European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology
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Eur J Cardiovasc Nurs · Jun 2013
Prediction of delirium after cardiac surgery and the use of a risk checklist.
Delirium is a temporary mental disorder, which occurs frequently among patients who undergo cardiac surgery. Delirium prediction and its associated prevention is essential. In a previous study, a risk checklist for delirium was developed. ⋯ The incidence of delirium was 17.3%. A higher Euroscore, but not a disturbance in electrolytes, was confirmed as a predictor of postoperative delirium. Based on this study, a new risk model was constructed with the following risk factors: a higher Euroscore, older age (≥70 years), cognitive impairment, number of comorbidities, history of delirium, alcohol use and type of surgery. When using a probability of delirium of 20%, as predicted by the model, the sensitivity was 80.8% and the specificity 82.2%. The area under the curve was 0.89. With the revised delirium risk checklist, including seven new risk factors, patients with an increased risk of developing delirium following cardiac surgery could be identified more accurately.
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Eur J Cardiovasc Nurs · Jun 2013
Randomized Controlled TrialA new model for integrated heart failure and palliative advanced homecare--rationale and design of a prospective randomized study.
Guidelines have concluded that there is a great need for new models of integrated care, e.g., heart failure and palliative care, in order to facilitate equality of care for dying patients, regardless of diagnosis. We found no evidence in the literature concerning the advantages and effects of integrated heart failure and palliative advanced home care for patients with severe chronic heart failure. ⋯ The PREFER study is designed to investigate whether a new concept of managing patients with severe chronic heart failure by integrating palliative homecare and active heart failure treatment will reduce symptom burden, increase quality of life and ADL, and reduce the number of hospitalizations in patients with severe chronic heart failure.
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The purpose of this study was to explore the theoretical linkages between symptom experiences and meaning associated with medication adherence. The specific objectives were to evaluate the key constructs of Meaning-Response theory for understanding medication adherence in patients with chronic heart failure; to assess the influence of symptom persistence on the meaning associated with prescribed medicines; and to explore the extent to which meaningful associations improve medication adherence. Among patients with heart failure, poor medication adherence occurs in over half of the population, resulting in high rates of symptom exacerbation, avoidable hospitalization, and death. Nurses play a key role in facilitating self-management skills, but patients' perceptions of the relationship between symptoms and medicines is not clear. ⋯ Development of meaningful associations with medicines may improve long-term adherence with prescribed medication in heart failure.
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Eur J Cardiovasc Nurs · Jun 2013
Comparative StudyScreening for mild cognitive impairment in patients with heart failure: Montreal cognitive assessment versus mini mental state exam.
Cognitive impairments occur frequently in patients with chronic heart failure (CHF), resulting in worse health outcomes than expected. These impairments can remain undetected unless specifically screened. There are limited sensitive screening measures available in nursing practice to identify mild cognitive impairment (MCI). ⋯ The MoCA, a screening tool for MCI, identified subtle but potentially clinically relevant cognitive dysfunctions with greater frequency than MMSE.