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Clinical Accuracy Spoken Here
Resynchronization Restores Effective Heart Beat Electrical conduction disturbances are common in heart failure and are associated with increased mortality risk. Resynchronization restores the normal coordinated pumping action of the ventricles by overcoming the delay in electrical conduction caused by bundle branch block. Most pacemakers have two leads. The CRT device has a third lead that is positioned in a vein on the surface of the left ventricle. This allows the CRT device to simultaneously stimulate the left and right ventricles and restore a "synchronous" squeezing pattern. This is sometimes referred to as "bi-ventricular pacing" because both ventricles are electrically stimulated (paced) at the same time resulting in a more coordinated and effective heart beat. Devices that have a defibrillator are called CRT-D. After insertion, patients usually have fewer symptoms and have a longer survival rate than similar patients who do not receive CRT therapy. Athena Forum, Heart Failure Care, Module C www.athenaforum.com

Biological Factors Influence Pain Perception Recent advances show that pain transmission is a dynamic process that involves multiple pathways. Each pathway integrates a convergence of molecular signals, and then relays them along their own specific routes to the brain. The research challenge is to define the molecular details of these multiple routes of pain transmission with the aim of increasing the number of pain management strategies. Pain perception and transmission progress define the biological pathways and networks of pain. This knowledge is important to provide future pain management options. A multidisciplinary group of NIH grantees have discovered several biological factors that influence pain perception using novel, real-time imaging techniques that track the mu-opioid system, a specific type of protein receptor that researchers have long suspected triggers a dampening of the pain. Athena Forum, Pain Management: Module A
Excellence in Case Mgmnt
HCM Obligation: Professional Responsibility
Case Managers have three professional obligations. The second obligation is professional responsibility. It is generally accepted to mean the characteristic of being accountable for an action or deed. In the case manager's position, this includes:
  • The code of conduct governs how members of the profession behave

  • The case manager-client relationship

  • The competence of the case manager

  • The duty of the case manager to keep abreast of changes in the field

  • Conflicts of interest

  • The case manager's reputation

  • The relationship between the case manager and society at large.

[Reference: Athena Forum, Principles of CM: Module A]
In the Headlines . . .
3-D Model of Human HDL Isolated
According to the NIH, scientists at the University of Cincinnati created the first-ever 3-D model of HDL isolated from human blood. Researchers used cross-linking chemistry and mass spectrometry techniques to analyze the geometric configuration of human HDL proteins resulting in a model of the structure of apolipoprotein A-I (apoA-I). The apoA-I proteins surround the HDL particle in a cage-like structure that holds fats inside while making them accessible to other proteins. The strands of apoA-I use a twisting motion to expand and contract as HDL particles take in and release fat. The surprise was how much of the surface of HDL particles is dominated by apoA-I. This monopolization suggests that other proteins interact directly with apoA-I. This could help explain apoA-I's protective effect. The work has important implications for understanding the interactions between HDL and other molecules that help prevent cardiovascular disease.

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The look of confidence
  CM Excellence® Series: 
  » Principles of Case
  » Patient Advocacy
  » Utilization Management
  » Discharge Planning
  » Hospital Revenue Cycle

  Clinical Series: 
  » Asthma
  » Behavioral Health
  » Colorectal Cancer
  » COPD
  » CV Risk: Stroke & MI
  » Diabetes
  » EOL & Palliative
  » GI Disorders
  » Heart Failure
  » Multiple Sclerosis
  » Obesity Management
  » Pain Management
  » Rheumatoid Arthritis
  » Women’s Health



Cathy Wright Cathy Wright, BSN, RN
Clinical Editor
Athena Forum


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