Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

This study examined the differences between nurses' (N = 3,337) scores on organizational support, workload, satisfaction, and intent to stay between Magnet, Magnet-aspiring, and non-Magnet hospitals. The study was conducted using the Individual Workload Perception Scale, a valid and reliable tool with 32 Likert scale items, with nurses from 11 states, 15 institutions, and 292 diverse units. Results indicate that nurses at Magnet hospitals had significantly better scores on all subscales. Furthermore, nurses from Magnet-aspiring hospitals had better scores than did nurses from non-Magnet facilities. Conclusions of the study indicate that the Magnet program is meeting its intended goal: to provide a professional practice environment for staff nurses. Nurse executives may consider using the Individual Workload Perception Scale as a way to assess their organization's culture as it relates to professional practice of the registered nurse.

Background The most common, persistent concern among breast cancer survivors is the fear that their disease will return, yet few interventions targeting fear of cancer recurrence (FCR) have been developed. This pilot study examined the feasibility, acceptability, and preliminary efficacy of a home-delivered cognitive bias modification (CBM) intervention to reduce FCR. The intervention, Attention and Interpretation Modification for Fear of Breast Cancer Recurrence (AIM-FBCR), targeted two types of cognitive biases (i.e., attention and interpretation biases). Methods Breast cancer survivors (n=110) were randomized to receive eight sessions of one of two versions of AIM-FBCR or a control condition program. Computer-based assessments of cognitive biases and a self-report measure of FCR were administered pre-intervention, post-intervention, and 3 months post-intervention. Results Improvements in health worries (p=.019) and interpretation biases (rates of threat endorsement, p<.001; and reaction times for threat rejection, p=.007) were found in those who received AIM-FBCR as compared to the control arm. While only 26% of participants who screened into the study agreed to participate, the trial otherwise appeared feasible and acceptable, with 83% of those who began the intervention completing at least 5 of 8 sessions, and 90% reporting satisfaction with the computer-based program used. Conclusions This pilot study suggests the promise of AIM-FBCR in reducing FCR in breast cancer survivors. Future research should attempt to replicate these findings in a larger-scale trial using a more sophisticated, user-friendly program and additional measures of improvement in more diverse samples. ClinicalTrials.gov Identifier: NCT01517945.

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