Intra-aortic balloon pump counterpulsation (IABPC) has been used in various forms for decades. The change in physiology brought about by their use is conceptually appealing in managing cardiogenic shock and mechanical complications of myocardial infarction. A common myth is that this method of managing acute cardiological emergencies is to be limited to the realms of this specialist field. However, as medical physicians an appreciation and understanding of this novel therapy is essential not only as a lifesaving measure but also as a bridging therapy to more definitive management in the acute medical setting. IABPC is a safe and under-utilized technique despite featuring in all major international guidelines (ESC and ACC) for the management of cardiogenic shock secondary to acute coronary syndromes. Without awareness of this intervention we may be suboptimally managing patients in the first instance. To improve awareness we examine the evidence supporting the use of the IABPC therapy and the contraindications to their use. Complications and advances in technology are also addressed.
Research article
Free accessResearch articleFirst published February, 2013pp. 57-67
To explore the individual experiences of those who had experienced the death of a parent(s) before the age of 18, and investigate how such experiences were perceived to impact on adult life.
Design
An exploratory qualitative design using written (n = 5) and oral (n= 28) narratives and narrative analysis was adopted to explore the experiences 33 adults (7 men and 26 women) who had experienced parental death during childhood.
Setting
UK
Participants
Individuals living in the North West of England who had lost a parent(s) before the age of 18.
Main outcome measures
Views of adults bereaved of a parent before the age of 18 of impact of parental loss in adult life.
Results
While individual experiences of bereavement in childhood were unique and context bound, the narratives were organized around three common themes: disruptions and continuity, the role of social networks and affiliations and communication and the extent to which these dynamics mediated the bereavement experience and the subsequent impact on adult life. Specifically they illustrate how discontinuity (or continuity that does not meet the child's needs), a lack of appropriate social support for both the child and surviving parent and a failure to provide clear and honest information at appropriate time points relevant to the child's level of understanding was perceived to have a negative impact in adulthood with regards to trust, relationships, self-esteem, feeling of self-worth loneliness and isolation and the ability to express feelings. A model is suggested for identifying and supporting those that may be more vulnerable to less favourable outcomes in adult life.
Conclusions
The findings suggest that if the negative consequences are to be minimized it is crucial that guidelines for ‘best practice’ that recognize the complex nature of the bereavement experience are followed.
Other
Free accessOtherFirst published February, 2013pp. 68-71