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2.
Clin J Oncol Nurs ; 28(2): 173-180, 2024 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-38511913

RESUMEN

BACKGROUND: This study introduced Zentangle®, which involves drawing simple, repetitive lines and shapes to create patterns, as a tool to promote wellness for oncology nurses in a clinical practice setting. OBJECTIVES: The purpose of this study was to determine whether Zentangle used as a meditative activity in an acute time frame decreased stress, fatigue, and burnout while increasing professional quality of life and well-being in oncology nurses. METHODS: Twenty-six oncology nurses participated in a two-hour Zentangle class and received materials to complete art over four weeks. The Perceived Stress Scale, the Warwick-Edinburgh Mental Wellbeing Scale, the Patient-Reported Outcomes Measurement Information System-29, and the Professional Quality of Life measure were administered at selected periods. Twenty-four participants completed the study. FINDINGS: Nurses' well-being, socialization, anxiety, fatigue, secondary traumatic stress levels, and stress levels improved significantly. Most participants noted they would continue using Zentangle after the study. Zentangle is another tool to advance nurses' wellness by encouraging self-care.


Asunto(s)
Agotamiento Profesional , Desgaste por Empatía , Atención Plena , Enfermeras y Enfermeros , Pruebas Psicológicas , Autoinforme , Humanos , Proyectos Piloto , Calidad de Vida , Satisfacción en el Trabajo , Enfermería Oncológica , Agotamiento Profesional/prevención & control , Desgaste por Empatía/prevención & control , Encuestas y Cuestionarios
3.
Gastroenterol Nurs ; 46(1): 23-29, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36706139

RESUMEN

Bowel prep for inpatient cases are for the most part inadequate. Gastroenterology nurses are ideally situated to recognize the importance of bowel preparation for patients who require a colonoscopy. Unique challenges exist for inpatients who require a colonoscopy preparation as part of their hospitalization. We identified that inpatients scheduled for colonoscopies during their hospitalization were not appropriately prepped, leading to unsuccessful and repeat procedures. We conducted this research study to determine whether an educational intervention would optimize inpatients, bowel preparation and improve the quality of bowel preparation, patient satisfaction, and understanding of bowel preparation. Three months prior to an educational intervention, inpatients who required a colonoscopy completed surveys about their colonoscopy preparation. Then, educational in-services on how to administer bowel preparation were presented to multidisciplinary staff, which included 70% of all registered nurses (RNs). Following the education phase, 40 inpatients were surveyed. We found that patients' perception of education differed if they verbalized a past experience and the highest prep scores were obtained in patients educated by a physician and RN. Our results indicated that an educational intervention targeting inpatient staff improved patient satisfaction, decreased aborted colonoscopies by 22%, and increased Boston Bowel Preparation Scale utilization in 100% of cases. Educating inpatient providers on the necessary preparation protocol improved inpatient care outcomes by decreasing the amount of incomplete and repeat inpatient colonoscopies and therefore may reduce healthcare costs.


Asunto(s)
Catárticos , Colonoscopía , Humanos , Colonoscopía/métodos , Hospitalización , Pacientes Internos , Cuidados Preoperatorios/métodos
4.
J Pediatr Nurs ; 68: 18-23, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36328915

RESUMEN

PURPOSE: To describe existing guidance for qualifications of principal investigator s (PI s) of human subjects research and explore how they are operationalized for pediatric nurse scientists and clinical nurses in children's hospitals. DESIGN AND METHODS: After reviewing federal regulations, accreditation guidelines, and the literature, a convenience sample of members of the National Pediatric Nurse Scientist Collaborative (NPNSC). Participants completed a 33-item survey that included questions about Institutional Review Board (IRB), guidelines, and policies for PI status at their affiliated children's hospitals. RESULTS: The survey was electronically disseminated to 179 members of NPNSC through the Collaborative's listserv. Of the 39 members who responded, 90% hold a PhD and 80% practice in a free-standing children's hospital, nearly all of which (93%) are recognized as Magnet® hospitals. While the majority of respondents indicated that nurse scientists and other nurses were allowed to be PIs of research studies, educational requirements for PI status varied, with 3% requiring a PhD, 15% a baccalaureate degree, and 10% a graduate degree. 54% of respondents reported there was no degree requirement for PI status; however15% reported that even doctorally prepared nurse scientists cannot serve as PIs of research studies at their affiliated children''s hospitals. CONCLUSIONS: The survey identified substantial variability in requirements for PI status and potential barriers to pediatric nurses conducting independent research as PIs at children's hospitals. PRACTICE IMPLICATIONS: Operationalizing existing guidance will expand inclusion of nurse scientist expertise in human subjects research.


Asunto(s)
Enfermeras Pediátricas , Investigadores , Niño , Humanos , Encuestas y Cuestionarios , Escolaridad , Enfermería Pediátrica
5.
Am J Nurs ; 122(3): 57-62, 2022 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-35200192

RESUMEN

This article is part of a series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to https://links.lww.com/AJN/A133). This follow-up series features exemplar success stories, in which authors describe how initiatives using an implementation framework or evidence-based strategy resulted in a successful practice or program change. Column coordinators Sharon J. Tucker and Lynn Gallagher-Ford alternate in providing commentary at the end.


Asunto(s)
Práctica Clínica Basada en la Evidencia , Liderazgo , Humanos
6.
J Clin Nurs ; 31(3-4): 454-463, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33179360

RESUMEN

AIM AND OBJECTIVES: To explore and understand the current practice, perceptions, and knowledge of general surgery trainees, advanced practice providers, and surgical nurses regarding opioid prescribing and administration. To this end, a novel opioid education and training was introduced to educate these practitioners on safe opioid practices in surgical patients. BACKGROUND: National awareness of the opioid epidemic has increased significantly in the last several years. However, there remain a disturbingly high number of opioid prescriptions written in the US indicating a need for improved provider and nurse education. This involves increasing awareness and understanding of national guidelines as well as implementing multi-modal therapy to treat pain. DESIGN: Pre-post-intervention quality improvement project. METHODS: An opioid education and training involving a morphine equivalent daily dosing calculator in the electronic medical record was provided to 26 surgical trainees, eight advanced practice providers and 97 surgical nurses in November 2019. Perceptions, current practice and knowledge were measured using a pre- and post-intervention survey (SQUIRE checklist). RESULTS: The survey results showed a positive clinical change in perception of opioid use in surgical patients following the intervention and a modest decrease in the average morphine equivalent daily dosing at discharge in general and transplant surgery patients. CONCLUSIONS: Effective pain management for surgical patients must be individualised. Safe opioid prescribing should involve an interdisciplinary approach with all members of the team undergoing assessment of their opioid knowledge and prescribing habits, easily accessible training tools and opioid calculators in the electronic medical record. RELEVANCE TO CLINICAL PRACTICE: Our initiative may provide useful information to settings that replicate use of a morphine equivalent daily dosing calculator in the electronic medical record. Utilisation of safe opioid prescribing tools in the electronic medical record and continuing education for providers and nurses can help ensure the safety of surgical patients.


Asunto(s)
Analgésicos Opioides , Trastornos Relacionados con Opioides , Centros Médicos Académicos , Analgésicos Opioides/uso terapéutico , Prescripciones de Medicamentos , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina
7.
J Clin Nurs ; 31(3-4): 435-444, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33326657

RESUMEN

AIMS: The aims of the study were to compare characteristics, resources, benefits and outcomes of academic-clinical collaborations of nursing researcher leaders from academic, clinical and joint-employer sites. BACKGROUND: Few research-based publications addressed academic-clinical research collaborations. New knowledge could increase nursing and multidisciplinary research productivity, including implementation science. DESIGN: An anonymous survey using a 40-item questionnaire. METHODS: Information letters with a link to the questionnaire were emailed to United States nursing research leaders. Data were grouped by institution type: academic, clinical or joint-employer. Analyses included Kruskal-Wallis tests for ordered responses, Pearson's chi-square test or Fisher's exact test for categorical responses and Cohen's Kappa agreement statistic for expected and actual time devoted to research. STROBE guidelines were followed. RESULTS: Of 120 respondents from academic (n = 60; 50.0%), clinical (n = 53; 41.2%) and joint-employer (n = 7; 5.8%) sites, 78.3%, 92.3% and 100%, respectively, were from metropolitan areas. Mean (SD) priority for active collaborations was higher at joint-employer sites; p = .002. Clinical sites were more likely to have directors of evidence-based practice (p = .031) and informatics (p = .008) and librarians (p = .029). Sites with collaborations were more likely to have access to research subjects (p = .008) and post-award research account management (p = .045). By collaboration status, there were no differences in the number of ethics board-approved studies. Collaborating site benefits were perceived to be executive leadership support (p = .003), greater research engagement by clinical nurses (p = .048), more co-authored publications (p = .048) and more abstracts accepted at national meetings (p = .044). Despite more resources and perceived benefits, outcomes did not differ by collaboration status. CONCLUSIONS: Sites with and without academic-clinical research collaborations differed; however, outcomes were similar. Future efforts should focus on nurse scientist collaboration to address important clinical questions aimed at improving clinical outcomes. RELEVANCE TO CLINICAL PRACTICE: Despite some successful outcomes, potential benefits of academic-clinical research collaborations have not been fully actualised.


Asunto(s)
Liderazgo , Investigación en Enfermería , Estudios Transversales , Humanos , Estados Unidos
8.
J Prof Nurs ; 37(2): 399-403, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33867097

RESUMEN

A unique nursing faculty mentoring process within a large academic medical center, and led by the College of Nursing (CON), Center for Clinical Research and Scholarship, provides faculty with the resources needed to collaborate with clinical nursing staff and multidisciplinary project teams who want to engage in clinical evidence based practice, quality improvement, and research projects. Guidelines for mentoring clinical staff allow CON faculty mentors work with clinical staff to enhance their own professional growth and leadership activities and improve clinical outcomes, as well as to increase faculty scholarship activities.


Asunto(s)
Tutoría , Práctica Clínica Basada en la Evidencia , Docentes de Enfermería , Humanos , Mentores , Rol de la Enfermera
9.
Holist Nurs Pract ; 35(1): 10-18, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32282563

RESUMEN

Burnout decreases work performance and quality of care and can result in medical errors, lower patient satisfaction, and higher rates of turnover. A study of 68 000 registered nurses showed that 35% of hospital nurses were experiencing symptoms of burnout. A systematic review identified that mindfulness-based interventions for health care professionals reduced stress and burnout and increased self-compassion and general health. However, the authors determined that more high-quality research is needed. This study examined the impact of a 4-hour workshop on burnout syndrome, perceived stress, and mindfulness skills. The objective of this study was to determine whether a 4-hour mindfulness workshop was effective in reducing burnout and perceived levels of stress and increasing mindfulness. Nurses at a Midwest academic medical center were recruited through e-mail to attend a 4-hour mindfulness workshop. Participants completed the Maslach Burnout Inventory-Human Service Survey, Perceived Stress Scale, and Cognitive and Affective Mindfulness Scale-Revised prior to the start of the workshop and 1 and 6 months after the workshop. The study design allowed for comparisons preintervention and postintervention. Of the 52 nurses who completed the baseline questionnaires, 94% were female with an average age of 38 years. Thirty-one percent completed the questionnaires at 1 month and 20 nurses at 6 months. At 1 month, nurses reported statistically significant decreased perceptions of stress (-2.31, P = .01) and emotional exhaustion (-4.78, P = .03). Mindfulness skills, personal accomplishment, and depersonalization improved but were not statistically significant. At 6 months, statistically significant findings included increased perceptions of mindfulness (2.50, P = .04), personal accomplishment (4.43, P = .04), and decreased emotional exhaustion (-6.21, P = .05). Perceptions of stress and depersonalization improved but were not statistically significant. In this study, nurses reported decreases in burnout and perceived stress and increases in mindfulness after attending a 4-hour mindfulness workshop. Further research is needed to determine the long-term impact of mindfulness-based training on nurses' burnout, stress, and mindfulness skills. The results of this study add to the body of literature that supports the benefits of mindfulness-based interventions.


Asunto(s)
Agotamiento Profesional/terapia , Educación/normas , Atención Plena/métodos , Enfermeras y Enfermeros/psicología , Estrés Laboral/terapia , Adulto , Agotamiento Profesional/prevención & control , Agotamiento Profesional/psicología , Educación/métodos , Educación/estadística & datos numéricos , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Atención Plena/normas , Atención Plena/tendencias , Enfermeras y Enfermeros/estadística & datos numéricos , Estrés Laboral/psicología , Encuestas y Cuestionarios
10.
J Interprof Care ; 34(5): 716-718, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32935613

RESUMEN

The response to a pandemic crisis requires strong preparedness and an action plan that is well defined yet flexible enough to address the uncertainties that accompany an infectious disease outbreak. Interprofessional collaboration is an integral component when implementing a robust and comprehensive response to such a crisis. As the needs of our academic medical center evolved during the COVID-19 pandemic, the COVID-19 Mobilizer Team used an interprofessional approach to respond to the diverse and complex needs of the organization. Team members included employees deployed from diverse departments such as Physical and Occupational Therapy, Nursing Education, Hospital Operations, and Advance Practice Providers. The team's function transitioned from ensuring compliance with infection control policy and procedure and use of personal protective equipment to ensuring a two way channel of communication between front line staff and the Hospital Incident Command System (HICS) concerning testing and isolation procedures, supplies, visitor restrictions, and staff wellness issues. The Mobilizer Team members became integral contributors to the HICS and provided members of our staff outside of the COVID-19 care units an opportunity to partner with colleagues from professions they may have never worked with and the chance to contribute to the COVID-19 pandemic response.


Asunto(s)
Conducta Cooperativa , Infecciones por Coronavirus , Relaciones Interprofesionales , Pandemias , Grupo de Atención al Paciente , Neumonía Viral , Centros Médicos Académicos , Betacoronavirus , COVID-19 , Difusión de Innovaciones , Eficiencia Organizacional , Humanos , Liderazgo , Equipo de Protección Personal , SARS-CoV-2
11.
Nurs Outlook ; 68(5): 626-636, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32739096

RESUMEN

BACKGROUND: High-value healthcare focuses on improving healthcare to produce cost effective care, however limited information on the role of advanced practice registered nurses (APRNs) exists. PURPOSE: This descriptive report describes APRN-led initiatives implemented as part of a national collaborative promoting the Choosing Wisely® campaign and high-value care measures. METHOD: An APRN national collaborative focuses on developing and implementing high-value care initiatives. Monthly calls, podcasts, and a file sharing platform are used to facilitate the work of the national collaborative. FINDINGS: A total of 16 APRN teams from 14 states are participating and have implemented a number of initiatives to reduce unnecessary testing and treatments, promote appropriate antibiotic use, and promote optimal clinical practices such as mobility for hospitalized elderly patients, among others. DISCUSSION: A national collaborative has proven to be a successful way to engage APRN teams to focus on targeting high-value care and promoting evidence-based practices in clinical care.


Asunto(s)
Enfermería de Práctica Avanzada , Difusión de Innovaciones , Reforma de la Atención de Salud , Rol de la Enfermera , Anciano , Atención a la Salud , Humanos
12.
J Nurs Adm ; 49(5): 234-241, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31008833

RESUMEN

Academic-clinical research partnerships can benefit academic and clinical partners when goals are clearly articulated and mutually determined and include increased research dissemination and lower research costs. This article explores the history of academic-clinical research partnerships and discusses the drivers of collaborative academic-clinical research relationships, resources from academia and clinical sites, and sustainability of collaborative partnerships. Through collaboration, academic-clinical partners can improve clinical outcomes and reduce healthcare costs.


Asunto(s)
Centros Médicos Académicos/organización & administración , Conducta Cooperativa , Relaciones Interinstitucionales , Investigación Metodológica en Enfermería/organización & administración , Humanos , Proyectos de Investigación , Estados Unidos
13.
J Pediatr Nurs ; 41: 131-134, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29754749

RESUMEN

PURPOSE: Accurate body temperature measurement is essential in providing timely care to critically ill patients. Current practice within the Pediatric ICU (PICU) at a Midwestern academic medical center is to obtain axillary temperatures in endotracheally intubated patients. According to research, axillary temperatures have greater variance than other forms of temperature measurement. Research in adult patients show that oral temperature measurement in endotracheally intubated patients is acceptable as the heated gases from the ventilator has no significant effect on measured temperatures. This study sought to determine if the same is true in pediatrics. DESIGN AND METHODS: Oral and axillary temperatures of endotracheally intubated pediatric patients were obtained during unit prescribed vital assessment intervals. Patients were divided into neonate, infant, and children age groups with 25 sets of temperatures obtained for each group. Descriptive statistics and Bland-Altman plot interpretation were performed to determine confidence intervals for each age group. RESULTS: Bland-Altman plot analysis of oral and axillary routes of temperature measurement showed a high positive correlation within all age groups studied. The infant age group showed lower correlation in comparison to neonates and children. The infant age group also had an outlier of data sets with lower oral temperatures as compared to the axilla. CONCLUSIONS: Oral temperature measurement is a viable alternative to axillary temperature measurement in endotracheally intubated pediatric patients. Correction factors for age groups were calculated for prediction of axillary temperature based on measured oral temperature. PRACTICAL IMPLICATIONS: This study serves as evidence for practice change within the studied unit.

14.
Catheter Cardiovasc Interv ; 87(3): E97-103, 2016 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-26152363

RESUMEN

OBJECTIVE: Distortion of transcatheter heart valve (THV) stent shape and morphology has been shown to impact on THV function. This study sought to evaluate the relationship between geometrical CT follow-up data and consequent valve function in patients undergoing transcatheter pulmonary valve replacement with the Edwards SAPIEN THV. METHODS: All patients were enrolled in the COMPASSION trial. Multidetector computed tomography (MDCT) was performed as part of the study protocol at 6 months and yearly thereafter following valve implantation. Prosthesis eccentricity indices, circularity ratios, and expansion ratios (ER) were calculated. Valve function and reintervention rates were correlated with MDCT findings. RESULTS: Twenty consecutive patients undergoing 58 CT scans were included. Maximum Doppler gradients across the right ventricular outflow tract (RVOT) were significantly reduced following valve implantation (P < 0.001). Geometrical indices and maximum RVOT gradients were compared between the reintervention group (n = 4) and the nonreintervention group (n = 16). Although there was no difference in eccentricity index between the groups, ER [6 months: 90 +/- 12% vs. 69 ± 9%; P = 0.014; at 12 months: 89 ± 14 vs. 69 ± 10%; P = 0.018; at 24 months: 87 ± 14% vs. 70 ± 11%; P = 0.056] and valve area [6 months: 3.98 ± 0.54 vs. 2.86 ± 0.38 P = 0.005; at 12 months: 3.93 ± 0.56 vs. 2.86 ± 0.39 P = 0.006; 24 months: 3.78 ± 0.50 vs. 2.90 ± 0.45 P = 0.019] were lower in the reintervention group compared with the nonreintervention group at all time periods. CONCLUSION: Geometrical THV measurements as assessed by CT may predict the need for reintervention in patients undergoing transcatheter pulmonary valve replacement with the SAPIEN valve. Valve symmetry is maintained, however under-expansion and smaller valve area are strongly associated with the need for reintervention.


Asunto(s)
Cateterismo Cardíaco/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Tomografía Computarizada Multidetector , Estenosis de la Válvula Pulmonar/terapia , Válvula Pulmonar/diagnóstico por imagen , Stents , Adolescente , Adulto , Anciano , Cateterismo Cardíaco/efectos adversos , Niño , Ensayos Clínicos como Asunto , Ecocardiografía Doppler , Estudios de Factibilidad , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Diseño de Prótesis , Válvula Pulmonar/fisiopatología , Estenosis de la Válvula Pulmonar/diagnóstico por imagen , Estenosis de la Válvula Pulmonar/fisiopatología , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
15.
Heart Lung ; 44(3): 230-7, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25766042

RESUMEN

Evidence suggests that family presence as an option during invasive procedures may provide a comforting presence to the patient and may not be notable disruptive to the health care team. Little research has explored family presence during cardiac procedures. This is the first documented report of family presence in the congenital cardiac catheterization lab (CCCL). The purpose of this article is to review the course for implementing a family presence program in the CCCL. The Iowa Model of Evidence-Based practice guided this process which included the development of a written policy of family presence in the CCCL at two academic medical centers. Successful family presence in the catheterization lab must include: written guidelines, involvement of all staff, family presence offered as an option, and preparation of the patient and family for the catheterization experience as well as emergency procedures.


Asunto(s)
Cateterismo Cardíaco/métodos , Familia , Cardiopatías Congénitas/diagnóstico , Humanos , Grupo de Atención al Paciente , Desarrollo de Programa
16.
Pediatr Cardiol ; 36(1): 76-83, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25070389

RESUMEN

High-quality live imaging assessment of cardiac valves and cardiac anatomy is crucial for the success of catheter-based procedures. We present our experience using Intracardiac echocardiography (ICE) during transcatheter Percutaneous Pulmonary Valve replacement (tPVR).This is a retrospective study that included 35 patients who underwent tPVR between April 2008 and June 2012. Thirty-one of these patients had the procedure performed under continuous ICE guidance. Pre-procedure transthoracic echocardiography (TTE) was obtained in all patients. ICE was performed at baseline, during the procedure, and at the conclusion of the procedure. Comparisons between the pre-procedure TTE and baseline ICE data and between post-procedure ICE data and the following day TTE were performed. Total of 35 patients had tPVR during the above-mentioned time period. Twenty-one patients received the Edwards Sapien valve and 14 patients had the Melody valve. Thirty-one patients had the procedure performed under continuous ICE guidance. The mean Pre-TTE peak gradient (PG) and Pre-ICE-PG were 45.5 ± 20 vs 33 ± 13 mmHg (p < 0.001) and the mean Pre-TTE mean gradient (MG) and Pre-ICE-MG were 27.7 ± 13 vs 21 ± 18 mmHg (p < 0.001). The mean Post-TTE- PG and Post-ICE-PG were 24.3 ± 11 vs 15.3 ± 7 mmHg (p < 0.001) and the mean of the Post-TTE-MG and Post-ICE-MG were 14.2 ± 7 vs 8.4 ± 4 mmHg (p < 0.001). There was a good correlation between peak ICE and TTE gradient at baseline and after valve placement. For the degree of pulmonary regurgitation, there was no significant difference between TTE and ICE. ICE is an important modality to guide tPVR in patients with dysfunctional homograft valve between the right ventricle and pulmonary artery and should be used to assess valve function before, during and immediately after the procedure.


Asunto(s)
Cateterismo Cardíaco , Ecocardiografía Doppler , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Pulmonar/cirugía , Válvula Pulmonar/cirugía , Ultrasonografía Intervencional , Ecocardiografía , Femenino , Humanos , Masculino , Diseño de Prótesis , Válvula Pulmonar/diagnóstico por imagen , Insuficiencia de la Válvula Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , Stents , Resultado del Tratamiento , Adulto Joven
17.
Catheter Cardiovasc Interv ; 82(4): E535-41, 2013 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-23008193

RESUMEN

BACKGROUND: Two transcatheter pulmonary valve replacement (tPVR) systems (Edwards SAPIEN and Medtronic Melody) are available; however, comparative studies evaluating outcome data are lacking. The aim of this study was to compare short- with medium-term outcome data of these valves in the pulmonary position from a single institution. METHODS: Retrospective data analysis of all patients undergoing tPVR from April 2008 until April 2012. Pre-procedural investigations, patient demographics, procedural hemodynamics, and clinical and echocardiographic follow-up data were included. Data are presented as mean ± standard deviation. RESULTS: Thirty-three patients underwent successful tPVR (SAPIEN (S) n = 20, Melody (M) n = 13). Patient age and weight were similar between the two groups. Primary indication included regurgitation (S (n = 2), M (n = 3)), stenosis (S (n = 13), M (n = 7)), or mixed (S (n = 5), M (n = 3)). There was no difference in pre-procedural peak Doppler gradients across the pulmonary outflow (S = 47.73 ± 21.14 mm Hg, M = 42.62 ± 15.59 mm Hg, P = 0.46). All but one patient underwent pre-stenting prior to valve implantation. Immediately following valve deployment, the transvalvar gradient was not statistically different between the two groups (S = 11.5 ± 8.07 mm Hg, M = 8.15 ± 4.56 mm Hg, P = 0.18). There were no procedural deaths. Follow-up mean pulmonary Doppler gradients were higher with the SAPIEN cohort (18.43 ± 9.06 mm Hg (S) and 11.17 ± 5.24 mm Hg (M), P = 0.016); however, no differences were seen when similar procedural epochs were assessed. All but one patient remained with PR grade = 2. CONCLUSIONS: In a single-center series, the SAPIEN and Melody valves demonstrated comparable medium-term valve function. Greater residual gradients with the SAPIEN valve may represent a more conservative early pre-stenting approach with this valve.


Asunto(s)
Cateterismo Cardíaco/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Pulmonar/terapia , Estenosis de la Válvula Pulmonar/terapia , Válvula Pulmonar , Adolescente , Adulto , Chicago , Niño , Ecocardiografía Doppler , Femenino , Implantación de Prótesis de Válvulas Cardíacas/métodos , Hemodinámica , Humanos , Masculino , Diseño de Prótesis , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/fisiopatología , Insuficiencia de la Válvula Pulmonar/diagnóstico , Insuficiencia de la Válvula Pulmonar/fisiopatología , Estenosis de la Válvula Pulmonar/diagnóstico , Estenosis de la Válvula Pulmonar/fisiopatología , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
18.
J Am Coll Cardiol ; 58(21): 2248-56, 2011 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-22078433

RESUMEN

OBJECTIVES: The purpose of this study was to evaluate the safety and effectiveness of the Edwards SAPIEN transcatheter heart valve (Edwards Lifesciences LLC, Irvine, California) in the pulmonary position in patients with moderate to severe pulmonary regurgitation with or without stenosis. BACKGROUND: Transcatheter pulmonary valve replacement is evolving, but to date, experience has been limited to the Melody valve (Medtronic Inc., Minneapolis, Minnesota). METHODS: Eligible patients with dysfunctional right ventricle-to-pulmonary artery conduits were screened if body weight was ≥35 kg and the in situ conduit diameter was ≥16 mm and ≤24 mm. Standardized implantation and follow-up protocols were used. RESULTS: Thirty-six patients from 4 centers were recruited between April 2008 and May 2010. Mean body weight was 73.4 ± 22.9 kg. Successful valve deployment was achieved in 33 of 34 attempts (97.1%). Valve migration occurred in 3 patients, with 2 requiring surgical retrieval; however, 1 patient underwent successful perventricular valve implantation. Further intraprocedure complications included pulmonary hemorrhage (n = 2), ventricular fibrillation (n = 1), and stent migration (n = 1). Pullback gradient across the conduit decreased from 26.8 ± 18.4 mm Hg to 11.7 ± 8.0 mm Hg (p < 0.001). The right ventricular/aortic pressure ratio decreased from 0.6 ± 0.2 to 0.4 ± 0.1 (p < 0.001). Peak Doppler gradient across the right ventricular outflow tract decreased from 41.9 ± 27.9 mm Hg to 19.1 ± 13.3 mm Hg (p < 0.001). At 6-month follow-up, all patients were alive. The number of patients with New York Heart Association functional class I increased from 5 at baseline to 27 at follow-up. Pulmonary regurgitation was ≤2+ in 97% of patients. Freedom from reintervention was 97% with 1 patient undergoing elective placement of a second valve due to conduit-induced distortion of the initial implant. CONCLUSIONS: Transcatheter pulmonary valve replacement using the Edwards SAPIEN transcatheter heart valve is safe and effective in patients with dysfunctional right ventricle-to-pulmonary artery conduits.


Asunto(s)
Bioprótesis , Cateterismo Cardíaco/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Insuficiencia de la Válvula Pulmonar/cirugía , Válvula Pulmonar/cirugía , Obstrucción del Flujo Ventricular Externo/cirugía , Adulto , Ecocardiografía Doppler , Femenino , Estudios de Seguimiento , Humanos , Masculino , Válvula Pulmonar/diagnóstico por imagen , Insuficiencia de la Válvula Pulmonar/diagnóstico por imagen , Reoperación , Insuficiencia del Tratamiento , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/etiología
19.
Catheter Cardiovasc Interv ; 77(5): 664-70, 2011 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-21433271

RESUMEN

INTRODUCTION: Obstruction to flow in the left pulmonary artery (LPA) is a well-known complication after transcatheter device closure of patent ductus arteriosus (PDA). This complication has been studied for different devices using lung perfusion radionuclide scintigraphy (LPRS), but not for Amplatzer devices. This study was performed to evaluate the effect of such devices on lung perfusion using LPRS. METHODS: This is a retrospective study that looked at all patients who had PDA closure using different Amplatzer devices at our center between July 1999 and January 2007. All patients underwent LPRS within 24 hr of the procedure. We compared LPRS with other hemodynamic data obtained by cardiac catheterization and echocardiography. Results are presented as mean ± SD or median and ranges. RESULTS: A total of 70 patients had PDA closure using an Amplatzer device; median age was 1.8 years (4 months to 75 years) and median weight was 12 kg (5-112 Kg). Nine patients had associated cardiac anomalies. Sixty eight patients had available LPRS. The mean percent of left lung perfusion (LLP) was 42.7% (± 6.7%). Excluding patients with pre-existing LPA stenosis, 17% had abnormally decreased LLP. On hemodynamic measurements, 62 patients had available direct pressure measurements following PDA closure. None had significant increase. No correlation was found with echocardiographic data. CONCLUSION: PDA closure with Amplatzer family of devices is associated with a relatively significant risk of decreased perfusion to the left lung, mostly mild abnormalities. Comparison with catheterization and echocardiographic measurements showed lack of correlation with LPRS findings.


Asunto(s)
Cateterismo Cardíaco/instrumentación , Conducto Arterioso Permeable/terapia , Pulmón/irrigación sanguínea , Imagen de Perfusión , Arteria Pulmonar/fisiopatología , Circulación Pulmonar , Dispositivo Oclusor Septal , Adolescente , Adulto , Anciano , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Cateterismo Cardíaco/efectos adversos , Chicago , Niño , Preescolar , Conducto Arterioso Permeable/fisiopatología , Ecocardiografía Doppler , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Arteria Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , Resultado del Tratamiento
20.
J Nurses Staff Dev ; 22(6): 296-9, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17149046

RESUMEN

Preparing nurses to incorporate research and evidence-based findings into nursing practice is important to meet the needs of patients and their families in today's healthcare arena. This article highlights the use of a mock trial as an innovative approach to educating staff nurses on evidence-based practice and identifies future implications for educating staff nurses on incorporating evidence into nursing practice.


Asunto(s)
Educación Continua en Enfermería/organización & administración , Medicina Basada en la Evidencia/educación , Investigación en Enfermería/educación , Personal de Enfermería en Hospital/educación , Desempeño de Papel , Actitud del Personal de Salud , Reanimación Cardiopulmonar/psicología , Chicago , Creatividad , Familia/psicología , Conocimientos, Actitudes y Práctica en Salud , Hospitales Universitarios , Humanos , Personal de Enfermería en Hospital/psicología , Habitaciones de Pacientes , Enseñanza/organización & administración , Visitas a Pacientes/psicología
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