Evaluation of the Effect of Intensive Nursing Intervention Based on Process Analysis.

In order to achieve significant improvements in the evaluation of key indicators such as speed, quality, cost, and service, this paper fundamentally rethinks and completely redesigns the business process, and recreates a new business process. This study combines the particularity of AMI with emergency nursing to construct an in-hospital AMI emergency nursing process to further standardize the AMI rescue work. The implementation of the process helps to clarify the responsibilities and requirements of nurses in the AMI emergency process, reduce the delay time of AMI emergency, and improve the efficiency and effectiveness of emergency. In addition, after refactoring the business process, this paper builds an intelligent digital critical illness monitoring system. This system combines the original work flow of the ICU medical staff, optimizes the work flow of the medical staff through computer technology and information technology, and designs and completes the digital intensive nursing system software to run and use in the hospital and obtain significant results.

Home health care after discharge is associated with lower readmission rates for patients with acute myocardial infarction.

OBJECTIVE: We studied the utilization of home health care (HHC) among acute myocardial infarction (AMI) patients, impact of HHC on and predictors of 30-day readmission. METHODS: We queried the National Readmission Database (NRD) from 2012 to 2014identify patients with AMI discharged home with (HHC+) and without HHC (HHC-). Linkage provided in the data identified patients who had 30-day readmission, our primary end-point. The probability for each patient to receive HHC was calculated by a multivariable logistic regression. Average treatment of treated weights were derived from propensity scores. Weight-adjusted logistic regression was used to determine impact of HHC on readmission. RESULTS: A total of 406 237 patients with AMI were discharged home. Patients in the HHC+ cohort (38 215 patients, 9.4%) were older (mean age 77 vs. 60 years P < 0.001), more likely women (53 vs. 26%, P < 0.001), have heart failure (5 vs. 0.5%, P < 0.001), chronic kidney disease (26 vs. 6%, P < 0.001) and diabetes (35 vs. 26%, P < 0.001). Patients readmitted within 30-days were older with higher rates of diabetes (RR = 1.4, 95% CI: 1.37-1.48) and heart failure (RR = 5.8, 95% CI: 5.5-6.2). Unadjusted 30-day readmission rates were 21 and 8% for HHC+ and HHC- patients, respectively. After adjustment, readmission was lower with HHC (21 vs. 24%, RR = 0.89, 95% CI: 0.82-0.96; P < 0.001). CONCLUSION: In the United States, AMI patients receiving HHC are older and have more comorbidities; however, HHC was associated with a lower 30-day readmission rate.

Fatores de risco para infarto agudo do miocárdio evidenciados em pacientes hospitalizados em unidade coronariana / Risk factors for acute myocardial infarction evidenced in hospitalized patients in the coronary care unit / Factores de riesgo de infarto agudo de miocardio en evidencia en los pacientes hospitalizados en la unidad de cuidados coronarios

Objetivo: descrever os fatores de risco identificados em pacientes com infarto agudo do miocárdio hospitalizados em unidade coronariana. Método: estudo descritivo, transversal com abordagem quantitativa, realizado com 125 indivíduos com diagnóstico de infarto agudo do miocárdio. a amostra foi coletada por conveniência de forma consecutiva. os dados foram analisados com auxílio do programa estatístico Statistical Package for Social Sciences versão 21 e aprovado sob parecer 457.504. Resultados: predominou indivíduos do sexo masculino de etnia branca e com uma média de 62 anos. os fatores de risco mais prevalentes na amostra foram: sedentarismo, hipertensão arterial, histórico familiar, tabagismo, ingesta alcoólica e diabetes mellitus. Conclusão: a pesquisa traz dados relevantes para o controle dos fatores de risco identificados, mostra onde direcionar as ações preventivas, a fim de diminuir a incidência do infarto agudo do miocárdio, suas sequelas e a mortalidade

Objective: to describe the risk factors identified in patients with acute myocardial infarction hospitalized in coronary unit. Method: a descriptive, cross-sectional citado with a quantitative approach. conducted with 125 individuals diagnosed with acute myocardial infarction. the sample was collected for convenience consecutively. data were analyzed using the Statistical Package For Social sciences version 21 and approved under opinion 457 504. Results: the predominant male subjects were caucasian and with an average of 62 years. the most prevalent risk factors in the sample were: physical inactivity, high blood pressure, family history, smoking, alcohol consumption and diabetes mellitus. Conclusion: the research provided data relevant to the control of identified risk factors, showing where to focus preventive actions in order to reduce the incidence of acute myocardial infarction, its sequels and mortality

Objetivo: describir los factores de riesgo identificados en pacientes con infarto miocardio agudo hospitalizados en una unidad coronaria. Método:estudio descriptivo, transversal con enfoque cuantitativo, realizado con 125 personas con diagnostico de infarto miocardio agudo. la muestra fue recogida conveniencia consecutivamente. los datos se analizaron con ayuda del paquete statistical package for social sciences versión 21 y aprobado bajo la opinión 457.504. Resultados: predominou individuos del género masculino de étnico blanco y con un promedio de 62 años. los factores de riesgo más prevalentes de la muestra fueron: sedentarismo, hipertensión arterial, historia familiar, fumar, ingesta alcohólica y diabetes mellitus. Conclusión: la investigación trae datos relevantes para el control de factores de riesgo identificados, mostrando dónde enfocar las acciones preventivas, para reducir la incidencia de infarto de miocardio agudo, sus secuelas y mortalidad

A Transformative Impact of Theory in Clinical Practice: A Study in a Cardiogenetics Clinic.

BACKGROUND AND PURPOSE: This qualitative phenomenological study explored the lived experiences of family members who have been referred to a cardiogenetics clinic following the loss of a family member to sudden cardiac death (SCD). These family members were evaluated in a Cardiogenetics Clinic in a Children's Hospital in the New York region, which utilizes an interprofessional approach to care. METHODS: A qualitative phenomenological approach was used to explore the lived experience of family members that were referred following the SCD of a family member. The researcher used hermeneutic dialectics and interviewed family members that attended the Cardiogenetics Clinic. RESULTS: Insights gained through discussion were discussed in the following themes: stories of feelings being heard, stories of meaningfulness, and stories of mutual process. This led to the transformation of the typical linear clinic process to a transformative and dynamic model for integrated delivery of care. IMPLICATIONS FOR PRACTICE: This interprofessional model of care offers information regarding SCD, a genetic profile to determine risk for SCD, an integrative collaborative approach to care as well as nursing, medical interventions, psychological support, and counseling for families.

To be seen as a unique person after suffering a second myocardial infarction: Expressed needs of patients and descriptions of personnel.

OBJECTIVES: The aim of this study was to describe patients' expressed needs during cardiac rehabilitation after suffering a second myocardial infarction in comparison to personnel's descriptions of how they work with these patients. RESEARCH METHODOLOGY: A descriptive qualitative design. Interviews were conducted with patients affected by two myocardial infarctions and registered nurses, physiotherapists and cardiologists working with cardiac rehabilitation. Data were analysed with qualitative content analysis. FINDINGS: An interpretation of the underlying meaning in the categories was formulated into one theme: 'To be seen as a unique person'. Patients expressed a need for individualised care; they wanted the cardiac rehabilitation to be customised to their condition and prognosis; however, they did not perceive their care was individualised. Personnel described the importance of the care being individualised, although they had guidelines to follow. It was crucial for them to see the individual and discover what was important for each patient. CONCLUSIONS: There was a shared opinion from patients and personnel that individual care is essential. Using the concept and working in accordance with person-centred care could meet the patients' need for individualised care.

Effect of a nurse-led individualized self-management program for Chinese patients with acute myocardial infarction undergoing percutaneous coronary intervention.

BACKGROUND: The study of the development and evaluation of self-management intervention among patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) is lacking, especially in China. AIM: To examine the effects of a nurse-led individualized self-management program (NISMP) on health behaviors, control of cardiac risk factors, and health-related quality of life (HRQoL) among patients with AMI undergoing PCI. METHODS: The quasi-experimental design included a convenience sample of 112 participants recruited from a tertiary hospital in China. The participants were assigned to the control group (n = 56) or the intervention group (n = 56). The intervention group underwent the NISMP, which includes six group-based education sessions, a face-to-face individual consultation, and 12-month telephone follow-ups. Data were collected at baseline and at the end of the 12-month program using the Health Promotion Lifestyle Profile, the Risk Factors Assessment Form, and the Short Form 36-item Health Survey. RESULTS: The baseline sociodemographic and clinical characteristics of the two groups were comparable (p > 0.05). After the 12-month intervention, the health behaviors and HRQoL of the participants in the intervention group had significantly improved (p < 0.05 for both) compared to those of the control group. Compared to the control group, the participants in the intervention group also reported significantly better control of cardiac risk factors including smoking (χ2 = 4.709, p = 0.030), low-density lipoprotein (χ2 = 4.160, p = 0.041), body mass index (χ2 = 3.886, p = 0.049) and exercise (χ2 = 10.096, p = 0.001). CONCLUSION: The NISMP demonstrated positive effects on health behaviors, control of cardiac risk factors, and HRQoL among Chinese patients with AMI undergoing PCI.

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event.

AIMS AND OBJECTIVES: To understand clinical reasoning and decision-making of triage nurses during telephone conversations with callers suspected of having acute cardiac events, and support from a computer decision support system (CDSS) herewith. BACKGROUND: In telephone triage, nurses assess the urgency of callers' conditions with clinical reasoning, often supported by CDSS. The use of CDSS may trigger interactional workability dilemmas. DESIGN: Qualitative study using principles of a grounded theory approach following COREQ criteria for qualitative research. METHODS: Audio-stimulated recall interviews were conducted amongst twenty-four telephone triage nurses at nine out-of-hours primary care centres (OHS-PC). RESULTS: Telephone triage nurses use clinical reasoning elements for urgency assessment. Typically in telephone triage, they interpret the vocal-but not worded-elements in communication (paralanguage) such as tone of voice and shortness of breath and create a mental image to compensate for lack of visual information. We confirmed that interactional workability dilemmas occur. Congruence, established when the CDSS supports the triage nurses' decision-making, is essential for the CDSS' value. If congruence is absent, triage nurses may apply four working strategies: (a) tinker to make CDSS final recommendation align with their own assessment, (b) overrule the CDSS recommendation, (c) comply with the CDSS recommendation or (d) transfer responsibility to the GP. CONCLUSION: Triage nurses who assess urgency may experience absence of congruence between the CDSS and their decision-making. Awareness of how triage nurses reason and make decisions about urgency and what aspects influence their working strategies can help in achieving optimal triage of callers suspected of acute cardiac events at OHS-PC. RELEVANCE TO CLINICAL PRACTICE: Triage nurses' reasoning and their working strategies are vital for outcome of triage decisions. Understanding these processes is essential for CDSS developers and OHS-PC managers, who should value how triage nurses interact with the CDSS, while they have the benefit of callers in mind.

High-Fidelity Mannequin Simulation versus Virtual Simulation for Recognition of Critical Events by Student Registered Nurse Anesthetists.

Early recognition of intraoperative critical events is essential in optimizing the health outcomes of surgical patients. Use of simulation in nurse anesthesia education allows students to practice recognizing changes in the patient's condition in a safe learning environment. Second- and third-year student registered nurse anesthetists were randomly assigned to 2 groups to explore differences in recognizing intraoperative myocardial infarction (MI) using highfidelity mannequin simulation vs virtual simulation. One group participated in a virtual simulation first, followed by a high-fidelity mannequin simulation. The other group participated in a high-fidelity mannequin simulation first, then virtual simulation. Second-year students recognized an intraoperative MI faster when using high-fidelity mannequin simulation than when using virtual simulation. However, there was no significant difference among third-year students in the time it took to recognize a critical event when using high-fidelity mannequin simulation vs virtual simulation. These findings indicate that both simulation modalities are useful in evaluating student registered nurse anesthetists' timely recognition of intraoperative critical events such as MI. However, for students with less didactic and clinical practicum experience in the program, such as second-year students, the use of high-fidelity mannequin simulation for recognizing an intraoperative MI may be more beneficial than virtual simulation.

Individualized parameterization of multiparametric monitors alarms in infarcted patients.

OBJECTIVE: To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. METHOD: Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. RESULTS: The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). CONCLUSION: The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.

Individualized parameterization of multiparametric monitors alarms in infarcted patients / Parametrización individualizada de alarmas de monitores multiparamétricos en pacientes infartados / Parametrização individualizada de alarmes de monitores multiparamétricos em pacientes infartados

ABSTRACT Objective: To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. Method: Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. Results: The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). Conclusion: The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.

RESUMEN Objetivo: Medir la magnitud del efecto de un protocolo de parametrización individualizada de alarmas hemodinámicas en pacientes con infarto agudo de miocardio. Método: Ensayo clínico pragmático, open label y single arm cuya intervención ocurrió por medio de un protocolo validado y testado en 32 pacientes, utilizándose monitores multiparamétricos. Las alarmas de frecuencia cardíaca, presión arterial, frecuencia respiratoria, saturación de oxígeno y segmento ST fueron valorados y clasificados según su consistencia clínica, una hora antes y después de la intervención, durante 64 horas. Resultados: El protocolo obtuvo un índice de Validez de Contenido de 0,92. De las 460 alarmas registradas, 261 fueron consideradas inconsistentes antes de la intervención y 47 después. El Riesgo Relativo de las alarmas incoherentes después del protocolo fue de 0,32 (IC 95% 0.23-0.43, p <0,0001). Conclusión: El protocolo se mostró un factor protector al surgimiento de alarmas clínicas inconsistentes de monitores multiparamétricos.

RESUMO Objetivo: Medir a magnitude do efeito de um protocolo de parametrização individualizada de alarmes hemodinâmicos em pacientes com infarto agudo do miocárdio. Método: Ensaio clínico pragmático, open label e single arm, cuja intervenção ocorreu por meio de um protocolo validado e testado em 32 pacientes usando monitores multiparamétricos. Os alarmes de frequência cardíaca, pressão arterial, frequência respiratória, saturação de oxigênio e segmento ST foram mensurados e classificados quanto à consistência clínica uma hora antes e após a intervenção, durante 64 horas. Resultados: O protocolo obteve Índice de Validade de Conteúdo de 0,92. Dos 460 alarmes registrados, 261 foram considerados inconsistentes antes da intervenção e 47 após. O Risco Relativo de alarmes inconsistentes após o protocolo foi de 0,32 (IC 95% 0.23-0.43, p<0,0001). Conclusão: O protocolo mostrou-se um fator protetor ao surgimento de alarmes clínicos inconsistentes de monitores multiparamétricos.

Interaction between tele-nurses and callers with an evolving myocardial infarction: Consequences for level of directed care.

BACKGROUND: Rapid contact with emergency medical services is imperative to save the lives of acute myocardial infarction patients. However, many patients turn to a telehealth advisory nurse instead, where the delivery of urgent and safe care largely depends on how the interaction in the call is established. PURPOSE: The purpose of this study was to explore the interaction between tele-nurses and callers with an evolving myocardial infarction after contacting a national telehealth advisory service number as their first medical contact. METHOD: Twenty men and 10 women (aged 46-89 years) were included. Authentic calls were analysed using inductive content analysis. FINDINGS: One overall category, Movement towards directed level of care, labelled the whole interaction between the tele-nurse and the caller. Four categories conceptualised the different interactions: a distinct, reasoning, indecisive or irrational interaction. The interactions described how tele-nurses and callers assessed and elaborated on symptoms, context and actions. The interaction was pivotal for progress in the dialogue and affected the achievement of mutual understanding in the communicative process. An indecisive or irrational interaction could increase the risk of failing to recommend or call for acute care. CONCLUSION: The interaction in the communication could either lead or mislead the level of care directed in the call. This study adds new perspectives to the communicative process in the acute setting in order to identify a myocardial infarction and the level of urgency from both individuals experiencing myocardial infarction and professionals in the health system.

Elaboration and validation of an ICNP® terminology subset for patients with acute myocardial infarction.

OBJECTIVE: To elaborate a terminological subset for the International Classification for Nursing Practice (ICNP®) for patients with acute myocardial infarction using the Activities of Living Model. METHOD: A methodological study which followed the guidelines of the International Nursing Council and was based on theoretical framework of the Activities of Living Model for its elaboration. Content validation was performed by 22 nursing specialists. RESULTS: Twenty-two (22) diagnoses and 22 nursing outcomes were elaborated. Of these, 17 nursing diagnosis statements and 17 nursing outcome statements presented Content Validity Index (CVI) ≥ 0.80. Of the 113 elaborated nursing interventions, 42 reached a CVI ≥ 0.80, and 51 interventions made up the terminological subset after the expert suggestions. CONCLUSION: The ICNP® was suitable for use with the Activities of Living Model, having compatible terms with those used in clinical nursing practice, and valid for construction of the terminological subset for patients with acute myocardial infarction and most likely to facilitate clinical nursing judgment.

Elaboration and validation of an ICNP® terminology subset for patients with acute myocardial infarction / Elaboración y validación de subconjunto terminológico CIPE ® para la persona con infarto agudo del miocardio / Elaboração e validação de subconjunto terminológico CIPE® para a pessoa com infarto agudo do miocárdio

ABSTRACT Objective: To elaborate a terminological subset for the International Classification for Nursing Practice (ICNP®) for patients with acute myocardial infarction using the Activities of Living Model. Method: A methodological study which followed the guidelines of the International Nursing Council and was based on theoretical framework of the Activities of Living Model for its elaboration. Content validation was performed by 22 nursing specialists. Results: Twenty-two (22) diagnoses and 22 nursing outcomes were elaborated. Of these, 17 nursing diagnosis statements and 17 nursing outcome statements presented Content Validity Index (CVI) ≥ 0.80. Of the 113 elaborated nursing interventions, 42 reached a CVI ≥ 0.80, and 51 interventions made up the terminological subset after the expert suggestions. Conclusion: The ICNP® was suitable for use with the Activities of Living Model, having compatible terms with those used in clinical nursing practice, and valid for construction of the terminological subset for patients with acute myocardial infarction and most likely to facilitate clinical nursing judgment.

RESUMEN Objetivo: Elaborar el subconjunto terminológico de la Clasificación Internacional para la Práctica de Enfermería (CIPE®) para la persona con infarto agudo del miocardio, utilizando el Modelo de Actividades de Vida. Método: Estudio metodológico, que siguió las orientaciones del Consejo Internacional de Enfermeros y tuvo como base teórica el Modelo de Actividades de Vida para su elaboración. La validación de contenido fue realizada por 22 enfermeros expertos. Resultados: Fueron elaborados 22 diagnósticos y 22 resultados de enfermería. De esos, 17 enunciados de diagnósticos y 17 resultados de enfermería presentaron Índice de Validez de Contenido (IVC) ≥ 0,80. De las 113 intervenciones enfermeras diseñadas, 42 alcanzaron IVC ≥ 0,80 y, después de sugerencias de los expertos, 51 intervenciones compusieron el subconjunto terminológico. Conclusión: La CIPE® se mostró adecuada para empleo con el Modelo de Actividades de Vida, contando con términos compatibles con los utilizados en la práctica clínica enfermera, siendo válido para la construcción del subconjunto terminológico para la persona con infarto agudo del miocardio y probablemente para la facilitación del juicio clínico enfermero.

RESUMO Objetivo: Elaborar o subconjunto terminológico da Classificação Internacional para a Prática de Enfermagem (CIPE®) para a pessoa com infarto agudo do miocárdio, utilizando o Modelo de Atividades de Vida. Método: Estudo metodológico, que seguiu as orientações do Conselho Internacional de Enfermeiros e teve como base teórica o Modelo de Atividades de Vida para a sua elaboração. A validação de conteúdo foi realizada por 22 enfermeiros especialistas. Resultados: Foram elaborados 22 diagnósticos e 22 resultados de enfermagem. Destes, apresentaram Índice de Validade de Conteúdo (IVC) ≥ 0,80 17 enunciados de diagnósticos e 17 resultados de enfermagem. Das 113 intervenções de enfermagem elaboradas, 42 alcançaram IVC ≥ 0,80, e, após sugestões dos especialistas, 51 intervenções compuseram o subconjunto terminológico. Conclusão: A CIPE® mostrou-se adequada para uso com o Modelo de Atividades de Vida possuindo termos compatíveis com os utilizados na prática clínica do enfermeiro, sendo válida para a construção do subconjunto terminológico para a pessoa com infarto agudo do miocárdio e provavelmente para a facilitação do julgamento clínico de enfermagem.

Variação do duplo-produto em pacientes pós-infarto agudo do miocárdio submetidos ao banho de aspersão / Variation of the double product in patients after acute myocardial infarction submitted to aspersion bath / Variación de doble producto en pacientes después de un infarto de miocardio agudo presentó rociar baño

Objetivo: Mensurar a variação do duplo-produto nos pacientes com infarto agudo do miocárdio submetidos ao banho de aspersão. Métodos: Pesquisa observacional realizada na Unidade Coronariana de um hospital de referência em cardiologia localizado na cidade do Rio de Janeiro. A amostragem deu-se por conveniência e teve como amostra os banhos de aspersão de pacientes adultos, ambos os sexos, com diagnóstico médico de infarto agudo do miocárdio com supradesnível ou sem supradesnível de segmento ST, e que tivessem indicação de banho de aspersão, fornecida pelo médico e enfermeiro responsáveis. Resultados: Houve aumento do valor médio do duplo-produto em todos os pacientes acompanhados, porém sem significância estatística. Conclusão: A indicação do banho de aspersão nesta amostra foi segura

Objective: To measure the variation of the double product in patients with acute myocardial infarction submitted to spray bath. Methods: Observational study, conducted in the Coronary Care Unit of a referral hospital in cardiology located in the city of Rio de Janeiro. Sampling was given for convenience and was to sample the spray baths adult patients, both sexes, with a diagnosis of AMI with elevation or non-ST segment elevation, and they had spray bath indication provided by the doctor and nurse responsible. Results: There was increase in the average value of the double product in all patients followed, but without statistical significance. Conclusion: The indication of the spray bath in this sample was safe

Objetivo: Medir la variación del doble producto en pacientes con infarto agudo de miocardio sometido a baño de aerosol. Métodos: Estudio observacional, realizado en la Unidad Coronaria de un hospital de referencia en cardiología ubicada en la ciudad de Río de Janeiro. El muestreo se da por conveniencia y era para probar los baños de aspersión pacientes adultos, de ambos sexos, con diagnóstico de IAM con elevación o sin elevación del segmento ST, y que había indicación de baño de aerosol proporcionada por el médico y la enfermera responsable. Resultados: No hubo aumento en el valor medio de la doble producto en todos los pacientes siguió, pero sin significación estadística. Conclusión: La indicación del baño de pulverización en esta muestra era seguro

Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study.

BACKGROUND: Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. METHOD: This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. RESULTS: Patients in the tailored group achieved better control of total cholesterol (- 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p = 0.01), LDL cholesterol (- 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (- 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02). CONCLUSION: A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients.

An avatar-based education application to improve patients' knowledge of and response to heart attack symptoms: A pragmatic randomized controlled trial protocol.

AIM: To evaluate the effectiveness of an interactive, avatar-based education application to improve knowledge of and response to heart attack symptoms in people who are at risk of a heart attack. BACKGROUND: Poor knowledge of heart attack symptoms is recognized as a significant barrier to timely medical treatment. Numerous studies have demonstrated that technology can assist in patient education to improve knowledge and self-care. DESIGN: A single-center, non-blinded, two parallel groups, pragmatic randomized controlled trial. METHODS: Seventy patients will be recruited from the coronary care unit of a public hospital. Eligible participants will be randomized to either the usual care or the intervention group (usual care plus avatar-based heart attack education app). The primary outcome of this study is knowledge. Secondary outcomes include response to heart attack symptoms, health service use and satisfaction. Study participants will be followed up for 6 months. DISCUSSION: This study will evaluate the avatar-based education app as a method to deliver vital information to patients. Participants' knowledge of and response to heart attack symptoms, and their health service use, will be assessed to evaluate the intervention effectiveness.

Evaluation of the effectiveness of an interactive avatar-based education application for improving heart failure patients' knowledge and self-care behaviours: A pragmatic randomized controlled trial protocol.

AIM: The aim of this study was to evaluate the effectiveness of an avatar-based education application for improving knowledge and self-care behaviour in patients with heart failure (HF). BACKGROUND: Avatar-based technologies for supporting education are an innovative approach for patients with low literacy, low health literacy and English as a second language. The use of avatar technologies for patient education has shown benefits in improving knowledge, self-care behaviours and quality of life in chronic diseases such as cancer, diabetes and depression. Research has demonstrated positive outcomes in clinical practice. However, the effectiveness of this technology has not been evaluated among patients with HF. DESIGN: A multi-centred, non-blinded randomized, two-armed parallel pragmatic, controlled trial. METHOD: Eighty-eight participants will be recruited from the HF clinics at three public hospitals and randomized into either control or intervention groups. The intervention group will receive the avatar-based education plus usual care. The control group will receive usual care. The primary outcome is HF knowledge, secondary outcomes include; improved self-care behaviours, readmission and satisfaction. Data will be collected at the baseline and at 1- and 3-month follow-ups. DISCUSSION: This study will measure the effectiveness of avatar-based education on patients' knowledge and self-care behaviours following HF. The evidence will be evaluated in terms of the reduction in patients' readmission.

Psychometric Evaluation of a Persian Version of the Cardiac Depression Scale in Iranian Patients With Acute Myocardial Infarction.

PURPOSE: The aim of this study was to validate a Persian version of the Cardiac Depression Scale (CDS) in Iranian patients with acute myocardial infarction (AMI). METHODS: The CDS was forward translated from English into Persian and back-translated to English. Validity was assessed using face, content, and construct validity. Also Cronbach's alpha (α), theta (), and McDonald's omega coefficient were used to evaluate the reliability. RESULTS: Construct validity of the scale showed two factors with eigenvalues greater than one. The Cronbach's α, , McDonald's omega, and construct reliability were greater than .70. CONCLUSION: The Persian version of the CDS has a two-factor structure (i.e., death anxiety and life satisfaction) and has acceptable reliability and validity. Therefore, the validated instrument can be used in future studies to assess depression in patients with AMI in Iranians.

Another Chance at Life: Jordanian Patients' Experience of Going Through a Myocardial Infarction.

BACKGROUND AND PURPOSE: Myocardial infarction (MI) is a life-threatening health condition that has physical, spiritual, emotional, and social changes. Understanding feelings and thoughts of patients who suffered MI attacks is essential to recovery. Among Jordanian patients who suffered an acute attack of MI, the aim of the study was to describe the experiences and the varied meanings that they assign to their experiences. METHODS: A qualitative hermeneutic phenomenological research design was used. Five participants were engaged in in-depth semistructured interviews. The participants were identified using a purposeful sampling technique, after being admitted at a coronary care unit in a university hospital located in Amman, the capital city of Jordan. The hospital provides a full range of cardiovascular medical and surgical care for patients admitted from different socioeconomic levels. Transcribed data were analyzed following inductive qualitative content analysis method. RESULTS: The experience of MI was a traumatizing event characterized by life-threatening symptoms, and participants feared they would not come back home. However, cultural values and religiosity among the Jordanian patients played a major role in facilitating their positive coping during and after the MI attack. The participants' recount of their experience was summed-up into 5 major themes: frightening experience, needed support, religiosity, experiencing changes, and lifestyle modifications. After the MI attack, most of the participants felt that they had given another chance to live, showing a pressing need to make healthier lifestyle modifications to avoid another MI attack. IMPLICATIONS FOR PRACTICE: Health care workers should need not only pay attention on physical and physiological caring aspects but should also consider other patients' needs, while supporting the patients and their family members.