Patient-reported Symptoms of Acute Coronary Syndrome in Prehospital Cardiac Care

院前心脏护理中患者报告的急性冠状动脉综合征症状

• 批准号: 9903462
• 负责人: Jessica Kathleen Zegre-Hemsey
• 金额: $ 14.17万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9903462
• 关键词: 911 call; Academic Medical Centers; Accident and Emergency department; Accounting; Address; Adult; Adverse event; Age; Ambulances; Award; Cardiac; Cardiac Catheterization Procedures; Caring; Cause of Death; Cessation of life; Chest Pain; Chronic Disease; Clinical; County; Data; Development; Diagnosis; Diagnostic; Diagnostic tests; Discipline of Nursing; Early Diagnosis; Electrocardiogram; Emergency Department evaluation; Emergency Situation; Emergency medical service; Event; Extramural Activities; Faculty; Foundations; Funding; Future; Goals; Health Care Costs; Health Services Research; Heart Diseases; Heart failure; Hospitalization; Hospitals; Individual; Intervention; Investigation; Knowledge; Life; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Monitor; Myocardial Infarction; North Carolina; Oranges; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Pattern; Perception; Persons; Postdoctoral Fellow; Prevalence; Process; Quality of life; Recording of previous events; Reperfusion Therapy; Reporting; Research; Research Methodology; Research Personnel; Sampling; Savings; Scientist; Service delivery model; Severities; Sex Differences; Strategic Planning; Suggestion; Symptoms; Techniques; Time; United States; Universities; Vulnerable Populations; acute coronary syndrome; acute symptom; base; cardiovascular disorder epidemiology; cardiovascular emergency; cardiovascular nursing; care seeking; career development; clinical decision-making; clinical development; clinical practice; design; digital; effective intervention; experience; functional status; improved; improved outcome; innovation; insight; mortality risk; outcome forecast; pain symptom; patient oriented; patient oriented research; patient subsets; pre-doctoral; prevent; professor; programs; rapid diagnosis; recruit; sex; skills; sudden cardiac death; symptom cluster; symptom management; symptom science

PROJECT SUMMARY/ABSTRACT Acute coronary syndrome (ACS) is a potentially life-threatening emergency, and rapid diagnosis and life-saving reperfusion therapies are essential to prevent devastating patient outcomes. Dr. Zègre-Hemsey has extensive clinical experience in the emergency department (ED), where she became committed to improving outcomes for patients with ACS. In her dissertation research, she investigated prehospital electrocardiography (ECG) to improve early diagnosis of ACS, which provided a foundation for the proposed study of patient-reported symptoms and outcomes in her emerging program of emergency cardiac care research. The mentored K23 award is the logical next step to support Dr. Zègre-Hemsey’s long-term goal of becoming an independent cardiovascular nurse scientist, and her outstanding mentoring team will be pivotal to her career development. Dr. Wayne Rosamond (primary) is a professor and preeminent researcher in cardiovascular epidemiology and emergency medical services (EMS) research. He has an extensive history of sustained funding and successful mentorship of numerous junior faculty. Dr. Holli DeVon (co-mentor), is a professor of nursing and expert on symptoms and sex differences in ACS with a strong record of extramural funding and successful mentorship of predoctoral and postdoctoral fellows and junior faculty. In the proposed research, Dr. Zègre-Hemsey will acquire new skills in symptom science and mixed-methods research through coursework, mentoring, and active engagement with established research teams. Using a mixed-methods design, she will investigate how outcomes vary by symptoms in the prehospital period (i.e., symptom onset to ED arrival) in adults transported by ambulance for suspicion of ACS. Specific aims are to: 1) examine the occurrence, severity, and changes in symptoms from prehospital period (Time 1) to ED (Time 2) and evaluate symptom clusters, using the ACS Symptom Checklist; 2) determine if symptoms suggestive of ACS predict adverse patient and clinical outcome; 3a) describe reports of symptoms on 911 call recordings (qualitative aim); and 3b) patterns of symptoms, clusters, and outcomes using mixed-methods techniques (integrated aim). The study will be implemented with a sample recruited from Orange County EMS in North Carolina and transported to the University of North Carolina Hospital, a large academic medical center with an outstanding program in emergency cardiac care. Study results will provide evidence of how symptoms relate to patient and clinical outcomes in patients with suspicious ACS. Results will advance knowledge of symptom science and provide the data to develop future patient-centered interventions in emergency cardiac care. Knowledge from this award will be used for an R-level proposal, to be submitted in Year 3. This patient-oriented study supports NINR’s Strategic Plan to advance symptom science and innovative care delivery models to change chronic illness trajectories. The likely long- term impact of this research is a change in clinical practice resulting in improved survival, functional status, and quality of life for ACS patients in the United States and globally.

项目摘要/摘要 急性冠状动脉综合征（ACS）是一种潜在的威胁生命的紧急情况，并且快速诊断和挽救生命 再灌注疗法对于防止毁灭性患者预后至关重要。 Zègre-Hemsey博士有广泛的 急诊科（ED）的临床经验，她致力于改善结果 ACS患者。在论文研究中，她调查了院前心电图（ECG） 改善ACS的早期诊断，这为拟议的患者报告提供了基础 她的紧急心脏护理研究出现计划中的症状和结果。物质的K23 奖项是支持Zègre-Hemsey博士的长期目标的逻辑下一步 心血管护士科学家和她杰出的心理团队将对她的职业发展至关重要。 韦恩·罗萨蒙德（Wayne Rosamond）博士（小学）是心血管流行病学的教授兼杰出研究员 紧急医疗服务（EMS）研究。他有持续资金和成功的悠久历史 众多初级教师的指导。 Holli Devon博士（Co-Incertor）是护士和专家的教授 ACS的症状和性别差异，具有巨大的壁外资金和成功心态的记录 博士后和博士后研究员和初级教师。在拟议的研究中，Zègre-Hemsey博士将获得 症状科学和混合方法的新技能通过课程，心理和主动研究 与已建立的研究团队互动。使用混合方法设计，她将调查如何 在院前时期的症状（即，症状发作到到达）中的结果有所不同） 通过救护车可疑。具体目的是：1）检查发生，严重性和变化 使用ACS的院前期（时间1）到ED（时间2）并评估症状簇的症状 症状清单； 2）确定症状是否暗示ACS是否可以预测患者不良和临床结果； 3A）描述911呼叫记录（定性目标）上符号的报告；和3b）符号模式， 群集和使用混合方法技术的结果（综合目的）。该研究将通过 从北卡罗来纳州奥兰治县EMS招募的样本，并运送到北大学 卡罗来纳州医院是一个大型的学术医疗中心，拥有急诊心脏保健方面的出色计划。 研究结果将提供证据表明与患者和临床结果相关的符号如何 可疑的ACS。结果将提高症状科学知识，并提供数据以发展未来 以患者为中心的紧急心脏护理干预措施。该奖项的知识将用于R级 提案，将在第三年提交。这项面向患者的研究支持NINR的战略计划 症状科学和创新护理分娩模型，以改变慢性病轨迹。可能很长的 这项研究的术语影响是临床实践的变化，从而提高了生存，功能状态和 美国和全球ACS患者的生活质量。