Heart failure is a complex clinical syndrome in which the heart cannot pump enough blood to meet the body's requirements. It results from any disorder that impairs ventricular filling or ejection of blood to the systemic circulation. Patients usually present with fatigue and dyspnea, reduced exercise tolerance, and fluid retention (pulmonary and peripheral edema). This activity reviews the evaluation and management of congestive heart failure and highlights the role of the healthcare team in improving care for patients with this condition.
International statistics regarding the epidemiology of HF are similar to those of the United States. The incidence increases dramatically with age, and metabolic risk factors along with a sedentary lifestyle are major risk factors. Ischemic cardiomyopathy, along with hypertension, is a major cause of HF in developing countries. The notable difference based on a review of small cohort studies from these nations is a higher prevalence of isolated right heart failure. The theoretical cause of this is thought to be due to the higher prevalence of tuberculous, pericardial disease, and lung disease. There is a lack of robust data to verify these claims.
Heart failure is a complex clinical syndrome with high morbidity and mortality. It requires a multifaceted treatment approach, including patient education, pharmacologic management, and surgical interventions to optimize clinical outcomes. Specialty trained HF nurses are essential to the interprofessional team caring for patients with HF. They educate the patient on the importance of lifestyle modifications and medical compliance to help improve morbidity and mortality for the patient. They also educate the patient on symptom and weight management to prevent HF exacerbations and hospital admissions. The HF-trained social worker and case manager can help evaluate the patient in community settings/in-home visits to help the patient adhere to the lifestyle modifications recommended by the medical team. The clinical pharmacists assist the medical providers by reviewing patient medication lists and decreasing potential adverse drug-drug interactions. Primary care medical providers and cardiologists must coordinate care to minimize any adverse outcomes of medical therapy and prevent the progression of this disease. A collaborative interprofessional team can greatly improve the quality of life for patients with HF and decrease mortality.[Level 5]
Based on declassified government documents, in-depth interviews, and access to Plum Island itself, this is an eye-opening, suspenseful account of a federal government germ laboratory gone terribly wrong. For the first time, Lab 257 takes you deep inside this secret world and presents startling revelations on virus outbreaks, biological meltdowns, infected workers, the periodic flushing of contaminated raw sewage into area waters, and the insidious connections between Plum Island, Lyme disease, and the deadly West Nile virus. The book also probes what's in store for Plum Island's new owner, the Department of Homeland Security, in this age of bioterrorism.
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Rob Lee created the original SIFT Workstation in 2007 to support forensic analysis in the SANS FOR508 class. Over the years, he and a small team have continually updated the SIFT Workstation for use in class, as well as for the wider community as a public resource. With over 125,000 downloads to date, the SIFT Workstation continues to be one of the most popular open-source incident-response and digital forensic offerings available.
Rob has more than 20 years\' experience in computer forensics, incident response, threat hunting, vulnerability and exploit discovery, and intrusion detection/prevention. Over his career, Rob has worked on both Offensive and Defensive Cyber Operations supporting multiple organizations and agencies in and out of uniform. He co-authored the book Know Your Enemy, 2nd Edition and was recently inducted into the Forensic 4Cast Hall of Fame. Rob is also a co-author of the MANDIANT threat intelligence report M-Trends: The Advanced Persistent Threat. He earned his MBA from Georgetown University in Washington DC and currently lives in the Denver, CO area where he helps lead the SANS Institute as the Chief, Curriculum Director, and Head of Faculty.
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