Current Issue : January - March Volume : 2016 Issue Number : 1 Articles : 7 Articles
Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the\nemergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse\ntriage for ACS of the tertiary care hospital. Methods.We retrospectively enrolled consecutive patients who were identified as ACS\nat risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate\nlogistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was\nconstructed. Results.There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS.\nPatients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were\nindependently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval)\nwere 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED\nnurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals....
Background: Recruitment to randomised controlled trials (RCTs) is a perennial problem. Calls have been made for\ntrialists to make recruitment performance publicly available. This article presents our experience of recruiting to a\npilot RCT of cardiac rehabilitation for patients with bowel cancer with an embedded process evaluation.\nMethods: Recruitment took place at three UK hospitals. Recruitment figures were based on the following: i) estimated\nnumber of patient admissions, ii) number of patients likely to meet inclusion criteria from clinician input and\niii) recruitment rates in previous studies. The following recruitment procedure was used:\n1. Nurse assessed patients for eligibility.\n2. Patients signed a screening form indicating interest in and agreement to be approached by a researcher\nabout the study.\n3. An appointment was made at which the patient signed a consent form and was randomised to the\nintervention or control group.\nInformation about all patients considered for the study and subsequently included or excluded at each stage of\nthe recruitment process and reasons given were recorded.\nResults: There were variations in the time taken to award Research Management approval to run the study at the\nthree sites (45ââ?¬â??359 days). Sixty-two percent of the original recruitment estimate was reached. The main reason for\nunder-recruitment was due to over-estimation of the number of patient admissions; other reasons were i) not assessing\nall patients for eligibility, ii) not completing a screening form for eligible patients and iii) patients who signed a\nscreening form being lost to the study before consenting and randomisation.\nConclusions: Pilot trials should not simply aim to improve recruitment estimates but should also identify factors likely\nto influence recruitment performance in a future trial and inform the development of that trialââ?¬â?¢s recruitment strategies.\nPilot trials are a crucial part of RCT design. Nevertheless, pilot trials are likely to be small scale, involving only a small\nnumber of sites, and contextual differences between sites are likely to impact recruitment performance in any future\ntrial. This means that ongoing monitoring and evaluation in trials are likely to be required....
Background: Clinical decision support systems (CDSS) can modify clinician behaviour, yet the factors influencing\ntheir effect remain poorly understood. This study assesses the feasibility and acceptability of a CDSS supporting\ndiagnostic and treatment decisions for patients with suspected stable angina.\nMethods: Intervention The Optimising Management of Angina (OMA) programme includes a CDSS guiding\ninvestigation and medication decisions for clinicians managing patients with new onset stable angina, based on\nEnglish national guidelines, introduced through an educational intervention. Design and participants A mixed\nmethods study i. A study of outcomes among patients presenting with suspected angina in three chest pain clinics\nin England before and after introduction of the OMA programme. ii. Observations of clinic processes, interviews and\na focus group with health professionals at two chest pain clinics after delivery of the OMA programme. Outcomes.\nMedication and cardiovascular imaging investigations undertaken within six months of presentation, and\nconcordance of these with the recommendations of the CDSS. Thematic analysis of qualitative data to understand\nhow the CDSS was used.\nResults: Data were analysed for 285 patients attending chest pain clinics: 106 before and 179 after delivery of the\nOMA programme. 40 consultations were observed, 5 clinicians interviewed, and a focus group held after the\nintervention. The proportion of patients appropriate for diagnostic investigation who received one was 50 %\n(95 CI 34ââ?¬â??66 %) of those before OMA and 59 % (95 CI 48ââ?¬â??70 %) of those after OMA. Despite high use of the CDSS\n(84 % of consultations), observations and interviews revealed difficulty with data entry into the CDSS, and structural\nand practical barriers to its use. In the majority of cases the CDSS was not used to guide real-time decision making,\nonly being consulted after the patient had left the room.\nConclusions: The OMA CDSS for the management of chest pain is not feasible in its current form. The CDSS was\nnot used to support decisions about the care of individual patients. A range of barriers to the use of the CDSS were\nidentified, some are easily removed, such as insufficient capture of cardiovascular risk, while others are more deeply\nembedded in current practice, such as unavailability of some investigations or no prescribing privileges for nurses....
Objectives: White coat hypertension (WCH) is defined as high blood pressure (BP) when measured by health care providers in medical environments, but normal BP in other settings. In this study, we examine the effects of occupation and attire on the accuracy of BP readings and WCH. Methods: 50 individuals were recruited and had their BP assessed twice by a cardiologist, a cardiac nurse, and a cardiovascular technician, once wearing a white lab coat, and once without, in random order. All individuals underwent a 24 hour ambulatory BP monitoring (ABPM). The mean of the daytime measurements of the ABPM served as the control. Results: Compared to the ABPM, the cardiologist recorded a 23.7 mm Hg higher systolic BP reading wearing a white coat and 13.3 mmHg without a white coat (p<0.0001). The cardiac nurse recorded a 14.2 mmHg higher reading with a white coat and 5.7 mmHg without a white coat (p<0.0001). There was no statistically significant difference between the measurements of the cardiovascular technician and the ABPM with a white coat, 2.8 mmHg, or without a white coat, -1.8 mmHg. Conclusions: This study demonstrates that the incidence of WCH and BP measurement inaccuracy occurs more frequently when assessed by a cardiologist or nurse than when assessed by a cardiovascular technician. Wearing a white coat aggravates blood pressure measurement inaccuracy. It may be advisable for healthcare providers to avoid wearing white lab coats or attire that identifies their occupation when measuring blood pressure....
Background: Intensive care units (ICUs) are complex work environments where false alarms occur more frequently than on\nnon-critical care units. The Joint Commission National Patient Safety Goal .06.01.01 targeted improving the safety of clinical\nalarm systems and required health care facilities to establish alarm systems safety as a hospital priority by July 2014. An important\ninitial step toward this requirement is identifying ICU nurses� perceptions and common clinical practices toward clinical alarms,\nwhere little information is available.\nObjective: Our aim was to determine perceptions and practices of transplant/cardiac ICU (TCICU) nurses toward clinical alarms\nand benchmark the results against the 2011 Healthcare Technology Foundation�s (HTF) Clinical Alarms Committee Survey.\nMethods: A quality improvement project was conducted on a 20-bed TCICU with 39 full- and part-time nurses. Nurses were\nsurveyed about their perceptions and attitudes toward and practices on clinical alarms using an adapted HTF clinical alarms\nsurvey. Results were compared to the 2011 HTF data. Correlations among variables were examined.\nResults: All TCICU nurses provided usable responses (N=39, 100%). Almost all nurses (95%-98%) believed that false alarms\nare frequent, disrupt care, and reduce trust in alarm systems, causing nurses to inappropriately disable them. Unlike the 2011\nHTF clinical alarms survey results, a significantly higher percentage of our TCICU nurses believed that existing devices are\ncomplex, questioned the ability and adequacy of the new monitoring systems to solve alarm management issues, pointed to the\nlack of prompt response to alarms, and indicated the lack of clinical policy on alarm management (P<.01). Major themes in the\nnarrative data focused on nurses� frustration related to the excessive number of alarms and poor usability of the cardiac monitors.\nA lack of standardized approaches exists in changing patients� electrodes and individualizing parameters. Around 60% of nurses\nindicated they received insufficient training on bedside and central cardiac monitors. A correlation also showed the need for\ntraining on cardiac monitors, specifically for older nurses (P=.01).\nConclusions: False and non-actionable alarms continue to desensitize TCICU nurses, perhaps resulting in missing fatal alarms.\nNurses� attitudes and practices related to clinical alarms are key elements for designing contextually sensitive quality initiatives\nto fight alarm fatigue. Alarm management in ICUs is a multidimensional complex process involving usability of monitoring\ndevices, and unit, clinicians, training, and policy-related factors. This indicates the need for a multi-method approach to decrease\nalarm fatigue and improve alarm systems safety....
Background: Prenatal screening for foetal cardiac abnormalities has been increasingly practiced in Sweden during\nthe last 25 years. A prenatal diagnosis may have medical benefits but may also cause sustained parental\npsychological distress. The aim of this study was to explore pregnant womenââ?¬â?¢s, and their partnerââ?¬â?¢s, experiences of\ncounselling and need for support during continued pregnancy following a prenatal diagnosis of a cardiac defect. A\nsecond aim was to use this information to propose a structured follow-up programme for continued support after\nthe first counselling.\nMethod: Design: Qualitative study, using interviews performed 5ââ?¬â??9 weeks after a prenatal diagnosis of congenital\nheart disease.\nSetting: A tertiary foetal cardiology unit in Sweden\nSample: Six pregnant women and their 6 partners, consecutively recruited after a prenatal diagnosis of an isolated\nand significant cardiac defect.\nData analysis: Qualitative content analysis.\nResults: The analysis resulted in three themes. 1/ Counselling and making a decision - the importance of\nknowledge and understanding: Short waiting time for specialist evaluation together with clear and straightforward\ninformation was essential. Parents called for written information together with a high-quality website with relevant\ninformation about congenital heart disease. 2/ Continued support during pregnancy: Continued and easy access to\nhealth care professionals, including a paediatric specialist nurse, throughout pregnancy, was important. Contact\nwith couples with similar experiences and social media were also considered valuable sources of support. 3/ Next\nstep ââ?¬â?? the near future: Practical and economical issues during the postnatal hospital stay and the initial period\nfollowing the hospital stay were common concerns.\nConclusions: The following aspects should be considered in a structured follow up program during pregnancy\nafter a prenatal diagnosis of CHD; written information, access to a safe web-site with information of high quality in\ntheir native language, support from parents with similar experiences and continued contact with a specialist liaison\nnurse with experience of paediatric cardiology....
Aim\nTo explore and describe long-term thoughts and perceptions of the Aussie\nHeart Guide Programme including the role of the mentor, held by patients\nrecovering from myocardial infarction.\nDesign\nA qualitative design.\nMethods\nThirteen patients recovering from myocardial infarction who were unable to\nattend a hospital-based or affiliated outpatient cardiac rehabilitation programme\nwere interviewed by telephone at the completion of the programme\nand asked to describe the relationship with their assigned nurse mentor and\ntheir perception of the audiovisual used in the programme.\nResults\nThree themes emerged; assisting me to cope, supporting me and my family and\ntailoring the programme to my needs. Patients were satisfied with the programme\nand appreciative of the supportive and caring relationships provided\nby mentors during their hospitalization through to their discharge from the\nprogramme....
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