Telemedicine practices in adult patients with atrial fibrillation.

BACKGROUND: Atrial fibrillation is a cardiac rhythm disorder associated with embolic stroke risk, decreased functional capacity, and worsening quality of life. Increasing patient access to atrial fibrillation specialists via telemedicine has the potential to improve patient outcomes. OBJECTIVES: The purpose of this systematic review was to describe atrial fibrillation telehealth education treatment programs unrelated to postablation or early detection of atrial fibrillation. DATA SOURCES: PubMed and CINAHL databases were searched using key terms identified by the authors and informed by a panel of clinicians with expertise in cardiac electrophysiology. CONCLUSIONS: Little literature exists on educational telehealth programs for atrial fibrillation treatment unrelated to postablation or early detection of atrial fibrillation. Only three studies met our inclusion criteria. Three themes emerged from review of these studies: (a) atrial fibrillation requires specialty care that is difficult to obtain; (b) comprehensive atrial fibrillation education should include a broad overview of the condition, management options, stroke prevention, and symptom management; and (c) telemedicine is effective for diagnosing and managing atrial fibrillation. IMPLICATIONS FOR PRACTICE: Telemedicine clinics for atrial fibrillation represent an emerging form of clinically important health care delivery. These clinics can potentially decrease wait time for specialty care access, reduce unnecessary emergency department visits, reduce stroke risk, and increase guideline adherence. Nurse practitioners are well suited to create and lead telemedicine atrial fibrillation clinics with relevant clinical expertise and collaborative skills.

Acute blood loss anemia after COVID-19 nasopharyngeal sampling.

ABSTRACT: Long-term care residents with novel coronavirus disease 2019 (COVID-19) experience high mortality rates and require frequent screening. Most resident testing occurs via nasopharyngeal swab that potentially causes epistaxis with rates of 5% to 8% in healthy populations. It is estimated that 48% of long-term care residents receive oral anticoagulation that increases risk of bleeding. A long-term care resident receiving oral anticoagulation experienced an episode of acute blood loss anemia after nasopharyngeal sampling. Current medications were not reviewed before testing, and oral anticoagulation was not held resulting in acute blood loss anemia. A medication review is indicated for skilled nursing and assisted living residents to identify oral anticoagulation before nasopharyngeal testing. Less invasive testing may be recommended or should bleeding occur, discontinuation of oral anticoagulation for a short term may be appropriate.

A randomized pilot study of a community-based weight loss intervention for African-American women: Rationale and study design of Doing Me! Sisters Standing Together for a Healthy Mind and Body.

INTRODUCTION: Despite the high prevalence of obesity among African-American women and modest success in behavioral weight loss interventions, the development and testing of weight management interventions using a community-based participatory research (CBPR) approach have been limited. Doing Me!: Sisters Standing Together for Healthy Mind and Body (Doing Me!) is an intervention adapted from an evidence-based behavioral obesity intervention using a CBPR approach. The purpose of Doing Me! is to test the feasibility and acceptability of this adapted intervention and determine its efficacy in achieving improvements in anthropometrics, diet, and physical activity. METHODS: Sixty African-American women, from a low-income, urban community, aged 30-65 years will be randomized to one of two arms: 16-week Doing Me! (n = 30) or waitlist control (n = 30). Doing Me! employs CBPR methodology to involve community stakeholders and members during the planning, development, implementation, and evaluation phases of the intervention. There will be thirty-two 90-minute sessions incorporating 45 min of instruction on diet, physical activity, and/or weight management plus 45 min of physical activity. Data will be collected at baseline and post-intervention (16 weeks). DISCUSSION: Doing Me! is one of the first CBPR studies to examine the feasibility/acceptability of an adapted evidence-based behavioral weight loss intervention designed for obese African-American women. CBPR may be an effective strategy for implementing a weight management intervention among this high-risk population.

"You have to hunt for the fruits, the vegetables": environmental barriers and adaptive strategies to acquire food in a low-income African American neighborhood.

This qualitative study sought to understand food acquisition behaviors and environmental factors that influence those behaviors among women in a low-income African American community with limited food resources. We drew on in-depth interviews with 30 women ages 21 to 45 years recruited from a community health center in Chicago, Illinois. Data were analyzed using qualitative content analysis. Emergent themes revealed that women identified multiple environmental barriers--material, economic, and social-interactional--to acquiring food in an acceptable setting. In response, they engaged in several adaptive strategies to manage or alter these challenges, including optimizing, settling, being proactive, and advocating. These findings indicate that efforts to improve neighborhood food environments should address not only food availability and prices but also the physical and social environments of stores.