Autogestão na pessoa com doença coronária: importância da intervenção de enfermagem / Self-management in patients with coronary heart disease: importance of nursing intervention

Introduction and objectives: Coronary heart disease is one of the main causes of death in Portugal, especially. It is a chronic illness with a complex therapeutic regimen, and since it is often asymptomatic non-adherence is quite frequent, especially in relation to the non-pharmacological component. The present study aims to: a) characterize patients with coronary disease in relation to cardiovascular risk factors, adherence to non-pharmacological treatment, perceived competence and perception of autonomous support by health professionals b) study if nursing intervention promotes self-management in patients with coronary heart disease. Methodology: This is a descriptive, cross-sectional study and correlational study. The participants were 46 patients with coronary heart disease, from two hospitals in the northern region of Portugal, 45,7 % of which were followed by a nursing consultation. Instruments used were: the Perceived Competence Scale, the Health Care Climate Questionnaire, a questionnaire about non-pharmacological adherence. Results and discussion: Results showed that participants reported a moderate adherence to the non-pharmacological treatment, feel very competent to manage their treatment, and perceive the health climate as supportive of their autonomy. Patients supported by nurses reported higher adherence to non-pharmacological treatment strategies, higher perceived competence and perceived the health care climate as supportive of their autonomy when compared to those attended only by doctors. Conclusions: This study suggests that nursing interventions are important for the promotion of self-management in coronary heart patients, and that these interventions should be focused on perceived competence and the promotion of autonomous motivation

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Blended collaborative care in the secondary prevention of coronary heart disease improves risk factor control: Results of a randomised feasibility study.

BACKGROUND: Risk factor control is essential in limiting the progression of coronary heart disease, but the necessary active patient involvement is often difficult to realise, especially in patients suffering psychosocial risk factors (e.g. distress). Blended collaborative care has been shown as an effective treatment addition, in which a (non-physician) care manager supports patients in implementing and sustaining lifestyle changes, follows-up on patients, and integrates care across providers, targeting both, somatic and psychosocial risk factors. AIMS: The aim of this study was to test the feasibility, acceptance and effect of a six-month blended collaborative care intervention in Germany. METHODS: For our randomised controlled pilot study with a crossover design we recruited coronary heart disease patients with ⩾1 insufficiently controlled cardiac risk factors and randomised them to either immediate blended collaborative care intervention (immediate intervention group, n=20) or waiting control (waiting control group, n=20). RESULTS: Participation rate in the intervention phase was 67% (n=40), and participants reported high satisfaction (M=1.63, standard deviation=0.69; scale 1 (very high) to 5 (very low)). The number of risk factors decreased significantly from baseline to six months in the immediate intervention group (t(60)=3.07, p=0.003), but not in the waiting control group t(60)=-0.29, p=0.77). Similarly, at the end of their intervention following the six-month waiting period, the waiting control group also showed a significant reduction of risk factors (t(60)=3.88, p<0.001). CONCLUSION: This study shows that blended collaborative care can be a feasible, accepted and effective addition to standard medical care in the secondary prevention of coronary heart disease in the German healthcare system.

Support from next of kin and nurses are significant predictors of long-term adherence to treatment in post-PCI patients.

BACKGROUND: Adherence to treatment is a crucial factor in preventing the progression of coronary heart disease. More evidence of the predictors of long-term adherence is needed. AIMS: The purpose of this study was to identify the predictive factors of adherence to treatment six years after percutaneous coronary intervention. METHODS: Baseline data (n=416) was collected in 2013 and follow-up data in 2019 (n=169) at two university hospitals and three central hospitals in Finland. The self-reported Adherence of Patients with Chronic Disease Instrument was used. Data were analysed using descriptive statistics and binary logistic regression analysis. RESULTS: The respondents reported higher adherence to a healthy lifestyle six years after percutaneous coronary intervention in comparison to four months post-percutaneous coronary intervention; adherence was seen in their healthy behaviour, such as decreased smoking and reduced alcohol consumption. Participating in regular follow-up control predicted adherence. Support from next of kin predicted physical activity and normal cholesterol levels; this outcome was associated with close relationships, which also predicted willingness to be responsible for treatment adherence. Women perceived lower support from nurses and physicians, and they had more fear of complications. Fear was more common among respondents with a longer duration of coronary heart disease. Physical activity and male gender were associated with perceived results of care. CONCLUSION: Support from next of kin, nurses and physicians, results of care, responsibility, fear of complication and continuum of care predicted adherence to treatment in long term. These issues should be emphasised among women, patients without a close relationship, physically inactive and those with a longer duration of coronary heart disease.

Aplicativo móvel para a escolha do banho do paciente em uma unidade coronariana / Mobile app for choosing a patient's bath in a coronary unit

Introdução: As doenças cardiovasculares são uma das principais causas de mortalidade no mundo. A forma aguda desta situação é denominada Síndrome Coronariana Aguda (SCA) que pode ser classificada como: angina instável e infarto agudo do miocárdio. Após o diagnóstico médico definido como SCA, o paciente necessita de internação em uma Unidade Coronariana. Neste ambiente é oferecida uma assistência guiada por protocolos clínicos e diretrizes de forma a contribuir na sua recuperação, minimizar o risco de complicações e prevenir os danos. Entre os protocolos que envolvem esse cuidado destaca-se o banho, que pode ser classificado como no leito ou de aspersão. Para a tomada de decisão do do enfermeiro quanto a indicação ao banho do paciente coronariopata são necessárias informações clinicas, e da hemodinâmica atual do paciente. Pontua-se como problema "A ausência de sistematização para tomada de decisão quanto a escolha banho do paciente coronariopata em uma Unidade Coronariana". Objetivo: Elaborar um algoritmo no formato de aplicativo móvel para auxiliar a tomada de decisão do enfermeiro quanto ao banho do paciente coronariopata em uma Unidade Coronariana. Método: Trata-se de estudo exploratório, metodológico e abordagem quantitativa para a elaboração de um algoritmo no formato de aplicativo móvel. O estudo foi realizado em duas etapas: 1ªetapa: elaborou-se um intrumento a partir de uma revisão de literatura abordando as temáticas reabilitação cardíaca e banho. Este instrumento foi submetido a validação de seus critérios por enfermeiros. A abordagem dos dados, foi realizada por estatística descritriva como cálculo do Coeficiente de Alfa de Cronbach. 2ªetapa: Elaboração do algoritmo baseado nos achados do instrumento aplicado, em formato de aplicativo móvel para auxiliar na tomada de decisão quanto ao banho do paciente coronariopata na UTI. Resultados: Avaliaram o instrumento um total de 29 enfermeiros, em um período de 03 meses. Dentre estes 26 (89%) eram do sexo feminino, com idade na faixa de 23 à 58 anos e todos os enfermeiros possuíam algum tipo de pós-graduação em seu currículo. Foram 22 critérios submetidos à validação por 29 especialistas, totalizando 638 avaliações. Dentre estes, 63% (401) foi classificada como Concordância. O valor encontrado para o coeficiente α foi de aproximadamente 0,9536. Foram 19 itens validados, através do coeficiente α, e 19 itens sugeridos e utilizados pelos especialistas. Após categorização, foram selecionados 19 itens, organizados em formato de algoritmo, com respostas dicotômicas (sim ou não) o que sugere a cada final de fluxo o tipo do banho (não banho, banho no leito ou banho de aspersão) indicado ao paciente, devido suas condições clínicas. Conclusão: O aplicativo móvel, produto desta pesquisa, foi elaborado por um colaborador que o utilizou a interface de desenvolvimento Android Studio® com a linguagem Java® a partir do algoritmo estruturado baseado nos achados do julgamento prévio dos especialistas para auxiliar na tomada de decisão quanto ao banho do paciente em uma Unidade Coronariana, para sua disponibilização para download, sugere-se a validação através de um estudo piloto, para garantir a segurança ao paciente

Introduction: Cardiovascular diseases are one of the leading causes of mortality in the world. The acute form of this condition is called Acute Coronary Syndrome (ACS), which can be classified as unstable angina and acute myocardial infarction. After the medical diagnosis defined as SCA, the patient needs hospitalization in a Coronary Unit. In this environment, it is offered assistance guided by clinical protocols and guidelines in order to contribute to its recovery, to minimize the risk of complications and to prevent damages. Among the protocols that involve this care is the bath, which can be classified as bedding or spraying. The clinician's clinical information and the patient's current hemodynamics are necessary for the decision-making of the nurse regarding the indication to the coronary patient's bath. The problem "The absence of systematization for decision making regarding the choice of bath of the coronariopata patient in a Coronary Unit" is a problem. Objective: To elaborate an algorithm in the format of a mobile application to aid the decision making of the nurse regarding the bath of the coronariopata patient in a Coronary Unit. Method: This is an exploratory, methodological and quantitative approach to the elaboration of an algorithm in the mobile application format. The study was carried out in two stages: 1st stage: an instrument was elaborated from a literature review addressing the themes of cardiac and bath rehabilitation. This instrument was submitted to validation of its criteria by nurses. The data approach was carried out by a statistic described as the calculation of Cronbach's Alpha Coefficient. 2nd stage: Elaboration of the algorithm based on the findings of the applied instrument, in a mobile application format to aid in decision making regarding the coronary patient's ICU bath. Results: A total of 29 nurses were evaluated in a period of 03 months. Of these, 26 (89%) were female, ranging in age from 23 to 58 years old and all nurses had some type of postgraduate degree in their curriculum. There were 22 criteria submitted to validation by 29 specialists, totaling 638 evaluations. Of these, 63% (401) was classified as Concordance. The value found for the coefficient α was approximately 0.9536. There were 19 items validated through the α coefficient and 19 items suggested and used by the specialists. After categorization, we selected 19 items, organized in an algorithm format, with dichotomic responses (yes or no), which suggests to each end of the flow the type of bath (not bath, bath in the bed or bath of sprinkling) due to its clinical conditions. Conclusion: The mobile application, the product of this research, was developed by a developer who used the Android Studio® development interface with the Java® language from a structured algorithm based on the findings of the expert's prior judgment to assist in decision making to the patient's bath in a Coronary Unit, for its availability for download, validation is suggested through a pilot study, to guarantee patient safety

Relationship between self-management behaviors and health-related quality of life among Chinese patients with coronary heart disease: A cross-sectional study.

Background: Coronary heart disease (CHD) has become one of the leading cause of death and physical disability in China. However, the relationship between self-management behaviors and health-related quality of life (HrQoL) among CHD patients in Chinese community settings is unclear.Aim: To explore the relationship between self-management behaviors and HrQoL among CHD patients in Chinese community settings.Methods: 220 participants were recruited from a community setting in Xi'an city, China. A cross-sectional study was conducted by using the Coronary Artery Disease Self-Management Scale (CSMS) and Chinese Mandarin version of the Short-Form 36 Health Survey (SF-36) on HrQoL.Results: Compared with Chinese norms, the CHD patients reported poorer HrQoL (P < 0.05). Pearson correlation analyses identified positive correlations (r = 0.117-0.328, P < 0.05) between self-management behaviors and HrQoL among the CHD patients in Chinese community settings.Conclusion: It is critical to improve self-management behaviors and HrQoL of CHD patients in Chinese communities.

[Advanced nurse triage for emergency department]. / Le triage infirmier avancé aux Urgences.

To cope with overcrowding, a consequence of their constant growth, emergency departments have implemented operational strategies based on triage systems. Despite its interest, nurse triage has been limited by several hindrances, and new strategies are emerging. Among those, advanced nurse triage, allowing a nurse to initiate the diagnostic process just after categorization of the patient, seems to be promising. A study on advanced nurse triage for patients presenting with chest pain has been conducted in the emergency department of the CHU of Liège. The encouraging results obtained following this new system demonstrate a reduction of the delay to management of patients, and a reduction of the total length of stay in the emergency unit mainly during overcrowding periods. Advanced nurse triage, in addition to a conventional triage during overcrowding periods, improves management of patients in terms of time and reduces the total time spent in the emergency department.

Confronté au problème de surpopulation, conséquence de leur fréquentation sans cesse croissante, les services d'urgence ont mis en place des stratégies opérationnelles basées sur des filières de soins organisées au départ de systèmes de triage des patients. Pareils outils ont démontré leur intérêt, mais s'avèrent aujourd'hui insuffisants, raison pour laquelle de nouvelles stratégies voient le jour. L'une d'elles, le triage infirmier avancé, permettant à un infirmier d'initier la démarche diagnostique juste après la catégorisation du patient, semble être une promesse d'avenir. Une étude portant sur un triage infirmier avancé pour les patients se présentant pour une douleur thoracique a été menée récemment au CHU de Liège. Les résultats encourageants de cette étude révèlent un gain de temps dans la prise en charge des patients en faveur de ce nouveau système et une durée totale de séjour aux urgences réduite, principalement en période de surpopulation. Il se confirme donc que le triage infirmier avancé, couplé à un triage classique, particulièrement en période de surpopulation, améliore la prise en charge des patients en termes de temps et réduit le temps total de séjour aux urgences, tout en garantissant la qualité, combattant, par là, la surpopulation.

Effectiveness of nurse-led patient-centered care behavioral risk modification on secondary prevention of coronary heart disease: A systematic review.

BACKGROUND: Despite establishment of advocacies centered on using patient-centered care to improve disease-related behavioral changes and health outcomes, studies have seldom discussed incorporation of patient-centered care concept in the design of secondary cardiac prevention. OBJECTIVES: This review aimed to identify, appraise, and examine existing evidence on the effectiveness of nurse-led patient-centered care for secondary cardiac prevention in patients with coronary heart disease. DESIGN: A systematic review of randomized controlled trials focusing on nurse-led patient-centered care for secondary cardiac prevention was conducted. Primary outcomes were behavioral risks (e.g. smoking, physical activity), secondary outcomes were clinically relevant physiological parameters (e.g. body weight, blood pressure, blood glucose, blood lipoproteins), health-related quality of life, mortality, and self efficacy. DATA SOURCES: Twenty-three English and seven Chinese electronic databases were searched to identify the trials. REVIEW METHODS: The studies' eligibility and methodological quality were assessed by two reviewers independently according to the Joanna Briggs Institute guidelines. Statistical heterogeneities of the included studies were assessed by Higgins I2 and quantitative pooling was performed when studies showed sufficient comparability. RESULTS: 15 articles on 12 randomized controlled trials were included in this review. Methodological quality of the included studies was fair. Based on the Joanna Briggs Institute critical appraisal tool for experimental studies, the included studies had met a mean of six criteria out the ten in this appraisal tool. The meta-analyses of the included studies revealed that nurse-led patient-centered care had significantly improved patients' smoking habits, adherence toward physical activity advices, and total cholesterol level with medical regime optimization, in short- to medium-term. The intervention was also favorable in improving the patients' health-related quality of life in several domains of SF-36. Furthermore, from single-study results, the intervention was favorable in improving the patients' weight management and alcohol consumption. However, it did not show significant effects on improving the patient's dietary habits, certain cardiac physiological parameters, mortality and self-efficacy. Currently, no addition long-term benefit of the intervention on secondary cardiac prevention was identified. CONCLUSION: This review has systematically analyzed the effects of nurse-led patient-centered care on patients' behavioral risks, cardiac physiological parameters, mortality, health-related quality of life and self-efficacy. Given limited quantity of existing evidence regarding certain outcomes and long-term follow-up period; cross-trial heterogeneity of the interventions, measurement methods and statistical results; high or unclear risk of bias in some quality dimensions, the effectiveness of the intervention on secondary cardiac prevention remains inconclusive and subject to additional trials and evidences.

Risk Knowledge and Awareness of Coronary Heart Disease, and Health Promotion Behaviors Among Adults in Oman.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the relationships between an individual's characteristics and experiences (age, gender, level of education, income, and employment), knowledge of coronary heart disease (CHD) risk factors, perception of health status, awareness of CHD, and health promotion behaviors among adult Omanis. METHODS: Using Pender's health promotion model, a cross-sectional and correlational survey design was employed. A self-administered questionnaire was distributed to 180 participants in Muscat, the capital of Oman. Descriptive and multivariate linear regression analyses were employed. RESULTS: Increasing age was associated with high levels of awareness about CHD. Participants who were employed and knowledgeable about CHD risk factors were more likely to have lower perceptions of health. The regression model showed that knowledge of CHD risk factors and awareness of CHD had positive associations with health promotion behaviors. Meanwhile, employed participants had lower health promotion behaviors scores. IMPLICATIONS FOR PRACTICE: Interventions to increase health promotion behaviors should include application of behavioral change strategies that are suitable for age and employment status. The strategies must focus on providing information to enhance knowledge and awareness about CHD.

Examination of a Nurse-led Community-based Education and Coaching Intervention for Coronary Heart Disease High-risk Individuals in China.

PURPOSE: Early detection and management of coronary heart disease (CHD) are embedded into many community health service and primary care practices in western countries. The Framingham CHD risk score has been used to predict CHD and mortality for nearly 20 years, and it has predicted CHD event risk accurately in multiethnic populations. The aim of this study was to access the effect of a 6-month community-based intervention on CHD risk in individuals at high risk. METHODS: A randomized controlled trial of individuals with a high 10-year CHD risk were recruited from two communities in China. Individuals in the intervention group (n = 53) received a 3-month group education and a 3-month coaching session. Physical examination and self-report questionnaires were used to collect both pre- and postintervention data on blood pressure, glucose, cholesterol, body mass index, smoking, depression, and health-related quality of life (HRQoL). RESULTS: A total of 102 participants (85.0%) completed the 6-month study. Compared with the usual care group, the intervention group had a 5 mmHg greater reduction in systolic blood pressure (t = 2.01, p = .047), larger declines in glucose (t = -2.49, p = .015), cholesterol (t = -2.44, p = .017), body mass index (t = -2.58, p = .011), and depression (t = -2.05, p = .043), and better reports of HRQoL (t = 3.36, p = .001). No significant group differences in smoking behaviors were reported. CONCLUSION: A 6-month community-based intervention in a CHD high-risk population improved disease-related risk factors, depression, and HRQoL. Results provide preliminary evidence for primary prevention of cardiovascular disease risk in a community high-risk population.

Perceived consequences, changeability and personal control of coronary heart disease are associated with health-related quality of life.

AIMS AND OBJECTIVES: To explore changes in illness perception and health-related quality of life in patients with coronary heart disease following percutaneous coronary intervention from the time when patients were discharged from hospital and five months later and to investigate association between illness perception and physical and mental health-related quality of life at five-month follow-up. BACKGROUND: Illness perception is known to influence patients' motivation to engage in preventive behaviour. DESIGN: Prospective and comparative with two measurement points: at discharge from hospital (time 1) and five months later (time 2). METHODS: Two self-administered questionnaires were used as follows: the Illness Perception Questionnaire-Revised measured illness perception and the Short Form Health Survey (SF-36) measured physical and mental health-related quality of life. The sample consisted of patients with coronary heart disease admitted to University Hospital between November 2011-April 2012. RESULTS: A total of 69 questionnaires were returned for both measurement times. Most responders were male (71%), mean age was 68·9 (SD 10·3) years. Health-related quality of life increased over time, and illness perception changed; five months after discharge, participants were more aware that the disease was chronic and could worsen suddenly, and they perceived that the disease had less of a consequence on their lives compared to when they were staying in the hospital. Associations between increased personal control, changeability of the disease, perceptions of less of a consequence of the disease on daily life and increased health-related quality of life were demonstrated at time 2. CONCLUSION: Perceptions of personal control, changeability and consequences of the disease should be assessed and discussed with cardiac patients, as these illness perceptions are related to physical and mental health-related quality of life. RELEVANCE TO CLINICAL PRACTICE: Increased understanding of consequences of the disease, personal control and perceived changeability of the illness affects health-related quality of life; these are factors that nurses in clinical practice can influence and thereby improve patients' outcomes.

Cardiovascular Disease and HIV: Pathophysiology, Treatment Considerations, and Nursing Implications.

HIV infection has progressed from an acute, terminal disease to a chronic illness with cardiovascular disease as the leading cause of death among persons living with HIV. As persons living with HIV infection continue to become older, traditional risk factors for atherosclerosis compounded by the pathophysiological effects of HIV infection and antiretroviral therapy markedly increase the risk for cardiovascular disease. Further, persons living with HIV are also at high risk for cardiomyopathy. Critical care nurses must recognize the risk factors for cardiovascular disease and the pathophysiology and complex treatment options in order to manage care of these patients and facilitate multidisciplinary collaboration. Two case studies are used to highlight the treatment options and nursing considerations associated with cardiovascular disease among persons living with HIV.

Evidências para o cuidado de enfermagem na avaliação do risco coronariano em pacientes hospitalizados / La evidencia de Cuidados de enfermería en la evaluación del riesgo coronario en pacientes hospitalizados / Evidence for nursing care in the evaluation of coronary risk in hospitalized patients

assess coronary risk in hospitalized patients the likelihood of developing an acute myocardial infarction over the next decade and discuss the nursing care based on scientific evidence. Method: this is a descriptive cross-sectional study. The sample consisted of 42 hospitalized patients. Data were collected between May and June 2013. This study was approved by the Research Ethics Committee of the University of Bahia (protocol 266.907). Results: it was checked that 42.5% of hospitalized present a high risk of developing myocardial infarction within the next 10 years. Conclusion: The data reveal that there are hospitalized patients in coronary risk becoming clear that the risk was higher with increasing age...

avaliar o risco coronariano em pacientes hospitalizados a probabilidade de desenvolver um infarto agudo do miocárdio nos próximos dez anos e discutir o cuidado de enfermagem com base nas evidências científicas. Método: trata-se de um estudo descritivo de corte transversal. A amostra foi constituída por 42 pacientes hospitalizados. Os dados foram coletados no período de maio a junho de 2013. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade do Estado da Bahia (protocolo 266.907). Resultados: foi verificado que 42,5% dos hospitalizados apresentam um alto risco para desenvolver infarto agudo do miocárdio nos próximos 10 anos. Conclusão: Os dados revelam que existem pacientes hospitalizados em risco coronariano, ficando evidente que o risco apresentou-se maior com o avanço da idade...

evaluar el riesgo coronario en pacientes hospitalizados desarrollar infarto agudo de miocardio en los próximos diez años y discutir los cuidados de enfermería basada en la evidencia científica. Método: se trata de un estudio descriptivo de corte transversal. La muestra consistió en 42 pacientes hospitalizados. Los datos fueron recogidos entre mayo y junio de 2013. Este estudio fue aprobado por el Comité de Ética en Investigación de la Universidad de Bahía (protocolo 266 907). Resultados: se encontro que el 42,5% de los hospitalizados presentan un alto riesgo de desarrollar infarto de miocardio en los próximos 10 años. Conclusión: Los datos muestran que no son hospitalizados los pacientes en riesgo coronario es bastante evidente que el riesgo fue mayor con la edad avanzada...

Effective components of nurse-coordinated care to prevent recurrent coronary events: a systematic review and meta-analysis.

Current guidelines on secondary prevention of cardiovascular disease recommend nurse-coordinated care (NCC) as an effective intervention. However, NCC programmes differ widely and the efficacy of NCC components has not been studied. To investigate the efficacy of NCC and its components in secondary prevention of coronary heart disease by means of a systematic review and meta-analysis of randomised controlled trials. 18 randomised trials (11 195 patients in total) using 15 components of NCC met the predefined inclusion criteria. These components were placed into three main intervention strategies: (1) risk factor management (13 studies); (2) multidisciplinary consultation (11 studies) and (3) shared decision making (10 studies). Six trials combined NCC components from all three strategies. In total, 30 outcomes were observed. We summarised observed outcomes in four outcome categories: (1) risk factor levels (16 studies); (2) clinical events (7 studies); (3) patient-perceived health (7 studies) and (4) guideline adherence (3 studies). Compared with usual care, NCC lowered systolic blood pressure (weighted mean difference (WMD) 2.96 mm Hg; 95% CI 1.53 to 4.40 mm Hg) and low-density lipoprotein cholesterol (WMD 0.23 mmol/L; 95% CI 0.10 to 0.36 mmol/L). NCC also improved smoking cessation rates by 25% (risk ratio 1.25; 95% CI 1.08 to 1.43). NCC demonstrated to have an effect on a small number of outcomes. NCC that incorporated blood pressure monitoring, cholesterol control and smoking cessation has an impact on the improvement of secondary prevention. Additionally, NCC is a heterogeneous concept. A shared definition of NCC may facilitate better comparisons of NCC content and outcomes.

Caracterización de pacientes en posoperatorio de revascularización miocárdica según eventos clínicos de cuidado de enfermería / Characterization of patients in postoperative period of myocardial revascularization according to clinical nursing care events", "_e": "n

Antecedentes: las enfermedades cardiovasculares constituyen la primera causa de morbimortalidad a nivel mundial y nacional; sobresale la enfermedad coronaria. Esto ha contribuido para que el tratamiento quirúrgico de revascularización miocárdica sea considerado como un procedimiento de rutina. Éste es uno de los avances más importantes de la medicina durante el siglo XX. En Bogotá, los registros estadísticos muestran que más del 50% del total de cirugías cardiovasculares corresponde a ella. Objetivo: realizar la caracterización de pacientes que se encuentran en posoperatorio temprano de revascularización miocárdica, quienes presentan cambios fisiológicos en su esfera biológica, secundarios al procedimiento, a nivel neurológico, cardiovascular, respiratorio, gastrointestinal, de eliminación y de la piel. Metodología: se realizó un estudio descriptivo, de seguimiento prospectivo. Se observaron y revisaron las historias clínicas de 151 pacientes en posoperatorio de 48 a 96 horas. La revisión de la historia clínica se realizó por el investigador. Se consignó la información en una hoja de registro de información y se procesó mediante métodos de análisis exploratorio multidimensional: análisis factorial de correspondencias múltiples combinado con el Método Cluster de Clasificación. Resultados: estuvieron relacionados con clases de pacientes de acuerdo con los eventos clínicos presentes en cada uno de los sistemas estudiados donde se evidencia que presentan alteración de los sistemas neurológico, cardiovascular, respiratorio y de la piel. Conclusión: la caracterización de los pacientes en posoperatorio de una revascularización miocárdica permite que el cuidado de enfermería sea enfocado hacia la solución de problemas de los sistemas antes mencionados.

Background: cardiovascular diseases are the leading cause of morbidity and mortality at global and national level; stands out coronary disease. This has contributed to make the surgical treatment of coronary artery bypass grafting being considered a routine procedure. This is one of the most important advances in medicine during the twentieth century. In Bogota, statistical records show that more than 50% of all cardiovascular surgeries corresponds to it. Objective: to characterize patients who are in early postoperative myocardial revascularization, who present physiological changes secondary to procedure, in the biological area at neurological, cardiovascular, respiratory, and gastrointestinal level, elimination system and skin. Methodology: a descriptive study was performed and followed prospectively. The medical records of 151 patients in postoperative 48 to 96 hours were seen and reviewed. The review of the medical history was performed by the researcher. The information was collected on a recording sheet and then recorded and processed by methods of multidimensional exploratory analysis: Multiple correspondence analysis combined with Cluster Classification Method. Results: they were related to the kind of patient according to clinical events present in each of the studied systems where there is evidence of alteration of the neurological, cardiovascular and respiratory systems, and skin. Conclusion: the characterization of patients in postoperative of myocardial revascularization allows nursing care to be focused on solving problems of the aforementioned systems.

Coronary heart disease: self-care, communication and quality of life.

Aysha Mendes discusses coronary heart disease, the UK's biggest killer, and describes the range of roles that nurses play in prevention, treatment and support.

A randomized controlled trial of an educational programme to improve self-care in Brazilian patients following percutaneous coronary intervention.

AIMS: To test an educational programme with telephone follow-up to improve self-care in Brazilian patients who underwent percutaneous coronary intervention. BACKGROUND: Percutaneous coronary intervention has been established as a treatment for coronary disease. However, additional intervention is needed to improve self-care for individuals who undergo this procedure to reduce further disease. Telephone follow-up is one strategy that has been used to improve chronic disease self-care. DESIGN: Randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01341093. METHODS: Sixty patients who were preparing for their first percutaneous coronary intervention between 2011-2012 were randomly allocated to an educational programme with telephone follow-up (N = 30) or a control group (N = 30). Perceived health status was assessed with the Medical Outcomes Study 36-Item Short Form. Self-efficacy, symptoms of anxiety and depression and medication adherence were also assessed. Measures were collected before intervention (baseline) and 6 months later. RESULTS: Both groups improved from baseline to 6 months in the 'Physical Component Summary' and in the domains of 'Physical Functioning', 'Role-Emotional' and 'Role-Physical'. The educational programme group showed a reduction in anxiety from baseline to 6-month follow-up, while the control group showed a slight increase. No differences in symptoms in depression and self-efficacy were found and both groups reported high levels of medication adherence. CONCLUSION: The educational programme with telephone follow-up is a promising intervention as it led to reduction in anxiety for those receiving the educational programme. Further improvements in timing and focus of the educational programme, such as targeting emotional and social lifestyle changes, might be warranted.

Evaluation of nurses' perceptions of the impact of targeted depression education and a screening and referral tool in an acute cardiac setting.

AIMS AND OBJECTIVES: The aim of this study was to evaluate nurses' perceptions of an education programme and screening and referral tool designed for cardiac nurses to facilitate depression screening and referral procedures for patients with coronary heart disease. BACKGROUND: There is a high prevalence of depression in patients with coronary heart disease that is often undetected. It is important therefore that nurses working with cardiac patients are equipped with the knowledge and skills to recognise the signs and symptoms of depression and refer appropriately. DESIGN: A qualitative approach with purposive sampling and semi-structural interviews was implemented within the Donabedian 'Structure-Process-Outcome' evaluation framework. METHODS: Semi-structured interviews were conducted with 14 cardiac nurses working in a major metropolitan hospital six weeks post-attending an education programme on depression and coronary heart disease. Thematic data analysis was implemented, specifically adhering to Halcomb and Davidson's (2006) pragmatic data analysis, to examine nurse knowledge and experience of depression assessment and referral in an acute cardiac ward. RESULTS: The key findings of this study were that the education programme: (1) increased the knowledge base of nurses working with cardiac patients on comorbid depression and coronary heart disease, and (2) assisted in the identification of depression and the referral of 'at risk' patients. CONCLUSIONS: Emphasis was placed on the translational significance of educating cardiac nurses about depression via the introduction of a depression screening and referral instrument designed specifically for use in the cardiac ward. As a result, participants found they were better equipped to identify depressive symptoms and, guided by the screening instrument, to confidently instigate referral procedures. RELEVANCE TO CLINICAL PRACTICE: Much complexity lies in caring for cardiac patients with depression, including issues such as misdiagnosis. Targeted education, including use of appropriate instruments, has the potential to facilitate early recognition of the signs and symptoms of depression in the acute cardiac setting.

An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial.

BACKGROUND: Most people referred to rapid access chest pain clinics have non-cardiac chest pain, and in those diagnosed with stable coronary heart disease, guidance recommends that first-line treatment is usually medication rather than revascularisation. Consequently, many patients are not reassured they have the correct diagnosis or treatment. A previous trial reported that, in people with non-cardiac chest pain, a brief discussion with a health psychologist before the tests about the meaning of potential results led to people being significantly more reassured. The aim of this pilot was to test study procedures and inform sample size for a future multi-centre trial and to gain initial estimates of effectiveness of the discussion intervention. METHODS: This was a two-arm pilot randomised controlled trial in outpatient rapid access chest pain clinic in 120 people undergoing investigation for new onset, non-urgent chest pain. Eligible participants were randomised to receive either: a discussion about the meaning and implication of test results, delivered by a nurse before tests in clinic, plus a pre-test pamphlet covering the same information (Discussion arm) or the pre-test pamphlet alone (Pamphlet arm). Main outcome measures were recruitment rate and feasibility for a future multi-centre trial, with an estimate of reassurance in the groups at month 1 and 6 using a 5-item patient-reported scale. RESULTS: Two hundred and seventy people attended rapid access chest pain clinic during recruitment and 120/270 participants (44%) were randomised, 60 to each arm. There was no evidence of a difference between the Discussion and Pamphlet arms in the mean reassurance score at month 1 (34.2 vs 33.7) or at month 6 (35.3 vs 35.9). Patient-reported chest pain and use of heart medications were also similar between the two arms. CONCLUSIONS: A larger trial of the discussion intervention in the UK would not be warranted. Patients reported high levels of reassurance which were similar in patients receiving the discussion with a nurse and in those receiving a pamphlet alone. TRIAL REGISTRATION: Current Controlled Trials ISRCTN60618114 (assigned 27.05.2011).