European journal of cardiovascular nursing最新文献

Aims: To (1) identify characteristics of digital technologies (DTs) used to facilitate shared decision-making (SDM) within the field of cardiovascular care, (2) examine conceptualizations of SDM underpinning these DTs, and (3) summarize designs and outcomes of evaluation studies concerning these DTs.

Methods and results: We conducted a scoping review following methodological guidelines by the Joanna Briggs Institute. Ten scientific databases were searched. We selected peer-reviewed articles in cardiovascular care, with SDM and DT in the title and/or abstract published between January 2000 and March 2023. We extracted data on the type of DT, intended user(s), timepoint and mode of use, purpose, decision topic, underlying SDM model, and designs and outcomes of evaluation studies. Data were analyzed descriptively in a narrative synthesis.From 4,432 search results, 48 articles reporting on 31 DTs were included. Half of the articles were published after 2018, with most published in 2022. Most DTs are web-based applications for interactive use before and during the encounter between patient and healthcare professional, to convey information on cardiovascular care, calculate personal risk and/or recommend treatment options. SDM conceptualizations refer to the International Patient Decision Aid Standards and authors in the field. Thirty-seven evaluation studies report on 31 DTs, with heterogeneous results related to variation in intervention designs, measurement timepoints, and outcome measures.

Conclusion: A recent increase in the reporting of DTs to facilitate SDM in cardiovascular care indicates their potential. This scoping review offers researchers, developers, and clinicians a comprehensive overview of this literature.

Registration: Open Science Framework, https://doi.org/10.17605/OSF.IO/TRGQ5.

Aim: Sense of coherence (SOC) allows individuals to be more resilient to adverse life events and it is associated with quality of life (QoL), but its long-term effects are unknown in patients with myocardial infarction. This study aimed to examine longitudinal variations of SOC and associations between SOC at baseline and QoL at a 10-year follow-up in relation to gender.

Method and results: This longitudinal study included 61 patients, 16 women and 45 men with a mean age of 57.1 ± 6.5 years, who completed a questionnaire package in relation to hospital discharge, two years, five years, and 10 years later. The questionnaire package included the Sense of Coherence Scale (SOC-13), 12-item Short Form Health Survey (SF-12), and Seattle Angina Questionnaire (SAQ). Data were analysed with repeated measure ANOVA and linear regression. Overall, SOC was stable over the 10-year follow-up, but Comprehensibility improved significantly (p = 0.003). A significant main effect for gender was shown regarding SOC total (p = 0.032) and Comprehensibility (p = 0.034); women reported lower SOC compared to men. An interaction effect between gender and time was shown in Comprehensibility (p = 0.007), as the differences between genders decreased over time. SOC-13 was significantly associated with all dimensions of QoL; three significant interaction effects showed that the associations was true for women but not men.

Conclusion: SOC is an important aspect to consider in the care of patients with myocardial infarction, as it is associated with long-term QoL, particularly for women. This means that SOC can also be used to identify patients who are at risk for poor QoL after a myocardial infarction.

Aims: Hospitals are encouraged to provide care closer to patients' homes. This study investigates how patients, informal caregivers and nurses experience home-based hospital-level care for decompensated heart failure.

Methods and results: This mixed-methods study employed semi-structured interviews with 11 patients and 4 informal caregivers, a questionnaire administrated to 16 nurses from the Intensive Care, Cardiac Care and general cardiology ward, and interviews with 4 nurses, supplemented by two group discussions.A convenience sample was utilized, member checks were performed, and two researchers analysed the patient interviews using thematic analysis based on the Normalization Process Theory. Five overarching themes emerged: 1) Appreciation of personal environment, routines, and autonomy. 2) Quality of care. 3) Commitment to the treatment. 4) Influence of personal characteristics. 5) Changing role of informal caregivers.Regarding nurse satisfaction, findings were mapped according to Proctor et al.'s implementation outcomes: Acceptability: hospital-at-home care increases job satisfaction, through increased autonomy, personalized care, and patient satisfaction; Appropriateness: hospital-at-home was perceived positively, although safety and adherence needed attention; Adoption: hospital-at-home was not particularly challenging but offered a refreshing change; Feasibility: On-call duty impacted personal commitments for some nurses; Fidelity: information folders with clear protocols were deemed helpful.

Conclusion: Patients, caregivers, and nurses generally favour home-based heart failure treatment over hospital-based treatment. Key conditions include comprehensive education on home treatment, adherence support like dietary restriction maintenance, prioritizing patient autonomy, recognizing caregiver burden, and exploring cost-effective strategies such as collaboration with home care organizations.

Aim: Delirium is common in patients aged over 70 years after cardiac surgery. Screening to detect delirium in high-risk patients is important, yet hypoactive delirium is often missed in nurse-reported screening. Polymorphic delta waves are associated with delirium, and can be detected with single-channel electroencephalography (SC-EEG). The aim of the study is to assess whether SC-EEG as a screening instrument for delirium will increase the detection rate of postoperative delirium and reduce hospital stay of delirious patients.

Methods and results: A prospective quasi-experimental study compared Delirium Observation Screening Scale (DOSS) screening (442 patients) to SC-EEG screening (462 patients) to detect postoperative delirium in cardiac surgery patients aged over 70 years. Delirium was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders 5th edition.Detection of delirium was higher in the SC-EEG group (20%) compared to DOSS group (14%), p = 0.016. A difference in length of stay for delirious patients was attributed to baseline differences as pneumonia and EuroSCORE II, but not delirium screening method. Length of stay for all patients was -0.11 (95% CI -0.18 to -0.04) night shorter for SC-EEG cohort patients compared to DOSS cohort patients, p = 0.002.

Conclusion: Screening with SC-EEG increased delirium detection after cardiac surgery. Only length of stay for all patients was significantly reduced in the SC-EEG cohort. This reduction in hospital stay is small, yet relevant for high volume cardiac surgery centres and should be further studied in other centres.

Registration: International Clinical Trials Registry Platform: NL-OMON27069.

Aim: To assess impact of triage initiatives for rapid 12-lead electrocardiogram acquisition on Door-To-ECG, Door-To-Balloon, length of stay, and in-hospital mortality for self-presenting emergency department patients with ST-elevation myocardial infarction.

Methods: This systematic review encompassed cohort studies, controlled trials, one-group pretest-post-test studies, interventional, observational, and randomized controlled trials assessing rapid acquisition of electrocardiograms for patients above 18 years experiencing symptoms of ST-elevation myocardial infarction in emergency departments. Data from seven databases underwent screening, extraction, and quality appraisals by two independent reviewers. Employing a random-effects model, meta-analyses were conducted for primary outcomes; Door-To-ECG, Door-To-Balloon, length of stay, and in-hospital mortality. Subgroup analyses and meta-regression were performed for meta-analyses with over 10 studies.

Results: This review included 25 studies with 19,475 ST-elevation myocardial infarction patients. All were cohort studies with acceptable evidence quality. Our findings revealed that enhanced triage initiatives for electrocardiograms related to significant reductions in Door-To-ECG (MD -6.45 minutes, P < 0.001) and Door-To-Balloon (MD -24.40 minutes, P < 0.001) times. More institutions met benchmarked goals for Door-To-ECG (MD 22.2%, P < 0.001) and Door-To-Balloon (MD 15.6%, P < 0.001) times. Improvements reported in length of stays and in-hospital mortality were not significant. Subgroup and meta-regression analyses revealed significant differences in Door-To-ECG times but not in Door-To-Balloon times.

Conclusion: Positive impacts of such initiatives on ST-elevation myocardial infarction patient outcomes offer institutions opportunities to improve triage processes and training. Future research should focus on extended follow-up and larger sample sizes for a comprehensive understanding of sustained impacts.

Registration: PROSPERO: CRD42023472392.