McBride M.,Hamilton Health Sciences
Canadian journal of cardiovascular nursing = Journal canadien en soins infirmiers cardio-vasculaires | Year: 2013
Patients are often sent home with complex discharge plans that can become overwhelming and difficult to follow. By contrast, implementing effective teaching at the time of discharge can lead to a decrease in the rate of hospital readmissions and mortality for patients post discharge (Koelling, Johnson, Cody, & Aaronson, 2005). Unfortunately, many of the discharge teaching practices and programs used in health care settings have been criticized as being ineffective. Ensuring that patients are prepared for the transition from hospital to home after a cardiac event will require a fundamental shift in how teaching is performed in acute care settings. In this paper, the authors identify and examine models and concepts relevant to improving the process of providing discharge education in acute care settings. This includes attention to adult education, self-management and patient-centred care. A practical framework was developed: Important Elements of Effective Discharge Teaching. This framework can be used by frontline staff to initiate realistic practice change and promote the use of evidence-based strategies related to discharge teaching in acute care settings. The Important Elements of Effective Discharge Teaching framework provides health care practitioners with a tool to evaluate and reflect on their current professional practice and provides examples of teaching strategies that are based on best evidence. Nurses can incorporate elements of this framework while providing health teaching to patients after a cardiac event.
Warkentin T.E.,McMaster University |
Warkentin T.E.,Hamilton Health Sciences
Seminars in Thrombosis and Hemostasis | Year: 2015
Many critically ill patients receive heparin, either before intensive care unit (ICU) admission (e.g., postcardiac surgery), for prophylaxis/treatment of thrombosis, for hemodialysis/filtration, or even incidentally (e.g., flushing of intravascular catheters), and are therefore at risk for developing immune heparin-induced thrombocytopenia (HIT), a prothrombotic drug reaction caused by platelet-activating antiplatelet factor 4 (PF4)/heparin antibodies. However, HIT explains at most 1 in 100 thrombocytopenic ICU patients (HIT frequency 0.3-0.5% vs. 30-50% background frequency of ICU-associated thrombocytopenia), and most patients who form anti-PF4/heparin antibodies do not develop HIT; hence, HIT overdiagnosis often occurs. This review discusses HIT-related issues relevant to ICU patients, including how to (1) distinguish HIT both clinically and serologically from non-HIT-related thrombocytopenia; (2) recognize HIT-mimicking disorders, such as the acute disseminated intravascular coagulation (DIC)/liver necrosis-limb necrosis syndrome; (3) prevent HIT in the ICU through use of low-molecular-weight heparin; and (4) treat HIT, including awareness of PTT confounding when anticoagulating patients with DIC. Copyright © 2015 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York.
Vege S.S.,Mayo Medical School |
Ziring B.,Thomas Jefferson University |
Jain R.,Texas Digestive Disease Consultants |
Moayyedi P.,Hamilton Health Sciences
Gastroenterology | Year: 2015
This article has an accompanying continuing medical education activity on page e12. Learning Objective: At the conclusion of this exercise, the learner will understand the approach to counseling patients regarding the optimal method and frequency of radiologic imaging, indications for invasive tests like endoscopic ultrasonography (EUS) and surgery, select patients for follow-up after surgery, decide the duration of such follow-up, and decide when to stop surveillance for those with and without surgery. © 2015 by the AGA Institute.
Nunes M.C.P.,Federal University of Minas Gerais |
Dones W.,Ryder Memorial Hospital |
Morillo C.A.,Hamilton Health Sciences |
Encina J.J.,Hospital Universitario Japones |
Ribeiro A.L.,Federal University of Minas Gerais
Journal of the American College of Cardiology | Year: 2013
Chagas disease, caused by the parasite Trypanosoma cruzi, is a serious health problem in Latin America and is an emerging disease in non-endemic countries. In recent decades, the epidemiological profile of the disease has changed due to new patterns of immigration and successful control in its transmission, leading to the urbanization and globalization of the disease. Dilated cardiomyopathy is the most important and severe manifestation of human chronic Chagas disease and is characterized by heart failure, ventricular arrhythmias, heart blocks, thromboembolic phenomena, and sudden death. This article will present an overview of the clinical and epidemiological aspects of Chagas disease. It will focus on several clinical aspects of the disease, such as chronic Chagas disease without detectable cardiac pathology, as well as dysautonomia, some specific features, and the principles of treatment of chronic cardiomyopathy. © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.
Connolly B.,Hamilton Health Sciences |
Fox S.H.,University of Toronto
Neurotherapeutics | Year: 2014
Neuropsychiatric symptoms are common in Parkinson's disease (PD) and add significantly to the burden of disease. These symptoms are most commonly part of the disease spectrum owing to pathological changes within relevant brain regions. Neuropsychiatric problems include disorders of cognition, ranging from mild cognitive impairment to dementia, psychotic symptoms, including, most commonly, well-formed visual hallucinations and paranoid delusions, and mood disorders, such as depression and anxiety. The other common cause of neuropsychiatric problem is secondary to use of dopaminergic drugs. Some PD patients may develop behavioral disorders, including impulse control disorders (ICDs) and addictive symptoms. Psychosis can be due to a mixture of underlying pathology, with triggering or worsening of symptoms with changes to PD medications. Currently, management of these disorders primarily uses therapies developed for general psychiatry and cognitive neurology, rather than specifically for PD. However, significant adverse effects, such as worsening of the motor symptoms of PD, can limit use of some drug therapies. Identification of drug-induced symptoms, such as ICDs, enables withdrawal of the offending drug as the principal management strategy. Research is ongoing in an effort to develop more specific therapies for PD-related neuropsychiatric symptoms. © 2013 The American Society for Experimental NeuroTherapeutics, Inc.