Current Issue : April - June Volume : 2016 Issue Number : 2 Articles : 9 Articles
Background: Temporary pacemaker wires are placed in the majority of patients after cardiac surgery. There is no\ninformation on mechanical factors related to wire removal.\nMethods: Clinical information related to temporary wire use and removal was prospectively collected from a large\ncardiac surgical unit over one year. Measurements of maximal tension that nurses and doctors would apply to\nremove temporary wires was determined using a hand-held portable scale. In a prospective trial, patients (n = 41)\nhad their wires extracted in series to the portable scale to determine the maximal tension required for safe removal.\nResults: Ventricular wires were placed in 86.5 % of patients during the observed year. Pacing facilitated weaning\nfrom CPB in over 15 % of patients and pacer dependence was seen in 2.1 %. No patients suffered major\ncomplications after wire removal. There was no difference in the tension that physicians or nurses would apply to\ncomfortably extract temporary wires. In the prospective trial, there was no difference in the tension required for\nremoval of atrial or ventricular wires (atrial 18.3 �± 17.9 oz versus 14.5 �± 14.2 oz, p = 0.430). There were no patient\nfactors that correlated with the degree of resistance and there was no significant difference between the tension\nrequired to remove wires with (21.0 �± 22.5 oz) or without (14.1 �± 5.1 oz) an atrial button.\nConclusions: Temporary epicardial wire removal is innocuous and was not associated with any complications. In\nsome patients tension required for safe removal exceeded 20 ounces. Strategies to standardize wire removal may\nprevent complications and may minimize unnecessary wire retention....
Background: Heart failure is a major public health problem, and self-management\nis the primary approach to control the progression of heart failure. The low research\nparticipation rate among rural patients hinders the generation of new evidence for\nimproving self-management in rural heart failure patients.\nPurpose: The purpose of this study is to identify the barriers and strategies in\nthe recruitment and retention of rural heart failure patients in behavioral intervention\nprograms to promote self-management adherence.\nMethod: This is a descriptive study using data generated from a randomized\ncontrolled trial.\nResults: Eleven common barriers were identified such as the inability to perceive\nthe benefits of the study, the burden of managing multiple comorbidities, and the lack of\ntransportation to appointments. Possible gateways to improve recruitment and retention\ninclude using recruiters from the local community and promoting provider engagement\nwith research activities. Multiple challenges inhibited rural heart failure patients from\nparticipating in and completing the behavioral intervention study.\nConclusion and implications: Anticipation of those barriers, and identifying\nstrategies to remove those barriers, could contribute to an improvement in the rural\npatients� participation and completion rates, leading to the generation of new evidence\nand better generalizability of the evidence....
Background: Ceruloplasmin is an acute phase protein with plasma copper binding properties, and\nis a potent extracellular antioxidative enzyme. Inflammation and oxidative stress might explain\nthe role of ceruloplasmin in the pathophysiology of heart failure. Study objective: The objective is\nto assess the correlation of ceruloplasmin levels with biomarkers of cardiac remodelling and myofibrosis\nin patients with acute decompensated heart failure. Patients and methods: Blood samples\nwere taken and serum levels of soluble ST2, galectin-3, NT-proBNP and ceruloplasmin were analysed\nin 31 consecutive patients with systolic HF referred to tertiary care nurse lead heart failure\nclinic with acute decompensated CHF requiring i.v. diuretics. The mean patients� age was 68 years,\nmean left ventricular ejection fraction (LV EF) was 29%, 66% patients had ischemic aetilogy of\nCHF and 33% had atrial fibrillation. Results: The mean ceruloplasmin level was 0.243 g/l, mean\ngalectin-3 level was 1.26 ng/ml, mean sST2 level was 38.15 ng/ml, and mean NT-proBNP was 1927\npg/ml. The ceruloplasmin level correlated with NT-proBNP (r = 0.58, p < 0.05) and with sST2 (r =\n0.77, p < 0.001), sST2 levels correlated significantly with NT-proBNP (r = 0.66, p < 0.01). The ceruloplasmin\nlevel did not correlate with galectin-3 concentration. Conclusion: The ceruloplasmin\nlevel correlates with the biomarkers of cardiac remodelling (NT-proBNP, sST2), but not with the\nbiomarker of myofibrosis (galectin-3). This finding supports the hypothesis of inflammatory re-sponse in acute decompensated heart failure....
Living with a congenital heart condition can require a daunting and uncertain patient journey\nduring which the support of a specialist nursing service is vital. A descriptive, cross-sectional\nevaluation completed over two years, utilised a postal questionnaire to investigate patient�s satisfaction\nwith aspects of service. Qualitative responses to open questions on satisfaction with emotional\nsupport (n = 103) and contributions to well-being (n = 90) were analysed using a framework\napproach which identified eight themes. Professional knowledge and expertise, service accessibility,\ncaring attributes, enabling patients to cope with anxiety, depression and meeting\nchanging needs contributed positively to both patient well-being and emotional support. Family\nsupport was influential on emotional support alone, whilst mediating medical liaison exerted an\nimpact on well-being by enhancing feelings of security. In conclusion, the specialist nursing service\ncontributed positively to well-being and emotional support of patients and thereby to selective\naspects of continuity of care....
Background: Pre-eclampsia progressing to eclampsia is one of the major causes of maternal death in Nigeria. Since\nthere is long term association of pre-eclampsia with cardiovascular disease, cerebrovascular disease, renal disease,\nshort life expectancy and mortality, it is essential to obtain obstetric history for better counseling and long term\nmonitoring. The study assessed the knowledge of health workers about the association of pre-eclampsia with future\ncardiovascular disease and offering any risk-reduction counseling to women with pre-eclampsia.\nMethods: During a training workshop, a validated questionnaire on the association between pre-eclampsia and cardiovascular\nrisk was distributed among health care workers working at the infant welfare and family planning clinics\nin Osun State. Data were analysed using descriptive and inferential statistics.\nResults: One hundred and forty-six out of 150 health workers approached participated in the study (response rate\n97.3 %). Mean age of respondents was 35.6 Ã?± 9.1 years. Median age of practice was 7 years, ranging from 1ââ?¬â??40 years.\nThey were medical doctors (60.3 %), community health workers (26.7 %) and nurses/midwives (13.0 %). Most participants\nhad good knowledge on future cardiovascular risk of pre-eclampsia. The medical doctors had better knowledge\ncompared to nurses/midwives and community health workers (78.4 vs. 57.9 vs. 53.8 %; p < 0.05). Below half (45.9 %)\noffered risk-reduction counseling.\nConclusion: Knowledge of the cardiovascular risk factors was lower among the nurses/midwives and community\nhealth workers. Risk reduction counseling was quite low across all the health workers. There is need for continuous\nmedical education and possible review of the training curriculum of the lower cadres of health workers....
Background: Heart failure (HF) is expected to be highly prevalent in nursing home residents, but precise figures\nare scarce. The aim of this study was to determine the prevalence of HF in nursing home residents and to get\ninsight in the clinical characteristics of residents with HF.\nMethods: The study followed a multi-centre cross-sectional design.\nNursing home residents (n = 501) in the southern part of the Netherlands aged over 65 years and receiving long-term\nsomatic or psychogeriatric care were included in the study. The diagnosis of HF and related characteristics were based\non data collected from actual clinical examinations (including history, physical examination, ECG, cardiac markers and\nechocardiography), patient records and questionnaires. A panel of two cardiologists and a geriatrician ultimately\njudged the data to diagnose HF.\nResults: The overall prevalence of HF in nursing home residents was 33 %, of which 52 % had HF with preserved\nejection fraction. The symptoms dyspnoea and oedema and a cardiac history were more common in residents with\nHF. Diabetes mellitus, chronic obstructive pulmonary disease (COPD) were also more prevalent in those with HF.\nResidents with HF had a higher score on the Mini Mental State Examination. 54 % of those with HF where not\nknown before, and in 31 % with a history of HF, this diagnosis was not confirmed by the expert panel.\nConclusion: This study shows that HF is highly prevalent in nursing home residents with many unknown or falsely\ndiagnosed with HF. Equal number of HF patients had reduced and preserved left-ventricular ejection fraction....
This study aimed to investigate the knowledge of nursing students\nabout cardiorespiratory arrest. It consisted in a qualitative research\nwith 29 nursing students of the Federal University of Campina Grande,\ncampus Cajazeiras, ParaÃ?Âba, Brazil. A semi-structured interview\nwas used for data collection, which took place in December 2014\nafter approval by the Ethics and Research Committee of the institution\nof education. The technique of Collective Subject Discourse\nwas used for data analysis. Unpreparedness and insecurity of academics\nwith respect to cardiorespiratory arrest were evident. The\nlack of practice makes them afraid and they point to the educational\ninstitution as responsible for not providing environments to better\nprepare them for stressful situations. Therefore, there is a need for\nstrengthening the academic training of future nurses by increasing\nthe opportunities for practice so that students get familiar with the\nreality they will face and, this way, this gap in the nursing training\nmay be reduced....
Background: Patients with cardiac arrest have lower survival rates, when resuscitation performance is low. In\nIn-hospital settings the first responders on scene are usually nursing staff without rhythm analysing skills. In such\ncases Automated External Defibrillators (AED) might help guiding resuscitation performance. At the Wuerzburg\nUniversity Hospital (Germany) an AED-program was initiated in 2007.\nAim of the presented study was to monitor the impact of Automated External Defibrillators on the management of\nin-hospital cardiac arrest events.\nMethods: The data acquisition was part of a continuous quality improvement process of the Wuerzburg University\nHospital. For analysing the CPR performance, the chest compression rate (CCR), compression depth (CCD), the no\nflow fraction (NFF), time interval from AED-activation to the first compression (TtC), the time interval from AED activation\nto the first shock (TtS) and the post schock pause (TtCS) were determined by AED captured data. A\nquestionnaire was completed by the first responders.\nResults: From 2010 to 2012 there were 359 emergency calls. From these 53 were cardiac arrests with an AEDapplication.\nComplete data were available in 46 cases. The TtC was 34 (32ââ?¬â??52) seconds (median and IQR).The TtS\nwas 30 (28ââ?¬â??32) seconds (median and IQR) . The TtCS was 4 (3ââ?¬â??6) seconds (median and IQR)\n. The CCD was 5.5 Ã?± 1 cm while the CCR was 107 Ã?± 11/min. The NFF was calculated as 41 %.\nROSC was achieved in 21 patients (45 %), 8 patients (17 %) died on scene and 17 patients (37 %) were transferred\nunder ongoing CPR to an Intensive Care Unit (ICU).\nConclusion: The TtS and TtC indicate that there is an AED-user dependent time loss. These time intervals can be\nmarkedly reduced, when the user is trained to interrupt the AEDââ?¬â?¢s ââ?¬Å?chain of advicesââ?¬Â by placing the electrodepaddles\nimmediately on the patientââ?¬â?¢s thorax. At this time the AED switches directly to the analysing mode.\nIntensive training and adaption of the training contents is needed to optimize the handling of the AED in order to\nmaximize its advantages and to minimize its disadvantages....
Background: Recent decades have shown major improvements in survival rates after cardiac arrest. However, few\ninterventions have been tested in order to improve the care for survivors and their family members. In many countries,\nincluding Sweden, national guidelines for post cardiac arrest care and follow-up programs are not available and current\npractice has not previously been investigated. The aim of this survey was therefore to describe current post cardiac\narrest care and follow-up in Sweden.\nMethods: An internet based questionnaire was sent to the resuscitation coordinators at all Swedish emergency hospitals\n(n = 74) and 59 answers were received. Quantitative data were analysed with descriptive statistics and free text responses\nwere analysed using manifest content analysis.\nResults: Almost half of the hospitals in Sweden (n = 27, 46 %) have local guidelines for post cardiac arrest care and\nfollow-up. However, 39 % of them reported that these guidelines were not always applied. The most common routine is\na follow-up visit at a cardiac reception unit. If the need for neurological or psychological support are discovered the\nroutines are not explicit. In addition, family members are not always included in the follow-up.\nConclusions: Although efforts are already made to improve post cardiac arrest care and follow-up, many hospitals\nneed to focus more on this part of cardiac arrest treatment. In addition, evidence-based national guidelines will have to\nbe developed and implemented in order to achieve a more uniform care and follow-up for survivors and their family\nmembers. This national survey highlights this need, and might be helpful in the implementation of such guidelines....
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