Unplanned admissions after outpatient cardiac catheterization

Increasing numbers of patients are undergoing diagnostic catheterization as outpatients; however, a small proportion of patients requires hospital admission following the procedure. Unplanned admissions after consecutive outpatient cardiac catheterizations performed during 1 year were prospectively reviewed to determine the incidence of and reasons for admission. Among 847 patients undergoing outpatient cardiac catheterization, 130 patients (15%) required hospital admission after the procedure. Admitted patients were divided into four groups: patients undergoing immediate percutaneous transluminal coronary angioplasty (PTCA) (Group 1; 33%), patients with severe cardiac disease requiring urgent intervention (Group 2; 48%), patients suffering complications or hemodynamic instability (Group 3; 15%), and patients whose procedures were completed too late to allow same-day discharge (Group 4; 4%). Patients over 65 were more likely to require admission and women were more likely to be admitted with complications or hemodynamic instability. Findings are compared with results of other outpatient series, and implications regarding appropriate setting for outpatient catheterization are discussed.     

Sexual activities and attitudes of adolescent Koreans

Data regarding the sexual behaviors of 849 Korean adolescents ( years) were collected. Behaviors reported for males vs. females were 36.5 vs. 27.0% for kissing, 27.2 vs. 14.8% for petting, and 22.9 vs. 9.8% for coitus. In addition to reporting a greater number of experiences, males reported a greater number of partners for all three behavior categories. Among those who participated in coitus, nearly one third of the males and two thirds of the females reported only one partner. Two thirds of the males considered their recent experiences with coitus to be satisfactory, whereas over half of the females gave a neutral response. About 37% of males and 55% of females reported that their most recent coital experience was less than a month ago. On average, the coitally active adolescents began sexual activity at about 18 years of age. Interpretations of these data must take into consideration the respondents' hesitancy in the Korean setting to admit to having sexual experiences. Because premarital sex for adolescents is considered very undesirable in the Korean social setting, the respondents' reporting bias might be in the direction of underreporting. Findings are discussed in the context of unplanned pregnancy and abortion. This investigation was supported by the Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Project No. 91207 BSDA.     

ICU机械通气患者意外拔管的原因分析及对策

对2008年1月至2010年6月,在ICU发生意外拔管的16例气管插管病人的临床资料进行了总结分析。结果导致意外拔管的相关因素有:缺乏有效的固定、未使用镇静剂、未使用适当的肢体约束及护患沟通不良等。因此,对人工气道的患者应高度重视,重在预防,做到正确固定,充分沟通,适当镇静和肢体约束,是有效的护理措施。     

基于DEMATEL的非计划性拔管风险因素分析

目的应用决策试验与评价实验室方法(DEMATEL)确定非计划性拔管的关键风险因素,为临床管道管理提供决策依据。方法对49例非计划性拔管不良事件,由管道护理小组现场认证确定19项风险因素;选取35名专家进行2轮函询,以函询结果构建风险因素的直接影响矩阵,运用DEMATEL软件计算综合影响度(Tr)、被影响度(Tc)、中心度(Mi)和原因度(Ri)。结果专家积极性为100%,权威程度0.857,协调系数0.297(P0.05);19项风险因素的Tr为0~2.535,Tc为0~2.321,Mi为0.653~3.891,Ri0的风险因素有10个,Ri0的风险因素有9个。结论基于DEMATEL分析影响非计划性拔管的风险因素,其主要风险因素有操作方法、固定方法、肢体约束、健康教育及高危人群评估,其中操作方法为最关键因素。     

Intrauterine Device Initiation After Gonococcal and Chlamydial Infections: A Practice Workflow Initiative

Unplanned pregnancy remains an issue in the United States. The intrauterine device (IUD) is a solution. The IUD is safe for most women and is recommended for adolescents. Misconceptions exist about IUDs and sexually transmitted infections caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Accepted guidelines ensure the management of these sexually transmitted infections and subsequent, safe initiation of the IUD. The use of best practice alerts preserves the health care team’s adherence to clinical guidelines. This IUD provision initiative creates a workflow for the interprofessional team to ensure the safe initiation of an IUD to clients with a gonococcal or chlamydial infection.     

Managing Patients With Heart Failure: A Qualitative Study of Multidisciplinary Teams With Specialist Heart Failure Nurses

PURPOSE

The purpose of this study was to explore the perceptions and experiences of health care clinicians working in multidisciplinary teams that include specialist heart failure nurses when caring for the management of heart failure patients.

METHODS

We used a qualitative in-depth interview study nested in a broader ethnographic study of unplanned admissions in heart failure patients (HoldFAST). We interviewed 24 clinicians across primary, secondary, and community care in 3 locations in the Midlands, South Central, and South West of England.

RESULTS

Within a framework of the role and contribution of the heart failure specialist nurse, our study identified 2 thematic areas that the clinicians agreed still represent particular challenges when working with heart failure patients. The first was communication with patients, in particular explaining the diagnosis and helping patients to understand the condition. The participants recognized that such communication was most effective when they had a long-term relationship with patients and families and that the specialist nurse played an important part in achieving this relationship. The second was communication within the team. Multidisciplinary input was especially needed because of the complexity of many patients and issues around medications, and the participants believed the specialist nurse may facilitate team communication.

CONCLUSIONS

The study highlights the role of specialist heart failure nurses in delivering education tailored to patients and facilitating better liaison among all clinicians, particularly when dealing with the management of comorbidities and drug regimens. The way in which specialist nurses were able to be caseworkers for their patients was perceived as a method of ensuring coordination and continuity of care.