Allied health professionals/Nursing/Health scientists最新文献

{"title":"60 Effective echo screening and inter modality agreement in the assessment of ascending thoracic aorta dimension","authors":"Sian Botley, Emily Challinor, Tom E Ingram, Eveline Lee, V. Pakala","doi":"10.1136/HEARTJNL-2020-BCS.60","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.60","url":null,"abstract":"Introduction Accurate measurement and interval monitoring of the ascending aorta for at risk individuals are crucial for prevention of life-threatening complications. Echocardiography (echo) is the first line screening test. Positive results are referred for computed tomography (CT) or magnetic resonance imaging (MRI), both are considered gold standard methods for imaging the whole aorta. These tests involve radiation (CT) and contrast (CT & MRI) exposure. An effective screening echo streamlines subsequent referrals to CT and MRI. Several published references (1,2,3) are in clinical use. Measurements are normalised to body surface area (1,3), height (2), gender (2,3) and age (3). The aims of this study were: Assess the inter-modality agreement of ascending aorta measurements between echo and CT. Compare the rate of ‘dilated aorta’ using the existing references (1,2,3). Methods Between Sep 2018 and Sep 2019, 107 patients underwent gated CT thoracic aorta at our institute as per clinically indicated. We retrospectively examined these records. We used Bland Altman plot to assess inter-modality agreement (echo & CT) of ascending aorta measurements. We reported inter and intra-observer variability for echo measurements as coefficient of variation. Echo aorta measurements were coded into ‘dilated’ or ‘normal’ after normalising for age, sex, height and weight as per the existing references (1,2,3). The rates of ‘dilated aorta’ using the three reference methods (1,2,3) were compared using Chi-squared test with Bonferroni adjustment. Statistical analysis was performed using SPSS 25 (IBM). Results Data were excluded from analysis due to incomplete biometrics (9), poor echo images (27). 71 subjects were included for analysis (age 68 ± 14 years, BSA 1.9 ± 0.2 m2, 52.1% male). 16 had bicuspid aortic valves. Intra- and inter-observer variability for echo measurements were 1.2% and 1.4% respectively. Figure 1 shows the inter-modality agreement of ascending aorta measurements. Echo underestimated ascending aorta dimensions by a mean of 1.4 ± 2.7 mm (95% CI 0.7-2.0 mm). There was a significant difference in the rates of ‘dilated aorta’ using the existing reference ranges (1,2,3): 59% (1), 27% (3) and 59% (2) of subjects had ‘dilated aorta’, χ2 = 15.3, p=0.00. Conclusion Echo is an effective screening test for detecting ascending aorta dilatation. In our department, it has excellent intra- and inter- observer variability and good measurement agreement with CT. Normalising aortic dimension (3) resulted in the fewest ‘positive test’ requiring further imaging; potentially improving clinical efficacy of the service and avoiding contrast and radiation exposure for the patients. References Evangelista A, Flachskampf FA, Erbel R, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. European Journal of Echocardiography 2010;11(8):645–658. Pham MH, Ballegaard C, de Knegt MC, et al. Normal values of aortic dimensions assessed by multidetect","PeriodicalId":193598,"journal":{"name":"Allied health professionals/Nursing/Health scientists","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128879829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"55 Use of the index beat method to improve the echocardiographic assessment of cardiac function in patients with atrial fibrillation","authors":"K. Bunting, S. Gill, A. Sitch, S. Mehta, K. O’Connor, James Hodosn, Mary Stanbury, G. Lip, P. Kirchhof, Michael Griffith, J. Townend, R. Steeds, D. Kotecha","doi":"10.1136/HEARTJNL-2020-BCS.55","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.55","url":null,"abstract":"Introduction Echocardiography is essential for the management of patients with atrial fibrillation (AF), but current methods are time consuming and lack any evidence of reproducibility. Purpose To compare conventional averaging of consecutive beats with an index beat approach, where systolic and diastolic measurements are taken once after two prior beats with a similar RR interval (not more than 60 ms difference). Methods Transthoracic echocardiography was performed using a standardized and blinded protocol in patients enrolled into the RAte control Therapy Evaluation in permanent AF randomised controlled trial (RATE-AF; NCT02391337). AF was confirmed in all patients with a preceding 12-lead ECG. A minimum of 30-beat loops were recorded. Left ventricular function was determined using the recommended averaging of 5 and 10 beats and using the index beat method, with observers blinded to clinical details. Complete loops were used to calculate the within-beat coefficient of variation (CV) and intraclass correlation coefficient (ICC) for Simpson’s biplane left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and filling pressure (E/e’). Results 160 patients (median age 75 years (IQR 69-82); 46% female) were included, with median heart rate 100 beats/min (IQR 86-112). For LVEF, the index beat had the lowest CV of 32% compared to 51% for 5 consecutive beats and 53% for 10 consecutive beats (p Conclusion Index beat determination of left ventricular function improves reproducibility, saves time and does not compromise validity compared to conventional quantification in patients with heart failure and AF. After independent validation, the index beat method should be adopted into routine clinical practice. Conflict of Interest Nothing to declare","PeriodicalId":193598,"journal":{"name":"Allied health professionals/Nursing/Health scientists","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124674056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"54 A contemporary interprofessional collaboration scheme to support patients undergoing percutaneous coronary intervention for myocardial infarction","authors":"N. Nagesh, M. Gandhi","doi":"10.1136/HEARTJNL-2020-BCS.54","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.54","url":null,"abstract":"Introduction There is a profound physical and psychological impact on patients presenting with acute ST elevation myocardial infarction (STEMI) during symptom onset, transit to hospital, during primary percutaneous coronary intervention (PPCI), and prior to discharge. There is little multimedia support for patients during this acute phase. To (i) undertake a survey of healthcare professionals about patient support for STEMI, and (ii) develop a high quality mobile application with film, animation and audio as an educational resource, utilizing a novel interprofessional collaboration (IC) utilising experience and thoughts from key health professionals who support STEMI patients during the early phase of an acute admission. Methods A mixed methods questionnaire survey about communication and patient education was prospectively self-administered to members of the IC. Results were utilised to develop multimedia resources hosted on a novel mobile application and website to support patients during acute STEMI. Results A total of 53 members of contributed to the IC (4 cardiologists, 5 ambulance paramedics, 6 coronary care nurses, 5 cardiac rehabilitation nurses, 5 cardiac physiologists, 2 cardiac catheterisation nurses, 8 non cardiology doctors, 15 medical and nursing students and 4 STEMI patients). 51% rated the current education resources for acute MI patients as ‘inadequate’. 74% felt that these education resources should be contained in an online/mobile resource and 79.6% felt it should be delivered via an interactive film. 92.5% felt there was inadequate psychological support for STEMI patients during the admission. A novel mobile application and website was developed with an interactive film, virtual reality and psychological support for STEMI patients during an acute admission (Figure 1). Conclusions This IC survey identified a gap in educational and psychological support resources for patients with STEMI during the acute admission. A novel mobile application and website with interactive multimedia has been developed to enhance patient centered education and support. These resources will be piloted amongst STEMI patients during an acute admission. Conflict of Interest No Conflict of Interest","PeriodicalId":193598,"journal":{"name":"Allied health professionals/Nursing/Health scientists","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115939919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"57 A feasability study for radiographer reporting and analysis of left ventricular ejection fraction in cardiac magnetic resonance imaging","authors":"K. Strachan, M. Sosin","doi":"10.1136/HEARTJNL-2020-BCS.57","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.57","url":null,"abstract":"Introduction The purpose of this study was to compare the accuracy of a reporting radiographer to an experienced cardiologist in reporting MRI assessment of Left Ventricular Ejection Fraction (LVEF) on patients taking potentially cardiotoxic trastuzumab based chemotherapy (including Herceptin). Radiographer reporting of MRI studies has become more and more widespread (Snaith et Al 2015) However, to date there have been limited instances of radiographer reporting cardiac MRI studies. All Herceptin studies are currently reported by consultant cardiologists and radiologists. It was proposed that an experienced MRI radiographer could be trained to report these studies as a way of relieving pressure upon the cardiac service. Method 100 sequential Herceptin MRI studies were performed on a Philips Ingenia 1.5 tesla MRI scanner. The lead cardiac radiographer with 8 years of cardiac MRI experience was trained to use Medis suite MR version 3.2 (published by Medis medical imaging systems) software package by a senior cardiologist. The appointment time for each patient was 30 minutes with 15 minutes of actual scanning time. The sequences used were: Black blood axial stack. Balanced Gradient echo Cine sequences performed in 2 chamber(CH), 4CH and 3CH planes with a short axis cine stack (SAX) prescribed through the entirety of left ventricle. LV volume and EF were measured from the SAX. Each study was reported separately by an imaging consultant and by the radiographer who were blind to each-others reports. Results Results are shown in figure 1 below Of the 100 studies reported: 95 had a measured EF difference of 2% or lower between reporters. Of the remaining 5, only 1 had an EF difference greater than 4%. (see figure 1) The higher percentage difference in this case was 13%, due to the fact that the patient had a prosthetic mitral valve in situ, artefact from which rendered measurements unreliable. This case was evaluated by three other imaging consultants (blinded to the original results) and the EF measurements ranged from 44% to 62%. Conclusion We have shown that a trained and experienced MRI radiographer calculates LVEF with low levels of variability. (+/- 2% in 95% of cases). This compares favourably with published data comparing the reproducibility of LVEF measurements between imaging consultants (Bhuva et al 2019, George 2017) The difficulty in assessment of LV function in the presence of a prosthetic Mitral valve is widely accepted (Gulsin et al 2017, Shellock 2016) and resulted in an extreme outlier in the results. The consequent variation in opinion between imaging consultants is evidence that this discrepancy was due to the presence of significant artefact form the prosthesis. The reporting radiographer is now awaiting trust approval to commence independently reporting Herceptin cases. This study has also highlighted the potential for radiographer reporting in other areas of cardiac MRI which we intend to explore. Conflict of Interest none","PeriodicalId":193598,"journal":{"name":"Allied health professionals/Nursing/Health scientists","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125937863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}