Using implementation science to help integrate preoperative evidence-based measures into practice for vascular surgery patients

Feasibility of Nurse-Managed Tobacco Use Interventions in Outpatient Surgical Practice

PURPOSE

The aim of this study was to determine the feasibility of developing and implementing a brief nurse-delivered tobacco intervention in an outpatient surgical practice.

DESIGN AND METHODS

Initial formative work used a survey and focus groups to determine knowledge, attitudes, and practices of perioperative nurses working in three outpatient surgical practices regarding smoking use and cessation. Based on this work, a brief intervention was designed and implemented in one of the three practices. The documentation of tobacco use and intervention elements was assessed both immediately and approximately 9 months after implementation.

FINDINGS

Formative work identified not only several barriers to implementation and little current activity but also favorable attitudes toward interventions. Implementation improved self-efficacy for intervention delivery and compliance with documentation of intervention elements that was sustained for at least 9 months.

CONCLUSIONS

Our results suggest that it is feasible for perioperative nurses to play an important role in the delivery of perioperative tobacco interventions.

Tackling Elevated Risk in PAD: Focus on Antithrombotic and Lipid Therapy for PAD

The PAD population is at increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Risk factor modification, symptom control, antithrombotic, and lipid therapies are the mainstays of PAD medical therapy. Recent data has challenged prior recommendations regarding the optimal secondary prevention strategies in PAD. PURPOSE OF REVIEW: To review clinical evidence from large randomized controlled trials showing the benefit of antithrombotic and lipid therapy in the PAD population. RECENT FINDINGS: The COMPASS trial challenged prior recommendations regarding anticoagulation in PAD. Among the PAD subgroup, rivaroxaban 2.5 mg plus aspirin reduced MACE (HR 0.72, 95% CI 0.57-0.90, p = 0.0047), MALE (HR 0.54, 95% CI 0.35-0.82, p = 0.0037), and major amputation (HR 0.30, 95% CI 0.11-0.80, p = 0.011) compared with aspirin monotherapy. The THEMIS trial showed a 55% risk reduction for MALE with ticagrelor DAPT compared with aspirin monotherapy (HR 0.45, 95% CI 0.23-0.86). The FOURIER trial revealed that lowering LDL cholesterol below current targets with a PCSK9 inhibitor reduced MACE (HR 0.73, 95% CI 0.59-0.91, p = 0.0040) and MALE (HR 0.43, 95% CI 0.19-0.99, p = 0.042) in subjects with symptomatic PAD. Recent high-quality evidence shows the benefit of antiplatelet therapy, anticoagulation therapy, and lipid therapy in reducing MACE and MALE in PAD. Despite these findings, implementation remains a challenge and focus should now shift towards adopting evidence-based recommendations in clinical practice.