ABSTRACT
A critical path defines the optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure. Critical paths are developed through collaborative efforts of physicians, nurses, pharmacists, and others to improve the quality and value of patient care. They are designed to minimize delays and resource utilization and to maximize quality of care. Critical paths have been shown to reduce variation in the care provided, facilitate expected outcomes, reduce delays, reduce length of stay, and improve cost-effectiveness. The approach and goals of critical paths are consistent with those of total quality management (TQM) and can be an important part of an organization's TQM process.
Subject(s)
Critical Pathways , Humans , Patient-Centered Care , Process Assessment, Health Care , Total Quality ManagementABSTRACT
Until recently, sudden cardiac death in a young person often remained an unexplained tragedy. However, in the last decade there have been dramatic advances in medical knowledge regarding inheritable dysrhythmias that increase the risk of SCD in otherwise healthy young individuals. The primary mechanism in this group of dysrhythmias appears to be an alteration of cardiac repolarization. In some diseases, the specific genes affected and even precise cellular mechanisms have been identified. The information about these diseases is often complex and rapidly evolving, challenging both healthcare providers and the families who must make important decisions based on emerging and incomplete information. The purpose of this article is to describe current understanding of the repolarization-related dysrhythmias and discuss the clinical implications for advanced practice nurses.
Subject(s)
Long QT Syndrome/genetics , Action Potentials , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/genetics , Arrhythmias, Cardiac/therapy , Catecholamines/adverse effects , Electrocardiography , Humans , Long QT Syndrome/diagnosis , Long QT Syndrome/etiology , Long QT Syndrome/therapy , Myocytes, Cardiac/physiology , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/geneticsSubject(s)
Cardiovascular Diseases/diagnosis , Diagnostic Techniques, Cardiovascular/standards , Preoperative Care/standards , Adaptation, Psychological , Adolescent , Age Factors , Anxiety/prevention & control , Anxiety/psychology , Child , Child, Preschool , Diagnostic Techniques, Cardiovascular/psychology , Heart Defects, Congenital/diagnosis , Humans , Nurse's Role/psychology , Pain/prevention & control , Pain/psychology , Parents/education , Parents/psychology , Physician's Role/psychology , Preoperative Care/psychology , Psychology, Child/methods , Stress, Physiological/prevention & control , Stress, Physiological/psychologyABSTRACT
OBJECTIVES: This study examined the indications, efficacy and outcomes of implantable cardioverter defibrillator (ICD) use in the pediatric population. BACKGROUND: ICDs are first-line therapy for adults resuscitated from sudden cardiac death (SCD) or at high risk for life-threatening ventricular arrhythmias. Use of ICDs in children and young adults is infrequent and there are few data regarding this group. METHODS: We abstracted and analyzed data for all patients in whom ICDs were implanted. RESULTS: A total of 38 devices were implanted in 27 patients. Age ranged from 6 to 26 years (mean, 14) and weight ranged from 16 to 124 kg (mean, 47). Diagnoses included long QT syndrome (9), hypertrophic cardiomyopathy [6], repaired congenital heart disease [5];, and idiopathic ventricular tachycardia/fibrillation [4]. Indications comprised resuscitated SCD [15], syncope [9], and life-threatening ventricular arrhythmia [3]. Initial device placement was infraclavicular in 13, abdominal in 13 and intrathoracic in 1. Epicardial leads were used with 5 systems. A single coil lead was used in 17. Seven patients, all previously resuscitated from SCD, experienced 88 appropriate successful discharges. There were 6 inappropriate discharges in 3 patients. Mean time to device replacement was 3.1 years (n = 11). Complications included 2 infected systems, 2 lead dislodgments, 2 lead fractures, 1 post-pericardiotomy syndrome, 1 adverse event with defibrillation threshold (DFT); testing, and 1 patient with psychiatric sequelae. No deaths occurred with implanted ICDs. CONCLUSIONS: These data demonstrate that ICDs provide safe and effective therapy in young patients. The indications for ICDs as primary preventive therapy remain uncertain.
