Lisa Kuhn

Gender-specific barriers and facilitators to heart failure self-care: A mixed methods study

BACKGROUND Although approximately half of adults with heart failure (HF) are women, relatively little is known about gender differences and similarities in HF self-care. AIMS The aim of this study was to describe HF self-care in men and women and to identify gender-specific barriers and facilitators influencing HF self-care. METHODS A total of 27 adults (8 women) with chronic HF participated in a cross-sectional, comparative mixed methods study. An analysis of in-depth interviews was used to describe gender-specific barriers and facilitators of self-care. After the interview data were analyzed, the results were confirmed in quantitative data obtained from the same sample and at the same time. Concordance between qualitative and quantitative data was assessed. RESULTS There were no consistent gender-specific differences in self-care practices but there were distinct gender differences in the decisions made in interpreting and responding to symptoms. The men were better than the women at interpreting their symptoms as being related to HF and in initiating treatment. These differences were associated with differences in self-care confidence, social support, and mood. CONCLUSION Gender-specific differences in self-care behaviors are minimal. However, gender-specific barriers and facilitators greatly influence the choice of self-care behaviors.

The process and utility of classification and regression tree methodology in nursing research

Aim This paper presents a discussion of classification and regression tree analysis and its utility in nursing research. Background Classification and regression tree analysis is an exploratory research method used to illustrate associations between variables not suited to traditional regression analysis. Complex interactions are demonstrated between covariates and variables of interest in inverted tree diagrams. Design Discussion paper. Data sources English language literature was sourced from eBooks, Medline Complete and CINAHL Plus databases, Google and Google Scholar, hard copy research texts and retrieved reference lists for terms including classification and regression tree* and derivatives and recursive partitioning from 1984–2013. Discussion Classification and regression tree analysis is an important method used to identify previously unknown patterns amongst data. Whilst there are several reasons to embrace this method as a means of exploratory quantitative research, issues regarding quality of data as well as the usefulness and validity of the findings should be considered. Implications for Nursing Research Classification and regression tree analysis is a valuable tool to guide nurses to reduce gaps in the application of evidence to practice. With the ever-expanding availability of data, it is important that nurses understand the utility and limitations of the research method. Conclusion Classification and regression tree analysis is an easily interpreted method for modelling interactions between health-related variables that would otherwise remain obscured. Knowledge is presented graphically, providing insightful understanding of complex and hierarchical relationships in an accessible and useful way to nursing and other health professions.

Effect of patient sex on triage for ischaemic heart disease and treatment onset times: A retrospective analysis of Australian emergency department data

UNLABELLED Time between emergency department (ED) presentation and treatment onset is an important, but little-researched phase within the revascularization process for ischaemic heart disease (IHD). OBJECTIVE To determine if sex influences triage score allocation and treatment onset for patients with IHD in the ED. METHODS Retrospective data for patients 18-85 years presenting to EDs from 2005 to 2010 for acute myocardial infarction (AMI), unstable and stable angina, and chest pain were analysed collectively and separately for AMI. RESULTS Proportionately more men (61% of males) were triaged correctly for AMI than women (51.4% of females; P<0.001). Across all triage categories, average treatment time was faster for men than women with AMI (P<0.001). When incorrectly triaged for AMI, treatment time for men was faster than for women (P=0.04). When correctly triaged for AMI, there was no difference in mean treatment time between men and women (P=0.538). CONCLUSIONS Substantial undertriage of AMI occurred for both sexes, but was worse in women. Incorrect triage led to prolonged treatment times for AMI, with womens treatment delays longer than mens. When triaged correctly, both sexes were treated early for AMI, emphasising the need for all patients to be accurately triaged for this time-sensitive disease.

Gender difference in treatment and mortality of patients with ST-segment elevation myocardial infarction admitted to Victorian public hospitals: a retrospective database study.

BACKGROUND Death from acute coronary syndrome (ACS) is avoidable with early reperfusion therapy, however, evidence suggests inequity in womens ACS treatment within a number of international healthcare systems, when compared to mens. Research indicates mortality rates are higher in some age groups of women when compared to men for the sub-group of ACS known as ST-segment elevation myocardial infarction (STEMI). OBJECTIVE To determine whether patient sex was associated with patterns of reperfusion treatment variation or increased inhospital mortality in patients with STEMI. METHODS We undertook retrospective analyses on a government database for patients admitted to Victorian public hospitals with STEMI. Patients were categorised into two age groups: 18-64 and 65-84 years (inclusive), to determine whether patient sex and these age groups influenced treatment from 2005 to 2008 and mortality from 2005 to 2010. RESULTS Both younger and older women received less frequent angioplasty with stent and more often received no reperfusion treatment than men in corresponding younger and older age groups (p=0.006 and p<0.001, respectively). Overall, women in both age groups were more likely to die inhospital than men from equivalent age groups with STEMI (p<0.001, both groups). CONCLUSIONS Proportionately, both younger and older women received less interventional reperfusion therapy for STEMI than their male cohorts, and died more often during admission than men. Further research needs to be undertaken to verify the findings and causes, and guide future research to ensure application of evidence to treatment in patients with STEMI.

ECG Interpretation Part 1: Understanding Mean Electrical Axis

The ability to determine electrical axis is important to detect subtle early warning signs of a change in the patient’s cardiovascular condition. Abnormal or altered conduction patterns may occur as a result of changed physical conditions (e.g., increased ascites), conduction disturbances (e.g., bundle branch or fascicular blocks), or biochemical imbalances (e.g., hyperkalemia). Furthermore, determination of the electrical axis may assist in the differentiation of aberrant paroxysmal supraventricular tachycardia from ventricular tachycardia. The purpose of this article is to provide a concise overview of the electrophysiologic concepts of axis determination including vectors and the hexaxial reference system and the common causes of axis deviation.

Factors associated with delayed treatment onset for acute myocardial infarction in Victorian emergency departments: a regression tree analysis

BACKGROUND Minimising time to treatment onset for acute myocardial infarction (AMI) in the emergency department (ED) is essential, yet little is understood about the interactions between variables affecting it. The aim of this study was to develop a regression tree model explicating the influence of patient and non-patient factors on the time taken to commence treatment for patients with AMI in Victorian EDs. METHODS A regression tree model for variables impacting time to treatment was developed on retrospective data for patients aged 18-85 years with AMI treated in Victorian EDs from 2005 to 2010 (n=21,080). Data were partitioned into three subsets, with a complexity parameter set at 0.0005. RESULTS Four variables emerged in the final regression tree model: triage score; mode of arrival; area of residence; and patient sex. The variable most influencing time to treatment onset for AMI was triage category. For undertriaged patients, treatment time patterns were affected by arrival mode, residential location and their sex, significantly extending delays to treatment onset. CONCLUSIONS Interactions between specific variables influenced whether patients with AMI were treated with equity in Victorian EDs, resulting in previously unidentified evidence-practice gaps and an improved understanding of which patient groups were vulnerable to delayed treatment for AMI.

Effect of gender on evidence-based practice for Australian patients with acute coronary syndrome: A retrospective multi-site study

BACKGROUND Early acute coronary syndrome (ACS) care occurs in the emergency department (ED). Death and disability from ACS are reduced with access to evidence-based ACS care. In this study, we aimed to explore if gender influenced access to ACS care. METHODS A retrospective descriptive study was conducted for 288 (50% women, n=144) randomly selected adults with ACS admitted via the ED to three tertiary public hospitals in Victoria, Australia from 1.1.2013 to 30.6.2015. RESULTS Compared with men, women were older (79 vs 75.5 years; p=0.009) less often allocated triage category 2 (58.3 vs 71.5%; p=0.026) and waited longer for their first electrocardiograph (18.5 vs 15min; p=0.001). Fewer women were admitted to coronary care units (52.4 vs 65.3%; p=0.023), but were more often admitted to general medicine units (39.6 vs 22.9%; p=0.003) than men. The median length of stay was 4days for both genders, but women were admitted for significantly more bed days than men (IQR 3-7 vs 2-5; p=0.005). CONCLUSIONS There were a number of gender differences in ED care for ACS and women were at greater risk of variation from evidence-based guidelines. Further research is needed to understand why gender differences exist in ED ACS care.