B-type natriuretic peptide in the cardiology department

Heart Failure is one of the fastest growing cardiovascular diseases of the 21st century. Echocardiogram is considered the gold standard for diagnosis, but is costly, time consuming and not readily accessible to all patients. Our aim was to assess the diagnostic utility of BNP to risk stratify patients for ECHO. Seventy-four GP referred, non-pregnant patients of > or = 18 years with a working diagnosis of HF were recruited. Patients were given two appointments to attend the Cardiology Department and at each, were examined by the same cardiologist, had their medications recorded and blood drawn for BNP analysis. ECHO was performed at the second visit. The diagnosis of HF was confirmed in 49 of 74 patients (66%). The clinical utility of BNP to rule-in HF was evaluated using ROC curve analysis. The AUC was satisfactory at 0.691 (C.I. 0.573-0.793). The positive likelihood ratio (+LR) was 5.87, negative likelihood ratio (-LR) was 0.58, the positive predictive value was 92% and a negative predictive value was 47%. One-third of patients (n = 25) had a BNP >178 pg/mL, 23 of whom had HF confirmed. At this decision threshold BNP correctly classified 23 of 25 patients who were confirmed not to have HF (Specificity for HF of 92%). A BNP of > or = 178 pg/mL can be used to prioritise GP patients for ECHO.

Coping while caring for the dying child: nurses' experiences in an acute care setting

The aim of this study was to describe and understand behavior and coping strategies used by pediatric nurses caring for dying children on an inpatient acute care cardiology unit. Qualitative descriptive methods consisting of semistructured questions were presented to acute care nurses participating in focus groups. The nurses who participated in the focus groups had cared for an acutely ill child who died. Conventional content analysis was used to analyze data and organize results. The categories that emerged included the following: boundaries, memories, disconnecting, and labeling. Colleague support, institutional resources, and nurses' experience level were critical to the process of coping. Coping and grieving are facilitated by colleague and unit resources. Studies exploring job dissatisfaction, stress, and burnout from an inadequate grieving process are required.

Outcomes of PCI at hospitals with or without on-site cardiac surgery

BACKGROUND

Performance of percutaneous coronary intervention (PCI) is usually restricted to hospitals with cardiac surgery on site. We conducted a noninferiority trial to compare the outcomes of PCI performed at hospitals without and those with on-site cardiac surgery.

METHODS

We randomly assigned participants to undergo PCI at a hospital with or without on-site cardiac surgery. Patients requiring primary PCI were excluded. The trial had two primary end points: 6-week mortality and 9-month incidence of major adverse cardiac events (the composite of death, Q-wave myocardial infarction, or target-vessel revascularization). Noninferiority margins for the risk difference were 0.4 percentage points for mortality at 6 weeks and 1.8 percentage points for major adverse cardiac events at 9 months.

RESULTS

A total of 18,867 patients were randomly assigned in a 3:1 ratio to undergo PCI at a hospital without on-site cardiac surgery (14,149 patients) or with on-site cardiac surgery (4718 patients). The 6-week mortality rate was 0.9% at hospitals without on-site surgery versus 1.0% at those with on-site surgery (difference, -0.04 percentage points; 95% confidence interval [CI], -0.31 to 0.23; P=0.004 for noninferiority). The 9-month rates of major adverse cardiac events were 12.1% and 11.2% at hospitals without and those with on-site surgery, respectively (difference, 0.92 percentage points; 95% CI, 0.04 to 1.80; P=0.05 for noninferiority). The rate of target-vessel revascularization was higher in hospitals without on-site surgery (6.5% vs. 5.4%, P=0.01).

CONCLUSIONS

We found that PCI performed at hospitals without on-site cardiac surgery was noninferior to PCI performed at hospitals with on-site cardiac surgery with respect to mortality at 6 weeks and major adverse cardiac events at 9 months. (Funded by the Cardiovascular Patient Outcomes Research Team [C-PORT] participating sites; ClinicalTrials.gov number, NCT00549796.).

Myocardial infarction and normal coronary arteries: the experience of the cardiology department of Sfax, Tunisia

OBJECTIVE

The purpose of the present study is to describe our experience with patients who have a transmural myocardial infarction (MI) in the presence of a normal coronary artery. The clinical profile, demographic characteristics and outcomes of these patients are discussed.

METHODS

Between January 2006 and August 2011, 21 patients who presented with a Q-wave myocardial infarction were found to have normal coronary arteries. The prevalence rate of this entity was 1.5% (21 out of 1,400 Q wave MI patients). These patients were characterized by their young age (the mean age=44.95±14.86), male dominance (90.47%), and a high prevalence of smoking (85.71%). In this study, 4 patients have an evident spontaneous spasm shown on coronary angiography which disappeared after intracoronary injection of nitrates. Coagulation Disorders, such as activated protein C resistance (APC) resistance, protein C deficiency and antiphospholipid antibody syndrome were found in 4 of 12 patients who underwent systematic examination. One patient had a history of lung cancer which may be associated with a hypercoagulable state and may explain the occurrence of myocardial infarction with a normal coronary artery. The mean left ventricle ejection was 56. 5±12. The mean follow-up was 24±10 months. Six patients developed residual chest pain which was generally easily controlled by anti-spastic therapy and no patient had a major cardiovascular event.

CONCLUSION

Patients with Q-wave MI and with normal coronary arteries seem to have a good short and long-term prognosis especially when they are treated with an exclusive medical strategy.

[The use of computer pulse oximetry monitoring for screening of sleep apnea in patients of a hospital cardiology department]

In order to assess the overall prevalence of sleep apnea of obstructive and central origin in of patients hospital cardiology department we performed continuous pulse oximetry monitoring during sleep in all patients admitted over 2 months. Of the 139 patients reliable results were obtained in 125 (89.9%). In 72% of patients desaturation index was 5 or more, indicating probability of sleep apnea. In 36% of patients oxygen desaturation index was > or = 15, which corresponded to moderate forms of sleep apnea. And only 28% of patients had no pathological changes in the nocturnal oxygen saturation curve. Thus, in patients hospital cardiology department we revealed extremely high prevalence of sleep apnea of various origins. Showed the technical feasibility of the continuous pulse oximetry monitoring for mass screening of apnea during sleep.

Faible taux de succès du sevrage tabagique à court et moyen termes au décours d’un infarctus aigu du myocarde dans un service de cardiologie de Dakar au Sénégal

Introduction

Le tabagisme est un puissant facteur de risque cardio-vasculaire. Son sevrage semble moins bien pris en compte chez les coronariens. Les objectifs de ce travail étaient d’évaluer la prévalence du tabagisme et le sevrage tabagique au décours d'un infarctus du myocarde dans un service de cardiologie au Sénégal.

Méthodes

Il s'agit d'une étude transversale et descriptive réalisée entre janvier 2008 et juin 2010. Nous avons recruté les patients hospitalisés pour infarctus du myocarde puis les fumeurs actifs ont été inclus dans notre enquête. Les malades étaient sensibilisés pour l'arrêt du tabac puis suivis à 3 mois, 6 mois et 12 mois pour évaluer le sevrage tabagique.

Résultats

Nous avons recensé 82 patients hospitalisés pour un infarctus du myocarde, parmi eux 26 sujets (25 hommes) étaient fumeurs (31,7%). L’âge moyen des sujets fumeurs était de 56±11,5 ans. La consommation moyenne de tabac était de 32±14 paquets-année et le score moyen de Fagerström de 8. Tous les patients ont arrêté le tabac pendant l'hospitalisation. Après un suivi de 3 mois, 45% des patients ont repris le tabac, 65% à 6 mois et 85% à 12 mois.

Conclusion

Le tabagisme est assez fréquent chez les patients sénégalais présentant un infarctus du myocarde. Le taux de sevrage tabagique à court et moyen termes est faible. Le sevrage tabagique devrait alors constituer un objectif privilégié dans la prévention des maladies cardio-vasculaires.

A tablet computer application for patients to participate in their hospital care

Building on our institution's commercial electronic health record and custom personal health record Web portal, we developed a tablet computer application to provide interactive information to hospital patients. Using Apple iPad devices, the prototype application was provided to five patients in a cardiology step-down unit. We conducted detailed interviews to assess patients' knowledge of their inpatient care, as well as their perceptions of the usefulness of the application. While patients exhibited varying levels of comfort with using the tablet computer, they were highly enthusiastic about the application's ability to supply health information such as their inpatient medication histories and photographs of their care providers. Additional research is warranted to assess the benefit such applications may have for addressing inpatient information needs, enhancing patient-provider communication and improving patient satisfaction.

Managing professionals: exploring the role of the hospital HR function

PURPOSE

The purpose of this paper is to consider the role of the HR function in the management of professional and non-professional staff in the acute hospital sector.

DESIGN/METHODOLOGY/APPROACH

A qualitative approach was adopted. Empirical data from three hospital case studies is utilised to explore the role of the hospital HR function. Cases were compiled from 45 interviews, observation and secondary data analysis.

FINDINGS

The paper finds that in two of the three cases the human resource (HR) function predominantly provides services to non-professional workforce groups. However, the effective and strategic management of professionals is undertaken in the third case, without a professional HR function.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings of this paper require some caution in extrapolation, being based on research in one national context. The authors suggest the delivery of service as a useful lens to explore the enacted practice of HRM in hospitals.

PRACTICAL IMPLICATIONS

The paper draws attention to a significant deficit in the role of the HR function in managing core professional staff.

ORIGINALITY/VALUE

The paper applies an existing conceptual framework to explore the role of the HR function in hospitals. It identifies a significant deficit in the management of core professional staff. On this basis the paper suggests alternative research methodologies to investigate the management of all hospital staff.

Evaluation of possibilities in demographic data exchange support in Czech healthcare

This paper summarizes the evaluation of two standardized approaches to implementation of messages for demographic data exchange between the preventive cardiology outpatient department located at the Institute of Computer Science AS CR, v.v.i. in Prague and the Outpatients Department of Cardiology of Municipal Hospital in Caslav. Our setting consists of four independent systems maintaining different clinical data (scheduling system, hospital information system, EHR system and a digital ECG). The aim is to avoid repetitive patient demographic data entry. We evaluate the suitability of IHE Patient Administration Management Profile (including HL7 v.2.5) and Czech national standard DASTA using Standard Evaluation Framework proposed and published in 2008 by J. Mykkänen et al. Besides the evaluation of standards, we also discuss some aspects of the framework.

Christchurch experience of pulmonary embolism with and without thrombolysis

AIMS

Thrombolysis for normotensive patients with large clot burden pulmonary embolism remains debatable. We aim to document our current management of pulmonary embolism, examining determinants of therapy and outcomes.

METHOD

A retrospective chart-based review of all patients admitted with pulmonary embolism under Cardiology service in Christchurch Hospital between 2002-2007. All related CT pulmonary angiograms were also reviewed for quantification of clot burden and evidence of right ventricular strain.

RESULTS

120 patients were admitted during the audit period. Hypotensive patients had a significantly higher troponin level and Qanadli scores. RV/LV ratio >1 in CTPA was 80% sensitive and 57% specific in predicting RV strain on echocardiogram. Forty-six patients were thrombolysed, most with large clot burden and right ventricular strain. No treatment related death or intracranial haemorrhages occurred; however six patients required blood transfusion and six patients had persistent pulmonary hypertension at 6 months. There was a higher in-patient event rate in thrombolysed group, due to increased bleeding, compared to non-thrombolysed patients.

CONCLUSION

Thrombolysis was successfully performed with relatively low in-patient and 6-month event rate. Long term advantage over routine anticoagulation was not demonstrated. The role of thrombolysis in normotensive patients with large clot burden remains uncertain. CTPA markers of RV strain correlated well with echocardiography.

Blood pressure control among diabetic hypertensives under cardiology follow-up at a regional hospital in rural Malaysia

Three hundred thirty-one consecutive patients presenting with hypertension to the outpatient medical clinic of Tengku Ampuan Afzan Hospital, Kuantan, Malaysia were screened and 150 patients with concurrent diabetes were enrolled into a cross-sectional study. The majority of patients were male (60.6%) with a mean age of 60.0 +/- 11.0 years. The mean systolic blood pressure (SBP) was 140.9 +/- 20.1 mmHg and the mean diastolic blood pressure (DBP) was 81.7 +/- 9.8 mmHg. Only 38.0% (57/150) of patients had blood pressures within recommended guidelines (130/80 mmHg). The mean blood pressure in this group was 123.7 +/- 8.5/76.4 +/- 5.6 mmHg. The majority of patients were on either 2 (41.3%) or 3 (31.3%) anti-hypertensives. Females had a significantly higher SBP 145.4 +/- 22.7 vs. 138.0 +/- 17.8 mmHg in males (p = 0.026). The level of blood pressure control in diabetics was unsatisfactory, especially in females and the elderly. A reassessment of priorities in the management of patients with concurrent hypertension and diabetes is therefore, urgently needed.

[Dealing with error in cardiology]

A commonly used definition describes an error as a harmful or potentially harmful occurrence for the patient. Although over the last years the evolution of medicine has been characterized by remarkable technological advances, the percentage of errors in clinical practice has not changed since the '40s. In this setting, the aim of our review is to assess how errors develop in real life in modern cardiology and how they can be identified early, corrected, and possibly prevented. In our opinion, the more a healthcare system (i.e., a cardiology ward or a hospital) is capable of facing its error, the safer it is. In our daily practice, errors can be distinguished in "clinical errors" (mainly related to knowledge) and "system errors" (mainly referring to healthcare organization; i.e., the integrated cardiac network). Bearing in mind the high frequency and consequences, cardiologists should consider errors as among the main determinants of quality of care, which the whole team has to deal with. Time and resources should be spent to identify the best approaches to cope with errors, tailored for each cardiology team. Ultimately, the care of a patient with heart disease should be viewed holistically and not as the afinalistic sum of procedures, no matter how technically developed.

The heart of PACS. While most CIOs feel secure taking on the challenge of traditional radiology-focused PACS, cardiology PACS is another story

In terms of both workflow and the type of specialty care involved, cardiology PACS is inherently more complex and challenging than radiology PACS. Very few organizations have gotten beyond some initial work in automating the collection of data from one or a few different clinical processes. Even at this early phase of development, it's clear that clinician workflow and efficiency can be dramatically improved by cardiology PACS implementation. Enterprise-wide image and data storage, retrieval, and sharing capability across cardiology, radiology, and other specialties, is where hospital organizations are headed, though the path is a long and difficult one.