Epicardial pacing wires after cardiac surgery: an Irish cross-sectional study

2020 ◽  
Vol 29 (8) ◽  
pp. 476-480
Author(s):  
Niamh Kiely ◽  
Frances O'Brien ◽  
Mary Mooney
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Best Practice ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Delayed Discharge ◽  
Epicardial Pacing ◽  
Delayed Removal

Background: Temporary epicardial pacing wires are inserted after cardiac surgery. However, there are no international guidelines on which to base best practice regarding wire insertion or removal. Methods: Data were collected on patients following cardiopulmonary bypass and analysed in terms of use, duration of use and complications of pacing wires after surgery. Results: Wires were inserted in 164 of the 167 patients. Most (74%) did not require pacing. Patients were categorised into those who had aortic valve replacement (AVR) (n=42) and those who did not (n=122). Of the AVR group, 26% (n=11) were pacemaker dependent after surgery and 10% (n=4) required permanent pacemakers. Most pacing wires were removed by day 4. The only noted complication was delayed discharge. Conclusion: Unused pacing wires are normally removed on day 4, but for 77 (47%) of patients they remained in place longer. Forty patients (24%) had delayed wire removal because of a policy of wire removal during business hours only. Of these 40 patients, 27 (17% of the 77 with delayed removal) had delayed discharge as a result of our wire removal policy.

scholarly journals Pharmacological analgesia in neonates undergoing cardiac surgery

2008 ◽  
Vol 16 (4) ◽  
pp. 727-732 ◽  
Author(s):  
Mariana Bueno ◽  
Amélia Fumiko Kimura ◽  
Cibele Andrucioli de Mattos Pimenta
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Pain Control ◽  
Private Hospital ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Postoperative Pain Control ◽  
Fentanyl Citrate ◽  
Cross Sectional ◽  
The City

The objectives of this study were to verify the frequency of pharmacological analgesia and the occurrence of postoperative pain in neonates undergoing cardiac surgery. METHODS: This is a cross-sectional study and data were collected from 30 medical charts of neonates who underwent cardiac surgery in a private hospital in the city of São Paulo. RESULTS: The majority (96.6%) of neonates received analgesia: 18 (60.0%) received continuous analgesics, five (16.7%) received intermittent drugs, and six (20.0%) received a combination of continuous and intermittent analgesics. Fentanyl citrate was continuously administered to 24 (80.0%) neonates. Intermittent dipyrone and morphine was administered to ten (33.3%) and one (3.3%) neonates, respectively. Pain registers were observed in 17 (56.7%) medical charts and the occurrence of pain among neonates who received analgesics was 53.4%. CONCLUSION: There was no efficacy in pharmacological postoperative pain control in the neonates included in this study.

scholarly journals Mental capacity assessment: a descriptive, cross-sectional study of what doctors think, know and do

2020 ◽  
pp. medethics-2019-105819
Author(s):  
Dexter Penn ◽  
Anne Lanceley ◽  
Aviva Petrie ◽  
Jacqueline Nicholls
Keyword(s):  
Best Practice ◽  
Secondary Analysis ◽  
Cross Sectional Study ◽  
Mental Capacity ◽  
Capacity Assessment ◽  
Career Stage ◽  
Sectional Study ◽  
Cross Sectional ◽  
Self Confidence ◽  
Mental Capacity Act

BackgroundThe Mental Capacity Act (MCA) (2005) was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors’ compliance with legal and professional standards is inconsistent, but the reasons for poor compliance are not well understood. This preliminary study investigates doctors’ experiences of and attitudes toward mental capacity assessment (MCAx).MethodsThis is a descriptive, cross-sectional study where a two-domain, study-specific structured questionnaire was developed, piloted and digitally disseminated to doctors at differing career stages employed in a large, multi-site National Health Service Trust in London over 4 months in 2018. Descriptive statistics and frequency tables adjusted for missing data were generated and secondary analysis was conducted.ResultsParticipants (n=92) were predominantly UK trained (82%), female (58%) and between the ages of 30 and 44 years (45%). Less than half (45%) of the participants reported receiving formal MCAx training. Only one-third (32%) of the participants self-rated themselves as very competent (29%) or extremely competent (4%). Self-reported MCA confidence was significantly affected by career stage with Consultants with over 10 years of experience reporting lowest confidence (p=0.001).ConclusionsThis study describes significant variation in practice by doctors and low self-confidence in the practice of MCAx. These results raise concerns that MCAx continues to be inconsistently performed by doctors despite appropriate awareness of the law and professional guidance on best practice.

scholarly journals Anxiety and Depression Symptomatology Related to Inspiratory Muscle Strength and Functional Capacity in Preoperative Cardiac Surgery Patients: A Preliminary Cross-sectional Study

2020 ◽  
Vol 42 (6) ◽  
pp. 549-554
Author(s):  
Kornanong Yuenyongchaiwat ◽  
Sasipa Buranapuntalug ◽  
Karan Pongpanit ◽  
Chitima Kulchanarat ◽  
Opas Satdhabudha
Keyword(s):  
Cardiac Surgery ◽  
Muscle Strength ◽  
Cardiorespiratory Fitness ◽  
Psychological Health ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
Sectional Study ◽  
Cross Sectional ◽  
Psychological Conditions ◽  
Inspiratory Muscle Strength

Background: Poor psychological health and cardiorespiratory fitness prior to open heart surgery (OHS) might be predictors of postoperative pulmonary complications that lead to morbidity and mortality. Assessment of physical and psychological conditions should be considered for patients receiving OHS, to possibly prevent these complications. This study investigates how inspiratory muscle strength (IMS) and functional capacity (FC) relate to the psychological health of preoperative cardiac surgery patients. Method: A cross-sectional study was designed before OHS; the 6-minute walk test and IMS were performed on patients who were admitted for OHS. All participants were requested to complete Hospital Anxiety and Depression Scale. Pearson correlation and hierarchal regression analysis were performed to determine the relationships between IMS and FC and psychological conditions (anxiety and depression). Results: Overall, 36 males and 28 females aged 56.89±10.23 years were recruited. Significant relationships were observed between IMS and anxiety and depression symptoms (r = –0.33 and r = –0.27, respectively). Anxiety was negatively related to FC ( r = –0.25). These relationships remained significant after adjustment for age, sex, and body mass index (BMI) (∆ R2 = 0.11 and ∆ R2 = 0.09). In addition, anxiety was also related to FC after controlling for age, sex, and BMI (∆ R2 = 0.09). Conclusion: Among patients undergoing OHS, those with a higher level of depression or anxiety had a lower cardiorespiratory fitness than those with a low level of depression or anxiety.

scholarly journals Non-home discharge after cardiac surgery in Australia and New Zealand: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049187
Author(s):  
Mahesh Ramanan ◽  
Aashish Kumar ◽  
Chris Anstey ◽  
Kiran Shekar
Keyword(s):  
Cardiac Surgery ◽  
New Zealand ◽  
Artery Bypass ◽  
Care Facility ◽  
Cross Sectional Study ◽  
Adult Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Home Discharge ◽  
Over Time

ObjectiveTo determine the proportion of patients surviving their cardiac surgery who experienced non-home discharge (NHD) over a 16-year period in Australia and New Zealand (ANZ).DesignRetrospective, multicentre, cross-sectional study over the time period 01 January 2004 to 31 December 2019.SettingAdult patients who underwent cardiac surgery from the Australia New Zealand Intensive Care Society Adult Patient Database (APD).ParticipantsAdult patients (age 18 and above) who underwent index coronary artery bypass grafting, cardiac valve surgery or combined valve/coronary surgery.ExposureThe primary exposure variable was the calendar year during the which the index surgery was performed.OutcomeThe primary outcome was NHD after the index surgery. NHD included discharge to locations such as nursing home, chronic care facility, rehabilitation and palliative care.ResultsWe analysed 252 924 index cardiac surgical admissions from 101 discrete sites with a median age of 68 years (IQR 60–76), of which 74.2% (187 662 out of 252 920) were males. Of these, 4302 (1.7%) patients died in hospital and 213 011 (84.2%) were discharged home, 18 010 (7.1%) were transferred to another hospital and 17 601 (7%) experienced NHD. In Australia, 14 457 (6.4%) of patients progressed to NHD, compared with 3144 (11.7%) in New Zealand. The rate of NHD increased significantly over time (adjusted OR per year=1.06, 95% CI, 1.06 to 1.07, p<0.001). Increasing age, female sex, non-elective surgery, surgery type and Acute Physiology and Chronic Health Evaluation III Score were all associated with significant increase in NHD.ConclusionsThere was significant increase in NHD after cardiac surgery over time in ANZ. This has significant clinical relevance for informed consent discussions between healthcare providers and patients, and for healthcare services planning.

scholarly journals Delayed discharge for non-clinical reasons among stroke patients in a high-complexity hospital: A cross-sectional study

2021 ◽  
Author(s):  
Amada Pellico-López ◽  
Ana Fernández-Feito ◽  
David Cantarero ◽  
Manuel Herrero Montes ◽  
Joaquín Cayón- De las Cuevas ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Sudden Onset ◽  
Sectional Study ◽  
High Complexity ◽  
Northern Spain ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Delayed Discharge ◽  
Recovery Resources

Abstract Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007-2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The mean age was 80.22 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care.

scholarly journals Relationship between burnout and nursing practice environment in pediatric cardiology: a cross-sectional study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Bagnasco ◽  
M Zanini ◽  
N Dasso ◽  
S Rossi ◽  
G Catania ◽  
...  
Keyword(s):  
Patient Safety ◽  
Cardiac Surgery ◽  
Work Environment ◽  
Emotional Exhaustion ◽  
Pediatric Cardiology ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Skill Mix ◽  
The Relationship

Abstract Introduction The relationship between burnout and patient safety is widely demonstrated in the literature. Recent studies have shown that in pediatrics the burnout rates are even higher, thus increasing young patients' exposure to risks. Pediatric cardiology is often characterized by acute onset in the pre-natal period and requires long periods of hospitalization. Strategies to reduce burnout and its impact on patient safety is a priority. Purpose To test the relationship between nursing work environment and emotional exhaustion in nurses in pediatric cardiology. Methods Data were drawn from the database of a larger study, RN4CAST@IT-Ped, a cross-sectional study in which 13 Italian hospitals were involved. Convenience sampling was adopted, and inclusion criteria were nurses providing direct routine care in wards. For this study, only data relating to nurses working in Pediatric Cardiology were extracted. The data were collected through a web survey from September 2017 to January 2018. The questionnaire investigated several aspects relating to care and nursing staff including workload, skill mix, work environment measured with PES-NWI, and emotional exhaustion with the Maslach Burnout Inventory. Descriptive statistical analyses were conducted to describe the sample and variables taken into consideration; a binomial logistic regression model was built to test the relationships between the dependent variable “high Emotional Exhaustion” and the independent variables “PES-NWI composite score”, adjusted for “workload” and “skill mix”. Results The responses from eighty-five pediatric nurses from 7 units (mixed cardiology-cardiac surgery, cardiology, arrhythmology, cardiac surgery and a cardiology intensive care unit), in 5 hospitals, were analyzed. These findings show that with the same skill mix and workload, the improvement of the workplace environment conditions decreased by 81% (OR 0.192; 95% CI 0.062–0.591) the risk that nurses working in pediatric cardiology would develop a high level of Emotional Exhaustion. Conclusions Demonstrating the association between emotional exhaustion and work environment in pediatric cardiology is only a first step towards improvement. Workplace environment includes relational, logistic, and organizational aspects that require further investigation to ensure that nursing in pediatric cardiology is even safer and of better quality in all its key aspects: urgency, intensity, chronicity and complexity. Funding Acknowledgement Type of funding source: None

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