A Nurse Practitioner-Led Multidisciplinary Diabetes Clinic for Adult Patients Discharged From Hospital.

OBJECTIVES: In this study, we evaluated the feasibility of a nurse practitioner-led outpatient clinic (NPC) to facilitate the safe transition of patients with diabetes receiving insulin therapy between hospital and the community. METHODS: An NPC was set up to manage patients who had diabetes education in hospital and who were discharged on insulin. In addition to patient demographics and admission diagnosis, days seen postdischarge, duration of follow up, diabetes interventions and discharge care plan were recorded. For quality improvement, patients were asked to complete a questionnaire at the time of discharge from the NPC. RESULTS: Within a 12-month period, 71 patients with diabetes attended the NPC 3 to 21 days after discharge and they were followed for 1 to 98 days. Thirteen patients required management of hypoglycemia and 56 patients had adjustment of medications to basal/prandial insulin or switched to oral antihyperglycemic agents. Fifty-four patients were returned to the care of their family physicians and 18 patients required a referral to a diabetes specialist. A postclinic questionnaire indicated that the clinic enabled patients to improve management of their diabetes. However, communication of the diabetes management plan to the family physician was an identified concern. CONCLUSIONS: An NPC clinic can provide timely management and is a viable option to ensure safe transition of patients with diabetes from hospital back to their family physicians.

The Effect of Nurse Practitioner-Led Intervention in Diabetes Care for Patients Admitted to Cardiology Services.

OBJECTIVE: To determine the benefits of diabetes nurse practitioner (DNP) intervention on glycemic control, quality of life and diabetes treatment satisfaction in patients with type 2 diabetes (T2DM) admitted to cardiology inpatient services at a tertiary centre. PATIENTS AND METHODS: Patients admitted to the cardiology service with T2DM who had suboptimal control (HbA1c >6.5%) were approached for the study. Diabetes care was optimized by the DNP through medication review, patient education and discharge care planning. Glycemic control was evaluated with 3-month post-intervention HbA1c. Secondary outcomes of lipid profiles, quality of life and treatment satisfaction were evaluated at baseline and at 3 months with fasting lipids, Audit of Diabetes-Dependent Quality of Life questionnaires (ADDQoL) and Diabetes Treatment Satisfaction Questionnaires (DTSQ) respectively. RESULTS: With almost 49% of patients admitted to the Mazankowski Alberta Heart Institute having HbA1c <6.5%, only 23 patients completed the study over a 12-month period. We found a significant decrease in HbA1c values at 3 months post-intervention from 8.0% (SD=1. 2) to 6.9% (SD=0.7), p=0.002. LDL showed a significant decrease at 3 months from 1.7 mmol/L (SD=0.7) to 1.1 mmol /L (SD=0.6), p=0.011. Overall median ADDQoL impact scores improved at follow up, from -1.4 to -0.4, p = 0.0003. Overall no significant changes in DTSQ scores were seen. CONCLUSIONS: Short-term DNP intervention in T2DM patients admitted to the inpatient cardiology service was associated with benefits in areas of glycemic control and various domains of QoL. Our study provides support for the involvement of DNP in the care of cardiology inpatients at tertiary centres.

Sensations during removal of epicardial pacing wires after coronary artery bypass graft surgery.

BACKGROUND: One procedure that is commonly performed after coronary artery bypass graft surgery is removal of epicardial pacing wires (EPWs). Currently, there is a paucity of information regarding the sensations experienced by patients during this procedure. OBJECTIVE: To determine the sensations commonly reported by patients during EPW removal. METHODS: A secondary analysis was performed on data sets from 2 previous studies to determine the sensations commonly experienced by patients during EPW removal. The sample consisted of 144 subjects from 2 teaching hospitals. RESULTS: The most commonly reported sensation during EPW removal was a "mild to moderate pulling" sensation. CONCLUSION: This secondary analysis provides important information regarding the sensations most commonly reported by patients during EPW removal. This sensory information could be incorporated into a psycho-educational information intervention to prepare patients for EPW removal.

Cardiovascular nurse practitioner practice: results of a Canada-wide survey.

Despite an increase in the number of nurse practitioners (NPs) practising within the realm of cardiovascular care, roles and responsibilities of cardiovascular NPs in similar areas appear to be vast and variable. With the recent changes in certification and regulation of the NP role by the Canadian Nurses Association, there has been an attempt to standardize patient care practices. In the spring of 2005, the University of Alberta Hospital-based cardiovascular NPs conducted a national survey. This survey was the first formalized attempt to gather information on the practice patterns of cardiovascular NPs and determine if similarities in roles, responsibilities, manpower and patient workload existed across Canada. A survey was mailed out to all centres that were known to have cardiovascular NPs in their employ. An impressive response rate of 63% was obtained. As predicted, survey results reveal that roles and responsibilities of cardiovascular NPs are diverse and unique. One hundred per cent of respondents were Masters-prepared with 88% of cardiovascular NPs practising in a ward and/or outpatient setting. However, reporting structure, patient workload, clinical, educational, administrative, and research responsibilities were more diversified. The results of the survey may facilitate a better understanding of the NP role within the health care setting and in cardiovascular care. In turn, the findings may provide a basis by which to establish a template for developing future NP roles or enhancing existing NP roles in cardiovascular centres across Canada.

The dangers of cardiac myxomas.

A variety of cardiac tumors have been acknowledged in the literature since the 16th century as rare forms of cardiac disease. Of the primary tumors, myxomas account for at least 30% to 50% of benign tumors. Despite significant advances in cardiac diagnostics leading to early recognition of myxomas, the potential for deleterious effects secondary to embolic complications remains high. The purpose of this paper is to provide nurses with an understanding of the epidemiology, pathology, clinical presentation, and assessment of individuals with cardiac myxomas. A case presentation is used to illustrate how the misdiagnosis of cardiac myxoma led to a delay in patient treatment. Prompt recognition, diagnosis, and treatment are important in improving patient outcomes and quality of life. Due to the infrequency of cardiac myxomas, ensuring appropriate preoperative and postoperative nursing care to the patient with a cardiac myxoma is essential.

Coronary artery bypass graft patients' pain perception during epicardial pacing wire removal.

Surgical placement of temporary epicardial pacing wires (EPWs) onto the epicardial surface of the heart is standard practice during cardiac surgery. The purpose of this study was to determine the intensity and quality of pain and sensations experienced during the procedure of EPWs removal for coronary artery bypass graft (CABG) patients. A descriptive study, incorporating the McGill Pain Questionnaire-short form and visual analogue scales, was used with 100 CABG patients requiring EPW removal. The pain intensity was reported as mild (47%), while the main sensation experienced was pulling (70%). Age, gender, previous cardiac surgery and EPW removal experience, and use of analgesics did not influence the pain and sensations experienced. However, subjects who had EPWs removed on post-operative day five or earlier did present with higher MPQ-SF affective and combined scores. CABG patients can be prepared for EPW removal by providing information that the procedure is a mildly painful, pulling sensation.

Pain in adults post surgical repair of congenital heart defects.

The purpose of this study was to describe pain in adults post surgical repair for congenital heart defects. What is the intensity, sensory, and affective dimensions of pain experienced post-operatively? What is the trend in pain experienced post-operatively over time? What is the effectiveness of post-operative pain management strategies? What factors influence the dimensions of post-operative pain experienced? A descriptive prospective repeated measures design was used with 30 adult congenital heart (ACH) post-operative patients. Pain assessments using the McGill Short Form Questionnaire (MSFQ), a visual analogue pain scale (VAP), and recordings of other variables (analgesic, anxiety, activity level, non-pharmacologic intervention) were performed three times daily until hospital discharge. Mean pain intensity scores ranged from 2.44 +/- 1.31 following extubation to 1.30 +/- 0.66 on post-operative day (POD) five (scale, 0-5). Mean MSFQ scores ranged from 9.26 +/- 7.21 following extubation to 4.40 +/- 5.22 on POD five (scale, 0-45). Mean VAP scores ranged from 50.77 +/- 25.79 following extubation to 18.76 +/- 18.50 on POD five (scale, 0-100). Mean number of narcotic doses per day ranged from 4.61 +/- 2.01 to 1.88 +/- 1.98 on PODs one and five, respectively. Anxiety predicted VAP and MSFQ scores on PODs one and two; anxiety and analgesia doses predicted VAP and MSFQ scores on POD three; analgesia doses predicted MSFQ scores, analgesia and anxiety predicted VAP scores on POD four; analgesia doses and anxiety predicted VAP and MSFQ scores on POD five. No relationships were found among pain and other demographic, treatment, or clinical variables. Overall, pain was reported as mild to moderate intensity, variable in sensations, decreased over time, and adequately managed.