A Survey of Practices in the United States Regarding Hepatitis C Screening in Pregnant Women

PurposeHepatitis C virus (HCV) cases have increased in the past decade, with many cases in pregnant patients. However, recommendations for HCV screening during pregnancy vary by professional organization.MethodsPrenatal care providers were surveyed via e-mail about factors affecting choice of HCV screening.FindingsA total of 86 completed surveys were received. Providers using risk-based screening valued guidance from obstetrics and gynecology societies and risk for vertical transmission. Providers using universal screening valued availability of curative treatment in addition to guidance from the Centers for Disease Control and Prevention/infectious diseases societies and obstetrics and gynecology societies.ImplicationsThe results highlight the need for consensus guidelines on HCV screening as a part of prenatal care.     

Cardiovascular Disease in Women: A Nurse Practitioner's Guide to Prevention

Cardiovascular disease (CVD) is the number 1 cause of death in women, accounting for about 1 in 3 deaths. This article reviews the 2011 American Heart Association effectiveness-based guidelines for CVD prevention in women. Risk assessment, prevention, and management of risks through lifestyle changes and pharmacotherapy are discussed. The article concludes with implications for nurse practitioners on ways to improve cardiovascular health among women in their practice.     

Cardiovascular Screening and Early Detection of Heart Disease in Adults With Chronic Kidney Disease

Cardiovascular disease (CVD) and chronic kidney disease (CKD) are among the most common disease states that nurse practitioners encounter in various health care settings. In many cases, patients with CVD and CKD have overlapping risk factors and underlying medical conditions. CVD is one of the most common causes of death in patients with CKD, and therefore, appropriate recognition and screening are important for preventing disease progression and complications. Nurse practitioners can become familiar with various risk factors, screen patients, and provide nonpharmacologic and pharmacologic measures for CVD in CKD patients.     

Validation of a Rapid Urine Screening Assay for Cocaine Use among Pregnant Emergency Patients

Objectives: To determine the accuracy of the OnTrak rapid urine latex agglutination immunoassay (AIA) for testing pregnant ED patients for the cocaine metabolite benzoylecgonine (BE), and to determine the frequency of urine BE in pregnant ED patients and the association of test results with patient demographics.
Methods: A test performance evaluation was conducted using an inception cohort of pregnant patients at an urban teaching hospital ED. Patients with positive urine chorionic gonadotropin tests who had adequate remaining urine samples were studied. Patient demographics, ED diagnoses, and assay results were recorded without patient identifiers. Urine was tested using the rapid AIA. The first 150 samples were confirmed using a second immunoassay and gas chromatography with a nitrogen phosphorus detector. All positive samples also were confirmed with thin-layer chromatography, and quantification by gas chromatography-mass spectrometry.
Results: Twenty of 342 (5.9%, 95% CI 3.4–8.4%) pregnant patients had urine samples positive by AIA testing for BE. Confirmation testing demonstrated no false-positive or -negative AIA result. Positive test results were not associated with specific patient diagnoses or demographics.
Conclusions: ED screening for cocaine use among pregnant patients can be accurately performed using the On Trak AIA for BE. In the ED population screened, 5.9% of the pregnant women had urine samples positive for BE.     

Hypertensive Disorders of Pregnancy and Risk of Future Cardiovascular Disease in Women

Cardiovascular disease continues to be the leading cause of mortality in women globally. In addition to traditional risk factors, some sex-specific conditions increase the burden of cardiovascular disease in women. With this literature review, we aimed to review evidence on associations between hypertensive disorders of pregnancy and risk of cardiovascular disease in later life. After a database search and application of inclusion and exclusion criteria, 11 studies were included in the review. Our findings suggest that a history of preeclampsia, gestational hypertension, or elevated systolic blood pressure alone during pregnancy is consistently associated with increased risk of developing and dying from myocardial infarction, heart failure, hypertension, and/or stroke in later life. Nurses and other health care providers should be aware of the cardiovascular risk associated with hypertensive disorders of pregnancy and engage women at risk in discussions about health promotion strategies and interventions to address modifiable cardiovascular disease risk factors.     

Commentary on a Cochrane Review of Hormone Therapy for Preventing Cardiovascular Disease in Postmenopausal Women

Findings of a Cochrane Review provide strong evidence that use of hormone therapy has little if any benefit in preventing cardiovascular disease in postmenopausal women and could increase risk for stroke and venous thromboembolic events.     

Cardiovascular disease: application of a composite risk index from the Telehealth System in a district community

Assessing a combination of cardiovascular disease (CVD)-risk factors may be a practical tool for risk assessment and for finding the high-risk group among local community members. This study examines the association between the number of CVD-risk factors, regardless of any specific combination with the CVD ambit, using data from 1,570 residents in Tsing Yi community (Hong Kong) who registered with the Telehealth System. A quantitative composite CVD Risk Index (CVDRI) with scores ranging from 0 to 6 included rankings for high systolic and diastolic blood pressure, presence of diabetes, body mass index (BMI), smoking, and age. Multivariate logistic regression was used to estimate odds ratios for the prevalence of CVD. Those with a CVDRI of 1, 2, or 3 and above were 1.7 [95% confidence interval (CI) = 1.34-3.99], 5.3 (95% CI = 3.60-7.90), and 10 times (95% CI = 6.41-15.50) more likely to have CVD, respectively, than those with a risk index of 0. Among the CVDRI components, high blood pressure had the greatest influence on CVD risk, followed by presence of diabetes and high BMI. In conclusion, a CVDRI based on existing health data from a Telehealth System was developed and used to identify local community members at risk of CVD. Nurse intervention may achieve greater reduction of CVD morbidity and mortality if multiple risk factors for the high-risk group are addressed at the same time.     

Use of a Standardized Tool to Identify Women at Risk for Hereditary Breast and Ovarian Cancer

ObjectiveTo increase rates of identification and genetic counseling referral for women at risk of hereditary breast and ovarian cancer (HBOC).DesignEvidence-based practice improvement initiative.Setting/Local ProblemPrivate suburban obstetric and gynecologic (OB/GYN) practice in Tennessee with no standardized process for HBOC risk assessment or referral to genetic services.ParticipantsProvider-led women's health care teams delivering well-woman care for women ages 18 years and older.Intervention/MeasurementsWe implemented the use of a standardized familial risk assessment tool and clinical decision-making algorithm. Preimplementation and postimplementation risk identification and genetic services referral rates were measured, as was clinicians’ compliance with using the risk assessment tool. The aim of the initiative was to increase identification and referral rates by 25 percentage points.ResultsWomen at risk of HBOC in the postimplementation group were 25.9 times more likely to be identified as being at risk (OR = 25.88, 95% confidence interval [10.78, 62.14]) and 31.5 times more likely to be offered referral to genetic counseling (OR = 31.50, 95% CI [13.37, 74.22]) compared with those in the preimplementation group. Rates of risk identification and referral to genetic counseling for women at risk of HBOC improved by 58.2 and 69.3 percentage points, respectively, surpassing the aims of this initiative and showing statistical significance of p < .001 for both indices.ConclusionThe use of a standardized risk assessment tool and process for HBOC risk identification and genetic referral resulted in a significant increase in the identification and referral of women at risk in this setting. Early identification of women with HBOC is a crucial first step in increasing the use of enhanced screening and interventions that can reduce HBOC-associated cancer morbidity and mortality.     

The Link Between Reproductive History,Cardiovascular Disease,and Peripheral Arterial Disease in Women: Implications for Practice

The average life expectancy in the United States fell for the second straight year. Attributed mostly to COVID-19 and unintentional injuries (driven by drug overdoses), the third most prevalent cause of death is heart disease. Peripheral arterial disease (PAD) is an often-unrecognized global pandemic affecting more than 220 million. Since early 2000, the incidence of PAD has increased by 25% globally, Once considered a male-dominated disease, PAD is a significant cause of morbidity and mortality among women. This article provides a comprehensive review of the sex-linked risk factors for PAD that pose additional threats for women. Implications for practice are provided.     

2010年-2012年成都市龙泉驿区中孕期产前筛查临床分析

目的 分析成都市龙泉驿区产前筛查数据,评价产前筛查技术对该区出生缺陷的预防作用。 方法 对2010年11月－2012年12月在成都市龙泉驿区产前筛查中心进行中孕期产前筛查的10 230例孕妇血清样本进行检验分析,从而得出孕妇罹患21-三体综合征、18-三体综合征和开放性神经管缺陷的风险率,借助高风险转诊、孕期追踪及妊娠结局随访等方式对产前筛查结果进行核实及评价。 结果 成都市龙泉驿区10 230 例产前筛查数据中21-三体综合征、18-三体综合征及开放性神经管缺陷筛查高风险率分别为6.02%、0.42%及0.57%,高风险孕妇产前诊断依从率为51.56%,其中57例开放性神经管缺陷筛查高风险的孕妇中有53例进行了系统超声诊断（依从率为92.98%）,而647 例21-三体或18-三体综合征高风险孕妇仅47.30%进行了羊水穿刺,超声诊断与羊水穿刺产前诊断依从率差异有统计学意义（P＜0.05）,通过诊断确诊3例21-三体综合征患者。 结论 中孕期产前筛查对控制成都市龙泉驿区出生缺陷具有重要作用,该区产前筛查21-三体或18-三体综合征高风险孕妇产前诊断依从率有待提高。     

Selection of Screening Tool for Sleep-Disordered Breathing or Obstructive Sleep Apnea in Pediatric Patients in the Perianesthesia Setting

PurposeThis study was undertaken to select an appropriate tool to predict risk of obstructive sleep apnea (OSA) among pediatric patients in the preoperative setting.Design/MethodsA retrospective chart review and a survey of nursing staff to compare two tools that were determined to be valid in assessing risk of OSA and postanesthesia complications in pediatric patients aged 6 months to 18 years was conducted. About 300 pediatric patients presenting for elective surgery were screened for OSA using STBUR (Snoring, Trouble Breathing during sleep, struggling to Breathe during Sleep, and waking UnRefreshed) and ST(1)OP-BANG (Snoring, Tonsillar hypertrophy, sleep Obstruction, BMI, Age, Neuromuscular disorders, and Genetic/congenital deformities) concurrently. Six preoperative nurses were then surveyed to compare ease of use and time to complete the screening tools.FindingsThe STBUR tool was found to predict complications in 37.5% patients versus 22.7% patients with the pediatric ST(1)OP-BANG. Nursing staff found that although both tools were quick and easy to use, the STBUR tool was easier for parents to answer.ConclusionsUse of a screening tool to help predict risk of OSA and postanesthetic complications also helps to dictate anesthesia technique, nursing staffing requirements, and plans of care for postoperative management of pediatric patients.