Day 2 :
Texas A&M University, USA
Keynote: Origin and perpetuation of chronic low-grade inflammation as a driver for cardiovascular complications during metabolic syndrome
Time : 10:00-10:45
Narendra Kumar is a tenured Associate Professor and Chair of Graduate Program Committee at the College of Pharmacy at the Texas A&M University. He has completed his PhD from the Indian Institute of Technology (IIT) and postdoctoral training from the University of Tennessee Health science center. Previously, he held a joint appointment as instructor of Physiology and Pediatric Gastroenterology at the University of Tennessee HSC and Le Bonheur Children Medical Center respectively. He has rated among top 25% in the college by the students, he teaches immunology, biochemistry, pharmacogenomics, and autoimmune diseases under Pharm D program. In research he is the recipient of several national awards, such as Crohn’s and Colitis Foundation of America (CCFA) Research Fellowship Award, CCFA Career Development Award, National Institute of Health (NIH) Basic Scientist Career Development Award, NIH small business innovation award (SBIR) and American Gastroenterology Association (AGA) Research Scholar Award to name a few. He has published more than 25 peer reviewed research articles, 50 abstracts, and a book chapter. He also has three patents to his credit, two of which are commercialized while the third is under negotiation for licensing.
Statement of the Problem: Obesity associated cardiometabolic risk factors (CMetRF) is both a US and a worldwide epidemic and a major burden to healthcare system. Chronic low-grade inflammation (CLGI) is a well-established characteristic of the obese-human condition and conventionally, research has focused on the CLGI of liver and adipose tissue as a driver. Though, the gastrointestinal (GI) mucosa is the first tissue that interacts with dietary components and luminal microbiota both of which are known to regulate obesity associated CMetRF, the research on the role of GI-mucosa in obesity associated CMetRF has been ignored.Methodology & Theoretical Orientation: Recent novel findings from my lab support a key role of Janus kinase 3 (Jak3), a non-receptor tyrosine kinase, in intestinal and systemic CLGI associated CMetRF in both an animal-model and in humans. De-identified and discarded tissue samples from CMetRF were analyzed for the markers of CLGI. The human model was reconstituted in mouse using tissue-specific genetic manipulation of non-receptor tyrosine kinase Jak3.
Findings: Our data show that in human CMetRF are associated with compromises intestinal expression and localization of not only Jak3 but also drug transport proteins. In mouse model, intestinal loss of Jak3 leads to colonic dysbiosis associated CLGI, obesity, and metabolic syndrome. Mechanistically, we show that Jak3 mediates intestinal tolerance through suppressed-expression and limited activation of intestinal TLR4/2. Moreover, pharmacological manipulation of both PI3K and TLR pathways in intestine leads to amelioration of CLGI and improvement of CMetRF.
Conclusion & Significance: This study showed that CLGI is associated with CMetRF where localized intestinal inflammation may play a major role in systemic manifestation of the inflammation leading to increased CMetRF. Moreover, intestinal regulation of inflammation may provide new avenue for a long-term reduction of CMetRF.
University of Texas Medical Branch, USA
Keynote: Hypertriglyceridemia: Identifying and treating patients at risk for coronary artery disease
Time : 10:45-11:30
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 provide 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.
The U S Department of Health and Human Services Data Brief describing trends in elevated triglycerides among adults in the United States from 2001 to 2012, indicated that approximately one-quarter of adults over the age of 20 had elevated triglycerides. The percentage of those with elevated triglycerides greater than 150 mg/dl did decline from 2001 to 2102 from 33.3% from 2001-2004 to 25.1% during 2009 to 2012. However, hypertriglyceridemia remains a significant risk factor for coronary artery disease (CAD). Many of the risk factors for hypertriglyceridemia are preventable and are related to sedentary lifestyles, obesity, and cigarette smoking. Some of the primary causes for high triglycerides today are caused by high carbohydrate diets with added sugars, and fructose along with diets high in trans-fatty acids, and high alcohol consumption. Patients often do not understand that high triglycerides levels are correlated with increased risks of heart disease and pancreatitis when levels are close to or greater than 1,000 mg/dl. Chylomicronemia syndrome is also associated with triglyceride levels greater than 1,000 mg/dl, but is a less severe condition than pancreatitis. This condition is often unrecognized in primary care providers and generally resolves when triglyceride levels decrease. In addition, hypertriglyceridemia is associated with several genetic causes, which will be discussed. Furthermore, genetic variants along with environmental factors can predispose a patient with hypertriglyceridemia to CAD and heart attacks. This presentation will explore what is known in our current state of science related to hypertriglyceridemia and explore effective management treatments for patients seen in primary care practices.
- Advanced Nursing Practice | Nurse Practitioners and Global Perspectives | Current Studies in Cardiology | Cardiovascular Disease Epidemiology
Location: DoubleTree by Hilton Chicago - North Shore 9599 Skokie Boulevard Skokie Illinois United States-600
University of Texas Medical Branch, USA
Center for Healthcare and Organizational Research, USA
Center for Healthcare and Organizational Research, USA
Damien Byas is currently serving as an Associate Faculty Member in a Master of Public Health (MPH) Program. He is the president of the North American Scientific Committee on Cardiovascular Health, a part-time Public Health Researcher, Senior Research Fellow, and an adjunct Professor for an MPH program.
Statement of the Problem: Physical inactivity, diabetes, diets high in fats and cholesterol, and obesity are all considered poor health conditions which serve as significant gateway factors which may lead to heart disease and possibly cardiac death reporting more than 17.3 million cardiac related deaths in 2012 worldwide (World Health Federation, 2016). Cardiovascular diseases were the main cause of death in almost all Organization for Economic Co-operation and Development (OECD) countries, and accounted for 35% of all deaths in 2009 (OECD, 2011). This study examined specific identifiable risk factors which may be associated with sudden cardiac death rates in children and adult populations using the Kids’ Inpatient Database (KID), Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality (AHRQ, 2016).
Orientation: A large randomly drawn sample (N=422,599) of boys (n=198,960) and girls (n=223,639) ages 4 to 12, was examined in this research study to test for the association between risk factors which may be associated with heart disease prevalence. The Pearson Chi Square test was applied to measure for significant variable relationships in this research study.
Methodology & Theoretical Orientation: The Pearson Chi Square test was applied to measure for significant variable relationships in this research study.
Findings: The results of this study found that there was a statistically significant association between cardiovascular disease prevalence and identifiable risk factors in children and adult groups (p<0.05). Other significant associations were also found as a result of the Chi square analysis.
Conclusion & Significance: Recommendations are made for to implement more effective strategies for health promotion and disease prevention, health education, cultural competence training for healthcare professionals, improve healthcare quality, and economic development.
Madeline Gervase is currently a Critical Care Clinical Education Specialist at Carepoint Health, and affiliated with Rowan University as a professional development educator of excellence in New Jersey. Over the years, she has garnered a wealth of experience as a nurse practitioner for over twenty years in areas that include; cardiology, surgery, and critical care. She has also held positions as assistant professor of Nursing at Rutgers University, Seton Hall University, and Union County College, and as a clinical nurse specialist/advanced practice nurse at Somerset Medical Center in the Emergency and Cardiology departments. She served as a clinical nurse specialist at Maimonides Medical Center, Brooklyn, NY, a nurse practitioner at Saint Vincent Catholic Medical Center of New York. She has also held senior critical care/open heart nursing positions at both Robert Wood Johnson University Hospital in New Brunswick, and at Saint Vincent Catholic Medical Center in Staten Island. Gervase holds a B.S. in Nursing from The College of Staten Island and an M.S. in Nursing/ Family Nurse Practitioner from Wagner College. She has completed coursework for a Ph.D. in Instructional Leadership and Curriculum Design, and is presently in pursuit of her Doctor of Nursing Practice degree. She is also a member of several professional associations, community boards and health care collaborative organizations, and continues to identify new paths to education to promote safe and effective practice and improved patient care.
Cardiac disease which includes chronic heart failure (CHF) is a familiar diagnosis in long term care (LTC) and facilities that are considered skilled nursing facilities (SNF) in the United States. According to the American Heart Association (2017), cardiovascular disease consists of cardiac and neuro ischemia, heart failure, and cardiac valve malfunction. With over 1.5 million residents >65 years of age living in skilled nursing facilities (SNF) in the United States, cardiovascular disease is the most common diagnosis with heart failure prevalent and ranging from 20% -37.4. Heckman et al. (2013) identifies that heart failure is significant and reaches 20% of long term care residents with a one year mortality of 40%. When compared to other diagnoses, heart failure 50% more prevalent than residents without this diagnoses. According to Jungens et al. (2015), hospital readmission rates for residents with heart failure range from 27% - 43% in SNF’s, as the incidence of heart failure increases with age. The Agency for Healthcare Research and Quality (AHRQ, 2015) has identified that rates for hospitalization of patients with cardiac disease have decreased by 30% nationally, but readmission rates have not reduced. A significant number of care services are available before and after discharge compared to twenty years ago, patients are being discharged earlier and followed up as outpatients or in the community. The high rate of readmission identifies a need for appropriate transition of care tools in acute care institutions. Resources to reduce readmission rates and support the American Heart Association’s (AHA, 2017) standard of care, have been implemented by some organizations to assist with this process. The purpose of this project is to integrate an education program and tools into the acute care institution, to reduce future hospital readmissions and improve overall quality of care.
Rrson University, Canada
Time : 12:50-13:20
Haitham Kan’an granted his MN degree in 2015 from School of Nursing- Ryerson University, Canada. In 1996, he received a Bachelor’s degree in Nursing from Jordan University. He has more than 20 years of clinical experience, mainly in cardiology speciality. He assumed many nursing roles during his nursing career such as Charge Nurse, Manager’s Assistant, and Clinical Educator for cardiology nurses. He used his expertise in Cardiology and appraisal skills in reviewing and synthesising the literature to identify the determinants that enhance the provision of education to Coronary Care Unit (CCU) patients by CCU nurses.
Background: Patients with heart diseases become a burden on the health care system especially in the era during which the population is aging and has much comorbidity. Health professional organizations and political leaders have identified Patient Education (PE) as a fundamental solution to address this situation. Patient education reported to enhance patient self-care management skills and decrease health care costs. The Coronary Care Unit (CCU) Nurses in my practicum do not have a systematic approach to the provision and documentation of PE. This resulted in lack of consistency and continuity of implementation of PE.
Aim: The purpose of this presentation is to identify if using PE tool will enhance provision of PE by CCU nurses.
Method: Roger’s theory ‘diffusion of innovation’ (2003) was used as a framework to guide this presentation. Rogers’s theory has five phases: Awareness, interest, evaluation, trial, and adoption. Literature reviews were conducted to identify the factors that influence the PE process and suggested strategies to enhance the provision of effective PE process.
Findings: Creating a PE record tool identified as an important strategy to enhance systematic PE process, and to ensure the continuity and consistency of the PE process.
Conclusion: PE is an important factor to improve the patient health outcomes. Creating PE record identified as an important strategy to enhance the PE process.
Rutgers School of Nursing, USA
Maria Christina Bernardo has worked in the emergency department setting for seven years , with focus on the last three years as an observation nurse practitioner evaluating the chest pain population. Working closely with emergency department practitioners and cardiologists, she has worked diligently on assessing the effects of chest pain work ups to improve patient safety and efficiency of care at her current institution.
Chest pain presentation has grown into a public health concern as patients crowd emergency departments for urgent evaluation. This has led not only to hospital congestion and increased length of emergency room stays, but also the utilization of costly resources such as subsequent hospital admissions and objective cardiac testing. Risk stratification is an important component of chest pain assessment, as it can determine subgroups that necessitate inpatient intervention while identifying those safe for early discharge. The TIMI tool has persisted as the standard for risk evaluation, but the HEART score has recently emerged as a potential superior method. A retrospective chart review of patients who presented to the emergency department with chest pain retrieved components of existing documentation to risk stratify patients according to each scoring method and compare their accuracy in predicting major adverse cardiac events (MACE). After accounting for inclusion and exclusion criteria, a total of 381 patient charts were reviewed for risk score calculation and evaluated for reaching an endpoint, or MACE. The HEART scoring method demonstrated stronger diagnostic accuracy than the TIMI, as well as increased sensitivity, specificity, positive predictive value, and negative predictive value. The routine use of a precise risk stratification tool incorporated into a policy or clinical practice guideline has the potential increase clinician confidence in facilitating discharge of low risk patients, while directing those with increased risk for more thorough workups. This, in turn, allows for hospital decongestion and fiscal savings without compromising patient safety and quality care.
American University of Madaba, Jordan
Ahmed Al-Smadi, PhD, RN, has 16 years of experience as Nurse and Researcher. He earned his Bachelor’s and Master’s degrees in Nursing from Jordan University of Science and Technology and his PhD in Nursing from University of Ulster, United Kingdom. Currently, he is working as Assistant Professor in Nursing at American University of Madaba. His main research interests are cardiac care nursing, refugee’s health and psychological health.
Background: Previous studies showed a negative impact of anxiety on progression of coronary artery disease (CAD). However, few studies examined the association of modifiable CAD risk factors among individuals not previously diagnosed with CAD and each anxiety and insomnia.
Aim of the Study: The study aimed to examine prevalence of anxiety and insomnia in Jordanian individuals with one or more modifiable CAD risk factors; and to examine the association among CAD modifiable risk factors, anxiety and insomnia.
Methods: A cross-sectional descriptive design was used utilizing a simple random sampling technique. Participants inclusion criteria were; Jordanian with 18 years or more, had one or more of CAD modifiable risk factors, agreed to participate and mentally competent. Exclusion criteria were participants diagnosed with coronary artery diseases or any other diseases. In addition to demographical and clinical details, the Insomnia Severity Index and Hamilton Anxiety Rating Scale (HAM-A) was used. Linear regression was used to examine as possible predictors for each anxiety and insomnia.
Results: One thousand and eleven participants had met the inclusion criteria and willing to participate in the study. The results indicated that 30.2% had higher anxiety, and 29.7% had higher insomnia level. Linear regression indicated that individuals diagnosed with diabetes mellitus, hypertension, or dislipidemia predicted high insomnia. Moreover, individuals with higher insomnia were associated with high anxiety.
Conclusion: The study concluded that both anxiety and insomnia are relatively high among individuals with one or more CAD risk factors. Individuals diagnosed with diabetes mellitus, hypertension, or dislipidemia had higher insomnia. As these risk factors impacted negatively on insomnia with the presence of high anxiety; this may accelerate the development of CAD. The current study recommends nurses and health care professionals to assess and develop interventions aiming to decrease anxiety and insomnia among this population. Furthermore, the current study recommends further longitudinal research examining this association.
B P Koirala Institute of Health Sciences, Nepal
Ram Sharan Mehta is Head of Medical-Surgical Nursing Department in College of Nursing, B P Koirala Institute of Health Sciences Nepal. He is involved in teaching medical-surgical nursing for more than 20 years. He is involved in teaching the nursing education to the undergraduate and post graduate nursing students. He is the Research Committee Member of this institute and actively involved in guiding the undergraduate and post graduate nursing students.
Background & Objectives: Cardiovascular disease is a class of disease that involves heart, the blood vessels or both. The most important behavioral risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. The objectives of the study were to assess the cardiovascular health risk behavior among the faculties of BPKIHS Nepal and to find out the association between the cardiovascular health risks behaviors with selected demographic variables.
Materials & Methods: A descriptive cross-sectional study design was conducted to find out the cardiovascular health risk behavior among the faculties of B P Koirala Institute of Health Sciences. A total of 99 samples meeting the eligibility criteria were included by purposive sampling method. Data was collected by using self-administered questionnaire method. SPSS-11.5 software was used for data analysis.
Result: Majority of the respondents (77.8%) were of age group <40 years, maximum of the respondents (70.7%) were male. Among 99 respondents, 13.1% were light smoker, 54.5% consumed alcohol sometimes, 73.3% consumed high fat food sometime, 48.5 % consumed extra salt in their diet and 86.9% felt stress sometimes. The study showed that there is significant association between cardiovascular health risk behaviors with cardiovascular disease in family of the respondents.
Conclusion: Based on the study result it concludes that alcohol consumption, high fat food consumption and stress felt usually are the cardiovascular health risk behavior commonly found among the respondents but there is no significant association between cardiovascular health risk behavior with discipline, highest educational degree, designation, socio-demographic variables, health problems in the respondents, problems faced by the respondents within last 3 months and BMI of the respondents.
St. Paul University Manila, Philippines
Hilario Noveno has completed his PhD in Nursing Education Major in Leadership and Management from St. Paul University Manila Graduate School, Philippines. He is currently pursuing a Family Nurse Practice degree. He was instrumental in the establishment of the BLS Training Center, creation of the new BSN curriculum, formulation of several clinical and laboratory manuals in the University of Tabuk, KSA. Prior to this, he served as a Dean for a College of Nursing in the Philippines where he achieved high board exam performance in the national licensure exams and school accreditation during his leadership.
Historically, nurses have been known as persons who provide direct nursing care to individuals who are afflicted with any health condition. The passing of time and the development of new caring approaches have made a great impact on caring in the nursing profession. At present, nurses not only care for those who are afflicted with a certain health conditions, but also for people who actually need nursing care. However, caring behaviours of nurses continue to evolve with the changing of times. This research utilized an exploratory qualitative design and focused on the personal accounts of each participant on how they view caring behaviours of nurses. Participants included nurses themselves from different areas of nursing practice, patients with different stable medical conditions, relatives of patients, and other health care providers such as medical technologist and doctors. Data gathering procedures included individual interviews and focus group discussions. Data analysis utilized data reduction, data display, and conclusion drawing/verification. This research identified six (6) caring behaviour indexes categorized into social and personal caring behaviours. Social caring behaviours include perform patient-centric care, express affinitive demeanor, and exhibit reverence to individualities. Personal caring behaviours include caring behaviours for patients and for self that include practice excellent work principles, exude wisdom-built presence, and demonstrate professional influence.