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Norske Abstrakter Ved Nordisk-Baltisk Kongress NORSKE ABSTRAKTER VED NORDISK-BALTISK KONGRESS OC-002 Practice and Results of contrast doses in some patients are a concern and measures to further reduce radiation and Chronic Total Occlusion (CTO) contrast should be scrutinized. Training of a new Program at Haukeland Univer- operator might partly explain the high doses. sity Hospital ON-002 European Cardiovas- Eriksen E.*, Tuseth V. Haukeland University Hospital, Norway cular Nurses Need to Increase Study Objectives: Haukeland University Hospital their Knowledge of Warfarin of Bergen has had dedicated CTO operators Therapy for more than 10 years. In 2012 we started a dedicated CTO program with training of a new Oterhals K.*1, Deaton C.2, De Geest S.3, operator. We did a post hoc analysis of CTO Jaarsma T.4, Lenzen M.5, Moons P.6, Mårtens- procedures over 6 months from September 2012 son J.7, Smith K.8, Stewart S.9, Strömberg to March 2013. Total volume of CTO’s in our cen- A.10, Thompson D.R.11, Norekvål T.M.1 1Hau- ter is about 100/year. Methods and Materials: keland University Hospital, Norway; 2Univer- CTO’s referred for secondary attempt from our sity of Manchester and Central Manchester own or other hospitals, or because of complexity NHS, United Kingdom; 3University of Basel, scheduled for primary attempt by CTO team, Switzerland; 4Linköping University, Norr- were systematically analyzed. Patients with sta- köping, Sweden; 5Erasmus MC, Netherlands; ble angina, acute coronary syndrome or proven 6KU Leuven, Belgium; 7Jönköping University, ischemia of more than 10% of the myocardium Sweden; 8Ninewells Hospital, United King- mass by a non-invasive image diagnostic modal- dom; 9Baker IDI Heart and Diabetes Institute, ity, was accepted. No patients were refused on Australia; 10Linköping University, Sweden; the basis if CTO characteristics. Results: 23 11Australian Catholic University, Australia patients with 24 CTO’s were registered from Study Objectives: Successful management of August 2012 to March 2013. 11 patients had warfarin requires that health care professionals previous failed attempts. 15 patients had stable effectively counsel and educate patients, though angina and 6 patients had acute coronary syn- studies indicate that health care professionals drome. 5 patients underwent noninvasive isch- themselves do not always have the knowledge emia tests. Successful PCI with TIMI 3 flow was to provide patients with the correct information. achieved in 22 of 24 (92%) of the cases. 1 failed The purpose of this study was to investigate case no longer had angina and was not motivated European cardiovascular nurses` knowledge for a 2nd attempt. 1 failed case is scheduled for of the overall management of anticoagulation 2nd attempt in April. Method of success was therapy and examine if this knowledge was influ- antegrade in 14 (64%) cases, retrograde in 5 enced by level of education and years in clinical (23%) cases and by dissection- recrossing in 3 practice. Methods: A self-report questionnaire (14%) cases. 20 patients had only one attempt with 32 items on warfarin, warfarin-drug and by CTO team. 3 patients had more attempts (2, warfarin-food interactions was distributed to 3 and 4 attempts respectively). Median contrast attendants at a European cardiovascular nursing delivered was 284 ml (mean 320 ml, range conference in 2012. For items with more than 150–716 ml), and median operator time 201 min one correct answer, points were also given for (mean 192 min, range 76–360 min). Median not ticking the wrong answer, giving a maximum radiation skin dose was 25.000 μGy/m2 (mean possible score of 53. Results: The response rate 36.524 μGy/m2, range 9.730– 91.519 μGy/m2). was 206/647 of conference attendees (32%). 6 patients had radiation skin dose >50.000 μGy/ Respondents, who came from 24 different m2. One patient experienced local skin reaction countries, were predominantly female (92%), (after a dose of 91.519 μGy/m2) which resolved had a mean age of 42±9 years and most (84%) without treatment. One had hematoma of the reported having direct patient contact. Around groin requiring prolonged hospitalization. One half were working in inpatient care (48%) and patient had acute stent thrombosis requiring new had spent an average of 17±9 years in clinical procedure. Conclusion: CTO programs can be practice, most of which (13±8 years) were in adapted safely at intermediate volume centers cardiovascular care. Respondents demonstrated with dedicated operators, achieving angiographic knowledge deficits of oral anticoagulation evaluated success rates equal to international therapy and medication interactions, especially reference centers (92%). The high radiation and regarding warfarin interactions with vitamin hjerteforum N° 3/ 2013 / vol 26 80 E, vitamin C and antibiotics. Knowledge of the black electrode (p < 0.001), use of protec- warfarin-diet interactions and how to advise tive cover (p < 0.001), information regarding patients on warfarin was somewhat better. Mean purpose of monitoring (p = 0.005) and informa- total knowledge scores (was 28±6 (range 3–41, tion regarding limitations in cellular phone use maximum possible score 53) with those involved (p = 0.003). Still, 23% of the electrodes were in direct patient care scoring higher (29±6 misplaced. Conclusion: Our study highlights the versus 26±6, p = 0.011). There was a consistent need for continued education regarding in-hos- decrease of knowledge of oral anticoagulation pital telemetry monitoring in both coronary care therapy with increasing level of education. Con- units and other units monitoring their patients clusion: European cardiovascular nurses need to with telemetry. Furthermore, this study indicates increase their knowledge of oral anticoagulation that development of national guidelines for elec- therapy if they are to deliver optimal care to their trocardiographic monitoring in hospitals would patients and to minimise adverse effects of the be beneficial as this is non-existent in Norway. treatment ON-004 Translating and Valida- ON-003 Improvement of In- ting the Norwegian Version of Hospital Telemetry Monitoring the Coronary Revascularisation Regarding Electrode Placement Outcome Questionnaire and Attachment, Hygiene and Patient Information: An Inter- Lillevik S.*, Hanssen T.A. University Hospital vention Study North-Norway (UNN), Norway Study Objective: Health related quality of life Pettersen T.R.*, Fålun N.B., Norekvål T.M. (HRQOL) questionnaires are increasingly used as Haukeland University Hospital, Norway outcome measure in research and clinical prac- Background: Today, in-hospital telemetry mon- tice to assess treatment effectiveness in coronary itoring is an important part of both diagnosis heart disease (CHD) patients together with and treatment of patients at risk of developing traditional outcome measures such as mortality life threatening arrhythmias and is widely used and morbidity. The Coronary Revascularisation in critical as well as non-critical wards. Cardiac Outcome Questionnaire (CROQ) is a patient- nurses staff the central monitor stations and are based instrument to evaluate health outcomes responsible for correct electrode placement and and HRQOL before and after surgery and angio- satisfactory electrode attachment, thus ensuring plasty. The aim of this study was to translate and optimal quality of the monitoring. Therefore, the validate the CROQ angioplasty/percutaneous aims of this study were to determine whether a coronary intervention (PCI) version into Norwe- complex educational intervention had an effect gian. Methods and Material: Following inter- on i) electrode placement, ii) electrode attach- national guidelines the translation followed the ment, iii) hygiene, and iv) patient information following steps: independent forward and back- regarding in-hospital telemetry monitoring. ward translations, validation and pilot testing Methods: The study was conducted during two in both professionals and patients, and testing six-week periods in an urban 1400-inpatient the psychometric properties in patients having bed university hospital in western Norway with undergone PCI. The latter was carried out in a 104.000 somatic admissions a year. A prospec- cross sectional design where a total of 171 out of tive interventional study design was applied with 256 eligible patients participated in the testing. data collected before and after the implemen- Data collection included the Short Form-12 (SF- tation of a complex educational intervention 12), The Seattle Angina Questionnaire (SAQ) consisting of continued education, informational and clinical and sociodemographic variables as posters, and an eLearning course particularly well as the CROQ. Results: Dimensions of the developed for this study. Data was obtained instruments reliability was assessed applying using two registration forms examining demo- measure of internal consistency and test-retest graphic background variables and ten different reliability. Internal consistency and test-retest variables regarding electrode placement and reliability within all scales were satisfactory with attachment, hygiene, and patient information. All a Chronbach’s alpha above 0.70 and a Inter Class patients ordained to telemetry monitoring during Correlation coefficient above 0.89. Good face the registration periods were included, none were validity was reported from both patients and excluded. Results: At pre-intervention regis- professionals. Criterion validity, assessed using tration, 26% of the electrodes were misplaced. the SF-12 and SAQ, and known groups’
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