Direct oral anticoagulant drugs for the management of venous thromboembolism.

Direct oral anticoagulants (DOACs) are effective for both prevention and treatment of venous thromboembolism (VTE) and have favorable safety in comparison with warfarin. Although drug-drug interactions with DOACs are not as frequent as with warfarin, certain drugs can interfere with DOAC metabolism, affect DOAC efficacy, and potentially cause adverse reactions when used in combination with DOACs. The NP must determine which agent is most beneficial for the individual patient with VTE based on a number of factors.

Cardiac risk assessment: decreasing postoperative complications.

Preoperative cardiac assessment helps identify patients undergoing noncardiac surgery who are at risk for significant postoperative cardiac complications and those who may benefit from additional preoperative evaluation and perioperative care. Advanced practice nurses can identify surgery- and patient-related risks by conducting a thorough health history and physical examination. Multiple risk indices and evidence-based guidelines are available to inform health care providers regarding patient evaluation and strategies to reduce postoperative cardiac risk.

The impact of an electronic medical record surveillance program on outcomes for patients with sepsis.

Objectives: To evaluate the effects of this EMR surveillance on sepsis, severe sepsis or septic shock outcomes in patients admitted to a medical telemetry unit, including length of hospital stay, patient discharge and mortality.

Methods: A retrospective review of pre- and post-implementation of a pilot electronic medical record (EMR) sepsis surveillance.

Results: Implementing EMR sepsis surveillance significantly improved home discharge (49.

Moyamoya disease: a case of vanishing cerebral vessels.

Purpose: To provide an overview of moyamoya disease (MMD) including pathophysiology, epidemiology, clinical presentation, diagnosis, treatment, and prognosis.

Data Sources: Selected clinical and epidemiological studies, review articles, and diagnostic guidelines for MMD.

Conclusions: MMD is a rare cerebrovascular disease characterized by progressive stenosis of the distal internal carotid arteries and their major branches.

Postoperative pulmonary complications: reducing risks for noncardiac surgery.

Postoperative pulmonary complications (PPCs) are a major contributor to the overall risk of noncardiac surgery that may lead to serious postoperative morbidity and long-term mortality. Nurse practitioners should be familiar with risk indices for PPCs, clinical guidelines, and risk reduction strategies to prevent PPCs and improve PPC outcomes.

ICD deactivation: review of literature and clinical recommendations.

Implanted cardioverter defibrillators (ICDs) are an essential part of the management for patients at risk for life threatening arrhythmias. Despite new technologies, all patients ultimately will reach the end of their lives, either because of underlying cardiac disease or another terminal illness. Having an ICD at the end of life may deny a patient the chance of sudden cardiac death and result in a slower terminal disease and pain and anxiety due to shocks from their device.

Effect of bronchodilator treatment on the incidence of postoperative atrial fibrillation after cardiac surgery.

Objective: We sought to examine the effects of bronchodilator treatment on the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery.

Methods: A cross-sectional design using a retrospective chart review was performed in patients who underwent cardiac surgery. Those who had previous atrial fibrillation or preoperative bronchodilator treatment were excluded from the final sample (n = 506).

Methadone-induced torsades de pointes: a twist of fate.

A case of methadone-induced torsades de pointes is presented to demonstrate clinical features that predispose patients to this serious cardiac arrhythmia. A patient who was receiving methadone maintenance treatment for heroin addiction presented to the hospital with dizziness and near-syncope. He was taking a relatively high dose of methadone but was not taking any concomitant cytochrome P450 inhibitor or QT-prolonging drugs.

Diagnosis and management of primary aldosteronism.

Primary aldosteronism (PAL) is characterized by excessive production of aldosterone, which leads to hypernatremia, hypertension (HTN), hypokalemia, and alkalosis. Three crucial diagnostic steps include case detection, case confirmation, and subtype classification. Marked improvement or cure of HTN is achieved with appropriate treatment.

Postural orthostatic tachycardia syndrome: diagnosis and treatment.

Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by an exaggerated increase in heart rate that occurs during standing, without orthostatic hypotension. Women are most frequently affected, and may present with palpitations, chest discomfort, shortness of breath, weakness, exercise intolerance, lightheadedness, presyncope, and syncope.

Methods: We present three cases of POTS in otherwise healthy women, and discuss the clinical management of different types of this orthostatic intolerance.

Health promotion behaviors in women with chest pain.

Objective: We sought to determine health promotion behavior (HPB) in women with chest pain (CP), and to explore the best predictors of HPB.

Methods: The sample included 39 women without previous coronary heart disease (CHD), between ages 30 and 65 years, who were admitted with low-risk or intermediate-risk CP. The Health Promotion Lifestyle Profile II, the CHD Knowledge Tool for Women, and the Benefits and Barriers Scales were used to measure HPB, CHD knowledge, benefits, and barriers to risk modification for the study.

Clinical presentation and treatment of atrial fibrillation in Wolff-Parkinson-White syndrome.

A case of Wolff-Parkinson-White syndrome with atrial fibrillation (AF) is reported in a patient who presented with syncope, tachycardia, and hypotension. The electrocardiogram (ECG) showed a fast irregular rhythm with wide polymorphic QRS tachycardia without the QRS twisting around the isoelectric baseline, diagnostic of AF and Wolff-Parkinson-White syndrome. The patient did not respond to intravenous amiodarone.

Coronary heart disease knowledge tool for women.

Purpose: To develop a tool that measures coronary heart disease (CHD) knowledge specifically for women.

Data Sources: The new CHD knowledge tool, based on previous surveys of women's CHD knowledge, has 25 multiple-choice questions. An expert panel evaluated content and face validity.

Predictors of poor coronary heart disease knowledge level in women without prior coronary heart disease.

Purpose: The purpose of this study was to measure coronary heart disease (CHD) knowledge levels in women without a history of CHD and to determine predictors of poor CHD knowledge in these women.

Data Sources: The sample included 120 women between the ages of 35 and 60, who had no CHD history. Women were asked to complete self-administered surveys including demographic data, personal CHD risk factors, and a CHD Knowledge Test.

Predictors of health promotion behavior in women without prior history of coronary heart disease.

The purpose of this study was to determine health promotion behavior (HPB) and the best predictors of HPB in women without prior history of coronary heart disease (CHD). The sample included 119 women aged between 35 and 60 years who had no prior CHD history. The women were asked to complete a self-administered survey regarding their demographic data, personal CHD risk factors, HPB, CHD knowledge, and perceived benefits and barriers to CHD risk factor modification.

Barriers to coronary heart disease risk modification in women without prior history of coronary heart disease.

Purpose: To explore the extent to which women perceive barriers to coronary heart disease (CHD) risk modification and to determine if access to a nurse practitioner (NP) decreases perceived barriers to CHD risk modification.

Data Sources: Surveys completed by 120 women between the ages of 35 and 60 years, with no known history of CHD. The barriers scale was used to examine women's perceived barriers to CHD risk modification.