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International Journal of Nursing... Apr 2022This qualitative study explored de-implementation of feeding tube auscultation practice in adult patients by critical care nurses.
AIM
This qualitative study explored de-implementation of feeding tube auscultation practice in adult patients by critical care nurses.
BACKGROUND
Despite years of evidence suggesting inaccuracy and harm, auscultation (air bolus method) continues to be used by the majority of critical care nurses to verify small-bore feeding tube placement in adults.
DESIGN
This descriptive qualitative study used thematic analysis with telephone interview data.
METHODS
Fourteen critical care nurses from four stratified groups within the United States (by hospital type and auscultation practice) participated in telephone interviews.
RESULTS
Two major themes of individual influence and organizational leadership emerged from the data. Categories identified key components required for auscultation de-implementation.
CONCLUSIONS
Nurses feel obligated to follow hospital policies and expressed less accountability for their own practice. Organizational leadership involvement is recommended to facilitate de-implementation of this tradition-based, low-value practice and mitigate harm events.
Topics: Adult; Auscultation; Critical Care; Critical Care Nursing; Humans; Leadership; Qualitative Research
PubMed: 34664768
DOI: 10.1111/ijn.13026 -
Journal of Obstetrics and Gynaecology... Mar 2020To present evidence and recommendations regarding use, classification, interpretation, response, and documentation of fetal surveillance in the intrapartum period and to...
OBJECTIVE
To present evidence and recommendations regarding use, classification, interpretation, response, and documentation of fetal surveillance in the intrapartum period and to provide information to help minimize the risk of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention.
INTENDED USERS
Members of intrapartum care teams, including but not limited to obstetricians, family physicians, midwives and nurses, and their learners TARGET POPULATION: Intrapartum women OPTIONS: All methods of uterine activity assessment and fetal heart rate surveillance were considered in developing this document.
OUTCOMES
The impact, benefits, and risks of different methods of surveillance on the diverse maternal-fetal health conditions have been reviewed based on current evidence and expert opinion. No fetal surveillance method will provide 100% detection of fetal compromise; thus, all FHS methods are viewed as screening tests. As the evidence continues to evolve, caregivers from all disciplines are encouraged to attend evidence-based Canadian educational programs every 2 years.
EVIDENCE
Literature published between January 1976 and February 2019 was reviewed. Medline, the Cochrane Database, and international guidelines were used to search the literature for all studies on intrapartum fetal surveillance.
VALIDATION METHODS
The principal and contributing authors agreed to the content and recommendations. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care.
BENEFITS, HARM, AND COSTS
Consistent interdisciplinary use of the guideline, appropriate equipment, and trained professional staff enhances safe intrapartum care. Women and their support person(s) should be informed of the benefits and harms of different methods of fetal health surveillance.
RECOMMENDATIONS
CommunicationSupport During Active LabourPrinciples of Intrapartum Fetal SurveillanceSelecting the Method of Fetal Heart Rate Monitoring: Intermittent Auscultation or Electronic Fetal MonitoringPaper SpeedAdmission AssessmentsEpidural AnalgesiaIntermittent Auscultation in LabourElectronic Fetal Monitoring in LabourClassification of Intrapartum Fetal SurveillanceMaternal Heart RateFetal Health Surveillance Assessment in the Active Second Stage of LabourIntrauterine ResuscitationDigital Fetal Scalp StimulationFetal Scalp Blood SamplingUmbilical Cord Blood GasesDocumentationFetal Surveillance Technology Not RecommendedFetal Health Surveillance Education.
Topics: Asphyxia Neonatorum; Canada; Consensus; Female; Fetal Monitoring; Heart Rate, Fetal; Humans; Infant, Newborn; Pregnancy; Prenatal Care
PubMed: 32178781
DOI: 10.1016/j.jogc.2019.05.007 -
Journal of Cardiology Nov 2022The effectiveness of cardiac auscultation training with a cardiology patient simulator for medical students is still unclear. Starting such training earlier may help...
BACKGROUND
The effectiveness of cardiac auscultation training with a cardiology patient simulator for medical students is still unclear. Starting such training earlier may help students improve their proficiency. We investigated whether cardiac auscultation training using a simulator for first-year students is feasible and effective.
METHODS
A total of 43 first-year medical students (5-12 in each year, 2015-2019) participated in three 1.5-hour extra-curricular classes comprising mini-lectures, facilitated training, two different auscultation tests (the second test closer to clinical setting than the first), and a questionnaire. The test results were compared with those of 556 fourth-year medical students who participated in a compulsory 3-hour cardiac auscultation class in 2016-2019.
RESULTS
The accuracy rate of all heart sounds and murmurs was higher in the first-year students than in the fourth-year students in both the first (85.8 vs. 79.4 %, p = 0.001) and second (71.3 vs. 61.2 %, p = 0.02) tests. That of second/third/fourth sounds was also higher in the first-year students than in the fourth-year students in both the first (86.0 vs. 79.7 %, p = 0.01) and second (70.9 vs. 53.9 %, p = 0.002) tests. The accuracy rate of murmurs was higher in the first-year students than in the fourth-year students in the first test (85.5 vs. 78.9 %, p = 0.04), but not in the second test (72.1 vs. 75.7 %, p = 0.58). All the first-year students and 65 % of them agreed that they had received sufficient knowledge and built sufficient skills, respectively. All the first-year students and 93 % of them agreed that they were satisfied with the program, and that the program was suitable for first-year students, respectively.
CONCLUSIONS
Although training time was different between the two groups and it is possible that only motivated first-year students participated in the program, these results suggest that our cardiac auscultation training is feasible and effective for first-year medical students.
Topics: Cardiology; Clinical Competence; Feasibility Studies; Heart Auscultation; Heart Murmurs; Humans; Students, Medical
PubMed: 35750554
DOI: 10.1016/j.jjcc.2022.06.007 -
The American Journal of Emergency... Nov 2021The purpose of this review is to draw attention to the presence and significance of murmurs other than the murmur of aortic regurgitation, in patients with aortic... (Review)
Review
The purpose of this review is to draw attention to the presence and significance of murmurs other than the murmur of aortic regurgitation, in patients with aortic dissection. For that purpose, a literature search was conducted using Pubmed and Googlescholar. The search terms were "dissecting aneurysm of the aorta", "systolic murmurs", "ejection systolic murmurs", "holosystolic" murmurs, "continuous murmurs", and "Austin-Flint" murmur. Murmurs other than the murmur of aortic regurgitation, which were associated with aortic dissection, fell into the categories of systolic murmurs, some of which were holosystolic, and continuous murmurs, the latter attributable to fistulae between the dissecting aneurysm and the left atrium, right atrium, and the pulmonary artery, respectively. Mid-diastolic murmurs were also identified, and these typically occurred in association with both the systolic and the early diastolic murmurs. Among patients with systolic murmurs clinical features which enhanced the pre-test probability of aortic dissection included back pain, stroke, paraplegia, unilateral absence of pulses, interarm differences in blood pressure, hypertension, shock, bicuspid aortic valve, aortic coarctation, Turner's syndrome, and high D-dimer levels, respectively. In the absence of the murmur of aortic regurgitation timely diagnosis of aortic dissection could be expedited by increased attention to parameters which enhance pretest probability of aortic dissection. That logic would apply even if the only murmurs which were elicited were systolic murmurs.
Topics: Aortic Dissection; Heart Auscultation; Heart Murmurs; Humans; Physical Examination
PubMed: 34102459
DOI: 10.1016/j.ajem.2021.05.041 -
BMC Pediatrics Aug 2022To conduct a retrospective evaluation of a large clinical implementation of combined pulse oximeter (POX) and cardiac auscultation as a fast-screening device for...
PURPOSE
To conduct a retrospective evaluation of a large clinical implementation of combined pulse oximeter (POX) and cardiac auscultation as a fast-screening device for congenital heart disease (CHD).
METHODS
Every newborn in a large maternity healthcare center received auscultation and POX screening within 24 hours after delivery. When an abnormal heart murmur or SpO level was detected, an echocardiogram was ordered to confirm the diagnosis of CHD.
RESULTS
From January 1, 2018 to December 31, 2019, there were 44,147 livebirths at the studied hospital where 498 suspected CHD were identified: 27 newborns by POX screening and 471 by cardiac auscultation. The diagnosis was further confirmed in 458 neonates through echocardiogram. This result put forth an overall diagnosis rate of 92.0%. Cardiac auscultation detected the majority of CHD cases 438 (95.6%) while POX only screened 20 (4.4%) cases. Interestingly, no CHD case was detected by both auscultation examination and POX screening. Auscultation detected most of the common types of CHD, but POX excelled in identifying rare and critical cases. POX screening alone had a very low accuracy of 74.07% in positive predict value (PPV). On the other hand, auscultation functioned well in terms of PPV and negative predict value (NPV) (92.99 and 99.95%, respectively), but the addition of POX improved the overall screening performance resulting in 100% NPV. We also validate the finding with the data 6 months after the study period.
CONCLUSION
Our study demonstrated that addition of pulse oximetry to routine cardiac auscultation could be used as an accurate and feasible screening for early screening of CHD in newborns in large-scale clinical practice.
Topics: Auscultation; Female; Heart Defects, Congenital; Humans; Infant, Newborn; Neonatal Screening; Oximetry; Pregnancy; Retrospective Studies; Sensitivity and Specificity
PubMed: 35962379
DOI: 10.1186/s12887-022-03540-7 -
Proceedings of the Institution of... Jun 2023The high prevalence of cardiac diseases around the world has created a need for quick, easy and cost effective approaches to diagnose heart disease. The auscultation and... (Review)
Review
The high prevalence of cardiac diseases around the world has created a need for quick, easy and cost effective approaches to diagnose heart disease. The auscultation and interpretation of heart sounds using the stethoscope is relatively inexpensive, requires minimal to advanced training, and is widely available and easily carried by healthcare providers working in urban environments or medically underserved rural areas. Since René-Théophile-Hyacinthe Laennec's simple, monoaural design, the capabilities of modern-day, commercially available stethoscopes and stethoscope systems have radically advanced with the integration of electronic hardware and software tools, however these systems are largely confined to the metropolitan medical centers. The purpose of this paper is to review the history of stethoscopes, compare commercially available stethoscope products and analytical software, and discuss future directions. Our review includes a description of heart sounds and how modern software enables the measurement and analysis of time intervals, teaching auscultation, remote cardiac examination (telemedicine) and, more recently, spectrographic evaluation and electronic storage. The basic methodologies behind modern software algorithms and techniques for heart sound preprocessing, segmentation and classification are described to provide awareness.
Topics: Heart Sounds; Auscultation; Stethoscopes; Software; Algorithms; Heart Auscultation
PubMed: 37139865
DOI: 10.1177/09544119231172858 -
The Journal of Perinatal & Neonatal...
Topics: Humans; Pregnancy; Female; Auscultation; Labor, Obstetric; Heart Rate, Fetal; Heart Auscultation; Fetal Monitoring
PubMed: 37494682
DOI: 10.1097/JPN.0000000000000754 -
Nature Reviews. Chemistry Feb 2023
Topics: Humans; Male; Fathers; Parenting; Auditory Perception; Auscultation
PubMed: 37117912
DOI: 10.1038/s41570-022-00459-6 -
Cureus Sep 2023Cardiac murmurs are a common problem in pediatric clinical practice. Studies demonstrated low accuracy in detecting and diagnosing various cardiac murmurs at all levels...
INTRODUCTION
Cardiac murmurs are a common problem in pediatric clinical practice. Studies demonstrated low accuracy in detecting and diagnosing various cardiac murmurs at all levels of medical training. So, supplementary training methods started to evolve, including simulation for auscultation skills training. Over the years, mannequins have evolved with different types of technology. Therefore, we decided to compare cardiac auscultation accuracy among high-fidelity mannequins as the primary objective and compare the performance of various postgraduate-level residents as a secondary objective.
METHOD
Pediatric residents at King Abdulaziz University Hospital were given a lecture on the basics of cardiac auscultation and then requested to auscultate four mannequins, namely SimJumior® (Laerdal Medical, Stavanger, Norway), SimBaby™ (Laerdal Medical), Pediatric HAL® (Gaumard Scientific, Miami, FL, USA), and Cardiac Patient Simulator K-Plus (Kyoto Kagaku Co. Ltd., Kyoto, Japan). The accuracies of murmur type, diagnosis, and auscultation time were compared. Results: A total of 56 pediatric residents were enrolled. Median murmur accuracy ranged from 50% to 53% (p-value 0.79), and median diagnosis accuracy ranged from 33% to 36% (p-value 0.77), with a nonsignificant difference between mannequins. Comparing resident levels in all mannequins, median murmur accuracy ranged from 49% to 56% (p-value 0.70), and median diagnosis accuracy ranged from 29% to 41% (p-value 0.09). While the median average auscultation time was between 41 and 50 seconds (p-value 0.34).
CONCLUSION
Auscultation skills can be taught through simulation on any mannequin used in this comparison, not necessarily the cardiac one. For better accuracy, future comparisons might include more advanced cardiac mannequins based on cardiac auscultation expertise (i.e., consultant level). The introduction of an auscultation program from the undergraduate level throughout the training process and monitoring of these skills are mandated.
PubMed: 37842489
DOI: 10.7759/cureus.45127