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Inappropriate cardiac monitoring leads to increased hospital resource utilization and alarm fatigue, which is ultimately detrimental to patient safety. Our institution implemented a continuous cardiac monitoring (CCM) policy that focused on selective monitoring for patients based on the American Heart Association (AHA) guidelines. The primary goal of this study was to perform a three-year median follow-up review on the longitudinal impact of a selective CCM policy on usage rates, length of stay (LOS), and mortality rates across the medical center. A secondary goal was to determine the effect of smaller-scale interventions focused on reeducating the nursing population on the importance of cardiac alarms.

A system-wide policy was developed at The Ohio State University in December 2013 based on guidelines for selective CCM in all patient populations. Patients were stratified into Critical Class I, II, and III with 72 hours, 48 hours, or 36 hours of CCM, respectively. Pre- and post-implementation measures included average cardiac monitoring days (CMD), emergency department (ED) boarding rate, mortality rates, and LOS. A 12-week evaluation period was analyzed prior to, directly after, and three years after implementation.

There was an overall decrease of 53.5% CMDs directly after implementation of selective CCM. This had remained stable at the three-year follow-up with slight increase of 0.5% (p = 0.2764). Subsequent analysis by hospital type revealed that the largest and most stable reductions in CMD were in noncardiac hospitals. The cardiac hospital CMD reduction was stable for roughly one year, then dipped into a lower stable level for nine months, then returned to the previous post-implementation levels. This change coincided with a smaller intervention to further reduce CMD in the cardiac hospital. There was no significant change in mortality rates with a slight decrease of 3.1% at follow-up (p = 0.781). Furthermore, there was no significant difference in LOS with a slight increase of 1.1% on follow-up (p = 0.649). However, there was a significant increase in ED boarding rate of 7.7% (p < 0.001) likely due to other hospital factors altering boarding times.

Implementing selective CCM decreases average cardiac monitoring rate without affecting LOS or overall mortality rate. Selective cardiac monitoring is also a sustainable way to decrease overall hospital resource utilization and more appropriately focus on patient care.

This chapter examines why managed clinical networks are an appropriate approach to sustainable healthcare, and discusses the conditions for the effectiveness of these multi-stakeholder, clinician-led modes of organizing. It describes the development of a national clinical network to achieve system-wide improvement in the provision of publicly funded cardiac surgery services in New Zealand, and the subsequent evolution of a broader network encompassing the whole cardiac care patient pathway.

The case study of the two cardiac clinical networks focuses on the emergence and evolution of the networks over a four-year period from 2009. Data were collected from interviews with key stakeholders of both networks and from internal and published documentary evidence. Analysis of the case study is informed by network theory and prior studies of managed clinical networks.

Progress made towards the achievement of the goals of the initial cardiac surgery network encouraged a broadening of focus to the entire cardiac care pathway and the establishment of the national cardiac network. An important benefit has been the learning and increase in understanding among the different stakeholders involved. Both clinical networks have demonstrated the value of clinician engagement and leadership in improving the delivery of health services, and serve as a best practice model for the development of further clinical networks for health services that require a national population base.

The case study analysis of the two cardiac clinical networks identifies five mutually reinforcing themes that underpin network effectiveness: network structure, management and governance, and internal and external legitimation. These themes encompass a number of factors suggestive of successful managed clinical networks, and offer insights into the use of such networks in organizing for sustainable healthcare.

This study aims to scrutinize the efficacy of chitosan (CT) on cardio-lipotoxic responses elicited by a high-fat diet (HF).

Thirty-six male Wistar rats were distributed across six groups (n = 6): normal diet (ND), HF, ND-5%CT, HF-1%CT, HF-3%CT and HF-5%CT, for seven weeks. Blood and cardiac tissues were processed for biochemical, immunohistochemical and histopathological analyses.

Ingestion of HF induced hyperlipidaemia and lipid accumulation, leading to increased body and heart weight by 70.5% (p < 0.0001) and 124% (p = 0.0021), respectively, compared to ND-groups. Cardiac damage markers (creatine kinase, lactate dehydrogenase and malondialdehyde) were higher in the HF-group compared to control rats. Also, atherogenic and coronary risk indices were significantly elevated by 155% (p = 0.0044) and 174% (p = 0.0008), respectively, compared to control rats. Rats fed HF had significantly reduced cardiac antioxidants (superoxide dismutase, catalase and glutathione peroxidase) and elevated expression of NF-κB-p65 and p53 (p < 0.0001) in the cardiac tissues. Histology revealed lipid inclusions in the cardiac tissues of HF-groups. CT (1%–5%) prevented hyperlipidaemia, lipid accumulation, oxidative stress and cardiac damage in HF-fed rats, while greatly improving the histology of the cardiac tissues in HF-fed rats in a dose-dependent manner.

To the best of the authors’ knowledge, this is the first report of the effects of CT against cardio-lipotoxicity elicited by HF diet ingestion. The findings suggest that CT may present a safe therapeutic alternative for managing complications arising from cardio-lipotoxicity.

Debates why and how some practices become universal – taking as a case in point closed‐chest massage (CCCM). Points out that CCCM was recognized in 1960 and its use generated heated debates, which altered the technique and reshuffled existing infrastructures. Claims that debates act as a catalyst for university. Investigates the emergence of CCCM, the debate on the merits (or otherwise) of closed versus open‐chested cardiac massage, and who could use the method of CCCM. Indicates that CCCM only became universally practised when it was incorporated into the infrastructure for dealing with emergency cases, and thus became taken for granted.

The purpose of this paper is to re-conceptualise the hot debrief process after cardiac arrest as a collaborative and distributed process across the multi-disciplinary team. There are multiple benefits to hot debriefs but there are also barriers to its implementation. Facilitating the hot debrief discussion usually falls within the remit of the physician; however, the American Heart Association suggests “a facilitator, typically a health-care professional, leads a discussion focused on identifying ways to improve performance”. Empowering nurses through a distributed leadership approach supports the wider health-care team involvement and facilitation of the hot debrief process, while reducing the cognitive burden of the lead physician.

A mixed-method approach was taken to evaluate the experiences of staff in the Emergency Department (ED) to identify their experiences of hot debrief after cardiac arrest. There had been some staff dissatisfaction with the process with reports of negative experiences of unresolved issues after cardiac arrest. An audit identified zero hot debriefs occurring in 2019. A quality Improvement project (Model for Healthcare Improvement) used four plan do study act cycles from March 2020 to September 2021, using two questionnaires and semi-structured interviews to engage the team in the design and implementation of a hot debrief tool, using a distributed leadership approach.

The first survey (n = 78) provided a consensus to develop a hot debrief in the ED (84% in the ED; 85% in intensive care unit (ICU); and 92% from Acute Medicine). Three months after implementation of the hot debrief tool, 5 out of 12 cardiac arrests had a hot debrief, an increase of 42% in hot debriefs from a baseline of 0%. The hot debrief started to become embedded in the ED; however, six months on, there were still inconsistencies with implementation and barriers remained. Findings from the second survey (n = 58) suggest that doctors may not be convinced of the benefits of the hot debrief process, particularly its benefits to improve team performance and nurses appear more invested in hot debriefs when compared to doctors.

There are existing hot debrief tools; for example, STOP 5 and Take STOCK; however, creating a specific tool with QI methods, tailored to the specific ED context, is likely to produce higher levels of multi-disciplinary team engagement and result in distributed roles and responsibilities. Change is accepted when people are involved in the decisions that affect them and when they have the opportunity to influence that change. This approach is more likely to be achieved through distributed leadership rather than from more traditional top-down hierarchical leadership approaches.

To the best of the authors’ knowledge, this study is the first of its kind to integrate Royal College Quality Improvement requirements with a collaborative and distributed medical leadership approach, to steer a change project in the implementation of a hot debrief in the ED. EDs need to create a continuous quality improvement culture to support this integration of leadership and QI methods combined, to drive and sustain successful change in distributed leadership to support the implementation of clinical protocols across the multi-disciplinary team in the ED.

This study aims to determine the factors influencing caregivers' uncertainty about children undergoing cardiac surgery in a tertiary hospital in Bangkok, Thailand.

A correlational predictive study was conducted among 75 caregivers of children from infancy to fifteen years old who were undergoing first time cardiac surgery in a tertiary hospital in Bangkok, Thailand. Four questionnaires were inquired to evaluate caregivers' uncertainty about the illness, and influential factors included (1) perception of the severity of the illness, (2) credible authority of health-care providers and (3) information and emotional support. The descriptive statistics, Pearson correlation coefficient and multiple regression analysis were used to analyze the data and influential factors.

The significant influential factors affecting caregivers' uncertainty were (1) perception of the severity of the illness (β = 0.413, p < 0.001), (2) credible authority of health-care providers (β = −0.287, p = 0.004) and (3) information and emotional support (β = −0.223, p = 0.026), and their explanation power was about 33.9 % (R² = 0.339, F = 13.630, p < 0.001).

A limitation of this study was that the researcher selected the sample group by convenient sampling and only caregivers of children who underwent cardiac surgery in Siriraj hospital were selected. Therefore, the sample group might have lacked variety and was not a good representative of the population. Future studies should be conducted by varying the setting and using randomized sampling.

This study provides clear recommendations to assess the perception of the severity of the illness by caregivers, build credibility and trust by providing quality care and should develop information and emotional support interventions for reducing the levels of caregivers' uncertainty of children undergoing cardiac surgery.

Health-care providers should develop the appropriate intervention for reducing caregivers' uncertainty by assessing the perception of the severity of the illness, providing information and emotional support and building trust for the caregivers of the children who are undergoing cardiac surgery.

The paper discusses how a decision analytic framework has been used by an English health authority in relation to the commissioning of ambulance cardiac services. Strategies for the management by ambulance personnel of victims of cardiac arrest and persons with acute chest pain of cardiac origin were modelled in a decision‐event tree, and a bibliographic database established. The international research literature prior to 1997 was searched in order to derive probability values for the tree. However, after checking whether the sub‐groupings of results in the papers were in accordance with the variables in the tree, the number of useful papers on acute chest pain was found to be only two. In the almost complete absence of information ‐ even from small observational studies ‐ on the management of the great majority of patients with cardiac symptoms transported by ambulance, the local ambulance service and the main providers of hospital services in the district are now collaborating in field studies of cardiac care in order to improve the inputs into the model.

The purpose of this work is to perform an application study on experimental animals (dogs) to investigate the efficiency of using weft knitted mesh fabric as cardiac support mesh to support left ventricular hypertrophy.

In this work, weft-knitted mesh sample “Knitted Cardiac Support Mesh” manufactured using Nylon (6, 6) yarns, with count 20 Denier and medium mesh size, was placed around the two ventricles to prevent further dilatation, support and reduce left ventricular wall stress.

Medical textile is a rapidly expanding field in technical textiles that are widely used in a variety of medical applications. One of these medical textile applications is “Knitted Cardiac Support Mesh”, which is used in the treatment of Dilated Cardiomyopathy.

After the implantation of the manufactured Knitted Cardiac Support Mesh around the myocardium, all dogs survived for three months before being euthanized, and some clinical examinations were performed to investigate and evaluate the sample performance. It was demonstrated from the experimental application, that the nylon mesh sample performed the best during the surgical operation due to its good ability to stretch and recover at a moderate rate, as well as the textile mesh lightweight.

The aim of this paper is to investigate the coupling model which describes the relationship between the electromagnetic (EM) field emitted by a field source, in this case the mobile phone, and the interfering voltage at a cardiac pacemaker which is digitally implanted into the human body model.

The research was carried out using two kinds of numerical phantoms with various configurations, i.e. the mobile placed in front of a trunk and the mobile placed near the human ear (totally 12 configurations). Moreover, the simplified homogeneous human model with numerically implanted cardiac pacemaker is considered (two configurations). The simulations are carried out using the finite difference time domain method according to international standards.

From the investigation it was found that the interfering voltage at the cardiac pacemaker (for each of the considered models) was much smaller than the one proposed by IEC standard. A practical conclusion that can be drawn is that the highest interfering voltages occur when the mobile is in a vertical position.

The analysis was limited to the cardiac pacemaker with a unipolar electrode and could be carried out for other types of pacemakers.

The evaluations such as those presented should be useful in the development of protection standards of human exposure to EM field with respect to humans with implants such as cardiac pacemakers. Furthermore, such a modeling allows for the evaluation of potential EM interference prior to an implantation of implants.

Such a detailed analysis of a coupling model considering various configurations of mobile phone position to a human model has so far never been carried out.

Ventricular surface activation time maps are estimated from simulated and measured body surface potential (BSP) maps and extra‐corporal magnetic field maps. In a first step the transfer matrix, relating the primary cardiac sources to the measured potential and/or magnetic field data, is calculated applying the boundary element method. Activation times are determined by minimizing a cost function which is based on this transfer matrix. This optimization method is solved by a quasi Newton method. The critical point theorem is used in order to estimate the starting column matrix.