Frequent rehospitalizations among patients with heart failure (HF) result in patient burden and high cost. Homebound patients with HF qualify for home healthcare after hospital discharge. It is not known if nonhomebound patients with HF could also benefit from home healthcare nursing (HHN) visits to improve the transition from hospital to home. The purpose of this quality-improvement pilot study was to assess the impact of HHN visits provided to nonhomebound HF patients after hospital discharge on 30-day rehospitalization rates. We included patients with HF who were ineligible for home healthcare services due to their nonhomebound status. Home healthcare nurses followed a modified version of the discharge checklist from the American Heart Association's Rise Above Heart Failure materials, and provided education as appropriate based on patients' responses. We enrolled 68 patients in the study. The mean age was 60.2 years; 61.8% were male and 77.9% were White. Based on patient responses to the checklist, key areas addressed during HHN visits were medication management and HF self-care. In the HHN visit group, 15% of the patients experienced rehospitalization within 30 days, compared with 23% in the non-HHN visit group among 540 patients discharged in the same time frame who met the inclusion criteria but were not enrolled in the study (p = .12). Our pilot data show that HHN visits for nonhomebound patients are feasible and result in a numerically lower 30-day rehospitalization rate after discharge. Further study is needed to confirm the clinical efficacy of this approach.Understanding the experiences of home healthcare nurses and exploring the factors that influence job satisfaction is important in reducing costly staff turnover. The purpose of the qualitative case study was to describe experiences related to job satisfaction among home healthcare nurses. Herzberg's Two Factor theory was used to frame the study. Twelve home healthcare nurses from an agency in South Texas volunteered to participate in in-depth interviews. Four themes emerged from the data 1) patients contribute to job satisfaction, 2) autonomy promotes job satisfaction, 3) occupational stressors negatively influenced job satisfaction, and 4) leadership impacts job satisfaction. Home healthcare leadership should take safety concerns seriously and explore innovative ways to promote communication between field nurses and physicians. Further research is needed with a larger and more diverse sample of home healthcare nurses in order to be able to generalize findings.The U.S. Department of Veterans Affairs Home-Based Primary Care program (HBPC) serves Veterans with multiple comorbid physical and psychological conditions that can increase suicide risk. HBPC teams are uniquely able to implement suicide risk assessment and prevention practices, and the team's mental health provider often trains other team members. An online suicide prevention toolkit was developed for HBPC mental health providers and their teams as part of a quality improvement project. Toolkit development was guided by a needs assessment consisting of first focus group and then data from surveys of HBPC program directors (n = 53) and HBPC mental health providers (n = 56). Needs identified by both groups included training specific to the HBPC patient population and more resources if mental health needs could not be fully managed by the HBPC team.  https://www.selleckchem.com/products/rgd-arg-gly-asp-peptides.html  HBPC mental health providers within integrated care teams play a key role in clinical intervention, policy development, and interprofessional team education on suicide prevention. HBPC teams have specific learning and support needs around suicide prevention that can be addressed with a feasible, easily accessible clinical and training resource.Atrial fibrillation is a common cardiac arrhythmia in which the atria of the heart do not beat synchronously with the ventricles. It affects 2.7 to 6.1 million people in the United States. The erratic beating of the atria can cause blood clots to form in the atria, and if released into the circulation, an embolism can travel to the brain, causing a stroke. The primary goals of care for the management of atrial fibrillation are stroke-risk reduction, control of heart rate, rhythm management, and prevention of cardiac-related morbidity and mortality. This article reviews the guideline for the management of patients with atrial fibrillation by the American College of Cardiology and American Heart Association Task Force on Clinical Practice Guidelines and provides recommendations for home healthcare clinicians.To achieve optimal chest compression depth, victims of cardiac arrest should be placed on a firm surface. Backboards are usually placed between the mattress and the back of a patient in the attempt to increase cardiopulmonary resuscitation (CPR) quality, but their effectiveness remains controversial. A systematic search was performed to include studies on humans and simulation manikins assessing CPR quality with or without backboards. The primary outcome of the meta-analysis was the difference in chest compression depth between these two conditions. Out of 557 records, 16 studies were included in the review and all were performed on manikins. The meta-analysis, performed on 15 articles, showed that the use of backboards during CPR increases chest compression depth by 1.46 mm in manikins. Despite statistically significant, this increase could have a limited clinical impact on CPR, due to the substantial heterogeneity of experimental conditions and the scarcity of other CPR quality indicators.
  Narcotics are the cornerstone of postoperative pain control, but the opioid epidemic and the negative physiological and psychological effects of narcotics implore physicians to utilize nonpharmacological methods of pain control.
 
  This pilot study investigated a novel neurostimulation device for postoperative analgesia. We hypothesized that active neurostimulation would decrease postoperative narcotic requirements.
 
  This was a placebo-controlled, double-blinded trial.
 
  This trial was conducted at an academic medical center and a Veterans Affairs hospital.
 
  This trial included adult patients who underwent elective bowel resection between December 2016 and April 2018.
 
  Patients were randomly assigned to receive an active or inactive (sham) device, which was applied to the right ear before surgery and continued for 5 days.
 
  The primary outcome was total opioid consumption. The secondary outcomes included pain, nausea, anxiety, return of bowel function, complications, 30-day readmissions, and opioid consumption at 2 weeks and 30 days.