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NAM National Plan for Health Workforce Well-being: Applications for Radiology
No full textThe National Academy of Medicine Plan for Health Workforce Well-Being identifies seven priority areas, including creating positive work environments, addressing burnout and stress, promoting transparency and equity in compensation, providing education and training to promote resilience, enhancing community and social support systems, addressing the stigma associated with seeking help for mental health and substance use disorders and fostering leadership commitment and accountability for workforce well-being. This paper will explore the National Plan for Health Workforce Well-Being, providing an overview of the seven priority areas and offering strategies for implementation in radiology
Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting
No full textIntroduction: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function.
Methods: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE).
Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19-15.76], p \u3c 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79-3.73]; p \u3c 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71-1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90-1.39], p = 0.312).
Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function.
Keywords: Coronary artery bypass grafting; Gulf; Impaired renal function; Left main coronary artery; Outcomes; Percutaneous coronary intervention
Nursing News & Views - January 2023
Get PDFhttps://scholarlycommons.libraryinfo.bhs.org/nursing_newsletters/1018/thumbnail.jp
Use of Complementary Pain Management Strategies in Postoperative Cardiac Surgical Patients
No full textBackground: Complementary pain management strategies are effective at reducing pain in postsurgical patients.
Local problem: Cardiac nurses at a large academic hospital reported inconsistent awareness of patient opioid utilization and poor implementation of complementary pain management strategies.
Methods: A pre/post-quality improvement project was conducted on 2 inpatient cardiac units. Outcomes included nursing staff\u27s perceived knowledge, confidence, and use of complementary pain management strategies and knowledge of patient postsurgical opioid utilization through calculation of morphine milligram equivalence (MME).
Interventions: A comprehensive education program was implemented that included increased patient access to pain management resources, nurse education about complementary pain management strategies, and nurse education and access to MME calculations using a custom electronic health record application.
Results: Nursing staff\u27s perceived knowledge, confidence, and use of complementary pain techniques increased. Patient opioid utilization findings were inconclusive.
Conclusions: Educational programs about complementary pain management offer promise to improve cardiac postsurgical patient care
Outcomes of transcatheter aortic valve replacement in patients with mitral annular calcification and concomitant mitral valve dysfunction: A systematic review and meta-analysis
No full textBackground: Calcific aortic stenosis is the principal indication for transcatheter aortic valve replacement (TAVR). Comorbid mitral annular calcification (MAC) is often present in patients undergoing TAVR. Limited data exist on the impact of MAC on TAVR outcomes. We conducted a systematic review and meta-analysis to explore the effects of MAC and concomitant mitral valve dysfunction (MVD) on TAVR outcomes.
Methods: A comprehensive literature review was conducted using PubMed, Embase, Google Scholar, ClinicalTrials.gov, Scopus, and OVID for studies until March 20, 2023. Using the random-effects Mantel-Haenszel method, we calculated pooled risk ratios (RRs) and their corresponding 95 % confidence intervals (CIs) for all dichotomous variables.
Results: Six studies comprising 5822 patients (2541 with MAC [severe MAC (\u3e4 mm thickness) 583; non-severe MAC 1958; 400 with MVD; and 1071 without MVD], 3281 without MAC) met inclusion criteria. At 30 days and 1 year, no significant differences were observed between the overall MAC and no MAC groups in terms of mortality, stroke, and permanent pacemaker implantation. However, MAC with MVD was associated with a higher risk of all-cause mortality compared to MAC without MVD at 30 days (RR = 3.43, 95 % CI 2.04-5.76, P \u3c 0.00001) and at 1 year (RR = 2.44, 95 % CI 1.85-3.20, P \u3c 0.00001). Moreover, the risk of cardiovascular mortality was higher in patients with MAC and MVD compared to those with MAC alone (RR = 2.77, 95 % CI 1.89-4.06, P \u3c 0.00001). Additionally, patients with severe MAC had a higher risk of major bleeding at 30 days compared to the non-severe MAC group (RR = 1.33, 95 % CI 1.04-1.69, P = 0.02).
Conclusion: TAVR appears to be safe in patients with non-severe MAC, but severe MAC is associated with a higher risk of major bleeding and concomitant MVD increases the mortality risk in patients undergoing TAVR.
Keywords: Major bleeding; Meta-analysis; Mitral annular calcification (MAC); Mitral regurgitation; Mitral stenosis; Mortality; Transcatheter aortic valve replacement (TAVR)
Locoregional Therapy of Hepatocellular Carcinoma: Reporting Recommendations from the Liver Imaging Reporting and Data System and Society of Interventional Radiology Reporting Committees to Improve Assessment of Response
No full textMulti-Organ Nutrigenomic Effects of Dietary Grapes in a Mouse Model
No full textAs a whole food, the potential health benefits of table grapes have been widely studied. Some individual constituents have garnered great attention, particularly resveratrol, but normal quantities in the diet are meniscal. On the other hand, the grape contains hundreds of compounds, many of which have antioxidant potential. Nonetheless, the achievement of serum or tissue concentrations of grape antioxidants sufficient to mediate a direct quenching effect is not likely, which supports the idea of biological responses being mediated by an indirect catalytic-type response. We demonstrate herein with Hsd:ICR (CD-1® Outbred, 18-24 g, 3-4 weeks old, female) mice that supplementation of a semi-synthetic diet with a grape surrogate, equivalent to the human consumption of 2.5 servings per day for 12 months, modulates gene expression in the liver, kidney, colon, and ovary. As might be expected when sampling changes in a pool of over 35,000 genes, there are numerous functional implications. Analysis of some specific differentially expressed genes suggests the potential of grape consumption to bolster metabolic detoxification and regulation of reactive oxygen species in the liver, cellular metabolism, and anti-inflammatory activity in the ovary and kidney. In the colon, the data suggest anti-inflammatory activity, suppression of mitochondrial dysfunction, and maintaining homeostasis. Pathway analysis reveals a combination of up- and down-regulation in the target tissues, primarily up-regulated in the kidney and down-regulated in the ovary. More broadly, based on these data, it seems logical to conclude that grape consumption leads to modulation of gene expression throughout the body, the consequence of which may help to explain the broad array of activities demonstrated in diverse tissues such as the brain, heart, eye, bladder, and colon. In addition, this work further supports the profound impact of nutrigenomics on mammalian phenotypic expression.
Keywords: colon; dietary influence on phenotype; differentially expressed genes; kidney; liver; ovary; pathway analysis
Can a Checklist Facilitate Recognition of a Transfusion-Associated Adverse Event by Prelicensure Nursing Students?
No full textBackground: Early identification of a transfusion-associated adverse event (TAAE) is key to patient safety. Research has indicated that use of a TAAE checklist resulted in greater frequency of TAAE recognition behaviors.
Purpose: To explore whether use of a TAAE checklist resulted in greater frequency of TAAE recognition behaviors among nursing students.
Methods: A prospective, randomized controlled study was conducted with 62 nursing students playing the role of a registered nurse in a simulation of a patient exhibiting clinical indicators of a TAAE. Subjects were randomly assigned to have or not have a TAAE checklist. Time to recognition of the TAAE was measured.
Results: The checklist group (CG) identified TAAEs on average 4 minutes sooner than the non-CG (P \u3c .001). CG subjects were also significantly less likely to miss TAAEs completely.
Conclusions: A checklist may improve the safety of transfusions by promoting earlier recognition and treatment of TAAEs
A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities
No full textCardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.
Keywords: cardiac rehabilitation; coronary disease; heart failure; telemedicine
Aortic valve infective endocarditis due to Streptococcus pyogenes : A case report
No full textGroup A Streptococcus is a common cause of pharyngitis, scarlet fever, glomerulonephritis, and various skin infections. However, there have only been a few reports of Group A Streptococcus (GAS) associated with infective endocarditis. We present a case of a 31-year-old male who presented to the hospital with a few days of weakness and myalgias after recently receiving treatment with azithromycin for GAS pharyngitis as an outpatient. The patient was admitted to the intensive care unit in septic shock from Group A beta-hemolytic Streptococcus bacteremia and acute hypoxic respiratory failure. He was found to have new severe aortic insufficiency from infective endocarditis. He underwent urgent partial aortic valve annuloplasty reconstruction and incision and drainage of root abscess with intraoperative cultures growing gram positive cocci consistent with GAS. The majority of cases of infective endocarditis are caused by Staphylococcus aureus, virdians group Streptococci and Streptococcus gallolyticus, while Streptococcus pneumoniae and Streptococcus pyogenes have the lowest prevalence of infective endocarditis. Penicillin remains the first line treatment for GAS pharyngitis. However, in cases of severe penicillin allergy, macrolides should be avoided given the increasing rate of macrolide resistance GAS strains. This case emphasizes the importance of using beta-lactams as first line therapy for GAS pharyngitis to avoid harmful complications and infection recurrence.
Keywords: Bacteremia; Group A Streptococcus; Infective endocarditis; Macrolide resistance; Penicillin allergy