Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 7 Articles
Background: Despite substantial investment in detection, early intervention and evidence-based treatments, current\nmanagement strategies for diabetes-associated retinopathy and cardiovascular disease are largely based on real-time\nand face-to-face approaches. There are limited data re telehealth facilitation in type 2 diabetes management. Therefore,\nwe aim to investigate efficacy of telehealth facilitation of diabetes and cardiovascular disease care in high-risk\nvulnerable Aboriginal and Torres Strait Islanders in remote/very remote Australia.\nMethods: Using a pre-post intervention design, 600 Indigenous Australians with type 2 diabetes will be recruited from\nthree primary-care health-services in the Northern Territory. Diabetes status will be based on clinical records. There will\nbe four technological interventions: 1. Baseline retinal imaging [as a real-time patient education/engagement tool and\ntelehealth screening strategy]. 2. A lifestyle survey tool administered at ââ?°Ë? 6-months. 3. At ââ?°Ë? 6ââ?¬â? and 18-months, an\nelectronic cardiovascular disease and diabetes decision-support tool based on current guidelines in the Standard\nTreatment Manual of the Central Australian Rural Practitionerââ?¬â?¢s Association to generate clinical recommendations.\n4. Mobile tablet technology developed to enhance participant engagement in self-management. Data will\ninclude: Pre-intervention clinical and encounter-history data, baseline retinopathy status, decision-support and\nsurvey data/opportunistic mobile tablet encounter data. The primary outcome is increased participant adherence\nto clinical appointments, a marker of engagement and self-management. A cost-benefit analysis will be performed.\nDiscussion: Remoteness is a major barrier to provision and uptake of best-practice chronic disease management.\nTelehealth, beyond videoconferencing of consultations, could facilitate evidence-based management of diabetes and\ncardiovascular disease in Indigenous Australians and serve as a model for other conditions....
To explore the effect of early rehabilitation nursing on the quality of life of patients\nwith acute myocardial infarction. Methods 41 cases of patients with acute myocardial\ninfarction were selected according to the diagnostic criteria of acute myocardial infarction,\nstable vital signs, and no obvious complications. On the basis of routine nursing care, the\nsystem of early rehabilitation nursing care, the development of daily rehabilitation nursing plan.\nThe cardiac function, clinical symptoms, quality of life and average length of stay were\nobserved in 41 patients. Results During hospitalization, 41 patients had no deaths and all\npatients clinical symptoms significantly reduced; length of hospital stay was significantly\ndecreased; heart function recovered well; the quality of life of patients significantly improved.\nConclusion Early rehabilitation nursing care for patients with acute myocardial infarction is\nconducive to improving the condition, shorten the hospital stay, can greatly improve the quality\nof life of patients, it is worthy of clinical promotion....
When patients are hospitalized for diagnostic methods, including cardiac catheterization, the anxiety increases. Therefore, treating these reactions can speed up recovery and decrease of anxiety that causes cardiac complication. Study evaluates the effect of early nursing preparation on anxiety among patients undergoing cardiac catheterization. A quasi experimental research design was utilized. The study was conducted at the Cardiac Catheterization Unit of Menoufia University Hospital, Menoufia Governorate, Shebien El-Kom, Egypt. Subjects: A purposive sample of 100 adult patients of both sexes who were admitted to the cardiac catheterization unit. Tools: two tools were utilized. Tool I: cardiac catheterization patients needs assessment: structured interviewing scheduled questionnaire, consisted of the following: Part 1: Sociodemographic and clinical data. Part II: Cardiac Catheterization Knowledge Assessment Sheet. Tool II: Hamilton anxiety rating scale (HAM-A). Results: the study group had better knowledge than control group, there were statistical significant differences were existed between study and control group regarding the anxiety level at day and post procedure at P values = 0.0001. There were highly statistically significant difference and correlation existed between anxiety and age, gender and level of education at p value= 0.0001. There was a significant correlation between knowledge and anxiety scores at P value= 0.004. Conclusion: it can be concluded that, the early preparation and gave patients� information before cardiac catheterization improve patients� knowledge and reduced anxiety....
Background\nMyocardial infarction (MI) is the leading cause of death in Iran. Every attempt to improve\ntreatment patterns and patient outcomes needs a surveillance system to both consider the\nefficacy and safety measures. Fasa Registry on Myocardial Infarction (FaRMI) is the first\npopulation-based registry for acute MI in Iran targeted to provide meticulous description of\npatients� characteristics, to explore the management patterns of these patients, to discover\nthe degree of adherence to the practice guidelines, and to investigate the determinants of\npoor in-hospital and later outcomes.\nMethods\nA diagnosis of acute MI (type I, II and III) was made upon the accepted criteria by the attending\ncardiologists and types IV and V MI were excluded. Two registrar nurses gathered data\non demographics, place of residence and ethnicity, past medical history, risk factors, and\nthe clinical course. Management patterns in the pre-hospital setting, during the hospital stay\nand at the discharge time were recorded. Routine laboratory results and cardiac biomarkers\non three consecutive days were registered.\nResults\npilot phase included the first 95 patients, 63.5% of whom were men and 31.5% were\nwomen. With a mean age of 62.8913.75 years among participants, the rate of premature\nMI was 31.8%. ST segment elevation MI accounted for 68.2% cases and inferior wall was\nthe most prevalent region involved followed by anterior and posterior walls. Discussion\nObtained data on the characteristics of patients suffering an MI event revealed the major\ndeterminants of delay in initiation of therapies and contributors of poor outcome. Completeness\nof data was guaranteed upon involvement of multiple checkpoints and data quality was\nsecured by means of automatic validation processes in addition to weekly physicians�\nroundups.\nConclusion\nExecution of FaRMI in the form presented is feasible and it will build up a comprehensive\npopulation-based registry for MI in the region....
Background: Heart failure is one of the leading reasons for hospitalization in developed countries. Our goal was to\ndescribe the hemodynamic vital signs (heart rate and systolic blood pressure) of patients presenting to the\nemergency department (ED) with heart failure and to describe the frequency of adverse events for patients\npresenting with various heart rate and systolic blood pressure values.\nMethod: We conducted two prospective cohort studies of heart failure conducted at six Canadian teaching\nhospital sites and this study was a secondary analysis of these data. The primary outcome was serious adverse\nevents defined as death from any cause within 30 days of the ED visit or any complication following within 14 days\nof the index ED visit.\nResults: We included a convenience sample of adults > 50 years of age who presented with acute shortness of\nbreath or new-onset heart failure. In total, 1,638 patients were included in this analysis. Patients with heart rates\n< 50 % MHR (maximal heart rate) and systolic blood pressure (SBP) > 140 mmHg had the lowest rate of serious\nadverse events (6 %). patients with heart rates > 75 % MHR had the highest rate of serious adverse events,\nregardless of the SBP. Among patients with heart rates > 75 % MHR, the proportion of serious adverse events\ndecreased as SBP increased (30 % when SBP < 120 mmHg, 24 % when SBP between 120 and 140 mmHg, and 21 %\nwhen SBP > 140 mm Hg). Patients with heart rates < 50 % MHR and with SBP > 140 mm Hg had the lowest rate of\nadmissions to hospital (38 %).\nConclusions: We found a relatively high frequency of serious adverse events among patients who present to the\nED with heart failure, particularly among the patients having low systolic blood pressure and high heart rate....
Background: A tailored implementation programme to improve cardiovascular risk management (CVRM) in general\npractice had little impact on outcomes. The questions in this process evaluation concerned (1) impact on\ncounselling skills and CVRM knowledge of practice nurses, (2) their use of the various components of the\nintervention programme and adoption of recommended practices and (3) patients� perceptions of counselling for\nCVRM.\nMethods: A mixed-methods process evaluation was conducted. We assessed practice nurses� motivational\ninterviewing skills on audio-taped consultations using Motivational Interviewing Treatment Integrity (MITI). They also\ncompleted a clinical knowledge test. Both practice nurses and patients reported on their experiences in a written\nquestionnaire and interviews. A multilevel regression analysis and an independent sample t test were used to\nexamine motivational interviewing skills and CVRM knowledge. Framework analysis was applied to analyse\nqualitative data.\nResults: Data from 34 general practices were available, 19 intervention practices and 14 control practices. No\nimprovements were measured on motivational interviewing skills in both groups. There appeared to be better\nknowledge of CVRM in the control group. On average half of the practice nurses indicated that they adopted the\nrecommended interventions, but stated that they did not necessarily record this in patients� medical files. The\ntailored programme was perceived as too large. Time, follow-up support and reminders were felt to be lacking.\nAbout 20% of patients in the intervention group visited the general practice during the intervention period, yet\nonly a small number of these patients were referred to recommended options.\nConclusions: The tailored programme was only partly used by practice nurses and had little impact on either their\nclinical knowledge and communication skills or on patient reported healthcare. If the assumed logical model of\nchange is valid, a more intensive programme is needed to have an impact on CVRM in general practice at all....
Team-based care is paramount to meet the mission of the American College of Cardiology which is to transform\ncardiovascular care and improve heart health. Advanced practice registered nurses (APRN) are integral to this team.\nAlthough the recent ACC 2015 health policy statement on cardiovascular team-based care address contributions of\nall members of the team, further information that defines APRNs, their contributions to the cardiovascular team and\nbarriers to practice are needed. Therefore, the purpose of this manuscript is to further explain the role of the APRN\nas a member of the cardiovascular team with a focus on the certified nurse practitioner and clinical nurse specialist\nwithin the United States....
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