Corrected QT Interval (QTc) Diagnostic App for the Oncological Routine: Development Study

BACKGROUND

Numerous antineoplastic drugs such as chemotherapeutics have cardiotoxic side effects and can lead to long QT syndrome (LQTS). When diagnosed and treated in time, the potentially fatal outcomes of LQTS can be prevented. Therefore, regular electrocardiogram (ECG) assessments are critical to ensure patient safety. However, these assessments are associated with patient discomfort and require timely support of the attending oncologist by a cardiologist.

OBJECTIVE

This study aimed to examine whether this approach can be made more efficient and comfortable by a smartphone app (QTc Tracker), supporting single-lead ECG records on site and transferring to a tele-cardiologist for an immediate diagnosis.

METHODS

To evaluate the QTc Tracker, it was implemented in 54 cancer centers in Germany. In total, 266 corrected QT interval (QTc) diagnoses of 122 patients were recorded. Moreover, a questionnaire on routine ECG workflow, turnaround time, and satisfaction (1=best, 6=worst) was answered by the centers before and after the implementation of the QTc Tracker.

RESULTS

Compared to the routine ECG workflow, the QTc Tracker enabled a substantial turnaround time reduction of 98% (mean 2.67, 95% CI 1.72-2.67 h) and even further time efficiency in combination with a cardiologic on-call service (mean 12.10, 95% CI 5.67-18.67 min). Additionally, nurses and patients reported higher satisfaction when using the QTc Tracker. In particular, patients' satisfaction sharply improved from 2.59 (95% CI 2.41-2.88) for the routine ECG workflow to 1.25 (95% CI 0.99-1.51) for the QTc Tracker workflow.

CONCLUSIONS

These results reveal a significant improvement regarding reduced turnaround time and increased user satisfaction. Best patient care might be guaranteed as the exposure of patients with an uncontrolled risk of QTc prolongations can be avoided by using the fast and easy QTc Tracker. In particular, as regular side-effect monitoring, the QTc Tracker app promises more convenience for patients and their physicians. Finally, future studies are needed to empirically test the usability and validity of such mobile ECG assessment methods.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04055493; https://classic.clinicaltrials.gov/ct2/show/NCT04055493.

Anti-embolism stocking care protocol to prevent associated skin problems: A quasi-experimental study

AIM

The aim of this quasi-experimental study was to develop an anti-embolism stocking care protocol and assess its effectiveness in preventing associated skin problems on the legs.

MATERIALS AND METHODS

The study was conducted between 02 March and July 20, 2016 in the surgical clinics of a private university hospital in Ankara, Turkey. The sample consisted of 27 nurses and 162 patients (three different patients were fitted of anti-embolism stockings by each of the 27 nurses; pre-protocol 81 patients and post-protocol 81 patients). Data were collected using data collection forms developed by the researchers. An anti-embolism stocking care protocol was developed and used. Nurses and patients were evaluated using an observational method.

RESULTS

Following implementation of the protocol, nurses' mean knowledge (95.24 ± 5.60) and intervention skill (92.06 ± 10.42) scores were significantly higher than their pre-protocol knowledge (73.54 ± 14.26) and intervention skill (15.30 ± 6.84) scores. Nurses performed almost all steps of the care protocol correctly after the protocol was implemented. The rates of skin problems such as pressure ulcers, neurovascular problems and issues associated with wrinkles or creases in stockings were significantly reduced after implementation of the protocol.

CONCLUSIONS

This study demonstrates that nurses' knowledge and intervention skills are increased when a care protocol is used, together with the prevention of errors and improved patient outcomes. The use of care protocols guides nurses in practice, raises awareness and helps to achieve nursing care objectives by standardizing information.

O cotidiano de idosos com insuficiência venosa que usam meia elástica de compressão

Objetivo: Compreender o cotidiano de idosos com insuficiência venosa que usam meia elástica de compressão. Métodos: Pesquisa fenomenológica que entrevistou 13 idosos atendidos em Unidades Básicas de Saúde no estado de Minas Gerais, entre novembro de 2017 e janeiro de 2018. Os depoimentos foram organizados em categorias e discutidos segundo o referencial da fenomenologia social de Alfred Schütz e literatura temática. Resultados: Emergiram das entrevistas as categorias que explicitam a perspectiva dos participantes sobre seu dia a dia com a meia elástica de compressão: “alívio dos principais sintomas da insuficiência venosa”, “adversidades que permeiam o uso das meias elásticas de compressão” e “uso de meia elástica de compressão em longo prazo”. Conclusão: Para os idosos com insuficiência venosa crônica, o uso da meia elástica de compressão promove alívio dos sintomas, porém requer ajuda para calçar e descalçar e provoca sensação de calor e desconforto nos membros inferiores. Os idosos esboçaram a expectativa de continuar usando a meia elástica em longo prazo com vistas a controlar a recidiva de úlcera varicosa. Valorizar as adversidades relacionadas ao uso desse dispositivo de compressão poderá auxiliar esses idosos a ampliar sua autonomia e capacidade funcional comprometidas pela insuficiência venosa.

Everyday life of elderly with venous insufficiency, who use elastic compression socks

Objective: To comprehend every day of older people with venous insufficiency, who use elastic compression socks. Methods: Phenomenological research that interviewed 13 elderly attended Basic Health Units in the state of Minas Gerais, between November 2017 to January 2018. The depositions were organized in categories and discussed according to the Alfred Schütz social phenomenology and theme literature. Results: Emerged from the interviews that make explicit the perspective of the participants regarding their everyday activities with compression elastic socks: “main symptoms of the venous insufficiency relieved”, “adversities that permeate the use of elastic compression socks” and “long term use of compression elastic socks”. Conclusion: For elderly people with chronic venous insufficiency, the use of elastic compression socks promotes relieve of the symptoms; however, it demands help to put them on and take them off and provokes heat sensation and discomfort in the limbs. The elderly showed the expectation to continue the long term use of the elastic sock aiming at avoiding the relapse of varicose ulcer. To validate the adversities related to the use of this compression device may help the elderly to broaden their autonomy and functional capacity, which may be compromised by venous insufficiency.