Libman-Sacks endocarditis (LSE) is an uncommon disorder that might be confused with infective endocarditis. It is one of the systemic lupus erythematosus (SLE) manifestations that could present with heart failure. We report a 12-year-old girl who presented with a history of shortness of breath, joint pain for four weeks, and fever for about one week. On examination, she was pale, edematous, and febrile. Her cardiac exam revealed a pan-systolic murmur of mitral regurgitation, harsh, grade 3/6 best heard at the apex. She was diagnosed with systemic lupus erythematosus with lupus nephritis and carditis. Her echocardiography revealed severe mitral regurgitation with nodular thickening of the valve in keeping with a diagnosis of LSE. After appropriate management of her underlying disorder using immunosuppressive, we saw a dramatic clinical improvement and her heart failure symptoms resolved. This case proves that SLE can have significant cardiac involvement and a proper evaluation would help in overall management and prognosis.

Background The handover system is a great communication tool used by physicians to transfer and receive patients’ care-related information. The introduction of structured handover tools has resulted in a dramatic reduction in hospital-acquired injury and death cases. We hypothesize that the I-PASS handover tool will improve both written and verbal communication without compromising the duration of the handover. The current study aims to improve the quality of care and patient safety by evaluating the applicability of I-PASS handover in the Child Health Department at Sultan Qaboos University Hospital, Oman.Results A total of twenty trainees were enrolled in this study. After the implementation of I-PASS, 70% (14/20) of the respondents thought that the handover was well-structured, compared to 30% (6/20) prior to the implementation of I-PASS (P = .003). Due to I-PASS, about 80% of the participants could identify deteriorating patients and around 60% were confident in addressing emergencies. The I-PASS handover technique has raised participants’ satisfaction from 80–95%. Before I-PASS, the mean adherence rate across all 10 variables was 28.7/50 (57.4%), compared to post I-PASS rate of 47/ 50 (94%).Conclusion The I-PASS system is a feasible and flexible clinical handover tool. This study showed that I-PASS has improved on-call handovers and patient safety.

Background: Beta-blockers (BBs) are commonly prescribed to manage arrhythmias in children and adolescents without any standardised approach to establish BB adequacy. We invited all Canadian pediatric cardiologists to participate in an anonymous survey to understand practice variation in the assessment of BB adequacy in school-aged children and adolescents with arrhythmia or the potential for arrhythmia. Methods: An electronic survey approved by the Institutional Ethics Board was distributed by e-mail to 96 Canadian pediatric cardiologists who had been active in practice for at least 1 year. Incomplete surveys were excluded. Results: Forty-one cardiologists (43%) responded to all questions in the survey. Thirteen cardiologists (32%) reported always assessing BB adequacy, 17 (41%) did so only for specific arrhythmias, and 11 (27%) reported never performing such an assessment. A total of 19 cardiologists (46%) and 18 cardiologists (44%) reported using Holter monitoring and exercise testing, respectively, to assess beta receptor CJC Open -(2020) 1e5