Current Issue : July - September Volume : 2016 Issue Number : 3 Articles : 6 Articles
Background: Persisting delay in seeking treatment among Acute Myocardial Infarction (AMI) patients was reported in\nMalaysia despite intensified efforts in educating the public on symptoms of AMI and the importance of seeking prompt\ntreatment. Studies outside Malaysia have shown that patients� personal thoughts during symptom onset could contribute\nto the delay. The purpose of this study is to explore the barriers of AMI patients prior to the decision of seeking treatment\nin Malaysia.\nMethods: A qualitative descriptive research approach was chosen. Individual in-depth interviews were conducted\namong 18 patients with AMI. Data were analysed using thematic analysis. Recordings were transcribed and\ncoded, codes were subsequently organized into categories. The stages of coding and identifying categories were\nrepeated before themes were identified.\nResults: Three meaningful themes with nine sub-themes that may have influenced the delayed decision to seek\ntreatment were identified. Some themes identified were culturally bound.\nConclusions: The findings of this study give insights on barriers prior to the decision of seeking treatment when\npatients were experiencing AMI. Findings indicates that interventions targeted at increasing knowledge about AMI\nsymptoms and correct actions using an informative approach at the current practice may not be adequate to reduce\npatient delay. The findings of this study could provide basis for the development of interventions that are culturally\nrelevant to the Malaysians setting to promote behavioural change in the population and reduce pre-hospital delay....
Background: Patients� knowledge of their atrial fibrillation (AF) and anticoagulation therapy are determinants of the\nefficacy of thromboprophylaxis. Nurses may be well placed to provide counselling and education to patients on all\naspects of anticoagulation, including self-management. It is important that nurses are well informed to provide\noptimal education to patients. Current practice and knowledge of cardiovascular nurses on AF and anticoagulation\nin the Australian and New Zealand (ANZ) context is not well reported.\nThis study aimed to; 1) Explore the nurse�s role in clinical decision making in anticoagulation in the setting of AF;\n2) Describe perceived barriers and enablers to anticoagulation in AF; 3) Investigate practice patterns in the\nmanagement of anticoagulation in the ANZ setting; 4) Assess cardiovascular nurses� knowledge of anticoagulation.\nMethods: A paper-based survey on current practices and knowledge of AF and anticoagulation was distributed\nduring the Australian Cardiovascular Nursing College (ACNC) Annual Scientific Meeting, February 2014. This survey\nwas also emailed to Cardiovascular Trials Nurses throughout New South Wales, Australia and nursing members of\nthe Cardiac Society of Australia and New Zealand (CSANZ).\nResults: There were 41/73 (56 %) respondents to the paper-based survey. A further 14 surveys were completed\nonline via nurse members of the CSANZ, and via an investigator developed NSW cardiovascular trials nurse email\ndistribution list. A total of 55 surveys were completed and included in analyses. Prior education levels on AF, stroke\nrisk, anticoagulation and health behaviour modification were mixed. The CHA2DS2VASc and HAS-BLED risk stratification\ntools were reported to be underused by this group of clinicians. Reported key barriers to anticoagulation included;\nfears of patients falling, fears of poor adherence to medication taking and routine monitoring. Patient self-monitoring\nand self-management were reported as underutilised. ANZ cardiovascular nurses reported their key role to\nbe counselling and advising patients on therapy regimens. Anticoagulant-drug interaction knowledge was\ngenerally poor.\nConclusion: This study identified poor knowledge and practice in the areas of AF and anticoagulation. There is scope\nfor improvement for cardiovascular nurses in ANZ in relation to AF and anticoagulation knowledge and practice....
Background: Peripheral arterial disease is a chronic illness, and patients with peripheral arterial disease should\nreceive advice about lifestyle changes and medical therapies to reduce further atherosclerotic complications.\nPrevious research has indicated that patients with peripheral arterial disease lack information about their disease\nand secondary prevention measures. The aim was to elucidate how patients with peripheral arterial disease\ncommunicate their knowledge about their illness and treatments.\nMethods: During 2009, seven focus group interviews were conducted with twenty-one patients (50ââ?¬â??81 years old)\nwith peripheral arterial disease and were analysed using content analysis.\nResults: When respondents with PAD communicate their knowledge about the illness and its treatments they\nââ?¬Å?Navigate through uncertainty, believes and facts about PAD, displaying an active or passive information-seeking\nbehaviourââ?¬Â. After discharge, they felt a feeling of relief at first, which was later exchanged into uncertainty from their\nrestricted knowledge about the illness and how to behave following re vascularisation. For example, during the\ndiscussions about risk factors, smoking was noted as a major risk factor, that triggered feelings of guilt. Thus, the\nrespondents needed to consult other sources of information to manage their everyday lives.\nConclusions: Following endovascular treatment, the short amount of time spent with peripheral arterial disease\npatients requires innovative guidance in clinical practice to meet individualsââ?¬â?¢ needs regardless of whether the\npatient actively or passively understands and manages their peripheral arterial disease....
Background: Cardiovascular secondary preventive recommendations are often not reached. We investigated\nwhether a nurse-led telephone-based follow-up could improve the implementation of a new guideline within a\nyear after its release.\nMethods: In February 2013, a new secondary preventive guideline for diabetic patients was released in the\ncounty of JÃ?¤mtland, Sweden. It included a changed of the low-density lipoprotein cholesterol (LDL-C) target\nvalue from <2.5 mmol/L to <1.8 mmol/L. In the Nurse-Based Age-Independent Intervention to Limit Evolution of Disease\n(NAILED) trial, patients with an acute coronary syndrome, stroke, or transient ischemic attack were randomized to\nsecondary preventive care with nurse-based telephone follow-up (intervention) or usual care (control). Patient data were\nobtained from the NAILED trial to study the implementation of the new LDL-C guideline by comparing telephone\nfollow-up with usual care. The Mannââ?¬â??Whitney U-test was used for continuous variables, and Personââ?¬â?¢s Ãâ?¡2 test was\nused for categorical variables to assess between-group differences.\nResults: Out of the 1267 patients that entered the study period, 101 intervention and 100 control patients with diabetes\nfulfilled the inclusion criteria and completed the study period. Before the guideline change, 96 % of the intervention\npatients and 70 % of the control patients reached the target LDL-C value (p < 0.001). After the guideline change, the\ncorresponding respective proportions were 65 % and 36 % (p < 0.001). The main reason that intervention patients did\nnot achieve the target LDL-C value was that they received full-dose treatment; for control patients, the main reason was\nthat medication was not adjusted, for an unknown reason.\nConclusions: One year after a change in the cardiovascular secondary preventive guideline, nurse-based telephone\nfollow-up performed better than usual care to implement the new recommendation...
Background: Cardiovascular disease (CVD) is the leading cause of death in Russia. Hypertension and hyperlipidemia\nare important risk factors for CVD that are modifiable by pharmacological treatment and life-style changes. We\naimed to characterize the extent of the problem in a typical Russian city by examining the prevalence, treatment\nand control rates of hypertension and hyperlipidemia and investigating whether the specific pharmacological\nregimes used were comparable with guidelines from a country with much lower CVD rates.\nMethods: The Izhevsk Family Study II included a cross-sectional survey of a population sample of 1068 men, aged\n25ââ?¬â??60 years conducted in Izhevsk, Russia (2008ââ?¬â??2009). Blood pressure and total cholesterol were measured and\nself-reported medication use was recorded by a clinician. We compared drug treatments with the Russian and\nCanadian treatment guidelines for hypertension and hyperlipidemia.\nResults: The prevalence of hypertension was 61 % (age-standardised prevalence 51 %), with 66 % of those with\nhypertension aware of their diagnosis and 50 % of those aware taking treatment. 17 % of those taking treatment\nachieved blood pressure control. The majority (59 %) of those taking treatment were not doing so regularly.\nPrevalence of hyperlipidemia was 45 % (age-standardised prevalence 40 %), however less than 2 % of those with\nhyperlipidemia were taking any treatment. Types of lipid-lowering and anti-hypertensive medications prescribed\nwere broadly in line with Russian and Canadian guidelines.\nConclusion: The prevalence of hypertension and hyperlipidemia is high in Izhevsk while the proportion of those\ntreated and attaining treatment targets is very low. Prescribed medications were concurrent with those in Canada,\nbut adherence is a major issue....
Background: In myocardial infarction (MI), pre-hospital delay is associated with increased mortality and decreased\npossibility of revascularisation. We assessed pre-hospital delay in patients with first time MI in a northern Swedish\npopulation and identified determinants of a pre-hospital delay ââ?°Â¥2 h.\nMethods: A total of 89 women (mean age 72.6 years) and 176 men (mean age 65.8 years) from a secondary\nprevention study were enrolled in an observational study after first time MI between November 2009 and March\n2012. Total pre-hospital delay was defined as the time from the onset of symptoms suggestive of MI to admission\nto the hospital. Decision time was defined as the time from the onset of symptoms until the call to Emergency\nMedical Services (EMS). The time of symptom onset was assessed during the episode of care, and the time of call\nto EMS and admission to the hospital was based on recorded data. The first medical contact was determined from\na mailed questionnaire. Determinants associated with pre-hospital delay ââ?°Â¥ 2 h were identified by multivariable\nlogistic regression.\nResults: The median total pre-hospital delay was 5.1 h (IQR 18.1), decision time 3.1 h (IQR 10.4), and transport time\n1.2 h (IQR 1.0). The first medical contact was to primary care in 52.3 % of cases (22.3 % as a visit to a general\npractitioner and 30 % by telephone counselling), 37.3 % called the EMS, and 10.4 % self-referred to the hospital.\nDeterminants of a pre-hospital delay ââ?°Â¥ 2 h were a visit to a general practitioner (OR 10.77, 95 % CI 2.39ââ?¬â??48.59), call\nto primary care telephone counselling (OR 3.82, 95 % CI 1.68ââ?¬â??8.68), chest pain as the predominant presenting\nsymptom (OR 0.24, 95 % CI 0.08ââ?¬â??0.77), and distance from the hospital (OR 1.03, 95 % CI 1.02ââ?¬â??1.04). Among patients\nwith primary care as the first medical contact, 67.0 % had a decision time ââ?°Â¥ 2 h, compared to 44.7 % of patients\nwho called EMS or self-referred (p = 0.002).\nConclusions: Pre-hospital delay in patients with first time MI is prolonged considerably, particularly when primary\ncare is the first medical contact. Actions to shorten decision time and increase the use of EMS are still necessary....
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