[The Role of a Nurse Practitioner in Cardiovascular Surgery at a Japanese Private Hospital].

Since 2020, our hospital has introduced nurse practitioners( NP) into cardiovascular surgery with the aim to improve labor efficiency. A cardiovascular surgery NP has both pre- and postoperative roles. An NP is not only involved in a necessary intervention but also in an intervention as the first assistant regardless of regular or emergency surgery. By having an NP perform the work normally performed by doctors, a labor burden on doctors is reduced and care administered by the medical team is smoothened. This study reports the role of NPs in the field of cardiovascular surgery in private hospitals.

Simulation training for continuing professional development of nurses in cardiology and cardiovascular surgery.

BACKGROUND:   Nurses play a key role in cardiac arrest management, especially those assigned to cardiac intensive care units, where they are often actively involved in cardiopulmonary resuscitation. AIM: To evaluate the effect of simulation training in in continuing professional development of nurses in this setting. METHODS: A comparative study using paired samples (where the candidate was his own control with repeated measures before and after intervention), was conducted among nurses working in the cardiology and cardiovascular surgery division of our institution. The primary endpoint was the change in skills judged on the basis of competency score of 20 assessed before and after simulation training. RESULTS: 32 nurses participated in the training session. Despite a median job seniority of 8.5 years [4.0 - 12.5], only 44% of nurses had already participated in a simulation session. Although most of the candidates (84%) had previously performed chest compressions, only 34% had delivered an electrical defibrillation during their exercise. We showed a significant increase in overall scores from 8.0 [5.0 - 9.8] to 17.5 [17.0 - 19.0] after the simulation training session (p<0.0001). All the criteria judged in the evaluation grid (basic life support, manual electrical defibrillation) were significantly improved and the most positive effect was observed in the manual defibrillation where the prior experience of the participants was limited. CONCLUSIONS: Simulation learning had a major positive impact on the development of nurses' skills in terms of cardiopulmonary resuscitation.

Occupational radiation exposure to nursing staff during cardiovascular fluoroscopic procedures: A review of the literature.

Fluoroscopy is a method used to provide real time x-ray imaging of the body during medical procedures to assist with medical diagnosis and treatment. Recent technological advances have seen an increase in the number of fluoroscopic examinations being performed. Nurses are an integral part of the team conducting fluoroscopic investigations and are often located close to the patient resulting in an occupational exposure to radiation. The purpose of this review was to examine recent literature which investigates occupational exposure received by nursing staff during cardiovascular fluoroscopic procedures. Articles published between 2011 and 2017 have been searched and comprehensively reviewed on the referenced medical search engines. Twenty-four relevant studies were identified among which seventeen investigated nursing dose comparative to operator dose. Seven researched the effectiveness of interventions in reducing occupational exposure to nursing staff. While doctors remain at the highest risk of exposure during procedures, evidence suggests that nursing staff may be at risk of exceeding recommended dose limits in some circumstances. There is also evidence of inconsistent use of personal protection such as lead glasses and skull caps by nursing staff to minimize radiation exposure. Conclusions: The review has highlighted a lack of published literature focussing on dose to nurses. There is a need for future research in this area to inform nursing staff of factors which may contribute to high occupational doses and of methods for minimizing the risk of exposure, particularly regarding the importance of utilizing radiation protective equipment.

Advanced Resuscitation Guidelines Improve Mortality Rates Among Cardiovascular Surgery Patients.

In this month's Magnet® Perspectives column, Melanie Roberts, DNP, RN-BC, CNS, CCNS, CCRN, critical care clinical nurse specialist at Medical Center of the Rockies (MCR) and Poudre Valley Hospital, discusses her efforts to implement the state-ofthe-art European Resuscitation Council (ERC) guideline for resuscitation of cardiovascular (CV) surgery patients. Her evidence-based initiative has improved quality of care and mortality rates among the CV surgery population at MCR. Dr Roberts' pioneering work earned her the 2017 National Magnet Nurse of the Year Award for Empirical Outcomes. She shares details of her innovative program and examines the value of implementing practice enhancements in a Magnet environment. She describes the importance of an interdisciplinary team effort to achieve success.

Evaluation of an Intervention With Nurses for Delirium Detection After Cardiac Surgery.

BACKGROUND: Completion of a delirium detection tool allows rapid management, which alleviates complications. However, these tools are often underused. AIMS: To assess the effect of a knowledge transfer (KT) intervention on the completion of a delirium detection tool by nurses working with cardiac surgery patients. Secondary aims included describing completion rates per work shift, and patient characteristics associated with higher rates. METHODS: In a pre-post study, the intervention included a survey and focus groups to identify barriers to use of a delirium detection tool (Intensive Care Delirium Screening Checklist [ICDSC]). Nurses' suggestions for a KT activity and its implementation were also included. Using chi-square analysis and medical charts from 242 patients, we compared the pre- and postintervention rates of completion of the ICDSC. RESULTS: The majority of nurses who completed the survey (n = 30) felt they had the knowledge, skills, and intention to complete the ICDSC. During the focus groups (n = 4), a need for information on delirium symptoms and its management was raised as a barrier. This barrier was addressed with the selected KT activity (clinical capsule and aide-memoire handed out to nurses [n = 24]). Across all work shifts, the completion rate was similar pre- and postintervention. Overall, the completion rate was lower during the day shift than the night and evening shifts. A higher rate was associated with the first three postoperative days, and longer hospital and intensive care unit stays. LINKING EVIDENCE TO ACTION: A tailored intervention based on preidentified barriers and facilitators, using the Determinants of Implementation Behavior Questionnaire, and in collaboration with participants, has the potential to promote evidence-based practice.

Evaluation of a Progressive Mobility Protocol in Postoperative Cardiothoracic Surgical Patients.

Cardiothoracic surgical patients are at high risk for complications related to immobility, such as increased intensive care and hospital length of stay, intensive care unit readmission, pressure ulcer development, and deep vein thrombosis/pulmonary embolus. A progressive mobility protocol was started in the thoracic cardiovascular intensive care unit in a rural academic medical center. The purpose of the progressive mobility protocol was to increase mobilization of postoperative patients and decrease complications related to immobility in this unique patient population. A matched-pairs design was used to compare a randomly selected sample of the preintervention group (n = 30) to a matched postintervention group (n = 30). The analysis compared outcomes including intensive care unit and hospital length of stay, intensive care unit readmission occurrence, pressure ulcer prevalence, and deep vein thrombosis/pulmonary embolism prevalence between the 2 groups. Although this comparison does not achieve statistical significance (P < .05) for any of the outcomes measured, it does show clinical significance in a reduction in hospital length of stay, intensive care unit days, in intensive care unit readmission rate, and a decline in pressure ulcer prevalence, which is the overall goal of progressive mobility. This study has implications for nursing, hospital administration, and therapy services with regard to staffing and cost savings related to fewer complications of immobility. Future studies with a larger sample size and other populations are warranted.

Causas de readmissão hospitalar após cirurgia cardíaca / Causes of hospital readmission after heart surgery

Objetivou-se identificar o perfil e as causas de readmissão de pacientes submetidos à cirurgia cardíaca. Estudo retrospectivo, descritivo, realizado por meio de revisão de prontuários de pacientes submetidos à cirurgia de revascularização do miocárdio ou implante de prótese valvar com readmissão posterior. A amostra foi constituída por 62 pacientes. A taxa de readmissão foi de 5,9%. A infecção do sítio cirúrgico foi a principal causa de readmissão em 87,5% dos pacientes submetidos à revascularização do miocárdio e em 12,5% dos implantes de prótese valvar (p˂0,001) e esteve associada às variáveis obesidade (p=0,05) e dislipidemia (p=0,007). A identificação dos pacientes em risco para o desenvolvimento de infecção do sítio cirúrgico pode minimizar as taxas de readmissão e diminuir os custos associados ao cuidado, e, merece um planejamento diferenciado de ações multiprofissionais

The objective was to identify readmission's profile and causes of heart surgery patients. A retrospective, descriptive study, through the revision of records from patients submitted to myocardial revascularization surgery or valvar prosthesis implantation with posterior readmission. Sixty-two patients composed the sample. The readmission rate was 5.9%. Surgical site infection was the main cause for readmission in 87.5% of patients submitted to myocardial revascularization surgery and in 12.5% of valvar implantation (p<0.001) and, it was associated with obesity (p=0.05) and dyslipidemia (p=0.007). To identify patients at risk of surgical site infection can minimize readmission rates and decrease care costs and, it deserves a special planning of multi-professional actions.

Ventilação não invasiva após cirurgia cardiovascular: um ensaio clínico randomizado / Non-invasive ventilation after cardiovascular surgery: a randomized clinical trial

Fundamentos: A hipoxemia é a complicação mais comum no pós-operatório (PO) de cirurgia cardíaca, sendo consequência principalmente da formação de atelectasias, edema intersticial alveolar e acúmulo de secreção pulmonar. Essas alterações aumentam a incidência de infecções pulmonares, tempo de internação na UTI e custos hospitalares. Objetivo: Avaliar as trocas gasosas e alterações hemodinâmicas de pacientes hipoxêmicos submetidos à ventilação não invasiva (VNI) no PO imediato de cirurgia cardiovascular. Métodos: Ensaio clínico randomizado conduzido na UTI cirúrgica de um hospital cardiológico. Foram incluídos pacientes com hipoxemia (300>PaO2/FiO2>150) uma hora após extubação orotraqueal, no PO imediato de cirurgia cardiovascular eletiva e que foram submetidos à cateterização da artéria pulmonar no bloco cirúrgico (BC). O grupo-controle recebeu oxigenoterapia e o grupo-intervenção, VNI e oxigênio durante três horas consecutivas. Na análise estatística foram utilizados os testes t de Student, Mann-Whitney, exato de Fisher, ANOVA e generalized estimating equation (GEE). Resultados: Estudados 42 pacientes. Os pacientes do grupo-intervenção (n=21) apresentaram melhora significativa da relação PaO2/FiO2 (p=0,007). Houve discreta diferença entre os grupos na pressão capilar pulmonar (p=0,012), no índice cardíaco (p=0,006) e na pressão venosa central (p=0,022).

Background: Hypoxemia is the most common complication during the post-operative stage of cardiovascular surgery, due mainly to atelectasis, alveolar interstitial edema and accumulations of pulmonary secretions. These changes may increase the incidence of lung infections with longer ICU stays and consequently higher hospital costs. Objective: To evaluate gas exchanges and hemodynamic alterations in hypoxemic patients under non-invasive ventilation (NIV) during the immediate post-operative period subsequent to cardiovascular surgery. Methods: A randomized clinical trial conducted in the surgical ICU of a cardiology hospital of patients with hypoxemia (300>PaO2/FiO2>150) one hour after orotracheal extubation during the post-operative period immediately after elective cardiovascular surgery who underwent pulmonary artery catheterization in the surgical ward. The control group received oxygen therapy, while the intervention group received NIV plus oxygen for three consecutive hours. For the statistical analysis, we used the Student t, Mann-Whitney, Fisher’s exact tests, as well as ANOVA and generalized estimating equations (GEE). Results: Among the 42 patients studied, the intervention group (n=21) presented significant improvements in the PaO2/FiO2 ratio (p=0.007), with little difference between the groups for pulmonary capillary pressure (p=0.012), cardiac index (p=0.006) and central venous pressure (p=0.022).

Eficacia de un plan de cuidado de enfermería en la intensidad del dolor en pacientes posoperados de cirugía cardiovascular en el Hospital Santa Clara E. S. E / Efficacy of a nursing care plan on pain intensity in post-operative cardiovascular surgery patients at Hospital Santa Clara E. S. E

Introducción: El dolor intenso es una de las principales quejas referidas por los pacientes sometidos a cirugía cardiovascular. Objetivos: Determinar la eficacia de la aplicación de un plan de cuidado fundamentado en la "teoría del equilibrio entre la analgesia y los efectos secundarios", en la disminución de la intensidad del dolor, en comparación al manejo habitual de enfermería en los pacientes en posoperatorio de cirugía cardiovascular en la unidad de cuidado intensivo del Hospital Santa Clara ESE. Pacientes y método: Estudio cuasiexperimental con grupo control, aleatorizado, con cegamiento, realizado durante el primer semestre del año 2014, en pacientes sometidos a cirugía cardiovascular con ingreso en la unidad de cuidado intensivo del Hospital Santa Clara ESE., previo Consentimiento Informado. A todos los sujetos luego de la intervención quirúrgica ya en la unidad de cuidado intensivo cardiovascular y una vez extubados orotraquealmente, se realizaron las mediciones, evaluando la percepción de la intensidad de su dolor cada hora hasta completar 6 horas con la Escala Visual Análoga y la etiqueta de resultado de enfermería: Nivel del Dolor. Los pacientes del grupo experimental recibieron intervención adicional con el plan de cuidado aquí propuesto el cual tiene como eje teórico y de orientación la teoría del equilibrio entre la analgesia y los efectos secundarios, que es una teoría propuesta por las Enfermeras, Marion Good y Shirley M. Moore,1996 1 . Para la elaboración se revisó la literatura sobre el tema a estudio y las intervenciones farmacológicas y no farmacológicas que han demostrado eficacia. El plan de cuidado se organiza de acuerdo a la estructura del proceso de enfermería y las interrelaciones de las taxonomías NANDA2 ; NOC3 Y NIC4 . Para el estudio de las variables de características sociodemográficas al igual que la relacionada al tipo de intervención quirúrgica se realizó un análisis descriptivo, para el resto de variables se utilizó la prueba no paramétrica U de Mann-Whitney y poder analizar las comparaciones necesarias entre los grupos. Todas las pruebas de hipótesis estadísticas se hicieron a un nivel alfa de 5%. Resultados y conclusiones: Muestra de 42 pacientes distribuidos, 21 en el grupo experimental y 21 en el grupo control; las características en ambos grupos fueron similares, la edad promedio fue 59 años; el 61.9% hombres y el 38.1% Mujeres, predomina el estrato dos con el 78% de las personas participantes y la escasa escolaridad con el 83.3% que realizaron educación básica la mayoría incompleta; las intervenciones quirúrgicas que más se observaron fueron la revascularización miocárdica de uno, dos o tres vasos con un 76,2% en total y los cambios de válvula aórtica y de válvula mitral con 23.8% en total. Se demostró que el plan de cuidado fundamentado en la "teoría del equilibrio entre la analgesia y los efectos secundarios es eficaz modificando la puntuación de la intensidad del dolor medida con el instrumento escala visual análoga (EVA) en 3 puntos y que también es eficaz en la obtención de resultados de enfermería al aumentar la puntuación de la etiqueta de la clasificación de resultados de enfermería (CRE) Nivel del dolor en 2 puntos.

Introduction: Severe pain is one of the main complaints reported by patients undergoing cardiovascular surgery To determine the effectiveness of the implementation of a plan of care based on the "theory of the balance between analgesia and side effects" in reducing pain intensity, compared to the usual management of nursing in postoperative patients of cardiovascular surgery in the intensive care unit of the Hospital Santa Clara ESE. Patients and method. Quasi-experimental study with a control group, randomized, blinded, conducted during the first half of 2014, in patients undergoing cardiovascular surgery with admission to the intensive care unit of the Hospital Santa Clara ESE, prior informed consent. All subjects after surgery and in the cardiovascular intensive care unit and extubated once orotracheally, measurements were performed by evaluating the perception of pain intensity every hour until 6 hours to complete the visual analog scale and nursing outcome label: Level of Pain. Patients in the experimental group received additional intervention with the here proposed care plan which has the theoretical axis orientation and the theory of the balance between analgesia and side effects, which is a mid-range theory given by the nurse, Marion Good and Shirley M. Moore, 1996. In preparing the literature to study the pharmacological and non-pharmacological interventions that have demonstrated efficacy was reviewed. The care plan is organized according to the structure of the nursing process and the interrelationships of the NANDA taxonomy; NOC and NIC. To study the variables of sociodemographic characteristics as related to type of surgery, a descriptive analysis was performed for the remaining variables the nonparametric Mann-Whitney test and to analyze the necessary comparisons between groups . All tests of statistical hypotheses were made at an alpha level of 5%. Results and conclusions: 42 patients distributed sample, 21 in the experimental group and 21 in the control group; characteristics were similar in both groups, the mean age was 59; 61.9% male and 38.1% female, predominantly two layer with 78% of participants with poor schooling and 83.3% who performed mostly incomplete basic education; surgical interventions were most frequently observed myocardial revascularization of one, two or three glasses with 76.2% overall and changes in aortic and mitral valve with 23.8% in total. It was demonstrated that the care plan based on the "theory of the balance between analgesia and side effects is effectively changing the score pain intensity measured with the visual analog scale (VAS) instrument on 3 points and is also effective in outcome of nursing to increase the score of label ranking nursing outcomes (CRE) Level of pain at 2 points.

La simulación clínica. Entrenamiento de equipos clínicos y facilitador de cambios asistenciales / Clinical simulation as a training tool for clinical teams and care change facilitator

Objetivo. Describir y mostrar los resultados de un programa de formación interprofesional basado en simulación clínica para para dar respuesta a una necesidad formativa de los profesionales del área quirúrgica del Hospital Valdecilla en el manejo de las urgencias vitales en cirugía cardiovascular (CCV). Material. La actividad fue dirigida para entrenar a las 42 enfermeras de turno rotatorio del área quirúrgica junto con personal auxiliar, cirujanos cardiovasculares y anestesistas. Para ello se realizó un estudio de las necesidades formativas y se diseñaron jornadas de entrenamiento mediante simulación clínica, además de sesiones teóricas y talleres in situ en el lugar habitual de trabajo. Resultados. El proyecto formativo se realizó en cuatro fases entre el 21 de mayo al 18 de junio del 2012, dentro de las cuales se efectuaron tres casos clínicos para el entrenamiento multidisciplinar de urgencias habituales en CCV, con la participación total de 65 profesionales y 17 instructores; gracias a los análisis posteriores a los casos, se alcanzaron resultados de mejora del trabajo en equipo y se recogieron diferentes cambios a realizar en la organización clínica del servicio. Conclusiones. La simulación clínica responde al modo de aprendizaje de los adultos, basado en la propia experiencia y la reflexión personal, y todo ello en un entorno que no pone en riesgo a pacientes, ni a profesionales. Es realmente útil y flexible para hacer frente a diferentes retos institucionales; y los participantes resaltaron dos aspectos clave: el caracter multidisciplinar, pudiendo entrenar el equipo habitual de profesionales, y la posibilidad del análisis y reflexión posterior al caso para compartir experiencias y buscar áreas de mejora entre todo el equipo clínico (AU)

Objective: The objective of this article is to describe and show the results of a simulation training interprofesional program to meet a training need of Surgical area professionals in management in cardiovascular surgery emergencies in Valdecilla Hospital. Material: The activity was aimed to train at the 42 nurses in rotation in the surgical area, nursing assistances, cardiovascular surgeons and anesthetists. For it was made a study of the training needs and were designed clinical simulation escenarios, theoretical sessions as well in workshops usual workplace. Results: The training project was conducted in four phases between May 21 to June 18, 2012, within which were 3 clinical cases for multidisciplinary training in emergency usual CCV. With the full participation of 65 professionals and 17 instructors, after further analysis to cases, results were achieved improved teamwork, and picked up, several changes to be made in the organization of the service. Conclusions: Clinical simulation mode responds to adult learning, based on their own experience and personal reflection, and all in an environment that does not risk to patients or professionals. It is really helpful and flexible to meet different institutional challenges and where participants highlighted two key aspects in this activity such as the multidisciplinary team where they could train the professional standard and the possibility of analysis and reflection after the event to share experiences and look for areas of improvement among all the clinical team (AU)

Nivel de satisfacción del paciente sobre la calidad de atención profesional de enfermería en el Servicio de Cirugía Cardiovascular del Instituto Cardiovascular del Corazón - 2010 / Level of satisfaction of the patient about the quality of professional attention of nursing in the Service of Cardiovascular Surgery of the Cardiovascular Institute of Heart - 2010

La satisfacción global de los pacientes es uno de los indicadores que con mayor frecuencia se utiliza para determinar la actitud que tienen hacia los cuidados que les brinda el profesional de enfermería. Esta satisfacción, puede ser definida como una respuesta afectiva que se deriva de una evaluación positiva o negativa del trabajo que se desempeña las enfermeras(os), esto implica que un futuro cercano las instituciones de salud priorizaran los cuidados de enfermería basados en la calidad y calidez. Es por ello que el presente trabajo "Nivel de Satisfacción del paciente sobre la Calidad de Atención profesional de Enfermería en el servicio de Cirugía Cardiovascular del Instituto Cardiovascular del Corazón" tuvo como objetivo: Determinar el nivel de satisfacción del paciente respecto a los cuidados que recibe de la enfermera en el servicio de cirugía cardiovascular del Instituto Nacional del Corazón. El presente estudio es de tipo descriptivo transversal estando constituida por una población de 30 pacientes, los datos fueron recolectados mediante un cuestionario individuales, utilizando un formulario estructurado, previo consentimiento informado del paciente, durante los meses de junio a julio del 2010...

Déficit de Auto-cuidado en un agente con alteración de la perfusión cardíaca / Deficit of Self-care in an agent with alteration in the cardiac perfusion", "_i": "

La cardiopatía isquémica, en el año 2007 representó la segundacausa de mortalidad general y la tercera causa de muerte en elgrupo de edad entre los 15 a 64 años de edad. La enfermedadisquémica, representa un área de oportunidad para el trabajoprofesional de Enfermería y obliga la participación a través deun proceso enfermero especializado, con el objetivo de generarel Auto-cuidado. El modelo de atención de Enfermería empleadoen este estudio de caso fue el Déficit de Auto-cuidado de DoroteaOrem, con aplicación metodológica del proceso de atenciónde Enfermería en cada una de sus cinco etapas. Resultadode este estudio se lograron diferenciar dos líneas de trabajo: 1)la construcción de intervenciones especializadas y 2) la trascendenciade la participación del profesional de enfermería en elmanejo del paciente con enfermedad cardíaca isquémica.

Ischemic heart disease in the year 2007 represented the second cause of mortality and the third leading cause of death in the age group between 15 to 64 years of age. Ischemic heart disease represents an area of opportunity for the professional work of nursing and requires participation by a specialized nursing process with the objective of generating Self-Care. The nursing care model used in this case study was the Self-Care Deficit of Dorothea Orem, with methodological application of nursing process in each of its five stages. Results of this study could distinguish two main lines of work, 1) the construction of specialist and 2) the importance of nurse participation in the management of patients with ischemic heart disease.

Control de anti coagulación oral en una planta de cirugía cardiaca / Oral Anticoagulation Control in a cardiac surgery ward

En pacientes sometidos a cirugía cardiaca, especialmente valvular, es preciso realizar frecuentes controles de anticoagulación durante su hospitalización. Se plantea si es fiable hacerlo con un coagulómetro portátil que, a priori, puede suponer ventajas en la atención. Para determinarlo, se evalúa la concordancia entre las mediciones obtenidas con este dispositivo y las de laboratorio. Se comparan los INR (Tiempo de protrombina, Ratio Internacional Normalizada) de 106 pares de muestras sanguíneas simultáneas, venosa y capilar, obtenidas de 60 pacientes anticoagulados, ingresados en la unidad de cirugía cardiaca del hospital La Fe, tras ser intervenidos. Las muestras venosas se procesaron en el laboratorio de hemostasia y las capilares con un coagulómetro portátil CoaguChek(r) S de Roche. Los análisis estadísticos aplicados fueron el coeficiente de Pearson, el coeficiente de correlación intraclase (CCI) y el método de la media de las diferencias (MMD). Se tienen en cuenta las cifras de hematocrito y la terapia combinada con heparina. Los resultados muestran, para el conjunto de los datos, un grado de acuerdo muy bueno, CCI=0,939 (intervalo de confianza [IC] del 95%=0,902-0,961) y unas cifras MMD <10%. Para hematocritos <32, la concordancia disminuye, CCI=0,876 (IC 95%=0,787-0,930). Se concluye que nuestro coagulómetro es fiable, por lo que su uso permitiría mejorar la atención del paciente anticoagulado durante su estancia en la planta (obtener resultados inmediatos, menor traumatismo en la extracción, etc.). Sin embargo, en los casos de hematocritos bajos es más prudente el empleo de resultados de laboratorio(AU)

In patients who undergo cardiac surgery, particularly valvular surgery, it is essential to carry out frequent anticoagulation controls during their hospital stay. The author questions if it is viable to carry out these controls by means of a portable coagulation meter which, in principle, can provide advantages in patient care. To determine this viability, the author evaluates the concordance between the measurements obtained with this device and measurements taken in a laboratory. The author compared the INR (prothrombin time, Normalized International Ratio) in 106 pairs of simultaneous blood samples, from both veins and capillaries, taken from 60 patients receiving anticoagulation medicine hospitalized in the cardiac surgery ward at the La Fe Hospital after each underwent surgery. The samples taken from veins were processed in a hemostasia laboratory, while the capillary samples were processed with a portable coagulation meter, a Roche CoaguChek(r) S. The statistical analyses applied were Pearson coefficient, intraclass correlation coefficient (CCI) and the method for mean differences (MMD). Numbers for hemocytes and therapy combined with heparine were taken into account. The results showed, in the overall analysis of data, a very good degree of concordance, CCI=0,939 (confidence interval, IC=95%, 0.902-0.961) and MMD numbers <10%. For hemocytes <32, the concordance decreases, CCI=0.876 (IC 95%=0.787-0.930). The author concludes that this coagulation meter is trustworthy, therefore using it would improve care for a patient needing anti-coagulation treatment during his/her stay in the ward since using this meter helps to obtain immediate results and reduces the trauma when extracting blood samples, etc. Nonetheless, when dealing with patients having a low hemocyte level, it is more prudent to make use of laboratory results(AU)

[Risk management in the operating room in cardiovascular and thoracic surgery; from the nursing point of view].

The primary risk management, on the side of a nurse, in the operating room includes prevention of misidentificatin of both the patient and the site of operation. Leaving of a foreign body in the patient, falling of the patient from the operating table, incidence of deep venous thrombosis and mismatch of blood transfusion should also be prevented with utmost care. The long operating time in cardiovascular surgery and the lateral position of the patient on the operating table in chest or esophageal surgery require additional risk management. Risks of pressure sore as well as nervous injury can be prevented by fixing the patient securely with soft pads to maintain comfortable posture. Above all, careful watching of the patient's condition is most important.

Use of a telehealth device to deliver a symptom management intervention to cardiac surgical patients.

A variety of approaches can provide cardiac patients with needed follow-up care. However, with the explosion of telehealth capabilities, clinicians are more ready to explore other methods to integrate the use of telehealth devices into the delivery of effective nursing interventions. This article summarizes the development of a symptom management intervention for coronary artery bypass graft patients using the Health Buddy to deliver a nursing intervention in the early recovery period after hospital discharge. Considerations used to design the symptom management intervention and selection of this telehealth modality are discussed. This overview can help clinicians and researchers gain perspective on how to evaluate telehealth modalities to aid in the delivery of interventions for cardiac and other clinical populations.

Cardiovascular surgeon and acute care nurse practitioner: collaboration on postoperative outcomes.

Changes occurring in the healthcare environment require healthcare delivery systems to provide high quality care services with increased efficiency and cost-effectiveness. Healthcare systems are encouraged to use less expensive care providers for medical management responsibilities while maintaining or increasing quality of patient care. Accompanying the changes in healthcare delivery modes is the parallel rise in patient acuity levels related to chronic illnesses of patients admitted for cardiac services such as cardiovascular surgeries. This retrospective, 2-group comparison study examined patient and economic outcomes between 2 groups of adult patients for whom postoperative cardiovascular care was directed by either cardiovascular surgeons alone or cardiovascular surgeons in collaboration with acute care nurse practitioners. Outcome measures included length of stay and cost for an episode of care. Findings revealed that when cardiovascular surgeons, in collaboration with acute care nurse practitioners, directed postoperative care, the length of stay decreased 1. 91 days and total cost decreased 5,038.91 dollars per patient.