Bob Marshall

Factors Influencing Outpatient Cardiac Rehabilitation Attendance.

Purpose: In the current health climate, the length of stay of cardiac patients in hospital has been decreasing, and this has significantly reduced the time nurses and colleagues have for providing inpatient cardiac rehabilitation (CR). The purpose of this research was to determine if inpatient CR has an influence on outpatient cardiac rehabilitation attendance for women, Māori, and older people. Methods: An audit of patients discharged from hospital between November 2011 and July 2012 with a diagnosis of acute coronary syndrome were sent a postal questionnaire. Findings: The survey was completed by 143 people: 46% female, 12% Māori, and 70% >65 years. Only 38% attended outpatient CR on discharge. Reasons for not attending included lack of referral to CR, and 61% understood only some/none of the information given to them while in hospital. The Cardiac Rehabilitation Coordinator most consistently recommended attendance, but this invitation was extended after discharge from hospital. Conclusions: Attendance at outpatient CR is low and may increase with an improved individualized plan of care including greater cultural considerations and attention to discharge planning. An automatic referral tool as well as following evidence‐based guidelines for inpatient care may increase participation rates for CR. Clinical Relevance: Nursing staff have the majority of contact with patients and it appears that very few nurses are discussing CR programs with their patients. The information to attend CR should be offered by all of the health professionals patients meet during their stay in hospital.

Discharge Planning: Screening Older Patients for Multidisciplinary Team Referral

The objective was to determine whether the Elders Risk Assessment Index can predict multi-disciplinary team referral of older patients (≥ 65 years) in Emergency Department same-day discharges. The study identified 1,376 qualifying individuals from a regional New Zealand hospital database. Of these, 12.7 % were referred to the multi-disciplinary team. Univariate and multivariate analyses were used to explore associations between the Index, its components, and other demographic factors with referral. With every unit increase in the Index there was a 9% increase in the odds of being referred. When the components of the Index were analysed separately, an increased likelihood of being referred was associated with not being married, having had a previous hospital admission of more than five days, having chronic obstructive pulmonary disease, and being older. Conversely, a decreased likelihood was associated with having diabetes. When non-Index items were analysed it was found that females were more likely to be referred than males and that Māori were less likely to be referred than New Zealand Europeans. With adaptation, the Elders Risk Assessment Index may provide a simple, cost-effective, and timely tool to assist in determining the need for multi-disciplinary team referral for older people who present to the Emergency Department.

Exercise treadmill tests in patients with low cardiovascular risk: are we wasting our time?

INTRODUCTION The efficacy and cost-effectiveness of exercise treadmill testing for patients with low cardiovascular risk is unclear. This is due to the low incidence of coronary artery disease in this population and the potential for false-positive results leading to additional invasive and expensive investigation. AIM To investigate the value of exercise treadmill testing (ETT) as a predictor of coronary artery disease in patients with different levels of cardiovascular risk. METHODS An observational study was completed on an outpatient population from a chest pain clinic (n = 529). Cross-tabulations and binary logistic regressions were used to examine relationships between variables. RESULTS A negative ETT result was recorded for 72.5% of patients with low cardiovascular risk compared to 54.3% of those with moderate or high risk. Within the low cardiovascular risk group, patients with symptoms atypical for cardiac ischaemia were 11.1-fold more likely to have a negative ETT result. Of the patients with positive or equivocal ETT results, coronary artery disease was subsequently confirmed in only 23.1% of the low cardiovascular risk group compared to 77.2% of those with moderate or high cardiovascular risk. DISCUSSION Results show low cardiovascular risk patients are significantly more likely to return negative ETT results, particularly when associated with atypical symptoms. Similarly, positive or equivocal ETTs in this group are significantly more likely to be false positives. This suggests the ETT is not efficacious in predicting coronary artery disease in patients with low cardiovascular risk. Is it therefore appropriate to offer exercise testing to this cohort or should alternative management strategies be considered?

Changes in Health Perceptions of Male Prisoners Following a Smoking Cessation Program

The aim was to explore the changes in health perceptions of men in prison following a smoking cessation program. Interviews, lung age tests, and a quality-of-life questionnaire were carried out with prisoners. Four main themes emerged from the interviews: the increase in exercise tolerance with improvements in general health, an ability to taste food again, an acknowledgment of stress, and the reasoning behind beginning smoking. Lung age tests showed most prisoners had a lung age older than their chronological age. The quality-of-life survey showed that mean normalized results for physical functioning, general health, vitality, social functioning, and mental health were above 50%. Helping prisoners to remain smoke-free once they leave prison is a new challenge for health providers.

Toward Developing a Nurse Endoscopist Role in New Zealand

The purpose of this exploratory descriptive mixed-method study was to explore the potential role of the nurse endoscopist as a part of the solution in fulfilling the workforce requirements of a bowel screening program, ascertain the possible enablers of a nurse endoscopist role in New Zealand, and determine whether there are endoscopy nurses who would wish to follow the nurse endoscopist/nurse practitioner pathway. A questionnaire with both open- and closed-ended questions gained in-depth information regarding the aspirations of New Zealand endoscopy nurses, their perceived enablers and barriers of a nurse endoscopist role, and statistical information on the New Zealand endoscopy nursing workforce. New Zealand has a highly experienced and educated endoscopy nursing workforce who supports the development of the nurse endoscopist role, some of whom expressed interest in a nurse endoscopist/practitioner pathway. It was concluded that with the addition of a specific education pathway and funding, standardization of training for endoscopists, and specific job description for nurse endoscopists, the future development of this role is possible in New Zealand.