CX Vascular Nursing Course

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With the support of Medi, this year’s Vascular Nursing Course returns on Monday 10th April concentrating on the issues that are at the forefront of vascular nursing.

Held in the Pippard Lecture Theatre and chaired by Angela Williams, London, UK, the session will open with a presentation by Dr Edward Diethrich, Phoenix, USA, who will stress the value of specialist vascular nursing in the 21st century.

Diethrich will be followed by Katie Scales, London, UK, who will discuss the importance to vascular nurses of early warning systems. Continuing theme of checks and balances, Adam Howard, London, UK, will analyse thromboembolic phrophylaxis and why it is important toadhere to protocol. The next presentation, by Moira Morgan, London, UK, will highlight the significance of implementing vascular pathways.

Morgan’s presentation will be followed by Dr Justine Reise, department of vascular surgery, London, UK, who will present one of the highlights of the Nursing Course, an overview of the Mild-to-Moderate Intermittent Claudication (MIMIC) trials. The trials are funded by the Camelia Botnar Arterial Research Foundation with contributions from Bard, Boston Scientific and Cook. The MIMIC trials aim to determine whether angioplasty offers adjuvant benefit over best medical treatment and supervised exercise training in mild-to-moderate claudicants. There is currently no evidence of efficacy of angioplasty in either the femoro-popliteal or aorto-iliac segments over and above supervised exercise training. The MIMIC trials include patients with intermittent claudication (i.e. pain on walking with ABPI < 0.9 or ABPI > 0.9) with positive stress test, with all patients having undergone an assessment by Duplex mapping or diagnostic arteriography. In the trial all suitable patients (n=128) received best medical treatment and supervised exercise and half were also randomised balloon angioplasty. Patients were divided into two groups according to site of disease: aorto-iliac (n=35) or femoro-popliteal (n=93). The primary endpoint is absolute walking distance (AWD) on a fixed load treadmill at two years. Secondary endpoints include: quality of life – disease specific (Charing Cross Claudication Questionnaire) and Generic (EuroQol and SF-36), patency and revascularisation rates.

After lunch, the programme will move on to a topic that is very much in the public eye at the moment, methicillin-resistant staphylococcus aureus (MRSA). Shelagh Murray, London, UK, will talk about methods of reducing MRSA in the vascular surgery ward. Maintaining the theme of infection control, Keith Cutting, Chalfort St Giles, UK, will provide criteria for control of infection in lower limb wounds.

The next presentation involves two of the crucial trials of the past few years, namely the UK EndoVascular Aneurysm Repair (EVAR) trials. Louise Brown, London, UK, will assess the results so far and provide the audience with clinical updates. Thus far, the interpretation of EVAR 1 has shown that endovascular aneurysm repair in fit patients had an ongoing 3% better aneurysm-related survival than open repair but no demonstrable all-cause mortality or HRQL benefit. The continuing need for interventions necessitates ongoing surveillance, which leads to marginally increased costs. However, longer term follow-up for detailed cost-effectiveness evaluation is underway.

Whereas in EVAR 2, unfit patients do not appear to benefit from the implantation of an endovascular aneurysm repair device. In fact, they are disadvantaged with the need for continual surveillance and secondary interventions and this greatly increases costs. Thus, in these sick patients the emphasis has shifted towards improving patient fitness before considering EVAR, particularly in terms of cardiac, respiratory and renal function. This promises to be a fascinating presentation.

The final lecture of the course is delivered by Georgie Dwight, London, UK, who will examine the factors affecting nursing recruitment and what can be done to improve the current situation.

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