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Background:Increasing rates of medical errors necessitate incorporation of patient safety education for health professions students. Institutions must address the needs of both campus- and distance-based learners to meet interprofessional education (IPE) accreditation requirements. The purpose of this project was to evaluate a synchronous interprofessional patient safety simulation to train students on interprofessional teamwork and communication through recognition of patient safety and medical hazards.Method:Students from health care professions participated in a Haunted Hospital/Heartbreak Hospital patient hazard/medical error simulation. A total of 201 students in 41 teams, both campus and distance, participated over three semesters.Results:Mean Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) scores significantly improved from 44.81 ± 3.59 to 47.08 ± 3.31 (Mean Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) scores significantly improved from 44.81 ± 3.59 to 47.08 ± 3.31 (p< .0001). Qualitative responses indicated that students appreciated working with other health care students through collaborative practice and recognized the importance of discipline-specific expertise.Conclusion:This simulation provided campus and distance learners with a collaboration opportunity that improved their perceptions of IPE. This simulation provided campus and distance learners with a collaboration opportunity that improved their perceptions of IPE. [[J Nurs Educ.2019;58(10):577–582.]

Financial stress is implicated in poor health and decreased Quality of Life (QOL). The purpose of this project was to assess the 2-year effect of a financial education program on the health of single, low-income women. A total of 30 women were enrolled and 20 continued through follow-up. Two years following intervention, women demonstrated a $8,026 increase in mean annual income and significant improvements in health-related QOL and hopefulness. Half of the participants lost weight, and while not statistically significant, mean weight decreased by 2.2 pounds. Trends in decreased fast food consumption were observed. The results suggest that financial education has a significant, sustained effect on the health and health-related QOL of single, women of low income.

Suboptimal adherence to medications taken chronically for secondary prevention of cardiovascular disease (CVD, e.g., aspirin) continues to burden the healthcare system despite the well‐established benefits of prevention. We conducted a literature search to examine patient adherence to medications for secondary prevention of CVD—as evaluated by prescription refill data, electronic medication monitors, pill counts, and physiologic markers—to better identify an unmet need for measures to improve patient adherence to these therapies. English‐language articles were obtained from the PubMed database using the following key words or combinations thereof “adherence,” “compliance,” “secondary prevention,” and “cardiovascular disease.” Publications that provided adherence data only for primary prevention, lacked data on medication adherence (e.g., focus on guideline adherence), emphasized quality‐of‐care outcomes, or focused on outcomes of acute interventions were excluded. Multiple patient‐, disease‐, and treatment‐related factors may contribute to poor adherence to treatment regimens, and therefore, a multifactorial approach will likely be needed to improve compliance with prescribed treatments for CVD. Although no magic bullet exists to assure full adherence, adherence programs coupled with patient counseling and education (inclusive of over‐the‐counter therapies), along with treatments that are less complex or avoid bothersome adverse effects, are more likely to be associated with successful outcomes. Given the burden of CVDto the community and the healthcare system, nonadherence to CVD‐preventative medications such as aspirin remains a substantial area of unmet need and represents a key opportunity for the development of quality‐of‐care enhancement programs to improve health outcomes in this patient population.

SUMMARYPurpose: Atrial fibrillation (AF) is the most common arrhythmic complication following coronary artery bypass graft surgery (CABG). The efficacy and safety of esmolol and diltiazem were compared in patients with post-CABG AF.Methods: This study was a retrospective medical record review of consecutive patients with post-CABG AF >15 min in duration with a ventricular rate >110 b.p.m. who received either i.v. esmolol (n = 59) or i.v. diltiazem (n = 48) with or without concomitant digoxin therapy at a single university-affiliated teaching hospital. Treatment success was defined as either cardioversion to sinus rhythm or a reduction in the ventricular rate to <90 b.p.m. at 24 h after the start of therapy. Time to treatment success and the occurrence of adverse effects were considered secondary outcomes.Results: A total of 107 patients with post-CABG AF were treated with i.v. esmolol (n = 59) or i.v. diltiazem (n = 48). The mean maximum dose of esmolol and diltiazem were 115 ± 38 μg/kg/min and 11.2 ± 3.5 mg/h, respectively. The average duration of the esmolol and diltiazem infusions were 19.3 ± 8.5 h and 20.1 ± 11.3 h, respectively. Based on the combined efficacy endpoint of cardioversion or ventricular rate control, esmolol was significantly more effective than diltiazem (90% vs 77%; p = 0.038). Time to treatment success was significantly better for esmolol than diltiazem at all time points (1, 2,4,6,12, and 24 h post-treatment). The overall incidence of adverse effects was 44% with esmolol and 60% with diltiazem (p = 0.04). Rates of drug discontinuance for adverse effects were significantly less for esmolol (20%) compared with diltiazem (38%) (p = 0.04).Conclusions: Esmolol is significantly more effective than diltiazem in the management of post-CABG AF. More patients converted to sinus rhythm with esmolol as compared to diltiazem. Esmolol was associated with fewer adverse effects than diltiazem, including adverse effects leading to drug discontinuance. Due to study design limitations (retrospective data collection), an adequately powered randomised, controlled trial is needed to confirm these preliminary findings.

Study Objective.To compare the lipid‐lowering effects of gemfibrozil and fenofibrate in patients with dyslipidemic coronary heart disease.

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors are often associated with an increased incidence of cough and bronchial responsiveness that may cause further deterioration of patients with impaired pulmonary function.OBJECTIVE: To review the available literature on the incidence of cough and bronchial responsiveness associated with ACE-inhibitor therapy in patients with asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF).DATA SOURCES: Literature was accessed through MEDLINE (1985–September 2001). Key search terms included cough, bronchospasm, asthma, congestive heart failure, chronic obstructive pulmonary disease, ACE inhibitors, and angiotensin II receptor blockers.DATA SYNTHESIS: The literature reports several cases of increased bronchial responsiveness associated with ACE inhibitors. Larger, controlled studies evaluating the increased risk in patients with pulmonary dysfunction are limited. Data from these trials are summarized in this article.CONCLUSIONS: The literature shows that patients with primary airway disease such as asthma and COPD are not at an increased risk of developing cough or bronchoconstriction as a result of ACE-inhibitor therapy. Despite the ability of ACE inhibitors to improve exercise tolerance, perfusion, and gas transfer, patients with CHF may be at higher risk of developing cough than the general population. Whether this cough is attributed to ACE inhibition or increased left-ventricular dysfunction remains uncertain. If increased bronchial responsiveness does occur, angiotensin II receptor antagonists are another reasonable option.

OBJECTIVE: To report the occurrence of a novel group of adverse effects associated with initiation and rechallenge of orlistat.CASE SUMMARY: A 42-year-old white woman developed symptoms of constipation, polyuria, polydipsia, and increased lower-leg edema after 2 weeks of treatment with orlistat 120 mg 3 × daily. The drug was discontinued for 4 days and the symptoms resolved. On reinstitution of the orlistat treatment, the symptoms reappeared within 2 days. Thereafter, the medication was permanently discontinued.DISCUSSION: Common gastrointestinal adverse reactions associated with orlistat use include fecal urgency and abdominal pain and discomfort. Pedal edema has also been reported to occur, although less frequently. No reports were discovered documenting the occurrence of constipation, polydipsia, and polyuria associated with the use of orlistat. Despite careful consideration of other possible causes of these symptoms, the temporal association between initiation, discontinuation, and rechallenge of orlistat and the patient's symptoms suggest a medication-related adverse event. Based on the Naranjo probability scale, the likelihood that orlistat was the cause of this cluster of adverse effects is possible.CONCLUSIONS: It is important for the healthcare provider to be aware of these adverse effects to promptly evaluate and differentiate between possible causes of similar reactions.

Purpose:Premature discontinuation of antiplatelet therapy in ACS patients receiving a drug-eluting stent (DES) can be associated with increased morbidity and mortality. The purpose of this study was to determine if refill notification reminders for clopidgrel by a pharmacist would improve long term adherence and outcomes for patients receiving a DES.

Objectives. To determine the effectiveness of the heart failure screening form in teaching heart failure treatment guidelines and prompting students to evaluate patients' medications to initiate patient education and provider intervention.