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\"As a teenager, Molly Case underwent an operation that saved her life. Nearly a decade later, she finds herself in the operating room again--this time as a trainee nurse. She learns to care for her patients, sharing not only their pain, but also life-affirming moments of hope. In doing so, she offers a compelling account of the processes that keep them alive, from respiratory examinations to surgical prep, and of the extraordinary moments of human connection that sustain both nurse and patient. In rich, lyrical prose, Case illustrates the intricacies of the human condition through the hand of a stranger offered in solace, a gentle word in response to fear and anger, or the witnessing of a person's last breaths. It is these moments of empathy, in the extremis of human experience, that define us as people. But when Molly's father is admitted to the cardiac unit where she works, the professional and the personal suddenly collide. Weaving together medical history, art, memoir, and science, How to Treat People beautifully explores the oscillating rhythms of life and death in a tender reminder that we can all find meaning in being, even for a moment, part of the lives of others.\"--Publisher's description.

Objective To investigate whether an internet based, nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinically manifest vascular disease.Design Prospective randomised controlled trial.Setting Multicentre trial in secondary and tertiary healthcare setting.Participants 330 patients with a recent clinical manifestation of atherosclerosis in the coronary, cerebral, or peripheral arteries and with at least two treatable risk factors not at goal.Intervention Personalised website with an overview and actual status of patients’ risk factors and mail communication via the website with a nurse practitioner for 12 months; the intervention combined self management support, monitoring of disease control, and drug treatment.Main outcome measures The primary endpoint was the relative change in Framingham heart risk score after 1 year. Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor.Results Participants’ mean age was 59.9 (SD 8.4) years, and most patients (n=246; 75%) were male. After 1 year, the relative change in Framingham heart risk score of the intervention group compared with the usual care group was −14% (95% confidence interval −25% to −2%). At baseline, the Framingham heart risk score was higher in the intervention group than in the usual care group (16.1 (SD 10.6) v 14.0 (10.5)), so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score. This produced a relative change of −12% (−22% to −3%) in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and −8% (−18% to 2%) adjusted for the baseline score. Of the individual risk factors, a difference between groups was observed in low density lipoprotein cholesterol (−0.3, −0.5 to −0.1, mmol/L) and smoking (−7.7%, −14.9% to −0.4%). Some other risk factors tended to improve (body mass index, triglycerides, systolic blood pressure, renal function) or tended to worsen (glucose concentration, albuminuria).Conclusion An internet based, nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease.Trial registration Clinical trials NCT00785031.

It is vital for NPs and PAs to be highly skilled in EKG interpretation to correctly identify high-risk patients and to make appropriate clinical decisions.This reference book is the first to present a comprehensive, multifaceted approach to EKG interpretation, covering all major topics required for expertise in this area.

ObjectivesHandheld echocardiography (HAND) has good sensitivity and specificity for rheumatic heart disease (RHD) when performed by cardiologists. However, physician shortages in RHD-endemic areas demand less-skilled users to make RHD screening practical. We examine nurse performance and interpretation of HAND using a simplified approach for RHD screening.MethodsTwo nurses received training on HAND and a simplified screening approach. Consented students at two schools in Uganda were eligible for participation. A simplified approach (HAND performed and interpreted by a non-expert) was compared with the reference standard (standard portable echocardiography, performed and interpreted by experts according to the 2012 World Heart Federation guidelines). Reasons for false-positive and false-negative HAND studies were identified.ResultsA total of 1002 children were consented, with 956 (11.1 years, 41.8% male) having complete data for review. Diagnoses included: 913 (95.5%) children were classified normal, 32 (3.3%) borderline RHD and 11 (1.2%) definite RHD. The simplified approach had a sensitivity of 74.4% (58.8% to 86.5%) and a specificity of 78.8% (76.0% to 81.4%) for any RHD (borderline and definite). Sensitivity improved to 90.9% (58.7% to 98.5%) for definite RHD. Identification and measurement of erroneous colour jets was the most common reason for false-positive studies (n=164/194), while missed mitral regurgitation and shorter regurgitant jet lengths with HAND were the most common reasons for false-negative studies (n=10/11).ConclusionsNon-expert-led HAND screening programmes offer a potential solution to financial and workforce barriers that limit widespread RHD screening. Nurses trained on HAND using a simplified approach had reasonable sensitivity and specificity for RHD screening. Information on reasons for false-negative and false-positive screening studies should be used to inform future training protocols, which could lead to improved screening performance.

Abstract Objective To assess whether a nurse led, flow monitored protocol for optimising circulatory status in patients after cardiac surgery reduces complications and shortens stay in intensive care and hospital. Design Randomised controlled trial. Setting Intensive care unit and cardiothoracic unit of a university teaching hospital. Participants 174 patients who underwent cardiac surgery between April 2000 and January 2003. Interventions Patients were allocated to conventional haemodynamic management or to an algorithm guided by oesophageal Doppler flowmetry to maintain a stroke index above 35 ml/m2. Results 26 control patients had postoperative complications (two deaths) compared with 17 (four deaths) protocol patients (P = 0.08). Duration of hospital stay in the protocol group was significantly reduced from a median of nine (interquartile range 7-12) days to seven (7-10) days (P = 0.02). The mean duration of hospital stay was reduced from 13.9 to 11.4 days, a saving in hospital bed days of 18% (95% confidence interval −12% to 47%). Usage of intensive care beds was reduced by 23% (−8% to 59%). Conclusion A nurse delivered protocol for optimising circulatory status in the early postoperative period after cardiac surgery may significantly shorten hospital stay.

Background After hospitalization for cardiac disease, older patients are at high risk of readmission and death. Although geriatric conditions increase this risk, treatment of older cardiac patients is limited to the management of cardiac diseases. The aim of this study is to investigate if unplanned hospital readmission and mortality can be reduced by the Cardiac Care Bridge transitional care program (CCB program) that integrates case management, disease management and home-based cardiac rehabilitation. Methods In a randomized trial on patient level, 500 eligible patients ≥ 70 years and at high risk of readmission and mortality will be enrolled in six hospitals in the Netherlands. Included patients will receive a Comprehensive Geriatric Assessment (CGA) at admission. Randomization with stratified blocks will be used with pre-stratification by study site and cognitive status based on the Mini-Mental State Examination (15–23 vs ≥ 24). Patients enrolled in the intervention group will receive a CGA-based integrated care plan, a face-to-face handover with the community care registered nurse (CCRN) before discharge and four home visits post-discharge. The CCRNs collaborate with physical therapists, who will perform home-based cardiac rehabilitation and with a pharmacist who advices the CCRNs in medication management The control group will receive care as usual. The primary outcome is the incidence of first all-cause unplanned readmission or mortality within 6 months post-randomization. Secondary outcomes at three, six and 12 months after randomization are physical functioning, functional capacity, depression, anxiety, medication adherence, health-related quality of life, healthcare utilization and care giver burden. Discussion This study will provide new knowledge on the effectiveness of the integration of geriatric and cardiac care. Trial registration NTR6316 . Date of registration: April 6, 2017.

IntroductionEvidence-based early rehabilitation intervention after heart valve surgery has been proven to have many benefits, but the experience of implementing nurse-led early rehabilitation combining exercise and psychology is still lacking. It is urgent to find a more acceptable and cost-effective method to provide exercise intervention and psychological support. The aim of this study is to design a nurse-led cardiac rehabilitation programme to increase the physical capacity and mental health for heart valve patient based on broaden-and-build theory.Methods and analysisA non-blinded randomised controlled trial will be conducted. A total of 86 adults diagnosed with heart valve disease will be recruited and randomly assigned to the control group and intervention group. The recovery for valvular heart disease intervention, based on the broaden-and-build theory, will be guided one-on-one by a multidisciplinary team and will consist of two main components: physical intervention and psychological intervention. The baseline assessment will be conducted 1 to 2 days after admission, and sequent evaluations will be implemented at post-intervention, 3 months after intervention and 6 months after intervention. The primary outcome is the finding of six-min walk test and mental state. Other outcomes include quality of life, 36-item short-form health survey, Short Physical Performance Battery, stress, coping modes and social support.Ethics and disseminationThis study was conducted following the Helsinki Declaration and was approved by the ethics committee of the Zhong Da Hospital, Southeast University (2024ZDSYLL098-P01). The results of this study are scheduled to be published in relevant peer-reviewed journals.Trial registration numberRegistered at the Chinese Clinical Trials.gov (ChiCTR2400090853).

Nursing the Cardiac Patient is a practical guide that addresses the management of cardiac patients across the spectrum of health care settings. It assists nurses in developing a complete understanding of the current evidence-based practice and principles underlying the care and management of the cardiac patient. It combines theoretical and practical components of cardiac care in an accessible and user-friendly format, with case studies and practical examples throughout.

[...]a systematic review and meta-analysis assessing the effect of different screening methods on estimated prevalence of RHD showed that echocardiographic screening had a four-time higher rate of subclinical disease detection, compared with clinical screening.3 However, echo screening is still cost-prohibitive in places where RHD is more prevalent, which usually are very resource-limited areas. [...]the specificity of handheld echo equipment was not ideal, generating false-positive examinations and indicating that positive screening by handheld echo equipment would have to be confirmed by standard echocardiography, which then imposes additional cost to screening in areas of limited resources.4 In the Heart paper by Ploutz et al,5 the strategy of handheld echo equipment performed by non-experts was used in 953 school children in Uganda. Diuretics are necessary for treating fluid retention, and establishing adequate doses of diuretics is an important point and depends on the correct evaluation of patient's fluid balance, which is clinically challenging to obtain.6 Since readmissions are frequently secondary to congestion, the accurate determination of volume status before discharge could be an effective alternative, allowing the identification of patients at risk of deterioration, in whom intervention at an early stage may probably avert hospitalisation. In particular, reducing HF hospitalisation rates may improve patient quality of life and decrease HF-related costs.