bluuebunny/crossref_metadata_2025_split huggingface dataset:
Re-engineering the cardiology ward round to improve efficiency of care
Authors: Lymn A , Clark R , Lambrakis K , Chew D 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Flinders Medical Centre and Flinders University.

Background
There is limited literature investigating effective mechanisms improving clinical team cohesion and effectiveness to achieve clinical excellence.

Purpose
To re-engineer the cardiac care unit (CCU) ward rounds through enhanced cardiac-trained nurse input and advocacy to improve decision-making and deliver patient centred care.

Methods
A prospective observational design, ensuring CCU nurse attendance at every ward round (arrhythmia, acute coronary syndrome, heart failure) in consecutive 2-week control and implementation periods, conducted over three 4-week cycles. The primary endpoint was timely administration of cardiac medications. Secondary endpoints were length of stay, time to procedure bookings, patient mobility and education.

Results
206 patients were recruited (control n=101, intervention n=105). Median time to cardiac medication administration was significantly shorter in the intervention cycle, (Intervention:0 hr/med [IQR 0-0.5] versus Control: 0.2 hr/med [IQR 0-1.2],p = 0.012). Heart Failure patients had the most significant improvements; (Intervention 0 hr/med [IQR 0-0.03] versus control 0.9 hr/med [IQR 0.3-1.6], p&lt;0.001). Secondary endpoints trended toward improvement in all ward rounds, but results did not reach statistical significance. See Figure 1.

Conclusion
Empowering CCU nurses on ward rounds reduced medication delays, with clinically valuable improvements in secondary endpoints observed. Further research into implementable and sustainable interventions to drive clinical excellence is essential.Cardiac Medication Delays
Procedure videos to support rare clinical procedures in acute cardiac nursing, an implementation evaluation
Authors: Colgan J , Miles K , Kourouche S , Tofler G , Buckley T 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Central Coast Local Health District Research Grant.

Background
Cardiology procedures are often lifesaving and time-critical, but some are so infrequent that nurses may have rarely encountered them in practice. Videos demonstrating rare procedures can potentially support clinicians performing rare clinical procedures. We evaluated using locally created nursing clinical procedure videos as an adjunct to traditional written procedures.

Purposes
This study evaluated the implementation of 7 newly created clinical procedure videos on temporary cardiac pacing (n=3), non-invasive ventilation (NIV) (n=2) and pericardiocentesis (n=2).

Methods
A pre/ post -implementation Survey based on the Theoretical Domains Framework (TDF), Clinical Reasoning Cycle and the Spielberger State-Trait Anxiety Inventory (STAI) was distributed via email and Facebook groups to over 500 eligible nurses in the implementation sites. In addition, data from the hosting platform Vimeo for the implementation period and procedure numbers (15 October 2020 to 15 March 2021) were analysed.

Results
122 respondents, 86% female, viewed the videos, mean age of 40.75 years (20 to 71 years). The most common procedure during the implementation period was NIV (n=170), followed by Pericardiocentesis (n=7) and Temporary Cardiac Pacing (n=5). The total number of video views over the 6 months was 598, temporary pacing-preparation (n=152), NIV Mask why and when (n=137), NIV Set up and Patient Care (n=89), Pacing: Procedure (n=62), Cardiac Tamponade (n=52), Pacing: Threshold testing and Pericardiocentesis Procedure (n=51 each). Participants agreed /strongly agreed that video procedures increased their recall (93.8%), made learning a better experience (98.3%), and was time-saving (88.0%) (Figure 2). Participants preferred videos to be an adjunct to existing written procedures and not a replacement (78%). Major themes from qualitative feedback included participants describing them as "clear and easy to understand" and the benefits of videos for rare procedures "Rarely seen in ED easy to follow and fast refresher when the procedure is time critical".
Prior to implementation, the mean score for state anxiety before a rare procedure was 41.43 (SD= 9.307) with scores over 40 indicating clinically significant levels of anxiety. Older age and a higher number of years in the role were significantly correlated with lower anxiety levels (r = -0.144 p = .037; and r = 0.532 p = .000) perceived anxiety related to rare procedures did not significantly change from pre- to post-implementation.

Conclusion
Clinical procedure videos at the point of care are acceptable and valued. Findings suggest videos are a useful adjunct to written procedures for time-critical or rare procedures.Figure 2:Experience with video.
Patient experiences of remote hypertension management during covid-19: a qualitative study
Authors: Mchale S , Hanley J , Paterson M 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): British Heart Foundation.

Background
Telemonitoring of blood pressure [BP] managed within primary care is effective in reducing the risk of cardiovascular disease in patients with hypertension. However, COVID-19 disrupted service delivery and affected the support of people living with hypertension. It is unknown how patients who did or did not utilise telemonitoring self-managed their BP during the pandemic.

Purpose
To understand patients’ experience of hypertension service delivery in Scotland during the COVID-19 pandemic, with a focus on the use of remote BP telemonitoring technology.

Methods
Qualitative individual semi-structured telephone interviews were conducted between April and November 2022. Interview transcripts were analysed using the framework approach to code and categorise the data into key concepts and overarching themes.

Results
We interviewed 43 participants (23 males and 20 females) from 6 primary care practices. From the views of 25 patients utilising telemonitoring technology and 18 who did not, we identified five overarching themes that represented participants' experiences of hypertension services delivery during the COVID-19 pandemic. 1) Adapting NHS services. Covid-19 disrupted routine services and resulted in infrequent in-person health checks for BP, asthma, and diabetes for both groups and a lack of primary care feedback for non-telemonitored patients’ home-monitored BP. 2) Navigating access to services. Gaining timely and/or in-person access to services was challenging. Also there was fear and delay in access because it was viewed as a source of covid infection. 3) Telemonitoring. Remote telemonitoring permitted telemonitoring participants to continue receiving hypertension management during the pandemic. 4) Self-management of BP. Some non-telemonitoring participants were motivated to self-measure BP readings using home monitoring equipment to increase self-care for hypertension and lifestyle. Also, some telemonitoring participants were empowered to self-manage medication changes. 5) Experiences of covid. Upon contracting the covid-19 virus, some participants experienced an immediate increase in their BP, and post-virus, longer-term increased BP readings and/or feelings of chest discomfort and breathlessness.

Conclusions
The covid-19 pandemic disrupted care for patients with hypertension and although it was clear that service delivery had been adapted, patients were unwilling to access the NHS due to covid-19 risk and found access to effective primary care support difficult. When compared to non-telemonitoring, telemonitoring provided a more direct link to the primary care team who were able to manage hypertension remotely. The service disruption may have longer-term implications for patient health outcomes; however, this study suggests there is greater scope for self-management of hypertension than currently recommended.
Delivery of virtual acute cardiac care- a pilot study
Authors: Martin L , Naismith C , Horrigan M 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The increasing incidence of chronic conditions, along with the SARS CoV-2 pandemic, put unprecedented capacity restraints on hospital bed access. New models of care are required to meet the increasing clinical demand for hospital services. Digital health technologies to support virtual hospital in the home services may address this need by offering patient-centered, safe and efficient models of care that are not reliant on physical hospital infrastructure. Specific cardiac conditions are well suited to a virtual model of care.

Purpose
To describe and evaluate a novel virtual model of care for cardiac patients that delivers early supported discharge from the acute inpatient ward to home.

Model of Care
The cardiac hospital in the home (cHITH) model was designed to provide an early supported discharge in a virtual ward environment by an expert team of advanced practice cardiac nurses, pharmacists and cardiologists. This 48-hour model of care utilized wearable technology to monitor cardiac rhythm and vital signs in conjunction with daily virtual ward rounds to manage recognised post operative/ procedural complications. Escalation pathways for clinical deterioration were designed to support patient safety. Transitional care to discharge was a key element of this model. Quality, safety, efficiency and patient experience were evaluated.

Key Results
From March-November 2022, 260 patients were referred to cHITH with 191 (74%) patients accepted according to the risk-stratification criteria. This cohort included post cardiac surgery (CSUR) patients (54%); post interventional procedures (31%), post device implant (6%) and other (9%). The cHITH length of stay (LOS) was 1.9 ± 0.1 days reflecting 20% of the episode of acute care delivered in the virtual environment. Re-admission rates were 9.4% at 30-days, with 0% mortality. Patient satisfaction was &gt;90% (net promoter score).
The CSUR cohort (n=103) had a mean age of 62 ± 4 years; male 82%; isolated CABG 62%; 30-day re-admission rate 7.8%. Total post-operative LOS was 7.1 ± 2.4 days with 35% of post-operative care delivered in the virtual cHITH environment. A total of 258 bed days were realized.

Conclusion
This pilot virtual model of care has demonstrated safety, efficiency and high levels of patient satisfaction. Ongoing analysis is required to understand the broader applications of this model and to further evaluate quality, safety and efficiency metrics.
Physical and perceived effort of patients with stroke during hospital-based rehabilitation when performing sit to stand: a pilot study
Authors: Roos R , Harington T , Comley-White N 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Information
Rehabilitation of patients with stroke includes optimisation of function and increasing individuals’ physical activity levels as a means of improving independence and preventing recurrence of cardiovascular events. Physical effort evaluation and monitoring is important to highlight exercise intensity level during rehabilitation. Sit to stand (STS) is a mechanically demanding functional task. Little is known about the physical effort experienced by patients with stroke when performing this activity during hospital-based rehabilitation.

Purpose
The study assessed the perceived effort, energy expenditure and metabolic equivalent of task (MET) levels of patients with stroke when performing STS as a means of outlining their physical effort.

Methods
A descriptive cross-sectional pilot study took place at two hospitals in Johannesburg, South Africa, between November 2018 to February 2020 and March to September 2021. Participants reported their perceived effort using the Modified Borg Scale (MBS) and their energy expenditure and MET level were assessed with a triaxial accelerometer. The Shapiro-Wilk Test was used to test for normality of data and descriptive and inferential statistics were used to determine findings (p-value set at ≤ 0.05).

Results
The team screened four hundred and twenty eight individuals for potential inclusion in the study. The pilot study consisted of nine participants (n=5 female, 55.5%), with a mean age of 52.77 (SD ± 11.33) years and mean body mass index of 24.31 (±5.36) kg/m2. Most had a haemorrhagic stroke (n=6, 66.6%), left hemiplegia (n=6, 66.6%), ‘mild’ stroke (n=7, 77.8%) as per the National Institutes of Health Stroke Scale and were assessed 9.11 (SD ±6.57) days post stroke. The mean time it took participants to complete STS was 6.04 (±4.03) seconds. Most participants (n=7, 77.8%) perceived STS at a ‘moderate’ or stronger effort level on the MBS. The calculated mean physical energy expenditure during STS was 2.82 (±1.9) kCal/min and the mean MET level 2.99 (±1.89). The correlation coefficient between the subjective perceived effort and physical effort as per energy expenditure was r = 0.61 (p = 0.08) and subjective perceived effort and MET level r = 0.34 (p = 0.38).

Conclusion
The ability to come from STS is one of the most frequent functional tasks used daily and a prerequisite to walking. Study participants’ exercise intensity during STS was much higher when compared to published literature in healthy individuals. This study found a fair to moderate positive correlation between physical effort parameters and MBS for patients with stroke during STS. The results did not meet statistical significance due to the small sample size, indicating further research is warranted.
The psychological effects of interventions targeting caregivers of patients with heart disease, a systematic review
Authors: Risom S , Moeller E , Wind G , Prip A , Hillersdal L , Pii K H , Grew J 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): University College Copenhagen, Denmark.

Background
The healthcare system is facing major challenges due to an increasing number of patients with chronic diseases, including patients with cardiovascular diseases. As a consequence more caregivers will experience having a greater role in the treatment and care of their loved ones. This can have significant psychological consequences for the caregivers. For that reason, there is a need for evidence-based interventions that support caregivers of patients with cardiovascular disease.
The aim: Is to contribute with evidence-based knowledge about the effects of interventions supporting caregivers in the care and treatment of patients with heart disease focusing on psychological effects.

Method
A systematic review has been conducted based on the methodology described by Cochrane Handbook (2022). The following databases have been searched: Pubmed, Embase, Cochrane Library, CINAHL & PsychInfo. The literature search was carried out on the basis of the developed search strategy and studies were collected based on pre-specified inclusion and exclusion criteria. Subsequently, a critical quality assessment using RoB-2 quality assessment tool, a data extraction and a data synthesis were carried out after.

Results
The systematic search revealed 3,659 manuscripts, from where eight randomized controlled studies were included. The results of the data synthesis showed that the interventions were heterogeneous in regard to timing, intensity, and length of interventions. Most of the interventions included educational face-to-face sessions, in combination with telephone support or written resources. Likewise, the synthesis showed inconsistent results across studies, but positive effects were seen on caregivers (including caregiver burden, quality of life and depression) in some studies and no harm were observed in any study. The results indicated that the intensity of the interventions was related to better outcomes.

Conclusion
The included studies contribute knowledge about the psychological effects of interventions targeting caregivers of patients with cardiovascular diseases. Overall, inconsistencies were found across studies, which can be expected to be attributed to the heterogeneity across the complex interventions. There is a need for further research in the area to map which elements or combinations of elements that are ideal to test in future interventions. The development of effective interventions supporting caregivers and their well-being is of great importance, as it has the potential to benefit patients, caregivers, as well as society in general.
Listening to the patient voice on home-based cardiac rehabilitation: a qualitative audit mapping patient-reported outcomes to current european guidelines
Authors: Talty A , Morris R , Deighan C , Cameron S , Taylor L 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): NHS Lothian.

Background and Purpose
Increasing evidence supports the efficacy of facilitated home-based cardiac rehabilitation as an alternative to hospital-based rehabilitation for individuals recovering from myocardial infarction and revascularisation. The objective of this audit was to explore qualitative patient-reported outcomes of a home-based cardiac rehabilitation programme in relation to current european guidelines.

Methods
Following their participation in the six-week cardiac rehabilitation programme, patients completed an evaluation questionnaire consisting of 1) a 25-item survey rating their satisfaction with elements of the programme and 2) five open-ended questions regarding their experiences and resulting outcomes. The anonymous patient responses were transcribed and stored securely using an electronic database. For the purpose of this audit, the qualitative data from 203 patients between April 2021 and January 2023 were analysed. The data was coded into the key risk, psychosocial and behavioural factors presented in current european guidelines, while also capturing additional themes. Once identified, inductive thematic analysis was employed to extract further meaning from featured codes.

Results
Deductive coding identified the following constructs from the guidelines within the data: risk factors (blood pressure, cigarette smoking, diabetes mellitus, adiposity), sex and gender and their impact on health, communication of cardiovascular disease risk, psychosocial factors, optimising lifestyle (physical activity and exercise, and nutrition and alcohol) and medication adherence. Within this, inductive themes that emerged included: successful risk modification (of factors such as diabetes and adiposity), successful behaviour modification, increased awareness, understanding and confidence, decreases in stress and anxiety, increased pacing and relaxation, preference for more content, resentment of generalised information, the impact of Covid-19 and the benefit of the programme to family members.

Conclusions
The results of this qualitative audit suggest that patient satisfaction was high, post-participation in the cardiac rehabilitation programme. The findings of reported successful risk and behaviour modification in relation to nutrition, exercise, smoking, alcohol intake, diabetes, adiposity and psychological factors indicate the programme’s efficacy in facilitating lifestyle changes amongst cardiac rehabilitation patients with multiple conditions. The preference for more content with regard to blood pressure and factors specific to women provides valuable insight for ongoing resource development and research.
Developing a care pathway for heart failure with preserved ejection fraction: patient perceptions of existing care and their needs
Authors: Mckeddie M , Cowie A , Mckay J , Cooke M 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Scottish Government

Background
The Heart Disease Action Plan’s vision is that everyone in Scotland receives care that supports them in living well with their heart condition [1]. In 2021 NHS Ayrshire and Arran (NHS A&A) was successful in attaining Scottish Government funding to develop and pilot a care pathway for those with heart failure with preserved ejection fraction (HFpEF). HFpEF is not widely understood by the wider healthcare community, and access to care for this population is limited. To help inform development of this pathway, a scoping exercise was undertaken to fully understand the needs of those with HFpEF, and to provide baseline data for evaluation of the new pathway.

Purpose
As part of the scoping exercise, patient interviews were conducted. The purpose of these was to establish patient perceptions of existing care for HFpEF and to ascertain how closely this aligned with their needs.

Methods
Five telephone interviews were conducted with individuals recently diagnosed and admitted to hospital with HFpEF within NHSA&A.
Interviews focused upon the following questions, with prompts on ‘what went well?’ and ‘what could have gone better?’:
- What brought you to hospital?
- How was your in-patient care?
- What was the support like after discharge?
- How is your current management of your medications?
All interviews were conducted by the HFpEF Project Lead Nurse and took approximately 20-30 minutes.

Results
Care experience varied widely and three main themes were identified: support, communication, and continuity. Patients highlighted the importance of feeling listened to, and of having clear communication around the HFpEF diagnosis and care plan, with an appropriate channel available for them to ask questions and access relevant support. Continuity of care was dependent upon good multidisciplinary communication and integrated working, and upon staffing levels. There was a desire for ongoing clinical support for self- and medical management of their HFpEF at home.
"No one is supporting....I manage myself"
[someone] "…should contact you on discharge….[because]…you get an explanation in hospital but then there are questions that arise after discharge…."
"I think they could have explained things better to me….just to have an opportunity to have questions answered and my heart condition discussed"
"…I would say that there was a breakdown in the service [after discharge]."

Conclusions
The interviews demonstrate a clear need for a pathway for HFpEF that provides support, communication and continuity of care. It is hoped that evaluation of the pathway will demonstrate a positive impact upon these data.