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1.
Heart Lung Circ ; 32(1): 16-25, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36464619

RESUMO

This Call to Action aims to provide key considerations for cardiovascular nursing, related to climate and environmental impacts. Strategies to optimise nursing preparation, immediate response and adaptation to climate emergencies are crucial to ensure those at greatest risk, including First Nations peoples, are protected from potentially avoidable harm. Professionals who manage climate consequences must also understand the impact of their care on the root cause of the problem.


Assuntos
Enfermagem Cardiovascular , Mudança Climática , Humanos , Adaptação Fisiológica
2.
N Z Med J ; 134(1538): 77-88, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239147

RESUMO

AIMS: Heart failure with reduced ejection fraction (HFrEF) is associated with poor outcomes. While several medications are beneficial, achieving optimal guideline-directed medical therapy (GDMT) is challenging. COVID-19 created a need to explore new ways to deliver care. METHODS: Fifty consecutive patients were taught to identify fluid congestion and monitor their vital signs using BP monitors and electronic scales with NP-led telephone support. Quantitative data were collected and a patient experience interview was performed. RESULTS: The majority (76%) of the cohort (male, 76%; Maori/Pacific, 58%) had a new diagnosis of HFrEF, with 90% having severe left ventricular (LV) dysfunction. There were 216 contacts (129 (60%) by telephone), which eliminated travelling, (time saved, 2.12 hours per patient), petrol costs ($58.17 per patient), traffic pollution (607 Kg of CO2) and time off work. Most (75%) received contact within two weeks and 75% were optimally titrated within two months. Improvements in systolic BP (SBP) (124mmHg to 116mmHg), pulse (78 bpm to 70 bpm) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (292 to 65) were identified. Of the 43 patients who had a follow-up transthoracic echocardiogram (TTE), 33 (77%) showed important improvement in left ventricular ejection fraction (LVEF). CONCLUSIONS: Patients found the process acceptable and experienced rapid titration with less need for clinic review with titration rates comparable with most real-world reports.


Assuntos
COVID-19/prevenção & controle , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Profissionais de Enfermagem , Padrões de Prática em Enfermagem , Telemedicina , Idoso , Fator Natriurético Atrial/sangue , Pressão Sanguínea , Estudos de Viabilidade , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Satisfação do Paciente , Projetos Piloto , Guias de Prática Clínica como Assunto , Precursores de Proteínas/sangue , SARS-CoV-2 , Volume Sistólico , Telemedicina/economia , Telemedicina/organização & administração , Telefone , Viagem/economia
4.
N Z Med J ; 132(1489): 39-47, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30703778

RESUMO

AIM: Chest pain is a common symptom that creates significant anxiety for patients until a diagnosis can be offered. However, hospital cardiology services can struggle to cope with referral demands from primary care. The aim of this paper is to describe the development and implementation of a nurse-led chest pain service, its care processes and clinical outcomes to show feasibility, safety and sustainability. METHOD: We retrospectively analysed referral, demographic, cardiovascular risk, management and clinical outcome data relating to patients assessed in the nurse-led chest pain clinic in a large metropolitan district health board. RESULTS: Between January 2010 to December 2016, 3,587 patients attended the clinic, median 2.6 weeks (IQR 2-3) from referral to attendance. 1,921 (54%) were male and 2,059 (57%) were less than 60 years old. Most patients, 3,059 (85%), had an exercise tolerance test (ETT) and of those, 294 (10%) were positive, 572 (18%) non-diagnostic and 2,193 (72%) negative. Cardiovascular disease (CVD) prevention medication was added or modified for 1,150 (32%) patients, all patients who smoked were offered cessation support and all patients were provided with tailored lifestyle advice depending on their absolute CVD risk. Of the 319 (9%) referred for a diagnostic coronary angiogram, 205 (64%) had important coronary disease. The majority of patients, 2,088 (58%) were able to be discharged without any further investigation planned. Over a median follow-up period of 3.6 years, we identified 14 (0.4%) cardiac-related deaths, median (IQR) 2 (1-4) years from review to death. CONCLUSION: The nurse-led clinic offers an enhanced prevention focus that is sustainably managing large numbers of patients with outcomes similar to international studies and within recommended local timeframes.


Assuntos
Dor no Peito , Doença das Coronárias , Clínicas de Dor/organização & administração , Padrões de Prática em Enfermagem/organização & administração , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta/organização & administração , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Atenção à Saúde/métodos , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Gestão de Riscos
7.
Acad Emerg Med ; 16(2): 168-77, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19076107

RESUMO

Early diagnosis of persons infected with human immunodeficiency virus (HIV) through diagnostic testing and screening is a critical priority for individual and public health. Emergency departments (EDs) have an important role in this effort. As EDs gain experience in HIV testing, it is increasingly apparent that implementing testing is conceptually and operationally complex. A wide variety of HIV testing practice and research models have emerged, each reflecting adaptations to site-specific factors and the needs of local populations. The diversity and complexity inherent in nascent ED HIV testing practice and research are associated with the risk that findings will not be described according to a common lexicon. This article presents a comprehensive set of terms and definitions that can be used to describe ED-based HIV testing programs, developed by consensus opinion from the inaugural meeting of the National ED HIV Testing Consortium. These definitions are designed to facilitate discussion, increase comparability of future reports, and potentially accelerate wider implementation of ED HIV testing.


Assuntos
Infecções por HIV/diagnóstico , Terminologia como Assunto , Comunicação , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Guias como Assunto , Infecções por HIV/economia , Humanos , Notificação de Abuso
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