Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 36th Cardiovascular Nursing & Nurse Practitioners Meeting Chicago, Illinois, USA.

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Day 1 :

Keynote Forum

John M Flack

Southern Illinois University, USA

Keynote: The emerging case for (much) lower than conventional (

Time : 09:30-10:15

Cardiologists and Nurses Meeting 2017 International Conference Keynote Speaker John M Flack photo
Biography:

John M. Flack, MD, MPH has been named professor and chair of the Department of Internal Medicine at Southern Illinois University School of Medicine in Springfield. He also is a member of SIU HealthCare, the medical school’s group practice. Dr. Flack is a renowned hypertension specialist. Flack is board certified in internal medicine and is an ASH-certified clinical hypertension specialist. He completed an NIH post-doctoral fellowship in cardiovascular epidemiology from the University of Minnesota (1990). He completed an internal medicine residency and received his medical degree from the University of Oklahoma Health Sciences Center (1985, 1982) where he also served as Chief Medical Resident in 1985-86. He received a bachelor’s degree in chemistry from Langston University (1978). Among his many honors, Flack has been named a “Top Doctor” from the Who’s Who Global Directory, was named one of Detroit’s “Super Doctors” and was Academic Physician of the Year from Oklahoma University School of Medicine.

Abstract:

Pharmacological hypertension treatment has traditionally been initiated when blood pressure (BP) is consistently 140/90 mm Hg or higher. The on-treatment target BP has been <140/90 mm H or <130/80 mm Hg in persons with diabetes and/or chronic kidney disease (CKD). It has long been known that CVD risk doubles every 20/10 mm Hg higher BP above 115/75 mm Hg. Recent epidemiological data have clearly demonstrated that pharmacological treatment of hypertension even down to SBP<120 mm Hg does not restore CVD risk to the level of persons with naturally occurring SBP below this threshold and pressure-related vascular injury is cumulative. Pharmacological treatment of BP lowers cardiovascular risk with pre-treatment BP levels as low as 110 mm Hg systolic. The recent SPRINT trial of pharmacological BP lowering in hypertensives 50–80 years old with SBP 130–180 mm Hg treated to SBP <120 versus <140 mm Hg has been a game changer because of clear benefit of the lower BP target on cardiovascular events and mortality. Most individuals with hypertension will require multiple drugs to lower BP in a sustained manner to conventional target levels (<140/90 mm Hg). Though individuals selected co-morbidities (eg, beta blockers post-MI, aldosterone antagonists in heart failure) benefit from specific drug therapies, most of the CVD risk reduction is much more closely linked to the magnitude of the BP reduction than to the specific drug(s) used for BP lowering. The approach to optimal diagnostic and therapeutic decision-making will be discussed. Accurate BP measurement is fundamental to optimal patient assessment and clinical decision-making. Key therapeutic considerations will be outlined including how to initiate antihypertensive drug therapy, a rational approach to up-titration of medication, the use of diuretics, and selecting optimal antihypertensive drug regimens (and avoiding ineffective combinations) in ambulatory settings.

 

Keynote Forum

M Eileen Walsh

University of Toledo, USA

Keynote: Lower extremity peripheral artery disease: Overview of evidence-based guidelines

Time : 10:15-11:00

Cardiologists and Nurses Meeting 2017 International Conference Keynote Speaker M Eileen Walsh photo
Biography:

M Eileen Walsh is a Professor in the College of Nursing at the University of Toledo. She has a long-standing career spanning more than 30 years of practice working with patients with cardiovascular diseases in inpatient, outpatient, specialty clinics, and rehabilitation settings. She has served as the Society for Vascular Nursing representative to the PAD writing committee. She has presented at numerous local, regional, national, and international vascular conferences. She has several publications on PAD and other cardiovascular topics. 

Abstract:

Lower extremity peripheral artery disease (PAD) affects the lives of 8.5 million Americans ages 40 years and older and has a significant impact on morbidity, mortality, and quality of life. Approximately 202 million people worldwide have PAD. Many patients with coronary atherosclerotic disease are at risk of developing PAD. Thus cardiovascular clinicians need to have the requisite knowledge and skill to appropriately diagnosis and manage patients with PAD. The purpose of this presentation is to discuss the 2016 American Heart Association/American College of Cardiology Guideline on the management of patients with lower extremity peripheral artery disease. This contemporary guideline addresses the diagnosis and management of patients with lower extremity PAD. Writing committee members with expertise in PAD were nominated as representatives from respective professional organizations. The writer of this abstract served as one of two nurse representatives. Protocols to critique and appraise the scientific literature as to the quality and level of the evidence were established. Recommendations were voted upon and peer-reviewed. Guidelines were premiered at the scientific sessions. During this presentation specific recommendations to guide the clinical assessment, including the importance of a thorough history and physical examination; resting and exercise ankle brachial indexes, physiological testing modalities, and imaging studies will be discussed. Medical therapies including, antiplatelet, oral anticoagulants, statins, antihypertensive, cilostazol, glycemic control and smoking cessation will be reviewed. Options to minimize tissue loss as well as surgical revascularization for claudication will be discussed. Specific recommendations to screen for atherosclerotic disease in other vascular beds and the role of structured exercise therapy for PAD will be highlighted. 

Keynote Forum

Bruce Leonard

University of Texas Medical Branch, USA

Keynote: Precision medicine: Using OMICS to improve health and wellness in healthcare

Time : 11:20-12:05

Cardiologists and Nurses Meeting 2017 International Conference Keynote Speaker Bruce Leonard photo
Biography:

Bruce Leonard is a Professor in the PhD program and a certified Family Nurse Practitioner at the University of Texas Medical Branch, School of Nursing, TX. Currently, his research focus involves using technology driven lifestyle monitoring devices for self-management that provides feedback to the healthcare provider for just-in-time coaching to improve long-term adherence to glycemic control among persons with type - 2 diabetes and examining circadian rhythm clock gene expressions as physiological outcome measures. Other research areas of interest have included: Quality-of-life and self-management of chronic illness among persons with COPD; instrument development in examining nurse practitioner student self-efficacy or confidence to perform standardized patient exams; the application of Team-Based Learning into online learning formats as an evidenced based flipped classroom learning format; and the integration and identification of biomarkers, genomics, and epigenetics into self-management research for persons with chronic illnesses. 

Abstract:

The Centers for Disease Control (CDC) indicates that 117 million people or approximately 50% of the total population suffer from one or more chronic illness. Many chronic diseases are preventable. More than half of adults (52%) over the age of 18 do not meet our national recommendations for physical activity, and exercise. Former President Obama introduced the Precision medicine initiative (PMI) in January 2015. The program is designed to transform healthcare by taking into account individual differences in our genes, environments, and lifestyles. Precision medicine focuses on tailored just-in-time treatment to individuals based upon their genetic makeup. A key component of the PMI is the creation of cohort of 1 million volunteers to create a database of biomedical and behavioral research that can identify individual differences in disease process. The potential to address individual variations may transform our healthcare practices on how we approach health and wellness of individuals, families, and communities. OMICS refers to the biological studies in the fields such as genomics, proteomics, and metabolomics. Nearly all physiologic, sleep, wakefulness activities, metabolic, and endocrine processes in the body including glycemic, lipid, and carbohydrate metabolism, and cardiac function (heart rate and blood pressure) are controlled by genes most specifically clock genes that relate to our daily circadian awake and sleep cycles. Exercise activity is known to improve sleep, overall health and wellness, reduce risks of chronic diseases, inflammatory process, and improve health outcomes as a self-management strategy. Recent research by Steidle-Kloc et al. explains how exercise training, a part of lifestyle modification, can alter muscle clock genes in CAD (coronary artery disease) and T2DM patients. This presentation will explore the translation of what is known in our current state of science and how OMICS may transform our future in healthcare practice. 

  • Cardiologists Education | Cardiovascular Nursing | Nursing Education and Career | Cardiovascular Alternative Medicine
Location: DoubleTree by Hilton Chicago - North Shore 9599 Skokie Boulevard Skokie Illinois United States-600
Speaker

Chair

John M. Flack

Southern Illinois University, USA

Speaker

Co-Chair

M. Eileen Walsh

University of Toledo, USA

Speaker
Biography:

Guillermo R Valdes has been a Nurse Professional for 30 years in Miami Dade County, Florida. He is an American Heart Association, Basic Life Support and Advanced Cardiac Life Support Instructor in 2011. He was awarded March of Dimes Nurse of The Year for clinical and academic education. In 2012, he received the Florida Nurses Association (FNA), South Region Award for Most Outstanding Evidence Based Project. In addition, in 2013 he was awarded Great 100 Florida Nurses for academic education and received the Nurse Educator Award for the state by FNA in 2014. In 2016 he was recognized by FNA for consistently promoting an environment of nursing excellence and by the Florida Center for Nursing as a Nurse Leader. In 2017, he continues to be recognized by his peers at FNA addressing translational evidence-based nursing when focusing on patient oriented evidence that matters. From 2014 to 2016, he has presented at FNA, QSEN, HANA, AACN, AONE, and Sigma Theta Tau International Nursing Honor Society. This year again, he will be presenting an collaborate academic EBP project at the Sigma Theta Tau Conference in Indianapolis, Indiana.

Abstract:

Background: The American Heart Association (AHA) has developed very concise steps when treating ventricular fibrillation; however health care professionals continue to have difficulties in following the AHA Advanced Cardiac Life Support (ACLS) guidelines when consistently following the V-Fib algorithm, specifically when preparing to defibrillate and not performing continuous cardio pulmonary resuscitation.

Methods: A comprehensive search of electronic databases, journal references and citation searching was done, reviewing articles derived from PubMed, Cinahl, AHA, and Cochran databases. Articles were reviewed from 2010-2016.

Purpose: This literature clinical review will address the importance of early defibrillation without CPR interruption when initially and effectively treating Ventricular Fibrillation in order to support maintaining coronary artery perfusion pressure according to the 2015 AHA update, ACLS guidelines V-Fib Algorithm, Link et al (2015).

Discussion: In the majority of time, health care professionals inappropriately may interrupt CPR to prepare for defibrillation or delay CPR after defibrillation when unsuccessfully breaking the V-Fib. Going back to 2010, AHA clearly stated the significance of not interrupting CPR for long periods of time. According to several observational studies, the average time without compressions during resuscitation varied from 25% to 50%. CPR is seen as the first line of approach in resuscitation along with early defibrillation when ventricular fibrillation is present.

Implications: There has been sufficient research done on the dangers of delaying or interrupting CPR in V Fib. Therefore, more inquiring should be done regarding the causes of why healthcare professionals may interrupt CPR while preparing to defibrillate.

Conclusion: Best practices in ACLS are not discipline specific but rather competency driven. Resuscitative strategies in ACLS as clinical updates, promotes best inter-professional situational awareness and are essential when promoting effective management of challenging patient scenarios within the emergent healthcare team and setting, specifically when consistently building an inter-professional culture of safety towards quality care and positive patient outcomes reliably.

Speaker
Biography:

For over 30 years, Dr. Daniels has been an executive coach, mentor, and advocate for nurses across the United States, who are in the pursuit of clinical and administrative excellence. She began her nursing career as a critical care nurse and continues to practice on an as needed basis. She maintains certification in Critical Care Nursing and has been an item writer for the national Critical Care Registered Nurse exam (CCRN)and is a Certified Nurse Educator (CNE). Her career path led her to promote the nursing profession and advance nurses in their careers as she became a Nursing Director for Critical Care, Cardiovascular, and Respiratory Services and eventually Assistant Vice President for Patient Care Services.

Abstract:

Background: The American Heart Association (AHA) has developed very concise steps when treating ventricular fibrillation; however health care professionals continue to have difficulties in following the AHA Advanced Cardiac Life Support (ACLS) guidelines when consistently following the V-Fib algorithm, specifically when preparing to defibrillate and not performing continuous cardio pulmonary resuscitation.

Methods: A comprehensive search of electronic databases, journal references and citation searching was done, reviewing articles derived from PubMed, Cinahl, AHA, and Cochran databases. Articles were reviewed from 2010-2016.

Purpose: This literature clinical review will address the importance of early defibrillation without CPR interruption when initially and effectively treating Ventricular Fibrillation in order to support maintaining coronary artery perfusion pressure according to the 2015 AHA update, ACLS guidelines V-Fib Algorithm, Link et al (2015).

Discussion: In the majority of time, health care professionals inappropriately may interrupt CPR to prepare for defibrillation or delay CPR after defibrillation when unsuccessfully breaking the V-Fib. Going back to 2010, AHA clearly stated the significance of not interrupting CPR for long periods of time. According to several observational studies, the average time without compressions during resuscitation varied from 25% to 50%. CPR is seen as the first line of approach in resuscitation along with early defibrillation when ventricular fibrillation is present.

Implications: There has been sufficient research done on the dangers of delaying or interrupting CPR in V Fib. Therefore, more inquiring should be done regarding the causes of why healthcare professionals may interrupt CPR while preparing to defibrillate.

Conclusion: Best practices in ACLS are not discipline specific but rather competency driven. Resuscitative strategies in ACLS as clinical updates, promotes best inter-professional situational awareness and are essential when promoting effective management of challenging patient scenarios within the emergent healthcare team and setting, specifically when consistently building an inter-professional culture of safety towards quality care and positive patient outcomes reliably.

Speaker
Biography:

Susan George has been working as a Heart Failure Nurse Practitioner since 2007. She is passionate about improving health and wellbeing of heart failure patients. Many of the end stage heart failure patients require advanced heart failure therapy such as left ventricular assist device (LVAD) implantation. 

Abstract:

Background: Left ventricular assist devices (LVAD) are increasingly being used in patients with advanced heart failure as bridge to transplant or as destination therapy. Infections are a major complication associated with LVADs. Staphylococcus aureus is one of the common causative organisms associated with LVAD infections. Methicillin-resistant staphylococcus aureus (MRSA) colonized patients are at increased risk for developing MRSA associated infections. Various studies have demonstrated decolonization of skin with topical chlorhexidine and nares with 2% intranasal ointment is effective in reducing MRSA associated infections.

Objective: The main objective of this quality improvement (QI) project was to examine the impact of a universal decolonization with topical chlorhexidine and intranasal mupirocin ointment for five days prior to LVAD implantation on postoperative infections, length of stay, and infection related rehospitalization.

Methods: A preoperative universal decolonization with 4% chlorhexidine daily whole body bath and 2% intranasal ointment twice daily for five days was implemented for patients undergoing elective LVAD implantation. This project was conducted using pretest-posttest non-experimental design. We included a total of 20 subjects, 10 in the standard protocol group, and 10 in the revised protocol group.

 

Results: In the standard protocol group there were two SSIs within 30 days (χ²=2.22, p=0.068) and one SSI within 90 days (χ²=0.640, p=0.212). In the decolonization group one SSI within 60 days (χ² =1.173, p=0.139). Even though there was absolute reduction in the number SSIs in the intervention group, it was not statistically significant due to very small sample size. Rehospitalization rate differences between the groups were not statistically significant (χ²=0.392, p=0.265).

Conclusion: A preoperative universal decolonization might be effective in reducing postoperative infections in LVAD patients.

Speaker
Biography:

Christy Cotner has received her RN license 18 years ago and completed her MSN FNP at California State University Dominguez Hills, and is nationally certified through AANP. She is currently completing her DNP in the study of heart failure and self- efficacy. She is the Director of the family nurse practitioner program at California Baptist University where she has advanced education through the work of standardized patient simulation. Additionally, she works in internal medicine at Riverside Medical Clinic with a specialty in heart failure. She has Spear-Headed the development of various programs throughout her career which include an emergency room case management program, gastric bypass program, acute care cardiac nurse practitioner program, and the medical home model. She is an active Member of NONPF involved in a program director sig group. She is also an active Member of CANP and looks forward to advancing the profession of the nurse practitioner.

Abstract:

In 2016, I established a heart failure program in a large primary care clinic. The fundamental goals of this clinic were to decrease hospital readmissions and improve patient outcomes. In the United States, three trillion dollars a year is spent on health care. Additional, 50% of the total expenditures are concentrated among just 5% of the population. This highly concentrated spending is centered on patients >65 years of age with at least one chronic disease, heart disease being the most common. Heart failure readmissions are a significant burden on the nation’s healthcare system. The 30 day readmission rate for the diagnosis of heart failure across the nation is 25%, climbing to 50% at the six-month mark. The astonishing factor is that 75% of these readmissions have been deemed preventable. So, the question remains, why can’t we as health care professionals prevent them? I began the heart failure program in hopes of closing the gap from hospital to home, however, in the midst of gathering data something amazing happened. I began to see the patients, not from the provider’s side, but the patients. I began to ask the right questions and found that many of the patients that were unsuccessful had one common theme. They scored low on their self-efficacy questionnaire that was given on their first visit to the heart failure clinic. Self-efficacy is the belief in one's capability to succeed. Various studies have shown that despite the severity of a patient’s disease, those with high self-efficacy showed improved quality of life and fewer hospitalizations. I believe if we can improve our patient’s self-efficacy through education and empowerment we can improve our patients quality of life and by doing so decrease the overwhelming burden of frequent hospitalization on the healthcare system. 

Speaker
Biography:

Jen-Chen Tsai is a Professor of National Yang-Ming University, School of Nursing, in Taiwan. Her clinical and professional specialty includes nursing care of adults with medical and surgical health problems, cardiovascular nursing, cardiac rehabilitation nursing, and physical activity interventions for patients with chronic illness.

Abstract:

Statement of the Problem: Cardiovascular disease remains a leading cause of mortality and morbidity in women with systemic lupus erythematosus (SLE). In addition, physical inactiveness is common in this population and increases the risk of developing cardiovascular diseases. This study aimed to explore physical activity levels and associated factors in SLE women.

Methodology: A cross-sectional study was conducted between August 2015 and July 2016. Women with SLE, age 20 years or older were recruited from immunology outpatient clinics of a medical center in Taiwan. Data on demographic characteristics, disease status, medications, perception of symptoms, exercise environment factors, and health related quality of life were collected. Each participant wore a pedometer at least 10 hours per day for seven consecutive days. Levels of physical activity were calculated by daily step counts. Multiple regression analyses were performed to identify predicting variables of physical activity.

Findings: The subject consisted of 124 SLE women, with a mean age of 43.5±11 years and an average disease duration 11.2±7.7 years. The mean daily step counts were 6077±2493 (range from 1320 to 13725). Mean time spent in moderate/vigorous physical activity (MVPA) was 17.4±13.0 min/day. Age, BMI, employment status, educational levels, disease duration and severity, fatigue, and sleep quality were not associated with both daily step counts and time spent in MVPA. The mean daily step counts were correlated with prednisolone usage (r=-0.26, p<0.001), accessibility of exercise environment (r=0.20, p=0.02), and reported physical functioning scores (r=0.22, p=0.02). Collectively these three variables accounted for 13.6% of the variance in daily step counts.

Conclusion & Significance: Result of our study showed the SLE women remain sedentary lifestyle. It is important for advanced practice nurses to consider medication responses and exercise environment issues when providing health education of physical activity for SLE patients.

Biography:

Cristina Florescu is lecturer at Craiova University of Medicine and Pharmacy, senior doctor in cardiology and internal medicine, has a Master degree in Health Services and is Doctor of Medicine. Her domains of interest are heart failure, echocardiography, prevention medicine and cardio-oncology. 

Abstract:

The prognosis of patients with cancer was substantially improved by early detection and modern treatments, one of these being signalling inhibitors, alone or combined with conventional chemotherapy. Patients receiving cancer therapies may have their quality of life and survival affected by cardiotoxicity, because higher survival rates brings more patients presenting with cardiac adverse effects. Signalling inhibitors like trastuzumab have a risk of cardiovascular adverse effects including cardiac dysfunction and development of heart failure, myocardial ischemia, arrhytmia, QT prolongation, and arterial hypertension. Iatrogenic side effects of these drugs could be irreversible lesions or reversible dysfunction, but exist also the possibility of being overlapped, for example, trastuzumab may produce irreversible cardiac damage in patients with preexisting cardiac dysfunction or augment anthracyclines type I cardiotoxicity. Cardiovascular treatment may delay expression of cardiac dysfunction in these patients. Monitoring the cardiac health of patients before, during and after cancer treatment is very important. It is possible that patients eligibility for cancer therapies may be affected, and also their life expectancy. In some cases, cancer treatments may be stopped without prompt access to cardio-oncology expertise. Also, patients are not eligible for the aggressive treatments needed, remaining a potential risk of being undertreated, having treatment delays or having dose decreased. Trastuzumab, a monoclonal antibody targeted against HER 2 / erb B2 and VEGF (vascular endothelial growth factor) signalling pathways, in combination with chemotherapy improved prognosis of women with HER 2 overexpressed breast cancer. The main concern of long-term therapy with trastuzumab remains its association with potential cardiotoxicity. Although real, cardiac side effects of trastuzumab are probably overemphasized. I report the case of a woman with metastatic breast cancer, who is currently in complete remission, and who was treated with trastuzumab for more than 9 years without significant cardiac toxicity.

Rose P Bagh

William P Clements Jr. University Hospital, USA

Title: Cardioversion: Keys to a safe and successful cardioversion

Time : 16:05-16:35

Speaker
Biography:

Rose P Bagh has been a Nurse and a Nurse Practitioner combined for over 25 years. She has lived and worked in three different countries for extended periods of time in her life. She currently work as an NP in the Cardiology Electrophysiology unit at the UT Southwestern Medical Center and Clements University Hospital in Dallas. She also work on a PRN basis in the ER department at Parkland Hospital in Dallas. Concurrently, she is a part-time student in the Doctor of Nursing Practice program at Texas Woman’s University, Dallas.

Abstract:

The objectives of the study is to understand cardioversion and difference between cardioversion and defibrillation, pre and post procedure safety checks, AHA guidelines for anticoagulation therapy, keys to safe and successful cardioversion and precautions to be considered for patients with devices. Cardioversion is a frequently performed procedure to terminate atrial arrhythmias commonly atrial fibrillation and atrial flutter, to relieve symptoms and improve cardiac performance. In simple terms, an electrical shock is delivered to patient’s chest wall during cardioversion to restore the heart back to normal sinus rhythm. It involves the delivery of high energy shock through the chest wall muscles to the heart to interrupt abnormal electrical currents to restore it to normal sinus rhythm. Prior to performing this procedure, there are several safety checks undertaken in terms of anticoagulation. There is a 48 hours safety window for cardioversion without appropriate anticoagulation and the need for continuation of appropriate anticoagulation for 4-6 weeks after cardioversion. The AHA guidelines for a safe and successful cardioversion will be discussed in this presentation.