How to achieve patient-centered testing: role of the protocol nurse.

INTRODUCTION: Patient-centered cardiac testing is predicated on choosing the right test for the right patient. We studied the effects of changing from script-driven scheduling to nurse-driven protocoling of stress tests. METHODS AND RESULTS: A protocol nurse reviewed records before scheduling and communicated with patients and ordering providers if needed. We found that instituting nurse protocolling of all non-imaging (ETT) and nuclear (MPI) stress tests (N = 3071) resulted in protocol changes in 37% of our patients, and reduced the proportion of tests that could not be performed as scheduled by 56% and cancelations by 71% (P < 0.001 for each). These changes were sustained over two successive 6-month periods following a baseline observation period of 6 months. For MPI, the most frequent nurse interventions were re-protocoling as stress-first MPI (12% of tests), changing test location for clinical reasons (13%), changing stress modality (7%), and care coordination (5%). CONCLUSIONS: Changing from script-driven scheduling to protocol nursing contributed measurably to patient-centered testing.

[VO2 max, a true exercise test]. / La VO2 max, une véritable épreuve d'effort.

VO2 max is nowadays an essential examination performed in the monitoring of heart failure. The nurse has a role to play during the test and in supporting the patient, although this test remains highly technical and complex.

Nurse-led pharmacological stress testing: an overview.

Myocardial perfusion imaging (MPI) is a noninvasive diagnostic tool that can provide valuable information on coronary blood flow at rest and during stress. Dynamic exercise is the stress technique of choice with patients who can achieve an acceptable workload; for those unable to do so, pharmacological stress testing with adenosine or dobutamine can be used. Nurses trained in ECG interpretation and advanced resuscitation skills are increasingly involved in supervising pharmacological stress tests. This article provides an overview of nurse-led pharmacological stress testing.

Enhancing nurses' roles to improve quality and efficiency of non-medical cardiac stress tests.

Myocardial perfusion imaging (MPI) is a test that aids the diagnosis of coronary heart disease, of which pharmacological stress is a key component. An increase in demand had resulted in a 42 week waiting time for MPI in Leicester. This article looks at how implementing non-medically led stress tests reduced this waiting list. It discusses the obstacles involved and the measures needed to make the service a success.

Exercise capacity in patients 3 days after acute, uncomplicated myocardial infarction.

In a randomized, controlled trial of early hospital discharge after acute myocardial infarction (MI), a heart rate, symptom-limited exercise thallium test was performed after the onset of MI. Patients' exercise capacity was evaluated by the exercise treadmill with accompanying thallium scintigraphy. Of 507 consecutive patients screened, the condition of 179 was classified as uncomplicated, which is defined as the absence of angina, heart failure, or serious arrhythmias at 72 hours from admission. Of the patients with uncomplicated conditions, 126 had an exercise test on day 3 and 53 did not exercise on day 3. Of the 126 patients who exercised on day 3, 36 had a positive test and 90 had a negative test for ischemia. The 36 patients with a positive test result exercised a mean time of 6.71 +/- 2.8 minutes, achieved a mean peak heart rate of 120.9 +/- 21.4 beats/min, reached a peak systolic blood pressure of 144.7 +/- 33.3 mm Hg, and achieved a double product (rate-pressure product) of 183.4 +/- 67.6. The 90 patients with a negative test result for ischemia exercised 9.45 +/- 12.7 minutes, achieved a peak heart rate of 130.2 +/- 14.4 beats/min, reached a mean systolic blood pressure of 155.5 +/- 29.4 mm Hg, and achieved a rate-pressure product of 210.5 +/- 44.0. Of the 90 patients with uncomplicated conditions who had a negative exercise test for ischemia, 85 patients received reperfusion therapy, which included thrombolysis or coronary angioplasty or both.(ABSTRACT TRUNCATED AT 250 WORDS)

Is nurse-supervised exercise stress testing safe practice?

OBJECTIVE: Nurses have been performing exercise stress tests (EST) without medical supervision since 1978 in our hospital-based cardiac rehabilitation unit. This study was conducted to examine the incidence of cardiovascular complications and to describe the competency-based training program for the nurses performing the EST. DESIGN: Descriptive, retrospective audit of prospective data. SETTING: Single comprehensive cardiac rehabilitation center in a large tertiary referral hospital in western Sydney, Australia. SUBJECTS: Seventeen thousand, four hundred and sixty-seven patients were included in this study over a 12-year period. METHOD: Data were collected on all ESTs performed by the cardiac rehabilitation nurses from January 1986 to December 1997 in relation to serious cardiovascular complications and other EST parameters. RESULTS: In this study, 17,467 ESTs were performed on 5054 patients who had 6273 separate presentations. The most common entry diagnosis was after an acute myocardial infarction (50%). The mean age was 58 +/- 10.5 years (range 15 to 87 years; 80% male). The left ventricular ejection fraction (n = 2822) was 49% +/- 14%. In a subgroup analysis of 14,454 patients, 14% had a positive EST (ST segment >1.9 mm depression). There were no deaths associated with the EST, and there were 13 major complications in 12 patients. This figure included no cardiac arrests, 11 episodes of conscious sustained ventricular tachycardia, 1 reinfarction, and 1 mitral valve rupture, representing a 0% mortality rate and a 0.075% major morbidity rate. CONCLUSION: This study shows that nurse-supervised EST of higher risk patients in the hospital-based cardiac rehabilitation setting has been a safe practice from a mortality and morbidity rate perspective. This finding may be accounted for by the high training standard and reaccreditation of the nurses on the advanced practice of performing EST.

[The communication process in the care of patients during echocardiography]. / O processo de comunicação no cuidado do paciente submetido ao eco-stress: algumas reflexões.

The article reviews some aspects of the communication process, its basic concepts, how it is approached in the theories of the nurses, and proposes to make reflections on the communication in the context of the patient undergoing the stress-echo study. Our goal is to emphasize and to rescue some important aspects related to the communication in health allies area, which is practiced in a constant manner in the daily practices of the nurse. Finally, this paper wishes to emphasize the importance of the knowledge of this process, incorporating it to the practice.

Avaliação da capacidade funcional de idosos por meio do teste de caminhada de seis minutos / La evaluación de la capacidad funcional de los adultos mayores a través de la prueba de caminata de seis minutos / Evaluation of functional capacity of elderly through the test of six-minute walk

Objective: To evaluate the functional capacity of older people engaged in physical activity through the test of six-minute walk test (6MWT). Method: An exploratory study with a quantitative approach, with 40 elderly participants of the Center for Health Care of the Elderly (CASI) of Piripiri (PI). We calculated the distance specified by demographics and the 6MWT was applied to identify the actual distance traveled. Results: The findings showed that the majority of participants were female, with 66 to 70 years old, married, a minimum wage income, low education. Individuals were considered hypertensive and diabetic patients traveled less value than individuals without the disease. There was no statistically significant difference between the average distance and the expected average distance. Conclusion: Older people who practice physical activity showed a level of functional capacity as demonstrated by satisfactory values of the distances traveled in the walk test six minutes...

Objetivo: Avaliar a capacidade funcional de idosos praticantes de atividade física por meio do teste de caminhada de seis minutos (TC6). Método: Estudo exploratório de abordagem quantitativa, com 40 idosos atendidos no Centro de Atenção à Saúde do Idoso (CASI), de Piripiri (PI). Foi calculada a distância prevista por meio de dados antropométricos e foi aplicado o TC6 para identificar a distância real percorrida. Resultados: Os achados apontaram que a maioria dos participantes era do sexo feminino, com 66 a 70anos, casados, renda de um salário mínimo, baixa escolaridade. Os indivíduos considerados hipertensos e diabéticos apresentaram valor percorrido menor do que os indivíduos sem a patologia. Não houve diferença estatisticamente significativa entre a distância média prevista e a distância média percorrida. Conclusão: Os idosos que praticam atividade física apresentaram um nível de capacidade funcional satisfatória conforme mostraram os valores das distâncias percorridas no teste de caminhada de seis minutos...

Objetivo: Evaluar la capacidad funcional de los ancianos practicantes de la actividad física a través de la prueba de caminata de seis minutos (PC6). Método: Un estudio exploratorio con abordaje cuantitativo, con 40 personas que participan en el Centro de Atención al Adulto Mayor (CASI) Salud de los chiles (IP). Distancia predicho por los datos antropométricos se calculó y la PM6M se aplicó para identificar la distancia real recorrida. Resultados: Los resultados indicaron que la mayoría de los participantes eran mujeres, con un 66 a 70 años de edad, casado, un ingreso de salario mínimo, bajo nivel de educación. Los individuos considerados hipertensos y diabéticos viajaron menos valor que las personas sin el trastorno. No hubo diferencia estadísticamente significativa entre la media prevista distancia y la distancia media recorrida. Conclusión: Las personas mayores que practican actividad física mostraron un grado de autonomía funcional satisfactoria como valores mostrados de las distancias recorridas en el test de caminata de seis minutos...

Perception of effort in minibasketball during small side games / Percepcion de esfuerzo en baloncesto de formación durante juegos reducidos

It was analyzed in what measurement the characteristics of the task in small side games influence the perception of effort (RPE) and his relation between the time of game and the RPE the type of tasks. Ten minibasketball players performed 50 tasks (10 training sessions, 450 records RPE, 5 with duration of 8, 10 or 12 minutes). Based on the description 7 variables were codified: Aim: (Assault / Defense / Compound), Duration: (8 minutes / more than 8 minutes), Space: (Track completes / 1/2 Track / 1/4 of Track), numerical Equality: (Without rival / numerical Inequality / numerical Equality), Transition: (If / Not), Player of support: (If / Not), Relation between players: (attackers[n] x defenders[n]). No parametric analysis and an analysis of the variable RPE in function of the characteristics of the task with logistic multinomial regression from the RPE were used. RPE's average in all the variables were 6.87 ± 1.76. Four variables contribute the model: Time of the task (X2 = 183.49; df= 8; p < .001), Relation among players (X2 = 63.71; df= 10; p < .001), Transition (X2 = 15.37; df= 2; p < .01) and the Aim (X2 = 9.68; df= 4; p < .05). The % of classification of the model for the group RPE (8-9), 90.1 % and for the group RPE (0-6), 71.6 %. The total percentage of classification predicted was 66.4. The tasks of 8 minutes in the group of RPE (0-6) have more possibilities of having RPE lower than those of any more 10 or 12 minutes. The tasks of attack have more possibilities of having a lower RPE. The characteristics of tasks influence the RPE. More than 8 minutes favor a very high RPE when the presence of attackers and defenders in 1x1 and 2x2 exist

Con el objetivo de analizar en qué medida las características de las tareas en los juegos reducidos influyen en la percepción de esfuerzo (RPE), y su relación entre el tiempo de juego y la RPE de los diferentes tipos de tareas, diez jugadores de minibasket desarrollaron 50 tareas (10 sesiones de entrenamiento, 450 registros de RPE, 5 registros de 8, 10 o 12 minutos). Basado en la descripción de 7 variables codificadas: objetivo (ataque / defensa /transición), duración: (8 minutos / más de 8 minutos), espacio: (campo completo / medio campo, 1/4 de campo), igualdad numérica: (sin rival / igualdad numérica/ superioridad numérica), transición: (si / no), ayuda del jugador: (si /no), relación entre jugadores: (atacantes[n] x defensores[n]). El análisis no paramétrico y el análisis de la variable RPE en función de las características de la tarea, se aplicó con una regresión logística multinomial. La media de RPE en todas las variables fue de 6.87 ± 1.76. Cuatro de ellas, contribuyeron al modelo: El tiempo de la tarea (X2 = 183.49; df = 8; p < .001), relación entre jugadores (X2 = 63.71; df = 10; p < .001), transición (X2 = 15.37; df = 2; p < .01) y el objetivo (X2 = 9.68; df= 4; p < .05). El % de clasificación del modelo para el grupo RPE (8-9) fue del 90.1 % y para el grupo RPE (0-6), 71.6 %. El porcentaje total de clasificación fue un predictor del 66.4. Las tareas de 8 minutos tuvieron más posibilidades de presentar una RPE más baja que las de más de 10 o 12 minutos. Las tareas de ataque tuvieron más posibilidades de presentar una RPE más baja. Las características de las tares influyeron en la RPE. Más de 8 minutos favorecen una RPE más alta con presencia de atacantes y defensores en situaciones de 1x1 y 2x2

A review of the six-minute walk test: its implication as a self-administered assessment tool.

BACKGROUND: Promoting self-management and monitoring physical activity are important strategies in chronic heart disease (CHD) management. The six-minute walk test (6MWT) is a commonly used sub-maximal exercise test for measuring physical functional capacity. AIM: The aim of this paper is to review the current literature on 6MWT relating to methodological issues as well as exploring the potential of the protocol to be adopted as a self-administered exercise test. METHOD: The Medline, CINAHL, Science Direct and the World Wide Web using the search engine Google, were searched for articles describing the administration, reliability and validity of the 6MWT. Findings of the integrative literature review The 6MWT is a simple, safe and inexpensive sub-maximal exercise test. The 6MWT distance is strongly associated with functional capacity, and it is a useful prognostic tool. To date, the capacity for self-administration of the 6MWT has not been investigated. CONCLUSIONS: Adapting the 6MWT as a patient-reported outcome measure may enhance the capacity, not only for clinicians to monitor functional status, but also promote self-management by enabling individuals to monitor changes in their functional capacity.

Diagnostic and functional exercise testing: test selection and interpretation.

Exercise stress tests are useful in many areas of medical practice and research. The results extend the clinical significance of information obtained from other sources (ie, detailed history, thorough physical examination, resting electrocardiogram, chest radiograph, and basic laboratory analyses) and serve as a diagnostic, prognostic, and therapeutic guide. Leg or arm ergometry is commonly used to assess a patient's functional status, diagnose relative myocardial ischemia, and investigate physiologic mechanisms of cardiac symptoms. The responses may also be used to determine the effects of interventions such as coronary artery bypass surgery, percutaneous transluminal coronary angioplasty, medications, or exercise training.

Transesophageal dobutamine stress echocardiography: the nurse's role.

Transesophageal dobutamine stress echocardiography uses ultrasonic imaging of the myocardium from the esophagus and stomach during the infusion of incremental doses of dobutamine. Given the semi-invasive nature of the procedure, the nurse who assists the physician plays an essential role in the successful completion of the test. This method is useful for the evaluation of patients with coronary artery disease and for investigations based on ultrasound imaging of the myocardium. Its expanding applications emphasize the relevance of a nursing collaboration and thereby create an opportunity to increase nurses' participation in echocardiography laboratories.