Cardiovascular Safety Considerations in the Treatment of Neurogenic Orthostatic Hypotension.

Neurogenic orthostatic hypotension (nOH), a drop in blood pressure upon standing resulting from autonomic malfunction, may cause debilitating symptoms that can affect independence in daily activities and quality-of-life. nOH may also be associated with cardiovascular comorbidities (e.g.

Incidence and Causes of Iatrogenic Hypoglycemia in the Emergency Department.

Introduction: Hypoglycemia is frequently encountered in the emergency department (ED) and has potential for serious morbidity. The incidence and causes of iatrogenic hypoglycemia are not known. We aim to describe how often the cause of ED hypoglycemia is iatrogenic and to identify its specific causes.

Group B streptococcus meningitis complicated by periodic lateralising epileptiform discharges in an elderly patient with type 2 diabetes mellitus.

(group B streptococcus or GBS) is the most common cause of bacterial meningitis in infants, but is rarely the cause in adults. Across all non-pregnant adults it comprises 7% of bacterial meningitis cases, with a mortality rate of 56% in the elderly. Therefore, while rare, GBS should be a part of a patient's differential when initiating antibiotics in adults with chronic illnesses.

Lay Consultations in Heart Failure Symptom Evaluation.

Purpose: Lay consultations can facilitate or impede healthcare. However, little is known about how lay consultations for symptom evaluation affect treatment decision-making. The purpose of this study was to explore the role of lay consultations in symptom evaluation prior to hospitalization among patients with heart failure.

A Supraventricular Tachycardia: What Is It? Where Should One Ablate?

During electrophysiology testing, cessation of atrial pacing resulted in a tachycardia with 2:1, that changed to 1:1 atrioventricular conduction after a premature ventricular contraction. The mechanism and the location to ablate are discussed.

Rate control in atrial fibrillation.

Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. We review heart rate control in patients with atrial fibrillation, including the rationale for the intervention, patient selection, and the treatments available. The choice of rate control depends on the symptoms and clinical characteristics of the patient, but for all patients with atrial fibrillation, rate control is part of the management.

Arrhythmia-Induced Cardiomyopathies: Mechanisms, Recognition, and Management.

Arrhythmia-induced cardiomyopathy (AIC) is a potentially reversible condition in which left ventricular dysfunction is induced or mediated by atrial or ventricular arrhythmias. Cellular and extracellular changes in response to the culprit arrhythmia have been identified, but specific pathophysiological mechanisms remain unclear. Early recognition of AIC and prompt treatment of the culprit arrhythmia using pharmacological or ablative techniques result in symptom resolution and recovery of ventricular function.

Second primary malignancies in chronic myeloid leukemia.

Survival of patients with chronic myeloid leukemia (CML) has improved with the use of imatinib and other tyrosine kinase inhibitors. There is limited data on second primary malignancies (SPM) in CML. We analyzed the SPMs rates among CML patients reported to Surveillance, Epidemiology, and End Results (SEER) database during pre-(1992-2000) and post-(2002-2009) era.

Second primary malignancies in adult acute myeloid leukemia--A US population-based study.

Background: Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. Long-term survivors from AML may be at higher risk of second primary malignancies.

Patients And Methods: We selected adult patients with AML aged≥18 years from the National Cancer Institute's Surveillance, Epidemiology and End RESULTS (SEER 13) database.

Four postmortem case reports with quantitative detection of the synthetic cannabinoid, 5F-PB-22.

In January 2014, the US government temporarily designated 5F-PB-22, along with three other synthetic cannabinoids (AB-FUBINACA, ADB-PINACA and PB-22), into Schedule I. Over the course of a 4-month time period (July-October 2013), our laboratory quantitatively identified 5F-PB-22 in specimens obtained from four postmortem cases. We describe the four cases, to include pertinent autopsy findings and decedent histories, together with quantitative results for 5F-PB-22 determined in postmortem blood and antemortem serum.

The dilemma of goodness: acknowledging beneficence tension in the search for consensus.

Patient care in family medicine and palliative medicine involves important communication with stakeholders. Beneficence is assumed to be crucial to achieving consensus in these encounters. However, stakeholders may have different perspectives of beneficence.

Validating nursing competencies using a fair format.

Across the healthcare system, staff development specialists and nurse leaders have been challenged with the development, implementation, and evaluation of processes by which clinical nursing staff demonstrate competence in an efficient and effective manner. The purpose of this article is to describe one approach used in an acute care setting. Staff development specialists and nurse leaders played key roles in assessing, developing, and evaluating a nursing competency validation fair.

Pregnancy care: an apprenticeship for palliative care?

The American Board of Medical Specialties has recently recognized palliative medicine as a new subspecialty. Family Medicine was one of 10 specialty boards cosponsoring this certification process. The role of the family physician has many parallels in the care of pregnant and dying patients.

Incontinence-associated dermatitis: a consensus.

Incontinence-associated dermatitis (IAD) is an inflammation of the skin that occurs when urine or stool comes into contact with perineal or perigenital skin. Little research has focused on IAD, resulting in significant gaps in our understanding of its epidemiology, natural history, etiology, and pathophysiology. A growing number of studies have examined clinical and economic outcomes associated with prevention strategies, but less research exists concerning the efficacy of various treatments.

Effective management of hospitalized patients--established role of hospitalists in the USA.

Objectives: Summarize and present benefits of effective management of inpatients in US hospitals by hospitalists and discuss the possible implications for healthcare system in Slovakia.

Background: Inpatient or hospital-based internal medicine started to separate from traditional office-based medicine about a decade ago. Today, hospitalist programs are an integral part of most progressive hospitals in the US and the value of such programs is well documented.

Evidence-based red cell transfusion in the critically ill: quality improvement using computerized physician order entry.

Objective: The implementation of evidence-based practice poses a significant challenge in the intensive care unit. In this quality improvement intervention we assessed the effect of an institutional protocol and computerized decision support for red cell transfusion in the critically ill.

Design: We compared processes of care and outcomes during the two 3-month periods before and after the introduction of a multidisciplinary quality improvement intervention.

Benzocaine-induced methemoglobinemia during transesophageal echocardiography.

Acquired or toxic methemoglobinemia is an uncommon complication of topically administered anesthetic agents in patients of all ages-but particularly in pediatric and elderly patients. This report describes a case of acquired methemoglobinemia that occurred after benzocaine spray was applied orally to a 69-year-old white woman weighing 175 lb who was undergoing transesophageal echocardiography. Patient care was successfully managed.

The hospital staff and community benefit. An Iowa facility works to involve busy employees in community benefit reporting.

Mercy Medical Center-North Iowa (MMC), Mason City, IA, has done much over the years to support the poor and underserved of its community. However, in recent years, the facilities leaders came to see that much of its community benefit activity went unreported. They decided to launch an initiative to improve this reporting.

Building bridges...and strengthening nursing.

In light of current nursing employment trends, nurses and employment specialists in one rural northern Iowa healthcare organization are collaborating to retain and recruit nurses. The purpose of this article is to describe how these individuals worked toward a comprehensive, cohesive approach to the development, implementation, and evaluation of learning opportunities that support these efforts. Staff development educators played key roles in developing program purposes, descriptions, curriculum, and outcome measures.

Managing workplace depression: an untapped opportunity for occupational health professionals.

Depression is one of the most prevalent and costly health issues affecting the American work force. Despite well established research demonstrating the association between employee depression and reduced on-the-job productivity, increased absenteeism, and higher health care use, most employers remain largely unresponsive to the need for company based depression initiatives. Organizational and individual barriers can prevent companies from effectively managing employee depression.

Screening for domestic violence.

Nurses have a unique opportunity to develop, implement, and evaluate the outcomes of routine assessments and interventions.

Hidden nuggets: nautical archeology and laboratory management.

Although the professions of nautical archaeology and clinical laboratory management seem to involve different bodies of knowledge, many of the principles and truisms of archaeology correlate to the art of laboratory management. On two occasions, I have been a member of a team excavating a 350-year-old shipwreck off the north shore of the Dominican Republic. I have illustrated those experiences to demonstrate that these seemingly disparate professions share frustrations that interfere with the pursuit of useful knowledge as well as successes that lead to new knowledge.