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

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.

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.

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.

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.

Cuidado familiar após infarto agudo do miocárdio / Family care after acute myocardial infarction / Cuidado familiar después del infarto agudo al miocardio

Objetivo: Descrever o cuidado desenvolvido pelas famílias de pacientes após Infarto Agudo do Miocárdio. Método: Estudo qualitativo e exploratório realizado com seis famílias entre os meses de fevereiro e maio de 2012. Para a coleta de dados utilizou-se entrevista com a família. A análise temática constituiu-se de três etapas: pré-análise, exploração do material, tratamento dos resultados obtidos e interpretação. Resultados: O cuidado familiar foi organizado em duas categorias: Cuidado familiar como proteção e Cuidado familiar controlador. Percebeu-se que o modo de cuidar ocorre, muitas vezes, simultaneamente, sendo que o cuidado que protege é o mesmo que controla. Além disso, pode-se afirmar que, no interior do cuidado familiar, existem diversas formas de desenvolver o cuidado, sendo este, portanto, multifacetado. Conclusão: O cuidado familiar desenvolvido após IAM, nas famílias entrevistadas, apresenta, principalmente, características protetivas e de controle. Acredita-se que por meio desses resultados se estará delineando caminhos para a Enfermagem e as outras profissões da área da saúde, favorecendo uma visualização mais aprofundada do cuidado familiar e suas variações.

Objective: To describe the care provided by families of patients after acute Myocardial Infarction. Method: Qualitative and exploratory study performed with six families between February and May of 2012. Interviews with the families were performed for data collection. The thematic analysis involved three steps: pre-analysis, material exploration, processing and interpretation of results. Results: Family care was organized in two categories: Family care as protection and family care as control. It could be observed that both types of care occur, often times, simultaneously, thus providing protection and control. Furthermore, it can be stated that, within the family care, there are several ways to perform the care, making it multifaceted. Conclusion: Family care after acute myocardial infarction can be described as controlling but mostly protecting. From these results, new ways are outlined for Nursing and other health professions, providing a deeper understanding of family care and its variations

Objetivo: Describir el cuidado desarrollado por las familias de pacientes después del infarto agudo al miocardio. Método: Estudio cualitativo y exploratorio realizado con seis familias entre los meses de febrero y mayo de 2012. Para la recolección de datos se utilizó la entrevista con la familia. El análisis temático constó de tres etapas: pre-análisis, exploración del material, tratamiento de los resultados obtenidos e interpretación. Resultados: El Cuidado familiar fue organizado en dos categorias: Cuidado familiar como protección y Cuidado familiar controlador. Se percibió que el modo de cuidar ocurre, muchas veces, simultáneamente, siendo el cuidado que protege el mismo que controla. Además, se puede afirmar que, en el interior del cuidado familiar, hay distintas maneras de desarrollar el cuidado, siendo este, por lo tanto, multifacético. Conclusión: El cuidado desarrollado por las familias entrevistadas, después de un infarto agudo al miocardio, tiene características de control y sobre todo de protección. Por medio de estos resultados se están delineando caminos para la Enfermería, favoreciendo una visualización más profunda del cuidado familiar y sus variaciones.

Saúde do homem: o cuidar/cuidado de enfermagem às vítimas de IAM em uma unidade de pronto atendimento - UPA

A relação entre masculinidade e saúde vem sendo trabalhada em diversos estudos, cujos resultados apontam que esse comportamento pode gerar danos à saúde.Uma das principais causas de mortalidade masculina segundo o Ministério da Saúde é a doença isquêmica do coração. Objeto de estudo: cuidados de enfermagem a homens com hipótese diagnóstica de IAM socorridos em uma Unidade de Pronto Atendimento –UPA. Objetivos: descrever os cuidados de enfermagem recebidos pelos homens com hipótese diagnóstica de IAM; identificar como a masculinidade se apresenta no contexto de adoecimento de homens por IAM; discutir a relação entre a masculinidade e o adoecimento por infarto agudo do miocárdio sob a ótica dos cuidados de enfermagem recebidos pelos homens no atendimento de emergência. Metodologia: método misto,descritivo exploratório. Resultados: A masculinidade influenciou no tocante ao adoecimento masculino, na dificuldade de realizar medidas de auto cuidado e adoção de comportamentos de risco. Evidenciou-se que a demanda de cuidados inicia-se desde a fase pré-hospitalar, na prevenção do adoecimento cardiovascular, no auxílio ao reconhecimento dos sintomas de isquemia miocárdica. Na análise dos boletins de atendimento verificou-se que os cuidados mais freqüentes foram: monitorização cardíaca contínua, ventilação não invasiva contínua, controle dos sinais vitais, controle da glicemia capilar, oximetria de pulso. Com base na observação dos atendimentos de emergência, pôde-se considerar que não existe uma especificidade dos cuidados prescritos aos homens, que são determinados a partir das diretrizes de cuidado de emergência ao IAM. Entretanto, os homens receberam cuidados que vão para além das prescrições realizadas, ou de aspectos fisiológicos da doença.

The relationship between masculinity and health has been worked in severalstudies, which results indicate that this behavior may cause damage to health. One ofthe main causes of male mortality according to the Ministry of Health is the ischemicheart disease. Object of study: nursing care for men with a diagnosis of acutemyocardial infarction (AMI) rescued in an Emergency Care Unit - ECU. Objectives: Todescribe the nursing care received by men with diagnostic hypothesis of AMI; identifyhow masculinity is presented in the context of men falling ill by AMI; discuss therelationship between masculinity and illness due to acute myocardial infarction from theperspective of nursing care received by men in emergency care. Methodology: mixedmethod, exploratory descriptive. Results: Masculinity influenced regarding the maleillness, the difficulty of performing self-care measures and adoption of risky behaviors.It was evident that the demand for care starts from the prehospital phase, in theprevention of cardiovascular illness, to aid in the recognition of symptoms ofmyocardial ischemia. In the analysis of service bulletins, it was identified that the mostfrequent care were: continuous cardiac monitoring, continuous non-invasive ventilation,control of vital signs, control of blood glucose, pulse oximetry. Based on theobservation of emergency care, it could be considered that there is not a specificity ofthe treatment prescribed to men, which is determined from AMI emergency careguidelines. However, men received care that go beyond the made prescriptions, or ofphysiological aspects of the disease.

Apoio social frente à necessidade de cuidado após infarto do miocárdio / Apoyo social frente la necesidad del cuidado después del infarto del miocardio / Social support towards the necessity of caring after myocardial infarction

RESUMOObjetivo:conhecer o apoio social recebido ou prestado pela família frente à necessidade de cuidado após Infarto Agudo do Miocárdio.Método:pesquisa qualitativa e exploratória. A coleta de dados ocorreu por meio de observação e entrevista com seis famílias, nos meses de fevereiro a maio de 2012. Os dados foram tratados por meio de análise temática.Resultados:da análise dos dados emergiram três categorias: Apoio social imediato; Apoio social mediato; Apoio social tardio.Conclusão:o apoio social acompanha a trajetória do infarto, passando pelos integrantes da família e favorecendo suporte de acordo com as necessidades de cuidado em cada momento vivido pelo paciente.

RESUMENObjetivo:conocer el apoyo social recibido o prestado por la familia delante la necesidad del cuidado después del infarto agudo de miocardio.Méodo:pesquisa cualitativa e exploratoria. La recolecta de datos ocurrió por medio de la observación e entrevista con seis familias, en los meses de febrero y mayo de 2012. Los datos fueron tratados por medio de análisis temático.Resultados:emergieran tres categorías: Apoyo social inmediato; Apoyo social mediato; Apoyo social tardío.Conclusión:el apoyo social acompaña la trayectoria del infarto, que pasa por los integrantes de la familia y favorece suporte de acuerdo con las necesidades de cuidado en cada momento vivido por el paciente.

ABSTRACTObjective:to know the received or assisted social support by the family towards the necessity of care after acute myocardial infarction.Method:qualitative and exploratory research. Data collection was carried out through observation and interviews with six families, from February to May, 2012. Data were also analyzed based on the thematic analysis.Results:three categories emerged: Immediate social support; Mediate social support; Late social support.Conclusion:social support follows the infarction trajectory, which attains the family members and favors the support according to the needs of care in each lived moments by the patient.

Myasthenia gravis: a careful perioperative anesthetic management of coronary artery bypass grafting.

Nowadays, even hazardous cardiac surgery can be performed on patients with autoimmune diseases like myasthenia gravis. It requires a sensitive perioperative anesthetic approach especially in relation to nondepolarizing muscle relaxant administration. Myasthenic patients produce antibodies against the end-plate acetylcholine receptors causing muscle weakness and sensitivity to nondepolarizing muscle relaxants that could lead to respiratory failure. Perioperative nurse care is critical for uncomplicated course of treatment; therefore, apprehension of surgical procedure should be helpful on an everyday basis. We describe successful management without any pulmonary complications of two patients with myasthenia gravis undergoing coronary artery bypass grafting. In addition, antiacetylcholine receptor antibodies concentrations were evaluated during treatment time. In conclusion, we have found that reduced titrated doses of cisatracurium may be safely used in patients with myasthenia gravis undergoing cardiac surgery without anesthesia and respiratory-related complications.

Lifestyle intervention and one-year prognosis of patients following open heart surgery: a randomised clinical trial.

AIMS AND OBJECTIVES: To evaluate the one-year prognosis of a lifestyle counselling intervention (diet, smoking cessation and exercise) among patients who had open heart surgery. BACKGROUND: Cardiovascular disease is the leading cause of morbidity worldwide in both developing and developed countries. Lifestyle modification plays an important role for patients who are at a high risk of developing cardiovascular disease and for those with an established cardiovascular disease. DESIGN: Randomised, nonblind and lifestyle counselling intervention study with a one-year follow-up. METHODS: A randomised, nonblind intervention study was performed on 500 patients who had open heart surgery. After hospital discharge, 250 patients (intervention group) were randomly allocated lifestyle counselling according to the recent guidelines provided by the European Society of Cardiology (European Journal Preventive Cardiology, 19, 2012, 585). The remaining 250 patients (control group) received the regular instructions. Primary end-point was the development of a cardiovascular disease (nonfatal event) during the first year; secondary end-points included fatal events, smoking abstinence, dietary habits and a physical activity evaluation. RESULTS: According to the primary end-point, the odds of having a nonfatal cardiovascular disease event are 0·56-times (95%CI 0·28, 0·96, p = 0·03) lower for the intervention group compared to the control group. One-year after surgery, it was found that participants in the intervention group were 1·96-times (95%CI 1·31, 2·93, p < 0·001) more likely to achieve dietary recommendations, 3·32-times (95%CI 2·24, 4·91, p < 0·001) more likely to achieve physical activity recommendations and 1·34-times (95%CI 1·15, 1·56, p < 0·001) more likely to return to work. CONCLUSION: Lifestyle counselling intervention following open heart surgery can improve health outcomes and reduce the risk of a new cardiac event. Health care services must recommend and organise well-structured cardiac rehabilitation programmes adjusted to the patient's needs. RELEVANCE TO CLINICAL PRACTICE: A well-structured cardiac rehabilitation programme adjusted to the patient's profile is a safe and cost-effective way to improve patients' outcome.

The development and testing of a nurse practitioner secondary prevention intervention for patients after acute myocardial infarction: a prospective cohort study.

BACKGROUND: Patients with acute myocardial infarction (AMI) are at high risk for reinfarction and death. Therapies that have been shown to reduce these risks (secondary prevention) continue to be underutilized. Nurse practitioners are well positioned to provide secondary prevention during and following hospitalization. OBJECTIVES: The purpose of this study was to evaluate the effects of NP care on the rate of provider implementation and patient achievement of evidence-based secondary prevention target goals. DESIGN: A prospective cohort design was used, which compared achievement of target goals between patients who received secondary prevention care from an NP to those who received usual care. PARTICIPANTS: The sample consisted of 65 patients with AMI, admitted to a large community hospital. Patients meeting eligibility criteria were recruited consecutively. METHODS: The intervention was delivered by the NP before discharge from hospital and one week, two weeks, six weeks and 3 months after discharge. Data on patients' achievement of goals were obtained before discharge from hospital and 3 months after discharge from both groups. RESULTS: This study's results provide preliminary evidence that an NP delivered secondary prevention intervention can significantly improve achievement of the following target goals when compared to usual care: smoking cessation (OR 5), blood pressure (OR 15), attendance at cardiac rehabilitation (OR 7), physical activity five days a week (OR 17), physical activity ≥ five days a week (OR 34), achieving a glycated haemoglobin < 7% in those with diabetes (OR 10), triglyceride levels (p = .02), statin use at follow-up (p = .05), and number of weeks to cardiac rehabilitation (p = .05). CONCLUSION: NP-led interventions such as this warrant duplication to evaluate reproducibility of the intervention and to determine if short-term improvements in secondary prevention goals translate into morbidity and mortality benefits.

The experience of an information system for nursing practice: the importance of nursing records in the management of a care plan.

Health information systems are becoming common because they are important tools to support decision making and assist nurses in their daily interventions. The Information System for Nursing Practice promotes consistent nursing records, as it is directed to the nursing practice and process. The aims of this study were to identify and describe the most frequent type of nursing actions in the care plan for a patient after acute myocardial infarction, considering the seven-axis model of the International Classification of Nursing Practice and the rate of health education given to patients during hospitalization. A cross-sectional analysis was performed retrospectively by searching the computerized database of the Information System for Nursing Practice. We verified some gaps in information with regard to unidentified records of diagnoses and interventions. During hospitalization, the most used interventions were in the fields of observing (40%) and managing (23%). Interventions associated with management of signs and symptoms were more frequent and were performed in 84.9% of the patients. In the field of informing, health education in relation to diet was performed in 21.7% of the patients; exercise, in 16%; and tobacco, in 11.3%. The use of nursing records and information systems can improve nursing care coordination and care plan management.

Fatores de Riscos Cardiovasculares: estudo com pessoas hipertensas, de um bairro popular na Região Amazônica / Cardiovascular Risk Factors: The study included hypertensive people in a popular Neighborhood in the amazon region / Factores de riesgo cardiovascular: el estudio incluyó a personas hipertensas en un barrio popular en la región amazónica

Estudo transversal, retrospectivo e quantitativo, cujo objetivo foi estimar fatores de risco cardiovasculares de 145 usuários portadores de hipertensão arterial de uma unidade de saúde, numa comunidade amazônica em Belém do Pará. Os dados foram coletados do Formulário de Cadastro do HIPERDIA. Aplicou-se teste U de Mann-Whitney para comparação inferencial entre gêneros e teste quiquadrado para identificar influência de alguma variável. Utilizou-se o software SPSS.16® na análise descritiva e o MINITAB.15® na realização dos testes. Foram identificados: pressão arterial elevada, tanto sistólica (89,4%) quanto diastólica (64,1%); circunferência abdominal aumentada (homens: 63,2%; mulheres: 88,6%); presença de antecedentes familiares cardiovasculares (45,5%); tabagismo (27,6%); sedentarismo (57,9%); sobrepeso e obesidade (75,2%). O teste U de Mann-Whitney evidenciou que, em média, o fator de risco é igual para homens e mulheres, e que existiu influência do sedentarismo em pessoas que apresentaram acidente vascular encefálico. A coexistência dos fatores de risco com a hipertensão arterial,está presente em 91,1% da amostra pesquisada. Esses achados ressaltam a necessidade de ações mais efetivas para o controle da doença do grupo estudado, tais como, reduzir e controlar o peso corporal; recomendar e estimular alimentação adequada e atividade física; controlar os valores pressóricos; além de avaliações globais das condições de vida, o que sustentaria melhor as recomendações dirigidas a este grupo.

Cross-sectional study, retrospective and quantitative character that aimed to estimated the cardiovascular risk factors of 145 users with hypertension of a Amazon community in Belém-PA. The collected data were from the Registration Form of HIPERDIA. The U test, by Mann-Whitney was applied for comparison between genders andthe chi-square test to identify the influence of some variable. The software SPSS. 16® was used on the descriptive analysis and MINITAB. 15® to perform the tests. Were identified: high blood pressure, both systolic (89.4%) and diastolic (64.1%), increased abdominal circumference (male: 63.2% female: 88.6%), presence of cardiovascular family history (45.5%), smoking (27.6%), sedentary (57.9%) and overweight and obesity (75.2%). The U Mann-Whitney test showed that showed the average risk factor is equal for men and women and that there is greater influence of sedentary lifestyle in people who had a stroke. The coexistence of risk factors with hypertension is present in 91.1% of the sample. These findings underscore the need for more effective action to control the disease in the study group such as, reduce and control body weight; recommend and encourage proper nutrition and physical activity, controlling blood pressure values, as well as global ratings of living conditions, which would sustain the best recommendations to this group.

Estudio transversal, retrospectivo y cuantitativo, cuyo objetivo fue estimar factores de riesgo cardiovasculares de 145 usuarios portadores de hipertensión arterial de una unidad de salud, en una comunidad amazónica en Belém do Pará. Los datos fueron recolectados del Formulario de Catastro del HIPERDIA. Se aplicó la prueba U de Mann-Whitney para la comparación inferencial entre los géneros y prueba chi-cuadrado para identificar la influencia de alguna variable. Se utilizó el software SPSS.16® en el análisis descriptivo y el MINITAB.15® en la realización de las pruebas. Fueron identificados: presión arterial elevada, tanto sistólica (89,4%) como diastólica (64,1%); la circunferencia abdominal aumentada (hombres: 63,2%, mujeres: 88,6%); la presencia de antecedentes familiares cardiovasculares (45 5%); tabaquismo (27,6%); sedentarismo (57,9%); sobrepeso y obesidad (75,2%). La prueba U de Mann-Whitney evidenció que el factor de riesgo promedio es igual parahombres y mujeres, y que ha existido influencia del sedentarismo en las personas que tuvieron un accidente cerebrovascular. La coexistencia de los factores de riesgo con la hipertensión arterial está presente en el 91,1% de la muestra investigada. Estos resultados resaltan la necesidad de acciones más efectivas para el control de la enfermedad del grupo estudiado, tales como, reducir y controlar el peso corporal; recomendar y estimular una alimentación adecuada y la actividad física; controlar los valores de presión arterial, así como las evaluaciones globales de las condiciones de vida, lo que sustentaría mejor las recomendaciones dirigidas para este grupo.

Reliability of the Cardiac Patients Learning Needs Inventory (CPLNI) for use in Portugal.

AIMS AND OBJECTIVES: To perform the semantic validation and to evaluate the reliability and the presence of ceiling and floor effects of the Cardiac Patients Learning Needs Inventory in Portuguese patients with coronary artery disease. BACKGROUND: Information should be selected based on what patients know and need to learn, which means that the teaching process should be based on each person's needs. The Cardiac Patients Learning Needs Inventory is aimed at identifying the cardiac patients' individual learning needs. DESIGN: Methodological research design. METHODS: Two hundred patients hospitalised at the coronary intensive care unit or at the cardiothoracic surgery unit of a public hospital in Lisbon answered the adapted version of the Cardiac Patients Learning Needs Inventory. Internal consistency was estimated based on Cronbach's alpha. Scores above 0·50 were considered acceptable. Stability was measured through test-retest and calculated using student's t test. Significance was set at 0·05. RESULTS: Patients' mean age was 65 years (SD = 11·8), and most were men (152; 76%). Cronbach's alpha for the total scale was high in the first and second measurement (0·91), and for seven domains, it was acceptable in the first and second measurement (range from 0·50-0·89). No statistically significant difference was found between mean scores on the first and second measurement. Lower diversity was observed in the answers, most of which ranged between important and very important (ceiling-effect). CONCLUSION: The adapted version for use in Portugal maintained the conceptual, semantic and idiomatic equivalences of the original version and showed adequate reliability. RELEVANCE TO CLINICAL PRACTICES: Owing to the lack of validated instruments translated into Portuguese, to measure cardiac patients' learning needs, this study entails important clinical and theoretical implications.

Percepción del paciente con infarto agudo de miocardio en la relación terapéutica con la enfermera, en el Servicio de Cardiología del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud 2012 / Perception of the patient with acute myocardial infarction in the therapeutic relationship with the nurse, in the Cardiology Service at the National Hospital Guillermo Almenara Irigoyen - EsSalud 2012

El objetivo fue determinar la percepción del paciente con infarto agudo de miocardio en la relación terapéutica con la enfermera, en el servicio de cardiología del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud. Material y Método: El estudio es de tipo cuantitativo, método descriptivo de corte transversal, la muestra estuvo constituida por 26 pacientes. La técnica fue la encuesta y el instrumento la Escala de Likert modificada, aplicado previo consentimiento informado. Resultados: Del 100 por ciento (26) en el Hospital Nacional Guillermo Almenara Irigoyen, en la dimensión de apoyo emocional en el indicador de comunicación el 77 por ciento (20) presenta una percepción desfavorable y el 23 por ciento (6) lo considera favorable. En el indicador trato un 69 por ciento (18) consideran a este aspecto con un nivel desfavorable, y el 31 por ciento (8) lo considera favorable. En cuanto a los indicadores afecto el 81 por ciento (21) lo considera desfavorable en cuanto un 19 por ciento (5) es favorable y en el indicador empatía un 65 por ciento (17) lo considera desfavorable, teniendo un 35 por ciento (9) favorable. Conclusiones: el mayor porcentaje de los pacientes con infarto agudo de miocardio tienen una percepción desfavorable en la relación con la enfermera y en cuanto un poco porcentaje de los pacientes refieren tener una percepción favorable en la relación terapéutica con la enfermera, lo cual refiere de alguna manera la calidad de atención que se le brinda al paciente...

The objective was to determine the perception of the patient with acute myocardial infarction in the therapeutic relationship with the nurse in the cardiology department of the Hospital Nacional Guillermo Almenara Irigoyen - EsSalud. Material and Methods: The study is quantitative, cross-sectional method, the sample consisted of 26 patients, the technique was the survey and modified Likert Scale instrument applied informed consent. Results: from 100 per cent (26) in the National Hospital Guillermo Almenara Irigoyen, in the dimension of emotional support in the communication indicator 77 per cent (20) has an unfavorable perception and 23 per cent (6) considers favorable. In the treatment indicator by 69 per cent (18) considered this aspect with an unfavorable level, and 31 per cent (8) considers favorable. As indicators affection 81 per cent (21) considered unfavorable as 19 per cent (5) is favorable and the display empathy by 65 per cent (17) considered unfavorable, with 35 per cent (9) favorable. Conclusions: The higher percentage of patients with acute myocardial infarction have an unfavorable perception in relation to the nurse as soon as a few percentage of patients reported having a favorable perception in the therapeutic relationship with the nurse, which relates somehow the quality of care that is given to the patient...

Pessoas pós-infarto agudo do miocárdio tardio permanecem com fatores de risco modificáveis para a doença / Do individuals after late acute myocardial post-infarction remain

Pesquisa quantitativa com o objetivo de identificar o perfilsociodemográfico e fatores de risco em pessoas que sofreraminfarto agudo do miocárdio, acompanhadas em uma Unidadede Saúde da Família. Foram entrevistadas 31 pessoas,utilizando-se questionários contendo fatores de risco parao infarto. Quarenta e oito por cento das pessoas possuemhistória familiar de infarto, 80% são hipertensas e 100% dasmulheres possuem circunferência cintura-quadril acima dorecomendado. Dezenove por cento apresentam depressãograve, 23% ansiedade grave a muito grave e 39% estressemoderado a muito severo segundo a escala utilizada. Os fatoresque aumentam o risco de sofrer infarto ainda possuem elevadaprevalência nas pessoas entrevistadas e estas permanecemcom hábitos de vida que podem levar à recidiva do infarto.Salientamos a importância da implementação de programaseducativos.

Quantitative research with aim to identify the socio-demographicand risk factors in people who had an acute myocardialinfarction, accompanied in a Family Health Unit. A groupof 31 individuals were interviewed and a questionnaire withrisk factors for myocardial infarction was applied. Forty-eightpercent have a family history of myocardial infarction, 80% werehypertensive and 100% of women have waist-hip circumferenceabove recommended. Nineteen percent have severe depression,23% anxiety severe to very severe and 39% moderate to verysevere stress according to the scale used. Factors that increasethe risk for heart attack also have high prevalence in individualsinterviewed and they remain with lifestyle habits that can lead torecurrence of myocardial infarction. We stress the importanceof implementing educational programs.

[Extracorporeal membrane oxygenation as bridge to recovery in infarction-related refractory right heart failure]. / Extrakorporale Membranoxygenierung als "Bridge-to-recovery" bei infarktbedingtem therapierefraktärem Rechtsherzversagen.

HISTORY AND CLINICAL FINDINGS: We present a 41-year-old man with cardiac arrest in need of cardiopulmonary resuscitation (CPR) with the diagnosis of a posterior wall infarction, who was hospitalized in our cardiac centre. INVESTIGATIONS: The cardiac catheterization showed a thrombotic obstruction of the right coronary artery. After percutaneous coronary revascularization a hemodynamically stable situation could be achieved and the patient was admitted to the intensive care unit (ICU). TREATMENT AND CLINICAL COURSE: The patient became again hemodynamically unstable and a CPR was required. Based on the acute right heart failure with therapy refractory cardiogenic shock we decided within our heart team for an extra corporeal membrane oxygenation (ECMO) applied during CPR in the ICU. The extracorporeal support was needed for three days. Seven days after the emergency cardiac catheterization the patient was extubated and transferred to our intermediate care. CONCLUSION: Extracorporeal life support is feasible und effective for bridging therapy in patients with acute ischemic right heart failure with refractory cardiogenic shock and successful reperfusion therapy.

Contribuição do cuidado clínico de enfermagem para o conforto psicoespiritual de mulheres com infarto agudo do miocárdio / Contribution of nursing clinical care for psycho-spiritual comfort of women with acute myocardial infarction

Objetivou-se analisar a contribuição do cuidado clínico de enfermagem para o conforto psicoespiritual de mulheres com Infarto Agudo do Miocárdio (IAM), mediado pela pesquisa-cuidado com base na Teoria do Conforto. Os sujeitos foram nove mulheres admitidas com IAM no período de abril a junho de 2011 em um hospital de Cardiologia em Sobral - Ceará, Brasil. O primeiro encontro ocorreu na admissão e durou em média seis horas; depois ocorreram mais três encontros. Para coleta e análise das informações, foram empregados entrevista individual semiestruturada, diário de campo, observação participante e análise temática categorial de conteúdo. Os cuidados implementados no contexto psicoespiritual foram: fortalecer a espiritualidade, esclarecer sobre o adoecimento, ajudar no enfrentamento da nova condição de saúde e nas situações de confusão mental e desorientação. A percepção do conforto psicoespiritual ocorreu por meio da implementação de cuidados clínicos neste contexto, utilizando-se pesquisa-cuidado com base na Teoria do Conforto.

The objective was to analyze the contribution of nursing clinical care for psycho-spiritual comfort of women with acute myocardial infarction (AMI), mediated by research-care based on the Comfort Theory. The subjects were nine women admitted with AMI from April to June 2011 in a Cardiology hospital in Sobral, Ceará, Brazil. The first meeting took place at the admission and lasted around six hours, after that there were three more meetings. For data collection and analysis we used individual semi-structured interviews, field diary, participant observation and thematic category content analysis. The cares implemented in the psycho-spiritual context were: strengthen the spirituality; clarify the illness; help in coping with new the health condition and situations of mental confusion and disorientation. The perception of psycho-spiritual comfort was present through the implementation of clinical cares in this context, using research-care based on the Comfort Theory.

El objetivo del estudio fue analizar la contribución de la atención clínica de enfermería para el confort psicoespiritual de mujeres con Infarto Agudo del Miocardio (IAM), mediada por la investigación-atención basada en la Teoría del Confort. Participaron nueve mujeres que ingresaron con IAM entre abril y junio de 2011 en el hospital de Cardiología de Sobral, Ceará, Brasil. El primer encuentro ocurrió en la admisión y duró alrededor de seis horas, después ocurrieron más tres encuentros. Para recolección y análisis de las informaciones, se utilizaron entrevista semi-estructurada, diarios de campo, observación participante y análisis temático categorial de contenido. Las atenciones psicoespirituales fueron: fortalecer la espiritualidad, aclarar las dudas sobre la enfermedad, ayudar a enfrentarse el nuevo estado de salud y las situaciones de confusión mental y desorientación. La percepción de confort psicoespiritual fue presente a través de la implementación de la atención clínica en este contexto, usándose de investigación-atención basada en la Teoría del Confort.