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1.
J Cardiovasc Nurs ; 34(3): E1-E8, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30789489

RESUMEN

BACKGROUND: Patient populations with low socioeconomic status (SES) experience psychological stress because of social determinants of health. Social determinants of health contribute to self-care-especially among patients with heart failure (HF). OBJECTIVE: We sought to describe the influence of stress and social determinants of health on self-care in patients with HF who have low SES. METHODS: In this mixed-methods, concurrent embedded study, participants (N = 35) were recruited from 2 urban hospitals in Chicago if they had low SES and were readmitted within 120 days of an exacerbation of HF. We conducted semistructured interviews to collect qualitative data about stressors associated with patients' living circumstances, strategies patients used to foster self-care, family dynamics, and coping strategies patients used to decrease stress. We measured psychological stress (Perceived Stress Scale [PSS-10]), and self-care (Self-care of Heart Failure Index). Content analysis was used to analyze the qualitative data, and descriptive statistics were used to describe the sample. In the final analytic phase, the qualitative and quantitative data were integrated. RESULTS: Self-care was poor: 91.5% of participants had Self-care of Heart Failure Index subscale scores lower than 70. Perceived stress was high: 34% of participants had PSS-10 scores of 20 or higher. Several social determinants of health emerged as affecting self-care: financial stress, family personal health, past impactful deaths, and a recent stressful event (eg, child's death). Participants lived in areas with high crime and violence, and participants described many stressful events. However, among participants whose PSS-10 scores were lower than 20 (indicating lower stress), there was discordance among the description of factors impacting self-care and their PSS-10 score. CONCLUSIONS: Social determinants of health negatively impact the ability of low-SES patients to manage their HF symptoms and adhere to a medication and dietary regimen. It is important that healthcare providers assess patients' stressors so appropriate referral to services can occur.


Asunto(s)
Actitud Frente a la Salud , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/psicología , Autocuidado/psicología , Determinantes Sociales de la Salud , Estrés Psicológico/etiología , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autocuidado/estadística & datos numéricos , Clase Social , Estrés Psicológico/epidemiología
2.
Cardiovasc Ultrasound ; 15(1): 6, 2017 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-28298230

RESUMEN

BACKGROUND: The goal of this study was to determine if left ventricular (LV) global longitudinal strain (GLS) predicts heart failure (HF) readmission in patients with acute decompensated heart failure. METHODS AND RESULTS: Two hundred ninety one patients were enrolled at the time of admission for acute decompensated heart failure between January 2011 and September 2013. Left ventricle global longitudinal strain (LV GLS) by velocity vector imaging averaged from 2, 3 and 4-chamber views could be assessed in 204 out of 291 (70%) patients. Mean age was 63.8 ± 15.2 years, 42% of the patients were males and 78% were African American or Hispanic. Patients were followed until the first HF hospital readmission up to 44 months. Patients were grouped into quartiles on the basis of LV GLS. Kaplan-Meier curves showed significantly higher readmission rates in patients with worse LV GLS (log-rank p < 0.001). After adjusting for age, sex, history of ischemic heart disease, dementia, New York Heart Association class, LV ejection fraction, use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, systolic and diastolic blood pressure on admission and sodium level on admission, worse LV GLS was the strongest predictor of recurrent HF readmission (p < 0.001). The ejection fraction was predictive of readmission in univariate, but not in multivariate analysis. CONCLUSION: LV GLS is an independent predictor of HF readmission after acute decompensated heart failure with a higher risk of readmission in case of progressive worsening of LV GLS, independent of the ejection fraction.


Asunto(s)
Ecocardiografía/métodos , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/fisiopatología , Readmisión del Paciente/tendencias , Función Ventricular Izquierda/fisiología , Enfermedad Aguda , Anciano , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Volumen Sistólico
3.
J Cardiovasc Magn Reson ; 16: 24, 2014 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-24674383

RESUMEN

BACKGROUND: Despite increasing clinical use, there is limited data regarding regadenoson in stress perfusion cardiovascular magnetic resonance (CMR). In particular, given its long half-life the optimal stress protocol remains unclear. Although Myocardial Perfusion Reserve (MPR) may provide additive prognostic information, current techniques for its measurement are cumbersome and challenging for routine clinical practice.The aims of this study were: 1) To determine the feasibility of MPR quantification during regadenoson stress CMR by measurement of Coronary Sinus (CS) flow; and 2) to investigate the role of aminophylline reversal during regadenoson stress-CMR. METHODS: 117 consecutive patients with possible myocardial ischemia were prospectively enrolled. Perfusion imaging was performed at 1 minute and 15 minutes after administration of 0.4 mg regadenoson. A subgroup of 41 patients was given aminophylline (100 mg) after stress images were acquired. CS flow was measured using phase-contrast imaging at baseline (pre CS flow), and immediately after the stress (peak CS flow) and rest (post CS flow) perfusion images. RESULTS: CS flow measurements were obtained in 92% of patients with no adverse events. MPR was significantly underestimated when calculated as peak CS flow/post CS flow as compared to peak CS flow/pre CS flow (2.43±0.20 vs. 3.28±0.32, p=0.03). This difference was abolished when aminophylline was administered (3.35±0.44 vs. 3.30±0.52, p=0.95). Impaired MPR (peak CS flow/pre CS flow<2) was associated with advanced age, diabetes, current smoking and higher Framingham risk score. CONCLUSIONS: Regadenoson stress CMR with MPR measurement from CS flow can be successfully performed in most patients. This measurement of MPR appears practical to perform in the clinical setting. Residual hyperemia is still present even 15 minutes after regadenoson administration, at the time of resting-perfusion acquisition, and is completely reversed by aminophylline. Our findings suggest routine aminophylline administration may be required when performing stress CMR with regadenoson.


Asunto(s)
Circulación Coronaria , Seno Coronario/fisiopatología , Imagen por Resonancia Cinemagnética , Isquemia Miocárdica/diagnóstico , Imagen de Perfusión Miocárdica/métodos , Agonistas del Receptor de Adenosina A2 , Anciano , Aminofilina/administración & dosificación , Velocidad del Flujo Sanguíneo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Antagonistas de Receptores Purinérgicos P1/administración & dosificación , Purinas , Pirazoles , Flujo Sanguíneo Regional
4.
Stud Health Technol Inform ; 310: 1352-1353, 2024 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-38270039

RESUMEN

EHRs have become a means for interprofessional practice in healthcare. Following a rapid review, a lack of study on interprofessional documentation (IPD) was identified, especially in professions other than physicians and nurses. We proposed the definition of IPD as two or more providers documenting in an electronic system to coordinate care. Our review identified this topic needs future studies.


Asunto(s)
Documentación , Médicos , Humanos , Electrónica , Instituciones de Salud
5.
J Health Commun ; 18 Suppl 1: 62-9, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24093346

RESUMEN

Patient education and effective communication are core elements of the nursing profession; therefore, awareness of a patient's health literacy is integral to patient care, safety, education, and counseling. Several past studies have suggested that health care providers overestimate their patient's health literacy. In this study, the authors compare inpatient nurses' estimate of their patient's health literacy to the patient's health literacy using Newest Vital Sign as the health literacy measurement. A total of 65 patients and 30 nurses were enrolled in this trial. The results demonstrate that nurses incorrectly identify patients with low health literacy. In addition, overestimates outnumber underestimates 6 to 1. The results reinforce previous evidence that health care providers overestimate a patient's health literacy. The overestimation of a patient's health literacy by nursing personnel may contribute to the widespread problem of poor health outcomes and hospital readmission rates.


Asunto(s)
Actitud del Personal de Salud , Alfabetización en Salud/estadística & datos numéricos , Personal de Enfermería en Hospital/psicología , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación en Evaluación de Enfermería
6.
JMIR Mhealth Uhealth ; 8(6): e15900, 2020 06 24.
Artículo en Inglés | MEDLINE | ID: mdl-32579120

RESUMEN

BACKGROUND: A lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin. OBJECTIVE: This study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial. METHODS: Potential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants' blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants' group membership. The primary outcome was a feasibility analysis of recruitment and retention. RESULTS: The mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients' reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found. CONCLUSIONS: Elderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education. TRIAL REGISTRATION: ClinicalTrials.gov NCT04439864; https://clinicaltrials.gov/ct2/show/NCT04439864.


Asunto(s)
Stents Liberadores de Fármacos , Aplicaciones Móviles , Intervención Coronaria Percutánea , Adulto , Anciano , Estudios de Factibilidad , Humanos , Cumplimiento de la Medicación , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico
7.
J Healthc Inform Res ; 3(1): 107-123, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35415420

RESUMEN

Comprehending medical information is a challenging task, especially for people who have not received formal medical education. When patients are discharged from the hospital, they are provided with lengthy medical documents that contain intricate terminologies. Studies have shown that if people do not understand the content of their health documents, they will neither look for new information regarding their illness nor will they take actions to prevent or recover from their health issue. In this article, we highlight the need for generating personalized hospital-stay summaries and several research challenges associated with this task. The proposed directions are directly informed by our ongoing work in generating concise and comprehensible hospitalization summaries that are tailored to suit the patient's understanding of medical terminologies and level of engagement in improving their own health. Our preliminary evaluation shows that our summaries effectively present required medical concepts.

8.
Contemp Clin Trials Commun ; 15: 100420, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31440690

RESUMEN

Previous work indicates the potential for community health workers and peer coaches serving as patient navigators to improve processes of care and health outcomes during care transitions, but have not been sufficiently tested to determine if such programs improve measures of patient experience in minority serving institutions. The objectives of the Patient Navigator to Reduce Readmissions (PArTNER) study was to: 1) conduct a pragmatic clinical effectiveness trial comparing a multi-faceted, stakeholder-supported Navigator intervention (in-person CHW visits in the hospital and after hospital discharge, plus telephone-based peer coaching) versus usual care on the experience of hospital-to-home care transitions in patients hospitalized with heart failure, pneumonia, chronic obstructive pulmonary disease, myocardial infarction, or sickle cell disease; 2) examine the effectiveness of the Navigator intervention in patient subgroups; and 3) understand the barriers and facilitators of successfully implementing the Navigator intervention across patient populations. The co-primary outcomes are the 30-day changes in: 1) Patient Reported Outcomes Measurement Information System (PROMIS) emotional distress-anxiety, and 2) PROMIS informational support. Secondary outcomes at 30 and 60 days include other PROMIS health measures and hospital readmissions. Innovative features of the PArTNER study include early and continuous engagement of patients, their caregivers, clinicians, health system administrators, and other stakeholders to inform the design and implementation of the Navigator intervention. In this report, we describe the design of the PArTNER study.

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