Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Al... more Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Although activity/exercise are HF self-care expectations, perceptions of patients are not well understood. Ambulatory adults with HF were interviewed. Data were transcribed, categorized, and themes were developed. Of 48 participants, mean age was 58.8 ± 13.2 years. Themes that emerged were: patients not knowing and physicians not telling; scared into doing or not doing it; life gets in the way; meaningful support versus meaningless talk; emotional connections to exercise; value does not equal motivation to move; and disconnection between self-confidence and actions. Self-confidence in and value of physical activity/exercise were not primary motivators to action. Generally, physicians failed to provide details regarding exercise dose, length, warm-up and cool-down expectations, and usual and adverse effects. Patient perceptions of what physical activity/exercise means are multi-dimensional;...
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2015
Disposable electrocardiographic lead wires (ECG-LWs) may not be as durable as reusable ones. To e... more Disposable electrocardiographic lead wires (ECG-LWs) may not be as durable as reusable ones. To examine differences in alarm events between disposable and reusable ECG-LWs. Two cardiac telemetry units were randomized to reusable ECG-LWs, and 2 units alternated between disposable and reusable ECG-LWs for 4 months. A remote monitoring team, blinded to ECG-LW type, assessed frequency and type of alarm events by using total counts and rates per 100 patient days. Event rates were compared by using generalized linear mixed-effect models for differences and noninferiority between wire types. In 1611 patients and 9385.5 patient days of ECG monitoring, patient characteristics were similar between groups. Rates of alarms for no telemetry, leads fail, or leads off were lower in disposable ECG-LWs (adjusted relative risk [95% CI], 0.71 [0.53-0.96]; noninferiority P < .001; superiority P = .03) and monitoring (artifact) alarms were significantly noninferior (adjusted relative risk [95% CI]: 0...
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2014
It is unknown if disposable electrocardiographic lead wires (ECG-LWs) reduce infection rates comp... more It is unknown if disposable electrocardiographic lead wires (ECG-LWs) reduce infection rates compared with cleaned, reusable lead wires. To compare infection rates in intensive care unit (ICU) patients receiving disposable versus reusable ECG-LWs. Matched adult ICUs were randomly assigned to disposable or reusable ECG-LWs. Outcomes were bloodstream infection, ventilator-associated pneumonia, and chest surgical site infections. Patients' characteristics and infections were collected from hospital databases. Event rates were described by using total counts and rates per 100 patient days and were compared between groups by using generalized linear mixed-effect models weighted by patients' ICU length of stay. Overall, 4056 patients from 6 ICUs received disposable and 3184 patients from 5 ICUs received reusable ECG-LWs. The characteristics of the 2 groups were similar, except patients receiving disposable ECG-LWs were less likely to be discharged home (P = .03) and had more comor...
Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Al... more Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Although activity/exercise are HF self-care expectations, perceptions of patients are not well understood. Ambulatory adults with HF were interviewed. Data were transcribed, categorized, and themes were developed. Of 48 participants, mean age was 58.8 ± 13.2 years. Themes that emerged were: patients not knowing and physicians not telling; scared into doing or not doing it; life gets in the way; meaningful support versus meaningless talk; emotional connections to exercise; value does not equal motivation to move; and disconnection between self-confidence and actions. Self-confidence in and value of physical activity/exercise were not primary motivators to action. Generally, physicians failed to provide details regarding exercise dose, length, warm-up and cool-down expectations, and usual and adverse effects. Patient perceptions of what physical activity/exercise means are multi-dimensional;...
Currently, fluid restriction recommendations in heart failure (HF) are based on expert opinion. A... more Currently, fluid restriction recommendations in heart failure (HF) are based on expert opinion. After implementing a 1,000-mL/d fluid restriction for 60 days after discharge, outcomes were examined. In a randomized controlled design, hyponatremic patients (serum sodium ≤137 mg/dL) received usual care (UC; n = 26) or 1,000 mL/d fluid restriction (n = 20) at discharge. Quality of life (QoL), thirst, difficulty following fluid recommendations, adherence to fluid restriction, HF emergency care, HF rehospitalization, and all-cause death were examined. Mean age was 62.8 ± 12.8 years; 46% were white. There were no differences by group in baseline demographics, comorbidities, and QoL, except that more UC patients had New York Heart Association (NYHA) functional class III/IV status (P = .019). Median [interquartile range] QoL scores were better in the 1,000 mL/d group for symptom burden (83.3 [68.8-91.7] vs 50 [29.2-79.2]; P = .018), total symptoms (77.1 [58.1-91.7] vs 54.2 [30.2-73.9]; P = .022), overall QoL summary (72.6 [52.2-86.3] vs 51.0 [37.7-68.5]; P = .038), and clinical QoL summary (75.5 [57.8-92.9] vs 59.1 [35.7-77.3]; P = .039). There were no group differences in thirst, difficulty adhering to fluid recommendations, adherence to fluid restriction, or health care consumption. The 1,000 mL/d fluid restriction led to improved QoL at 60 days after discharge. Future research in a larger more heterogeneous sample is needed.
Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Al... more Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Although activity/exercise are HF self-care expectations, perceptions of patients are not well understood. Ambulatory adults with HF were interviewed. Data were transcribed, categorized, and themes were developed. Of 48 participants, mean age was 58.8 ± 13.2 years. Themes that emerged were: patients not knowing and physicians not telling; scared into doing or not doing it; life gets in the way; meaningful support versus meaningless talk; emotional connections to exercise; value does not equal motivation to move; and disconnection between self-confidence and actions. Self-confidence in and value of physical activity/exercise were not primary motivators to action. Generally, physicians failed to provide details regarding exercise dose, length, warm-up and cool-down expectations, and usual and adverse effects. Patient perceptions of what physical activity/exercise means are multi-dimensional;...
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2015
Disposable electrocardiographic lead wires (ECG-LWs) may not be as durable as reusable ones. To e... more Disposable electrocardiographic lead wires (ECG-LWs) may not be as durable as reusable ones. To examine differences in alarm events between disposable and reusable ECG-LWs. Two cardiac telemetry units were randomized to reusable ECG-LWs, and 2 units alternated between disposable and reusable ECG-LWs for 4 months. A remote monitoring team, blinded to ECG-LW type, assessed frequency and type of alarm events by using total counts and rates per 100 patient days. Event rates were compared by using generalized linear mixed-effect models for differences and noninferiority between wire types. In 1611 patients and 9385.5 patient days of ECG monitoring, patient characteristics were similar between groups. Rates of alarms for no telemetry, leads fail, or leads off were lower in disposable ECG-LWs (adjusted relative risk [95% CI], 0.71 [0.53-0.96]; noninferiority P < .001; superiority P = .03) and monitoring (artifact) alarms were significantly noninferior (adjusted relative risk [95% CI]: 0...
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2014
It is unknown if disposable electrocardiographic lead wires (ECG-LWs) reduce infection rates comp... more It is unknown if disposable electrocardiographic lead wires (ECG-LWs) reduce infection rates compared with cleaned, reusable lead wires. To compare infection rates in intensive care unit (ICU) patients receiving disposable versus reusable ECG-LWs. Matched adult ICUs were randomly assigned to disposable or reusable ECG-LWs. Outcomes were bloodstream infection, ventilator-associated pneumonia, and chest surgical site infections. Patients' characteristics and infections were collected from hospital databases. Event rates were described by using total counts and rates per 100 patient days and were compared between groups by using generalized linear mixed-effect models weighted by patients' ICU length of stay. Overall, 4056 patients from 6 ICUs received disposable and 3184 patients from 5 ICUs received reusable ECG-LWs. The characteristics of the 2 groups were similar, except patients receiving disposable ECG-LWs were less likely to be discharged home (P = .03) and had more comor...
Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Al... more Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Although activity/exercise are HF self-care expectations, perceptions of patients are not well understood. Ambulatory adults with HF were interviewed. Data were transcribed, categorized, and themes were developed. Of 48 participants, mean age was 58.8 ± 13.2 years. Themes that emerged were: patients not knowing and physicians not telling; scared into doing or not doing it; life gets in the way; meaningful support versus meaningless talk; emotional connections to exercise; value does not equal motivation to move; and disconnection between self-confidence and actions. Self-confidence in and value of physical activity/exercise were not primary motivators to action. Generally, physicians failed to provide details regarding exercise dose, length, warm-up and cool-down expectations, and usual and adverse effects. Patient perceptions of what physical activity/exercise means are multi-dimensional;...
Currently, fluid restriction recommendations in heart failure (HF) are based on expert opinion. A... more Currently, fluid restriction recommendations in heart failure (HF) are based on expert opinion. After implementing a 1,000-mL/d fluid restriction for 60 days after discharge, outcomes were examined. In a randomized controlled design, hyponatremic patients (serum sodium ≤137 mg/dL) received usual care (UC; n = 26) or 1,000 mL/d fluid restriction (n = 20) at discharge. Quality of life (QoL), thirst, difficulty following fluid recommendations, adherence to fluid restriction, HF emergency care, HF rehospitalization, and all-cause death were examined. Mean age was 62.8 ± 12.8 years; 46% were white. There were no differences by group in baseline demographics, comorbidities, and QoL, except that more UC patients had New York Heart Association (NYHA) functional class III/IV status (P = .019). Median [interquartile range] QoL scores were better in the 1,000 mL/d group for symptom burden (83.3 [68.8-91.7] vs 50 [29.2-79.2]; P = .018), total symptoms (77.1 [58.1-91.7] vs 54.2 [30.2-73.9]; P = .022), overall QoL summary (72.6 [52.2-86.3] vs 51.0 [37.7-68.5]; P = .038), and clinical QoL summary (75.5 [57.8-92.9] vs 59.1 [35.7-77.3]; P = .039). There were no group differences in thirst, difficulty adhering to fluid recommendations, adherence to fluid restriction, or health care consumption. The 1,000 mL/d fluid restriction led to improved QoL at 60 days after discharge. Future research in a larger more heterogeneous sample is needed.
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