Antithrombotics in heart failure with reduced ejection fraction and normal sinus rhythm: an evidence appraisal.

Objective: To review the thromboembolic risk, pathophysiology associated with the risk, and literature investigating the use of antithrombotics in patients with heart failure with reduced ejection fraction and normal sinus rhythm (HFrEF-NSR).

Data Sources: An English language literature search was performed with MEDLINE/PubMed and Embase from January 1950 to October 2013 using the search terms heart failure, HFrEF, systolic heart failure, cardiomyopathy, left ventricular dysfunction, sinus rhythm, thromboembolism, deep vein thrombosis, pulmonary embolism, myocardial infarction, acute coronary syndrome, acute coronary events, coronary artery disease, stroke, and cerebrovascular events to identify relevant articles. References in the retrieved articles were also assessed to identify other important articles.

Successful alteplase bolus administration for a presumed massive pulmonary embolism during cardiopulmonary resuscitation.

Objective: To describe the case of a patient successfully resuscitated with bolus alteplase for a presumed massive pulmonary embolism (PE) with associated cardiac arrest.

Case Summary: A 54-year-old man presented to the emergency department for evaluation of syncope following recent open reduction and internal fixation of his ankle. On arrival, his condition rapidly deteriorated and progressed to cardiopulmonary arrest.

Accessory oral cavity.

This is a rare case report of a patient around 11 years with the complaint of extra mouth who reported to the hospital for removal of that extra mouth. On examination there was accessory oral cavity with small upper and lower lips, seven teeth and saliva was drooling out. Under general anesthesia crevicular incision from 32 to 43 was put and labial gingiva with alveolar mucosa was reflected completely and bone exposed to lower border of mandible.

Acute pulmonary emboli in a patient on long-term dabigatran therapy.

Objective: To describe the case of a patient who developed acute pulmonary emboli (PE) despite long-term anticoagulation with dabigatran.

Case Summary: A 69-year-old obese woman was hospitalized for worsening shortness of breath, dyspnea on exertion, and left pleuritic chest pain. On admission, a computed tomography angiogram revealed acute bilateral PE, despite use of dabigatran for atrial fibrillation for approximately 5 years prior to admission.

A phase II trial and pharmacokinetic study of oxaliplatin in children with refractory solid tumors: a Children's Oncology Group study.

Background: Platinating agents are used in the treatment of a spectrum of childhood cancers. Oxaliplatin, a third generation platinum compound, may provide less toxicity and be more effective. A phase 2 study was performed to estimate the response rate to single agent oxaliplatin in patients with refractory pediatric solid tumors, and to further describe the toxicities and pharmacokinetics of the drug in this population.

Multivitamin use among non-pregnant females of childbearing age in the Western North Carolina multivitamin distribution program.

Background: Daily consumption of 400 mcg of folic acid prior to conception and throughout the first trimester of pregnancy reduces the risk of neural tube defects (NTDs) by 50%-80%. A daily multivitamin with folic acid can ensure that females receive the recommended amount of folic acid during childbearing years.

Objective: The purpose of this study was to determine if vitamin consumption is influenced by providing a free bottle of multivitamins to non-pregnant women of childbearing age during a face-to-face interaction with a health care provider in health departments.

Mission Hospital's code stroke team: implications for an aging population.

Objective: To evaluate the success of an acute stroke program designed to streamline the evaluation and treatment of acute ischemic stroke patients, with particular regard to the risk of symptomatic intracerebral hemorrhage and discharge disposition based on age in those patients treated with acute stroke intervention.

Methods: Retrospective review of patients at Mission Hospitals in Asheville, North Carolina from January 2006 to October 2007 with sudden neurological deficit identified within six hours of onset. Data were obtained from Mission Hospital's in-house spreadsheet database and the American Stroke Association's "Get With the Guidelines" (GWTG) database.

Integrating traditional nursing service orientation content with electronic medical record orientation.

Traditional nursing service orientation classes at an acute care hospital were integrated with orientation to the electronic medical record to blend the two components in a user-friendly format so that the learner is introduced to the culture, processes, and documentation methods of the organization, with an opportunity to document online in a practice domain while lecture and discussion information is fresh.

Off-pump epicardial high intensity focused ultrasound ablation of atrial fibrillation in patients undergoing structural heart repair.

There are a number of different devices and approaches to the management of atrial fibrillation (AF) coexisting in patients undergoing structural heart repair. Based on the widespread applicability and safety of an epicardial approach, the uniqueness of the energy source and the lesion set obtainable, we began a systematic program in 2005 utilizing high intensity focused ultrasound (HIFU). Our approach has been standardized in the operative and postoperative phases.

Recessive CLCN1 mutation presenting as Thomsen disease.

This case report describes a young man referred for electrodiagnostic evaluation for hand stiffness and intermittent numbness. His needle electromyography revealed diffusely increased insertional and spontaneous motor activity in the form of myotonic discharges. Given the finding of symptomatic myotonia also in his mother, Thomsen myotonia was suspected.

The Asheville Project: clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia.

Objective: Assess clinical and economic outcomes of a community-based, long-term medication therapy management (MTM) program for hypertension (HTN)/dyslipidemia.

Design: Quasi-experimental, longitudinal, pre-post study.

Setting: 12 community and hospital pharmacy clinics in Asheville, N.

Clinical staff development: planning and teaching for desired outcomes.

Nursing staff development educators facilitate learning activities to promote learner retention of knowledge: factual, conceptual, procedural, and meta-cognitive. The Revised Bloom's Taxonomy provides a modern framework for the cognitive process dimension of knowledge and guides the nursing educator in planning activities that will assure learner progress along the learning continuum.

The Asheville Project: long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma.

Objective: To assess clinical, humanistic, and economic outcomes of a community-based medication therapy management (MTM) program for 207 adult patients with asthma over 5 years.

Design: Quasi-experimental, longitudinal pre-post study.

Setting: 12 pharmacy locations in Asheville, N.