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The issue of care for patients before and after intervention treatment for atrial fibrillation
PEŠKOVÁ, Petra
The topic of my diploma thesis is: ?The Questions of the Care of Patients before and after the Intervention for Ventricular Fibrillation ?. The diploma thesis defines three objectives. The first objective finds out the information level of patients about nursing care before and after the intervention for ventricular fibrillation. The second objective was to find out the most frequent problems in connection with the intervention for ventricular fibrillation. The third objective aims at surveying the requirements for the nursing care in connection with the intervention for ventricular fibrillation. To conduct my research I defined 4 questions along with these objectives: Are patients informed about nursing care before and after the intervention for ventricular fibrillation? In which way do nurses inform patients about nursing care before and after the intervention for ventricular fibrillation? How do nurses assess the cooperation with patients before and after the intervention for ventricular fibrillation? In which fields are patients most limited after the intervention for ventricular fibrillation? To fulfil the objectives of the diploma thesis I chose the quantitative research survey. The collection of data was conducted by the interview technique. These interviews constituted the basis for the chart of ideas in the X-mind programme. The research questions that were defined for the research survey yielded these conclusions: The information on the regime before the radiofrequency ablation for fibrillation of chambers is insufficient for the patients. The information on the regime after the radiofrequency ablation for ventricular fibrillation is insufficient for the patients. Nurses inform patients about the nursing care before the performance based on nursing standards. The largest problem encountered by patients after the radiofrequency ablation for ventricular fibrillation is bowel movement. Patients before the radiofrequency ablation for ventricular fibrillation worry because of lack of information about the performance. The patients before the radiofrequency ablation for ventricular fibrillation cooperate with the nursing staffs. The patients after the radiofrequency ablation for ventricular fibrillation cooperate with the nursing staffs.
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Nurse-specialist in the diagnosis and treatment of atrial fibrillation.
NEPRAŠOVÁ, Eva
Introduction: Atrial fibrillation is the most common sustained arrhythmia. The quality of atrial fibrillation treatment in clinical practice varies between hospitals and doctors. Due to the increasing prevalence of atrial fibrillation in the more elderly population, it might be difficult in the future to refer patients to a limited number of heart specialists. At the same time, a new generation of University educated nurses is growing, but, unfortunately, their competencies are as low as their colleagues' with high-school education. However, in some areas, such as diabetology or gastroenterology, specialist nurses, whose aim is to supplement medical doctors to some extent, are gradually occurring. In the Czech Republic, there are no specialist nurses in cardiology, even though they are quite common abroad. Our aim is to assess the feasibility of a specialist nurse for diagnosis and treatment of atrial fibrillation. Methods: Main inclusion criterion for our study was a diagnosis of atrial fibrillation made on one of the non-internal medicine wards or in the general practitioners' practice. An exclusion criterion was previous examination by one of the heart specialists either internal medicine doctor or a cardiologist. During the first interview, I checked previous investigations for the atrial fibrillation and the arrhythmia treatment. The questionnaire contained questions on demographic parameters and patients' knowledge about their disease and possible complications. Subsequently, I recorded my recommendations regarding further investigations and therapeutic possibilites. All patients were sent to a cardiologist as required by our national guidelines. The second interview was made over the phone 2 months later and comparison of the doctor's recommendations with my suggestions was made. During this interview, an assessment of the concept of a nurse specialist in atrial fibrillation was performed. Results: Forty patients with atrial fibrillation documented on an ECG were recruited. At a time of the first interview, only 10 patients (25%) had their echocardiogram performed and only 23 (57,5%) patients had their thyroid gland hormones checked. 26 (65%) patients were on anticoagulation medicine while CHADS2-Vasc score of 2 and more was documented in 34 (85%) patients. There was an agreement between doctor's and nurse's recommendations regarding missing investigations and anticoagulation treatment. However, no agreement was achieved in the area of arrhythmia treatment, which means that this should remain a doctor's responsibility. Patients were informed about possible complications in only 11 (27,5%) cases and about all therapeutic options in 2 (5%) cases. 29 (72,5%) patients would be interested in consulting a specialist nurse in the future, whereas 11 (27,5%) patients would prefer a doctor. Results: We managed to confirm that the novel concept of a specialist nurse for the diagnosis and treatment of atrial fibrillation is feasible. The specialist nurse is able to confirm the diagnosis, check the completeness of the investigations, educate patients and assess the risk of the thromboembolic disease. Competencies of the nurses should be extended, so this concept could be introduced into the clinical practice.
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Anticoagulant therapy focusing on patients with atrial fibrillation
VANÍČKOVÁ, Martina
Thrombosis has recently become a widely discussed issue due to an increasing number of cases and problematic treatment. Once developed, thrombosis cannot be cured completely. Currently used anticoagulant treatment is limited to avoid complications such a hemorrhage or stroke. INR value checks (Quick tests) and monitoring covering at least 70% of the treatment period within the therapeutic range are necessary (2-3), but could be rather difficult to maintain in some patients. So-called new anticoagulants could prove themselves as an appropriate solution.
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Effectiveness of treatment of chronic forms of atrial fibrillation by radiofrequency catheter ablation, application of preventive stimulation modes and hybrid therapies
Šedivá, Lucie ; Aschermann, Michael (advisor) ; Heinc, Petr (referee) ; Horký, Karel (referee)
Výsledky naší studie nám umožňují odpovědět na hlavní cíl studie: Pomocí paměťových záznamů z kardiostimulátoru jsme prokázali největší efektivitu na potlačení FS kombinovanou terapií, tedy radiofrekvenční katetrizační ablací a aktivovanými preventivními funkcemi kardiostimulátoru. Hodnocení celkové zátěže FS, které jsme měli umožněné díky paměťovým funkcím KS prokázalo výrazně lepší výsledky u skupiny C, 63% vyléčených ( FS=0), proti skupině B, která měla úspěšnost léčby 45% ( FS=0) a skupina A pouze 30% ( FS=0). Ad 1 Do naší studie byli zařazeni nemocní s chronickými typy FS, ze 150 nemocných bylo 39 nemocných ( 26%) ve stadiu permanentní FS, 111 nemocných (74%) mělo persistující FS, vyžadující pro výrazné potíže a hemodynamický dopad opakované kardioverze. Ve všech skupinách jsme prokazovali významné zlepšení ( ve skupině A mělo v závěru studie devět nemocných permanentní FS. Ve skupině B to byl jeden nemocný a ve skupině v C měli čtyři nemocní permanentní. Ve skupině C bylo nejvíce nemocných s nulovou zátěží FS ( celkem 24 nemocných). Ad 2 Posouzení kvality života-srovnání dotazníků před randomizací a po dvanácti měsících ukazuje nejlepší výsledek u skupiny C, i když u celého souboru došlo vlivem léčby ke zlepšení kvality života. Ad 3 V celém průběhu studie od aktivace preventivních algoritmů po...
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