Question

In: Nursing

Article Findings What are the findings of each article and what implications do they have individually...

Article Findings

What are the findings of each article and what implications do they have individually and collectively for solving the health problem in question? Support your answer with specific examples from your field.

Explain how key biostatistical calculations and methods support the conclusions in each article. Cite relevant information from the articles that support your answer.

Findings

It was found that the Evaluation of feasibility and safety of changing body position after transfemoral angiography: A randomized clinical trial article (Valiee, Fathi, Hadizade, Roshani, & Mahmoodi, 2016).

Findings

A total of 86 (male, n = 41; female, n = 45) subjects

completed the study, 43 in each group with a mean age of

63 years (SD = 9, range 34–75). Fifty-six (65%) subjects

had either received no formal education or were educated at

elementary level, and eight (9.3%) had received a college

education. Most (65.1%) subjects had a monthly family

income <HK$8000 (approximately US$1000). Seventy-one

patients (82.6%) were either retired or housewives. Table 1

shows that the two groups were not significantly different in

age, gender, education level, and monthly household income.

Occupation status was significantly different between the two

groups (chi-square, P ¼ 0Æ009) with more retired subjects in

the control groups but more housewives in the experimental

group.

There was no difference between the two groups on vascular

complications. One subject in the control and none in the

experimental group developed bleeding at the puncture site

that required manual pressure to re-establish haemostasis

(Fisher’s exact test, P ¼ 1). Repeated measures analysis of

variance was used to evaluate the back pain experienced across

time and between groups. There was a significant difference

between the two groups at the three time intervals on back

pain intensity (F2,83 ¼ 9Æ80, P < 0Æ001) with the control

group reporting more pain at each time interval. Moreover,

the two groups also differed significantly on urinary discomfort

(t65Æ6 ¼ 3Æ24, P ¼ 0Æ006) with the control group experiencing

higher levels of urinary discomfort (Table 1).

Implications for practice

The results suggests that early ambulation may play a

substantial role in reducing back pain and urinary discomfort

in post-transfemoral cardiac catheterization. Allowing patients

to get out of bed after four hours of bed rest following

cardiac catheterization could be introduced into routine

practice in Hong Kong, as it was found to be safe and might

aid in promoting patient comfort without increasing the

incidence of vascular complications. In addition, the shorter

bed rest duration may reduce the nursing time needed for

administering analgesics or back rubs to relieve back pain.

Early ambulation after cardiac catheterization may also

reduce the nursing time needed for assisting patients to use

urinal and bedpan during bed rest period after the procedure.

……………………………………………………………………………….

METHOD

The study is a single-blind randomized clinical trial in two

groups which was approved by the Kurdistan University of

Medical Sciences research Council. The study’s proposal is

registered at (www.irct.com) by the registration number

IRCT2015091424018N1.

Measuring tool

The instrument used to collect and record information in this

was a three-part questionnaire which was designed according to

the study.

The first part was demographic and clinical information form

which contained information about age, height, weight, gender,

marital status, education, occupation, history of smoking, diabetes,

history of previous coronary angiography, systolic and diastolic

blood pressure, body mass index, PT, PTT, international

normalized ratio, and platelet count which was recorded based

on the information contained in patients’ medical records.

Patients’ blood pressure was measured and recorded by one

person using a mercury sphygmomanometer (ALP K2 model:

no 300-VS; Tanaka Sangyo Co, Ltd, Tokyo, Japan) which was

calibrated before the start of the study. Their height and weight

were measured and recorded by one person using digital scales

(Bermend BD7750) and centimeters. The second section contained

procedural information form which contained the length

Vol. XXXIV No. 3 JOURNAL OF VASCULAR NURSING PAGE 107

www.jvascnurs.net of angiography, homeostasis time, size of the catheter used,

injury of the femoral artery, and the type and volume of contrast

agent, diagnosis of coronary artery stenosis which were prepared

using a chronometer and the information contained in patient

records.

Part three of the evaluation form included angiographic complications

such as hematoma, bleeding, urinary retention, back

pain, groin pain, and comfort. Back pain, groin pain, and comfort

were measured and recorded with standard numeric rating

scale.28 Patients’ comfort level was measured by a general question

about the overall level of comfort at the time of measurement.

The patients were asked to rate their comfort from 0 to

10 grades. The validity of this scale was set by Johnson and

Carol.22 The reliability was estimated by Farrar et al and Good

et al to be 0.78 and 0.83.29,30 Hematoma shape and bruise was

placed on transparent paper and then on graph paper, and the

side of intended shape was measured and recorded (based on

the biggest length and width) per square centimeter. The

amount of bleeding was measured by weighing Gauze soaked

in blood by 0.1 gm sensitive Japanese scale (standard future).

Urinary retention was also analyzed based on patient interview.

All the measurements were carried out by the principal

researcher.

Statistics

After collecting data to assess the normal distribution of data,

Kolmogorov–Smirnov test was used. To compare the two intervention

and control groups in terms of demographic, clinical,

and procedural quality, chi-square and Fisher’s exact tests were

used. Moreover, to compare quantitative variables independent

t-test and Mann–Whitney tests were used.

RESULTS

Eighty-one patients were assessed for inclusion criteria.

Some patients were excluded from the study for the following

reasons including; three patients because of a history of chronic

low back pain, four patients because of an unwillingness to

participate in the study, two patients because of the history of

anticoagulant, and three patients due to taking opium. Thirtythree

patients were assigned to each group. During the study,

in the intervention group, two patients were excluded from the

study due to chest pain and taking analgesic and one patient

due to needle entrance to the arteries more than once. In the control

group, two patients were excluded due to anaphylactic reactions

and one patient due to stenosis in the abdominal aorta.

Finally, two groups (n = 30, each group) were analyzed. There

was no significant difference between the two groups of

participants in terms of demographic and clinical data include

of mean age, height, weight, systolic blood pressure, diastolic

blood pressure, body mass index, PT, PTT, platelet count, international

normalized ratio, homeostasis time length, contrast media

volume, amount of smoking, marital status, education level,

smoking history, history of diabetes, history of previous coronary

angiography, rupture of the femoral artery, final diagnosis,

recommend treatment, and the amount of stenosis in the right

coronary, left main coronary, left circumflex arteries, and the

two groups were homogenous (Tables 3 and 4). But in terms of

gender, occupation, catheter size, type of contrast, the stenosis

of left anterior descending artery, and duration of angiography

were significantly different (Tables 3 and 4). The mean age of

the patients was 10.445 _ 57.71, and 34 patients (56.66%)

were male and 58 (96.65%) were married.

The results showed that the incidence of hematoma between

the two groups was not significant. Moreover, hematoma in the

intervention group (P = 0.006) was significantly different at

different times, but in the control group (P = 0.149), the difference

was not significant (Table 4).

Considering the P values in Table 5, to compare between

intervention and control groups at different times, there were

no significant differences between the intervention and control

groups in terms of hematoma (Table 5).

The results showed that the incidence of urinary retention in

the control group (P = 0.023) and intervention group (P = 0.020)

were significantly different at different times (Table 4). With regard

to the P values in Table 5, pairwise comparison between

intervention and control group at different times, there were no

significant differences between the intervention and control

groups in terms of complications of urinary retention (Table 4).

Furthermore, the incidence of thrombosis remained unchanged

at different times and was not observed in none of the

participants.

In addition, the incidence of bleeding was significantly

different in terms of time (P $ 0.001). The test results of Bonferroni

procedure showed that in the control group at third, eighth,

and 24th hours were not significantly different in terms of the

mean of this variable and in the intervention group there was a

significant difference only between the time of entrance and

the other times.

The results showed that the incidence of bruise between the

two groups in different measurements did not differ significantly

in terms of time (P = 0.081).

TABLE 1

PROTOCOLS OF BODY POSITION AND METHODS OF ANALYSIS IN THE GROUPS

Group 1st & 2nd hour 3rd & 4th hour 5th hour 6th hour 7th & 8th hour 9th hour 24th hour

Intervention

Group

Supine Supine, HOB Right side, HOB Left side, HOB Sitting position OOB OOB

45_ El 15_ El 15_ El

Control group Supine Supine Supine Supine Supine OOB OOB

HOB = head of bed; EL = elevation.

Vol. XXXIV No. 3 JOURNAL OF VASCULAR NURSING PAGE 109

www.jvascnurs.net