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Nurses are assessed periodically to demonstrate competence to deliver patient care. This study examined two approaches to assessing competency--skills fairs and the unit-based competence model., Health care is a dynamic field with frequent changes affecting the workforce. The constantly changing environment presents a challenge for organizations and nurses. Assuring nurses are competent in this changing [...]

Background: Ablation of atrial fibrillation is generally considered safe and effective. However, atrial-esophageal fistulas have recently been reported as a rare but fatal complication. Objective: To describe 9 patients with atrial-esophageal fistulas after ablation for atrial fibrillation. Design: Retrospective case series. Setting: Institutions where cardiologists performed atrial fibrillation ablation procedures. Patients: 9 patients with atrial--esophageal fistulas after atrial fibrillation ablation. Measurements: Demographic characteristics, mortality, presenting signs and symptoms, and days to presentation. Results: Patients presented a mean of 12.3 days (range, 10 to 16 days) after their procedures. Nonspecific symptoms included fever, leukocytosis, and neurologic abnormalities. All patients died. Only 4 patients received correct diagnoses before death, although all patients presented to a physician. In 3 patients, surgical repair was attempted. Limitations: Few physicians reported cases, and only approximate numbers of procedures performed by the physicians are known. Thus, the authors could not estimate the incidence of atrial-esophageal fistulas after ablation. Conclusions: Formation of atrial-esophageal fistulas is a rare but potentially devastating complication of atrial fibrillation ablation. This disorder may have an indolent presentation and may mimic other disease states, such as stroke or sepsis.

The authors are all employed at the Summa Health System (Akron City Hospital) in Akron, Ohio. Jennifer Cummings, MD, is an internal medicine resident. Kevin Mineo, MD, is is an [...]

Ablation is used for treatment of atrial fibrillation (AF) but recurrence is common. Dormant conduction is hypothesized to be responsible for these recurrences, and the role of adenosine in identification and ablation of these pathways is controversial with conflicting results on AF recurrence.

Time, cost, logistics, and negative perceptions of pelvic floor physical therapy are among the barriers that hinder its use for the treatment of high tone pelvic floor dysfunction.

This study used structurating activity theory to analyze 21 conversations between genetic counselors and individuals at increased risk for familial colorectal cancer. The qualitative analysis revealed ways elements of family, primary health care, cancer prevention and treatment, and other systems emerged in intervention conversations as shaping colorectal cancer screening attitudes and behaviors. Results indicate that family stories, norms, and roles are resources for enacting health practices in families and that the authority of health care providers is a resource for making screening decisions. Conclusions include practical implications for using findings in clinical applications as well as future research directions to build on this exploratory study.

The gonadal hormone estradiol modulates mesolimbic dopamine systems in the female rat. This modulatory effect is thought to be responsible for the observed effects of estradiol on motivated behaviors. Dopamine acting in the nucleus accumbens is thought to be important for the attribution of incentive motivational properties to cues that predict reward delivery, while dopamine in the striatum is associated with the expression of repetitive or stereotyped behaviors. Elevated concentrations of estradiol are associated with increased motivation for sex or cues associated with access to a mate, while simultaneously attenuating motivation for food. This shift in motivational salience is important for adaptive choice behavior in the natural environment. Additionally, estradiol’s adaptive effects on motivation can be maladaptive when increasing motivation for non-natural reinforcers, such as drugs of abuse. Here we discuss the effect of estradiol on mesotelencephalic dopamine transmission and subsequent effects on motivated behaviors.

Technological advances and increased utilization of medical testing and procedures have prompted greater attention to ensuring the patient safety of radiation use in the practice of adult cardiovascular medicine. In response, representatives from cardiovascular imaging societies, private payers, government and nongovernmental agencies, industry, medical physicists, and patient representatives met to develop goals and strategies toward this end; this report provides an overview of the discussions. This expert “think tank” reached consensus on several broad directions including: the need for broad collaboration across a large number of diverse stakeholders; clarification of the relationship between medical radiation and stochastic events; required education of ordering and providing physicians, and creation of a culture of safety; development of infrastructure to support robust dose assessment and longitudinal tracking; continued close attention to patient selection by balancing the benefit of cardiovascular testing and procedures against carefully minimized radiation exposures; collation, dissemination, and implementation of best practices; and robust education, not only across the healthcare community, but also to patients, the public, and media. Finally, because patient radiation safety in cardiovascular imaging is complex, any proposed actions need to be carefully vetted (and monitored) for possible unintended consequences.

Obstructive sleep apnea OSA may be associated with pulmonary vein antrum isolation PVAI failure. The aim of the present study was to investigate if treatment with continuous positive airway pressure CPAP improved PVAI success rates.

Abstract:The Texas State Library's multicounty bookmobile program and its earlier "traveling libraries" program had similar missions: to reach rural Texans deprived of proper library service. In both programs librarians faced inadequate funding and the daunting task of sending books over the vast distances of the Lone Star State. Ultimately, Texas's traveling libraries and bookmobiles introduced the pleasure of reading to families in the state's isolated farms and ranches and garnered support for today's county libraries.

To compare the mood and somatic effects during the initial 2 months of medroxyprogesterone acetate (MPA) or progesterone combined with conjugated equine estrogen (CEE) in early postmenopausal women.

Abstract. Objective: To determine whether pharmacologic antagonism of adenosine A1‐receptor‐mediated cardiovascular changes can improve cardiac function and prolong survival during systemic hypoxia. Methods: Rats were anesthetized with ketamine, instrumented [including left ventricular (LV) pressure transducing catheters], paralyzed with vecuronium, then ventilated to pCO2= 35‐40 torr. After 10 minutes of equilibration (baseline), treatment commenced with saline (n = 7), NPC‐205, an adenosine A1receptor selective antagonist, at doses of 1 mg/kg (n= 10) or 10 mg/kg (n= 10), or drug vehicle (n= 9). Ten minutes later, inspired oxygen was reduced to 5%. Results: Survival duration (min) post‐hypoxia increased in a dose‐dependent fashion from 10.4 ± 1.4 (mean ± SEM) with vehicle control to 23.0 ± 4.7 and 41.1 ± 5.7 with 1 and 10 mg/kg NPC‐205, respectively (p < 0.000). Five minutes post‐hypoxia, dose‐dependent increases were also seen in the percentage of pre‐hypoxic values of LV contractility [25.9 ± 8.1 (vehicle), 39.5 ± 9.6 (1 mg/kg NPC‐205), and 56.5 ± 8.7 (10 mg/kg NPC‐205), p = 0.01], heart rate [60.6 ± 8.3 (vehicle), 74.7 ± 8.2 (1 mg/kg NPC‐205), and 90.4 ± 24.1 (10 mg/kg NPC‐205), p = 0.02], and blood pressure [16.1 ± 4.8 (vehicle), 28.8 ± 8.6 (1 mg/kg NPC‐205), and 51.7 ± 8.2 (10 mg/kg NPC‐205), p = 0.004]. Conclusions: The adenosine A1selective antagonist prolonged survival in this model. This prolongation was attributed to inhibition of adenosine A1receptor‐mediated decline in cardiac inotropy and chronotropy. Adenosine A1receptor‐selective antagonists show promise as adjunctive therapy for hypoxia‐induced cardiac insufficiency by prolonging the treatment window until more definitive resuscitation measures are taken.

Otopteropus cartilagonodus (Megachiroptera, Pteropodidae) is a rare, small-bodied cynopterine bat endemic to Luzon Island in the Philippine Archipelago. Twenty-two female and seven male O. cartilagonodus were collected during March and May of 1988. Observations were made on early embryonic development and the morphology of ovaries, uteri, and testes. All females collected during March were pregnant, and their uterine swellings occurred within a narrow size range (2–4 mm in diameter). Moreover, the embryos of all eight females captured in March and examined histologically were all within or just before the primitive-streak stage of development. The uterine swellings of females captured in May ranged from 15 to 20 mm in diameter, and their extrapolated birth dates were in late May or June. The synchrony of embryologie development and the apparent lack of developmental progress during March suggests that O. cartilagonodus has a prolonged period at the primitive-streak stage of embryonic development. The morphology of the embryo, embryonic membranes, and uterus at these stages is similar to that of two other cynopterine fruit bats, Cynopterus sphinx and Haplonycteris fischeri.