RESUMO
BACKGROUND: Critical care nurses who care for postoperative cardiac surgery patients need such specialty knowledge as atrial electrograms (AEGs). An inadequate audit trail exists for psychometric performance of instruments to measure knowledge of AEGs. OBJECTIVES: The aim of this study was to revise a previously tested instrument and assess evidence for content validity (content validity index), internal consistency (Cronbach α), and stability (correlation coefficient, r) reliability against the a priori criterion of 0.80. METHODS: The multiple-choice response, self-administered, paper-and-pencil instrument was revised to 20 items and named the Drake Atrial Electrogram Assessment Survey (DAEGAS). A panel of 6 AEG experts reviewed the DAEGAS for content validity evidence. The instrument was further revised to 19 items (13 knowledge and 6 AEG interpretation) and tested with 76 critical care nurses from the greater Houston metropolitan area. RESULTS: The content validity index was 0.93. Cronbach α was .51, and test-retest r was 0.74. Cronbach α increased to .60 and r was 0.73 with removal of 3 items: 2 items with a negative item-total correlation and 1 item that was transitioned to a sample question. DISCUSSION: Content validity evidence exceeded the a priori criterion. Internal consistency and stability reliability estimates did not meet the criterion, albeit the latter met the criterion recommended by psychometricians for a new instrument. Recommendations include further development of the DAEGAS to improve internal consistency estimates and testing for evidence of other forms of validity. Reliable and valid assessment of critical care nurse knowledge of AEGs will require improved psychometric performance of the DAEGAS.
Assuntos
Técnicas Eletrofisiológicas Cardíacas , Enfermeiras e Enfermeiros , Competência Clínica , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosAssuntos
Insuficiência da Valva Mitral , Isquemia Miocárdica , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/complicaçõesRESUMO
Ventricular perforation during exposure of an intramyocardial left anterior descending artery (LAD) in preparation for coronary artery bypass grafting is a known surgical complication. In this report, we discuss the management of this complication which avoids closure of the LAD and a myocardial infarction.
Assuntos
Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Ventrículos do Coração/lesões , Ventrículos do Coração/cirurgia , Complicações Intraoperatórias/cirurgia , Técnicas de Sutura , Idoso , Feminino , Humanos , Resultado do TratamentoRESUMO
We report a 21-year-old patient with a ventricular septal defect (VSD) with an embolic vegetation on the tricuspid valve using a technique of septal leaflet detachment to facilitate the repair of the VSD. Although described in the pediatric patients, this technique has not been reported in adults. The technique of septal leaflet mobilization is described, along with other techniques of tricuspid leaflet mobilization that aid in VSD visualization and repair. Tricuspid leaflet detachment has application for adult surgeons repairing perimembranous, postinfarction, and iatrogenic VSD encountered in resection of subaortic stenosis.
Assuntos
Anuloplastia da Valva Cardíaca/métodos , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Valva Tricúspide/cirurgia , Ponte Cardiopulmonar/métodos , Ecocardiografia Transesofagiana , Seguimentos , Humanos , Masculino , Medição de Risco , Esternotomia/métodos , Resultado do Tratamento , Valva Tricúspide/patologia , Adulto JovemRESUMO
Increasingly, patients undergo heart transplant after previous heart surgery. In patients with a persistent left superior vena cava (LSVC), the preferred technique, preservation of drainage via the native coronary sinus, can be difficult in reoperative cases due to adhesions. We report a technique simplifying this operation in such a patient.