Coexistence of vasculogenic erectile dysfunction and peripheral artery disease.

Erectile dysfunction (ED) is the most common sexual problem experienced by men. The incidence increases with age and causes significant negative impacts on self-esteem, intimate relationships, mental health, and may be a powerful prognostic indicator for underlying vascular disease. The purpose of this clinical column is to provide an overview of the pathophysiology, evaluation, and management of vasculogenic ED in a patient with peripheral artery disease. There is very little research focused on the coexistence of these two disease conditions.

Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease: A Science Advisory From the American Heart Association.

Patients with lower-extremity peripheral artery disease (PAD) have greater functional impairment, faster functional decline, increased rates of mobility loss, and poorer quality of life than people without PAD. Supervised exercise therapy (SET) improves walking ability, overall functional status, and health-related quality of life in patients with symptomatic PAD. In 2017, the Centers for Medicare & Medicaid Services released a National Coverage Determination (CAG-00449N) for SET programs for patients with symptomatic PAD. This advisory provides a practical guide for delivering SET programs to patients with PAD according to Centers for Medicare & Medicaid Services criteria. It summarizes the Centers for Medicare & Medicaid Services process and requirements for referral and coverage of SET and provides guidance on how to implement SET for patients with PAD, including the SET protocol, options for outcome measurement, and transition to home-based exercise. This advisory is based on the guidelines established by the Centers for Medicare & Medicaid Services for Medicare beneficiaries in the United States and is intended to assist clinicians and administrators who are implementing SET programs for patients with PAD.

Tools for evidence-based vascular nursing practice: Achieving information literacy for lifelong learning.

Information literacy is essential in facilitating evidence-based practice (EBP) activities. In vascular nursing, the implementation of EBP is of utmost importance. Best practice grounded in research evidence can contribute to improved patient care outcomes for individuals with vascular disease. The following paper discusses information literacy competencies for nurses to develop in the context of EBP, with an emphasis on formulating a clinical question and searching for evidence. Relevant health science information resources are described, including their value and purpose in the 6S model of evidence. Also discussed are practical and supportive solutions with proven effectiveness in ensuring nurses' success with EBP.

A review of nia as an exercise option for cancer survivors.

Nia is a fusion fitness program that blends elements from the dance arts, martial arts, and healing arts, creating a workout that is adaptable to all ages and fitness levels. As a nontraditional form of exercise, Nia integrates body, mind, and spirit as well as the five sensations of flexibility, agility, mobility, strength, and stability. Nia incorporates both cardiovascular and whole-body conditioning and is adaptable to those with a sedentary or active lifestyle, making it useful for the varying abilities of cancer survivors. Oncology nurses are in a key position to educate individuals with cancer on the benefits of exercise, such as improved physical functioning and quality of life, and decreased cancer-related fatigue. The purpose of this article is to familiarize oncology nurses with the potential benefits of Nia for cancer survivors.

Effects of Nia exercise in women receiving radiation therapy for breast cancer.

PURPOSE/OBJECTIVES: To compare a 12-week nontraditional exercise Nia program practiced at home to usual care on fatigue, quality of life (QOL), aerobic capacity, and shoulder flexibility in women with breast cancer undergoing radiation therapy. DESIGN: Randomized clinical trial. SETTING: Large community-based hospital in the midwestern United States. SAMPLE: 41 women with stage I, II, or III breast cancer starting radiation therapy. METHODS: 22 women were randomized to the Nia group and 19 to the usual care group. Those in the Nia group were instructed to practice Nia 20-60 minutes three times per week for 12 weeks. Those in the usual care group were instructed to continue normal activities. MAIN RESEARCH VARIABLES: Fatigue, QOL, aerobic capacity, and shoulder flexibility. FINDINGS: Controlling for baseline scores, change over time between groups was significantly different for the women who practiced Nia at least 13 times during the 12-week period; those in the Nia intervention reported significantly less fatigue between weeks 6 and 12, as compared to control group (p = 0.05). No statistical differences in QOL, aerobic capacity, or shoulder flexibility were found, but trends favoring Nia were identified. CONCLUSIONS: For women undergoing radiation therapy for breast cancer, Nia can help relieve fatigue. Additional research in arm and shoulder mobility and preservation also may be beneficial. IMPLICATIONS FOR NURSING: Oncology nurses are in a unique position to offer suggestions to help manage fatigue, and Nia could be considered as part of a cancer survivorship program. KNOWLEDGE TRANSLATION: Exercise is beneficial for women with breast cancer, and interest is growing in nontraditional exercise options. Nia can benefit women with breast cancer undergoing radiation therapy.

Comparison of vein valve function following pharmacomechanical thrombolysis versus simple catheter-directed thrombolysis for iliofemoral deep vein thrombosis.

BACKGROUND: Successful catheter-directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (IFDVT) reduces post-thrombotic morbidity and is a suggested treatment option by the American College of Chest Physicians for patients with IFDVT. Pharmacomechanical thrombolysis (PMT) is also suggested to shorten treatment time and reduce the dose of plasminogen activator. However, concern remains that mechanical devices might damage vein valves. The purpose of this study is to examine whether PMT adversely affects venous valve function compared to CDT alone in IFDVT patients treated with catheter-based techniques. METHODS: Sixty-nine limbs in 54 patients (39 unilateral, 15 bilateral) who underwent catheter-based treatment for IFDVT form the basis of this study. Lytic success and degree of residual obstruction were analyzed by reviewing postprocedural phlebograms. All patients underwent bilateral postprocedure duplex to evaluate patency and valve function. Phlebograms and venous duplex examinations were interpreted in a blinded fashion. Limbs were analyzed based on the method of treatment: CDT alone (n = 20), PMT using rheolytic thrombolysis (n = 14), and isolated pharmacomechanical thrombolysis (n = 35). The validated outcome measures were compared between the treatment groups. RESULTS: Sixty-nine limbs underwent CDT with or without PMT. The average patient age was 47 years (range, 16-78). Venous duplex was performed 44.4 months (mean) post-treatment. Of the limbs treated with CDT with drip technique, 65% demonstrated reflux vs 53% treated with PMT (P = .42). There was no difference in long-term valve function between patients treated with rheolytic and isolated pharmacomechanical thrombolysis. In the bilateral group, 87% (13/15) demonstrated reflux in at least one limb. In the unilateral group, 64% (25/39) had reflux in their treated limb and 36% (14/39) in their contralateral limb. There was no correlation effect of residual venous obstruction on valve function, although few patients had >50% residual obstruction. CONCLUSIONS: In patients undergoing catheter-based intervention for IFDVT, PMT does not adversely affect valve function compared with CDT alone. A higher than expected number of patients had reflux in their uninvolved limb.

Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease: six-month outcomes from the claudication: exercise versus endoluminal revascularization (CLEVER) study.

BACKGROUND: Claudication is a common and disabling symptom of peripheral artery disease that can be treated with medication, supervised exercise (SE), or stent revascularization (ST). METHODS AND RESULTS: We randomly assigned 111 patients with aortoiliac peripheral artery disease to receive 1 of 3 treatments: optimal medical care (OMC), OMC plus SE, or OMC plus ST. The primary end point was the change in peak walking time on a graded treadmill test at 6 months compared with baseline. Secondary end points included free-living step activity, quality of life with the Walking Impairment Questionnaire, Peripheral Artery Questionnaire, Medical Outcomes Study 12-Item Short Form, and cardiovascular risk factors. At the 6-month follow-up, change in peak walking time (the primary end point) was greatest for SE, intermediate for ST, and least with OMC (mean change versus baseline, 5.8±4.6, 3.7±4.9, and 1.2±2.6 minutes, respectively; P<0.001 for the comparison of SE versus OMC, P=0.02 for ST versus OMC, and P=0.04 for SE versus ST). Although disease-specific quality of life as assessed by the Walking Impairment Questionnaire and Peripheral Artery Questionnaire also improved with both SE and ST compared with OMC, for most scales, the extent of improvement was greater with ST than SE. Free-living step activity increased more with ST than with either SE or OMC alone (114±274 versus 73±139 versus -6±109 steps per hour), but these differences were not statistically significant. CONCLUSIONS: SE results in superior treadmill walking performance than ST, even for those with aortoiliac peripheral artery disease. The contrast between better walking performance for SE and better patient-reported quality of life for ST warrants further study. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov/ct/show/NCT00132743?order=1. Unique identifier: NCT00132743.