The Effect of an Empowerment Program on the Perceived Risk and Physical Health of Patients With Coronary Artery Disease.

This study was conducted to assess the effect of an empowerment program on the perceived risk and physical health of patients with coronary artery disease. This randomized clinical trial recruited 84 patients with coronary artery disease admitted to post-cardiac care unit (CCU) wards in Tehran Heart Center in 2017. The study subjects were selected and assessed according to inclusion criteria and assigned to intervention and control groups by block randomization. Both groups completed questionnaires for demographic details and disease history, perceived risk in cardiac patients, and physical health. The Magic Empowerment Program was performed for the intervention group as 3 workshops on 3 successive days. Intervention continued after patients' discharge from the hospital through phone calls once a week for 8 weeks. The perceived risk in cardiac patients and physical health questionnaires were completed for both groups. Postintervention results showed significant differences between the 2 groups in total score of perceived risk (P = .001) and its subscales. The Empowerment Program changed patients' attitudes toward risk-motivating behavior change and improving physical health.

Real-world comparison of in-hospital Reveal LINQ insertable cardiac monitor insertion inside and outside of the cardiac catheterization or electrophysiology laboratory.

BACKGROUND: Traditionally, insertable cardiac monitor (ICM) procedures have been performed in the cardiac catheterization (CATH) or electrophysiology (EP) laboratory. The introduction of the miniaturized Reveal LINQ ICM has led to simplified and less invasive procedures, affording hospitals flexibility in planning where these procedures occur without compromising patient safety or outcomes. METHODS: The present analysis of the ongoing, prospective, observational, multicenter Reveal LINQ Registry sought to provide real-world feasibility and safety data regarding the ICM procedure performed in the CATH/EP lab or operating room and to compare it with insertions performed outside of these traditional hospital settings. Patients included had at least a 30-day period after the procedure to account for any adverse events. RESULTS: We analyzed 1222 patients (58.1% male, age 61.0 ± 17.1 years) enrolled at 18 centers in the US, 17 centers in Middle East/Asia, and 15 centers in Europe. Patients were categorized into 2 cohorts according to the location of the procedure: in-lab (CATH lab, EP lab, or operating room) (n = 820, 67.1%) and out-of-lab (n = 402, 32.9%). Several differences were observed regarding baseline and procedure characteristics. However, no significant differences in the occurrence of procedure-related adverse events (AEs) were found; of 19 ICM/procedure-related AEs reported in 17 patients (1.4%), 11 occurred in the in-lab group (1.3%) and 6 in the out-of-lab group (1.5%) (P = .80). CONCLUSIONS: This real-world analysis demonstrates the feasibility of performing Reveal LINQ ICM insertion procedures outside of the traditional hospital settings without increasing the risk of infection or other adverse events.

Estudio de tolerancia y aceptación de una fórmula enteral con alta densidad energética en pacientes de una unidad de coronarias / Study of tolerance and acceptance of a high energy density enteral formula in patients coronary unit study

Objetivo: el objetivo de nuestro trabajo fue evaluar la tolerancia de una fórmula enteral con alta densidad energetica en pacientes hospitalizados en una unidad de coronarias con indicación de soporte enteral al menos durante cinco días. Métodos: estudio abierto, no comparativo, no aleatorizado, descriptivo, para evaluar la tolerancia de una fórmula enteral con alta densidad energética en pacientes ingresados en una unidad coronaria. Resultados: se incluyeron 31 pacientes con una media de edad de 67,32 ± 13,8 años y de los cuales el 66,7% eran varones. El volumen medio final prescrito de Nutrison Energy® fue de 928,5 ± 278,5 ml/día (rango: 800-1.500 ml/día). La duración media de la nutrición enteral fue de 11,2 ± 3,2 días. El aporte final promedio de calorías fue de 1.392 ± 417 cal/día, con 169,9 ± 50,9 g/día de hidratos de carbono, 53,8 ± 16,1 g/día de grasas y 55,7 ± 16,9 g/día de proteínas. Tras la administracion existió un aumento significativo de los niveles de transferrina. Un total de 3 pacientes habían presentado algún episodio de diarrea (9,7%). El número de pacientes que presentaron al menos un episodio de residuo gástrico fue de 5 (16,1%) que no obligo en ningún caso a la suspensión de la nutrición enteral, obligando en 2 pacientes a disminuir el volumen del aporte nutricional durante 24 horas. Durante el soporte nutricional, solo en 3 pacientes fue necesario disminuir el volumen aportado el día previo de la fórmula energética. Con respecto a los vómitos, solo en 1 paciente se constató esta situación (3,2%). Ningún paciente presentó en el estudio otras complicaciones digestivas asociadas a la administración de la fórmula de nutrición enteral. Por último, no se registraron acontecimientos adversos relacionados con la fórmula administrada. Conclusiones: los resultados reflejan que una fórmula enteral con alta densidad energética es una fórmula bien tolerada con una muy baja frecuencia de síntomas gastrointestinales, lo que favorece el cumplimiento de la pauta (AU)

Objective: The aim of our study was to evaluate the tolerance of enteral formula with high energetic density in patients hospitalized in a coronary care unit requering enteral support for at least fi ve days. Methods: Opened, non-comparative, nonrandomized, descriptive study, evaluating the tolerance of enteral formula with high energy density in patients admitted to a coronary care unit. Results: 31 patients were included with a mean age of 67.32 ± 13.8 years, 66.7% were male. The average prescribed final volume Nutrison Energy® was 928.5 ± 278.5 mL/day (range: 800-1,500 mL/day). The average duration of enteral nutrition was 11.2 ± 3.2 days. The average calorie intake was 1,392 ± 417 cal/day, with 169.9 ± 50.9 g/day of carbohydrates, 53.8 ± 16.1 g/day of fat and 55.7 ± 16.9 g/day of protein. After administration there was a significant increased levels of transferrin. A total of 3 patients had an episode of diarrhea (9.7%). The number of patients experiencing at least one episode of gastric residue was 5 (16.1%) not forced in any way to withdrawing enteral nutrition, forcing in 2 patients to diminish the nutritional intake volume for 24 hours. During nutritional support, in only 3 patients it was required to decrease the volume made the previous day energy formula. With regard to vomiting, in 1 patient this situation (3.2%) was verified. No patient in the study presented any digestive complications associated with the administration of the enteral nutrition formula. Finally, no adverse events related to the administered formulation were recorded. Conclusions: The results show that enteral formula with high energy density is a well-tolerated formula with a very low frequency of gastrointestinal symptoms, which favors compliance (AU)

Spanish Catheter Ablation Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2014).

INTRODUCTION AND OBJECTIVES: This report presents the findings of the 2014 Spanish Catheter Ablation Registry. METHODS: For data collection, each center was allowed to choose freely between 2 systems: retrospective, requiring the completion of a standardized questionnaire, and prospective, involving reporting to a central database. RESULTS: Data were collected from 85 centers. A total of 12 871 ablation procedures were performed, for a mean of 149.5±103 procedures per center. The ablation targets most frequently treated were atrioventricular nodal reentrant tachycardia (n=3026; 23.5%), cavotricuspid isthmus (n=2833; 22.0%), and atrial fibrillation (n=2498; 19.4%). The number of ablation procedures for ventricular arrhythmias was similar to that of 2013, but there was a slight increase in the treatment of all the ventricular substrates, especially those associated with idiopathic ventricular tachycardia and scarring following myocardial infarction. The overall success rate was 95%, the rate of major complications was 1.3%, and the mortality rate was 0.02%. CONCLUSIONS: The 2014 registry shows that the number of ablation procedures performed continued its upward trend and that, overall, the success rate was high and the number of complications low. Ablation of complex conditions continued to increase.

Knowledge of and Attitudes Regarding Postoperative Pain among the Pediatric Cardiac Nursing Staff: An Indian Experience.

Pain following cardiac intervention in children is a common, but complex phenomenon. Identifying and reporting pain is the responsibility of the nursing staff, who are the primary caregivers and spend the most time with the patients. Inadequately managed pain in children may lead to multiple short- and long-term adverse effects. The aim of this cross-sectional study was to assess the knowledge and attitudes regarding postoperative pain in children among the nursing staff at B.M. Patel Cardiac Center, Karamsad, Anand, Gujarat, India. The study included 42 of the 45 nurses employed in the cardiac center. The nurses participating in the study were responsible for the care of the pediatric patients. A modified Knowledge and Attitudes Survey Regarding Pain and a sociodemographic questionnaire were administered after obtaining written informed consent. The study was approved by the institutional Human Research Ethics Committee. Mean (SD) experience in years of the nursing staff was 2.32 (1.69) years (range 1 month to 5 years). Of the nurses, 67% were posted in the cardiac surgical intensive care unit (ICU). The mean (SD) score for true/false questions was 11.48 (2.95; range 7,19). The average correct response rate of the true/false questions was 45.9%. Knowledge about pain was only affected by the ward in which the nurse was posted. In first (asymptomatic) and second (symptomatic) case scenarios, 78.6% and 59.5% underestimated pain, respectively. Knowledge and attitudes regarding pain and its management is poor among nurses. Targeted training sessions and repeated reinforcement sessions are essential for holistic patient care.

Changing trends of in vitro antimicrobial resistance patterns in blood isolates in a tertiary care hospital over a period of 4 years.

CONTEXT: Multidrug-resistant organisms continue to be a problem for clinicians worldwide. AIMS: To analyze the changing trend of antimicrobial susceptibility patterns in the blood isolates over a period of 4 years in our hospital. SETTINGS AND DESIGN: This is a retrospective study done in tertiary care cardiac institute over a period of 4 years. MATERIALS AND METHODS: We retrospectively analyzed blood culture positive isolates and studied the antimicrobial susceptibility patterns of microorganisms during the period starting from January 2007 to December 2010. STATISTICAL ANALYSIS USED: Statistical analysis was conducted using SPSS for windows version 13.0. Fisher exact test or chi-square test was applied for comparison of categorical variables. P values less than .05 were considered as statistically significant. RESULTS: The rate of blood culture positivity was 3.72%. Gram-negative bacteria were more common than Gram-positive bacteria. There was a gradual increase in Gram-negative bacteria especially Klebsiella pneumoniae and Acinetobacter species. Klebsiella pneumoniae showed a significant increase of resistance to cefoperazone sulbactam (P = .023), piperacillin tazobactam (P < 0.001), imipenem (P < 0.001), and meropenem (P < 0.001) between the first (2007-2008) and second period (2009-2010) of study. The carbapenems resistance is on rise in Gram-negative bacteria including Enterobacteriaceae and non-fermenters. CONCLUSIONS: Our findings suggest that there is a definite increase in the multidrug resistant organisms. The data on the changing trends in antibiotic resistance, we believe is an important pillar in our efforts at improving infection control practices.

Readmission and mortality in patients undergoing off-pump coronary artery bypass surgery with fast-track recovery protocol.

The development of less invasive methods for myocardial revascularization such as "off-pump" cardiac surgery, and new methods of anesthesia and postoperative care protocols such as "fast-track recovery" (FTRC), have contributed to a significant reduction in postoperative intensive care unit (ICU) and hospital length of stay after cardiac surgical procedures. The objectives of this study were to identify perioperative risk factors of prolonged hospital stay, hospital mortality, and readmission rates in off-pump coronary artery bypass surgery (CABG) patients undergoing the FTRC protocol. Eighty consecutive patients undergoing off-pump coronary artery bypass surgery with FTRC protocol were included in the study. For the first purpose of this protocol, early extubation is defined as removal of the endotracheal tube within 6 h of arrival at the surgical ICU. The second purpose was to obtain a minimal length of stay in the ICU (<24 h) and hospital discharge within 5 days. We analyzed the influence of the preoperative, intraoperative, and postoperative variables on prolonged hospital stay, hospital mortality, and hospital readmission. Three patients died during hospitalization, giving a hospital mortality rate of 3.75%. The causes of hospital death were massive stroke and sepsis. Using multivariate logistic regression analysis, hypertension (P = 0.0185), postoperative stroke (P = 0.0001), and sternal infection (P = 0.0007) were identified as independent predictors of hospital mortality. Mean hospital length of stay was 4.23 +/- 0.75 days. Univariate and multivariate logistic regression analysis revealed that postoperative blood use (P = 0.0095) was the major independent predictor of prolonged hospital stay. During the 30-day observation period, seven patients were readmitted. One of these patients died on postoperative day 45 from mediastinitis and sepsis. Multivariate logistic regression analysis identified age (P = 0.0033) and hypertension (P = 0.045) as independent predictors of hospital readmission. FTRC protocols can be performed safely in patients with off-pump CABG, and the mortality and readmission rates following this protocol were found to be within acceptable ranges.

Deaths due to absence of an affordable antitoxin for plant poisoning.

There is a severe shortage of affordable antivenoms and antitoxins in the developing world. An anti-digoxin antitoxin for oleander poisoning was introduced in Sri Lanka in July, 2001, but because of its cost, stocks ran out in July, 2002. We looked at the effect of its introduction and withdrawal on case fatality, and determined its cost-effectiveness. The antitoxin strikingly reduced the case fatality; its absence resulted in a three-fold rise in deaths. At the present price of US2650 dollars per course, every life saved cost 10209 dollars and every life year cost 248 dollars. Reduction of the antitoxin's price to 400 dollars would reduce costs to 1137 dollars per life gained; a further reduction to 103 dollars would save money for every life gained. Treatments for poisoning and envenoming should be included in the present campaign to increase availability of affordable treatments in the developing world.