Canadian journal of cardiovascular nursing = Journal canadien en soins infirmiers cardio-vasculaires最新文献

As the life expectancy of Canadians continues to increase, so does the economic burden of chronic conditions within the health care system. One chronic condition that has increased over the past decade is atrialfibrillation (AF). With health care costs forAF estimated at more than $800 million and rising, a new approach is needed to manage AF care to reduce hospitalizations and emergency room visits, while improving patients' quality of life. Multidisciplinary outpatient clinics for heart failure patients have been implemented across Canada over the past decade, and have shown a reduction in hospital admissions and emergency room visits. It is probable that the same benefit could be seen with the implementation of a structured, nurse-led outpatient AF clinic. The purpose of this article is to review the existing literature on AF outpatient management, and establish the best approachfor a clinical nurse specialist-led AF outpatient clinic within the Canadian health care system.

Aims: The purpose of the study was to investigate the agreement between carotid-femoral pulse wave velocity (cfPWV) and augmentation index adjusted at heart rate 75 bpm (AI@75) and to examine the relationship of AI@75 and cfPVW to demographic factors and blood pressures (BPs) in Korean Americans.

Methods: This study was a secondary analysis of a previous data setfrom 102 Korean Americans. AI@75 and cfPWV were measured using the SphygmoCor equipment. Age, gender, height, body weight and brachial BPs were included in the analysis.

Result and conclusion: cfPWV and AI@7S showed a good agreement. DBP was independently associated with both cfPWV (p=.022) and AI@75 (p<.001). Although PP is considered a surrogate measure of arterial stiffness, it was related to neither cfPWV nor AI@75 in our healthy middle-aged Korean Ameri- cans. Unlike cfPWV, AI@75 should be measured and analyzed carefully considering height since height was independently related to AI@75 (p<.001).

Mortality rates of women suffering from an acute myocardial infarction (AMI) are high, and in young women are on the rise. The goal of this review is to investigate what is known about women's experience of AMI symptoms. By exploring the complexity and intersections evident in the literature though an integrative literature review process, it becomes apparent that the problem involves deeper contextual influences arisingfrom women's situation in society. Keyfindings in this review suggest that not recognizing the risk or symptoms of an AMI can lead to delayed health care seeking behaviours, and warrants the need for further education. Awareness of these findings has implications for women's health outcomes and mortality rates. This review adds value to clinical practice by reifying the potential gaps in knowledge currently available to women and health care providers, and suggests filling these gaps with new more inclusive ways of knowing surrounding this phenomenon.

Background: Post-cardiac surgery surgical site infections (SSIs) pose devastating consequences in terms of morbidity and mortality to patients.

Objective: To examine current risk factors and best practice perioperative care for prevention of SSI following cardiac surgery through the lens of the demographic/clinical characteristics of patients who developed post-cardiac surgery SSIs at a major tertiary care institution, and to identify where documentation is lacking and could be improved to better serve clinical practice.

Methods: A literature review on post-cardiac surgery SSI prevention and risk factors was performed. These risk factors were examined through a retrospective chart review of the population of patients who developed SSIs during the study period.

Results: The study population was characterized by a high prevalence of riskfactors including age, diabetes, obesity, operative time, blood glucose control, surgical re-exploration, blood transfusions, and emergency context, as well as differences from best practice guidelines such as preoperative showering. Compared to other populations in the literature, several ofthese risk factors were more prevalent at the study site than in the other comparable populations.

Conclusion: The patient population had a relatively high prevalence of riskfactors, and the care received by these patients varied in some ways from best practices. Using best practice guidelines, known risk factors, and the data specific to the institution can provide insightsfor analysis and practice improvement efforts in the form of identifying at-risk patients, improving adherence to best practice guidelines, targeting areas to focus care efforts, and improving clincal documentation.

Out-of-hospital cardiac arrest (OOHCA) affects 20 to 140 people per 100,000 globally with survival rangingfrom 2% to 11% (Meaney et al., 2013). Patients who have survived, but have been left with cognitive impairments due to anoxic brain injury should be offered early identification and initiation of rehabilitation needs during their admission to mitigate the impact of these deficits (Moulaert et al., 2011). Unfortunately, most cardiac survivors do not receive specialized rehabilitation during their acute hospitalization and there are no clinical pathways that currently exist to guide acute care practitioners regarding the appropriate timing of cognitive screens and early rehabilitation interventions. This tertiary care institution designed and implemented a clinical pathway and patient and family education tools, which have systematically improved the identification and treatment ofpatients requiring cognitive rehabilitation. In this paper, the authors discuss the pathway/tool development and use a case study to highlight these interventions.

Background: Globally, about 8.6 million women die each year due to cardiovascular disease with cerebral vascular disease being the third leading cause of death in women. The province of New-foundland and Labrador has one of the highest rates of vascular disease in comparison to the rest of Canada. Women in New-foundland and Labrador have higher rates of vascular disease than their female cohorts across Canada. A vascular risk reduction programfor women aged 35 to 65 years was developed and implemented in a rural and an urban setting.

Purpose: An evaluation of the program was conducted to assess the impact of the program on participants' satisfaction and to assess how women were able to apply acquired knowledge into their everyday lives to improve their vascular health.

Procedure: A thematic analysis of qualitative data collected during tvo focus groups (N=19) was completed.

Findings: Three core themes were identified that captured the experiences of the women who participated in the program including Solidifying One's Risk, Translating Knowledge into Action, and Making a Change.

Implications: Implementation of community-based vascular education programs must consider the context in which the program is delivered, the population's unique needs, and existing resources if they are to be successful in sustaining healthy lifestyle behaviours known to decrease one's riskfor vascular disease.

Results: Participants expressed uncertainty about their future health and feared disease recurrence, which appeared to provide motivation for adopting a healthier lifestyle. Although two participants voiced the belief that the elective PCI cured their disease, this perception did not appear to influence their engagement in risk reduction behaviours. However, systemfactors such as a lack of information, direction, and/or support from health care providers appeared to play a limiting role in their ability to move forward with lifestyle change.

Background: Elective ad-hoc percutaneous coronary interventions (PCIs) are increasingly used to manage the symptoms of coronary artery disease (CAD). However, we have limited understanding of the patients' experiences and health behaviours post-procedure.

Purpose: Explore the factors that influence the perceptions and health behaviours of patients after elective ad-hoc PCI.

Methods: This interpretive descriptive study used purposive sampling to recruit participants (N = 10) aged 44 to 65 years following an elective ad-hoc PCI from a cardiac catheterization laboratory at a tertiary centre in Winnipeg, MB. Participants were interviewed 11 to 35 days following their procedure. Recruitment continued until no new substantive themes emerged. The Health Belief Model provided the frameworkfor developing, exploring, interpreting, and analyzing the data.

Practice implications: Nurses have a key role in the education of patients and in providingpatient-centred care that supports lifestyle change. Nurses need to develop strategies that decrease barriers to engaging in risk reduction behaviours following elective ad-hoc PCI if patients are to experience improved health and longevity.

In the area of cardiac rehabilitation, little attention has been given to phase III (maintenance phase), as compared to phase II (rehabilitation phase). Studies on the maintenance phase have highlighted the importance of maintaining the newly acquired healthy living habits in order to continue benefitting from them and prevent the recurrence of cardiovascular diseases and mortality. However, these studies have revealed disturbing dropout rates, from 25 to 50%. There is little research on the factors associated with the maintenance of the new healthy living habits after completing phase II of a cardiac rehabilitation program. This study innovates by measuring riskfactors and quality of life, as predictors of exercise maintenance. The goal of this project is to verify which variables are linked to the maintenance of physical activity during phase III. The sample of the study is composed of 529 patients who completed, between 2005 and 2012, phase II of the cardiac rehabilitation program, called Coeur en sant, offered by the Université de Moncton. The main results show that patients at risk of not maintaining their physical activity are younger, male, with only afew risk factors and a lower score on the quality of physical life scale, particularly with respect to the physical role and general health components.

This project aimed to co-develop and pilot an intervention plan to support shared decision-making (SDM) for patients considering a ventricular assist device (VAD), their caregivers and the health care team. The project involved a focus group with patients and caregivers to explore their decision-making needs along with regular participation in team meetings resulting in the creation of a decision aid. The decision aid answered needs expressed by patients and caregivers, as well as the team's initial needsfor informational support, optimization of information exchange and process standardization. A workshop on SDM was also conducted to increase competence toward this approach and the use of the decision aid. This project is timely and relevant given the increase in VAD implantation in Canada. The intervention could also be applicable to other decision-making situations in which active participation can improve the quality of the decision process.