Aggressive Risk Factor Research Articles

The moderating role of emotion regulation on the relationship between sensitivity to punishment and aggressive behaviour

IntroductionThe role of sensitivity to punishment on aggression is controversial, both positive and negative relationships have been observed in previous literature.ObjectivesThe aim of this research was to clarify the role of sensitivity to punishment in different types of aggression and provide a better understanding of the influence of emotional regulation on this relationship.MethodsTwo hundred and twenty-nine participants took part in the study (130 women; average age = 21.52 years). All of them were assessed for levels of verbal aggression, physical aggression, anger, and hostility (by Buss-Perry Aggression Questionnaire), levels of sensitivity to punishment (by SPSRQ–20), and emotional regulation ability (by MSCEIT).ResultsA higher reactivity to punishment had a direct negative effect on physical and verbal aggression. However, a higher reactivity to punishment also showed a positive indirect effect on verbal and physical aggression through an increase in anger and hostility. In addition, ability in regulating emotions moderated the indirect effects of sensitivity to punishment on physical aggression.ConclusionsOur results suggest that sensitivity to punishment can act both as a protective factor and as a risk factor for aggression. This relationship depended on the type of aggression studied and the emotional regulation abilities. These findings can help to inform the design of programs aimed at reducing aggressive behaviour. This work was funded by Junta de Andalucía (projects: EMERGIA20_00056 and UMA18-FEDERJA-137) to Alberto Megías Robles.DisclosureNo significant relationships.

The Never-Ending Story of Complicated Hypertension

Abstract Polyvascular disease affects up to 20% of atherosclerotic patients and portends a significantly higher cardiovascular risk, especially in terms of ischemic events. Therapeutic options mainly focus on aggressive pharmacotherapy and risk factor control. We present the case of a male obese patient with coronary artery disease, chronic renal disease, and refractory hypertension who underwent serial contrast imaging to document the extent and severity of his systemic atherosclerosis and was consequently referred for cardiovascular surgery to address total occlusion of the abdominal aorta. We further discuss specific features complicating the medical management of patients with severe hypertension, extensive atherosclerosis, and renal disease.

Correlates of Aggression in Men With Methamphetamine Use Disorder: Childhood Trauma and Methamphetamine-Use Characteristics.

BackgroundAggression is common among individuals with methamphetamine use disorder (MAUD) and constitutes a serious public health issue. The current study aimed to examine associations of methamphetamine-use characteristics and childhood trauma with aggression in men with MAUD.MethodsThis cross-sectional study was conducted from December 2017 to August 2018. MAUD patients recruited from a compulsory drug rehabilitation center (n = 360) and healthy comparison subjects (n = 604) completed a survey that measured aggression and childhood trauma, using the Chinese version of Buss-Perry Aggressive Questionnaire (AQ-CV), and the short form of Childhood Trauma Questionnaire (CTQ-SF), respectively. MAUD patients also provided information on methamphetamine-use characteristics such as the age of MAUD onset, MAUD severity, and co-occurring alcohol use disorder (AUD) and tobacco use disorder (TUD) using standard or self-designed questionnaires. Chi-square tests and t-tests were used to compare childhood trauma and aggression between the MAUD and comparison groups. Multiple linear regressions were conducted to determine correlates of overall aggression and its five sub-scales among the MAUD group.ResultsThe MAUD group had higher childhood trauma and aggression scores than the comparison group. Within the MAUD group, age of MAUD onset, having severe MAUD, co-occurring AUD, co-occurring TUD, and childhood trauma were associated with overall aggression, with slightly different correlates found for its five sub-scales.ConclusionsOur study shows a high level of childhood trauma and aggression in the MAUD group. Both methamphetamine-use characteristics (age of MAUD onset, severe MAUD, co-occurring AUD/TUD) and childhood trauma were associated with aggression in MAUD. Our findings provide useful information on potential risk factors for aggression and inform future longitudinal research to establish causal relationships between these factors and aggression to guide further prevention and treatment programs.

Positive Preoperative Stress Test Before Elective Carotid Revascularization Associated With Acceptable Perioperative Outcomes But Higher Mid-term Follow-up Mortality

This study compared outcomes in patients with and without preoperative stress testing undergoing carotid revascularization (carotid endarterectomy [CEA], transfemoral carotid artery stenting [TF-CAS], and transcarotid artery revascularization [TCAR]) Patients in the Vascular Quality Initiative database who underwent elective carotid revascularization between 2016 and 2020 were included. Patients were analyzed by group based upon whether they underwent cardiac stress testing within 2 years preceding revascularization without subsequent coronary intervention. Subset analysis was performed comparing outcomes between those with negative and positive results (evidence of ischemia or myocardial infarction). Risk stratification was performed via the Vascular Study Group of New England Cardiac Risk Index. Outcomes of interest were a composite end point of periprocedural myocardial infarction, stroke, and 30-day mortality; as well as 1-year mortality. We analyzed 86,367 patients (75.4% CEA, 12.8% TF-CAS, 11.8% TCAR). Of these, 32% underwent preoperative stress testing (33.9% of CEA patients, 23.2% of TF-CAS patients, and 30.3% of TCAR patients). Mean Vascular Study Group of New England Cardiac Risk Index across groups with or without preoperative stress testing was an intermediate risk score (5.4 ± 2.1 vs 5.1 ± 2.1), with a significantly higher risk score in the preoperative stress test group across all three procedures: CEA (5.2 vs 4.9; P < .001), TF-CAS (5.9 vs 5.3; P < .001), and TCAR (6.2 vs 5.8; P < .001). The composite periprocedural end point was similar between those patients with and without preoperative stress testing undergoing TF-CAS (3.8% vs 3.6%; P = .6) and TCAR (3.1% vs 2.8%; P = .3), but was significantly higher in patients with preoperative testing undergoing CEA (2.7% vs 2.4%; P = .03). One-year mortality was similar between patients with and without preoperative stress testing for CEA (2.6% vs 2.7%; P = .4) and TCAR (2.8% vs 2.4%; P = .3). Of 27,710 patients with preoperative stress tests, 24% had positive results. A higher proportion of patients undergoing TF-CAS (32.9%) had positive stress tests compared with those undergoing CEA (22.9%) or TCAR (28.1%). Composite periprocedural end point was not significantly different stratified by stress test positivity between patients undergoing TF-CAS (4.3% vs 3.6%; P = .4) and TCAR (3.0% vs 3.2%; P = .7), but was significantly higher in patients with a positive stress test undergoing CEA (3.4% vs 2.5%; P = .001). Patients with a positive test undergoing CEA (3.5% vs 2.3%; P < .001) and TF-CAS (5.1% vs 2.8%; P = .003) had significantly higher 1-year mortality; there was no significant difference in patients undergoing TCAR (3.2% vs 2.6%; P = .3). Our study suggests that positive preoperative stress test before elective carotid revascularization is associated with acceptable perioperative outcomes but portends worse follow-up mortality. These patients should be treated with aggressive atherosclerosis risk factor reduction to improve longer term outcomes.

LDL goal as a risk factor target in the post-intervention outpatient cardiology population

Abstract Funding Acknowledgements Type of funding sources: None. Background The relationship between an acute coronary event and cholesterol levels has been immensely researched, specifically the low-density lipoprotein (LDL) component of cholesterol. According to the Canadian guidelines, LDL cholesterol should be below 1.8 mmol/L if the patient has suffered an acute cardiac event. The European guidelines suggests that LDL target concentration should be below 1.4 mmol/L if the patient has had a previous cardiac event. European guidelines also lowered the LDL recommendations to less than 1 mmol/L if the patient has had 2 previous cardiac event in the previous 2 years. Purpose Assess the concordance of one Canadian cardiology clinic to the European LDL guidelines in patients with coronary artery disease. Methods Patients were randomly selected from a single centre outpatient Cardiology practice between January and June 2021. All patients were selected by 1 researcher. The patients selected must have been diagnosed with coronary artery disease by Angiography and undergone intervention in the form of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The blood cholesterol levels were evaluated before and after intervention. Results 101 patients were randomly selected for this study. Data encompassed 83 males and 18 females ages 43 to 88. Before the intervention, 15 patients had an LDL level below 1.4 mmol/L, 29 patients had an LDL level below 1.8 mmol/L. After the intervention, the number of patients with LDL &amp;lt;1.4 mmol/L was 50 and LDL&amp;lt;1.8 was 85. This population was divided by risk factors and the LDL levels were compared before and after intervention. 9 patients were known to be smokers, their LDL levels were on average 2.73 mmol/L before intervention and 1.3 mmol/L after intervention. 31 patients were known diabetic, their LDL levels were on average 2.15 mmol/L before intervention and 1.43 mmol/L after intervention. 69 patients had hypertension, their LDL levels were 2.36 mmol/L before intervention and 1.46 mmol/L after intervention. Of the 30 patient who had a positive family history, the LDL on average was 2.39 mmol/L before intervention and 1.84 mmol/L after intervention. Positive family history was contingent on having an immediate female relative with age &amp;lt;65 or immediate male relative with age &amp;lt;55 having had a cardiac event or coronary intervention. Conclusions The number of individuals on appropriate cholesterol medications after intervention increased thereby reducing the LDL concentration. The data shows that in a sample of the typical Canadian population, 84% of patients were adequately managed after a coronary artery intervention according to the Canadian guidelines. According to the UK guidelines, only 29.5% are being adequately managed. The North American guidelines will likely incorporate the new LDL targets into upcoming revisions and therefore more aggressive risk factor management will be required to meet the new target goals.

In vivo defensive behaviors, fear, and attention bias to physical and negative evaluation threats

Aggressive behavior is a major public health issue for which there are few efficacious treatments. Although much of information processing is automatic, there are few studies of early-stage decoding biases (e.g., attention bias to threat) and aggressive behavior, potentially resulting in missed opportunities for identifying targets of intervention. Previous studies are limited by indirect measures of attention bias and little consideration of proximal factors like state fear, which organizes perception and motivates defensive behaviors. We used laboratory methods (i.e., eye-tracking, idiographic mood induction, and the Point Subtraction Aggression Paradigm), to examine the association between attention bias to physical and negative evaluation threat and in vivo defensive responding (i.e., aggression and escape) and the potential moderating role of state fear among 74 undergraduate students. As predicted, attention bias to threat was positively associated with in vivo aggression. Fear did not potentiate aggression or modify the relationship between attentional bias to threat and aggression; however, in the fear condition, greater attentional bias to threat was associated with less escape behavior. Findings add to the sparse literature identifying early-stage decoding processes as possible risk factors of aggression and suggest a need for additional research on freeze behavior in response to threat and provocation.

A new marker of risk for ischemic events

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Although dobutamine stress echocardiography (SE) has a high specificity, there is still a subset of patients (P) with false positive tests (FP) and their prognosis remains unclear. Purpose To identify the clinical and echocardiographic predictors of FP on SE and to evaluate the prognostic impact of FP on SE. Methods Retrospective study of 355 consecutive adult P who underwent SE for ischemia assessment over a one-year period: 134 (37,7%) women, 70,3 ± 0,57 years, body surface area (ASC) 1,85±0,01 cm2. Demographics, risk factors, clinical and laboratorial parameters and SE variables were evaluated. A FP result was defined as a positive SE for ischemia in the absence of ≥50% coronary artery (CA) lesion in a major artery of the corresponding coronary territory on subsequent angiography. P were divided into 2 groups regarding the presence (FP+) or the absence (FP0: 15,5% true positives, 79,7% true negatives, 0,3% false negatives ) of a FP result on SE and a comparative analysis was performed in order to characterize the groups and identify potencial predictors of FP results. P were followed for 2 years to assess acute myocardial infarction (AMI), hospitalization for acute heart failure (HF) and mortality (M). Results The FP rate was 4,5% (16P). Comparing to F0, P in group FP+ were younger (65,1±2,4 vs 70,5±0,6 years; p=0,045), baseline wall motion abnormalities were more frequent (75,0% vs 41,6%; p=0,009), had higher mean blood pressure values at rest (99,3±5,4 vs 82,0±1,3 mmHg; p=0,004) and at peak stage (140,3±5,6 vs 102,8±2,3 mmHg; p&amp;lt;0,001) and more often hypertensive response (37,5% vs 7,1%; p&amp;lt;0,001). There were no significant differences regarding previous CA disease, medication or complete left bundle branch block. By multivariate analysis, only mean blood pressure values at rest (OR 0,01; 95%CI 0,005-0,02; p=0,003) and at peak stage (OR 0,02; 95%CI 0,000-0,004; p=0,003) were independente predictors of FP. During follow-up was observed: AMI (FP+: 12,5% vs FP0: 1,8%, p=0,046), HF (FP+: 6,3% vs FP0: 11,5%, p=0,44) and M (FP+: 6,3% vs FP0: 6,2%, p=0,65). After adjustment for age, sex and comorbidities, there were no diferences between the groups regarding HF (p=0,45) and M (p=0,77), but the group FP+ mantained a higher rate of AMI (OR 0,21; 95%CI 0,065-0,354; p=0,005). Conclusion A FP result on SE is associated with higher mean blood pressure values during the test and with higher rates of AMI during follow-up. This result on SE should therefore be faced as a risk marker for ischemic events and can identify P that may benefit from aggressive risk factor control and careful clinical follow-up.

P517. Aggression and Social Cognition in Schizophrenia Spectrum Disorders

Existing studies have not identified reliable personal predictors of aggression among individuals with Schizophrenia Spectrum Disorders (SSD). Since people who are unable to accurately process social situations may be more likely to react in a hostile way, we hypothesized that poor social cognition and negatively biased interpretations of social cues may be modifiable risk factors for aggression among individuals with SSD.

Presence of asymptomatic Peripheral Arterial Disease in combination with common risk factors elevates the cardiovascular risk Substantially

Background and aimsThis study evaluates the risks for adverse cardiovascular (CV) events in Asymptomatic Peripheral Arterial Disease (APAD) combined with different traditional CV risk factors. MethodsA population-based observational study of 8000 subjects, identified 559 subjects as having APAD through ankle-brachial index (ABI) measurements and questionnaires regarding limb symptoms. This cohort and subgroups classified by presence of different traditional CV risk factors at baseline were assessed for 10 years on CV outcome. The recorded endpoints were all-cause mortality, CV mortality and non-fatal CV events. ResultsBefore subdividing the APAD subjects, the CV mortality incidence was 28.5 deaths per 1000 person-years as compared to 8.7 deaths for references without APAD. For subjects with hypertension at baseline the CV mortality incidence was 35.4 when combined with APAD and 11.7 without. In women with hypertension but without other risk factors, presence of APAD increased the age-adjusted Hazard Ratio (HR) for fatal and non-fatal CV events by 1.86 [CI 1.54,2.24, p < 0.001]. ConclusionsABI measurements should be considered an important indication for aggressive multifactorial risk factor reduction in populations with any other prevalent CV risk factor. In hypertension, diabetes mellitus and a smoking history, coexisting APAD contributes significantly to the increased age-adjusted CV risk.

Significance of Insignificant Left Main Disease

Significance of Insignificant Left Main Disease

Sex Differences and Similarities in Risk Factors of Physical Aggression in Adolescence

Considerable research has documented risk factors of physical aggression in adolescence. However, less is known of sex differences in these associations. The current study addressed this important area by examining sex differences in concurrent associations of physical aggression with mental health concerns, trauma exposure, and substance use. The study sample consisted of 3686 boys (mean age 15.9 years) and 3881 girls (mean age 16.0 years) from Young-HUNT3, a population-based study of adolescents in Norway. Logistic regression was used to analyze the association of physical aggression, measured as involvement in physical fighting, with possible risk factors: attention problems, anxiety and depression, loneliness, self-esteem problems, trauma exposure, PTSD symptoms, and substance use. Twenty-one percent (n = 773) of boys and three percent (n = 133) of girls reported participating in physical fights. The results indicated that all risk factors were associated with physical aggression in the total sample as well as in boys and girls separately. Interaction effects with sex emerged for attention problems, anxiety and depression, loneliness, traumatic events, alcohol intoxication, and narcotics use, with larger odds ratios for girls than for boys. Attention problems, traumatic events, and alcohol intoxication showed unique associations with physical aggression for both boys and girls, in addition to PTSD symptoms for boys. In sum, boys’ and girls’ engagement in physical aggression was associated mainly with the same risk factors, but several of the factors increased the relative risk more for girls than for boys. The findings can inform interventions targeting physical aggression in adolescence.

Processing of Spoken Emotions in Schizophrenia: Forensic and Non-forensic Patients Differ in Emotional Identification and Integration but Not in Selective Attention.

Patients with schizophrenia (PwS) typically demonstrate deficits in visual processing of emotions. Less is known about auditory processing of spoken-emotions, as conveyed by the prosodic (tone) and semantics (words) channels. In a previous study, forensic PwS (who committed violent offenses) identified spoken-emotions and integrated the emotional information from both channels similarly to controls. However, their performance indicated larger failures of selective-attention, and lower discrimination between spoken-emotions, than controls. Given that forensic schizophrenia represents a special subgroup, the current study compared forensic and non-forensic PwS. Forty-five PwS listened to sentences conveying four basic emotions presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Their performance was compared to that of 21 forensic PwS (previous study). The two groups did not differ in selective-attention. However, better emotional identification and discrimination, as well as better channel integration were found for the forensic PwS. Results have several clinical implications: difficulties in spoken-emotions processing might not necessarily relate to schizophrenia; attentional deficits might not be a risk factor for aggression in schizophrenia; and forensic schizophrenia might have unique characteristics as related to spoken-emotions processing (motivation, stimulation).

Increased plasma levels of NT-proBNP, Troponin T and GDF-15 are driven by persistent AF and associated comorbidities: Data from the AF-RISK study.

Atrial fibrillation (AF) is a progressive disease, and early recognition and management may reflect an important strategy to reduce its disease burden. In this study, we evaluated plasma levels of three biomarkers - N-terminal pro-brain natriuretic peptide (NTproBNP), Troponin-T, and growth differentiation factor-15 (GDF-15) - in patients with paroxysmal AF (pAF) (≤7 days of continuous AF, n = 323) and persistent AF ((AF duration > 7 days and < 1 year, n = 84) using patients from AF RISK study (NCT01510210). In this AF-RISK sub-study, patients with persistent AF experienced more symptoms (higher European Heart Rhythm Association class (p < 0.001)), had a higher comorbidity burden (p < 0.001), and had more unfavorable echocardiographic parameters (p < 0.001). All three biomarker levels were significantly higher in patients with persistent AF as compared to those with pAF (p < 0.001). Multivariate linear regression analyses showed that age (beta-coefficient for NTproBNP: 0.21; GDF-15: 0.41; Troponin-T: 0.23) and CHA2DS2-VASc (beta-coefficient for NTproBNP: 0.20; GDF-15: 0.25; Troponin-T: 0.27) were determinants of all three biomarkers, and that persistent AF determined NTproBNP (beta-coefficient: 0.34), but not Troponin-T and GDF-15. More detailed analysis of CHA2DS2-VASc score showed that for all three biomarkers age, coronary artery disease and heart failure were determinants of plasma biomarkers levels, whereas sex determined NTproBNP and Troponin T, and hypertension determined NTproBNP and GDF15. Overall, this study therefore suggests that in AF, Troponin T and GDF15, and especially NTproBNP could be used to detect those patients with more persistent form of AF that may warrant more aggressive treatment of AF and concomitant comorbidities. Future studies, however, are essential to evaluate if more aggressive AF treatment and risk factor management will reduce disease progression and holds a novel therapeutic intervention to reduce the burden of AF.

The development of forms and functions of aggression during early childhood: A temperament-based approach.

This study used a short-term longitudinal design with theoretically derived preregistered hypotheses and analyses to examine the role of temperament in the development of forms (i.e., physical and relational) and functions (i.e., proactive and reactive) of aggressive behavior in early childhood (N = 300, M age = 44.70 months, SD = 4.38, 44% girls). Temperament was measured via behavioral reports of emotional dysregulation, fearlessness/daring, and rule internalization/empathy and, in a subsample that completed a physiological assessment, via skin conductance and respiratory sinus arrhythmia. Emotion dysregulation generally served as a risk factor for all subtypes of aggression, with evidence of stronger associations with reactive as compared to proactive functions of relational aggression for girls. Daring predicted increases in physical aggression, especially among boys, and rule internalization predicted decreases in relational aggression, especially among girls. Rule internalization mediated longitudinal associations between daring and proactive relational aggression for girls. Some evidence also emerged supporting associations between adaptive functioning (i.e., high empathy, high respiratory sinus arrhythmia) and proactive functions of aggression. Findings highlight distinct temperamental risk factors for physical versus relational aggression and provide partial support for gender-linked theories of the development of aggression.

Major cardiovascular events in patients presenting with acute stroke: a 5-year follow-up study in patients who had ischaemic stroke and stroke mimics

ObjectivesThe long-term acute stroke outcome has not been well studied in the Middle-Eastern population. The primary objective of our study is to compare the long-term outcome of acute ischaemic stroke...

Subclinical Cardiac Dysfunction is Associated with Reduced Cardiorespiratory Fitness and Cardiometabolic Risk Factors in Firefighters

BackgroundPast studies have documented the ability of cardiopulmonary exercise testing to detect cardiac dysfunction in symptomatic patients with coronary artery disease. Firefighters are at high risk for work-related cardiac events. This observational study investigated the association of subclinical cardiac dysfunction detected by cardiopulmonary exercise testing with modifiable cardiometabolic risk factors in asymptomatic firefighters. MethodsAs part of mandatory firefighter medical evaluations, study subjects were assessed at 2 occupational health clinics serving 21 different fire departments. Mixed effects logistic regression analyses were used to estimate odds ratios (ORs) and account for clustering by fire department. ResultsOf the 967 male firefighters (ages 20-60 years; 84% non-Hispanic white; 14% on cardiovascular medications), nearly two-thirds (63%) had cardiac dysfunction despite having normal predicted cardiorespiratory fitness (median peak VO2 = 102%). In unadjusted analyses, cardiac dysfunction was significantly associated with advanced age, obesity, diastolic hypertension, high triglycerides, low high-density lipoprotein (HDL) cholesterol, and reduced cardiorespiratory fitness (all P values < .05). After adjusting for age and ethnicity, the odds of having cardiac dysfunction were approximately one-third higher among firefighters with obesity and diastolic hypertension (OR = 1.39, 95% confidence interval [CI] = 1.03-1.87 and OR = 1.36, 95% CI = 1.03-1.80) and more than 5 times higher among firefighters with reduced cardiorespiratory fitness (OR = 5.41, 95% CI = 3.29-8.90). ConclusionSubclinical cardiac dysfunction detected by cardiopulmonary exercise testing is a common finding in career firefighters and is associated with substantially reduced cardiorespiratory fitness and cardiometabolic risk factors. These individuals should be targeted for aggressive risk factor modification to increase cardiorespiratory fitness as part of an outpatient prevention strategy to improve health and safety.

Book Reviews

McKnight SE. Sigma Theta Tau International Honor Society of Nursing; 2019. Paperback; 296 pages.Nurses are front and center in health care facilities; they maintain the contact with patients, families, and visitors. This position puts nurses at risk for physical and verbal abuse. The American Association of Critical-Care Nurses released a position statement in 2019 on preventing violence against health care providers.1 According to this position statement, As with many other situations, COVID-19 has put a spotlight on the gaps in health care systems’ processes to prepare for and prevent violence against health care workers. De-escalating Violence in Healthcare can help nurses understand de-escalation techniques in detail and prepare them for success when facing a potentially harmful situation.This book, which contains 20 chapters, informs readers about therapeutic de-escalation and effective communication. The first chapter provides an overview, and the next few chapters describe variables and risk factors for aggression and how to assess an escalating situation for early intervention. Then the author discusses de-escalation techniques, focusing on therapeutic communication, stress management, conflict resolution, and crisis intervention. Two chapters are dedicated to managing mental health emergencies and performing a detailed mental status assessment. The author highlights how to apply de-escalation techniques for patients with mental disorders; those exhibiting nonsuicidal self-harm behavior, dementia, and delirium; and difficult or angry patients. An entire chapter is dedicated to staying safe during de-escalation. The final chapters describe processes for debriefing, reporting, and documenting; creating and fostering a calm, caring, and healing environment; and bringing it all together to create a comprehensive prevention plan for health care violence.Nurses need to understand the material presented in this book for their own protection. You may feel that your hospital’s method to prevent violence in health care is sufficient or that you are not responsible for developing a violence prevention plan. Even so, this book will strengthen your awareness and knowledge of de-escalation methods on the basis of the latest evidence. In addition, after reading this book, you could contribute ideas to improve the current violence prevention plan at your facility.Love R, Hanrahan N, Ackerman ML, Lawlor FA, Taylor AR, Toner E. Springer Publishing Company; 2020. Paperback; 184 pages.Are you feeling like you are unsure what is next in your career journey? The Rebel Nurse Handbook is a collection of stories by nurses who have stepped outside their comfort zone to progress in their careers. Nurses in many different roles are represented in the book; they come from diverse backgrounds and have different levels of experience, but they all felt the desire and passion to make a change. Nurse clinicians, leaders, and entrepreneurs tell the story of their journey. Each story is brief yet thorough. The final chapter includes resources to help you drive your nursing career and the field of nursing forward. This book will inspire you to impact nursing—both the art and the science.Wright D. Creative Health Care Management; 2022. Paperback; 220 pages.The Ultimate Guide to Competency Assessment in Health Care provides everything you need to create a competency assessment process that is effective, efficient, and meaningful. In this book, the author presents a systematic approach to competency assessment; she moves beyond the technical skills checklist and includes assessment of critical thinking and interpersonal skills. Numerous examples of competency verification methods provide ideas to create competency assessments. The concept of including team accountability in competency assessment is woven throughout the book, making it a must-have for every nurse who manages or creates competency assessments.Rea R, Douglas K. Independently published; 2020. Paperback; 114 pages.Witnessing suffering has been both a privilege and painful for nurses. During the COVID-19 pandemic, nurses have witnessed overwhelming suffering, which has left many of them with unprocessed grief. Nurses Cry Too is not a traditional self-help book. Rea and Douglas have included poetry and imagery in this short book, imparting beauty, a sense of grace, and raw authenticity. Nurses Cry Too is an easy read meant to guide suffering nurses through loss and grief to selfcare.

False Positive Results on Dobutamine Stress Echocardiography: A New Marker of Risk for Ischemic Events

Background: Although dobutamine stress echocardiography (DSE) has a high specificity, there is still a subset of patients with false positive tests (FP); whether these results have prognostic value remains unclear. Aims: To identify the clinical and echocardiographic predictors of FP on DSE and to evaluate the prognostic impact of FP on DSE. Methods: Retrospective study of 355 consecutive patients who underwent DSE for ischemia assessment over a one-year period: 134 (37,7%) women, 70,3 ± 0,57 years. Demographics, risk factors, clinical and laboratorial parameters and DSE variables were evaluated. Patients were divided into 2 groups regarding the presence (FP+) or the absence (FP0) of a FP result on DSE and a comparative analysis was performed to characterize the groups and identify potencial predictors of FP results. Patients were followed for 2 years to assess acute myocardial infarction, hospitalization for acute heart failure (HF) and mortality. Results: The FP rate was 4,5%. Comparing to FP0, patients in group FP+ were younger, baseline wall motion abnormalities were more frequent, had higher mean blood pressure values at rest and at peak stage and more often hypertensive response. There were no significant differences regarding previous coronary artery disease, medication or complete left bundle branch block. By multivariate analysis, only mean blood pressure values at rest (OR 0,01; 95%CI 0,005-0,02; p=0,003) and at peak stage (OR 0,02; 95%CI 0,000-0,004; p=0,003) were independent predictors of FP. During follow-up was observed: acute myocardial infarction (FP+: 12,5% vs FP0: 1,8%, p=0,046), HF (FP+: 6,3% vs FP0: 11,5%, p=0,44) and mortality (FP+: 6,3% vs FP0: 6,2%, p=0,65). After adjustment for age, sex and comorbidities, there were no diferences between the groups regarding HF and mortality, but the group FP+ mantained a higher rate of acute myocardial infarction (OR 0,21; 95%CI 0,065-0,354; p=0,005). Conclusion: A FP result on DSE was associated with higher mean blood pressure values during the test and with higher rates of acute myocardial infarction during follow-up. This result on DSE should therefore be faced as a risk marker for ischemic events and can identify patients that may benefit from aggressive risk factor control and careful clinical follow-up.

Prevalence of Aortic Plaques in Cryptogenic Ischemic Stroke: Correlation to Vascular Risk Factors and Future Events.

Limited data is available regarding the prevalence of aortic plaques in cryptogenic ischemic strokes and its correlation with risk factors. To determine the prevalence of aortic plaques in patients with cryptogenic ischemic stroke and its association with vascular risk factors and future vascular events. Patients with cryptogenic ischemic stroke/TIA evaluated with CT angiogram (CTA) were recruited. Aortic plaque thickness ≥4 mm, plaque ulceration, protruding components, and complex plaques were considered significant. Of the 1,767 patients, 229 (12.9%) had cryptogenic ischemic stroke/transient ischemic attack (TIA). Of them, 36 (15.7%) patients were detected to have significant aortic plaques. The significant plaque group had a higher mean age (68.3 ± 8.3 vs 54.4 ± 13.2, P = 0.0005) and were more likely to have risk factors like hypertension (P = 0.025), coronary artery disease (CAD)(P = 0.015), and peripheral vascular disease (POVD) (P = 0.029). Plaque morphology showed plaques of ≥4 mm, ulcerated plaques, protruding components, and complex plaques in 14.8%, 5.6%, 3.1%, and 6.5% patients, respectively, which are predominantly located in the aortic arch (44%). At 1 year combined endpoint of stroke, TIA, and vascular death was significantly higher in the significant plaque group (19.4% vs 6.2%, P = 0.016). Advanced age (adjusted OR-1.11, 95% CI-1.07-1.17, P = <0.001) was identified as an independent risk factor for significant aortic plaques on multivariate analysis. Aortic plaques are an under-recognized cause of cryptogenic stroke. The significant risk factors in aortic plaque group highlight the importance of aggressive risk factor control for secondary stroke prevention.

Risk factors and outcomes associated with Left Ventricular Thrombus in patients with Peripartum Cardiomyopathy: An insight from National Inpatient Sample Database

Background: We sought to assess the prevalence and impact of left ventricular thrombus (LVT) in patients with peripartum cardiomyopathy (PPCM). Methods: We performed a retrospective cohort study of all admissions with PPCM as the primary diagnosis from the Nationwide Inpatient Sample database over a 11-year period. Univariate analysis of all risk factors and outcomes and multivariable logistic regression analysis of certain variables were performed and represented as odds ratio (OR) with 95% confidence interval (CI). A p value of < 0.05 was considered statistically significant. Statistical analysis was performed using epiDisplay in ‘R’ studio. Results: In the time frame spanning 2005 -2014, 43,986 admissions with PPCM were found which included 43,534 without LVT and 452 patients with LVT. Black race was associated with a higher incidence of LV thrombus, (p value <0.001). Comorbidities more prevalent in the LVT group were smoking, drug abuse, pregnancy induced hypertension, diabetes with complications, valvular heart disease, connective tissue disorders, coagulopathy, anemia and depression. Adverse outcomes such as congestive heart failure, arrhythmias and stroke were higher in LVT group. Conversely, Caucasian race, obesity, preeclampsia (p <0.005) were higher in those without LVT. Mean length of stay (9 vs 5 days, p <0.001), in hospital mortality (3.32% vs 1.41%, p = 0.001) and mean hospitalization charges ($85,390 vs $48,033) were higher in those with LVT. However, on multivariate logistic regression, although stroke was higher in the LVT group (adjusted OR 5.51, 95% CI, 2.2, 13.81, 5.05, p 0.002), in-hospital mortality was not significantly different between the two groups (adjusted OR 1.17, 95% CI,0.32, 4.23, p = 0.817). Conclusion: Our study showed that PPCM patients with LV thrombus had worse outcomes with respect to stroke, length of stay and in hospital mortality. Higher prevalence in patients with black race, complicated diabetes, peripheral vascular disease, valvular disease, coagulopathy, smoking, drug abuse, depression and psychoses calls for special attention to such high-risk groups for aggressive risk factor modification.