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ABSTRACT: According to the World Health Organization, breast cancer became the most common cancer in the world in 2020 and accounted for 685,000 deaths globally. In this article, breast cancer risk factors, considerations for genetic testing for BRCA1 and BRCA2 variants, signs and symptoms, and treatment are briefly discussed. Factors that impact the well-being and quality of life of women who have or have had breast cancer are also explored in depth, and practice implications for primary care providers are noted.

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Ulcerative colitis (UC) is an inflammatory bowel disease marked by mucosal inflammation. UC has an impact on quality of life and places a financial burden on the healthcare system. This article focuses on the impact, presentation, diagnosis and classification, systemic manifestations, complications, management, and treatment associated with UC.

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BACKGROUND: The authors hypothesized that patients may not understand the forms of effective hand hygiene employed in the hospital environment. LITERATURE REVIEW: Multiple studies demonstrate the importance of hand hygiene in reducing healthcare-associated infections (HAIs). Extensive research about how to improve compliance has been conducted. METHODOLOGY: Patients' perceptions of proper hand hygiene were evaluated when caregivers used soap and water, waterless hand cleaner, or a combination of these. RESULTS: No significant differences were observed, but many patients reported they did not notice whether their providers cleaned their hands. DISCUSSION: Educating patients and their caregivers about the protection afforded by proper, consistent hand hygiene practices is important. IMPLICATIONS FOR NURSING PRACTICE: Engaging patients to monitor healthcare workers may increase compliance, reduce the spread of infection, and lead to better overall patient outcomes. IMPLICATIONS FOR RESEARCH: This study revealed a need to investigate the effects of patient education on patient perceptions of hand hygiene. CONCLUSION: Results of this study appear to indicate a need to focus on patient education and the differences between soap and water versus alcohol-based hand sanitizers as part of proper hand hygiene. Researchers could be asking: "Why have patients not been engaged as members of the healthcare team who have the most to lose?"

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: Celiac disease is an autoimmune disorder with genetic predisposition that affects as many as 1 in 100 individuals. Treatment is a lifelong, strict adherence to a gluten-free diet. Management by a primary care provider may lead to increased adherence and can minimize effects of nonadherence to the diet.

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PURPOSE: Inadequate anticoagulation among elderly individuals with atrial fibrillation (AF) is a common problem. This synthesis of the literature review describes the pathophysiology of AF, explains the mechanism of action of warfarin (Coumadin), identifies factors that contribute to warfarin (Coumadin)-associated bleeding in the elderly population, and explores alternatives to warfarin (Coumadin) therapy. Implications for advanced practice nurse practice, education, and research will be discussed. METHODS: A literature search was conducted using Academic Search Premier, CINAHL Plus with Full Text, and Medline from 1999 to 2012. Search terms included warfarin (Coumadin), warfarin (Coumadin) genetics, diet, interactions, bleeding, atrial fibrillation, genetics, anticoagulation clinic, dabigatran, apixaban, rivaroxaban, and elderly. RESULTS: The literature indicates that the potential bleeding risk associated with warfarin (Coumadin) therapy limits its use in the elderly population. However, some studies have found warfarin (Coumadin) to be more effective than aspirin in preventing stroke. The safety profiles of both medications were comparable; also, effective alternatives to warfarin (Coumadin) that do not require routine testing are now available. CONCLUSIONS: Atrial fibrillation increases the probability of an embolic stroke, especially for the elderly population. Stroke risk and bleeding risk tools, in conjunction with patient preference, determine the best stroke prevention treatment. Anticoagulant clinics manage long-term warfarin (Coumadin) therapy effectively. Newer anticoagulants offer effective alternatives to warfarin (Coumadin) therapy.

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PURPOSE: To examine recent evidence concerning the health benefits and cost effectiveness of replacing a single dose of adult tetanus/diphtheria vaccine with a single dose of tetanus/diphtheria/pertussis (TDaP). METHODS: A review of the literature was conducted utilizing the databases CINAHL and Medline with the keywords pertussis, adult immunization, vaccination, TDaP, DTaP, and healthcare workers. CONCLUSIONS: Recent outbreaks of pertussis have shown that preventing such outbreaks through immunization of adults with a single TDaP vaccine is a cost-effective measure. These studies focused on hospitals and universities where air-borne diseases are easily spread. Four hospital studies that examined the financial cost of investigating and treating a pertussis outbreak were reviewed. Results presented offer strong evidence to support vaccinating adults with TDaP at their next scheduled immunization or sooner if they are frequently exposed to populations vulnerable to pertussis. IMPLICATIONS FOR PRACTICE: Financially, investigating a single case of pertussis can cost hospitals hundreds of thousands of dollars. This is related to the time and expense of determining who was exposed and the provision of preventive treatment for those exposed. Preventing unnecessary illness and potential mortality, especially among not yet immunized infants, provides a strong argument for administration of the TDaP vaccine. Healthcare providers should educate adults about the availability and advantages of TDaP immunization and encourage them to be immunized with TDaP.

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Atrial fibrillation is the most common complication occurring after coronary artery bypass graft surgery. The purpose of this article was to examine the incidence of, risk factors related to, and complications caused by postoperative atrial fibrillation. The pathophysiology and treatment of atrial fibrillation and postoperative atrial fibrillation will also be discussed.

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