11210 research outputs found
Sort by
Abstract P1054: Associations between household economic stability and childhood behavioral cardiovascular health: The Young Hearts Study
No full textOptimization of renin-angiotensin-aldosterone inhibitor therapies for evidence-based indications: A call to action from the cardio-kidney community
No full textAcute pericarditis in an adult with cystic fibrosis: A case report and literature review
No full textIntroduction:Cystic fibrosis, an autosomal recessive disorder (1 in 3,000-6,000 births), causes thick mucus and recurrent lung infections. Improved survival has revealed rare complications such as constrictive pericarditis and cardiac tamponade.
Case description:A 24-year-old female with cystic fibrosis, diagnosed at nine months, presented with two weeks of dyspnoea. Examination revealed bilateral rhonchi, facial oedema and non-pitting thigh oedema. Laboratory results showed a white blood cell count of 11.3 ×109/l, erythrocyte sedimentation rate of 99 mm/hr and C-reactive protein level of 45.3 mg/dl. Initially admitted for cystic fibrosis exacerbation, she was found to have pericardial effusion. Despite facial and lower extremity swelling, she denied cardiac symptoms. During hospitalisation, she developed haemodynamic instability requiring pericardiocentesis, with echocardiography confirming constrictive pericarditis. Chest computed tomography angiography showed pericardial calcifications; autoimmune workup was negative. She was discharged on colchicine with close follow-up.
Conclusion:Clinicians should have a high index of suspicion for underlying cardiac complications in patients presenting with exacerbations of cystic fibrosis.
Learning points:Pericardial disease - including constrictive pericarditis and tamponade - though rare, can complicate cystic fibrosis in adults and may mimic pulmonary exacerbations. Early cardiac imaging is crucial for timely diagnosis.This case highlights the need for a high index of suspicion in cystic fibrosis patients with unexplained dyspnoea, oedema or haemodynamic instability, especially in the setting of pericardial calcifications.Medical management with colchicine and diuretics can be effective in selected cystic fibrosis patients with constrictive physiology, potentially avoiding the need for invasive pericardiectomy
Top-of-license practice for registered nurses: A scoping review
No full textBackground:Registered nurses are vital to healthcare delivery, yet often perform non-nursing tasks, contributing to inefficiencies, dissatisfaction, and turnover. The concept top-of-license (TOL) nursing practice, introduced in 2013, remains inconsistently defined and applied.
Purpose:To explore how TOL nursing practice is defined and applied in existing literature.
Methods:A scoping review was conducted using Arksey and O\u27Malley\u27s framework and PRISMA-ScR guidelines. Searches of 15 databases and gray literature (no start date-May 4, 2024) yielded 1,377 articles. Following screening, 45 articles met inclusion criteria.
Findings:Definitions and applications of TOL varied. Three themes emerged: (a) work-workforce efficiency, (b) benefits to patients-improving patient care and clinical outcomes, and (c) benefits to nurses-nurse perceptions of clinical practice. Limited articles measured TOL outcomes. Definitions and applications of TOL varied, thus differentiation from scope of practice and a definition are provided.
Discussion:Standardizing the definition of TOL is essential to advance research, policy, and improve care quality and outcomes
Peak flow as a predictor: Identifying when surgical intervention is required in recurrent subglottic stenosis
No full textSubglottic stenosis (SGS) is a narrowing of the airway below the vocal cords, caused by congenital, idiopathic, or acquired factors. Management of SGS is difficult due to high recurrence rates. Objective tools, such as the SGS-6 questionnaire, peak expiratory flow (PEF), and expiratory disproportion index, have shown promise in assessing disease severity and guiding treatment timing. This case presents a 64-year-old man whose SGS was successfully managed using home PEF meter readings to guide timing for bronchoscopic intervention with balloon dilation. Remote tools, such as PEF monitoring, have proven effective in identifying the need for timely intervention. This case report aims to highlight the role of PEF in monitoring SGS progression and predicting the need for the next bronchoscopic intervention. Further validation of these remote tools should be encouraged to enhance patient outcomes, track disease progression, and streamline clinical workflows
NMDA receptor antagonists mitigate COVID-19-induced neuroinflammation and improve survival in a mouse model
No full textThe virus known to cause COVID-19, SARS-CoV-2, exhibits severe and complex neurological symptoms. These effects may be attributed to a virus-induced neuroinflammatory environment, warranting exploration of the respiratory centers of the brain, namely the pons and medulla, specifically in relation to neuroinflammation, demyelination, and neuronal death in response to COVID-19. Interestingly, older adults with neurological dysfunction maintained on N-methyl-D-aspartate receptor (NMDAR) antagonists, such as memantine, had reduced incidence and severity of COVID-19. Thus, the present study aimed to evaluate (1) the neuroinflammatory response to COVID-19 in the respiratory centers of the brain, and (2) to assess the extent to which NMDAR antagonists offer neuroprotective measures in the context of COVID-19. In a susceptible mouse model, animals inoculated with SARS-CoV-2 were pre-treated with either memantine or an alternative NMDAR antagonist, ifenprodil. Inoculated animals had poor survival and showed signs of neuroinflammation, evidenced by a reduction in morphological structure, demyelination, and changes in astrocyte and microglial expression in the pons and medulla. Mice pre-treated with memantine showed improved survival when challenged with COVID-19 and a reduction in virus-induced neuroinflammatory impairments. Our findings support the further investigation of memantine for the prevention of COVID-19 induced neuroinflammation and resultant neurological symptoms and shed light on the possible protective mechanism of memantine in the elderly maintained on NMDAR antagonists
F-73 | Feasibility and safety of radial access in peripheral arterial disease interventions: Insights from a single-center study
No full textKounis syndrome without systemic allergy: A subtle presentation of stent thrombosis
No full textKounis Syndrome, or allergic acute coronary syndrome, is a rare cause of myocardial ischemia triggered by hypersensitivity reactions. Type III Kounis Syndrome, involving in-stent thrombosis following an allergic insult, is particularly rare and underrecognized. We report the case of a 67-year-old woman with a known contrast allergy who developed inferior ST-elevation myocardial infarction (STEMI) complicated by early stent thrombosis, suspected to be due to type III Kounis Syndrome. This case underscores the importance of maintaining a high index of suspicion for allergic triggers in acute coronary syndromes and considering contrast-sparing strategies in high-risk individuals
System readiness and the patient care pathway for Alzheimer\u27s disease diagnosis and treatment
No full textPromising therapeutic interventions that target the underlying pathophysiology are changing the landscape of Alzheimer\u27s disease (AD) research. The AD care pathway must be transformed to meet the challenge of bringing these new therapies to the increasing number of people living with AD within the existing healthcare framework. Challenges include identifying patients who may benefit from treatment interventions early in the course of the disease, ensuring that diagnostic tools are accessible and accurate, and developing capabilities to monitor the effectiveness of interventions over time. These challenges must be addressed at all levels, from primary care settings to tertiary treatment centers; this will require collaborative efforts between health systems, drug manufacturers, and research institutions to navigate this evolving landscape and ensure system readiness for patients and their families with AD. The Spring 2024 Alzheimer\u27s Association Research Roundtable (AARR) meeting gathered industry representatives and clinicians to discuss insights, challenges, and solutions that will help researchers and health systems identify patients in the early stages of AD and deliver emerging therapies efficiently and safely. In this paper, we provide highlights from the Spring 2024 AARR meeting
A novel three-dimensional mapping device to guide lead placement for left bundle branch area pacing
No full textNavik 3D (APN Health, Waukesha, WI, USA) is a navigation software program that uses two-dimensional (2D) fluoroscopy images to provide three-dimensional (3D) information. Left bundle branch area (LBBA) pacing (LBBAP) is a novel physiologic pacing technique where the lead is placed in the right ventricular (RV) basal septum to capture the left bundle branch (LBB). Precise lead placement in this region can be challenging using 2D fluoroscopy. We studied the feasibility of using Navik 3D to identify the location, plane, and depth of the lead in the septum to assist with LBBAP procedures. This observational, prospective single-center study included 14 patients undergoing LBBAP. Navik 3D was used to identify the LBBA, RV septum, RV apex, and lead position in three dimensions using two orthogonal 2D views. The 3D images were overlaid on real-time, gated fluoroscopic images for navigation of the lead. Images of the 3D locations and successful or unsuccessful lead locations were projected onto 2D fluoroscopic images, allowing for repositioning if necessary. All attempted patients had successful LBBA lead implants. An LBB potential was recorded in 61.5% of the patients. Selective LBBAP was achieved in 85% of the patients. The mean QRS duration postimplant was 129.8 ± 13.1 ms. The mean left ventricular activation time (stimulus R-wave peak in V6) postimplant was 75 ± 12 ms. No acute complications were recorded. 3D localization of the LBBA using the Navik 3D mapping system was feasible and may assist with more appropriate LBBA lead placement