Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 7 Articles
Background: Around 17 % of people eligible for UK cardiac rehabilitation programmes following an acute coronary\nsyndrome report moderate or severe depressive symptoms. While maximising psychological health is a core goal of\ncardiac rehabilitation, psychological care can be fragmented and patchy. This study tests the feasibility and\nacceptability of embedding enhanced psychological care, composed of two management strategies of proven\neffectiveness in other settings (nurse-led mental health care coordination and behavioural activation), within\nthe cardiac rehabilitation care pathway.\nMethods/Design: This study tests the uncertainties associated with a large-scale evaluation by conducting an\nexternal pilot trial with a nested qualitative study. We aim to recruit and randomise eight comprehensive cardiac\nrehabilitation teams (clusters) to intervention (embedding enhanced psychological care into routine cardiac\nrehabilitation programmes) or control (routine cardiac rehabilitation programmes alone) arms. Up to 64 patients\n(eight per team) identified with depressive symptoms upon initial assessment by the cardiac rehabilitation team\nwill be recruited, and study measures will be administered at baseline (before starting rehabilitation) and at 5 months\nand 8 months post baseline. Outcomes include depressive symptoms, cardiac mortality and morbidity, anxiety,\nhealth-related quality of life and service resource use. Trial data on cardiac team and patient recruitment, and the\nretention and flow of patients through treatment will be used to assess intervention feasibility and acceptability.\nQualitative interviews will be undertaken to explore trial participants� and cardiac rehabilitation nurses� views and\nexperiences of the trial methods and intervention, and to identify reasons why patients declined to take part in\nthe trial. Outcome data will inform a sample size calculation for a definitive trial.\nDiscussion: The pilot trial and qualitative study will inform the design of a fully powered cluster randomised\ncontrolled trial to evaluate the effectiveness and cost-effectiveness of the provision of enhanced psychological\ncare within cardiac rehabilitation programmes...
Objective: Cardiovascular diseases are the most common causes of morbidity and the leading\ncause of mortality in the world scenario, accounting for about 20% of all deaths in individuals\nover 30 years. It has attributed this to the increase in the company�s exposure to risk factors. It\nidentifies cardiovascular risk factors in the nursing team and compares the cardiovascular risk by\nFramingham score among professionals of middle and upper working in a referral hospital in cardiology.\nMethod: Cross-sectional quantitative study was conducted in 2014, in a reference hospital\nin cardiology located in Recife/Pernambuco, Brazil. Data of cardiologic risk factors were collected\nfrom 82 nursing team members, comprised of technical, auxiliary nurses, and nurses between 30\nand 74 years of age. The cardiovascular risk level was evaluated by the Framingham Score. Data\nwere organized and analyzed by means of the SPSS, with descriptive statistics and Student-t test for\nthe continuous variables. Results: Family history, stress and sedentary life style were the prevalent\nrisk factors in more than half of the professionals. Only 5.23% of the technical and auxiliary nurses\nhad a high risk score for cardiovascular event. Conclusion: The data indicates a low cardiovascular\nrisk for these professionals and the presence of risk factors that can be modified. Health surveillance\nof these professionals is necessary in order to avoid a change to a risk of greater vulnerability....
Background: Improvement of health-related quality of life (HRQOL) is an important goal in preventive cardiology.\nHRQOL is also related to depressive symptoms, which represent a common co-morbidity and risk factor in patients\nwith an acute coronary syndrome (ACS). Comprehensive nurse-coordinated prevention programmes (NCPP) in\nsecondary care have been shown to reduce cardiovascular risk, however their effects on HRQOL and depressive\nsymptoms have not been evaluated. We therefore investigated HRQOL and depressive symptoms in a secondary\nanalysis in the RESPONSE trial, evaluating the effect of a NCPP on cardiovascular risk.\nMethods: RESPONSE was a multicentre (n = 11) randomised controlled trial in ACS-patients in secondary and\ntertiary healthcare settings evaluating a NCPP. The intervention consisted of four outpatient nurse clinic visits in the\nfirst 6 months after the index event, focusing on healthy lifestyles, biometric risk factors and medication adherence,\nin addition to usual care. The control group received usual care only. The outcome was change in HRQOL as\nmeasured by the MacNew questionnaire and change in depressive symptoms as measured by Beck�s Depression\nInventory (BDI) questionnaire at 12-months follow-up relative to baseline.\nResults: Of 754 patients randomised, 615 were analysed for HRQOL; 120 for depressive symptoms. At baseline, HRQOL\nwas 5.17 (SD 1.09) and 5.20 (SD1.04) (scale range 1.0 to 7.0) in the intervention and control group, respectively. At\n12 months follow-up, HRQOL increased by 0.57 (SD 0.89) in the intervention group as compared with 0.42 (SD 0.90) in\nthe control group (p = 0.03). This increase was observed across all relevant subscales. The BDI decreased by 1.9 in the\nintervention group as compared with 0.03 in the control group (p = 0.03) (scale range 1.0 to 63).\nConclusion: Participation in a NCPP is associated with a modest but statistically significant increase in HRQOL, and a\ndecrease of depressive symptoms, both of which are highly relevant to patients. A reduction in depressive symptoms\nmay in addition contribute to a reduction in the overall risk of recurrent events....
Background and Objective: Coronary artery disease (CAD) is the leading cause of sudden death. In\nthis article, we compared patients� illness perception (IP), treatment adherence and coping mechanisms\nof patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Methods:\nIn this descriptive, prospective observational study IP, treatment adherence and coping of\n140 patients were evaluated pre-PTCA, at the time of hospital discharge and 1 to 3 months post-\nPTCA by Illness Perception Questionnaire, Morisky Treatment Adherence and Carver�s brief COPE\nquestionnaires. Results: 1 - 3 months post-PTCA, all dimensions of IP changed significantly except\npersonal and treatment control. Adherence scores decreased simultaneously. With respect to\ncoping mechanisms, all increased except behavioral disengagement, emotional support, instrumental\nsupport and religion which decreased significantly post-PTCA. Conclusions: In Overall, an\nimproved IP and increased use of controllable causal attributions led to an increase in medication\nadherence and adaptive coping strategies. Post-treatment health behaviors are predictable by assessing\npatients� illness-related beliefs beforehand....
Background: proper documentation of Atherosclerotic\nCardiovascular Disease (ASCVD) risk score and its consequent\nmanagement in the newly applied electronic medical records (EMR)\nfor diabetic�s patients attending non-communicable diseases clinic\nin West Bay Health Center is less than ideal during Jan 2015 and Feb\n2015. Poor documentation of ASCVD risk score and its consequent\nmanagement will result in improper management for type 2 diabetic\npatients, and it will lead to undesirable consequences.\nAim: To improve the documentation of ASCVD risk score and its\nconsequent management in the EMR of diabetic patients attending\nnon communicable disease clinic (NCD) at west bay health center in\naccordance to American Heart Association and American College\nof Cardiology (AHA/ACC) guidelines for ASCVD risk assessment\nby end of April 2015.\nMethods: Pre-intervention Checklist was developed to collect\nbaseline data regarding the percentage of documentation of\nASCVD risk score and its consequent management from the EMR\nfor 60 Diabetic Patients attends NCD clinics. Intervention in the\nform of training session was done for all NCD nurses regarding\nthe importance of ASCVD risk score Calculation method and\nrole of nurses in documentation. For all doctors that run the NCD\nclinic training session was done regarding the ASCVD risk score\ninterpretation, documentation, and importance of preventive\nmanagement based on the score calculated with allocation of space\nin the new NCD chart in EMR for ASCVD risk score documentation\nand consequent management based on the score calculated and\ncreate a reminder poster in NCD nurse station and NCD clinics.\nResults: Percentage of complete ASCVD risk documentation for\ndiabetic patients in electronic medical (EMR) increased to 87%\nwith given proper treatment based on the calculated score after the\nintervention.\nConclusions: Intervention in the form of nurse and physician\nTraining improved the documentation of ASCVD by 87 %. This\nusually raise the issue that while implementing new systems,\nwe must put into consideration previous processes and making\nsuitable improvements....
Background: Complications post percutaneous coronary interventions (PCI) are more threatening\nthan it was previously thought so that necessary measures should be taken to minimize those\nrisks. Objective: To identify the risk factors related to patient and procedure which could be used\nas predictors of complications after sheath removal post PCI. Methods: The study used a prospective\nnon-experimental correlational descriptive. Design: The sample was chosen conveniently from\nthree different hospitals and included 118 patients who were subjected to PCI. Results: Three\nmodels were used to predict complications. In the first model, none of the baseline variables were\npredictive of complications. In the second model, the only type of procedure (diagnostic, stent or\nballoon) was predictive of complications. In the third model, compression time was found to be a\nrisk factor and a predictor of complications after sheath removal. Conclusion: Nurses and medical\nprofessionals are in a vital position to prevent, detect and manage PCI complications at the earliest\npossible opportunity. It is a must to assess and categorize patients in accordance with their\nrisk level to develop post PCI and post sheath removal complications, in order to plan management\nstrategies to decrease the health costs and the suffering....
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