Journal of Vascular Nursing

From the Editor's Perspective…

2012-06-01

Critically acclaimed novelist, poet and essayist Audre Lorde has said; “Our feelings are our most genuine paths to knowledge.” This quote very poignantly recognizes the importance of our emotions in our everyday exchanges. At our National Conference this May, we networked and shared our successes, solicited and gave feedback to one another and interacted positively. All these behaviors involved positive emotions and communication and made for a rewarding, successful conference.

The prevalence of peripheral arterial disease (PAD) and PAD risk factors among different ethnic groups in the US Population

Judith Aponte — 2012-06-01

The National Health and Nutrition Examination Survey (NHANES) 2003-2004 data set was utilized to examine and compare trends and differences in PAD-related risk factor variables among 5 different ethnic/racial groups. The sample included individuals 40 years and older with PAD and of the ethnic/racial groups: Mexican American, Other Hispanic, Non-Hispanic White, Non-Hispanic Black, and Other/Multiracial. Two demographic variables (age and gender) and 4 PAD-risk factors (hypertension [HTN], systolic blood pressure [SBP], and diastolic blood pressure [DBP]), dyslipidemia, high-density lipoprotein [HDL] and low-density lipoprotein [LDL], diabetes, and cigarette smoking) were examined for each group. The study design conducted was descriptive using the NHANES 2003-2004 secondary data set. Raw data were weighted. Descriptive statistics were measured, Chi-squares were compared, and Phi-coefficients were measured for association using SAS version 9.1 and SUDAAN 10.0. The group with the highest prevalence of PAD are females 40–50 years of age, and the ethnic group with PAD who have the highest risk for PAD-related risk factors are Non-Hispanic Black. Through Chi-square significant differences (P = 0.00001–0.03874) between specific ethnic groups for all four PAD-related risk factors (i.e., HTN, dyslipidemia, diabetes and cigarette smoking). All of the associations between the prevalence of HTN, dyslipidemia, diabetes, or cigarette smoking and ethnicity were statistically significant (P = < 0.0001). Overall differences exist among the different ethnic groups.

Development and implementation of a standardized care plan for carotid endarterectomy

Susanne Svensson, Karin Ohlsson, Christine Wann-Hansson — 2012-06-01

Carotid endarterectomy (CEA) is a standardized surgical procedure and is the third most common vascular surgical procedure in Sweden. To improve the quality of pre- and postoperative care for patients undergoing elective CEA, a standardized care plan (SCP) was developed and implemented during Spring of 2007 at a vascular clinic in Sweden. In order to spread light on obstacles and possibilities in the implementation-process of this procedure, the aim was to evaluate the development and implementation process of the standardized care plan for CEA.During the first ten months after the implementation of the SCP for CEA, a review of 83 SCPs was performed. Further, fifteen registered nurses and fourteen assistant nurses answered a questionnaire aimed at evaluating the use of standardized care plans.The review of the used SCP for CEA showed that three out of eighty-four patients had not been cared for in accordance to the SCP and that some of the documentation was redundant and unnecessary. All 29 nurses (100%) reported that they totally or partly agree with the Usability Items. Twenty-four of all nurses (82%) reported that their documentation was restricted by using the SCP; on the other hand, all nurses (100%) agreed that the documentation was easy, saved time, and decreased redundant information. The total sample reported high median scores in the areas of Quality of Care and Implementation (32.0, respectively 13.0), but sixteen nurses (59%) agreed that they mostly relied on their work experience and not the SCP.All nurses generally had a positive attitude towards SCP and felt that these procedures do facilitate their work and improve quality of care. The introduction of SCPs is one important way of implementing evidence-based knowledge and pursuing high quality work.

Retrospective study of emerging themes in the decision-making process of patients considering amputation

Michal Rassin, Valeria Tzevlin, Einat Malul, Shimrit Harel, Hadar Shakhar — 2012-06-01

How patients make decisions about their future treatment has been sparsely study and with respect to limb amputation, a particularly difficult decision, not at all. An examination of this should furnish nurses vital knowledge about how patients come to the decision to give or refuse this consent.To reach as deep understanding as possible of how from the patients’ point of view they reach the decision to consent to the amputation of a lower limb.The research was conducted in the qualitative method. Thirty lower-limb amputees (aged 32-88) took part in the study. In-depth interviews were held with the participants. The data were processed by means of content analysis.The main thematic categories identified were, in the chronological order of their appearance: ‘The trail of torment leading to the decision to amputate’, ‘The turning point—taking the decision’ “I just couldn’t take any more pain” “We opt for life, we don’t want to die”. The more protracted and pain-filled the ’the trail of torment’ the more mentally prepared patients were to give consent to amputation. Asked to look back on their choice, almost all interviewees had no regrets and even found virtues in it.The patients’ decisions represented a mix of their grasp of the medical information supplied them by their doctors, their own personal values—opting for life prevailing over the desire for a whole body, and consideration for their family. The patients saw the decision-making process about amputation as a process of achieving consensus between themselves, their doctors and their family.

The effect of obstructive sleep apnea on amputation site healing

2012-06-01

Obstructive sleep apnea (OSA) is an independent risk for hypertension, cerebral artery stenosis, stroke and hypercoagulability.1 Our research objective was to assess whether sleep disordered breathing affects the peripheral circulation, decreases perfusion as measured by TcPO2 and decreases the odds that a partial-foot amputation site will heal. We hypothesized that OSA would be an independent risk factor causing delayed healing of partial-foot amputations. We conducted a retrospective, observational study on a total of 307 patients who had TcPO2 measurements and underwent partial-foot amputation. Twenty-five of these patients had OSA. In our study, patients with OSA had a 3.7-fold increase in odds of healing within 3 months in comparison with patients without OSA. Of note, 16 patients (64%) with OSA were not treated with continuous positive airway pressure (CPAP) and healed within 3 months. Our results do not support our hypothesis that the presence of sleep apnea may impair healing of partial foot amputations. Further studies are needed to fully determine the effect of OSA and its treatment on TcPO2s and healing.

Review of an article: Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Initiative (2012). Culver AL, Ockene IS, Balasubramanian R, et al. (Arch Intern Med 2012;172(2):144-52)

Victoria L. Gilpin — 2012-06-01

The Women's Health Initiative (WHI) conducted an observational study from 1993 to 1998 at 40 clinical centers to investigate whether the incidence of new onset diabetes mellitus (DM) is associated with statin use among postmenopausal women. The WHI recruited 161 808 postmenopausal women aged 50 to 79 years with ongoing follow-up. Statin use was captured at enrollment and year 3 in the study. Diabetes status was captured at enrollment and annually. Cox proportional hazard models were used to estimate the risk of DM by statin use, with adjustments for propensity score and other confounding effects of other factors. To uncover effect modification, subgroups analyses were completed for race/ethnicity, obesity status and age group. At baseline there was no missing data in 153 840 women without DM. In this study 7.04% reported taking statin medication. There were 10,242 incident cases of self-reported DM over 1,004,466 person-years of follow-up. Statin use at baseline was associated with an increased risk of DM. This association remained after adjusting for other potential cofounders and was observed for all types of statin medications. The authors concluded the statin medication use in postmenopausal women is associated with an increased risk for DM. They suggest this risk may be a medication class effect. The authors recommend further study by type and dose of statin may reveal varying risk levels for new-onset DM in postmonopausal women.

2012-06-01

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2012-06-01

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2012-06-01

Journal of Vascular Nursing

From the Editor's Perspective…

The prevalence of peripheral arterial disease (PAD) and PAD risk factors among different ethnic groups in the US Population

Development and implementation of a standardized care plan for carotid endarterectomy

Retrospective study of emerging themes in the decision-making process of patients considering amputation

The effect of obstructive sleep apnea on amputation site healing

Review of an article: Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Initiative (2012). Culver AL, Ockene IS, Balasubramanian R, et al. (Arch Intern Med 2012;172(2):144-52)

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