Agreement of Computerized QT and QTc Interval Measurements Between Both Bedside and Expert Nurses Using Electronic Calipers.

BACKGROUND: In hospitalized patients, QT/QTc (heart rate corrected) prolongation on the electrocardiogram (ECG) increases the risk of torsade de pointes. Manual measurements are time-consuming and often inaccurate. Some bedside monitors automatically and continuously measure QT/QTc; however, the agreement between computerized versus nurse-measured values has not been evaluated. OBJECTIVE: The aim of this study was to examine the agreement between computerized QT/QTc and bedside and expert nurses who used electronic calipers. METHODS: This was a prospective observational study in 3 intensive care units. Up to 2 QT/QTc measurements (milliseconds) per patient were collected. Bland-Altman test was used to analyze measurement agreement. RESULTS: A total of 54 QT/QTc measurements from 34 patients admitted to the ICU were included. The mean difference (bias) for QT comparisons was as follows: computerized versus expert nurses, -11.04 ± 4.45 milliseconds (95% confidence interval [CI], -2.3 to -19.8; P = .016), and computerized versus bedside nurses, -13.72 ± 6.70 (95% CI, -0.70 to -26.8; P = .044). The mean bias for QTc comparisons was as follows: computerized versus expert nurses, -12.46 ± 5.80 (95% CI, -1.1 to -23.8; P = .035), and computerized versus bedside nurses, -18.49 ± 7.90 (95% CI, -3.0 to -33.9; P = .022). CONCLUSION: Computerized QT/QTc measurements calculated by bedside monitor software and measurements performed by nurses were in close agreement; statistically significant differences were found, but differences were less than 20 milliseconds (on-half of a small box), indicating no clinical significance. Computerized measurements may be a suitable alternative to nurse-measured QT/QTc. This could reduce inaccuracies and nurse burden while increasing adherence to practice recommendations. Further research comparing computerized QT/QTc from bedside monitoring to standard 12-lead electrocardiogram in a larger sample, including non-ICU patients, is needed.

Risk Factors for a Higher Symptom Burden in Patients With Cancer During the COVID-19 Pandemic.

OBJECTIVES: To evaluate for subgroups of patients with distinct symptom profiles and differences in demographic and clinical characteristics and stress and resilience among these subgroups. SAMPLE & SETTING: 1,145 patients with cancer aged 18 years or older completed a survey online. Data were collected between May 2020 and February 2021. METHODS & VARIABLES: Patients completed measures for depression, state anxiety, cognitive function, morning fatigue, evening fatigue, morning energy, evening energy, sleep disturbance, pain, stress, and resilience. Latent class profile analysis was used to identify subgroups of patients with distinct symptom profiles. Differences among the subgroups on study measures were evaluated using parametric and nonparametric tests. RESULTS: Four distinct profiles were identified (none, low, high, and very high). Patients in the high and very high classes reported clinically meaningful levels of all nine symptoms. Differences among the four profiles for stress and resilience exhibited a dose-response effect. IMPLICATIONS FOR NURSING: Findings can serve as benchmark data of the symptom burden of patients with cancer following the COVID-19 pandemic.

Ischemic Pre-Conditioning is Present in Patients with Non-ST Elevation Myocardial Infarction and ECG Derived Moderate Obstructive Sleep Apnea.

Background: Obstructive Sleep Apnea (OSA) is associated with an increased risk of cardiovascular events, including Acute Coronary Syndrome (ACS). There is conflicting evidence that suggests OSA has a cardioprotective effect (i.e., lower troponin), via ischemic pre-conditioning, in patients with ACS. Purpose: This study had two aims: (1) compare peak troponin between non-ST elevation (NSTE) ACS patients with and without moderate OSA identified using a Holter derived respiratory disturbance index (HDRDI); and (2) determine the frequency of transient myocardial ischemia (TMI) between NSTE-ACS patients with and without moderate HDRDI. Method: This was a secondary analysis. OSA events were identified from 12-lead ECG Holter recordings using QRSs, R-R intervals, and the myogram. Moderate OSA was defined as an HDRDI ≥15 events per/hour. TMI was defined as ≥1 millimeter of ST-segment ↑ or ↓, in ≥ 1 ECG lead, ≥ 1 minute. Results: In 110 NSTE-ACS patients, 39% (n=43) had moderate HDRDI. Peak troponin was higher in patients with moderate HDRDI (6.8 ng/ml yes vs. 10.2 ng/ml no; p=0.037). There was a trend for fewer TMI events, but there were no differences (16% yes vs. 30% no; p=0.081). Conclusions: NSTE-ACS patients with moderate HDRDI have less cardiac injury than those without moderate HDRDI measured using a novel ECG derived method. These findings corroborate prior studies suggesting a possible cardioprotective effect of OSA in ACS patients via ischemic pre-condition. There was a trend for fewer TMI events in moderate HDRDI patients, but there was no statistical difference. Future research should explore the underlying physiologic mechanisms of this finding.

ECG alarms during left ventricular assist device (LVAD) therapy in the ICU.

BACKGROUND: In hospitalized patients with left ventricular assist device (LVAD), electrical interference and low amplitude QRS complexes are common, which could impact the accuracy of electrocardiographic (ECG) arrhythmia detection and create technical alarms. This could contribute to provider alarm fatigue and threaten patient safety. OBJECTIVES: We examined three LVAD patients in the cardiac intensive care unit (ICU) to determine: 1) the frequency and accuracy of audible arrhythmia alarms; 2) occurrence rates of technical alarms; and 3) alarm burden (# alarms/hour of monitoring) METHODS: Secondary analysis. RESULTS: During 593 h, there were 549 audible arrhythmia alarms and 98% were false. There were 25,232 technical alarms and 93% were for artifact, which was configured as an inaudible text alert. CONCLUSION: False-arrhythmia and technical alarms are frequent in LVAD patients. Future studies are needed to identify both clinical and algorithm-based strategies to improve arrhythmia detection and reduce technical alarms in LVAD patients.

Lessons learned from a mentored graduate program in gerontological nursing.

An educational training grant provided the funding for a 3-year project to recruit candidates into a mentored and redesigned gerontological advanced practice nursing program. The project goal was to design and implement a part-time program in advanced practice gerontological nursing that allowed nurses currently working in a long-term care (LTC) facility to maintain their full-time employment. Most of the students recruited worked at a partner LTC facility. The cohort was ethnically diverse. The outcome objective is board certification in gerontological advanced practice nursing. The mentored model offered a high level of support, including tutoring, professional role development activities, writing support, regular meetings, and workshops. Project faculty learned valuable lessons from this project relating to mentoring, tutoring, course scheduling, learning styles and preferences, and writing support. The part-time curriculum should also be reviewed critically.