Riisereimer4008

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. buy Trichostatin A 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. 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.INTRODUCTION Tinnitus assessment and management is an important component of audiology. The benefits of continuing education (CE) workshops in the field of tinnitus have not been published. This study evaluated the outcomes of a workshop centered around a Sound Therapy and Aural Rehabilitation for Tinnitus (START) framework. Our hypotheses were that a CE workshop would (1) be useful, (2) improve clinician's knowledge and willingness to undertake tinnitus practice, and (3) result in learners using knowledge gained in their practice. METHODS Twenty-five participants attending a 3-day tinnitus workshop were invited to complete an evaluation immediately and 3 months after the workshop's completion. The workshop consisted of seminars and practical sessions. The pedagogical approaches employed were experiential (theory building, reflection, and testing) and community of practice (shared experiences). RESULTS Participants reported on a 5-point Likert scale (1 = not useful-5 = excellent) a high level of satisfaction both immediately after the workshop (ratings of usefulness mean, 4.8; SD, 0.4; willingness to practice 4.6; SD. 0.6; ability to manage 4.6; SD, 0.5; all "excellent" ratings) and 3 months later (ratings of usefulness mean, 4.2; SD, 0.9, "very useful;" willingness to practice 4.6; SD, 0.6, "excellent;" ability to manage 4.1; SD. 0.5, "very useful"). Open-ended questions indicated participants made changes in their practice that reflected material provided in the CE. CONCLUSION The workshop was successful in improving knowledge and confidence of audiologists in undertaking tinnitus assessment and management, but the need for ongoing support and supervision was a common theme.OBJECTIVES To assess agreement among pelvic surgeons regarding the interpretation of exam under anesthesia (EUA), the methodology by which EUA should be performed, and the definition of a positive exam. DESIGN Survey SETTING Online surveyPatients/Participants Ten patients who presented to our level-1 trauma center with a pelvic ring injury were selected as clinical vignettes. Vignettes were distributed to 15 experienced pelvic surgeons INTERVENTION Exam under anesthesia MAIN OUTCOME MEASUREMENTS Agreement regarding pelvic fracture stability (defined as >80% similar responses), need for surgical fixation, definition of an unstable EUA, and method of performing EUA. RESULTS There was agreement that a pelvic fracture was stable or unstable in 8 (80%) of 10 cases. There was agreement that fixation was required or not required in 6 (60.0%) of 10 cases. Seven (46.7%) surgeons endorsed performing a full 15-part EUA while the other 8 (53.3%) utilized an abbreviated or alternative method. Eight (53.3%) surgeons provided a definition of what constitutes a positive EUA while the remaining 7 did not endorse adhering to a strict definition. CONCLUSIONS Pelvic surgeons generally agree on what constitutes a positive or negative EUA, but not necessarily the implications of a positive or negative exam. There is no clear consensus among surgeons regarding the method of performing EUA nor the definition of a positive EUA. LEVEL OF EVIDENCE V.OBJECTIVES To investigate the clinical utility of additional axillary or Velpeau views in evaluating potential shoulder trauma following a standard radiograph series of anteroposterior, Grashey, and/or trans-scapular views. DESIGN Retrospective study. SETTING Level I academic medical center. PATIENTS All patients in a 10-year span who received an initial shoulder radiograph series followed by additional axillary/Velpeau views within 24 hours. MAIN OUTCOME MEASUREMENTS The clinical utility of the additional axillary/Velpeau views, including the final diagnosis and treatment plan, as ascertained through examination of radiology reports, progress notes, and radiograph images. RESULTS A total of 271 cases were reviewed, with 35 patients being excluded from the final cohort because they received post-treatment radiographs to confirm a successful therapeutic outcome. The additional axillary/Velpeau views did not affect clinical decision making in 230 (97.5%) of the remaining 236 cases. All 6 patients whose care benefitted from the additional views carried the diagnosis of shoulder instability, accounting for 40% of this diagnostic group. The additional views confirmed an equivocal finding in 5 of these 6 cases and changed the diagnosis (demonstrating a posterior dislocation that was not evident on initial radiographs) and treatment plan (leading to a closed glenohumeral reduction procedure) in the other case. CONCLUSIONS Additional axillary/Velpeau views of suspected shoulder trauma rarely led to a change in the final treatment plan, except in patients in which a definitive diagnosis of stability or instability could not be made based on initial radiographs. A cost/benefit analysis is required to weigh the cost of additional radiographs with the benefit of capturing infrequent yet serious dislocations (usually posterior). LEVEL OF EVIDENCE Level III diagnostic study.The Radiation and Nuclear Countermeasures Program at the National Institute of Allergy and Infectious Diseases (NIAID) mandated that medical countermeasures for treating Acute Radiation Syndrome (ARS) must have efficacy when administered at least 24 h after radiation exposure. At this time point, many cells within key target tissues, such as the hematopoietic system and the gastrointestinal (GI) tract, will already be dead. Therefore, drugs that promote the regeneration of surviving cells may improve outcomes. The serine/threonine kinase glycogen synthase kinase-3 (GSK-3) regulates stem and progenitor cell self-renewal and regeneration in the hematopoietic and GI compartments. We tested inhibition of GSK-3β by SB216763 24 h after total body irradiation (TBI) and sub-total body irradiation (SBI). Here, we show that subcutaneous administration of SB216763 promotes the regeneration of surviving hematopoietic stem/progenitor cells (HSPCs), including myeloid progenitor cells, and improves survival of C57Bl/6 male mice when administered 24 h after TBI.