Adolescents in transition of adult care: why the concern?

This article has described issues associated with transition planning for youth with CHD. A number of approaches have been described to address the needs of this growing number of youth with CHD. Transition to adulthood has been and will continue to be a significant clinical concern as the adult survival rate increases. Health care professionals who are involved in transition planning will be focused on the health-related concerns of the transfer to an ACHD, insurability, and long-term CHD management, as well as issues related to employment, education, social relationships, and independent living. Successful transitioning is dependent on long-term planning,. youth-centered approaches, service coordination, and referral to adult agencies. As youth, families, adult survivors, and experts have discovered, long-term survival means more than the physical aspects of CHD.     

Coronary heart disease in women: update 2008

Coronary heart disease (CHD) remains the leading cause of mortality for US women, responsible for almost 250,000 deaths annually. Preventive heart-health behavioral changes by women and aggressive coronary risk reduction can decrease the number of women disabled and killed by CHD. Angina is the predominant initial and subsequent presentation of CHD in women; categorization of chest pain and risk stratification of women assume pivotal roles. A robust evidence-based algorithm can guide cardiovascular imaging techniques to evaluate women with suspected myocardial ischemia to detect those with worsened survival. Restricted functional capacity (<5 METs) is a consistent marker of worsened prognosis. Younger women have substantially higher mortality rates than men following myocardial infarction and coronary bypass surgery. Although these women have more comorbidity and risk factors, other issues including biological differences, treatment differences, and psychosocial factors require management strategies tailored to the unique needs of women.     

More knocks to the oxidation hypothesis for vascular disease?

The oxidation hypothesis for CHD (coronary heart disease) is attractive; however, the almost universal failure of antioxidant vitamin supplementation as a CVD (cardiovascular disease) risk modifier challenges the oxidation hypothesis, at least as a concept that easily 'translates' into clinical benefit for the population. At the same time, quality prospective data on lipid or protein oxidation markers as predictors of vascular events are sparse. In the present issue of Clinical Science, Woodward and co-workers provide much needed prospective data examining the relationship between markers of oxidative damage and CHD outcome in a general population. Despite noting the expected associations between several established CHD risk factors and CHD events, no significant link was observed between measured oxidation markers and CHD risk, a finding which further challenges the oxidation hypothesis for CHD.     

Contraception for the adolescent and young adult with congenital heart disease

Increasing numbers of females born with congenital heart disease are reaching childbearing age. Practitioners involved in the management of the adolescents or adults must be aware not only of the risks of pregnancy associated with varying types of CHD but with other issues involving the reproductive cycle to provide appropriate care, counseling, and education.     

Using reflective nursing practice to improve care of women with congenital heart disease considering pregnancy

This article examines the issue of congenital heart disease (CHD) in women, specifically women who are considering pregnancy. Some of the authors' experiences with women with CHD are described, and a reflective approach to clinical practice is used to gain a greater understanding of the women's perspective. Women with CHD need to balance general lifespan developmental tasks with issues specific to their CHD, such as changes in functional abilities or the possibility of a shortened life expectancy. In women with CHD, physiological, psychological, and family issues need to be considered when they are contemplating pregnancy. As women with CHD move through this debate, nurses may play a key role in assisting them in their decision-making process by exploring issues related to pregnancy and CHD. This exercise in reflective nursing practice allowed us to review the literature, gain new knowledge from our patients, use that knowledge to help other patients, and thoughtfully consider what still needs to be discovered in the care of reproductive-aged women with CHD. The subject of pregnancy contemplation in women with CHD in requires systematic research.     

New developments in catheter ablation for patients with congenital heart disease

ABSTRACT

Introduction: There are numerous challenges to catheter ablation in patients with congenital heart disease (CHD), including access to cardiac chambers, distorted anatomies, displaced conduction systems, multiple and/or complex arrhythmia substrates, and excessively thickened walls, or interposed material.

Areas covered: Herein, we review recent developments in catheter ablation strategies for patients with CHD that are helpful in addressing these challenges.

Expert opinion: Remote magnetic navigation overcomes many challenges associated with vascular obstructions, chamber access, and catheter contact. Patients with CHD may benefit from a range of ablation catheter technologies, including irrigated-tip and contact-force radiofrequency ablation and focal and balloon cryoablation. High-density mapping, along with advances in multipolar catheters and interpolation algorithms, is contributing to new mechanistic insights into complex arrhythmias. Ripple mapping allows the activation wave front to be tracked visually without prior assignment of local activation times or window of interest, and without interpolations of unmapped regions. There is growing interest in measuring conduction velocities to identify arrhythmogenic substrates. Noninvasive mapping with a multielectrode-embedded vest allows prolonged bedside monitoring, which is of particular interest in those with non-sustained or multiple arrhythmias. Further studies are required to assess the role of radiofrequency needle catheters and stereotactic radiotherapy in patients with CHD.     

Solutions to the water flooding problem for unitized regenerative fuel cells: status and perspectives

Unitized regenerative fuel cells (URFC) are capable of generating, storing, and releasing energy on demand in a sustainable manner. Water management is of vital importance to achieve maximum performance, durability, and round-trip efficiency in URFCs. However, URFCs suffer from critical issues related to their mode-switching process, water flooding, and membrane dehydration. The essential problem of water management is maintaining a subtle equilibrium between membrane drying and liquid water flooding to prevent membrane dehydration and ensure high URFC performance. This paper provides an overview of the operating principle of URFCs and describes the underlying phenomena related to water management issues. It also summarizes state-of-the-art studies of water management with a focus on recent developments and discusses the technical challenges of water management strategies. In addition, we propose a novel system design to address these critical water management issues. Overall, this review identifies the gaps in the research and development of URFC water management and identifies several essential future developments and research directions for future investigation.

This review summarizes state-of-the-art studies on water management of URFC''s with a focus on recent developments and discusses the technical challenges of water management strategies.     

Issues in minority health: atherosclerosis and coronary heart disease in African Americans

Cardiovascular disease (in particular, CHD) is the leading cause of death in the United States for Americans of both sexes and of all racial and ethnic backgrounds. African Americans have the highest overall CHD mortality rate and the highest out-of-hospital coronary death rate of any ethnic group in the United States, particularly at younger ages. Contributors to the earlier onset of CHD and excess CHD deaths among African Americans include a high prevalence of coronary risk factors, patient delays in seeking medical care, and disparities in health care. The clinical spectrum of acute and chronic CHD in African Americans is the same as in whites; however, African Americans have a higher risk of sudden cardiac death and present clinically more often with unstable angina and non-ST-segment elevation myocardial infarction than whites. Although generally not difficult, the accurate diagnosis and risk assessment for CHD in African Americans may at times present special challenges. The high prevalence of hypertension and type 2 diabetes mellitus may contribute to discordance between symptomatology and the severity of coronary artery disease, and some noninvasive tests appear to have a lower predictive value for disease. The high prevalence of modifiable risk factors provides great opportunities for the prevention of CHD in African Americans. Patients at high risk should be targeted for intensive risk reduction measures, early recognition/diagnosis of ischemic syndromes, and appropriate referral for coronary interventions and cardiac surgical procedures. African Americans who have ACSs receive less aggressive treatment than their white counterparts but they should not. Use of evidence-based therapies for management of patients who have ACSs and better understanding of various available treatment strategies are of utmost importance. Reducing and ultimately eliminating disparities in cardiovascular care and outcomes require comprehensive programs of education and advocacy(Box 4) with the goals of (1) increasing provider and public awareness of the disparities in treatment; (2) decreasing patient delays in seeking medical care for acute myocardial infarction and other cardiac disorders; (3) more timely and appropriate therapy for ACSs; (4) improved access to preventive, diagnostic, and interventional cardiovascular therapies; (5) more effective implementation of evidence-based treatment guidelines; and (6) improved physician-patient communications.     

Management and leadership in nursing: an Australian educational perspective

dignam d., duffield c., stasa h., gray j., jackson d. & daly j. (2012) Journal of Nursing Management 20, 65–71
Management and leadership in nursing: an Australian educational perspective Aim In this article, we present an Australian perspective on issues influencing management and leadership education in nursing. Background Nurse leaders and managers work in a context of high pressure, uncertainty and rapid change, and face unprecedented challenges on a daily basis. Evaluation and Key Issues In the present paper, we reflect on the issues and challenges facing providers of management education for nursing, and consider these challenges in relationship to current trends and imperatives. Conclusions Collaborative approaches between educational and clinical settings are needed to ensure quality, relevant educational support for managers and leaders, and enhance curriculum integrity. Implications for Nursing Management There is a need for contemporaneous and relevant research to inform innovative models of collaborative education.     

新疆维吾尔族冠心病患者自我管理水平及影响因素研究

目的 了解新疆维吾尔族冠心病患者的自我管理现状,并分析其影响因素.方法 应用自我效能量表、社会支持量表和自行设计的自我管理问卷对255例维吾尔族冠心病患者进行调查.结果 维吾尔族冠心病患者的自我管理总体呈中等水平,总分为(69.00±13.00)分,其各维度影响因素主要有年龄、职业、病程、自我效能、家庭内支持、家庭外支...     

Understanding obesity in the older person: prevalence and risk factors

District nurses deal with many overweight and obese clients on their caseloads. Many of these people have various co-morbities; their weight issues are often glossed over, prioritizing more pressing clinical issues. This however is a mistake, in this article the issue of obesity in the elderly is mapped out. It starts with looking at the reasons behind the epidemic and looking at individual factors. The elderly suffer from sarcopenia as a result of ageing which leads to changes in body morphology. If not tackled early, such changes lead to considerable increases in cardiometabolic risk. Widespread increases in BMI have been shown to promote CHD, hypertension, type 2 diabetes and certain types of cancers. Clinical depression can be a manifestation of obesity. An overview of the prevalence and non-conservative clinical management is given.     

A South African perspective: current position and challenges in health care service management and education in nursing

jooste k. & jasper m. (2012) Journal of Nursing Management 20, 56–64
A South African perspective: current position and challenges in health care service management and education in nursing Aim The present study discusses the current context of South African nurse managers’ working environment, exploring the challenges of disease demographics, service change and development, and educating a nursing workforce to meet healthcare delivery demands. Background Post-apartheid South Africa has a legacy of inequalities in access to healthcare; increasingly poor morbidity and mortality demographics; and inadequate numbers of qualified nurses to provide a service to meet the Millennium Development Goals outlined by the Government in 2010. Evaluation The present study discusses the current position and developments pertaining to nursing management relating to both healthcare challenges and educating a nursing workforce. Key issues Collaborative action by various stakeholders in the development of nursing management will ensure a nursing workforce and service environment fit-for-purpose in delivering the healthcare outcomes envisaged in the transformed South Africa in the future. Conclusion Different role players are involved in critical issues regarding the management and education of nursing in South Africa. Nurse managers are central to the success of service redesign, delivery and education. Implications for nursing management Nurse managers need to influence policy decisions regarding nursing service design and delivery, and the education required to prepare the next generation of practitioners for these new services.     

Relationship challenges and relationship maintenance activities following disclosure of transsexualism

ACCESSIBLE SUMMARY: ? Transsexual persons are increasing their visibility in society, and health care providers and others (such as social workers) will be called upon to help with issues that transsexual persons face. Challenges that face transsexual persons often include issues involving relationships. Psychiatric and mental health nurses and other caregivers can increase their therapeutic skills in working with couples that include transsexual persons by becoming aware of these challenges and subsequent activities that can help with them. ? This research study looks at couple relationships in which one partner reveals male-to-female transsexual identity. These are relationships that were established as man-woman and now will transition into relationships that include a male-to-female person and a female partner. ? Common challenges for these couples include issues related to: (1) sexual identity and relationship uncertainty; (2) male-to-female transition decision making; and (3) presenting in public. ? Relationship maintenance activities that helped the couples in the study maintain and strengthen their relationships through these challenges include: (1) communication; (2) self-talk (for example, putting the situation in perspective); (3) social networks; (4) positive interactions; (5) impression management (for example, managing displays of affection in public); and (6) social activism. ABSTRACT: This qualitative study describes the relational dynamics that help sustain relationships of couples that include male-to-female transsexual persons (MTF) and their natal female partners (NF) following disclosure of transsexualism. Relationship challenges and relationship maintenance activities are identified. Each partner in 17 MTF-NF couples participated in individual surveys and interviews. The data were coded for themes related to relationship challenges and activities. MTF-NF couples experience challenges within the contexts of their relationships and of society. These challenges include: (1) sexual identity and relationship uncertainty; (2) male-to-female transition decision making; and (3) public presentation. Relationship maintenance activities enabled the study couples to maintain and strengthen their relationships through these challenges. These activities include: (1) communication; (2) self-talk; (3) social networks; (4) positivity; (5) impression management; and (6) social activism. Via this report, psychiatric and mental health nurses can increase their therapeutic skills in working with MTF-NF couples.     

Communicating Caregivers' Challenges With Cancer Pain Management: An Analysis of Home Hospice Visits

Context

Family caregivers (FCGs) of hospice cancer patients face significant challenges related to pain management. Addressing many of these challenges requires effective communication between FCGs and hospice nurses, yet little empirical evidence exists on the nature of communication about pain management between hospice nurses and FCGs.

Quality of life experienced by adults with congenital heart disease

Adults with congenital heart disease (CHD) represent a growing population of patients. Medical and surgical advances have increased the number of CHD adult survivors, which may create quality-of-life (QOL) issues not previously considered. Quality-of-life issues pertinent to this patient population involve health and life insurance acquisition, birth control, genetic counseling, pregnancy concerns, employment, and independent living arrangements. The purpose of this study was to describe the QOL of adults with CHD. The study used a prospective cross-sectional case-control design to examine QOL using the Sickness Impact Profile (SIP). The study participants were a sample of 124 adults with CHD from an outpatient cardiology clinic in a metropolitan university-affiliated teaching hospital in the Northeast and 124 matched healthy control subjects. Between the participants and the matched control subjects, there was a significant difference in the total mean SIP score, the physical and psychosocial dimension scores, and all the category scores (P < 0.05). The areas of life the adults with CHD reported as lacking in quality involved the categories of work (SIP of 11.1, moderate disability) and sleep and rest (SIP of 9.03, mild disability). The results of this study indicate that the SIP can be used for quantitative and subjective QOL assessment of adults with CHD. It is suggested that cardiac advanced practice nurses use the results of this study to develop appropriate information, counseling, and anticipatory guidance for this patient population.     

Practical Aspects of Implantable Defibrillator Therapy in Patients with Congenital Heart Disease

Improved awareness of the risk for malignant ventricular arrhythmias in patients with congenital heart disease (CHD), together with dramatic advances in implantable cardioverter-defibrillator (ICD) technology, have led to a rapid increase in device therapy for this population. Clinical challenges remain surrounding patient selection and difficulties with lead positioning that arise in response to the anatomic and physiologic complexities of CHD. This article will attempt to review contemporary data on ICD use in the CHD population with particular attention to the novel implant methodology required for many of these patients.     

Women and coronary heart disease. Implications for the critical care setting

The unique issues of women and CHD in the critical care setting have been highlighted. Because of the lack of large scientific studies in women with CHD, there is a need for more information and research in this area. Critical care nurses can meet this challenge by keeping current with the literature, by attending closely to women's responses after the cardiac event, and by systematically investigating various aspects of women and CHD.     

Adult congenital heart disease and pulmonary arterial hypertension: the Texas Adult Congenital Heart Program experience

Congenital heart disease (CHD) is a common structural defect of the heart or major blood vessels. Patients with adult congenital heart disease (ACHD) have medical needs that are distinct from those of pediatric patients with CHD, and the transition into adult health care is important for management of the patient with ACHD. A large proportion of patients with CHD develop diseases and complications associated with the long-term stress of intracardiac shunts. Pulmonary arterial hypertension (PAH) is a significant complication of some CHD lesions. The treatment of these patients remains challenging due to their combined heart and lung disease, and multidisciplinary care is ofen necessitated for a variety of secondary conditions. A number of treatment options are available for the management of PAH associated with CHD, including prostanoids, phosphodiesterase type-5 inhibitors, and endothelin receptor antagonists. This article discusses the diagnosis and management of such ACHD patients with PAH.     

APN plan improves outcome for pregnant patient with congenital heart disease

Advanced practice nurses work in many roles to support delivery of safe patient care. Eighty-five percent of children born with congenital heart disease (CHD) live to adulthood. The pregnant adult with CHD presents challenges for nursing across many care-delivery systems. Progression of care delivery across these systems requires innovative planning and organization. This article describes the plan developed by advanced practice nurses in a CHD clinic and in inpatient coronary care and obstetric units to support a pregnant patient with CHD. The plan focused on collaboration and communication among interdisciplinary teams. The goal was to address multidisciplinary communication, leadership, and staff education. The result was a successful high-risk delivery with organized education and patient care across systems.