Day 1 :
Keynote Forum
Louis P. Perrault
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada
Keynote: The PleuraFlow Active Chest Tube Clearance System
Time : 10:15-10:45
Biography:
Louis P. Perrault received his medical degree from University of Montreal in 1986. He completed 3 years of training in basic science research in Paris under the supervision of Professor Paul VanHoutte at Université Louis-Pasteur and obtained a doctor degree (PhD) in fundamental research in 1997. He is the current president for the CSCS.Dr. Perrault is a local Principal Investigator for the Cardiothoracic Surgical Trials Network (CTSNet) for the NIH/CIHR since 2007. He is also an investigator of the FRSQ (Fonds de la Recherche en Santé du Québec). Dr. Perrault has authored and co-authored more than 250 articles in peer-reviewed publications including New England Journal of Medicine, J Chir Thorac Cardio-Vasc, Circulation and J Heart Lung Transplant. His areas of clinical expertise include: Coronary Artery Bypass Grafting Surgery (CABG), valve surgery and heart transplantation ,endothelial dysfunction in left ventricular hypertrophy, pulmonary hypertension following CPB, stem cells therapy and heart transplantation.
Abstract:
To address the clinical consequences related to chest tube clogging, a novel chest drainage apparatus, the PleuraFlow Active Tube Clearance System (Clear Catheter Systems, Bend, OR), was developed. The aim of this world's first clinical experience study was to follow clinicians using the PleuraFlow system to assess usability issues and potential areas of improvement in the heart surgery setting.A user preference study was conducted to assess how specified users (surgeons, nurses, and intensive care physicians) used the PleuraFlow system to achieve specified goals in an efficient manner. Data were collected from patient charts and by a questionnaire that they had filled.All the surgeons (n = 7) noted that the device was not any more difficult to insert than a conventional chest tube and was easy to assemble and use. There were no reports of malfunction or complications related to the installation or use of the system. A majority, 77% (24/31), of nurses felt that the device was more time efficient than stripping, milking, or tapping the chest tubes to keep them open. A majority (16/19, 84%) of the PleuraFlow chest tubes and guide tubes were removed together in one piece within 1 day of surgery (on postoperative day 1).rnOverall, the physicians and nurses rated the PleuraFlow system positively for its ability to be incorporated into the postoperative workflow of managing the drainage of patients after heart surgery. This device may be useful to allow caregivers to be certain that chest tubes are functioning in the early hours after surgery, when active bleeding is resolving and when complications from undrained blood can ensue.
Keynote Forum
Sidney Chocron
Cardiac Surgeon University Hospital of Besancon – France
Keynote: Early Detection of Asymptomatic Bypass Graft Abnormalities Using a Cardiac Troponin I Ratio Following Coronary Artery Bypass Surgery
Time : 10:45-11:15
Biography:
Prof. Sidney Chocron is head of department of cardiac surgery in Besancon (France). He has published more than 100 papers in reputed journals. His research Interests Cardiovascular surgeries,Myocardial revascularization.He built internet websites with techniques of surgical myocardial revascularization using only the two mammary arteries (http://www.chirurgie-cardiaque-besancon.org/learncabg) and other surgical videos (http://www.chirurgie-cardiaque-besancon.org/index.php?xlpage=interventions).
Abstract:
rnTo identify the best cardiac Troponin I (cTnI) ratio to detect asymptomatic graft or anastomoses anomalies after myocardial revascularization.Patients with a rising cTnI profile, based on measurements at 6 and 12 hours (cTnI 12 hours : 6 hours ratio >1) after the last anastomosis in off-pump surgery or after cardiopulmonary bypass in on-pump surgery, underwent a coronary angiogram, despite an uncomplicated postoperative course and absence of electrocardiogram changes. The optimal threshold value for the ratio was determined using a receiving operator characteristic (ROC) curve.rnFrom April 2005 to May 2011, among 1693 patients undergoing isolated coronary artery bypass graft (CABG), 29 (1.7%) had a cTnI ratio >1 and underwent postoperative angiography. Twenty abnormalities were observed in 16 patients (55%). In the anastomoses, there were four occlusions and four stenosis. In the grafts, there were 12 stenosis: two of the Y graft anastomosis, two dissections, five hematomas and three kinking. TIMI flow grade based on results of the Thrombolysis In Myocardial Infarction trial was 3 in six patients, 1 in five, and 0 in five. In the 16 patients with lesions, the cTnI ratio was 2.1 ± 1.4 versus 1.4 ± 0.3 in patients with no lesions (p = 0.09). A ratio of 1.3 (p = 0.003) was determined by ROC curve analysis as having the greatest discriminant capacity, with associated sensitivity of 87.5% and specificity of 62%.A cTnI 12 hours : 6 hours ratio >1.3 may be indicative of these abnormalities. Early identification of these anomalies may avoid adverse outcomes. rn
Keynote Forum
Annika Odell
Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg. Sweden
Keynote: Restenosis after percutaneous coronary intervention (PCI): Experiences from the perspective of patients
Time : 11:15-11:45
Biography:
Annika Odell has completed a Master of Science in Health Care Science in Nursing 2006. PhD, 2014, at the Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg. With Tite: “Aspects on Revascularisation for coronary artery disease- from a patient, health care provider and societal perspective”. She is Head of the research unit, the development unit and the Tobacco preventive unit at the department of Cardiology at Sahlgrenska University Hospital, GöteborgrnPublications in American Journalof Cardiology, Cardiology and European Journal of Cardiovascular Nursing.
Abstract:
PCI has been established as an effective treatment for coronary artery disease. Restenosis is a recurrence of a significant narrowing in the treated vessel. Although a part of the investigative and research funding is invested in the prevention and resolving the restenosis problem, little is known about its clinical significance apart from further revascularisation.The intention of this study was to clarify the patients perspective of what it means to suffer from documented restenosis after PCI.Patients interviewed had undergone PCI. Data collection and analysis was done simultaneously according to Grounded Theory methodology and continued until new interviews provided no additional information."Living with uncertainty" was identified as the core category, and the central focus in the data explains what it means to patients' to suffer from restenosis. The core category was further illuminated in four additional categories labelled "fighting for access to care", "moderating health threats", "trying to understand" and "controlling relatives anxiety".Patients' perceptions of illness and illness-related events, such as symptoms, diagnosis, treatment and prognosis, are considerably affected by uncertainty. This infiltrates their struggle to acquire the care needed, their endeavour to comprehend and moderate health threats, and caring for their family.
- cardiovascular Rehabilitation
- Nursing Practice
- Collaborative Nursing
Session Introduction
Amanda Peat
Cabrini Hospital, Australia
Title: Man vs. Machine: A comparison of assessment of chest compressions by trained assessors compared with mannequin recording. – How research can inform practice.
Biography:
Amanda Peat currently works as the Advanced Care Educator and Simulation Educator at Cabrini Hospital in Melbourne, Australia. Within her role she is responsible for the development and delivery of the cardiovascular curriculum within her organisation. She has completed a post graduate degree in Intensive Care Nursing and is currently completing her Master of Health Professional Education. Her research in the field of Basic Life Support has been presented internationally and the systems changes, informed by her research findings, haave been adopted by multiple centres within Australia
Abstract:
The delivery of effective chest compressions is the single most important factor in positive patient outcomes following cardiac arrest (Kern et al, 2002; Iwami et al, 2012). Recent changes to Australian, American and European Resuscitation Council guidelines reinforce the need to deliver quality, uninterrupted chest compressions. Currently, all clinical staff in a major Australian private hospital are required to gain annual accreditation in basic life support (BLS). Previously, selected clinical staff were trained to assess their peers in BLS performance, however there was a lack of evidence to support whether these assessors could accurately grade the quality of chest compressions. Therefore, this study was conducted to compare assessor scores of chest compression performance with those generated by a mannequin. This study identified that trained BLS assessors are not able to accurately assess poor quality and competency in performing chest compressions. This study reinforced the use of innovative technology to improve the assessment of chest compressions with the hope to improve patient outcomes following cardiac arrest. Based upon the findings from this study, the BLS assessment method within the organisation has been reviewed and changed. The new program utilises resuscitation mannequins to provide low dose, high frequency training that provides real-time, objective feedback and negates the need to train BLS assessors or remove staff from the clinical area. This study has resulted in the development of a BLS assessment program that is both cost effective and sustainable. More importantly, the new program has an improved reliability in detecting poor chest compression competence amongst staff, provides objective assessment and feedback on performance and can ultimately have a positive impact on patient survival from cardiac arrest.
Elif Budak
BaÅŸkent University, Turkey
Title: Effects of Preoperative Individualized Education on Postoperative Anxiety and Pain on Patients Undergoing Heart Surgery.
Biography:
Elif graduated from Baskent University, Faculty of Health Sciences, Department of Nursing in 2011. She worked as a nurse at cardiovascular surgery intensive care unit for 2 years. She has completed her master degree at BaÅŸkent University in 2015. Master thesis title is “Effects of Preoperative Individualized Education on Postoperative Anxiety and Pain on Patients Undergoing Heart Surgery”. She has continued to PhD program at Gazi University, Department of Surgical Nursing. She is working as a Research Assistant at BaÅŸkent University, School of Nursing. She published two study. One of them was “Determination of the Beliefs Towards to Mental Illness in Nursing Students in Baskent University” and the other one was “Awareness of Skin Cancer, Prevention and Early Detection among Turkish University Students”.
Abstract:
Open heart surgery may produce emotional, cognitive, and physiological negative effects. This effects can be decreased with individualized education, therefore it can be reached positive patient outcomes. The study was to determine the effects of preoperative individualized education on postoperative anxiety and pain in patients undergoing open heart surgery. This 2015 quasi-experimental study included 109 patients. Data were collected using the “Data Collection Form”, “State-Trait Anxiety Inventory (STAI)”, and “Visual Analogue Scale (VAS)”. The mean age was 59.62 years. Of the patients, 69.7% were males and 92.7% were married, and 49.5% were graduated from primary school. Majority of the patients (71.6%) had concomitant coronary artery disease. Anxiety was mostly originated from lack of knowledge on surgery (70.6%), leaving the relatives (21.1%), fear of death (16.5%), and pain (15.6%). The mean preoperative state and trait anxiety scores were 34.34±9.03 and 37.98±8.28, respectively. The mean postoperative state anxiety scores were 35.94±8.92. There was no statistically significant difference in the mean pre- and postoperative state anxiety scores. However, the mean pre- and postoperative state anxiety scores were statistically significantly associated with the mean pain score. In conclusion, preoperative anxiety management based on individual patient’s characteristics in combination with individualized patient-centered education may reduce the degree of anxiety and improve postoperative healing.
Berrak Balanuye
BaÅŸkent University, Turkey
Title: The Nursing Care Process of a Patient with ECMO Device according to Gordon’s Functional Health Patterns
Biography:
She graduated from Baskent University, Faculty of Health Sciences, Department of Nursing in 2010. She worked as a nurse at cardiovascular surgery intensive care unit for 3 years. She completed her master degree at BaÅŸkent University in 2014. Master thesis title is “The Effects of Workloads of Nurses Whom Work in Surgical Clinics on Patient Safety”. She has continued to PhD program at Gazi University, Department of Surgical Nursing. She is working as a Research Assistant at BaÅŸkent University, School of Nursing. She has published two study. One of them was “The Attitude And Opinions Of Nurses Working In Operating Theaters Towards Technology And The Difficulties They Encounter ” and the other one was “Awareness of Skin Cancer, Prevention and Early Detection among Turkish University Students”.
Abstract:
ECMO (ExtraCorporeal Membrane Oxygenation) is a treatment method that has been applied to the patients with reversible cardiac or respiratory failure for temporary life support. The case study was determine the Nursing Care Process of a Patient with ECMO Device according to Gordon’s Functional Health Patterns. The patient (R.G.) who is 54-years-old male with inferior MI and PTCA applied. Cardiac support was provided with ECMO was in cardiovascular surgery intensive care unit and by monitored mechanical ventilation.The hemodynamics of R.G. was unstable and high dose of dopamine, adrenaline, lasix, heparin infusion was started. R.G.’s Glaskow Coma Scale is 9. Because of ECMO, the left arm occured compartment syndrome, the fasciotomy was made. Acinetobacter in blood, candida in the urine and pneumonia occured. He was taken in prisma dialysis machine. Braden Scale for Predicting Pressure Score Risk is 5 point, widespread ecchymosis in the coccyx, Bates-Jensen wound assesment tool was evaluated between 17-21 points. ECMO nurse follow-up in the form of parameters, in the first day of ECMO is Activated Clotting Time(ACT)=241second, Blood Pressure= 77/56mm-Hg, Revolution per minute (RPM)=6800, Flow=3.9min/L.The care was planned according to 28 nursing diagnosis under Gordon’s Functional Health Patterns. At the end of 26 days of treatment and nursing care to poor prognosis was inseparable from ECMO and R.G. died. Caring a patient with ECMO, aware of complications are important for nurses.The usage of improved ECMO nursing care guides was suggested.
Shade Akande
Stony Brook Medicine, USA
Title: Factors associated with heart failure readmissions from skilled nursing facilities
Biography:
Shade Akande has completed her Doctor of Nursing practice from Stony Brook University. NY, USA in the year 2015. She has given numerous podium presentations related to nursing practice. As a Clinician, she has the expertise, leadership and motivation to successfully contribute to the mission and values of programs and the institution as a whole. She is dedicated to continuously deliver excellent and quality care to the population with increased productivity and positive outcome, fostering education and to embrace the concept of continuous performance improvement.
Abstract:
Background: Despite guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital re-admission of heart failure patients and associated costs remain unacceptably high in the SNF populations. Transfer to SNF is one strategy to limit hospitalizations. As such, 25% of patients are still symptomatic at the time of discharge. Purpose: The objective of this study is to identify patient factors affecting re-admissions of HF patients residing in SNF within 30-days. Methods: A retrospective electronic chart review was completed on patients > 65 years with HF who were admitted into large medical center between 2012 and 2014. Descriptive statistics and univariate analyses using the Chi-square test or Fisher’s exact test for categorical variables and the Mann-Whitney test for continuous data was used to compare patients readmitted within 30 days vs. those who were not readmitted within 30 days. Significant factors associated with readmission in the univariate analysis (p<0.10) were included for a multivariate logistic regression model. Results: Fifteen variables: creatinine, weight difference, CKD, angina, arrhythmia, VHD, tobacco, ADL, independent in bathing, independent in the toilet, S3 heart sounds present, HJR, AF, nitrates, and hydralazine, were identified for the multivariate logistic regression as potential risk factors associated with “readmission within 30 days”. Creatinine and ADLs were included in the final model as this subset of predictors was found to be the best for prediction of “readmission within 30 days”. Creatinine (p<0.0087) and ADLs (p<0.0077) were both significantly associated with readmission within 30 days in the final logistic regression model. Every 1-unit increase in creatinine is associated with an 87% increase in the odds of being readmitted within 30 days (OR=1.87). Those patients who require assistance with ADLs are over 9 times more likely to be readmitted within 30 days (OR=9.25) as compared to patients who are independent.
Lars Andersen
Lancaster General Health Research Institute, USA
Title: Familial hypercholesterolemia screening: challenges and opportunities
Biography:
Lars Andersen completed his bachelor’s degree in history and pre-medical coursework at Brown University in 2015. He has since performed research on disorders of lipid metabolism, focused on familial hypercholesterolemia, familial defective apolipoprotein B-100, and loss-of-function mutations in APOC3, at the Lancaster General Health Research Institute within the Penn Medicine network. He has authored several publications on familial hypercholesterolemia screening and identification strategies for local and general populations.
Abstract:
Familial hypercholesterolemia (FH) is an inherited disorder of lipid metabolism characterized by the severe elevation of low-density lipoprotein (LDL) particles in the bloodstream. FH affects every racial and ethnic group, appearing at a rate of 1/200 to 1/500 persons worldwide. Despite its status as the world’s most common potentially deadly genetic illness, FH is highly underdiagnosed and undertreated in the United States and internationally. Without treatment FH increases the risk of cardiovascular disease to twenty times that of the general population. Cascade screening, a process of identifying affected family members of an FH index case, has been successfully executed in countries such as the Netherlands and the Czech Republic; however, the United States has fallen behind these nations in addressing FH on an epidemiological scale. Two primary factors have hindered successful screening for FH in the United States, and likely pose challenges in select countries internationally as well: disproportionately low funding allocations for FH research compared to its disease burden and strict privacy laws limiting contact with relatives of FH index cases. Cascade screening for FH has been repeatedly proven to be cost-effective in terms of quality-adjusted life years added, and serves as an opportunity to intervene early and halt the progression of atherosclerosis.
Tarun Dasari
University of Oklahoma College of Medicine, USA
Title: Peripartum Cardiomyopathy- An Update
Biography:
Tarun W. Dasari, M.D., M.P.H., is an assistant professor of medicine at University of Oklahoma College of Medicine. He is board certified in internal medicine, advanced heart failure and cardiac transplantation, cardiovascular diseases, echocardiography and nuclear cardiology. He completed a fellowship in heart transplantation and advanced heart failure at Loyola University Medical Center, Maywood, Ill., and in cardiovascular disease from the University of Oklahoma College of Medicine, where he also completed his residency and internship. He earned a master’s degree in public health from the same institute.He earned his medical degree from Osmania Medical College, Hyderabad, India.
Abstract:
Peripartum Cardiomyopathy (PPCM) is a rare cause of heart failure and remains to be a diagnosis of exclusion. PPCM is diagnosed in patients who meet the following three diagnostic criteria: development of clinical heart failure in the last month of pregnancy or within 5 months of delivery, left ventricular ejection fraction (LVEF) less than 45% and where no other obvious cause of heart failure can be found. It may occur in childbearing women of any age, but it is most common after age 30. PPCM is a rare disorder in the United States. The United States has an estimated case rate of 1 in 2500 to 4000 live birth. Traditional risk factors include: maternal age greater than 30, multiparity, multifetal pregnancy, African descent, high blood pressure, prior toxin exposure such as cocaine etc. PPCM has a poor prognosis with a high morbidity and mortality rate. The exact etiology of PPCM is still unknown. Some of the proposed mechanisms include inflammatory and prolactin mediated cardiomyopathy. Published data thus far has been limited by the small sample sizes without a comprehensive analysis of risk factors, treatment patterns, guideline recommended heart failure drug doses, echocardiographic and cardiac biomarker assessment and long term clinical outcomes.
Biography:
Syreeta Corbitt, is an Assistant Nurse Manager and provides front line leadership and nursing care for patients in the Maternal Child Health Department in Oakland, California. Syreeta has practiced nursing care for 19 years and has various clinical experience including Medical Surgical, Psychiatric Health, Women’s Health and Labor and Delivery. In 1997, she earned an Associate Degree in Nursing from Itawamba Community College. In 1999, Syreeta earned her Bachelor’s Degree from Mississippi University for Women. Syreeta is currently pursuing a dual Master’s Degree in Nursing and Business Administration from Holy Names University. She is a member of Bay Area Black Nurse’s Association, Bay Area Nursing Informatics Association and Sigma Theta Tau International Honor Society of Nurses and a student representative for HNU Student Coordinating Committee (SCC).
Abstract:
Graduate Nursing scholars from Holy Names University collaborated with a teaching hospital educator to develop three standard nursing protocols. Nurses identified the needs, wants and desire (NWDs) for developing an ECG Prn Protocol. An electrocardiogram or ECG is a common test used to record the flow of electrical current through the heart. A retrospective study uses existing data that have been recorded for reasons other than research. Health care labels as “chart reviews” because the data source is the medical record. In this study we report on the design of the retrospective patient record study on the frequency of electrocardiograms (ECGs) ordered in different units at a teaching hospital. Attention is paid to strengths and limitations of the study design. Due to lack of standardization in medical and nursing practice, the process in which ECGs are currently ordered and performed varies by unit. Changes in clinical practice guidelines (CPGs) have been found to not only be influenced by individual health professionals, but also by organizational factors. The purpose of this study is to examine the difference in frequency of ECGs ordered and performed between January and March 2016 on a Coronary Care Unit and a Medical-Surgical Unit at a teaching hospital. This protocol will allow nurses to rapidly order an ECG based upon nursing assessment and approved criteria. The ECG has valuable information based on the intensity of the heart's contractions and time intervals between those contractions for Physician’s evaluation, diagnosis and treatment. 80% ECG were ordered by RNs.
- Nursing management
Session Introduction
Pramote Thangkratok
Bangkok Heart Hospital, Bangkok Hospital group, Bangkok, Thailand.
Title: Development of Clinical Practice Guidelines for Reduce Back Pain After Cardiovascular Angiography and Interventions
Biography:
Mr. Pramote Thangkratok is Registered Nurse of Bangkok Heart Hospital, Bangkok Hospital group, Bangkok, Thailand. He Graduate Student in Master of Science Program (Public Health), Mahidol University, Thailand.
Abstract:
Back pain is quite common after Cardiovascular Angiography and Interventions. Patients are restricted to rest in bed with their foot in a straight position for 4-6 hours after the procedure due to potential vascular complications from using a femoral approach. This study aimed to develop a Clinical Practice Guidelines for Reduce Back Pain after Cardiovascular Angiography and Interventions. This Clinical Practice Guidelines was constructed based on the framework of the development of clinical practice guideline of Australian National Health and Medical Research Council. Eight articles were obtained which comprised of one systematic review, six randomized-controlled trials, and one descriptive study. The empirical evidences were analyzed and synthesized yielding the Clinical Practice Guidelines. The content and feasibility of developed Clinical Practice Guidelines was approved by three experts and corrected following their suggestion. The results showed that the Clinical Practice Guidelines for Reduce Back Pain after Cardiovascular Angiography and Interventions: (1) Early ambulation, (2) Changing patients' position in bed, (3) The Device to support the straight leg and had no application of a sandbag. The recommendation of this study is that the Clinical Practice Guidelines for Reduce Back Pain after Cardiovascular Angiography and Interventions should be implemented in practice and developed appropriately. The Clinical Practice Guidelines nurse can easily take a few are safe for patients. And the independent role of the nurse can. And should evaluate both the process and outcomes, and tailored to the context of the agency, together with the research results.
Norma caples
CNS ( Clinical nurse Specialist ) Heart Failure, University Hospital Waterford, Dunmore Road, Waterford, Ireland.
Title: The Effect of an Early Discharge Protocol Program After CABG
Biography:
Norma Caples completed her Masters in Advanced Practice Prescribing Pathway, Master of Science in 2013. As well as a nurse prescriber in medicatiob she is also a prescriber in Ionizing Radiation. She was also the Winner of the CJ Coleman Award 2011, for research. Winner of Irish HealthCare Award 2015 for education on precordial ECG lead placement.This piece of research is being submitted for publication at present. Committee member and treasurer of the Irish Nurses Cardiovascular Association. At present she is working in a nuse-led Heart Failure clinic in Ireland.
Abstract:
The wrong diagnosis can have fatal results for the cardiac patient. Up to five per cent of patients with acute myocardial infarction are missed. Cardiac biomarkers are critical in the rapid diagnosis of acute coronary syndrome. Cardiac biomarkers measures myocardial cell death. Troponin T (TnT) is a cardiac biomarker that is used to define myocardial infarct and also those at risk. A literature review revealed that there was not an algorithm for when TnT samples should be taken for in-patients complaining of chest pain. It was observed that over sixty six per cent were taken before the recommended six hours. This may lead to the potential of patients receiving a missed or wrong diagnosis. This incorporated a wasting of €13968 of the medical budget. The innovation design consists of the introduction of an algorithm for when serum TnT samples should be taken. The algorithm was formulated by Norma Caples. It would aid the person, in a step by step process, in making a decision if a TnT sample was needed and if so when it should be taken. A literature review did not show of any algorithm in existence for the taking of TnT on inpatients. A re-audit on the time of the patients’ chest and the time of when the serum TnT was taken proved that the algorithm was successful in attaining its goals. It revealed a positive relationship between the algorithm being implemented and appropriate serum TnT samples being taken. One hundred percent of the serum TnT samples were taken as per recommended guidelines.
Insil Jang
Department of Nursing, Ulsan University, Ulsan, South Korea
Title: The Effect of an Early Discharge Protocol Program After CABG
Biography:
Insil Jang has worked as a staff RN and Clinical nurse specialist of cardiovascular surgery part for 13years in Asan Medical Center. I have received a Ph.D. at the age of 35 years old and I became an assistant professor at department of nursing in University of Ulsan. My speciality is adult health nursing. My research interests are cardiovascular patient care, clilnical nurse specialists and nursing management. I already have published several papers and I am currently some ongoing some studies.
Abstract:
Purpose: The purpose of this study was to identify the effect of an early discharge protocol after coronary artery bypass graft surgery in Korea. Methods: The sample for this study consisted of 29 patients in an early discharge protocol (EDP) group and 31 patients in an conventional discharge protocol (CDP) group. The EDP group, led by the APNs, was formed to conduct a randomized controlled trial. A power analysis was performed using the outcome variable of hopital LOS. Results: Statistical analysis revealed that the EDP had discharged patients after an average of 6.87days, which was 2.39 days shorter than with the CDP. The safety of the EDP was evaluated by examining wound infection and postoperative complication in outpatient clinic. And other indicators were any emergency room visits and readmission by reviewing medical records in outpatient clinic. Although there were differences in the indicators between the EDP and CDP groups, the differences were not statistically significant, indicating that patient safety was maintained equally in the two groups. Conclusion: The results of the study levealed that an EDP program can be successfully implemented to guide best practice, reduce LOS, and reduce costs while maintaing patient safety outcomed in patients undergone CABG surgery in Korea.
Shaista Meghani
Clinical Nurse Specialist, Cardio-Pulmonary & Vascular Disorders, Aga Khan University Hospital ,Karachi, Pakistan
Title: The impact of an educational program on Knowledge, Attitude and Practices of healthcare professionals towards Family Presence During Resuscitation in an Emergency Department at a tertiary care setting, in Karachi, Pakistan
Biography:
Shaista Meghani has completed her Masters of Science in Nursing (MScN) from The Aga Khan University School of Nursing & Midwifery (AKUSONAM), Karachi, Pakistan in 2014. Currently, she is working as Cardio-Pulmonary Clinical Nurse Specialist in The Aga Khan University Hospital. She has a rich clinical experience working as a Critical Care Nurse in The Aga Khan University Hospital, Pakistan from 2004-2008 and in King Faisal Specialist & Research Center, Saudia Arabia from 2011-2012. She has published 15 papers in reputed Journals.
Abstract:
Family Presence During Resuscitation (FPDR) has remained a controversial issue since the early 1980s. The objective of this study was to evaluate the impact of an educational program on the Knowledge, Attitude, and Practices (KAP) of healthcare professionals (HCPs) towards FPDR in ED, at a tertiary care setting, in Karachi. This research study was conducted in the ED of a private tertiary care hospital in Karachi, Pakistan, and a quasi-experimental Pre-test and Post-test design was used. Universal sampling was done, and all ED nurses and physicians were selected for the study. The KAP of nurses and physicians were assessed before (pre-test), immediately after (post-test I), and at two weeks’ interval (post-test II), after the intervention. One hour of same educational program was offered as an intervention to both nurses and physicians separately. The findings of the study revealed that the mean scores of knowledge and attitude of HCPs at all three points (pre-test, post-test I, and post-test II) were found to be a statistically significant (p-value=0.05). Hence, the implementation of an educational program was found effective in improving knowledge and in changing the attitude of HCPs, whereas, practice remained unchanged. Moreover, studies need to be conducted in other hospital settings to evaluate the impact of such a program in other settings, and to explore HCPs’, families, and patients, perspectives regarding FPDR. Moreover, training modules need to be developed for the staff, and formal guidelines need to be proposed for FPDR, which should be structured through a multidisciplinary team approach, to expand the concept of FPDR in hospitals.
Li-li wang
Student ,Nursing School of Soochow University, Suzhou 215006, China
Title: Effectiveness of Voluntary Breathing Exercise on Cardiac Parameters and Quality of Life of Coronary Heart Disease Patients undergoing Percutaneous Coronary Intervention
Biography:
Li-li Wang is a student for master degree at Nursing School of Soochow University.
Abstract:
Objective: To evaluate the effectiveness of voluntary breathing exercise (VBE) on cardiac parameters and quality of life (QoL) of coronary heart disease (CHD) patients undergoing percutaneous coronary intervention (PCI). Method: From September 2015 to February 2016, CHD patients undergoing PCI from Cardiology Department of a hospital in Suzhou were randomly divided into non-VBE group (n=12) and VBE group (n=18). All patients received regular care. VBE group exercised using diaphragm breath, the ratio of expiration/inspiration >1, at least 6 breaths/min, 30 min/d and 5 days/w for 1 month. Cardiac parameters included heart rate (HR), Rate-pressure-Product (RPP), systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP). Cardiac parameters and QoL were compared at enrollment and one month. Results: There were no significant differences in cardiac parameters and QoL at baseline between two groups. Compared with the non-VBE group, VBE group had lower HR, RPP and SBP (72.83±7.11 vs. 81.50±8.03, P<0.01; 9182±1118.60 vs. 11178.92±1775.86, P<0.01; 126.28±11.97 vs. 136.67±12.68, P<0.05). Compared with baseline, the non-VBE group’s HR and RPP at one month increased significantly (5.17±5.62, P<0.01; 978.58±981.48,P<0.01), whereas HR and RPP in the VBE group reduced statistically (-4.56±56.24, P<0.01; -697.94±1325.16, P<0.05). QoL of the VBE group was significantly improved (87.61±12.75 vs 70.33±14.13, P<0.01) compared with that of the non-VBE group. QoL at one month was significantly improved compared with baseline in VBE group (13.89±11.05, P<0.01), whereas the same change was not seen in the non-VBE group. Conclusion: VBE can improve cardiac parameters and QoL in CHD patients undergoing PCI.
Biography:
Dr. Jacob DeLaRosa is the chief of Cardiac Surgery at Portneuf Medical Center in Pocatello, Idaho. Soon after completing his cardiothoracic training at the prestigious Emory University in Atlanta, Dr. DeLaRosa was heavily recruited in 2004 to start the heart program in Idaho. Dr. DeLaRosa has brought world-class heart care to Southeast Idaho and was the first small city/rural hospital to introduce Transcatheter aortic valve replacement surgery, (TAVR) in the United States. Dr. DeLaRosa has made hundreds of national and international presentations, authored multiple journal articles, text books, and books. Dr. DeLaRosa was featured in People Magazine for doing open heart surgery on a 1-pound Yorkie, (Operation Yorkie).
Abstract:
Dr. DeLaRosa was asked to give a TED talk based from his book The Heart Surgery Game Plan, on how positive energy by just a smile can enhance healing not only with cardiovascular patients, but in everyone we encounter. The TED talk was on April 2, 2016 He believes this is a message that needs to be shared to all healthcare providers that interact with patients before and after surgery. “By changing a patients mindset there is a shift in the patients energy. Why is this so important? I believe it does not matter how many valves, or bypasses, or what the treatment protocol is to be, without changing the patients mindset healing will fail!” Dr. DeLaRosa shares his own personal tragedy with getting hit by a car at freeway speed while jogging and how his own personal story has led to this understanding.
John P. Higgins
The University of Texas at Houston,USA
Title: Smartphone Applications for Patients’ Health and Fitness
Biography:
John P. Higgins is an Associate Professor of Medicine at The University of Texas Medical School at Houston, Chief of Cardiology at Lyndon B. Johnson General Hospital, and Director of Exercise Physiology, Institute for Sports Medicine and Human Performance, Memorial Hermann. He is also a Sports Cardiologist and works with the Houston Rockets and Rice Athletics. Dr. Higgins received his medical degree from the University of Queensland, Australia. He holds a Masters in Philosophy from the University of Cambridge, England; and an M.B.A. at The George Washington University, Washington, DC graduating with Honors & Inducted into Beta Gamma Sigma, The International Honor Society, recognizing business excellence. He completed an Internal Medicine Residency (University of Missouri-Columbia, MO), a Cardiology Fellowship (Brigham and Women's Hospital-Harvard Medical School, Boston, MA).
Abstract:
Healthcare providers are often looking for ways to objectively monitor and improve their patients’ health and fitness, especially in between patient visits. Some insurance companies are using applications data as incentives to improve health and lower premiums. As more and more people start to use smartphones, they may provide a tool to help improve a patient’s health and fitness. Specifically, fitness applications or “apps” on smartphones are programs that use data collected from a smartphone’s inbuilt tools, such as the Global Positioning System, accelerometer, microphone, speaker, and camera, to measure health and fitness parameters. The apps then analyze these data and summarize them, as well as devise individualized plans based on users’ goals, provide frequent feedback, personalized coaching, and additional motivation by allowing milestones to be shared on social media. This article introduces evidence that apps can better help patients reach their health and fitness goals. It then discusses what features to look for in an app, followed by an overview of popular health and fitness apps. Last, patient scenarios with app recommendations, limitations of apps, and future research are discussed.
Mona Abed El-Rahman
Port Said University, Egypt
Title: The Application of Alcohol Brief Intervention Using the Health Belief Model in Hospitalised Alcohol Use Disorders Patients.
Biography:
Dr. Mona has completed his PhD at the age of 37 years from Suez Canal University and workek in Zarqa University from 2006 to 2014. He is the lecture of medical surgical nursing in Egypt and Jordon. She has published 8 papers in reputed journals.
Abstract:
Aim: To examine the effect of implementing a brief alcohol intervention, using the heath-belief model, on the perception of susceptibility, severity, benefits, and barriers. Method: This pre-test post-test interventional study recruited 70 alcohol use disorders patients residing in the addiction centre in Amman-Jordan. The programme consisted of three 30-minuts sessions and included an introduction about alcohol abuse, orientation of the consequences of alcohol addiction, and practices towards promoting self-motivation. Data were collected before and two weeks after the intervention using a questionnaire of 58 items covering all the health-belief model components which were mentioned earlier. Results: Fifty seven out of 70 patients completed all study phases. After receiving the intervention, patients had improved their knowledge about factors triggering alcohol addiction including stress and tension. They showed better understanding of physical harms caused by addiction such as brain, heart, and liver damaging. Self-awareness of controlling the environmental factors and self-rewarding as attempts for quitting alcohol addiction had also increased. Lack of supportive systems such as families, care providers, and media were viewed as influential factors for quitting alcohol. On overall, perceived severity and benefits had shown a significant improvement after the delivery of intervention while perceived susceptibility and perceived barriers did not change over the study duration. Conclusion: Brief heath education for hospitalised alcoholic patients can increase patients' ability to clustering variables anticipating and triggering alcohol addiction. In addition, it increases selfawareness of factors impending alcohol quitting.
Gladys Saburi
University of Zimbabwe, Harare, Zimbabwe
Title: Knowledge of Cardiovascular disease risk factors in women aged 20-70 years with Diabetes Mellitus at a Central Hospital in Zimbabwe
Biography:
Gladys Saburi completed Masters in Nursing Science, Medical/Surgical Nursing at the age of 50 years from the University of Zimbabwe. She taught in various diploma schools of nursing for over 25 years. In 2003, she joined the Department of Nursing Science, College of Health Sciences, University of Zimbabwe as a lecturer. She was departmental Chairperson from 2010 to 2011, visiting lecturer at Ohio State University and University of Toronto in 2007 and 2011 respectively. She retired in December, 2013. Gladys has published 8 papers in refereed journals and is also a reviewer.
Abstract:
The purpose of the study was to assess the knowledge of cardiovascular disease risk factors in women aged 20 to 70 years with diabetes mellitus at a central hospital in Zimbabwe. A purposive sample of 67 women with diabetes mellitus, attending a diabetes clinic participated. An interview schedule, comprising of sixteen risk factors, adopted from the 25 item Heart Disease Fact Questionnaire and eight items, derived from literature, was used to measure heart disease risk factor knowledge and the link between diabetes and heart disease. Descriptive statistics, Pearson product moment correlation test and regression analysis was used to analyze data, at a significance level of < 0.05. Knowledge of cardiovascular disease risk factors was low (mean score =13.4, SD=5.7, range 0-21 out of 24), compared to earlier findings among Spanish speakers with diabetes mellitus (mean score =17,5, SD=5, range 0-24). Only residence was predictive of knowledge of cardiovascular disease risk factors (r= 0,308, p <.05. Thus residence is associated with increased knowledge. The effect of residence (R2 = .095, F = 6.811, p = < .05), explained 9.5% of the variance in knowledge of cardiovascular disease risk factors. The results showed that women with diabetes had low knowledge of established cardiovascular disease risk factors, mainly diet, family history and smoking. Provision of culturally relevant education should be prioritized to reduce cardiovascular disease risk in women with diabetes in Zimbabwe.
Biography:
Dr. Byron K. Lee graduated from Harvard Medical School and trained in internal medicine, cardiology, and cardiac electrophysiology at Stanford University Medical Center. Currently, he is the Medical Director of the UCSF Electrophysiology Laboratory and Clinics. He has published over 150 books, articles, abstracts, and chapters.
Abstract:
Every July, new residents and fellows arrive at hospitals across the country and are asked to immediately perform complex procedures on unstable, critically ill patients. Is this the wisest way to educate our young doctors? How dangerous is this first month of training for our patients? Are there more complications? Do the procedures take longer? Are the overall outcomes poorer? We will discuss how nurses make this annual transition smoother and safer.
Darla K. Topley
Nurse at Academic Healthcare systems
Title: Let’s Move It: Progressive mobility in the cardiac intensive and acute care environment
Biography:
As a retired military nurse, She has travelled the world being involved with many types of health care systems. Presently she is working in academic health care system that is patient centered involved in improving the health care. My nursing expertise is in critical care nursing where she believe patient mobility can improve patient outcomes and standard work via a multidisciplinary team approach. Currently she is a CNS in a cardiac thoracic ICU. She has published articles, research and presented at conferences on patient mobility.
Abstract:
A nurse-driven progressive mobility protocol was developed and implemented in a thoracic cardiovascular intensive care, coronary intensive care and thoracic cardiovascular acute care unit evaluating the impact on ventilator associated pneumonia, ventilator days, pressure ulcers, venous thromboembolism, discharge placement, length of stay and the number of patient falls. A multidisciplinary team approach was used to develop progressive mobility guidelines, protocol, education and interventions for 3 different patient care units. Several techniques were used to educate unit staff and implement the protocol. In-services, demos and hands on methods were used for education. In addition, mobility champions, laminated charts, incentives and a physician champion were approaches used for implementation. Research on immobility has found muscle weakness and wasting to be the most prominent complications responsible for disability in patients evaluated after discharge. Up to 60% of discharged critically ill patients may have long-term complications inhibiting them from complete functional recovery. In fact, critically ill patients who are on strict bed-rest have a decline of 1% to 1.5% per day and up to 50% of total muscle mass in 2 weeks. Prolonged immobilization of patients in intensive care contributes to the risk of ventilator associated pneumonia; weaknesses associated with immobility have been associated with deep vein thrombosis, falls, and pressure ulcers. Studies have been published demonstrating that early mobilization contributes to an improvement in patients’ quality of life, endurance, and facilitated early weaning from the ventilator. Exercising patients may be challenging, but with a dedicated interprofessional team and protocols, early mobility has been found to be safe.
- Cardiovascular Diseases
Session Introduction
Ram Bedi
Affiliate Assistant Professor,Department of Bioengineering,University of Washington, Seattle WA
Title: Detection of Subclinical Atherosclerosis to Guide Prophylactic Medical Intervention
Biography:
Dr. Bedi is an Affiliate Assistant Professor at the Bioengineering Department, University of Washington, Seattle, and serves on the Screening Committee of WINGS, a non-profit angel network that facilitates seed and early stage investments for medical technology companies in Washington State. His professional interests include development of ultrasound based instruments for the detection of subclinical atherosclerosis and neovasculature associated with tumours. Bedi has provided engineering consulting services to leading firms engaged in industrial and medical applications of ultrasound for over 25 years. Bedi completed his Ph.D. in electronics engineering at the University of Wales, UK, and his executive M.B.A. at the University of Washington, Seattle.
Abstract:
The objective of this talk will be to discuss subclinical atherosclerotic cardiovascular disease (ASCVD) detection using B-mode ultrasound, with special emphasis on the incremental value of performing imaging in multiple peripheral arteries, and to compare imaging findings with traditional risk factors for medical intervention eligibility. A simplified metric of atherosclerotic disease burden (FUster-Narula or FUN Score) has been developed from 3D imaging data by summing intima-media volume (IMV) over 5cm arterial segments. Effectiveness of ASCVD prevention guidelines to direct therapy will be compared to results from direct imaging. Data from two North American clinics (n=481, mean age 59.68±11.95, 39% female) showed that 203 subjects (42%) had carotid plaque; 82% of whom would not have qualified for lipid lowering therapy under the ATP III Guidelines. Using the recently published ATP IV Guidelines, 33% of the individuals with carotid plaque would also have failed to qualify for treatment. It will be shown how B-mode ultrasound examination improves identification of individuals who could be targeted for prophylactic medical intervention as an adjunct to traditional risk factor assessment.
Erin Flaherty
Boston College, USA
Title: The association of genetics, sleep and cardiovascular disease
Biography:
Erin Flaherty has completed her Bachelor’s and Master’s degrees at the Connell School and then served as a Nurse Practitioner for three years in the US. She has returned to BC as a Doctoral student in the Connell School and is a Resident Assistant.
Abstract:
Background: Cardiovascular disease is the most common cause of death in the United States and has been declared by the Centers for Disease Control and Prevention as a public health issue since 2004. Genetic factors related to sleep and circadian rhythms appear to contribute to CVD risk and disease progression. Objective: The purpose of this integrative review is to summarize the state of science regarding the association between genetics of cardiovascular disease prevention and circadian rhythms. Methods: A comprehensive literature search was conducted in consult with a reference librarian. A two-level search strategy was employed. The records of six electronic databases were searched from the past five years (2012) through the present. Searches were conducted with the terms cardiovascular disease, prevention, genetic and circadian rhythm. An integrative review guided by the Public Health Prevention Model was performed to summarize the state of science on circadian rhythms and CVD prevention. The study selection, data extraction and validation were performed independently by one reviewer. Results: Eight manuscripts were included in the final review. The results of this study showed that clock genes (BMAL1, Per2-13 and Cry 1-2) were affected by temporally restricted feeding, which appeared to cause an increase in obesity and a phase-shift in circadian gene expression. Alterations in clock core genetics can contribute to obesity. Clock core genes also play a role in glucose metabolism by affecting the pancreas through secondary effects of increased cell division and replication. Melatonin is an antioxidant under circadian regulation that can help to counter cellular changes contributing to obesity and CVD. Clock genetic makeup contributes to the effectiveness of dietary interventions in metabolic syndrome. Circadian genetics contribute to day and night time blood pressure differences as well as stroke risk from hypertension. Conclusions: Human sleep/wake cycles, otherwise known as circadian rhythms, appear to have a strong influence on both genetic and environmental components of CVD. Patient populations at higher risk for circadian desynchronization such as nurses, military personnel and other shift workers should be evaluated by clinicians for primary and secondary prevention of accelerated aging and CVD risk.
A.Teddy Weiss
Hadassah University Hospital,Jerusalem,Israel
Title: TED-a low-cost Time and life-saving automatic External Defibrillator for home
Biography:
Prof. Teddy Weiss has completed his MD in 1974 from Hebrew University School of Medicine and cardiology at Hadassah hospital in 1976 and postdoctoral studies at Cedars-Sinai cardiology center in Los-Angeles in 1984 .Since than he is a fellow of the American College of Cardiology. He was the director of the coronary care unit at Hadassah for 30 years and is the co-chairman of the Jerusalem Cardiology Chapter for the last 25 years. He is now the director of the Cardiac Rehabilitation center at Hadassah hospital and has published more than 250 papers in reputed journals with a great impact on nuclear and interventional cardiology and early pre-hospital thrombolysis for acute myocardial infarction
Abstract:
Sudden cardiac death(SCD)-caused by ventricular fibrillation(VF) or standstill- occurs in about 1000 persons/day in US alone. Since survival drops by 10% for every minute delay- no ambulance in the world will be quick enough to save them. The existing AEDs, that are now distributed in public places are not a good solution for home-use, due to their high cost for battery and capacitor not needed in TED. Our TED device modifies by computer the sinusoidal alternating electrical current from the mains to a biphasic defibrillatory wave and its cost-affordable to every household. In addition -it can pace the heart in case bradycardia or standstill caused SCD or it occurred after the electric shock.. In order to prove the safety and feasibility of TED -we performed 2 animal experiments: in the first-we used 5 pigs: defibrillation of stable VF after 15 seconds was applied by TED or by a standard AED. Defibrillation was successful by both devices and thresholds were found to be similar. The second experiment used a rat model: six rats, underwent a mid LAD coronary closure and 3 months later VF was induced and TED defibrillation and external pacing was successfully achieved using TED in all ,at a heart rate above their rate, for an unlimited time before and after defibrillation. We conclude that modified alternating shock delivered by our device-TED- is feasible and as effective as that of the standard AED. This low-cost new technology should be used to prevent sudden cardiac arrest occurring at home/office .
Abdallah M. Almaghraby
Department of Cardiology – University of Alexandria - Egypt
Title: A catastrophe caused by central venous catheter insertion – A case report
Biography:
Abdallah Almaghraby has completed his Master degree in Cardiology and Angiology at the age of 31 years from University of Alexandria – Egypt and he was a resident of Cardiology and Angiology for 5 years in the same university. He has about 5 published case reports and more than 10 preserntations in different conferences and meetings around the world.
Abstract:
Central venous catheterization (CVC) is a routine technique done in critical care and emergency departments for monitoring patients and giving certain parenteral medications in special conditions.A 50-year-old male patient with no previous medical history presented to our hospital complaining of high grade fever with gradual onset and stationary course with no response to antipyretics and antibiotics for 1 week. Work-up for fever was unremarkable, mild renal impairment was accidentally diagnosed with Creatinine level of 2.8 mg/dl, fever subsided after giving intravenous antibiotics for 3 days then the patient developed hypotension, blood pressure was 70/40 mmHg, heart rate was 140 beats per minute, electrocardiogram showed sinus tachycardia, liver enzymes were elevated, serum bicarbonate level was very low so the intensive care specialist inserted a central venous catheter to guide his fluid status control, central venous pressure was very low so he received intravenous fluids together with the antibiotics. Chest X-ray was done a day later after central venous catheter insertion and astonishingly we found the introducing guide wire left inside his heart starting from the right internal jugular vein towards the right atrium and ventricle making a loop inside the pulmonary artery then down through the inferior vena cava towards the hepatic vein. The lost wire was retrieved blindly without fluoroscopic guidance and follow-up X-ray showed no residual wire parts, then he was referred to us for echocardiography and we found severe tricuspid valve regurgitation with no signs of chronicity with perforation of the anterior leaflet, no visible vegetations or thrombi, right and left ventricular systolic and diastolic functions were completely normal and no pericardial effusion. Two days later the patient was referred to us again for follow up as he was still hypotensive with elevated central venous pressure. The new echocardiography revealed severely reduced left ventricular systolic function with borderline dimensions and reduced right ventricular systolic function with normal dimensions.
Guy fontaine
Université Pierre et Marie Curie 75013 Paris
Title: Advances in the understanding of inherited Cardiomyopathies
Biography:
Guy H Fontaine has made 15 original contributions in the design and the use of the first cardiac pace makers in the early 60s.He has serendipitously identified ARVD during his contributions to antiarrhythmic surgery in the early 70s. He has developed the technique of Fulguration to replace surgery in the early 80s. He has been one of the 216 individual who has made a significant contribution to the study of cardiovascular disease since the 14th century, one of the 500 greatest geniuses of the 21th century (USA Books), one of the 100 life time of achievement (UK Book). He has 900+ publications including 201 book chapters. Reviewer of 17 scientific journals both in basic and clinical science. 11 master lectures of 90’ each in inland China in 2014. He has developed new techniques of hypothermia for neurologic brain protection in OHCA, stroke and spinal cord injury.
Abstract:
Arrhythmogenic Right Ventricular Dysplasia (ARVD) is mostly due to PKP2 desmosomal mutation with increased RV size with apoptotic thinness of the free wall and segmental anomalies of contraction. This is also due to the presence of fat and interstitial fibrosis mostly observed in the RV free wall and LV apex. This disease is frequent in the general population but become clinically apparent in a small number of cases. Clinical presentation is mostly ventricular arrhythmias which can lead to unexpected sudden cardiac death especially in young people and during endurance sports. Some of these patients seen at a late stage of the disease can be misclassified as IDCM. Brugada syndrome (BrS) has a unique ECG pattern of coved type observed only in lead V1. Structural changes are sometimes suggesting ARVD. However, BrS and ARVD are two different entities with some degree overlap both phenotypically and genotypically in a small number of cases. Right Ventricular Outflow Tract Ventricular Tachycardia (ROVT VT) is generally benign but one personal case of SD with pathologic documentation demonstrated a localised infundibular anomaly suggesting localised ARVD. Hypertrophic Cardiomyopathy (HCM) is produced by a genetic mutation in the contractile molecules of the heart producing hypertrophy of myocardial fibres with disarray. It is also a major cause of SD during sports Idiopathic Dilated Cardiomyopathy (IDCM) is mostly due to multiple genetic mutations lamin and myosin affecting myocardial force of contraction. All of these cardiomyopathies can be affected by superimposed myocarditis which is frequently the determinant of prognosis.
Stephen F. Vatner
Cardiovascular Research Institute, Rutgers-New Jersey Medical School, NJ, USA
Title: Overexpression of Cardiomyocyte Alpha1A-Adrenergic Receptors Protects the Ischemic Heart by Inducing Angiogenesis Through Heterocellular Signaling
Biography:
Dr. Stephen F. Vatner, M.D. currently working as an University Professor of Cell Biology and Molecular Medicine, and he is the Director of Cardiovascular research Institute, Rutgers University- New Jersey Medical School. In past, he worked as a Professor of Medicine at Harvard Medical School.
Abstract:
Four to six weeks after permanent coronary artery occlusion (CAO), transgenic (TG) rats with cardiomyocyte-specific α1A-AR overexpression had better preserved left ventricular ejection fraction and wall stress with less myocardial fibrosis and hypertrophy than their non-transgenic littermates (NTLs). We reasoned that with total permanent CAO, in a model devoid of preformed collateral vessels, that the salutary response to CAO must have involved angiogenesis. Indeed, coronary blood flow, measured with microspheres, increased in the infarct zone in TG compared to NTLs (1.4±0.2 vs. 0.5±0.08ml/min/g) (p<0.05), which is consistent with angiogenesis, as reflected by a 20% increase in capillary density in the zone adjacent to the infarct. The question arose, how does TG overexpression of a gene in cardiomyocytes affect the coronary blood vessels to induce angiogenesis? We identified a paracrine mechanism, whereby vascular endothelial growth factor-A (VEGF-A) mRNA and protein were increased in isolated TG cardiomyocytes, and also by NTL cardiomyocytes treated with an α1A-agonist, resulting in angiogenesis. Conditioned medium from cultured TG cardiomyocytes enhanced human umbilical vein endothelial cell (HUVEC) tubule formation, which was blocked by an anti-VEGF-A antibody. Moreover, improved cardiac function, blood flow and increased capillary density after chronic CAO in TG rats were also blocked by a VEGF-A inhibitor. Thus, cardiomyocyte-specific overexpression of the α1A-AR resulted in enhanced cardiomyocyte VEGF-A expression, which stimulates angiogenesis via a paracrine mechanism involving heterocellular cardiomyocyte/endothelial cell signalling, protecting against heart failure following chronic CAO.
Yosef Blaer
Department of Cardiology, Barzilai University Medical Center, Ashkelon, Israel.
Title: Transient Ventricular Fibrillation, is it a real possibility?
Biography:
Dr. Yosef Blaer RN, has completed his M.Sc. from Tel Aviv University, Israel and PhD from Mind Body Medical University, Natural Health Science, California. USA. He is the supervising nurse of the Cardiology Department at the Barzilai Medical Center, Ashkelon which is affiliated to the Ben-Gurion University of the Negev, Israel. ACLS instructor. He has published more than 30 papers in reputed journals. One of the founders of the Cardiac Nursing Association in Israel. Emeritus Member of the European Society for Cardiac Nursing (NFESC). Lecturer of Cardiovascular physiology at the Nursing Division, Tel Aviv University, Israel
Abstract:
At least 400,000 people in the United States die suddenly every year from coronary heart disease (CHD). The leading cause of cardiac death is malignant arrhythmia such as ventricular fibrillation (VF). The precipitating causes are poorly understood. VF in humans is generally sustained (SVF) which results in death, unless effective artificial defibrillation is applied within minutes. Spontaneous reverting of VF to sinus rhythm is very rare. Sporadic cases of transient ventricular fibrillation (TVF) reported in English literature. The description of human TVF is rare clinically and can be founded in sporadic cases unrelated to any known cardiac or non-cardiac etiology: triggered automatically, idiopathic, local cardiac activation, structurally normal human heart. The same authors described that the cardiologists offered self-terminating VF to 15.6% of ventricular tachyarrhythmias. The AHA/ACC guidelines don't specify the ideal professional level of the monitor watcher, but highly recommend that staff receive formal education related to the monitoring system, goals of monitoring, and ECG interpretation. Early recognition of lethal dysrhythmias and quick action give the patient a best chance to survive. Finally, it is well-established fact, that arrhythmia monitoring with immediately available defibrillation has improved survival and patient outcomes. A TVF may represent in some patients in clinical practice. The patient survive "silent", un witnessed TVF remained at risk for sudden death and a preventive therapy must be established.
Wenger Nanette K
Professor of Medicine (Cardiology) Emeritus,Emory University School of Medicine,Consultant, Emory Heart and Vascular Center
Title: Transforming CVD Prevention for Women
Biography:
Dr. Wenger is Professor of Medicine in the Division of Cardiology at the Emory University School of Medicine. She is a Consultant to the Emory Heart and Vascular Center. Coronary heart disease in women is one of Dr. Wenger’s major clinical and research interests. She chaired the U.S. National Heart, Lung, and Blood Institute Conference on Cardiovascular Health and Disease in Women. Dr. Wenger has expertise in cardiac rehabilitation. She chaired the World Health Organization Expert Committee on Rehabilitation after Cardiovascular Disease, and co-chaired the Guideline Panel on Cardiac Rehabilitation for the U.S. Agency for Health Care Policy and Research.
Abstract:
The transformation of cardiovascular disease prevention for women must address that a number of nontraditional atherosclerotic cardiovascular disease risk factors are unique to or predominant in women. As well, many traditional atherosclerotic cardiovascular disease risk factors impart differential risks for women and for men. Gender-specific risk assessment and management have the potential to improve atherosclerotic cardiovascular disease outcomes in women.
Mohamed Soliman
Catharina Hospital, Eindhoven, The Netherlands
Title: Postoperative renal replacement therapy and long-term outcome after cardiac surgery
Biography:
Mohamed Soliman is a cardiothoracic surgeon in the Catharina Hospital in Eindhoven. Moreover, he is the head of the cardiac surgery research department. He completed his PhD from Maastricht University in the Netherlands. He has published more than 70 papers in reputed journals mostly about risk stratification in cardiac surgery.
Abstract:
In the present study, we investigated the survival of patients who received postoperative renal replacement therapy (RRT) after cardiac surgery. We specifically focused on factors predicting long-term outcome in elderly patients. Data of all patients that received unintentional renal replacement therapy following cardiac surgery between 2004 and 2010 were analyzed. Logistic- and Cox regression analyses were performed to detect the predictors of early and late mortality respectively. During the study period, 11 899 patients underwent cardiac surgery in our centre. Postoperative RRT was performed in 138 patients (1.2%). In this group of patients, thirty-day mortality included 72 patients (52%) and the total overall mortality included 107 patients (77.5%). Regression analyses revealed that age predicted 30-day mortality [Odds ratio=1.08 (1.03-1.12)] as well as late mortality (Odds ratio=1.05 (1.02-1.07). Patients requiring RRT after cardiac surgery have a poor prognosis with a high mortality. Older age predicted both 30-day and late mortality in these patients.
Luigi Gianturco
Galeazzi Orthopedic Institute, GSD Foundation, Milan, Italy
Title: Cardiovascular and autoimmune diseases in females: the role of microvasculature and dysfunctional endothelium
Biography:
Luigi Gianturco has completed his graduation in Medicine and Surgery at the age of 25 years from Sapienza University of Rome (Italy) and post-graduation specialty in Cardiology from the same Sapienza University University School of Medicine. In 2009 he has achieved the Master fo Sciences in Echocardiography practice for clinic from Milan University School of Medicine. He is actually the Assistant Director of Cardiology Unit in Galeazzi Orthopedic Institute of Milan (Italy) and Assistant Clinic Director in the same Hospital. He has published more than 10 papers in reputed journals and has been serving as an editorial board member of repute. Moreover, he is the Chief of Biomedical Commission in Italian Soccer Referees Association.
Abstract:
Cardiovascular (CV) diseases are becoming increasingly frequent and associated with a high incidence of CV events, disability and death. It is known that there is a relationship between CV burden and systemic autoimmune diseases (SADs) that is mainly due to inflammation and autoimmunity, but the other mechanisms underlying the high CV risk of SAD patients have not yet been fully clarified. The aim of this review article is to discuss some of the specific factors associated with the accelerated atherosclerosis (ATS) characterising SADs (female sex, the microcirculation and the endothelium) in order to highlight the importance of an early diagnosis and the prompt implementation of preventive measures, as well as the possible role of new therapeutic strategies such as vaccine immunomodulation. Finally, as the natural history of ATS begins with endothelial injury (a potentially reversible process that is influenced by various factors) and microvascular damage plays a central role in the etiopathogenesis of SADs, it underlines the crucial need for the development of reliable means of detecting sub-clinical abnormalities in the microcirculation, particularly coronary microcirculation dysfunction.
- Cardiovascular Epidemiology
Session Introduction
Pedro Jose
The George Washington University School of Medicine & Health Sciences,Washington, DC 20052
Title: The importance of the gastrorenal axis in the control of body sodium homeostasis and blood pressure
Biography:
Dr. Pedro A. Jose received his MD from the University of Santo Tomas, Philippines and PhD in Physiology from Georgetown University, Washington, DC. The primary goal of his research is to determine the epigenetic, genetic, and pharmacogenetic bases of essential hypertension and metabolic syndrome. He has published over 380 scientific articles in book chapters and journals. His Hirsch-index is 49. He has received several academic awards, including the 2003 Lewis K. Dahl Memorial Lecture (American Heart Association), 2007 Ernest H. Starling Distinguished Lecture (American Physiological Society), 2007 MERIT award (NIH), and 2015 Excellence Award for Hypertension Research (American Heart Association).
Abstract:
In order for normal sodium balance to occur, the amount of sodium that is ingested must equal the amount of sodium that is excreted, mainly in the urine. One mechanism by which sodium balance is regulated involves the sensing of ingested sodium by gastrin secreting cells (G-cells) in the stomach. An increase in intracellular sodium concentration in G-cells in the stomach, in conjunction with D1-like dopamine receptors, increases the transcription and secretion of gastrin. Of all the gut hormones released into the circulation, gastrin is the one that is taken up to the greatest extent by renal tubules. Gastrin transported into renal proximal tubules enhances the renal uptake of circulating L-3,4-dihydroxyphenylalanine which is decarboxylated to form dopamine. Gastrin, via the cholecystokinin B receptor, and dopamine, via its five dopamine receptor subtypes (D1R, D2R, D3R, D4R, and D5R), decrease renal tubular sodium reabsorption, in part, via inhibition of NHE3 and Na+, K+-ATPase activity, resulting in a natriuresis. Excess sodium is excreted and blood pressure remains in the normal range. However, in the presence of variants of G protein-coupled receptor kinase type 4, dopamine receptors (D1R and D3R) are desensitized, impairing their ability to inhibit renal tubular sodium transport. When excess sodium is retained and is not buffered in the interstitial space/lymph, blood pressure increases. Understanding the role of genes and gene-gene and protein-protein interaction in the regulation of renal function and blood pressure may lead to the tailoring of anti-hypertensive treatment based on genetic make-up (pharmacogenomics).
John James
Patient Safety America, Houston, 77062, USA
Title: Potassium and Magnesium – Essentials for Cardiac Performance
Biography:
After retiring from NASA in 2014, Dr. James has devoted full-time efforts to improving patient safety with special attention to collaborative projects involving physicians, nurses, and patients. He is the author of A Sea of Broken Hearts (2007) and co-editor of The Truth about Big Medicine (2015). The latter was a collaborative effort involving medical doctors, nursing leaders, and patient advocates. In 2013 he published a paper entitled “A new, evidence-based estimate of patient harms associated with hospital care†in the Journal of Patient Safety. It is the most cited paper ever published in that journal.
Abstract:
Potassium and magnesium are essential electrolytes for optimization of cardiac function, especially when the heart is stressed by physical demands, structural abnormalities, or emotional situations. A seminal case study of the tragic interplay of these factors will be described in a young runner, beginning at the molecular level. From the molecular level, the effects on the electrical performance of the heart will be characterized as the gateway to life-threatening arrhythmias, including numerous ectopic beats (premature ventricular contractions), prolongation of the corrected QT interval, and high dispersion of the QT intervals evident in the electrocardiogram. Medical guidelines from the National Council on Potassium in Clinical Practice and diagnostic criteria for long QT syndrome related to the case study will be described. Attention will be drawn to the diurnal variation of potassium levels as a masking-factor for life-threatening arrhythmias. Ultimately, data from studies in potassium-depleted animals will show that cardiac lesions characteristic of morphological injury to the heart, namely foci of heart-cell necrosis infiltrated by mononuclear cells and having early evidence of fibrosis, occurred with potassium depletion in the case study. This harmful effect on the heart is not well known. The present case study demonstrates the general need for more attention to electrolytes in cardiac function, especially to depletion of potassium and magnesium. Factors leading to depletion of these electrolytes will be surveyed. These include diuretic medications, intense exercise in hot climates, and diets lacking foods rich in potassium and magnesium.
Mavis Amankwah
MCPHS University, Worcester, MA 01608, USA
Title: Lifestyle Modification in African American Population with Hypertension
Biography:
Mavis Amankwah completed her BSN in May 2013 from MCPHS University and is currently a Family Nurse Practitioner student at MCPHS University expecting to complete her degree in May 2016. She works at Vibra healthcare in Rochdale, Massachusetts as a registered nurse. She is the vice president of Rescue Crusader Inc. in Worcester, Massachusetts.
Abstract:
Hypertension is a common and chronic condition and it affects the African American population more than other ethnic groups. Approximately 8,000 deaths occur annually from heart disease and stroke among African Americans as a result of uncontrolled hypertension. In general, a 10% increase in hypertension treatment would prevent about 14,000 deaths every year. An integrative literature review on lifestyle modification in the African American population living with hypertension was conducted to determine if lifestyle modification reduces long-term complications of hypertension, and to understand if there is a gap between evidence-based practice and clinical practiceEleven peer reviewed articles published within five years and written in the English language were selected, analyzed, and critiqued. Purposive sampling was used to include only African American population with hypertension. Exclusion criteria included unpublished manuscripts, meta-synthesis, abstracts, and meta-analysis. Lack of proper education, effective patient-centered communication, and culturally sensitive care were themes that emerged. Transtheoretical Model of Change (TTM) and Motivational Interviewing (MI) techniques are proven to be effective in generating positive health outcomes for patients and can be utilized by nurse practitioners in caring for the African American population with hypertension. Future research should be conducted to evaluate if nurse practitioners are using the protocol for TTM and MI technique in caring for the African American patient. Future research should also explore how well nurse practitioners are engaging in culturally sensitive care and the need for ongoing cultural sensitivity education for nurse practitioners.
Lee-Ing Tsao
National Taipei University of Nursing and health Sciences, Taipei, Taiwan
Title: An exploration of Chief complaints，Vasomotor disturbance symptoms and related factors among perimenopausal women in cardiovascular clinics
Biography:
Lee-Ing Tsao has completed her PhD from Universioty of San Diego, CA. Curreltly, she is professor, Dean and Vice presiodent in National Taipei University of Nursing and Health Sciences.
Abstract:
Perimenopausal women may seek medical consultation due to symptoms such as palpitation, intermittent hot flash, night sweat, and chest tightness, shortness of breath, headache, insomnia, anxiety, and fear. These symptoms often confuse women and lead to disruption of lifestyle. They may worry about whether or not they have heart diseases and seek cardiovascular outpatient treatment. In some cases these women did have heart diseases instead of perimenopausal symptoms, while in other cases these women were diagnosed with vasomotor symptoms of menopause. The purposes of current study was to explore the chief complaints, vasomotor symptoms, risk factors of cardiovascular diseases, perceived susceptibility to heart disease, and current status of health behaviors among perimenopausal women in cardiovascular outpatient clinics. Fifty women with the mean age of 51.58±3.00 were recruited. The top three ranking of the most frequent chief complaints were: palpitation (54%), high blood pressure (42%) and chest discomfort (4%). There is no correlation among disturbance levels of vasomotor symptoms, perceived susceptibility to heart disease, level of psychological disturbance, and perimenopausal health behavior. For perimenopausal women with the following characteristics, attention should be paid to their cardiovascular assessment: “chief complaint during medical consultationâ€, “using hormoneâ€, “inclination of anxiety or depressionâ€.The suggestion of current study was : to provide individualized and effective method for relieving symptoms of vasomotor discomforts, to provide appropriate emotional outlet, to establish favorable supporting system, to provide associated information regarding hormone therapy and health promotion for preventing coronart heart disease.
Keren Grinberg
Ruppin Academic Center-Department of Nursing, Emek –Hefer 40250, Israel
Title: Relationship between the Illness Perception of patients with acute myocardial infarction and their Quality of Life
Biography:
Keren Grinberg is working in Ruppin Academic Center-Department of Nursing,Israel.
Abstract:
MI is defined in pathology as myocardial cell death due to prolonged ischemia. After the onset of myocardial ischemia, histological cell death is not immediate, but takes a finite period of time to develop—as little as 20 min, or less in some animal models. One of the goals of treatment is to improve the patient's quality of life . The Illness Perception Questionnaire Revised (IPQ-R) and the Multi-dimensional Quality of Life (QOL) Questionnaire were administrated to 110 acute MI patients (77% men and 23% women). The average age of those sampled was 61. Associations between the variables were determined using Pearson’s correlation coefficient, and linear regression analysis was conducted. This study shows an association between the IP of MI patients and their perceived quality of life. Namely, a patients who perceives his disease in a more positive light sees himself as having a better quality of life (r=0.73, p=0.003). Perceived quality of life will be more lower in patients who thinks his disease is chronic (long duration) and not acute (rs=0.36, p≤0.0001), and the negative feelings attributes to his problem (r=0.42, p=0.02), as long as less sense of control on the disease and the treatment (r=0.039, p=0.003).The components of IP have an effect on the quality of life of acute MI patients. This indicates a need to evaluate and identify the components of the IP among those patients, in order to promote their response to the treatment and their rehabilitation process.
Mozhgan Kazemian
Mashhad University of Medical Science, Iran
Title: The effect of bimaxillary orthognathic surgery on airway resistance and lung Volumes by body plethysmography
Biography:
Mozhgan kazemian has finished her education at Mashhad University of Medical science and works there as assistant professor of oral and Maxillofacial surgery science 2012. She has published some papers about lip and palate cleft. She has done some researches about airway changes after orthognathic surgery. She has been research representative of OMFS department in Mashhad University of Medical Science and chief of oral and maxillofacial surgery ward science 2014 in Mashhad dental faculty.
Abstract:
Skeletal class III malocclusion can result from mandibular prognathism or maxillary Deficiency and bimaxillary surgery is now the treatment of choice. Bimaxillary orthognathic surgery can cause changes to respiration and the airways because of their proximity. We used body plethysmography to evaluate its effect on airway resistance and lung volumes in 20 patients with class III malocclusions (8 men and 12 women, aged 7 - 32 years). Lung volumes (forced vital capacity; forced inspiratory volume/one second; forced expiratory volume/one second: forced vital capacity; peak expiratory flow; maximum expiratory flow 25-75; maximum inspiratory flow; total lung capacity; residual volume; residual volume:total lung capacity), and airway resistance were evaluated one week before, and six months after, operation. Bimaxillary operations to correct class III malocclusions significantly increased airway resistance, residual volume, total lung capacity, and residual volume:total lung capacity. Other variables also changed after operation but not significantly so. Orthognathic operations should be done with caution in patients who have pre-existing respiratory diseases.
- Cardiovascular Nursing
Session Introduction
Xiao-hua wang
Nursing School of Soochow University, Suzhou 215006, China
Title: Improvement of Left Ventricular Remodeling and Reduction of CHF-rehospitalization Using a 12-month Weight Management Intervention
Biography:
Xiao-hua Wang has completed her PhD majored in immunology from Soochow University. She has been the director of Medical Nursing over ten years. She has published more than 30 papers in impact journals and has been serving as a reviewer of some journals.
Abstract:
The study was to determine the effectiveness of a 12-month weight management (WM) intervention on prognosis of chronic heart failure (CHF). Methods: CHF patients meeting our inclusion criteria were randomly assigned to the WM group (N=66) and the control group (N=64). WM consisted of the education of correct daily weight monitoring and the knowledge to deal with sudden weight gain, monthly telephone visits and diary kept by patients. We compared New York Heart Association (NYHA) classifications, the Left Ventricular Internal Diameter at end-diastole (LVIDd), Minnesota Living with Heart Failure Questionnaire (MLHFQ), CHF-related re-hospitalization and CHF-related mortality. Results: There were no significant differences in outcome variables at baseline. In 12 months, compared with the control group, the adherence to weight monitoring (60.61% vs 7.81%; P<0.001) and NYHA classification (P<0.001) were significantly improved; LVIDd was reduced (P=0.006). The global score of MLHFQ of WM group in 12 months was significantly lower than that of the control group and the baseline of WM group. The number of CHF-related re-hospitalization during the 12-month in WM group was significantly smaller than that of the control group (0.590±0.841 vs 1.170±1.409, P=0.005), but there was no significant reduction in CHF-mortality (1.49% vs 5.88%, P=0.366). Conclusion: This study demonstrates that the 12-month WM intervention had a positive impact on patients’ adherence to weight monitoring and WM ability, NYHA classification and left ventricular remodeling, quality of life and CHF-related re-hospitalization. However, the WM intervention has not improved CHF-mortality.
Adriano Marçal Pimenta
Federal University of Minas Gerais, Brazil
Title: Night-shift work is associated with cardiovascular risk among employees of a public university in Brazil
Biography:
Adriano M. Pimenta has completed his PhD in Nursing from Federal University of Minas Gerais – UFMG (Brazil) and postdoctoral studies in Public Health from University of Navarra (Spain). He is professor of Public Health in Graduate, Master and Doctoral courses from School of Nursing (UFMG). He has published more than 45 papers in reputed journals and has been serving as a reviewer board member of important journals as the British Medical Journal (England).
Abstract:
Cardiovascular diseases represent a significant public health problem and are responsible for one-third of all deaths in worldwide. Night-shift work has become common around the world, with approximately 22% of the population of industrialized countries performing their work activities during this period. We conducted a cross-sectional study with 211 workers of both genders, aged between 30 and 64 years, working on the health campus of a public university in the state of Minas Gerais, Brazil. The aim was to estimate the association between night-shift work and high cardiovascular risk. Night-shift work was defined as a work shift between 7 pm and 7 am, and high cardiovascular risk was calculated based on the Framingham score. The association between night-shift work and high cardiovascular risk was estimated by the prevalence ratio (PR) and its 95% confidence interval (95% CI) after adjusting for potential confounding factors, calculated by Poisson regression. Night-shift work was performed by 38.4% of the individuals, and high cardiovascular risk was diagnosed in 28% of the sample. In the bivariate analysis, night-shift work, passive and high job strain categories at the demand-control scale, work time > 120 months, schooling > 9 years, family income > 6 minimum wages, level 2 abdominal obesity, and triglyceride levels > 150 mg/dL were associated with high cardiovascular risk. After multivariate analysis, night-shift work remained independently associated with high cardiovascular risk (PR = 1.67; 95% CI = 1.10-2.54). This association should be considered when discussing the promotion of workers' health regarding changes in the work process.
- Diagnosis tests & Procedures in Cardiology
Session Introduction
Dave fornell
Editor, Diagnostic and Interventional Cardiology (DAIC) magazine, Chicago, IL
Title: Paradigm Shift Cardiac Technology Advances
Biography:
Dave Fornell is a medical journalist who has covered the latest advances in cardiology and radiology for the past nine years for Diagnostic and Intervention Cardiology (DAIC) and Imaging Technology News (ITN). He attends numerous medical conferences each year to to see what vendors are developing, attend key technology sessions and late breaking clinical trial presentations. In addition to his articles, he is a regular blogger on new medical innovation, a moderator for several technology webinars, and produces more than 40 videos a year on the new technologies, trends and interviews with late breaking trial principle investigators.
Abstract:
There are several technological advances that may change the current standards of care for cardiology in the coming years. These new technologies are coming at the same time the U.S. healthcare system is undergoing major reforms and they may contibute to efforts to reduce costs, cut lengths of stay, enable easier delivery of care and reduce complication rates. These tecnologie also might simplify management of patients with chronic cardiac conditions, like atrial fibrillation and heart failure. The newest technologies are also part of a larger trend in healthcare toward minimally invasive and noninvasive diagnostic and therapy options. These will eventually reduce the number of open-heart surgeries, diagnostic catheterizations and enable complex procedures such as heart valve replacement to be conducted as out-patient procedures. This technology update report will discuss advances across the cardiovascular subspecialties of interventional cardiology, electrophysiology, structural heart repair, heart valve repair and replacement, heart failure management and cardiac imaging. FDA cleared technologies entering practice include transcatheter aortic replacement (TAVR); left atrial appendage (LAA) occlusion; implantable cardiac monitors; leadless implantable cardioverter defibrillators (ICDs); and fractional flow reserve computed tomography (FFR-CT) for noninvasive assessment of coronary blockages. There are also several new technologies that may have major impacts on care in the future that are now entering FDA investigation device exemption trials or under current FDA review. These technologies include fully bioresorbable stents; transcatheter delivered, leadless pacemakers; transcatheter mitral valves and annuloplasty systems; and implantable early warning monitors for new onset of myocardial infarction in previously treated heart attack patients.
Roxanne M. Martinez
Orange Coast Memorial, USA
Title: An Integrated Multi-Disciplinary Apporach to Fast Track Extubation in Routine Cardiac Surgery Patients
Biography:
Roxanne M Martinez is a Board Certified Adult Gerontology Acute Care Nurse Practitioner and Clinical Nurse Specialist at Orange Coast Memorial with Cardiovascular Services and works with various patient populations including cardiac surgery, heart failure, and post acute myocardial infarctions. She completed her Master of Science degree at University of California, Los Angeles. She sits on the board of American Association of Critical Care Nurses, Greater Long Beach Orange County chapter and is an active member of National Association of Hispanic Nurses, Los Angeles chapter.
Abstract:
Introduction: Prolonged intubation in cardiac surgery patients has been associated with poor patient outcomes including risk of aspiration, ventilator-associated pneumonia, and ventilator induced lung injury. It also has been associated with prolonged Intensive Care Unit (ICU) and in-hospital length of stay (LOS). Prolonged intubation also increases cost to the hospital and individual patients. The literature suggests that reducing intubation time can lead to improve quality of care and postoperative patient outcomes. Our intubation time was 6.8 hours, which was higher than the six hours goal set forth by the Society of Thoracic Surgery. Aim: The aim of this study is to decrease the extubation time to less than six hours. The outcome variables that we measured were extubation time and in-hospital LOS. Method: We included all patients who underwent heart surgery (n=139) via sternotomy and minimally invasive procedures. Patients were identified as early extubation candidates by evaluating their PaO2/FiO2 (P/F) ratio. Patients who had a P/F ratio of greater than 200 were deemed eligible for early extubation. The rapid ventilator weaning protocol was implemented on patients whose P/F ratio was less than 200. Results: Following the implementation of the rapid weaning protocol, intubation time in our ICU for post cardiac surgery patients were decreased from 6.8 hours to 2.89 hours; and in-hospital LOS decreased from 6.5 days to 5.3 days. Conclusion: We recommend to use a standardized protocol to assess individual patient eligibility for early extubation. The rapid ventilator weaning protocol was effective in assisting early extubation of post cardiac surgery patients.
- Cardiovascular Epidemiology
Session Introduction
Kimberly S McClane
Sentara College of Health Sciences, USA
Title: Changing the health of a nation: A multiphase health promotion community
Biography:
Kimberly S McClane has completed her dual graduate degrees in MBA and MSN. She completed her PhD in 2003 at the Hahn School of Nursing at the University of San Diego. She had the opportunity to teach at International School, International University of Nursing on St. Kitts in the West Indies for over six years and spearheaded the conversion of the school to a baccalaureate program. She has been responsible for over 30 classes for traditional, hybrid, and online courses. She is currently an Adjunct Professor at Sentara College of Health Sciences.
Abstract:
St. Kitts is a small developing black island in the West Indies. There was a large population of women with hypertension and diabetes; where cardiovascular disease was the third cause of Kittitian women’s death. It was projected to increase 60% from 2000 to 2010 in the Caribbean with associated diabetes. The International University of Nursing (IUON) conducted a research project in 2007, was initiated to reduce the risks of cardiovascular diseases in women employed in the local manufacturing plants. The purpose of choosing female participants was that they would influence the family unit regarding diet, exercise and other health issues. 372 participants were recruited from five manufacturing sites with approval of either the owner or the plant manager. The field team of this project included nursing faculty and nursing students from IUON. The framework was Pender’s Health Promotion Model and the WHO STEPwise chronic disease risk factor surveillance. Pre and post physiological parameters were obtained including blood pressure, random blood sugars, body mass index and the waist to hip ratio. Information concerning their age, literacy, cultural and marital information, dietary preparation and diet were also collected. The educational focus was on hypertension and associated complications, diabetes, My plate measurements, portions, salt, alcohol consumption, and smoking. The educational sessions were conducted once in a month at the plants. In 2013, there was a meeting with several participants to discuss how successful the study was, and how we could have had a bigger impression of the participants.
- Nursing Education
Session Introduction
Kasey Carlson
Chippewa Valley Technical College,USA
Title: Application of Augmented Reality Integrated Simulation Education in Healthcare Education
Biography:
Kasey Carlson has been a Registered Nurse for 16 years. She holds a Master’s degree in Nursing Education from the University of Wisconsin – Eau Claire and has been teaching associate degree nursing for over 10 years. She also has a second Master’s degree in Learning Design and Technology from San Diego State University. Ms. Carlson specializes in healthcare simulation design and is the creator of the ARISE conceptual framework.
Abstract:
Simulation in nursing comes in a wide variety of forms – from low fidelity mannequins in a lab course to high fidelity trauma training. However, not all facilities and academic institutions have funding or space for such equipment. Augmented Reality Integrated Simulation Education (ARISE) is an inexpensive, emerging, and versatile instructional method for health care disciplines. ARISE merges the concepts of simulation with augmented reality and game-based situated learning theory. ARISE scenarios are developed using open source ARIS software, QR codes, and medical images yet completed using an iPad. This presentation will focus the results of a recent study of ARISE prototypes for nursing education developed as part of a Department of Labor TAACCCT 4 grant which was published in the April 2016 edition of Clinical Nursing Simulation. Four prototypes were trialed with representatives in the Wisconsin Technical College System in low and high fidelity environments. Demonstration of a scenario will be shown as well as utilization of ARISE scenarios in a variety of settings will be discussed. The results showed that ARISE positively enhances simulation and provides authentic interactions that may lead to future implications for nursing education. Further ARISE research, including student learning, student experience, and faculty evaluation is recommended as well as expanding the concept to other disciplines.