stranger. Results indicated that the nurse-family spiritual relationship is mutual and dialogic, and fosters spiritual growth for both nurses and families. Implications for nursing practice and theory are discussed.

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