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1.
J Clin Nurs ; 29(9-10): 1576-1589, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32141656

RESUMO

BACKGROUND: Palliative care for individuals with chronic heart failure is recommended for improving patients' symptoms, function and overall quality of life. Despite this mandate, there is limited access and referral to specialist palliative care for individuals with chronic heart failure. OBJECTIVES: To explore healthcare professionals' perspectives on access to palliative care for patients with chronic heart failure, focussing on patient, provider and system factors. METHODS: Cardiologists, palliative care specialists, heart failure nurses and palliative care nurses in acute and community care settings were interviewed using semi-structured interviews. Purposive and snowball sampling methods were used for recruitment. Interview data were analysed using thematic analysis. The COREQ checklist guided data collection and reporting. RESULTS: There were 15 participants in the study, and the majority were female. Participants included palliative medicine physicians, a palliative care nurse consultant, cardiologists, a general practitioner and advanced heart failure nurses. The themes derived from the thematic analysis centred on patient, provider and system factors impacting access and referral to palliative care in the context of chronic heart failure. The patient themes were (a) patient and family preconception of palliative care and (b) patient's clinical profile influences referral. The provider themes were (a) conflict, (b) making decisions and (c) education needs, and the system themes were (a) accessing services and resources and (b) improving the model of care. CONCLUSIONS: The patient's clinical profile, education needs of healthcare professionals and improving access to services and resources need to be considered to enhance palliative care access and referral as well as the interacting and influencing elements of the patient, provider and system.

2.
Res Social Adm Pharm ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32044279

RESUMO

BACKGROUND: Interacting and engaging with other health care professionals can enhance communication and collaboration within the multidisciplinary healthcare team, contributing to improved patient safety and patient outcomes. OBJECTIVE: To explore the student learning experience utilizing the Reflective Interprofessional Education Model (RIPE) model of interprofessional learning. METHODS: Qualitative study utilizing data from seven (7) focus groups sessions. Data were transcribed verbatim using a transcribing service; and analyzed using Braun and Clarke's 6-phase process for thematic analysis. RESULTS: Fifty-five Master of Pharmacy pre-licenced students (male n = 25; female: n = 30) participated in the study. The 7 focus groups consisted of 6-8 participants ranging between 18 and 28 min in duration. Thematic analysis generated four key themes: (i) Time management: managing interruptions in a time pressured acute care environment is challenging but necessary; (ii) Learning the Lingo: patient-centered communicating and engaging patients and family in care; (iii) Communication: developing interprofessional communication as a vital skill for healthcare professionals; and (iv) Teamwork: recognizing the importance of teamwork, relationships and respect. CONCLUSIONS: Students found the simulated, acute care setting challenging for effective communication and collaboration with other health professional team members. It was also perceived that critical patient information can be lost or misinterpreted if there is poor interprofessional communication and collaboration, contributing to iatrogenesis and poor patient outcomes. Effective collaboration was perceived to be beneficial to enhancing confidence with engagement and communication, appreciation and respect for the expertise of other healthcare professions.

3.
Heart Fail Rev ; 25(3): 457-467, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31900788

RESUMO

International clinical practice guidelines recommend that patients with chronic heart failure receive timely and high-quality palliative care. However, integrating palliative care is highly variable and dependent on decision-making and care models. This meta-synthesis aimed to examine health care professionals' decision-making processes and explore factors impacting decisions to refer or deliver palliative care in chronic heart failure. The electronic databases SCOPUS, CINAHL, and Medline were searched. Included studies were those that reported health care professionals' perceptions of palliative care in chronic heart failure through qualitative data collection, were written in English, and were peer-reviewed articles. Included articles were analysed using Thomas and Harden's approach. The dual-process theory was used and applied a priori to organise the findings. The perception of palliative care as a transition and active treatment failure fit within the intuitive system of thinking in the dual-process theory. The theme that overlapped into both intuitive and analytical systems of thinking was acquiring patient and illness information themes reflecting the analytical system of thinking were professional role and experience, pre-existing decision pathways, and balancing viewpoints. This meta-synthesis identified factors influencing the decision-making process in referring patients with chronic heart failure to palliative care. The findings from this review highlight the need for further development of decision-making tools or facilitate guidelines to assist health care professionals' shared decision-making to improve patient outcomes.

4.
J Clin Nurs ; 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31944460

RESUMO

AIMS AND OBJECTIVES: To assess the impact of a Twitterchat focusing on antimicrobial resistance and it is feasibility for integration within a nursing prelicensure research methods class. BACKGROUND: Antimicrobial resistance is one of the greatest threats to global health and food security. Consequently, developing a global approach with large outreach is critical. Twitter, as a popular social media platform, is useful for creating communities of practice and communities of interest. DESIGN: A case study design using a Twitterchat is a hosted, convened and focussed discussion on a particular topic using a discrete hashtag. METHOD: Using a standardised protocol, a Twitterchat was undertaken over a 24-hr period and digital metrics assessed at 72 hr. A summary of impact was undertaken using an online tool provided by Union Metrics (https://unionmetrics.com/). CONCLUSIONS: At 72 hr, 2,632,762 accounts were reached and over 10 million impressions achieved. Twitterchats can be useful in creating awareness and fostering a community of interest and demonstrating the role of nurses in thought leadership. A formalised research study will draw on this case study to evaluate the impact on the Twitter participants and nursing students. RELEVANCE TO CLINICAL PRACTICE: Social media are an accessible and useful tool to harness focus and attention on clinical issues with global relevance. Demonstrating the utility and leverage to nursing students is important in increasing their understanding of the importance of communication and diffusion of information.

5.
Eur J Cardiovasc Nurs ; 19(1): 55-63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31328532

RESUMO

BACKGROUND: Frailty is an important predictive measure of mortality and rehospitalisation in people with heart failure. To date, there are no frailty instruments validated for use in people with heart failure. AIM: The aim of this study was to evaluate the convergent and discriminant validity of three versions of the frailty phenotype in those with heart failure. METHODS: A single site, prospective cohort study was undertaken among individuals with a confirmed diagnosis of heart failure. Frailty was assessed concurrently using three versions of the frailty phenotype: the original frailty phenotype and two modified versions; the Survey of Health, Ageing and Retirement in Europe frailty instrument (SHARE-FI) and the St Vincent's frailty instrument. Convergent and discriminant validity were assessed by reporting the correlations between each version and related heart failure subconstructs, and by evaluating the ability of each version to discriminate between normal and abnormal scores of other physical and psychosocial scales specific to heart failure-related subconstructs. RESULTS: The New York Heart Association classes were moderately correlated with the St Vincent's frailty instrument (r=0.47, P⩽0.001), SHARE-FI (r=0.42, P⩽0.001) and the frailty phenotype (r=0.42, P⩽0.001). The SHARE-FI and the St Vincent's frailty instrument were both able to discriminate consistently between normal and abnormal scores in three out of five of the physical and psychosocial subconstructs that were assessed. The SHARE-FI was also able to discriminate between inpatients and outpatients who were classified as frail. CONCLUSIONS: Both the SHARE-FI and the St Vincent's frailty instrument displayed good convergent and discriminant validity.

6.
Eur J Cardiovasc Nurs ; 19(1): 8-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31347402

RESUMO

BACKGROUND: The purpose of this systematic review was to (a) examine the effects of interventions delivered by a heart failure professional for mild cognitive impairment and dementia on cognitive function, memory, working memory, instrumental activities of daily living, heart failure knowledge, self-care, quality of life and depression; and (b) identify the successful elements of these strategies for heart failure patients with mild cognitive impairment or dementia. METHODS AND RESULTS: During March 2018, an electronic search of databases including CINAHL, MEDLINE, EMBASE and PsycINFO was conducted. All randomised controlled trials, which examined an intervention strategy to help heart failure patients with mild cognitive impairment or dementia cope with self-care, were included. An initial search yielded 1622 citations, six studies were included (N= 595 participants, mean age 68 years). There were no significant improvements in cognitive function and depression. However, significant improvements were seen in memory (p=0.015), working memory (p=0.029) and instrumental activities of daily living (p=0.006). Nurse led interventions improved the patient's heart failure knowledge (p=0.001), self-care (p<0.05) and quality of life (p=0.029). Key elements of these interventions include brain exercises, for example, syllable stacks, individualised assessment and customised education, personalised self-care schedule development, interactive problem-solving training on scenarios and association techniques to prompt self-care activities. CONCLUSIONS: Modest evidence for nurse led interventions among heart failure patients with mild cognitive impairment or dementia was identified. These results must be interpreted with caution in light of the limited number of available included studies.

7.
Eur J Cardiovasc Nurs ; : 1474515119886798, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31680549

RESUMO

BACKGROUND: Maintaining good oral health remains a challenge among those hospitalised after stroke. Stroke nurses and allied health clinicians have a potential role in providing oral care, but no studies in Australia to date have explored their perceptions and needs. AIMS: To explore the perspectives of nursing and allied health stroke clinicians regarding oral care for stroke patients across acute care and stroke rehabilitation settings. METHODS: This study followed an exploratory qualitative design, using a constructivist approach. Participants from two metropolitan public hospitals were purposively recruited to participate in focus groups. Data was thematically analysed. RESULTS: Twenty-one clinicians participated. Clinicians' knowledge and practices relating to oral healthcare for stroke patients were inadequate. Most staff felt they did not have adequate knowledge, resources and training to administer oral care in this setting and proposed enhancing education of stroke clinicians, patients and informal caregivers, as well as improving quality point of care resources. There was overall support for the integrated dental care after stroke model of care. DISCUSSION: This study revealed many gaps in current care and highlighted areas for improvement. Patients and their caregivers needed to be actively engaged as partners to improve oral healthcare within acute and rehabilitation stroke settings. CONCLUSION: This study provided insight into nurses' and allied health stroke clinicians' current knowledge and practices of oral care in various stroke settings. The findings from this study will inform development of a model of care to train stroke nurses in providing oral care.

8.
Eur J Cardiovasc Nurs ; : 1474515119889764, 2019 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-31736378

RESUMO

BACKGROUND: Stabilising blood glucose levels (BGL) after starting or changing insulin and related therapies can be challenging for diabetes services and the patient with type 2 diabetes. Traditionally, a credentialled diabetes educator (CDE) would talk with the patient over the phone to obtain a history of their BGLs over the previous week and provide advice on the insulin dose adjustments as required. This study trialled a smartphone application for sharing BGLs, with the ability to digitally transmit advice back to patients compared with their usual care. AIMS: The aim of this study was to compare desirability, efficiency and ease of use. METHODS: Participants were enrolled in either the traditional (n=50) or Health2Sync (H2S) (n=42) treatment group by patient preference. All insulin stabilisations were conducted by the CDE. Descriptive statistics were used for analysis. RESULTS: The average total time taken to titrate patients was similar in both groups (p>0.05), however there were fewer failure of contacts reported with H2S (p<0.01) and time per interaction was also lower (p<0.01). Sensitivity analysis revealed that, excluding the influence of no contacts, H2S patients had a lower average time for titration (p<0.01). There was no difference in clinical outcomes as measured by HbA1c between the two groups (p=0.75). CONCLUSION: We demonstrated a high acceptance and clinical utility of the H2S application. Clinicians were happy to use H2S and found it easy and convenient for most patients. Importantly, this reduced frequency of contacts with patients, time per interaction and average time for titration (p<0.01). Patient selection for this communication intervention is important.

9.
J Caring Sci ; 8(3): 173-179, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31598510

RESUMO

Introduction: The purpose of this study was to explore the characteristics of undergraduate nursing students, which may determine the nature of their relationship with clinical nurses. Relationships between nursing students and clinical nurses are critical to maximize student learning outcomes and produce skilled graduates for the future health workforce. Methods: This qualitative content analysis study was conducted from January to August 2016. Twenty nine semi-structured in-depth interviews were conducted with 20 undergraduate nursing students in Tabriz nursing and midwifery faculty. Interviews were recorded and transcribed verbatim (in Persian), and analyzed using conventional content analysis to identify themes. Results: Four key themes emerged: educational factors (cognitive knowledge and practical skills, and learning motivation); communication skills; perceived support (perceived support from nurses and educators); and psychological state (fear of the relationship and self-confidence). Self-confidence is an emphasized concept in nursing students' willingness and ability to relate with clinical nurses. Conclusion: The results of the study showed that educational, communicative and psychological factors are important determinants of student communication with nurses. However, self-confidence is the most important factor in establishing such relationship. Self-confidence could be further assessed to identify nursing students who need greater support or would benefit from greater educational interventions to achieve relational skills.

10.
12.
J Am Heart Assoc ; 8(1): e010959, 2019 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-30590964

RESUMO

Background This eH ealth implementation study aimed to evaluate strategies to promote opportunistic atrial fibrillation ( AF ) screening using electronic screening prompts and improve treatment using electronic decision support ( EDS ) software. Methods and Results An electronic screening prompt appeared whenever an eligible patient's (aged ≥65 years, no AF diagnosis) medical record was opened in participating general practices. General practitioners and practice nurses offered screening using a smartphone ECG, with validated AF algorithm. Guideline-based EDS was provided to assist treatment decisions. Deidentified data were collected from practices using a data extraction tool. General practices (n=8) across Sydney, Australia, screened for a median of 6 months. A total of 1805 of 11 476 (16%) eligible patients who attended were screened (44% men, mean age 75.7 years). Screening identified 19 (1.1%) new cases of AF (mean age, 79 years; mean CHA 2 DS 2- VAS c, 3.7; 53% men). General practitioners (n=30) performed 70% of all screenings (range 1-448 patients per general practitioner). The proportion of patients with AF who had CHA 2 DS 2- VAS c ≥2 for men or ≥3 for women prescribed oral anticoagulants was higher for those diagnosed during the study: 15 of 18 (83%) for screen-detected and 39 of 46 (85%) for clinically detected, compared with 933 of 1306 (71%) patients diagnosed before the study ( P<0.001). The EDS was accessed 111 times for patients with AF and for 4 of 19 screen-detected patients. Conclusions The eH ealth tools showed promise. Adherence to guideline-based oral anticoagulant prescription was significantly higher in patients diagnosed during the study period, although the EDS was only used in a minority. While the proportion of eligible patients screened and EDS use was relatively low, further refinements may improve uptake in clinical practice. Clinical Trial Registration URL : www.anzctr.org.au . Unique identifier: ACTRN 12616000850471.


Assuntos
Algoritmos , Fibrilação Atrial/diagnóstico , Gerenciamento Clínico , Medicina Geral/estatística & dados numéricos , Fidelidade a Diretrizes , Programas de Rastreamento/métodos , Telemedicina/métodos , Administração Oral , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Austrália/epidemiologia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Morbidade/tendências , Estudos Retrospectivos , Smartphone , Fatores de Tempo
13.
Eur J Cardiovasc Nurs ; 18(1): 7-15, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30064254

RESUMO

BACKGROUND: There is a need to improve cardiovascular nurses' knowledge and practices related to stroke prevention, atrial fibrillation and anticoagulation therapy. AIMS: The aim of this study was to evaluate the efficacy of EVICOAG - a novel mHealth, smartphone-based, spaced-learning intervention on nurses' knowledge of atrial fibrillation and anticoagulation. METHODS: Nurses employed in four clinical specialties (neuroscience, stroke, rehabilitation, cardiology) across three hospitals were invited to participate. In this quasi-experimental study, 12 case-based atrial fibrillation and anticoagulation learning scenarios (hosted by an mHealth platform) were delivered to participants' smartphones over a 6-week period (July-December 2016) using a spaced timing algorithm. Electronic surveys to assess awareness and knowledge were administered pre (T1) and post (T2) intervention. RESULTS: From 74 participants recruited to T1, 40 completed T2. There was a 54% mean improvement in knowledge levels post-intervention. The largest improvement was achieved in domains related to medication interaction and stroke and bleeding risk assessment. Post-intervention, those who completed T2 were significantly more likely to use CHA2DS2-VASc (2.5% vs. 37.5%) and HAS-BLED (2.5% vs. 35%) tools to assess stroke and bleeding risk, respectively ( P<0.01). CONCLUSION: The EVICOAG intervention improved nurses' knowledge of atrial fibrillation and anticoagulation, and influenced their uptake and use of stroke and bleeding risk assessment tools in clinical practice. Future research should focus on whether a similar intervention might improve patient-centred outcomes such as patients' knowledge of their condition and therapies, medication adherence, time in the therapeutic range and quality of life.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/enfermagem , Enfermagem Cardiovascular/educação , Recursos Humanos de Enfermagem no Hospital/educação , Acidente Vascular Cerebral/prevenção & controle , Terapia Trombolítica/métodos , Adulto , Educação Continuada em Enfermagem , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , New South Wales , Qualidade de Vida , Medição de Risco , Smartphone , Inquéritos e Questionários , Telemedicina/métodos
14.
J Am Heart Assoc ; 7(23): e008251, 2018 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-30571603

RESUMO

Background Although frailty has been associated with increased risks for hospitalization and mortality in chronic heart failure, the precise average effect remains uncertain. We performed a systematic review and meta-analysis to summarize the hazards for mortality and incident hospitalization in patients with heart failure and frailty compared with those without frailty and explored the heterogeneity underlying the effect size estimates. Methods and Results MEDLINE , EMBASE, and Cochrane databases were queried for articles published between January 1966 and March 2018. Predefined selection criteria were used. Hazard ratios ( HRs ) were pooled for meta-analyses, and where odds ratios were used previously, original data were recalculated for HR . Overlapping data were consolidated, and only unique data points were used. Study quality and bias were assessed. Eight studies were included for mortality (2645 patients), and 6 studies were included for incident hospitalization (2541 patients) during a median follow-up of 1.82 and 1.12 years, respectively. Frailty was significantly associated with an increased hazard for mortality ( HR , 1.54; 95% confidence interval, 1.34-1.75; P<0.001) and incident hospitalization ( HR , 1.56; 95% confidence interval, 1.36-1.78; P<0.001) in chronic heart failure. The Fried phenotype estimated a 16.9% larger effect size than the combined Fried/non-Fried frailty assessment for the end point of mortality ( HR , 1.80; 95% confidence interval, 1.41-2.28; P<0.001), but not for hospitalization ( HR , 1.57; 95% confidence interval, 1.30-1.89; P<0.001). Study heterogeneity was found to be low (I2=0%), and high quality of studies was verified by the Newcastle-Ottawa scale. Conclusions Overall, the presence of frailty in chronic heart failure is associated with an increased hazard for death and hospitalization by ≈1.5-fold.


Assuntos
Fragilidade/mortalidade , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Doença Crônica , Fragilidade/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Fatores de Risco
15.
BMJ Open ; 8(10): e023130, 2018 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-30385444

RESUMO

INTRODUCTION: Screening for atrial fibrillation (AF) in people ≥65 years is now recommended by guidelines and expert consensus. While AF is often asymptomatic, it is the most common heart arrhythmia and is associated with increased risk of stroke. Early identification and treatment with oral anticoagulants can substantially reduce stroke risk. The general practice setting is ideal for opportunistic screening and provides a natural pathway for treatment for those identified.This study aims to investigate the feasibility of implementing screening for AF in rural general practice using novel electronic tools. It will assess whether screening will fit within an existing workflow to quickly and accurately identify AF, and will potentially inform a generalisable, scalable approach. METHODS AND ANALYSIS: Screening with a smartphone ECG will be conducted by general practitioners and practice nurses in rural general practices in New South Wales, Australia for 3-4 months during 2018-2019. Up to 10 practices will be recruited, and we aim to screen 2000 patients aged ≥65 years. Practices will be given an electronic screening prompt and electronic decision support to guide evidence-based treatment for those with AF. De-identified data will be collected using a clinical audit tool and qualitative interviews will be conducted with selected practice staff. A process evaluation and cost-effectiveness analysis will also be undertaken. Outcomes include implementation success (proportion of eligible patients screened, fidelity to protocol), proportion of people screened identified with new AF and rates of treatment with anticoagulants and antiplatelets at baseline and completion. Results will be compared against an earlier metropolitan study and a 'control' dataset of practices. ETHICS AND DISSEMINATION: Ethics approval was received from the University of Sydney Human Research Ethics Committee on 27 February 2018 (Project no.: 2017/1017). Results will be disseminated through various forums, including peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER: ACTRN12618000004268; Pre-results.


Assuntos
Fibrilação Atrial/diagnóstico , Programas de Rastreamento/métodos , Atenção Primária à Saúde , Serviços de Saúde Rural , Idoso , Fibrilação Atrial/terapia , Protocolos Clínicos/normas , Humanos , Programas de Rastreamento/normas , Aplicativos Móveis , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/normas , Smartphone
17.
PLoS One ; 13(10): e0206288, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30365567

RESUMO

BACKGROUND: Modifications to lifestyle risk factors for stroke may help prevent stroke events. This systematic review aimed to identify and summarise the evidence of acupuncture interventions for those people with lifestyle risk factors for stroke, including alcohol-dependence, smoking-dependence, hypertension, and obesity. METHODS: MEDLINE, CINAHL/EBSCO, SCOPUS, and Cochrane Database were searched from January 1996 to December 2016. Only randomised controlled trials (RCTs) with empirical research findings were included. PRISMA guidelines were followed and risk of bias was assessed via the Cochrane Collaboration risk of bias assessment tool. The systematic review reported in this paper has been registered on the PROSPERO (#CRD42017060490). RESULTS: A total of 59 RCTs (5,650 participants) examining the use of acupuncture in treating lifestyle risk factors for stroke met the inclusion criteria. The seven RCTs focusing on alcohol-dependence showed substantial heterogeneity regarding intervention details. No evidence from meta-analysis has been found regarding post-intervention or long-term effect on blood pressure control for acupuncture compared to sham intervention. Relative to sham acupuncture, individuals receiving auricular acupressure for smoking-dependence reported lower numbers of consumed cigarettes per day (two RCTs, mean difference (MD) = -2.75 cigarettes/day; 95% confidence interval (CI) = -5.33, -0.17; p = 0.04). Compared to sham acupuncture those receiving acupuncture for obesity reported lower waist circumference (five RCTs, MD = -2.79 cm; 95% CI: -4.13, -1.46; p<0.001). Overall, only few trials were considered of low risk of bias for smoking-dependence and obesity, and as such none of the significant effects in favour of acupuncture interventions were robust against potential selection, performance, and detection bias. CONCLUSIONS: This review found no convincing evidence for effects of acupuncture interventions for improving lifestyle risk factors for stroke.


Assuntos
Terapia por Acupuntura , Estilo de Vida , Acidente Vascular Cerebral/epidemiologia , Humanos , Fatores de Risco , Acidente Vascular Cerebral/prevenção & controle
19.
Med J Aust ; 209(8): 356-362, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30067936

RESUMO

INTRODUCTION: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work-up; acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies; stroke prevention and optimal use of anticoagulants; and integrated multidisciplinary care. Changes in management as a result of the guideline: Opportunistic screening in the clinic or community is recommended for patients over 65 years of age. The importance of deciding between a rate and rhythm control strategy at the time of diagnosis and periodically thereafter is highlighted. ß-Blockers or non-dihydropyridine calcium channel antagonists remain the first line choice for acute and chronic rate control. Cardioversion remains first line choice for acute rhythm control when clinically indicated. Flecainide is preferable to amiodarone for acute and chronic rhythm control. Failure of rate or rhythm control should prompt consideration of percutaneous or surgical ablation. The sexless CHA2DS2-VA score is recommended to assess stroke risk, which standardises thresholds across men and women; anticoagulation is not recommended for a score of 0, and is recommended for a score of ≥ 2. If anticoagulation is indicated, non-vitamin K oral anticoagulants are recommended in preference to warfarin. An integrated care approach should be adopted, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available. Regular monitoring and feedback of risk factor control, treatment adherence and persistence should occur.


Assuntos
Fibrilação Atrial , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/prevenção & controle , Fibrilação Atrial/terapia , Austrália , Humanos , Nova Zelândia
20.
Aust Health Rev ; 2018 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-29898812

RESUMO

Objective The aim of the present study was to compare the health status of South Australians with recent experience of caring for an adult with chronic disease with non-carers drawn from the same population.Methods Data were collected via the South Australian Health Omnibus, an annual population-based, cross-sectional survey. Respondents were asked whether they had provided care or support in the last 5 years to someone with cancer, heart disease, respiratory disease, mental illness, neurological disease or dementia. Health status was measured using the Short Form-12 version 1 (SF-12) physical and mental component scale summary scores (PCS and MCS respectively), with poor health status defined as ≥0.5 standard deviation below the normative mean. Logistic regression explored characteristics associated with poor health status.Results Of 3033 respondents analysed, 987 (32.5%) reported caring experience. Poor PCS and MCS were associated with carer status, lower-than-degree-level education, employment status other than employed and annual household income less than A$60000. Being Australian born was a protective factor for PCS, whereas factors protective for MCS were being married or in a de facto relationship and age ≥65 years.Conclusions Providing care or support in the last 5 years is independently associated with poorer health status, but not with the magnitude found in studies of current carers. Future research should explore health status recovery after completion of the caring role, and investigate whether relationships between health and socioeconomic status differ for carers versus non-carers.What is known about the topic? Population-based survey studies in Australia and overseas have consistently found that informal carers have worse health status than non-carers.What does this paper add? Including recent as well as current carers in a population-based sample was associated with less effect on health status compared with studies focused on current carers only. This finding is consistent with the possibility that health status recovers during the 5 years after caring.What are the implications for practitioners? Support for Australian carers is warranted to ensure their continuing contributions to society and return to productivity after their caring role is completed.

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