What have our patients learnt after being hospitalised for an acute myocardial infarction?

Background: Education for hospitalised patients is an important aspect of care for people who have an acute cardiovascular event. Objective: To investigate the cardiovascular risk factor behaviours of patients together with their acute coronary syndrome (ACS) knowledge, attitudes and beliefs following admission to hospital for an acute myocardial infarction. Methods: Patients diagnosed with an acute myocardial infarction participated in an observational study. Patients completed a questionnaire consisting of cardiovascular risk factor behaviour questions and the ACS Response Index prior to discharge and at follow-up 10 weeks later. Results: Of the 135 participants enrolled, 114 (84%) completed follow-up, 70% were males; mean age was 63 (±11.6) years. The median length of hospital stay was 3 days (IQR 1) and the time to follow-up after discharge was 10 weeks. Self-reported risk factor behaviours improved significantly for diet (p < 0.001) and smoking cessation (p = 0.023) following discharge. At discharge 39% of patients had inadequate knowledge of ACS symptoms. The ACS Response Index improved significantly after discharge for attitudes (p = 0.004) and beliefs (p = 0.008). Despite 85% of patients indicating they would attend cardiac rehabilitation only 30% had commenced a programme at follow-up. Conclusion: Patients reported implementing a number of healthy lifestyle changes following discharge including smoking cessation and healthy eating. Attitudes and beliefs regarding ACS showed a significant improvement following discharge. More than one third of patients had inadequate knowledge at discharge, suggesting current education practices may not be meeting the needs of patients with a myocardial infarction

Home medicines reviews following acute coronary syndrome: study protocol for a randomized controlled trial

Background: Despite continual improvements in the management of acute coronary syndromes, adherence to guideline-based medications remains suboptimal. We aim to improve adherence with guideline-based therapy following acute coronary syndrome using an existing service that is provided by specifically trained pharmacists, called a Home Medicines Review. We have made two minor adjustments to target the focus of the existing service including an acute coronary syndrome specific referral letter and a training package for the pharmacists providing the service.Methods/Design: We will be conducting a randomized controlled trial to compare the directed home medicines review service to usual care following acute coronary syndromes. All patients aged 18 to 80 years and with a working diagnosis of acute coronary syndrome, who are admitted to two public, acute care hospitals, will be screened for enrolment into the trial. Exclusion criteria will include: not being discharged home, documented cognitive decline, non-Medicare eligibility, and presence of a terminal malignancy. Randomization concealment and sequence generation will occur through a centrally-monitored computer program. Patients randomized to the control group will receive usual post-discharge care. Patients randomized to receive the intervention will be offered usual post-discharge care and a directed home medicines review at two months post-discharge. The study endpoints will be six and twelve months post-discharge. The primary outcome will be the proportion of patients who are adherent to a complete, guideline-based medication regimen. Secondary outcomes will include hospital readmission rates, length of hospital stays, changes in quality of life, smoking cessation rates, cardiac rehabilitation completion rates, and mortality.Discussion: As the trial is closely based on an existing service, any improvements observed should be highly translatable into regular practice. Possible limitations to the success of the trial intervention include general practitioner approval of the intervention, general practitioner acceptance of pharmacists' recommendations, and pharmacists' ability to make appropriate recommendations. A detailed monitoring process will detect any barriers to the success of the trial. Given that poor medication persistence following acute coronary syndrome is a worldwide problem, the findings of our study may have international implications for the care of this patient group.Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12611000452998. © 2012 Bernal et al; licensee BioMed Central Ltd

Prevention of foot ulcers in patients with diabetes in home nursing : a qualitative interview study

Summary Diabetes mellitus and foot ulcer increase the risk of amputation, and prevention of foot ulcers are therefore important. Patients with diabetes and other concomitant diseases are often cared for in a home nursing service and the registered nurses (RNs) have the opportunity to practise preventive care to avoid foot ulcers. How prevention of foot ulcer is performed in home nursing settings has not been previously described. The objective of this study was to explore RNs’ professional work with foot ulcer prevention in home nursing settings for patients with diabetes mellitus. Qualitative interviews were analysed, using manifest content analysis. The setting was four municipalities in Sweden (large and small cities, and rural areas). Fifteen RNs actively working in a home nursing service with more than two years’ experience were recruited. The participants were all women, had worked as RNs for 3–41 years (median 25), and in home nursing for 2–18 years (median 8). The results showed that the RNs work through leadership, coordination, education and evaluation. Health care assistants perform most of the nursing actions to prevent foot ulcers such as assessment of feet, off-loading, nutrition and hygiene. The RNs have medical and nursing responsibility but without the formal tools to execute this fully. The RNs’ formal education was some years back and they relied mostly on experience-based knowledge. It was concluded that patient assessment and nursing actions to prevent foot ulcers are mostly performed by health care assistants. The RNs need to be given formal responsibility in their role as leaders and educators, and need more education in pedagogy and leadership. Eur Diabetes Nursing 2013; 10(2): 52–57 Key words diabetes; diabetic foot ulcer; education; elderly; foot care; foot health; nursing; home care; pressure ulcer; preventio

Diabetes and infected foot ulcer : a survey of patients' perceptions of care during the preoperative and postoperative periods

Diabetic foot ulcer is a serious threat to the extremities and to the individual's survival. The most common risk factors for amputation are deep infection, plantar ulcer and gangrene. The aim of this study was to measure inpatients' perception of health care quality, and to identify the health care needs of people with diabetes and infected foot ulcers during the preoperative and postoperative periods. The study design was empirical with a quantitative approach. The short form of the Quality of care from the Patient's Perspective (Mini QPP) was used. The results are described in four categories related to the Mini QPP model: medical technology; physical-technical conditions; identity-oriented approach; and socio-cultural atmosphere. The study participants (n=30) expressed a need for continuous information, a secure and comfortable physical environment, shared decision making, and better quality of pain management. More research about how to improve information, the environment, shared decision making, and pain control would be desirable.Eur Diabetes Nursing 2013; 10(3): 91–9

Behavioral Pain Scale - translation, reliability, and validity in a Swedish context

Background: Assessing pain in the intensive care unit (ICU) is challenging. Due to intubation and sedation, communication can be limited. International guidelines recommend assessing pain with instruments based on behavioral parameters when critically ill patients are unable to self-report their pain level. One of the recommended instruments, the Behavioral Pain Scale (BPS), has shown good validity and reliability in international studies. The aim of this study was to translate and adapt the BPS for critically ill intubated and non-intubated patients in a Swedish ICU context and to assess inter-rater reliability and discriminant validity. Methods: The BPS (both for intubated and non-intubated patients) was translated and adapted into Swedish using a translation method consisting of ten steps. The Swedish version was then tested for inter-rater reliability and discriminant validity on 20 critically ill patients (10 intubated and 10 non-intubated) before and directly after a potentially painful procedure (repositioning Results: The Swedish version of the BPS showed inter-rater reliability with a percentage agreement of 85% when tested on a sample of critically ill patients. The instrument also showed discriminant validity between assessments at rest and after repositioning Conclusion: Results of the Swedish version of the BPS support its use in critically ill patients who cannot self-report their pain level. Still, additional studies are needed to further explore its reliability and validity in the Swedish ICU contex

Patient education for the prevention of diabetic foot ulcers. Interim analysis of a randomised controlled trial due to morbidity and mortality of participants

This study was designed to explore whether participant-driven patient education ingroup sessions, compared to provision of standard information, will contribute to astatistically significant reduction in new ulceration during 24 months in patients withdiabetes and high risk of ulceration. This is an interim analysis after six months.A randomised controlled study was designed in accordance with CONSORTcriteria. Inclusion criteria were: age 35–79 years old, diabetes mellitus, sensoryneuropathy, and healed foot ulcer below the ankle; 657 patients (both male andfemale) were consecutively screened.A total of 131 patients (35 women) were included in the study. Interim analysis of98 patients after six months was done due to concerns about the patients’ ability tofulfil the study per protocol. After a six-month follow up, 42% had developed a newfoot ulcer and there was no statistical difference between the two groups. The numberof patients was too small to draw any statistical conclusion regarding the effect of theintervention. At six months, five patients had died, and 21 had declined furtherparticipation or were lost to follow up. The main reasons for ulcer development wereplantar stress ulcer and external trauma.It was concluded that patients with diabetes and a healed foot ulcer develop footulcers in spite of participant-driven group education as this high risk patient group hasexternal risk factors that are beyond this form of education. The educational methodshould be evaluated in patients with lower risk of ulceration.Eur Diabetes Nursing 2011; 8(3): 102–10

To assess patients pain in intensive care : developing and testing the Swedish version of the Behavioural Pain Scale

Objectives: The Behavioural Pain Scale has previously been translated into Swedish and psychometrically tested. One of the domains- 'compliance with ventilation'- did not show equally as good psychometric proprieties as the other domains, which led to the question whether a development of that domain would be beneficial. This study aimed to develop the domain of 'breathing pattern' in the Swedish version of the Behavioural Pain Scale and then test the instrument for discriminant validity, inter-rater reliability and criterion validity. Method: The domain 'breathing pattern' was developed and included when the Swedish version of the Behavioural Pain Scale was psychometrically tested in 360 paired assessments. Results: The instrument showed discriminant validity through a significant positive change on the scale before and during turning and inter-rater reliability with an absence of significant disagreement on the scale between the paired assessments. The developed domain had a better result in discriminant validity than the original domain. The instrument also showed higher sensitivity in discriminating pain compared to assessment without an instrument. Conclusion: The Swedish version of the Behavioural Pain Scale, with a developed domain for 'breathing pattern' showed to be a reliable instrument for pain assessment in the adult intensive-care patient. (C) 2019 Elsevier Ltd. All rights reserved

Behavioral involvement and preference for information among male and females with cardiac disease

The aim of this pilot study was to explore and compare preferences for involvement and preferences for information among men and women who had suffered from cardiac disease. A convenience sample of 79 respondents (47 men and 32 women) was recruited from The National Association of Heart and Lung Patients in Sweden at ten local meeting places in different areas. Krantz Health Opinion Survey, KHOS, a 16-item self-rating questionnaire, was used to measure patients’ desire for involvement in healthcare. The results indicate that patients’ information preferences and behavioural preferences are not very high though the total score in KHOS was 5.47. A difference between the genders was also found, seen as higher scores in females than males; 5.93 vs 4.44, p = 0.032, indicating that women prefer a more active role in decision making than men do. The main practical conclusion drawn from this empirical study is that patients are still not as active in seeking information or in behavioural involvement as is desirable