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Ho K, Ganesh GK, Prasad S, Hoffmann TJ, Larsen A, Sandoval C, Berger S, Schell-Chaple H, Badilini F, Mackin LA, Pelter MM. Agreement of Computerized QT and QTc Interval Measurements Between Both Bedside and Expert Nurses Using Electronic Calipers. J Cardiovasc Nurs 2023:00005082-990000000-00138. [PMID: 37787695 DOI: 10.1097/jcn.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND In hospitalized patients, QT/QTc (heart rate corrected) prolongation on the electrocardiogram (ECG) increases the risk of torsade de pointes. Manual measurements are time-consuming and often inaccurate. Some bedside monitors automatically and continuously measure QT/QTc; however, the agreement between computerized versus nurse-measured values has not been evaluated. OBJECTIVE The aim of this study was to examine the agreement between computerized QT/QTc and bedside and expert nurses who used electronic calipers. METHODS This was a prospective observational study in 3 intensive care units. Up to 2 QT/QTc measurements (milliseconds) per patient were collected. Bland-Altman test was used to analyze measurement agreement. RESULTS A total of 54 QT/QTc measurements from 34 patients admitted to the ICU were included. The mean difference (bias) for QT comparisons was as follows: computerized versus expert nurses, -11.04 ± 4.45 milliseconds (95% confidence interval [CI], -2.3 to -19.8; P = .016), and computerized versus bedside nurses, -13.72 ± 6.70 (95% CI, -0.70 to -26.8; P = .044). The mean bias for QTc comparisons was as follows: computerized versus expert nurses, -12.46 ± 5.80 (95% CI, -1.1 to -23.8; P = .035), and computerized versus bedside nurses, -18.49 ± 7.90 (95% CI, -3.0 to -33.9; P = .022). CONCLUSION Computerized QT/QTc measurements calculated by bedside monitor software and measurements performed by nurses were in close agreement; statistically significant differences were found, but differences were less than 20 milliseconds (on-half of a small box), indicating no clinical significance. Computerized measurements may be a suitable alternative to nurse-measured QT/QTc. This could reduce inaccuracies and nurse burden while increasing adherence to practice recommendations. Further research comparing computerized QT/QTc from bedside monitoring to standard 12-lead electrocardiogram in a larger sample, including non-ICU patients, is needed.
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Hasanien AA, Albusoul RM, Aqel AA, Saleh ZT, Yousef KM. Proficiency in 12‑lead electrocardiography and arrhythmia monitoring among emergency and critical care nurses. J Electrocardiol 2023; 78:5-11. [PMID: 36680996 DOI: 10.1016/j.jelectrocard.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Amer A Hasanien
- Department of Clinical Nursing, The University of Jordan, Jordan.
| | - Randa M Albusoul
- Department of Clinical Nursing, The University of Jordan, Jordan.
| | - Ahmad A Aqel
- Department of Clinical Nursing, The University of Jordan, Jordan.
| | - Zyad T Saleh
- Department of Clinical Nursing, The University of Jordan, Jordan.
| | - Khalil M Yousef
- School of Humanities, Social Sciences, and Health, University of Wollongong in Dubai (UOWD), United Arab Emirates.
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Schwimer D, Al-Zaiti S, Beach M. Improving Corrected QT Interval Monitoring in Critical Care Units: A Single Center Report. Crit Care Nurse 2022; 42:33-43. [PMID: 35100627 DOI: 10.4037/ccn2022465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Corrected QT (QTc) interval prolongation is a type of ventricular tachyarrhythmia. Recommendations for QTc interval monitoring for critical care nurses are limited and variable. LOCAL PROBLEM The intensive care unit at the study institution had no policies for QTc interval monitoring. A quality improvement initiative for identifying and monitoring at-risk patients was begun. METHODS A QTc interval monitoring protocol was developed according to current recommendations for electrocardiogram monitoring and input from experts. Nursing staff received education on the QTc monitoring protocol. Numbers of patients with indications for monitoring were collected for 60 days before and 60 days after implementation. The rate of protocol adherence was collected for 60 days after implementation. Aknowledge assessment was administered to nurses at baseline, immediately after education, and 4 months after education. RESULTS Before protocol implementation, 537 patients had indications for monitoring. No QTc intervals were documented by nurses. After protocol implementation, 544 patients had indications for monitoring. Protocol adherence was higher during day shifts than during night shifts (45.3% and 38.4%, respectively). Of 170 documented QTc prolongation events, 26 (15%) were reported to physicians. Nurses' knowledge significantly improved after education and was retained 4 months after education (correct responses to assessment questions: 59% at baseline, 96% immediately after education, and 86% at 4 months after education). CONCLUSIONS This QTc interval monitoring protocol improved nurses' ability to identify and monitor patients with increased risk of QTc interval prolongation. Adherence was less than desired, suggesting that further protocol revisions are required.
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Affiliation(s)
- Danielle Schwimer
- Danielle Schwimer is a trauma/critical care nurse practitioner at Forbes Hospital, Monroeville, Pennsylvania
| | - Salah Al-Zaiti
- Salah Al-Zaiti is the primary teacher of Introduction to Basic Statistics for Evidence-Based Practice and of Clinical Diagnostics at the University of Pittsburgh, Pennsylvania. He also teaches bachelor of science in nursing and doctor of nursing practice students in the clinical and laboratory settings
| | - Michael Beach
- Michael Beach was an assistant professor at the University of Pittsburgh School of Nursing, Pennsylvania, when this article was written
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Chen Y, Kunst E, Nasrawi D, Massey D, Johnston ANB, Keller K, Fengzhi Lin F. Nurses' competency in electrocardiogram interpretation in acute care settings: A systematic review. J Adv Nurs 2022; 78:1245-1266. [PMID: 34989423 DOI: 10.1111/jan.15147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/03/2021] [Accepted: 12/18/2021] [Indexed: 12/22/2022]
Abstract
AIMS Identify and synthesize evidence of nurses' competency in electrocardiogram interpretation in acute care settings. DESIGN Systematic mixed studies review. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature, Medline, Scopus and Cochrane were searched in April 2021. REVIEW METHODS Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. A data-based convergent synthesis design using qualitative content analysis was adopted. Quality appraisal was undertaken using validated tools appropriate to study designs of the included papers. RESULTS Forty-three papers were included in this review. Skills and attitudes were not commonly assessed, as most studies referred to 'competency' in the context of nurses' knowledge in electrocardiogram interpretation. Nurses' knowledge levels in this important nursing role varied notably, which could be partly due to a range of assessment tools being used. Several factors were found to influence nurses' competency in electrocardiogram interpretation across the included studies from individual, professional and organizational perspectives. CONCLUSION The definition of 'competency' was inconsistent, and nurses' competency in electrocardiogram interpretation varied from low to high. Nurses identified a lack of regular training and insufficient exposure in electrocardiogram interpretation. Hence, regular, standard training and education are recommended. Also, more research is needed to develop a standardized and comprehensive electrocardiogram interpretation tool, thereby allowing educators to safely assess nurses' competency. IMPACT This review addressed questions related to nurses' competency in electrocardiogram interpretation. The findings highlight varying competency levels and assessment methods. Nurses reported a lack of knowledge and confidence in interpreting electrocardiograms. There is an urgent need to explore opportunities to promote and maintain nurses' competency in electrocardiogram interpretation.
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Affiliation(s)
- Yingyan Chen
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Elicia Kunst
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Dima Nasrawi
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Debbie Massey
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Amy N B Johnston
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Kathryn Keller
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, United States
| | - Frances Fengzhi Lin
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.,Sunshine Coast Health Institute, Birtinya, Queensland, Australia
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Rourke L, Leong J, Chatterly P. Conditions-Based Learning Theory as a Framework for Comparative-Effectiveness Reviews: A Worked Example. TEACHING AND LEARNING IN MEDICINE 2018; 30:386-394. [PMID: 29452002 DOI: 10.1080/10401334.2018.1428611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Phenomenon: An evidence-informed era of medical education encourages the generation and use of comparative-effectiveness reviews, yet the reviews often conclude, curiously, that all instructional approaches are equally effective. Approach: We used a conditions-based learning theory to structure a review of the comparative-effectiveness literature on electrocardiogram instruction. We searched MEDLINE, EMBASE (Ovid), ERIC (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO) from inception to June 2016. We selected prospective studies that examined the effect of instructional interventions on participants' knowledge and skill with electrocardiogram interpretation. Two reviewers extracted information on the quality of the studies, the effect of instruction on the acquisition of knowledge and skill, and instructional quality. Instructional quality is an index of the extent to which instruction incorporates 4 practices of Gagne's conditions-based learning theory: presenting information, eliciting performance, providing feedback, and assessing learning. Findings: Twenty-five studies (3,286 participants) evaluating 47 instructional interventions were synthesized. The methodological quality of most studies was moderate. Instructional quality varied: All interventions presented information and assessed learning, but fewer than half elicited performances or provided feedback. Instructional interventions that incorporated all 4 components improved trainees' abilities considerably more than those that incorporated 3 or fewer; respectively, standardized mean difference (SMD) = 2.80, 95% confidence interval (CI) [2.05, 3.55], versus SMD = 1.44, 95% CI [1.18, 1.69]. Studies that compared "innovative" to "traditional" types of instruction did not yield a significant pooled effect: SMD = 0.18, 95% CI [-0.09, 0.45]. Insights: The use of a conditions-based learning theory to organize the comparative-effectiveness literature reveals differences in the instructional impact of different instructional approaches. It overturns the unlikely, but common, conclusion that all approaches are equally effective.
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Affiliation(s)
- Liam Rourke
- a Department of Medicine , University of Alberta , Edmonton Alberta , Canada
| | - Jessica Leong
- a Department of Medicine , University of Alberta , Edmonton Alberta , Canada
| | - Patricia Chatterly
- a Department of Medicine , University of Alberta , Edmonton Alberta , Canada
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Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, Lampert R, May JL, McDaniel GM, Perez MV, Sendelbach S, Sommargren CE, Wang PJ. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e273-e344. [DOI: 10.1161/cir.0000000000000527] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Funk M, Fennie KP, Stephens KE, May JL, Winkler CG, Drew BJ. Association of Implementation of Practice Standards for Electrocardiographic Monitoring With Nurses' Knowledge, Quality of Care, and Patient Outcomes: Findings From the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003132. [PMID: 28174175 DOI: 10.1161/circoutcomes.116.003132] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses' knowledge, quality of care, and patient outcomes. METHODS AND RESULTS The PULSE (Practical Use of the Latest Standards of Electrocardiography) Trial was a 6-year multisite randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, time 2 after group 1 hospitals received the intervention, and time 3 after group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses' knowledge (N=3013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest; N=95 884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses' knowledge improved significantly immediately after the intervention in both groups but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention and was sustained. CONCLUSIONS Online ECG monitoring education and strategies to change practice can lead to improved nurses' knowledge, quality of care, and patient outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01269736.
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Affiliation(s)
- Marjorie Funk
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.).
| | - Kristopher P Fennie
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.)
| | - Kimberly E Stephens
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.)
| | - Jeanine L May
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.)
| | - Catherine G Winkler
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.)
| | - Barbara J Drew
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.)
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Pickham D, Hsu D, Soofi M, Goldberg JM, Saini D, Hadley D, Perez M, Froelicher VF. Optimizing QT Interval Measurement for the Preparticipation Screening of Young Athletes. Med Sci Sports Exerc 2017; 48:1745-50. [PMID: 27116644 DOI: 10.1249/mss.0000000000000962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Sudden cardiac death is the leading cause of death in athletes. Long QT syndrome (LQTS) is one of the most common cardiogenetic diseases that can lead to sudden cardiac death and is identified by QT interval prolongation on an ECG. Recommendations for QT monitoring in athletes are adopted from nonathlete populations. To improve screening, ECG data of athletes are assessed to determine a more appropriate method for QT interval estimation. METHODS ECG (CardeaScreen) data were collected from June 2010 to March 2015. ECG data with HR greater than 100 bpm were excluded. Fiducial points of outliers were manually corrected if the QRS onset or the T wave offset was misidentified. A model of best fit was determined and compared across four QT correction factors. Classification analysis was used to compare the Bazett's corrected QT interval to the 99th percentile of uncorrected QT interval. RESULTS High school (n = 597), college (n = 1207), and professional athletes (n = 273) (N = 2077) were analyzed. Mean age was 19 ± 3.5 yr. QT interval varied by cohort (HS = 388 ± 30, Col = 410 ± 33, Pro = 407 ± 27, p < 0.0001). A nonlinear power function with a cubic exponent of -0.349 fit the data the best (R = 0.64). Of the four common correction factors, Fridericia had the lowest residual dependence to HR (m = -0.10). With standard screening, 75% of athletes within the top 1% for QT interval were not identified for further investigation for LQTS. CONCLUSION Up to 75% of athletes possessing an uncorrected QT interval greater than 99% of the population are not identified for investigation for LQTS using the recommended criteria. We propose a new method of risk stratification that replaces QT interval correction. Further study is needed to establish QT interval distributions and risk thresholds in athletes.
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Affiliation(s)
- David Pickham
- 1Stanford Cardiovascular Institute, Stanford, CA; 2Division of General Medical Disciplines, Stanford University School of Medicine; Stanford, CA; 3Stanford University School of Medicine; Stanford, CA; 4Ohio State University College of Medicine; Columbus, OH; 5Department of Cardiology, University Of Pennsylvania; Philadelphia, PA; 6Gunn High School, Palo Alto, CA; 7CardeaScreen, Seattle, WA; and 8Division of Cardiovascular Medicine, Stanford University School of Medicine; Stanford, CA
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Loreto L, Andrea T, Lucia D, Carla L, Cristina P, Silvio R. Accuracy of EASI 12-lead ECGs in monitoring ST-segment and J-point by nurses in the Coronary Care Units. J Clin Nurs 2016; 25:1282-91. [DOI: 10.1111/jocn.13168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Lancia Loreto
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
| | | | - Dignani Lucia
- Nursing Science; University of L'Aquila; L'Aquila Italy
| | | | - Petrucci Cristina
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
| | - Romano Silvio
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
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Brooks CA, Kanyok N, O’Rourke C, Albert NM. Retention of Baseline Electrocardiographic Knowledge After a Blended-Learning Course. Am J Crit Care 2016; 25:61-7. [PMID: 26724296 DOI: 10.4037/ajcc2016556] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Among nurses, skill retention after an electrocardiography blended-learning course is unknown. OBJECTIVES To compare 3- and 8-week electrocardiography test scores, compare scores by nurse and work characteristics and self-assessed electrocardiographic competence, and compare 1-year work retention with 3- and 8-week scores and change in scores from week 3 to week 8. METHODS Data were collected on demographics, comfort with electrocardiography expectations, electrocardiography competence levels, and 1-year work retention. Correlational and comparative statistics were used in analyses. RESULTS Of 69 nurses, 58% were somewhat comfortable with interventions for abnormal rhythms. Test scores were higher at 3 weeks than at 8 weeks: mean difference, 26%; P < .001. Scores at 8 weeks reflected intermediate skill retention and were not associated with nurse characteristics, electrocardiography background, comfort with rhythms and measurements, or 1-year work retention. Nurses with greater comfort for intervening when rhythm abnormalities occurred had higher median 8-week scores (P = .01) than did nurses with less comfort, and perceptions of electrocardiographic competence were associated with 8-week scores (r = 0.28; P = .02). Reduction in scores at 8 weeks was less severe in nurses with greater comfort at 3 weeks in measuring electrocardiographic intervals (P = .008) and applying therapeutic interventions (P = .009). CONCLUSIONS Skill retention and competence in electrocardiographic interpretation were intermediate and correlated with baseline self-assessment. Electrocardiographic interpretation, measurement, and interventions should be reinforced at the bedside.
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Affiliation(s)
- Carol Ann Brooks
- Carol Ann Brooks is a clinical instructor and Nancy Kanyok is an education nurse specialist, Office of Nursing Education and Professional Practice Development, Nursing Institute; Nancy M. Albert is associate chief nursing officer, Office of Research and Innovation, Nursing Institute; and Colin O’Rourke is a biostatistician, Quantitative Health Science, Cleveland Clinic Health System, Cleveland, Ohio
| | - Nancy Kanyok
- Carol Ann Brooks is a clinical instructor and Nancy Kanyok is an education nurse specialist, Office of Nursing Education and Professional Practice Development, Nursing Institute; Nancy M. Albert is associate chief nursing officer, Office of Research and Innovation, Nursing Institute; and Colin O’Rourke is a biostatistician, Quantitative Health Science, Cleveland Clinic Health System, Cleveland, Ohio
| | - Colin O’Rourke
- Carol Ann Brooks is a clinical instructor and Nancy Kanyok is an education nurse specialist, Office of Nursing Education and Professional Practice Development, Nursing Institute; Nancy M. Albert is associate chief nursing officer, Office of Research and Innovation, Nursing Institute; and Colin O’Rourke is a biostatistician, Quantitative Health Science, Cleveland Clinic Health System, Cleveland, Ohio
| | - Nancy M. Albert
- Carol Ann Brooks is a clinical instructor and Nancy Kanyok is an education nurse specialist, Office of Nursing Education and Professional Practice Development, Nursing Institute; Nancy M. Albert is associate chief nursing officer, Office of Research and Innovation, Nursing Institute; and Colin O’Rourke is a biostatistician, Quantitative Health Science, Cleveland Clinic Health System, Cleveland, Ohio
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Tricco AC, Soobiah C, Hui W, Antony J, Struchkov V, Hutton B, Hemmelgarn B, Moher D, Straus SE. Interventions to decrease the risk of adverse cardiac events for patients receiving chemotherapy and serotonin (5-HT3) receptor antagonists: a systematic review. BMC Pharmacol Toxicol 2015; 16:1. [PMID: 25623303 PMCID: PMC4417335 DOI: 10.1186/2050-6511-16-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 01/22/2015] [Indexed: 12/01/2022] Open
Abstract
Background Patients may experience nausea and vomiting when undergoing chemotherapy or surgery requiring anesthesia. Serotonin 5-hydroxytryptamine 3 (5-HT3) receptor antagonists are effective antiemetics, yet may cause adverse cardiac events, such as arrhythmia. We aimed to identify interventions that mitigate the cardiac risk of 5-HT3 receptor antagonists. Methods Electronic databases, trial registries, and references were searched. Studies on patients undergoing chemotherapy or surgery examining interventions to monitor cardiac risk of 5-HT3 receptor antagonists were included. Search results were screened and data from relevant studies were abstracted in duplicate. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) group’s risk-of-bias tool. Due to a dearth of included studies, meta-analysis was not conducted. Results Two randomized clinical trials (RCT) and 1 non-randomized clinical trial (NRCT) were included after screening 7,637 titles and abstracts and 1,554 full-text articles. Intravenous administration of different dolasetron doses was examined in the NRCT, while dolasetron versus ondansetron and palonosetron versus ondansetron were examined in the RCT. Electrocardiogram (ECG) was the only intervention examined to mitigate cardiac harm. No differences in ECG evaluations were observed between dolasetron or palonosetron versus ondansetron after 15 minutes, 24 hours, and 1 week post-administration in the 2 RCTs. Four deaths were observed in one RCT, which were deemed unrelated to palonosetron or ondansetron administration. Minor increases in PR and QT intervals were observed in the NRCT for dolasetron dosages greater than 1.2 mg/kg 1–2 hours post-administration, but were deemed not clinically relevant. Conclusions ECG monitoring of chemotherapy patients administered with 5-HT3 receptor antagonists did not reveal clinically significant differences in arrhythmia between the medications at the examined time periods. The usefulness of ECG to monitor chemotherapy patients administered with 5-HT3 receptor antagonists remains unclear, as all patients received ECG monitoring. Trial registration PROSPERO registry number: CRD42013003565 Electronic supplementary material The online version of this article (doi:10.1186/2050-6511-16-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1 W8, Canada.
| | - Charlene Soobiah
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1 W8, Canada.
| | - Wing Hui
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1 W8, Canada.
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1 W8, Canada.
| | - Vladi Struchkov
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1 W8, Canada.
| | - Brian Hutton
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, Ontario, K1Y 4E9, Canada.
| | - Brenda Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
| | - David Moher
- Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, Ontario, K1Y 4E9, Canada.
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1 W8, Canada. .,Department of Geriatric Medicine, Faculty of Medicine, University of Toronto, 27 Kings College Circle, Toronto, Ontario, M5S 1A1, Canada.
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Blot S, Afonso E, Labeau S. Insights and advances in multidisciplinary critical care: a review of recent research. Am J Crit Care 2014; 23:70-80. [PMID: 24382619 DOI: 10.4037/ajcc2014403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The intensive care unit is a work environment where superior dedication is pivotal to optimize patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the abundance of research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovations in the field. This article broadly summarizes new developments in multidisciplinary intensive care, providing elementary information about advanced insights in the field by briefly describing selected articles bundled in specific topics. Issues considered include cardiovascular care, monitoring, mechanical ventilation, infection and sepsis, nutrition, education, patient safety, pain assessment and control, delirium, mental health, ethics, and outcomes research.
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Affiliation(s)
- Stijn Blot
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium. Elsa Afonso is a research nurse and clinical trial coordinator, CIBERES, Barcelona, Spain. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Elsa Afonso
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium. Elsa Afonso is a research nurse and clinical trial coordinator, CIBERES, Barcelona, Spain. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Sonia Labeau
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium. Elsa Afonso is a research nurse and clinical trial coordinator, CIBERES, Barcelona, Spain. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
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Tricco AC, Soobiah C, Antony J, Hemmelgarn B, Moher D, Hutton B, Straus SE. Interventions to decrease the risk of adverse cardiac events for post-surgery or chemotherapy patients taking serotonin (5-HT3) receptor antagonists: protocol for a systematic review and network meta-analysis. Syst Rev 2013; 2:45. [PMID: 23809884 PMCID: PMC3701482 DOI: 10.1186/2046-4053-2-45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 03/15/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients undergoing surgery or chemotherapy often experience nausea and vomiting. To increase their quality of life and treatment satisfaction, antiemetic medication, such as serotonin receptor antagonists, is often prescribed for patients experiencing these symptoms. However, early warning signs suggest that serotonin receptor antagonists can cause harm, including arrhythmia. Our objective is to identify the most effective interventions that mitigate the risk of adverse cardiac events associated with serotonin receptor antagonists in patients undergoing surgery and chemotherapy through a systematic review and network meta-analysis. METHODS/DESIGN We will search electronic databases (for example, MEDLINE, Embase) from inception onwards, as well as dissertations and governmental reports, to identify interventions (for example, telemetry, electrocardiography, electrolyte monitoring) that decrease the cardiac risk associated with serotonin receptor antagonists among surgery and chemotherapy patients. Eligible comparators include placebo or supportive care; eligible study designs are experimental studies (randomized controlled trials (RCTs), quasi-RCTs, non-RCTs), non-experimental studies (interrupted time series, controlled before-and-after studies), and cohort studies. Outcomes of interest include arrhythmia, sudden cardiac death, QT prolongation, PR prolongation, and all-cause mortality. We will include unpublished studies and studies published in languages other than English.Draft inclusion and exclusion criteria will be established and pilot tested amongst the team. Subsequently, two team members will screen the results in duplicate and resolve conflicts through discussion. The same process will be followed to screen full-text articles, data abstraction, and appraise quality or risk of bias. To determine validity of results, experimental and quasi-experimental studies will be assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) Risk of Bias tool, while cohort studies will be appraised using the Newcastle-Ottawa Scale. We anticipate sufficient data and homogeneity to conduct random effects meta-analysis and network or mixed treatment comparisons meta-analysis, if appropriate. DISCUSSION Our results will provide information regarding the utility of different strategies that can be used to mitigate cardiac risk amongst patients taking serotonin antagonist receptors. Such results are likely to be of use to clinicians prescribing these agents, as well as policy makers responsible for making decisions about antiemetic medications. TRIAL REGISTRATION PROSPERO registry number: CRD42013003565.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1 T8, Canada
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Fongemie JM, Al-Qadheeb NS, Estes NAM, Roberts RJ, Temtanakitpaisan Y, Ruthazer R, Devlin JW. Agreement between ICU clinicians and electrophysiology cardiologists on the decision to initiate a QTc-interval prolonging medication in critically ill patients with potential risk factors for torsade de pointes: a comparative, case-based evaluation. Pharmacotherapy 2013; 33:589-97. [PMID: 23529904 DOI: 10.1002/phar.1242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
STUDY OBJECTIVES To measure concordance between different intensive care unit (ICU) clinicians and a consensus group of electrophysiology (EP) cardiologists for use of a common rate-corrected QT interval (QTc)-prolonging medication in cases containing different potential risk factor(s) for torsade de pointes (TdP). DESIGN Prospective case-based evaluation. SETTING Academic medical center with 320 beds. SUBJECTS Medical house staff (MDs) and ICU nurses (RNs) from one center and select critical care pharmacists (PHs). INTERVENTION Completion of a survey containing 10 hypothetical ICU cases in which patients had agitated delirium for which a psychiatrist recommended intravenous haloperidol 5 mg every 6 hours. Each case contained different potential risk factor(s) for TdP in specific combinations. A group of five EP cardiologists agreed that haloperidol use was safe in five cases and not safe in five cases. MEASUREMENTS AND MAIN RESULTS For each case, participants were asked to document whether they would administer haloperidol, to provide a rationale for their decision, and to state their level of confidence in that decision. Most clinicians (92 of 115 [80%]) invited to participate completed the cases. Among the five cases where EP cardiologists agreed that haloperidol was not safe, 29% of respondents felt that haloperidol was safe. Conversely, in the five cases where EP cardiologists felt haloperidol was safe, 21% of respondents believed that it was not safe. Overall respondent-EP cardiologist agreement for haloperidol use across the 10 cases was moderate (κ = 0.51). MDs and PHs were in agreement with the EP cardiologists more than RNs (p=0.03). Interprofessional variability existed for the TdP risk factors each best identified. Clinician confidence correlated with EP cardiologist concordance for MDs (p=0.002) and PHs (p=0.0002), but not for RNs (p=0.69). CONCLUSION When evaluating use of a QTc interval-prolonging medication, ICU clinicians often fail to identify the TdP risk factors that EP cardiologists feel should prevent its use. Clinician-EP cardiologist concordance varies by the specific risk factor(s) for TdP and the ICU professional conducting the assessment.
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Affiliation(s)
- Justin M Fongemie
- Department of Pharmacy, Tufts Medical Center, Boston, Massachusetts, USA
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Affiliation(s)
- David Pickham
- David Pickham, is Assistant Adjunct Professor, Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way, San Francisco, CA 94143 . Amer A. Hasanien, is Doctoral Student, Department of Physiological Nursing, School of Nursing, University of California, San Francisco
| | - Amer A. Hasanien
- David Pickham, is Assistant Adjunct Professor, Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way, San Francisco, CA 94143 . Amer A. Hasanien, is Doctoral Student, Department of Physiological Nursing, School of Nursing, University of California, San Francisco
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