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prostinil patients can safely be switched to the intravenous route by the implantation of an infusion pump.

Exercise training (Ex) has beneficial effects on cardiovascular diseases by increasing Klotho and SIRT1. This study aimed to investigate whether the beneficial impact of Ex on myocardial infarction (MI) is mediated through Klotho and SIRT1. Fifty-six Wistar rats were divided into 4 main groups of Sham, MI, Ex, and MI + Ex. MI was induced by the closure of the left anterior descending. Animals were trained by endurance exercise for 4 weeks. In the end, hemodynamic and heart contractility indices were assessed. The levels of Klotho and SIRT1 in the serum and heart were measured by enzyme-linked immunosorbent assay and Western blot, respectively. The ADAM17 level in the heart and kidneys was assessed by enzyme-linked immunosorbent assay. The infarct size and fibrosis area were assessed by triphenyltetrazolium chloride and Masson trichrome staining, respectively. Ex recovered the reduction of dp/dt max and dp/dt min and decreased myocardial infarct size and fibrotic area in the MI group. Ex normalized the incre the MI group and is associated with reduction of the infarct size and normalization of Klotho and SIRT1 levels. Regarding unidirectional changes in Klotho and SIRT1, these proteins may play a role in beneficial effects of Ex on MI recovery.

The involvement of the vascular endothelium in the complications of coronavirus disease 2019 is now recognized. Chief among these are pulmonary endotheliitis, cytokine storm, endotoxic shock, and cardiovascular collapse. This Perspectives article is focused on therapeutical strategies to reduce the risk of these complications by targeting the vascular endothelium as a part of the overall treatment of coronavirus disease 2019.

The involvement of the vascular endothelium in the complications of coronavirus disease 2019 is now recognized. Chief among these are pulmonary endotheliitis, cytokine storm, endotoxic shock, and cardiovascular collapse. This Perspectives article is focused on therapeutical strategies to reduce the risk of these complications by targeting the vascular endothelium as a part of the overall treatment of coronavirus disease 2019.

No studies have assessed the differences in the incidences of falls and other patient safety events (PSEs) during handovers performed away from patients compared with when nurses are on the unit.

The primary aim was to explore the incidence of falls and their severity during handovers compared with during nonhandover times; the secondary aim was to explore the occurrence of other PSEs during handover versus nonhandover times.

This was a retrospective study of all PSEs that occurred from 2013 to 2017 in a large Italian academic trust.

There were 1966 falls and 1523 other PSEs. The incidence of falls per 100 hours was 4.9 during handovers and 4.4 during nonhandover times. The incidences of other PSEs were 2.9 and 3.5, respectively. No significant differences in fall outcome severity emerged.

No differences emerged in the occurrence of falls during handovers performed away from patients and when nurses were on the unit. Other PSEs decreased in occurrence during handovers as compared with other times during the shifts.

No differences emerged in the occurrence of falls during handovers performed away from patients and when nurses were on the unit. Other PSEs decreased in occurrence during handovers as compared with other times during the shifts.

A majority of sepsis cases originate in the home and community. Home health clinicians play an important role in the early identification and timely treatment of sepsis.

A home health care provider sought to prevent hospital readmissions due to sepsis by implementing a sepsis-screening protocol and quality improvement initiative.

The provider conducted a retrospective chart review of 33 264 sepsis screens of 7242 patients.

A sepsis-screening protocol, clinician and patient/caregiver sepsis education, physician and emergency department communication, and emergency medical services collaboration procedure were implemented.

A majority (69.2%) of positive sepsis screens resulted in patients receiving early medical intervention and avoiding hospitalization.

Having a formal sepsis-screening program in place prompts home health clinicians to communicate the patient’s symptoms to their primary care provider, which can positively impact hospital readmission rates and associated medical costs.

Having a formal sepsis-screening program in place prompts home health clinicians to communicate the patient’s symptoms to their primary care provider, which can positively impact hospital readmission rates and associated medical costs.

Intrahospital handovers are high risk. Standardization of content and process is recommended.

Emergency department to inpatient unit handovers were inefficient.

The intervention was a standardized operating protocol, including checklist and procedures.

The intervention was coproduced and prototyped. Handovers were observed for intervention adherence, and the Handover Evaluation Scale was used to measure nurses’ perceived quality of handover.

The handover had 3 steps. Step 1 had more content, prompting by the receiver, and family participation postintervention. Step 3 was shorter in duration, had less content, and occurred at the bedside more postintervention. Receiving nurses were able to ask questions and found that information provided was timely, current, and easy to follow. Sending nurses perceived that handover was less succinct postimplementation, despite decreases in handover duration and repetition of information.

This project has triggered ongoing improvement initiatives, necessary to keep accommodating the needs of nurses that work across boundaries.

This project has triggered ongoing improvement initiatives, necessary to keep accommodating the needs of nurses that work across boundaries.

Medication adherence is seldom examined in older people from diverse ethnic, cultural, and language backgrounds.

The purpose of this study was to explore medication adherence among culturally diverse older people with complex health care needs.

Using a mixed-methods design, a consecutive sample of 40 older people living in a culturally diverse, low socioeconomic area completed the Brief Medication Questionnaire; 12 reporting high medication nonadherence were interviewed. Analyses used descriptive statistics and thematic analyses.

Participants experienced high medication nonadherence (n = 34, 85%), language barriers (n = 15, 37.5%), financial difficulties (n = 24, 60%), and poor understanding of their medications (n = 34, 85%). Medication nonadherence was attributed to finger dexterity (57.5%), poor vision (85%), and memory problems (87.5%). selleck chemicals llc Interviews revealed 5 themes to explain nonadherence (1) illness beliefs; (2) experiences of the aging process; (3) challenges for non-English-speaking participants; (4) adherence impediments; and (5) therapeutic relationships.