Improving performance and self-efficacy of novice nurses using hybrid simulation-based mastery learning.

AIM: Acute chest pain is a commonly encountered symptom in hospital medical/surgical units; however, almost half of nurses in their second year of clinical experience in our facility have reported struggling to care for acute chest pain patients. We developed, implemented, and examined the effectiveness of a simulation-based, mastery learning clinical nursing educational program to improve self-efficacy and performance in caring for patients with acute chest pain. METHODS: The study adopted a single-site, single-cohort design using simulation-based performance assessment and self-efficacy surveys on a convenience sample of 37 second-year clinical nurse participants in multi-stage hybrid mastery learning educational intervention using asynchronous e-learning, and hands-on simulation training and assessment with feedback on caring for chest pain patients. Performance assessments and self-efficacy surveys were administered pre-, post-, and 5 months post-intervention. RESULTS: Clinical performance on the post- and 5 months follow-up assessments were significantly higher than those for the pre-test (P < .0001). The self-efficacy scores for the post- and the 5 months follow-up assessments were significantly higher than the pre-course scores (P < .0001). Participants' self-efficacy perceptions were positively correlated with their performances at 5 months post-intervention. CONCLUSION: Performance and self-efficacy of novice nurses in caring for acute chest pain patients improved significantly with the multi-stage hybrid mastery learning educational intervention, with improvements retained 5 months post-intervention. The results suggest the applicability of simulation-based mastery learning in a clinical setting for novice nurses to attain specific skills, and raise their self-perception of competence to care for patients in acute settings.

Transcatheter Occlusion of a Giant Coronary Artery Fistula in a Neonate.

BACKGROUND Although large coronary artery fistulas are uncommon; they lead to substantial over-circulation in the pulmonary vascular beds and left heart system. Fistula occlusions are achieved via surgical or transcatheter technique; however, reports on successful outcomes of transcatheter treatment during the neonatal period are limited. CASE REPORT A female infant was born at the gestational age of 37 weeks with a birth weight of 2615 grams via normal vaginal delivery. Cardiac auscultation revealed a loud continuous murmur emanating from the fourth right intercostal space. A right coronary artery-to-right ventricle fistula was confirmed using transthoracic echocardiography. The newborn developed respiratory distress 3 days after birth and was administered continuous positive airway pressure to assist breathing. On day 8, the ventilator was used through tracheal intubation due to gradual worsening of dyspnea. A 6-mm Amplatzer Vascular Plug 4 (AGA Medical Corporation, Plymouth, MN) was chosen, as the minimum diameter of the coronary artery fistula was 5 mm. In view of the risk of myocardial ischemia with additional devices, the procedure was stopped despite persistent shunting. The newborn's clinical condition significantly improved following the procedure and she was eventually weaned off ventilator support. CONCLUSIONS A self-expanding occlusion device was useful for relieving this life-threatening condition. Complete elimination of shunting is not always necessary, to avoid compromising myocardial circulation.

Altered central aortic elastic properties in Kawasaki disease are related to changes in left ventricular geometry and coronary artery aneurysm formation.

BACKGROUND: Recent evidence has suggested that patients display altered arterial elasticity after Kawasaki disease (KD). However, changes in the elastic properties of the central aorta and their relevance to left ventricular geometry have not been studied in patients after KD with and without coronary artery aneurysms (CAAs). METHODS: Clinical and laboratory characteristics of 75 patients with KD were compared with those of 57 controls. The patients with KD included 17 patients with CAAs and 58 patients without CAAs. Values for aortic stiffness index, aortic distensibility, aortic strain, and left ventricular mass index (LVMI) were retrospectively obtained from echocardiographic measurements of the ascending aorta and left ventricle with noninvasive blood pressure evaluation. RESULTS: Systolic blood pressure, pulse pressure, LVMI, and aortic stiffness index were significantly higher and aortic distensibility and aortic strain significantly lower in patients with KD than in the controls. In patients with KD, age at the time of study, interval between the onset of KD and the initiation of this study, CAAs, and LVMI were significantly associated with aortic stiffness index, aortic distensibility, and aortic strain. Multivariate analysis revealed that CAAs and LVMI were independently relevant to aortic stiffness index and aortic distensibility. CONCLUSIONS: The central aortas of patients after KD have altered elastic properties. CAAs and LVMI are independently correlated with central aortic elasticity.

Long-term administration of beraprost sodium for pulmonary arterial hypertension associated with congenital heart disease.

Pulmonary arterial hypertension (PAH) is often associated with congenital heart disease (CHD). Acute administration of beraprost reduces pulmonary vascular resistance in patients with idiopathic PAH and PAH associated with CHD; however, little is known about whether or not long-term treatment with oral beraprost benefits these patients. We report the case of a patient suffering from severe PAH associated with large patent ductus arteriosus (PDA), who was considered to be ineligible for PDA closure using a conventional treatment strategy. Eventually, long-term administration of oral beraprost ameliorated the degree of PAH and the patient subsequently underwent successful closure of the PDA.

Noninvasive estimation of left ventricular end-diastolic pressure using tissue Doppler imaging combined with pulsed-wave Doppler echocardiography in patients with ventricular septal defects: a comparison with the plasma levels of the B-type natriuretic Peptide.

BACKGROUND: There are limited data regarding whether the ratio of the peak transmitral flow velocity during early diastole (E) to the peak mitral annular velocity during early diastole (Ea) obtained by tissue Doppler imaging (TDI) and the plasma levels of the B-type natriuretic peptide (BNP) are useful for evaluating the left ventricular end-diastolic pressure (LVEDP) in children with ventricular septal defects (VSD). We investigated the validity of noninvasive estimation of the LVEDP in VSD infants. METHODS: We studied 48 patients (mean age, 9 +/- 6 months). Using pulsed-wave Doppler echocardiography and TDI, E and Ea were measured to calculate the E/Ea ratio. The LVEDP and the ratio of pulmonary to systemic blood flow (Qp/Qs) were determined invasively. RESULTS: There were significant positive correlations between E and both the LVEDP value and the Qp/Qs ratio. In contrast, Ea showed significant negative correlations with the LVEDP value and Qp/Qs ratio. The E/Ea ratio correlated significantly with the LVEDP value and Qp/Qs ratio. The plasma BNP levels correlated significantly with the Qp/Qs ratio, although they did not show a significant correlation with the LVEDP. An E/Ea ratio of >9.8 indicated patients with a LVEDP of >10 mmHg with a sensitivity of 92% and specificity of 80%. CONCLUSION: TDI combined with pulsed-wave Doppler echocardiography predicted the LVEDP of VSD infants, whereas the plasma BNP value did not have a significant association with the LVEDP.

Paradoxical relationship between B-type natriuretic peptide and pulmonary vascular resistance in patients with ventricular septal defect and concomitant severe pulmonary hypertension.

B-type natriuretic peptide (BNP) reflects volume overload on left ventricle and pulmonary hypertension (PH) in patients with ventricular septal defect (VSD). Pulmonary vascular resistance (PVR) has been reported to correlate positively with BNP in VSD patients with various degrees of PH. We aimed to investigate the relationship between PVR and BNP in VSD patients with severe PH. We examined 24 subjects with VSD concomitant severe PH aged from 2 months to 17 years (median: 4 months). The ratio of pulmonary to systemic pressure (Pp/Ps), the ratio of pulmonary to systemic flow (Qp/Qs), the ratio of pulmonary to systemic resistance (Rp/Rs), and PVR were determined by cardiac catheterization. PVR and Rp/Rs ranged from 1.6 to 15.5 (mean: 5.7 +/- 3.9) Wood unit . m(2) and 0.1 to 0.8 (mean: 0.4 +/- 0.2), respectively. BNP ranged from 5.5 to 69 (mean: 31 +/- 19) pg/ml. Negative correlations were observed between BNP and PVR (r = -0.56, p = 0.004) and BNP and Rp/Rs (r = -0.51, p = 0.01). BNP was significantly lower (<10 pg/ml) in VSD patients with Eisenmenger physiology as compared with the others (p = 0.003). We should draw attention to evaluate BNP values in VSD patients with severe PH.