Application of the WeChat Platform to Implement Continuous Nursing for Patients After Percutaneous Coronary Intervention.

BACKGROUND Percutaneous coronary intervention (PCI) is an effective treatment for coronary heart disease. However, a lack of cardiac rehabilitation and continuous nursing management leads to repeated patient hospitalizations. Long-term systematic rehabilitation and nursing management after discharge are key to ensuring quality of treatment and patient quality of life. This study aimed to explore the application of the WeChat platform in continuous nursing after PCI. MATERIAL AND METHODS This was a retrospective case-control study. The clinical data of 63 patients in our cardiac center who underwent PCI between June 2017 and January 2018 were recorded. Patients were divided into 2 groups: the continuous nursing through the WeChat platform (intervention) group and the conventional nursing (control) group. The Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Seattle Angina Questionnaire (SAQ) were used as the evaluation tools. RESULTS The SAQ scores in all 5 SAQ dimensions in the continuous nursing group were significantly higher than those of the control group at the 1-year follow-up. Scores on the SAS and SDS scales at 1-year follow-up were significantly better in the intervention group than in the control group. The SAS and SDS scores in both groups were better at the 1-year follow-up, but the difference was statistically significant in the continuous nursing group and not in the control group. CONCLUSIONS Using the WeChat platform can make continuous nursing more convenient and effective for patients after PCI. It may reduce the occurrence of complications, relieve patient depression and anxiety, and improve patient quality of life.

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.

Nefropatia inducida por contraste: identificación de riesgos para promoción de buenas prácticas / Contrast-induced nephropathy: identification of risks to promote good practices / Nefropatia induzida por contraste: identificação de riscos para promoção de boas práticas

Objetivo: Identificar factores de riesgo para nefropatía inducida por contraste (NIC) en pacientes sometidos al procedimiento de angioplastia coronaria transluminal percutánea (ACTP) y discutir los cuidados de enfermería en la perspectiva de las buenas prácticas para minimizarla. Método: Estudio transversal, retrospectivo, cuantitativo, realizado de enero a diciembre de 2015, utilizando análisis documental mediante registros médicos. Resultados: Se seleccionaron 87 registros. El sexo masculino prevaleció con el 67,8% (59), con un promedio de edad de 58,8 +/- 10,4. Se notó que 6 (6,8%) utilizaron inyecciones de contraste entre 100 ml o más y 32 (36,8%) presentaron cambios en los valores de hematocrito. Sobre el riesgo para nefropatía, 24 (27,6%) presentaron de moderado a altísimo. Conclusión: Factores de riesgo para NIC son frecuentes en pacientes que realizan ACTP. Así, discutir cuidados de enfermería que puedan colaborar en la identificación y prevención del problema renal es estratégico y contribuye a buenas prácticas

Objective: To identify the risk factors for contrast-induced nephropathy (CIN) in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and discuss the nursing care from the perspective of good practices in order to minimize it. Method: Cross-sectional, retrospective, quantitative study carried out from January to December 2015, using documentary analysis through medical records. Results: Eighty-seven medical records were selected. The male sex prevailed with 67.8% (59), with a mean age of 58.8 +/- 10.4. It was seen that 6 patients (6.8%) used contrast injections between 100 ml or more and 32 (36.8%) presented alterations in hematocrit values. Concerning the risk for nephropathy, 24 (27.6%) presented moderate to very high risk. Conclusion: Risk factors for CIN are common in patients who undergo PTCA. Thus, discussing nursing care that can collaborate in the identification and prevention of kidney injury is strategic and contributes to good practices

Objetivo: Identificar os fatores de risco para nefropatia induzida por contraste (NIC) nos pacientes que se submeteram ao procedimento de angioplastia coronária transluminal percutânea (ACTP) e discutir os cuidados de enfermagem na perspectiva das boas práticas para minimizá-la. Método: Estudo transversal, retrospectivo, quantitativo, realizado de janeiro a dezembro de 2015, que utilizou análise documental através de prontuários. Resultados: foram selecionados 87 prontuários. O sexo masculino prevaleceu com 67,8% (59), com uma média de idade de 58,8 +/-10,4. Verificou-se que 6 pacientes (6,8%) utilizaram injeções de contraste entre 100 ml ou mais e 32 (36,8%) apresentaram alterações nos valores de hematócrito. Quanto ao risco para nefropatia, 24 (27,6%) apresentaram de moderado a altíssimo. Conclusão: Fatores de risco para NIC são frequentes nos pacientes que realizam ACTP. Assim, discutir cuidados de enfermagem que possam colaborar na identificação e prevenção da injúria renal é estratégico e contribui para boas práticas

Decreasing length of limb immobilisation following nonelective transfemoral percutaneous coronary intervention: A randomised clinical trial.

AIMS AND OBJECTIVES: To assess the intensity and frequency of pain, use of analgesic drugs, and the incidence of paraesthesia, urinary retention and vascular complications upon decreasing affected limb immobilisation from 4-2 hrs after sheath removal in patients submitted to transfemoral percutaneous coronary intervention (PCI). BACKGROUND: After sheath removal from the femoral artery following urgent or emergency PCI, patients are maintained with limb immobilisation for a mean period of 4 hr. DESIGN: Randomised clinical trial (RCT) based on the CONSORT guidelines. METHOD: Randomised clinical trial was performed in patients with Acute Coronary Syndrome submitted to transfemoral PCI. The intervention group was submitted to a supine position with the head of the bed elevated (30-degree angle) with affected limb immobilisation for 2 hr after sheath removal and the control group for 4 hrs. The outcomes were pain complaints, need for analgesic drugs, incidence of paraesthesia, urinary retention and vascular complications. The outcomes were assessed immediately, 6, 12 and 24 hr after release from limb immobilisation before the patients were released from bed rest. RESULTS: A total of 150 patients (75 in each group) participated in the study. No significant differences in outcomes were observed between the groups, except in relation to the haematoma formation that was higher in the intervention group. CONCLUSION: A reduced length of limb immobilisation after sheath removal following PCI does not change the frequency and intensity of pain, need of analgesic drugs, urinary retention and paraesthesia. The incidence of haematoma was higher in the intervention group, without significant clinical manifestations. RELEVANCE TO CLINICAL PRACTICE: The results of this study can be considered for patients submitted to elective, urgent or emergency PCI, who have a lower risk of complications, thereby allowing for decreased periods of limb immobilisation.

Nurses' recognition and response to clinical deterioration in the cardiac catheterisation laboratory.

BACKGROUND: Patients presenting to the cardiac catheter laboratory for treatment of unstable acute coronary syndromes (ACS) experience a mismatch in myocardial oxygen supply and demand, causing vital sign abnormalities prior to neurological, cardiac and respiratory deterioration. Delays in detecting clinical deterioration and escalating care increases risk of adverse events, unplanned intensive care (ICU) admission, cardiac arrest, and in-hospital mortality. OBJECTIVES: The objective of the study was to explore how nurses in the cardiac catheter laboratory (CCL) recognise and respond to clinical deterioration in patients with unstable ACS undergoing primary percutaneous coronary intervention (PCI). METHODS: A prospective exploratory descriptive design was used with 30 participants completing 10 written clinical scenarios. Participants scored their level of concern for each physiological cue and then then ranked their preferred immediate response based on the deterioration identified. RESULTS: Hypotension and the presence of pain were the physiological cues of highest concern. The most common responses to clinical deterioration were to increase vital sign assessment to 5-minutely intervals, administer pain relief or provide reassurance. Despite the presence of clinical deterioration fulfilling organisational escalation of care criteria, calling cardiac arrest or rapid response team (RRT) were not commonly selected responses. CONCLUSION: Nurses most commonly use hypotension and the presence of pain to recognise clinical deterioration in patients presenting to the CCL with an unstable ACS. Once clinical deterioration is identified, interventional cardiac nurses delay the escalation of care to the RRT or cardiac arrest team, preferring to implement local nurse initiated interventions.

Family involvement in rehabilitation: Coronary artery disease-patients' perspectives.

AIMS AND OBJECTIVES: To describe coronary artery disease patients' perceptions of family involvement in rehabilitation and the connection between background factors and family involvement. BACKGROUND: Coronary artery disease patients' hospital stays can be very concise. Family members can support rehabilitation, but many challenges can emerge. There is a need to nurture patients and family members in an individual way and to recognise their concerns. More accurate patient education should be available for patients and their family members. DESIGN: This study is a descriptive cross-sectional study. METHODS: Data were collected from patients with coronary artery disease at least 6 weeks after discharge from hospital (n = 169) with a postal questionnaire. The Family Involvement in Rehabilitation (FIRE) scale measures family members' promotion of patients' rehabilitation and issues encumbering rehabilitation in family. The data have been analysed with statistical methods. Both parametric and nonparametric tests were used to evaluate group differences. RESULTS: Patients with coronary artery disease perceived that family promotes their rehabilitation significantly. Respondents also perceived challenges at home. Family relations before hospitalisation were related to all subareas of family promoting rehabilitation and one subarea of issues encumbering rehabilitation in family. Patients with symptoms at rest also had more encumbrance on their rehabilitation. Patients who had undergone coronary artery bypass surgery perceived more challenges than percutaneous coronary intervention (PCI) patients in many subareas of issues encumbering rehabilitation in family. CONCLUSIONS: Family relations prior to illness and the rigour of heart symptoms are significantly relevant to challenges that can occur between patient and their family members. RELEVANCE TO CLINICAL PRACTICE: Healthcare staff need to pay attention to coronary artery disease patients' individual situation, and patient education should be more family-centred. In the future, it would be noteworthy to collect more data from family members of patients with coronary artery disease and to find out their perceptions of family involvement.

Consensus Statement of Standards for Interventional Cardiovascular Nursing Practice.

Interventional cardiovascular nursing is a critical care nursing specialty providing complex nursing interventions to patients prone to clinical deterioration, through the combined risks of the pathophysiology of their illness and undergoing technically complex interventional cardiovascular procedures. No guidelines were identified worldwide to assist health care providers and educational institutions in workforce development and education guidelines to minimise patients' risk of adverse events. The Interventional Nurses Council (INC) developed a definition and scope of practice for interventional cardiac nursing (ICN's) in 2013. The INC executive committee established a working party of seven representatives from Australia and New Zealand. Selection was based on expertise in interventional cardiovascular nursing and experience providing education and mentoring in the clinical and postgraduate environment. A literature search of the electronic databases Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Health Source was performed, using the search terms: clinical deterioration, ST elevation myocardial infarction, vital signs, primary percutaneous coronary intervention, PCI, AMI, STEMI, acute coronary syndrome, peri-procedural care, unstable angina, PCI complications, structural heart disease, TAVI, TAVR, cardiac rhythm management, pacing, electrophysiology studies, vascular access, procedural sedation. Articles were limited to the cardiac catheterisation laboratory and relevance to nursing based outcomes. Reference lists were examined to identify relevant articles missed in the initial search. The literature was compared with national competency standards, quality and safety documents and the INC definition and scope of practice. Consensus of common themes, a taxonomy of education and seven competency domains were achieved via frequent teleconferences and two face-to-face meetings. The working party finalised the standards on 14 July 2017, following endorsement from the CSANZ, INC, Heart Rhythm Council, CSANZ Quality Standards Committee and the Australian College of Critical Care Nurses (ACCCN). The resulting document provides clinical practice and education standards for interventional cardiac nursing practice.

Enhancing Outcomes for Outpatient Percutaneous Coronary Interventions.

PURPOSE AND OBJECTIVES: A quality improvement project was conducted to create a sustainable continuum of care for increased volumes of outpatients receiving percutaneous coronary interventions. Dramatic growth exposed system vulnerabilities and left staff overwhelmed. Four postinterventional project objectives included reducing preprocedural preparation times, reducing bleeding complications, reducing hospital length of stay, and collectively increasing patient satisfaction. DESCRIPTION OF THE PROJECT: Amidst creating a specialized postintervention coronary recovery area and acquiring and training existing preregistration and recovery nurses, a fragmented system of care was united. The clinical nurse specialist-led project used a systematic and evidence-based implementation process to harmoniously acclimate perioperative staff. An evaluation process further defined new opportunities to support a growing service line. OUTCOMES: Postimplementation data were collected over a 3-month period. An overall improvement was found in all targeted objectives, despite an upsurge in case volumes. A moderately significant correlation (r [105] = 0.424, P < .001) was found between bleeding occurrences and hospital length of stay. CONCLUSION: The synergy between interdepartmental collaboration and strategic staffing reallocation was shown to be invaluable to alleviate procedural areas of service, such as the cardiac catheterization laboratory. As a project champion, the clinical nurse specialist is an essential catalyst to identify and creatively surmount system-level challenges.

Exploring the Perceptions and Health Behaviours of Patients Following an Elective Ad-hoc Percutaneous Coronary Intervention: A Qualitative Study.

RESULTS: Participants expressed uncertainty about their future health and feared disease recurrence, which appeared to provide motivation for adopting a healthier lifestyle. Although two participants voiced the belief that the elective PCI cured their disease, this perception did not appear to influence their engagement in risk reduction behaviours. However, systemfactors such as a lack of information, direction, and/or support from health care providers appeared to play a limiting role in their ability to move forward with lifestyle change. BACKGROUND: Elective ad-hoc percutaneous coronary interventions (PCIs) are increasingly used to manage the symptoms of coronary artery disease (CAD). However, we have limited understanding of the patients' experiences and health behaviours post-procedure. PURPOSE: Explore the factors that influence the perceptions and health behaviours of patients after elective ad-hoc PCI. METHODS: This interpretive descriptive study used purposive sampling to recruit participants (N = 10) aged 44 to 65 years following an elective ad-hoc PCI from a cardiac catheterization laboratory at a tertiary centre in Winnipeg, MB. Participants were interviewed 11 to 35 days following their procedure. Recruitment continued until no new substantive themes emerged. The Health Belief Model provided the frameworkfor developing, exploring, interpreting, and analyzing the data. PRACTICE IMPLICATIONS: Nurses have a key role in the education of patients and in providingpatient-centred care that supports lifestyle change. Nurses need to develop strategies that decrease barriers to engaging in risk reduction behaviours following elective ad-hoc PCI if patients are to experience improved health and longevity.

Implementation Strategies for Same Day Discharge Post Percutaneous Coronary Intervention: An Integrative Review.

BACKGROUND: Same day discharge following percutaneous coronary intervention has emerged worldwide to enhance discharge efficiency and decrease length of stay. However, uptake of this practice is variable and strategies to support its implementation have not been examined. RESEARCH QUESTION: Among patients who undergo nonurgent percutaneous coronary intervention, what components are included in and which strategies are used to facilitate the implementation of same day discharge in clinical practice? METHODS: An integrative review was conducted. Keywords including same day discharge, outpatient, percutaneous coronary intervention, outpatient coronary stenting were used to search databases including Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBase, Cochrane, and Medline between 1990 and 2014. Data were extracted and summarized specific to: (a) components of same day discharge, (b) patient selection, and (c) strategies used to implement same day discharge. RESULTS: Nineteen articles were included that provided information about implementation strategies for same day discharge. Variability was identified in how same day discharge was operationalized, how patients were selected, and the strategies that were used to implement same day discharge. Culture, patient preference, and acceptance of same day discharge were important for its implementation. Guideline or protocol, physical environment, champion, education, audit or feedback, and team building were all found to be important strategies in implementing same day discharge. LINKING EVIDENCE TO ACTION: The results of this integrative review inform our understanding of how same day discharge is operationalized and what strategies can be used to implement same day discharge. The findings of the review highlight that there is a need for more research examining implementation strategies in a detailed manner that can assist others to introduce and sustain same day discharge in routine practice.

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.

Bed rest duration after sheath removal following percutaneous coronary interventions: a systematic review and meta-analysis.

AIMS AND OBJECTIVES: To explore the effect of bed rest duration after sheath removal following percutaneous coronary interventions on the incidence of vascular complications, back pain and urinary problems. BACKGROUND: According to the literature, the duration of bed rest after sheath removal following percutaneous coronary interventions ranges from 2-24 hours. Several studies have assessed the effect of duration of bed rest on vascular complications, but a clear final conclusion about the exact duration of bed rest has not been reached. DESIGN: Systematic review and meta-analysis. METHODS: Cochrane Library, MEDLINE, SCOPUS, CINAHL, IranMedex and IranDoc were searched. No language limitation was applied. RCTs that used two different periods for ambulation were included. Two reviewers separately assessed the quality of each included study and extracted the data. Dichotomous outcomes were recorded as odds ratio with 95% confidence interval. RESULTS: Five studies involving 1115 participants were included in the review. Among them, two studies had three comparison groups. The studies considered a variety of periods as early and late ambulation, ranging from 2-10 hours. Totally, there were no statistically significant differences in the incidence of bleeding, pseudoaneurysm, arteriovenous fistula and urinary problems between early and late ambulation. There was a statistically significant reduction in the risk of haematoma formation at four to six hours of bed rest compared with eight hours of bed rest (odds ratio = 0·37, 95% CI: 0·15, 0·91). Back pain was reported in one study evaluating three hours of bed rest with an odds ratio of 0·45 (95% confidence interval: 0·28, 0·71) when compared with 10 hours of bed rest. CONCLUSIONS: Early ambulation after percutaneous coronary interventions is safe and feasible; however, the results should be used with caution as the majority of included studies had methodological flaws. RELEVANCE TO CLINICAL PRACTICE: The results of this study suggest that patients could be ambulated three to four hours after sheath removal following percutaneous coronary interventions and early ambulation dose does not increase the risk of vascular complications, but it moderates back pain occurrence.

[Perceived health status and pharmacological adherence of patients who underwent percutaneous coronary intervention]. / Estado de saúde percebido e adesão farmacológica em pacientes submetidos à intervenção coronária percutânea.

The objectives of this study were to evaluate the perceived health status and pharmacological adherence, and to verify the correlation between these measures in patients who underwent percutaneous coronary intervention, after hospital discharge. It was a cross-sectional study carried out from May 2011 to July 2012. The instruments used were: SF-86 and Measurement of Adherence to Treatment, with 101 patients, 54 (53.5%) of which were men; average age of 59.5 +/- 10.3; and 32 (32.7%) with previous cardiac treatment. All study participants were using antihypertensive drugs; the majority 99 (98%) used antiplatelet drugs; 98 (97%) used cholesterol reducers, and 59 (58.4%) used coronary vasodilators. The average number of drugs used was 6.8 +/- 2.1. Pharmacological adherence was observed in 98 (97%) patients. The participants presented best perceived health status in Social Functioning and Physical Functioning. Positive correlations of moderate magnitude were found between measurements of pharmacological adherence and Physical Functioning, General Health and Social Functioning. There was correlation between pharmacological adherence and perceived health status.

Estado de saúde percebido e adesão farmacológica em pacientes submetidos à intervenção coronária percutânea / Estado de salud percibido y la adhesión farmacológica en pacientes sometidos a intervención coronaria percutánea / Perceived health status and pharmacological adherence of patients who underwent percutaneous coronary intervention

Os objetivos foram avaliar o estado de saúde percebido e a adesão farmacológica, e verificar a correlação entre essas medidas em pacientes submetidos à intervenção coronária percutânea, após alta hospitalar. Trata-se de estudo transversal realizado no período de maio de 2011 a julho de 2012. Utilizaram-se os instrumentos SF-36 e Medida de Adesão aos Tratamentos, com 101 pacientes. Destes, 54 (53,5%) eram homens, a idade média era 59,5±10,3 e 32 (32,7%) haviam passado por tratamento cardíaco prévio. Todos utilizavam medicamentos anti-hipertensivos; 99 (98%) utilizavam antiagregantes plaquetários; 98 (97%), redutores de colesterol e 59 (58,4%), vasodilatadores coronarianos. A média do número de medicamentos utilizados foi 6,8±2,1. A adesão farmacológica foi verificada em 98 (97%) pacientes. Os participantes apresentaram melhor estado de saúde nos componentes "Aspectos sociais" e "Capacidade funcional". Constataram-se correlações positivas e de moderada magnitude entre as medidas de adesão e "Capacidade funcional", "Estado geral de saúde" e "Aspectos sociais". Houve correlação entre adesão farmacológica e estado de saúde percebido.

Las finalidades fueran evaluar el estado de salud percibido y la adhesión farmacológica y, verificar la correlación entre esas medidas en pacientes sometidos a intervención coronaria percutánea, tras el alta. Estudio transversal, realizado en el periodo de mayo/2011 a julio/2012. Los instrumentos utilizados fueron: SF-36 y Medida de Adhesión a los Tratamientos, con 101 pacientes, 54 (53,5%) hombres; promedio de edad 59,5±10,3; con tratamiento cardiaco previo 32 (32,7%). Todos estaban usando medicación antihipertensiva, la mayoría utilizaba antiplaquetario, 99 (98%); reductores de colesterol, 98 (97%); y vasodilatadores coronarios, 59 (58,4%). El número promedio de medicamentos utilizados fue 6,8±2,1. Se observó la adherencia farmacológica en 98 (97%) pacientes. Los participantes mostraron mejor estado de salud en los Aspectos Sociales y Capacidad Funcional. Fueron encontradas correlaciones positivas y moderadas entre la medida de adhesión farmacológica y Capacidad Funcional, Salud General y Aspectos Sociales. Hubo correlación entre adhesión farmacológica y estado de salud percibido.

The objectives of this study were to evaluate the perceived health status and pharmacological adherence, and to verify the correlation between these measures in patients who underwent percutaneous coronary intervention, after hospital discharge. It was a cross-sectional study carried out from May 2011 to July 2012. The instruments used were: SF-36 and Measurement of Adherence to Treatment, with 101 patients, 54 (53.5%) of which were men; average age of 59.5±10.3; and 32 (32.7%) with previous cardiac treatment. All study participants were using antihypertensive drugs; the majority 99 (98%) used antiplatelet drugs; 98 (97%) used cholesterol reducers, and 59 (58.4%) used coronary vasodilators. The average number of drugs used was 6.8±2.1. Pharmacological adherence was observed in 98 (97%) patients. The participants presented best perceived health status in Social Functioning and Physical Functioning. Positive correlations of moderate magnitude were found between measurements of pharmacological adherence and Physical Functioning, General Health and Social Functioning. There was correlation between pharmacological adherence and perceived health status.

Transitioning to transradials: a collaborative process in the cardiac catheterization laboratory.

As transradial approaches to cardiac catheterizations and percutaneous coronary interventions steadily rise in the United States, we reviewed evidence-based studies to compare the radial and femoral approaches to cardiac catheterization. The purpose of this article was to provide an overview of transradial and femoral approaches for cardiac catheterizations and percutaneous coronary interventions, preparation for the procedure, and nursing management of these patients. The strategies used to develop the transition process are also discussed.

Managing risk of complications at femoral vascular access sites in percutaneous coronary intervention.

Percutaneous coronary intervention for acute coronary syndrome or non-ST-elevation myocardial infarction requires the use of potent oral and intravenous anti-platelet and antithrombin medications. Although these potent antithrombotic agents and regimens may increase the effectiveness of percutaneous coronary intervention, they are also generally associated with an increased risk of vascular access complications such as hematoma, retroperitoneal hematoma, pseudoaneurysm, arterial occlusion, and arteriovenous fistula, which in turn are associated with increased morbidity, mortality, and costs. Risk factors predisposing patients to these complications are both modifiable (procedure technique, medications, hemostasis method) and nonmodifiable (sex, age, body mass index, blood pressure, renal function). Patients' risks can be reduced by nurses who are knowledgeable about these risk factors and identify complications before they become problematic.