Improvement of CHF patients’ fluid restriction education through self-efficacy

Improvement of CHF patients’ fluid restriction education through self-efficacy Johanna Ruckey RN and William Fyler BSN Background: Dietary discretion through limited salt and fluid intake is an important aspect of heart failure (HF) management. Keeping accurate account of fluid intake has shown itself to be a difficult task, as both staff and patients often fail to do so on a fairly regular basis. Although staff are aware of a patient\u27s fluid restrictions, there is a deficit in the patient\u27s role in tracking their own intake. Patients often express confusion and frustration regarding their daily fluid intake, but also lack of initiative to police themselves. Through fostering a sense of self-efficacy and self-management in the patient, they will be more likely to take a more active role in monitoring their fluids and may do so more accurately. Various fluid tracking sheets and teaching tools appealing to different learning styles can be combined into a HF teaching kit. Patients would be able to select a tracking tool that best meets their needs and use it to proactively monitor their fluid intake. By shifting the responsibility of fluid intake monitoring to a more patient focused task, there may be a more accurate account of intake on R7. Design/Method/Plans: We will be utilizing a teaching that the Heart Failure currently uses and a tracking tool that we designed. We will survey patients prior to discharge. Purpose/PICOT question: For the patients’ on R7, does patient centered fluid management thru increased patient efficacy result in more accurate fluid tracking versus nursing centered fluid monitoring? Results: TBD Time frame: We anticipate starting to educate with the tool in the next six months which will allow us to educate the R7 staff on the tool and then begin to survey patients prior to discharge to see if tool proves useful

Influence of Culture (US and Turkey) on Reactions to Social Network Screening

Abstract Social Media has impacted every facet of society. One implication of Social Media concerns hiring practices. The ubiquity, easy-access, and wealth of information offered by Social Media have caught the eyes of recruiters. A survey by Careerbuilder (2018), which suggests 7 in 10 US employers use Social Media to research job candidates, captures this growing trend. HR departments in favor of Social Network Screening (SNS) argue that it helps avoid negligent hiring, attracts passive job-seekers, and investigates beneficial personality traits. But comparable issues, like lack of validity, legality, and privacy, also accompany it (e.g., Van Iddekinge, Lanivich, Roth, & Junco, 2016). With the advent of globalization, familiarity with international applicant reactions to selection methods becomes paramount for retention. These concerns are heightened amidst the global “war for talent” (Michaels, Handfield-Jones, & Axelrod, 2001). As business expand globally and SNS hiring methods proliferate, an examination of how culture influences applicant reactions to SNS screening becomes exigent. However, while research has explored applicant reactions to SNS (e.g., Stoughton, Thompson, & Meade, 2015), little research has explored cross-cultural reactions to this practice. According to Black, Stone, & Johnson, (2015), applicant reactions are influenced by Socio-Cultural Factors, which includes Power Distance Index, Individualism/Collectivism and cultural specific norms of privacy(Hofstede & Bond, 1984). Accordingly, this study uses the privacy model of Black et al. (2015) and Hofstede’s Cultural Dimensions (Hofstede & Bond, 1984) to measure the differences in reactions to Facebook screening between US and Turkish applicants

Applicant Reaction To Facebook Screening: A Cross-Cultural Examination

As Social Media becomes more widely used by organizations for hiring and selection, research investigating applicant reactions to fairness, privacy and justice to social network screening has also proliferated. Because these factors can affect organizational attractiveness and withdrawal intentions, researchers have constructed a model predicting applicant reactions across different contexts. One context that received less attention is Socio-Cultural variables. Such variables like Power Distance and Individualism (from Hofstede’s Cultural Dimensions model) differ across cultures and could moderate applicant reaction to Social Network Screening. Two countries with significantly different Power Distance and Individualism scores are Turkey and the US. Therefore, this study seeks to investigate how Turkish applicant reaction to Social Network Screening might differ from US counterparts. The present study did not find significant relationships between certain social-cultural variables and Social Network Screening reactions as hypothesized. Further analysis revealed that the samples did not differ in relevant Socio-Cultural variables as predicted. Although the study did find other meaningful correlations between Socio-Cultural variables, Social Network Screening and applicant reactions. Findings are discussed

Therapy refractory hypertension in adults: aortic coarctation has to be ruled out

In patients with unexplained hypertension, especially in combination with a cardiac murmur, the presence of an aortic coarctation should always be ruled out given the high morbidity and mortality. However, particularly patients with an isolated coarctation often remain asymptomatic for years and the defect may be unnoticed even until the fifth or sixth decade of life. In the present article, we describe two patients with late detected coarctation to illustrate the clinical consequences, diagnostic clues for earlier detection and current therapeutic options to achieve optimal treatment. The key sign of an aortic coarctation, a difference in arterial blood pressure measured between the upper and lower extremities, should always be examined, followed by echocardiography. We conclude that even in case of a late detected severe coarctation, surgical or percutaneous repair has proven to be feasible and substantially effective, improving quality of life and lowering the risk of further hypertension-associated problems

Mutational analysis of the PITX2 coding region revealed no common cause for transposition of the great arteries (dTGA)

BACKGROUND: PITX2 is a bicoid-related homeodomain transcription factor that plays an important role in asymmetric cardiogenesis. Loss of function experiments in mice cause severe heart malformations, including transposition of the great arteries (TGA). TGA accounts for 5–7% of all congenital heart diseases affecting 0.2 per 1000 live births, thereby representing the most frequent cyanotic heart defect diagnosed in the neonatal period. METHODS: To address whether altered PITX2 function could also contribute to the formation of dTGA in humans, we screened 96 patients with dTGA by means of dHPLC and direct sequencing for mutations within the PITX2 gene. RESULTS: Several SNPs could be detected, but no stop or frame shift mutation. In particular, we found seven intronic and UTR variants, two silent mutations and two polymorphisms within the coding region. CONCLUSION: As most sequence variants were also found in controls we conclude that mutations in PITX2 are not a common cause of dTGA

Pattern of symptomatic congenital heart disease amongst Oriental neonates: a decade's experience

Between 1981 and 1990, 765 symptomatic neonates with major congenital heart malformations were admitted into the Grantham Hospital. This represented an incidence of 10 per 10,000 live births for Hong Kong. The figure was comparable to those reported for Caucasians. Among the 744 Oriental neonates, obstruction of the pulmonary outflow tract occurred most frequently (281, 37.8%), followed by left ventricular outflow tract obstruction (169, 22.7%), left-to-right shunting (115, 15.5%), complete transposition (92, 12.4%), common mixing situations (62, 8.3%), and miscellaneous causes (25,3.3%). When compared with the available reports from the West, Chinese neonates had a high preference for pulmonary outflow tract obstruction (p<0.005), especially the anomaly of pulmonary atresia and intact ventricular septum. This correlated well with cyanosis as the commonest neonatal presentation (64%). Contrary to previous reports that aortic coarctation was rare among Orientals, this abnormality was observed frequently in our study. The rare occurrence of critical aortic valvar stenosis among Chinese, however, was supported by our present analysis. Other lesions, such as left-to-right shunting and complete transposition, showed no significant racial difference in the frequency of occurrence. Such knowledge concerning the pattern of congenital heart disease amongst Oriental neonates can facilitate early diagnosis and timely referral of babies to the appropriate center for management.published_or_final_versio

Cardiac tumours in children

Cardiac tumours are benign or malignant neoplasms arising primarily in the inner lining, muscle layer, or the surrounding pericardium of the heart. They can be primary or metastatic. Primary cardiac tumours are rare in paediatric practice with a prevalence of 0.0017 to 0.28 in autopsy series. In contrast, the incidence of cardiac tumours during foetal life has been reported to be approximately 0.14%. The vast majority of primary cardiac tumours in children are benign, whilst approximately 10% are malignant. Secondary malignant tumours are 10–20 times more prevalent than primary malignant tumours. Rhabdomyoma is the most common cardiac tumour during foetal life and childhood. It accounts for more than 60% of all primary cardiac tumours. The frequency and type of cardiac tumours in adults differ from those in children with 75% being benign and 25% being malignant. Myxomas are the most common primary tumours in adults constituting 40% of benign tumours. Sarcomas make up 75% of malignant cardiac masses. Echocardiography, Computing Tomography (CT) and Magnetic Resonance Imaging (MRI) of the heart are the main non-invasive diagnostic tools. Cardiac catheterisation is seldom necessary. Tumour biopsy with histological assessment remains the gold standard for confirmation of the diagnosis. Surgical resection of primary cardiac tumours should be considered to relieve symptoms and mechanical obstruction to blood flow. The outcome of surgical resection in symptomatic, non-myxomatous benign cardiac tumours is favourable. Patients with primary cardiac malignancies may benefit from palliative surgery but this approach should not be recommended for patients with metastatic cardiac tumours. Surgery, chemotherapy and radiotherapy may prolong survival. The prognosis for malignant primary cardiac tumours is generally extremely poor

Modelling Survival and Mortality Risk to 15 Years of Age for a National Cohort of Children with Serious Congenital Heart Defects Diagnosed in Infancy

Congenital heart defects (CHDs) are a significant cause of death in infancy. Although contemporary management ensures that 80% of affected children reach adulthood, post-infant mortality and factors associated with death during childhood are not well-characterised. Using data from a UK-wide multicentre birth cohort of children with serious CHDs, we observed survival and investigated independent predictors of mortality up to age 15 years. Methods Data were extracted retrospectively from hospital records and death certificates of 3,897 children (57% boys) in a prospectively identified cohort, born 1992–1995 with CHDs requiring intervention or resulting in death before age one year. A discrete-time survival model accounted for time-varying predictors; hazards ratios were estimated for mortality. Incomplete data were addressed through multilevel multiple imputation. Findings By age 15 years, 932 children had died; 144 died without any procedure. Survival to one year was 79.8% (95% confidence intervals [CI] 78.5, 81.1%) and to 15 years was 71.7% (63.9, 73.4%), with variation by cardiac diagnosis. Importantly, 20% of cohort deaths occurred after age one year. Models using imputed data (including all children from birth) demonstrated higher mortality risk as independently associated with cardiac diagnosis, female sex, preterm birth, having additional cardiac defects or non-cardiac malformations. In models excluding children who had no procedure, additional predictors of higher mortality were younger age at first procedure, lower weight or height, longer cardiopulmonary bypass or circulatory arrest duration, and peri-procedural complications; non-cardiac malformations were no longer significant. Interpretation We confirm the high mortality risk associated with CHDs in the first year of life and demonstrate an important persisting risk of death throughout childhood. Late mortality may be underestimated by procedure-based audit focusing on shorter-term surgical outcomes. National monitoring systems should emphasise the importance of routinely capturing longer-term survival and exploring the mechanismsThis work was supported by a British Heart Foundation project grant (reference PG/02/065/13934). RLK was awarded an MRC Special Training Fellowship in Health of the Public and Health Services Research (reference G106/1083). HG and the Centre for Paediatric Epidemiology and Biostatistics benefited from Medical Research Council funding support to the MRC Centre of Epidemiology for Child Health (reference G04005546). Great Ormond St Hospital for Children NHS Trust and the UCL Institute of Child Health receives a proportion of funding from the Department of Health's NIHR Biomedical Research Centres schem