Bentzenmcknight3489

PURPOSE OF REVIEW Atrial arrhythmias are common among individuals with heart failure with a reduced ejection fraction (HFrEF). This review describes management options for these arrhythmias and discusses emerging clinical data supporting catheter ablation. RECENT FINDINGS Several recent clinical trials indicate that catheter ablation is superior to pharmacologic therapy for management of symptomatic atrial fibrillation in the setting of HFrEF. Restoration and maintenance of sinus rhythm appears to have the greatest benefit with regard to ejection fraction improvement among individuals with a nonischemic heart failure etiology and minimal left ventricular fibrosis. SUMMARY A rhythm control strategy should be strongly considered in patients with HFrEF, especially when the atrial arrhythmia is symptomatic or is present at the time of a heart failure diagnosis. Catheter ablation may be the preferred strategy for maintenance of sinus rhythm in this patient population.PURPOSE OF REVIEW To provide a framework for approaching ventricular arrhythmias in the setting of cardiomyopathy, outline the latest evidence-based recommendations for catheter ablation and device therapy, and discuss novel treatment strategies. RECENT FINDINGS Risk stratification of ventricular arrhythmias in systolic heart failure has evolved, with an increasing role for cardiac magnetic resonance imaging to identify underlying substrate and scar burden. Medical therapy for heart failure has greatly improved, and the role of primary prevention defibrillators in nonischemic cardiomyopathy has become more ambiguous. Catheter ablation is superior to medical therapy for arrhythmia control and should be considered early, particularly for premature ventricular complex mediated cardiomyopathy. Novel technologies to deliver energy to previously inaccessible sites include high-impedance catheter irrigants, multicatheter bipolar ablation, specialized catheters with extendable needles, transcoronary ethanol infusion, and stereotactic body radiation therapy. SUMMARY Assessment and management of ventricular arrhythmias in systolic heart failure requires a systematic, multimodality approach aimed at identifying the underlying cause and reversible causes, optimizing medical therapy, assessing need for an implantable cardioverter defibrillator, and considering catheter ablation. Further research will focus on prevention of disease progression, improved risk stratification, and ablation technologies that minimize procedure duration and enable delivery of durable lesions.Workplace violence is highly prevalent for nurses, often going unreported. Regrettably, the very patients and visitors being cared for often perpetrate the majority of violence. This article's purpose is to describe how an institution implemented a workplace violence prevention training program designed to increase nurses' perception and confidence with aggressive and violent events. Evaluation of this quality improvement program posttraining was positive, suggesting this approach may influence nurses' abilities to prevent and manage these events.Given the present opioid crisis, the use of opioids in the hospital setting is an increasing concern among hospital administrators and healthcare professionals. A serious problem related to surgical care is persistent postoperative opioid use among previously opioid-naïve patients. Certified registered nurse anesthetists (CRNAs) are strategically positioned within the hospital setting to address these concerns. These individuals are actively involved in managing the pain of their patients and can therefore lead change in relation to the opioid crisis. This article profiles a multidisciplinary acute pain service developed in a Magnet redesignated hospital led by CRNAs that has demonstrated positive outcomes in decreasing the use of opioids postprocedure and postdischarge, education for healthcare providers, information for community members related to opioid abuse, and support of new protocols, including Enhanced Recovery After Surgery.OBJECTIVE This survey study describes how nurses use personal communication devices while providing direct patient care and identifies generational differences. BACKGROUND Personal communication devices enhance and distract from patient care. Generational differences exist and these should be included in workplace policies. METHODS A study-specific survey was developed. Data were collected from 335 qualified participants and descriptively analyzed in total, then by generational specific study groups. RESULTS The perception of these participants is that personal communication devices do not pose a serious work distraction nor have a negative effect on patient care. Yet generational differences exist related to the presence of these devices in providing patient care. Antineoplastic and I activator CONCLUSIONS Access to personal communication devices, while at work, is an expectation. The reasons for accessing these devices, and the perception that these devices have a negative impact on work performance, should be included when developing workplace policies.INTRODUCTION Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed whether these were associated with years of practice and perceived preparedness for dementia care. METHODS Participants were multi-disciplinary clinicians attending a 5-day team-based dementia education program and physicians attending a similar condensed continuing medical education workshop. Pre-education, they completed an online survey in which they rated (5-point scales) interest in learning about various dementia-related topics, perceived challenges with various dementia-related practice activities and preparedness for dementia care, provided additional dementia-related topics of interest, number of years in clinical practice, and discipline. RESULTS Thirteen hundred surveys were completed across both education programs. Mean ratings of preparedness for dementia care across all respondents reflected that they felt somewhat prepared for dementia care. Challenge ratings varied from low to very challenging and mean ratings reflected a high level of interest in learning more about all of the dementia-related topics; significant differences between disciplines in these ratings were identified. In most cases, perceived challenges and learning needs were not correlated with number of years in clinical practice, but in some cases lower ratings of preparedness for dementia care were associated with higher ratings of the challenges of dementia care. DISCUSSION Clinicians perceived that their formal education had not prepared them well for managing dementia and desired more knowledge in all topic areas, regardless of years in practice. Implications for education are discussed.