RESUMO
A retrospective cohort study was performed of the Hospital-to-Home (H2H) program, a rapid clinic follow-up program for patients with recent heart failure (HF) admissions at the University of Virginia Health System. There were 6761 hospitalizations among 4685 patients (age 67.5 ± 14.2 years, 43.9% female), and 759 had H2H follow-up. Thirty day mortality after the initial HF hospitalization was lower in H2H patients (1.84% vs 3.13%; P = .049), and this difference remained significant after adjustment in a multivariable logistic regression model (odds ratio = 0.56 [95% CI = 0.31-099]; P = .046). There also was a 24% reduction in readmission days within the first 30 days after the index admission ( P < .0001), and readmission cost savings were found to be greater than the costs of staffing the H2H clinic. In summary, the H2H program is cost-effective, with significant improvements in survival, readmission days, and readmission costs over 30 days.
Assuntos
Insuficiência Cardíaca/economia , Insuficiência Cardíaca/terapia , Alta do Paciente/economia , Readmissão do Paciente/economia , Idoso , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores de RiscoRESUMO
Listening for the hidden questions of patients and families.
Assuntos
Estado Terminal/enfermagem , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem Hospitalar , Relações Profissional-Família , HumanosRESUMO
Marfan Syndrome (MFS) is an autosomal dominant, connective tissue disorder that is due to a deficiency in the structural protein, fibrillin. MFS patients are more likely to experience aortic aneurysms and dissections, dislocated lens, and/or severe musculoskeletal deformities than non-MFS patients. Attainment of a longer lifespan in MFS patients is directly dependent on vigilant blood pressure (BP) control, frequent cardiology surveillance, annual eye exams and frequent dental hygiene visits. This study evaluated the effect of a Marfan Syndrome Teaching algorithm (MFSTA) on 20 MFS patients, with regard to BP management, cardiovascular medication adherence; adherence to activity restrictions; and attendance at scheduled eye, cardiology and dental exams. This study demonstrated adherence improvement in the attendance at scheduled cardiology, ophthalmology, and dental exams from 50%, 55% and 70% prior to the study, respectively, to 95%, 90% and 100% post study. Furthermore, subject adherence with self-administration of ordered cardiovascular medications increased from 50% (pre-study) to 93.3% (93.3%), and subject adherence with activity restrictions escalated from 70% (pre-study) to 95% (post study). All subjects demonstrated proficiency in regular testing and recording of their blood pressure. There was no significant change in the mean systolic BP (SBP) for 13 of the subjects who had both pre- and post-intervention BP recording, although the post intervention SBP was slightly higher (p = 0.30). However all subjects in the intervention period demonstrated a mean SBP of 124.7 mm Hg, with standard deviation (SD) of 12.9 mm Hg. Limited pre-intervention BP readings of 7 subjects prevented a pre- and post-SBP comparison. The MFSTA model should be considered for other patient populations involving chronic cardiovascular healthcare conditions.
Assuntos
Algoritmos , Doenças Cardiovasculares/enfermagem , Cárie Dentária/enfermagem , Síndrome de Marfan/enfermagem , Ensino , Seleção Visual/enfermagem , Adolescente , Determinação da Pressão Arterial/enfermagem , Doenças Cardiovasculares/prevenção & controle , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Adesão à Medicação , Cooperação do Paciente , Projetos PilotoAssuntos
Insuficiência Cardíaca/terapia , Liderança , Enfermagem/métodos , Guias de Prática Clínica como Assunto , Sociedades Médicas , Sociedades de Enfermagem , Comportamento Cooperativo , Insuficiência Cardíaca/epidemiologia , Humanos , Enfermagem/normas , Defesa do Paciente/normas , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Sociedades de Enfermagem/normas , Estados UnidosAssuntos
Educação de Pós-Graduação em Enfermagem/normas , Insuficiência Cardíaca/enfermagem , Liderança , Modelos de Enfermagem , Pesquisa em Enfermagem/organização & administração , Guias de Prática Clínica como Assunto , Competência Profissional , Hospitais Universitários , Humanos , Enfermeiros Clínicos/organização & administração , Profissionais de Enfermagem/organização & administração , Papel do Profissional de Enfermagem , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto , Autonomia ProfissionalAssuntos
Derivação Gástrica , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Adulto , Índice de Massa Corporal , Cateterismo Cardíaco , Cardiomiopatia Dilatada/etiologia , Ecocardiografia , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Obesidade Mórbida/diagnóstico , Seleção de Pacientes , Fatores de Risco , Resultado do TratamentoRESUMO
The ACNP service in this study decreased the TA, TC, and LOS for patients transferred from outlying hospitals for cardiac catheterization or PCI. Patients on the ACNP service were provided prescription for appropriate discharge medications including beta-blockers, aspirin, ACE inhibitors, and lipid-lowering agents more often than patients on the housestaff service. Other aspects of care, including follow-up appointments and elements of patient education, were documented more often for patients on the ACNP interventional cardiac service and expand the role of ACNPs into other areas of acute-care cardiology practice.
Assuntos
Angioplastia Coronária com Balão/enfermagem , Cateterismo Cardíaco/enfermagem , Profissionais de Enfermagem/organização & administração , Papel do Profissional de Enfermagem , Comportamento Cooperativo , Análise Custo-Benefício , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pesquisa em Avaliação de Enfermagem , Avaliação de Resultados em Cuidados de Saúde , Admissão do Paciente , Alta do Paciente/normas , Educação de Pacientes como Assunto/normas , Seleção de Pacientes , Relações Médico-Enfermeiro , Autonomia Profissional , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de TempoRESUMO
INTRODUCTION: Some patients with ICDs experience the sensation of a shock in the absence of true therapy (phantom shock). We hypothesize that phantom shocks may be a manifestation of anxiety, depression or PTSD. METHODS AND RESULTS: All patients over 18 years old with an ICD were eligible to enroll in the study. The first 75 subjects who agreed to participate were enrolled and divided into three groups: ICD patients with phantom shocks (n = 19); ICD patients who had actual shocks (n = 28) and ICD patients who had no shocks (n = 28). During a clinic visit a demographic questionnaire and three psychological rating scales were administered: the Spielberger State-Trait Anxiety Inventory (STAI); the Center for Epidemiologic Studies Depression Scale (CES-D) and the Posttraumatic Stress Checklist (PCL-C). No significant differences between groups were found in gender, race, age, history of MI or cardiac surgery status. Data analysis of the psychological indices using one-way ANOVA showed that the group with phantom shocks had more depression (CES-D p = 0.011) and more anxiety (STAI p = 0.010) than the other groups. Multiple comparisons of group means showed a greater percentage of clinically depressed patients in the phantom shock group than in the other groups. CONCLUSION: Patients with phantom shocks are more likely to be clinically depressed and have higher levels of anxiety than other ICD patients, regardless of history of actual shocks.
Assuntos
Ansiedade/epidemiologia , Ansiedade/psicologia , Desfibriladores Implantáveis/psicologia , Desfibriladores Implantáveis/estatística & dados numéricos , Eletrochoque/psicologia , Eletrochoque/estatística & dados numéricos , Transtornos Psicofisiológicos/epidemiologia , Transtornos Psicofisiológicos/psicologia , Idoso , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco/métodos , Fatores de Risco , Virginia/epidemiologiaRESUMO
Chest pain is one of the most common presenting symptoms in healthcare settings and one of the most difficult diagnostic challenges. A comprehensive history is the cornerstone of evaluation and diagnosis and one of the most important skills in distinguishing among the many causes of chest pain. Because the differential diagnosis for chest pain ranges from conditions as minor as muscle strain to life-threatening conditions, such as an acute myocardial infarction or dissecting thoracic aortic aneurysm, the advanced practice nurse must quickly and systematically assess the patient.