Objective
This prospective observational study was designed to explore the relationships between post-traumatic stress disorder (PTSD), patients' memories of the intensive care unit (ICU) and sedation practices.

Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care.

In 2004 the World Allergy Organization's Specialty and Training Council conducted a survey of World Allergy Organization (WAO) member societies to obtain information about the status of the specialty of allergy worldwide. Responses were received from 33 countries, representing a population of 1.39 billion people, of whom it was estimated that 22% may suffer from some form of allergic disease. Allergy was reported by 23 respondents to be a certified or accredited specialty in their country, and the number of certified allergists per head of population ranged from 1:25 million to 1:16,000. Allergists were ranked as the fifth most likely clinicians to see cases of allergic asthma, third most likely to see allergic rhinitis, and fourth most likely to see eczema or sinusitis. Nine countries only reported that children with allergic diseases would be seen by a pediatrician with appropriate training. The survey results highlight a pressing need for the development of allergy services worldwide.

Allergy practice worldwide: a report by the World Allergy Organization Specialty and Training Council.

Motor neurone disease is a progressive neurodegenerative disorder leading to severe disability and death. It is clinically characterised by mixed upper and lower motor neurone involvement affecting bulbar, limb, and respiratory musculature. Recent guidelines have established diagnostic criteria and defined management of the condition. In a proportion of familial amyotrophic lateral sclerosis there is a mutation in the gene encoding the enzyme copper/zinc superoxide dismutase 1; this has allowed mutation screening and generated considerable laboratory based research. The diagnosis must be given with care and consideration and close follow up is essential. Management involves a multidisciplinary team based in the hospital and the community. Riluzole is the only drug shown to have a disease modifying effect and has been approved by the National Institute for Clinical Excellence. The essence of care is good symptomatic management, including nutritional support with percutaneous endoscopic gastrostomy and ventilatory care with non-invasive ventilation. Palliative care should be introduced before the terminal stages after careful discussion with the patient and carers. Knowledge of this condition has grown dramatically recently with a parallel improvement in treatment and ability to deal with the most troublesome problems.

Management of motor neurone disease.

Information and power: Women of color's experiences interacting with health care providers in pregnancy and birth

Heart failure is a global public health problem that affects more than 26 million people worldwide. The global burden of heart failure is growing and is expected to increase substantially with the ageing of the population. Heart failure with reduced ejection fraction accounts for approximately 50% of all cases of heart failure in the United States and is associated with substantial morbidity and reduced quality of life. Several diseases, such as myocardial infarction, certain infectious diseases and endocrine disorders, can initiate a primary pathophysiological process that can lead to reduced ventricular function and to heart failure. Initially, ventricular impairment is compensated for by the activation of the sympathetic nervous system and the renin–angiotensin–aldosterone system, but chronic activation of these pathways leads to worsening cardiac function. The symptoms of heart failure can be associated with other conditions and include dyspnoea, fatigue, limitations in exercise tolerance and fluid accumulation, which can make diagnosis difficult. Management strategies include the use of pharmacological therapies and implantable devices to regulate cardiac function. Despite these available treatments, heart failure remains incurable, and patients have a poor prognosis and high mortality rate. Consequently, the development of new therapies is imperative and requires further research. Heart failure can be broadly divided into two categories: heart failure with preserved ejection fraction and heart failure with reduced ejection fraction (HFrEF). HFrEF accounts for approximately 50% of all cases of heart failure in the United States and is the focus of this Primer by Butler and colleagues.

Heart failure with reduced ejection fraction

The new national service framework sets quality criteria for the care of patients with long-term neurological conditions. It aims to ensure early recognition of neurological conditions, increase self-management and independent living, and improve palliative care and support for families and carers.

The national service framework for long-term conditions.

Understanding heart failure.

Errors in prescribing and administering medication can have serious consequences. A Department of Health report highlights common medication errors and high-risk clinical areas. It includes many practical suggestions for the prevention of errors.

Improving medication safety.

The new National Service Framework for Children, Young People and Maternity Services (Department of Health, 2004) draws together current recommendations for best practice. This article highlights the points most relevant to nurses from this 10-year plan of practice improvement.

The NSF for children, young people and maternity services.

Administering a blood transfusion is a common part of nursing practice and a life-saving intervention. However, new guidance published by the RCN (2004) highlights that this is an area of practice with frequent errors. The guidance gives clear recommendations for good practice in the areas of sample collection, preadministration checking, and monitoring to recognise adverse reactions.

Terry Hainsworth

Papers

The national service framework for long-term conditions.

Understanding heart failure.

Improving medication safety.

The NSF for children, young people and maternity services.

Guidance for preventing errors in administering blood transfusions.