Improving Provider Compliance With Adult Inflammatory Bowel Disease Patient Care Guidelines in the Ambulatory Setting Through the Use of Electronic Health Records.

Electronic health record (EHR) systems have the ability to improve the quality of patient care, patient safety, and provide benefits to providers and clinic practices. These systems can transform quality measurement and quality improvement methods, facilitate workflow, and track patients over time to ensure that they receive guideline-recommended, evidence-based care. Simply having an EHR system, however, may not be enough to improve the quality and safety of healthcare, especially if the system is not designed to include features specific to the treatment population. A comprehensive literature review of the evidence on EHRs and the implementation of clinical guidelines was conducted. The positive outcomes in this review supports the notion that using well-designed, evidence-based clinical decision tools or checklists within the workflow of the EHR system can improve provider compliance with inflammatory bowel disease (IBD) clinical practice guidelines. Critical content to include in the IBD checklist for the adult patient in the ambulatory setting is also recommended.

Assessing and managing metabolic syndrome and cardiovascular risk in midlife women.

BACKGROUND: The components of metabolic syndrome (MetS), a major cardiovascular risk in women that includes diabetes, hypertension, and dyslipidemia, can evolve during the perimenopause transition. Lifestyle interventions have been shown to ameliorate or prevent individual components of MetS. PURPOSE: This article will describe the hormonal and vascular changes occurring during perimenopause and discuss how they set the stage for MetS in women. The available screening tools (Framingham Assessment for Coronary Heart Disease vs Framingham General Cardiovascular Risk Profile vs Reynolds Risk Assessment) will be compared and contrasted within the context of the 2011 Updated Guidelines for the Prevention of Cardiovascular Disease in Women via case study. CONCLUSIONS AND CLINICAL IMPLICATIONS: Target goals and interventions to reduce or ameliorate the components of MetS will be presented, with a focus on achieving ideal cardiovascular health.

A case study of myopericarditis due to immune checkpoint inhibitor therapy: Proposed surveillance and management.

ABSTRACT: Immune checkpoint inhibitor (ICI) therapy is a treatment modality used in many types of cancer. Immune-related adverse events are relatively common. Cardiovascular adverse events are uncommon, but carry a high mortality rate of 25-50%. They require cessation of therapy. There is currently no universal screening before initiation of ICI therapy to identify patients with cardiovascular risk. There is also no ongoing screening to identify myocarditis and treatment is driven by symptoms. This article provides a case study of a patient who developed myopericarditis and the patient's clinical course. Furthermore, it proposes surveillance for patients before and during ICI therapy to swiftly identify potential cases of myocarditis. There is currently no universal baseline screening for cardiovascular risk in patients planned for ICI therapy. A proposed baseline cardiac evaluation, as well as scheduled surveillance therapy, is outlined in this article. With further education and training, immune-related cardiac adverse events may be more promptly detected, leading to better patient outcomes.

Immune Checkpoint Inhibitor-Related Myocarditis: Recognition, Surveillance, and Management.

BACKGROUND: Immune checkpoint inhibitor (ICI) therapy is an effective treatment for many patients. Although rare, immune-mediated cardiovascular adverse events can occur, including myocarditis. OBJECTIVES: This article provides an overview of the incidence, proposed pathophysiology, and current surveillance for myocarditis in patients receiving ICI therapy. METHODS: A literature search was conducted using PubMed®, CINAHL®, and Scopus® for articles published from 2016 through 2021 to evaluate current recognition, surveillance, and management protocols for ICI-related myocarditis. A case study illustrates the challenges in managing patients experiencing ICI-related cardiac adverse events. FINDINGS: The incidence of myocarditis in patients treated with ICI therapy is 0.04%-1.14%, but it carries a high mortality rate of 25%-50%. A baseline cardiac evaluation and scheduled surveillance throughout therapy is recommended, particularly for patients with cardiovascular risk factors. Through continuing education and proper training, clinicians and nursing staff can recognize and promptly diagnose immune-related cardiac adverse events.

Cardio-Oncology: The Intersection Between Cardiovascular Disease and Cancer.

Cardio-oncology is a rapidly emerging field, and advanced practitioners (APs) play key roles in the prevention, early detection, and optimal treatment of cardiotoxicities associated with cancer therapies. At JADPRO Live Virtual 2020, Jessica Shank Coviello, DNP, APRN, ANP-BC, and Kejal Amin, PharmD, MBA, BCOP, reviewed patient risk factors and cardiovascular therapeutic agents that APs should be aware of.

A Proposed Transitional Care Tool to Improve Medication Continuity After Release of Older Inmates.

Despite a growing aging population in the correctional system, older persons are often released from jail unprepared for the transition to the free world and unable to access necessary medications. This article proposes a discharge form (transitional care tool) that may improve the medical care provided to older inmates upon release from jail, especially regarding their compliance with prescribed medications. The authors developed their tool in a three-step process: (1) review concerns raised in pertinent correctional medical literature, (2) expert panel determination of the relative importance for each of the concerns, and (3) assessment of the tool's likely efficacy as viewed by a focus group familiar with transitions to the free world after incarceration. Further research is required to validate the tool in the field.

Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.

BACKGROUND: Immune checkpoint inhibitors (ICIs) are highly effective in treating cancer; however, cardiotoxicity can occur, including myocarditis. Cardiac magnetic resonance (CMR) imaging is useful for evaluation of myocarditis, although it has not been well studied in ICI cardiotoxicity. METHODS: We identified patients referred for CMR evaluation of ICI cardiotoxicity from September 2015 through September 2019. We assessed structural and functional parameters, feature tracking (FT) left ventricular and atrial strain, T2- weighted ratios and quantitative late gadolinium enhancement (LGE). We also applied the Updated Lake Louise Criteria for diagnosis of myocarditis. RESULTS: Of the 20 patients referred, the median left ventricular ejection fraction (LVEF) was 52.5% ± 19.1 and 50% had a normal LVEF (≥53%). FT strain analysis revealed an average abnormal global longitudinal strain (GLS) of -9.8%± 4.2%. In patients with a normal LVEF, the average GLS remained depressed at -12.3%± 2.4%. In all patients, GLS demonstrated a significant negative correlation with LVEF (rs = -0.64, p 0.002). Sixteen patients (80%) had presence of LGE (14 non-ischemic pattern and 2 ischemic). Percent LGE did not correlate with any CMR parameters and notably did not correlate with LVEF (rs = -0.29, p = 0.22) or GLS (rs = 0.10, p = 0.67), highlighting the value of tissue characterization beyond functional assessment. Nine patients (45%) met full Updated Lake Louise Criteria and 85% met at least one criterion, suggestive of myocarditis in the correct clinical context. Thirteen patients (65%) were treated for ICI-associated myocarditis and, of these, 54% (n = 7) had recovery of LVEF to normal. There was no correlation between LVEF (p = 0.47), GLS (0.89), or % LGE (0.15) and recovery of LVEF with treatment. CONCLUSION: In patients with suspected ICI cardiotoxicity, CMR is an important diagnostic tool, even in the absence of overt left ventricular dysfunction, as abnormalities in left ventricular strain, T2 signal and LGE can identifying disease.

Development of a Medication Safety Science Curriculum for Nursing Students.

BACKGROUND: Medication errors, now thought to be 4 times greater than previous estimates, harm patients, families, health care institutions, and nurses themselves, who are second victims of their mistakes. PROBLEM: Current nursing education may lack coherent medication safety frameworks other than the classic Five Rights construct. APPROACH: This project piloted an educational intervention with senior associate degree nursing students based on high-reliability organization (HRO) safety principles. OUTCOMES: Subjects evaluated the HRO safety concepts learning experience positively and improved pretest to posttest scores by 74%. CONCLUSIONS: This study demonstrates subjects' ready acceptance and comprehension of HRO safety theory as applied to medication safety, an alternative to the Five Rights construct.

Cardiotoxicity in Hematopoietic Stem Cell Transplant: Keeping the Beat.

INTRODUCTION: The number of hematopoietic stem cell transplants (HSCTs) performed in the United States and worldwide is increasing. Cardiac events have been well described in HSCT, and the incidence and type of cardiac events have not changed over recent decades. PATIENTS AND METHODS: This study adds to the body of evidence in describing the incidence and type of cardiac events experienced by an allogeneic and autologous HSCT population at a single institution from 2012 to 2017. RESULTS: Sixty-five (9.8%) patients experienced cardiac events, including atrial arrhythmia (N = 39), acute heart failure (N = 9), acute coronary syndrome (N = 7), and new onset hypertension (N = 9), with a few instances of bradycardia, ventricular arrhythmia, pericardial effusion, and pericarditis. Our multivariable regression analysis identified age (older), creatinine (higher), and history of coronary artery disease to significantly correlate with risk of cardiac event (P = .005, P = .039, and P = .038, respectively). A subgroup analysis of those patients experiencing a cardiac event found pre-transplant atrial dilation by trans-thoracic echocardiogram to correlate with increased risk of atrial arrhythmia (33.8% vs. 9.7%; P = .03). Patients developing a CE had an increased risk of death within 1 year (11% vs. 32%; P < .001). CONCLUSION: We review our results in context of other important HSCT cardiac studies to illuminate the most relevant factors of medical history, laboratory data, and cardiac measurements that will identify patients at higher risk, allowing for intervention to improve HSCT outcomes.

Cardiovascular and Cancer Risk: The Role of Cardio-oncology.

Cardio-oncology is a subspecialty of cardiology. It was created to address oncology data indicating that newly developed drugs for cancer treatment were having unanticipated cardiac side effects. Cardio-oncology designs primary and secondary risk strategies through surveillance as well as interventions to reduce cardiovascular risk (CVR), prevent cardiotoxicities, and manage the side effects that may occur. Rather than discuss in detail the cardiotoxicities of specific therapies or radiation, this review article will explore the interplay of cancer, cancer treatment, and CVR. It will examine the link between CVR and cancer risk, define mechanisms associated with cardiotoxicity, and describe screening and surveillance for patients undergoing cancer treatment. Finally, effective preventative and management strategies used to reduce the incidence of cardiotoxicities in those receiving chemotherapeutics or radiation will be presented.

Accomplishing quality of life in end-stage heart failure: a hospice multidisciplinary approach.

The literature addresses using multidisciplinary teams to manage outpatient heart failure patients to reduce hospital readmission rates, increase functional capacity, and improve quality of life. This article shows how a multidisciplinary team can be used for these same patients in a hospice home care program.

Cardiac side effects of targeted therapies.

OBJECTIVES: To review common cardiac side effects, their clinical presentation, and recommendations for assessment and management of patients receiving molecularly targeted cancer therapies. DATA SOURCES: Peer-reviewed literature. CONCLUSION: Although there is no established guideline for pretreatment cardiac evaluation and monitoring of patients receiving molecularly targeted agents, data currently supports the need for early risk identification and prevention/reduction strategies. IMPLICATIONS FOR NURSING PRACTICE: As nurses, we have a unique opportunity to help improve and maintain the quality of life of cancer survivors. Cardiovascular assessment and prevention/reduction strategies are essential to reduce risk of cardiovascular disease, promote optimal quality of life, and improve survival outcomes in patients receiving molecularly targeted cancer treatment.

"I'd eat a bucket of nails if you told me it would help me sleep:" perceptions of insomnia and its treatment in patients with stable heart failure.

BACKGROUND: Poor sleep, including insomnia, is common among patients with heart failure (HF). However, little is known about the efficacy of interventions for insomnia in this population. Prior to developing interventions, there is a need for better understanding of patient perceptions about insomnia and its treatment. OBJECTIVES: To evaluate HF patients' perceptions about 1) insomnia and its consequences; 2) predisposing, precipitating, and perpetuating factors for insomnia; 3) self-management strategies and treatments for insomnia; and 4) preferences for insomnia treatment. METHODS: The study, guided by the "3 P" model of insomnia, employed a parallel convergent mixed methods design in which we obtained qualitative data through focus groups and quantitative data through questionnaires (sleep quality, insomnia severity, dysfunctional beliefs and attitudes about sleep; sleep-related daytime symptoms and functional performance). Content analysis was used to evaluate themes arising from the focus group data, and descriptive statistics were used to analyze the quantitative data. The results of both forms of data collection were compared and synthesized. RESULTS: HF patients perceived insomnia as having a negative impact on daytime function and comorbid health problems, pain, nocturia, and psychological factors as perpetuating factors. They viewed use of hypnotic medications as often necessary but disliked negative daytime side effects. They used a variety of strategies to manage their insomnia, but generally did not mention their sleep concerns to physicians whom they perceived as not interested in sleep. CONCLUSIONS: HF patients believe insomnia is important and multi-factorial. Behavioral treatments, such as cognitive behavioral therapy, for insomnia may be efficacious in modifying perpetuating factors and likely to be acceptable to patients.

Myocardial infarction & sudden death in recreational master marathon runners.

This review of the current literature on myocardial infarction and sudden death in recreational master marathon runners aims to help raise awareness of the scope of the problem to primary care providers, and to provide guidelines for educating and screening in recreational master marathon runners.

Lifestyle interventions for cardiovascular risk reduction in women with breast cancer.

PURPOSE: The purpose of this paper is to identify risk factors for cardiovascular disease in women with breast cancer and review healthy lifestyle behaviors as essential risk reduction strategies. FINDINGS: Women with breast cancer account for 22% of the 12 million cancer survivors. Women diagnosed with breast cancer often present with modifiable and non-modifiable cardiovascular risk factors and/or pre-existing co-morbid illness. Any one or a combination of these factors may increase the risk of cardiovascular disease. There is strong evidence that healthy eating and routine physical activity can reduce cardiovascular disease. Exercise improves cardiovascular fitness, body composition and quality of life in breast cancer survivors and observational studies suggest a survival benefit. CLINICAL IMPLICATIONS: Lifestyle interventions including a healthy diet, regular physical activity, weight management and smoking cessation should be integrated into a survivorship care plan to reduce cardiovascular disease risk and promote better health for women with breast cancer.

Heart failure: an update.

This article provides an overview of the latest in the standard of care and approaches for heart failure treatment. It presents two new American Heart Association Scientific Statements related to heart failure risk. The first addresses the prevention of heart failure with an emphasis on risk reduction. The second statement focuses on efforts to reduce hypertension, a primary risk factor for heart failure, through a self-care regimen that features home blood pressure monitoring. Implications for home care practice are presented.

Obesity and heart failure.

Current statistics on global obesity are staggering. In 2002, the International Obesity Task Force estimated that worldwide, nearly 1 billion (6%) people were overweight or obese. The American Heart Association's 2002: "Top 10" Research Advances for the Treatment of Heart Disease include obesity as a strong and independent risk factor for developing heart failure. This article outlines national and world statistics, cardiac risk factors, and pathophysiologic theories outlining the cellular mechanisms that associate obesity and heart failure. Access to guidelines for effective screening, evaluation, and treatment of obesity are also provided.