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The experience of a cardiac event is a significant source of stress for both patients and their family members. The acute phase after myocardial infarction reflects a crisis for patients and family members as they attempt to reconcile the affect of the event and adapt to the uncertainties associated with hospitalization and the initial recovery process. This article reviews empirical research available to cardiovascular nurses that may guide family-centered care during the acute phase after myocardial infarction. Directions for practice and research focus on cardiovascular nursing interventions that address family needs after an acute myocardial infarction. The experience of an acute myocardial infarction is a source of stress for both patients and their family members and may be viewed as a crisis that significantly disrupts family functioning and dynamics. The trajectory of cardiovascular disease involves multiple adjustments by patients and family members as they attempt to reconcile the affect of the event and adapt to the uncertainties associated with the acute phase of illness. Efforts by patients and family members to manage the stressors associated with the acute phase of cardiovascular illness are often associated with alterations in physiologic and psychologic functioning.

PURPOSE: Systems thinking is the ability to recognize and synthesize patterns, interactions, and interdependencies in a set of activities and is a key component in quality and safety. A measure of systems thinking is needed to advance our understanding of the mechanisms that contribute to improvement efforts. The purpose of this study was to develop and conduct psychometric testing of a systems thinking scale (STS). METHODS: The development of the STS included obtaining national quality and safety experts' conceptual domains of systems thinking and the generation of a provisional set of items. Further psychometric analyses were conducted with interprofessional healthcare faculty (N = 342) and students (N = 224) engaged in quality improvement initiatives and education. RESULTS: Of the 26 items identified in the development phase, factor analyses indicated three factors: (1) system thinking (20 items), (2) personal effort (2 items), and (3) reliance on authority (4 items). The six items from factors 2 and 3 were omitted due to low factor loadings. Testretest reliability of the 20-item STS was performed on 36 healthcare professionals and a correlation of 0.74 was found. Internal consistency testing on a sample of 342 healthcare professionals using Cronbach's alpha showed a coefficient of 0.89. Discriminant validity was confirmed with three groups of healthcare professions students (N = 102) who received high, low, or no dose levels of systems thinking education in the context of proce ss improvement. CONCLUSIONS: The 20-item STS is a valid and reliable instrument that is easy to administer and takes less than 10 min to complete. Further research using the STS has the potential to advance the science and education of quality improvement in two main ways: (1) increase understanding of a critical mechanism by which quality improvement processes achieve results, and (2) evaluate the effectiveness of our education to improve systems thinking.

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BackgroundInflammatory bowel disease (IBD) is a chronic condition of the bowel that affects over 1 million people in the United States. The recurring nature of disease makes IBD patients ideal candidates for patient-engaged care that is centered on enhanced self-management and improved doctor-patient communication. In IBD, optimal approaches to management vary for patients with different phenotypes and extent of disease and past surgical history. Hence, a single quality metric cannot define a heterogeneous disease such as IBD, unlike hypertension and diabetes. A more comprehensive assessment may be provided by complementing traditional quality metrics with measures of the patient’s quality of life (QOL) through an application like HealthPROMISE.ObjectiveThe objective of this pragmatic randomized controlled trial is to determine the impact of the HealthPROMISE app in improving outcomes (quality of care [QOC], QOL, patient adherence, disease control, and resource utilization) as compared to a patient education app. Our hypothesis is that a patient-centric self-monitoring and collaborative decision support platform will lead to sustainable improvement in overall QOL for IBD patients.MethodsParticipants will be recruited during face-to-face visits and randomized to either an interventional (ie, HealthPROMISE) or control (ie, education app). Patients in the HealthPROMISE arm will be able to update their information and receive disease summary, quality metrics, and a graph showing the trend of QOL (SIBDQ) scores and resource utilization over time. Providers will use the data for collaborative decision making and quality improvement interventions at the point of care. Patients in the control arm will enter data at baseline, during office visits, and at the end of the study but will not receive any decision support (trend of QOL, alert, or dashboard views).ResultsEnrollment in the trial will be starting in first quarter of 2015. It is intended that up to 300 patients with IBD will be recruited into the study (with 1:1 allocation ratio). The primary endpoint is number of quality indicators met in HealthPROMISE versus control arm. Secondary endpoints include decrease in number of emergency visits due to IBD, decrease in number of hospitalization due to IBD, change in generic QOL score from baseline, proportion of patients in each group who meet all eligible outpatient quality metrics, and proportion of patients in disease control in each group. In addition, we plan to conduct protocol analysis of intervention patients with adequate HealthPROMISE utilization (more than 6 log-ins with data entry from week 0 through week 52) achieving above mentioned primary and secondary endpoints.ConclusionsHealthPROMISE is a unique cloud-based patient-reported outcome (PRO) and decision support tool that empowers both patients and providers. Patients track their QOL and symptoms, and providers can use the visual data in real time (integrated with electronic health records [EHRs]) to provide better care to their entire patient population. U...

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Aim: Digital ELISA-based assays for blood biomarkers of neurological disease are on the verge of clinical use. Here, we aimed to determine whether different preanalytical blood processing techniques influence results. Materials & methods: Concentrations of neurofilament light chain (NfL), Tau and amyloid beta (Aβ) were measured in human plasma and serum specimens using digital ELISA and compared between blood products. Measured levels of NfL were highly equivalant between serum and plasma in all analyses, however, measured levels of Tau and Aβ were consistently lower in serum relative to plasma. Conclusion: Tau and Aβ are likely lost during clotting in serum preparations, and should be assayed in plasma to get an accurate measure of circulating levels.

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