Mind Your Heart-II: Protocol for a behavioral randomized controlled trial of mindfulness training to promote self-care in patients with comorbid heart failure and cognitive impairment.

BACKGROUND: Heart failure (HF) self-care is a robust predictor of prognosis in HF patients. Cognitive impairment is a common comorbidity in HF patients and constitutes a major challenge to HF self-care. Mindfulness training (MT) has been shown to improve cognitive function and interoception, two components essential to promoting effective HF self-care. OBJECTIVES: The aims of the Mind Your Heart-II (MYH-II) study are to investigate the effects of MT on HF self-care via changes in cognitive function and interoception in patients with comorbid HF and cognitive impairment, and to study the process by which MT can improve cognitive function via vagal control. We hypothesize that MT will improve cognitive function, interoception, and vagal control, resulting in enhanced HF self-care, compared to control participants. METHODS: MYH-II is a mechanistic parallel phase II behavioral randomized controlled trial. We will enroll 176 English or Spanish-speaking patients with comorbid chronic HF and mild cognitive impairment. Participants will be randomized to either: (1) 8-week phone-delivered MT + Enhanced Usual Care (EUC), or (2) EUC alone. Participants will complete baseline, end-of-treatment (3 months), and follow-up (9 months) assessments. The primary outcome is cognitive function (NIH Toolbox Fluid Cognition Composite Score). Additional key outcomes include: interoception (heartbeat tracking task, Multidimensional Assessment of Interoceptive Awareness), HF self-care (Self-Care of Heart Failure Index v7.2), and vagal control (high-frequency heart rate variability). IMPLICATIONS: If study hypotheses are confirmed, phone-based MT may be a key tool for improving HF self-care, and possibly clinical outcomes, in HF patients with comorbid cognitive impairment.

The multifaceted role of the Epilepsy Specialist Nurse: Literature review and survey study on patient and medical Staff Perceptions.

BACKGROUND: Epilepsy is frequently accompanied by learning, behavioural and psychological difficulties, therefore the management of this pathology extends far beyond the use of antiepileptic drugs. The specialist-nurse-service provides a multifaceted management. This study adds new points of view on how epilepsy-specialist-nurses work, the benefits they produce and their feedback. OBJECTIVES: The study was conducted to analyse the role of the epilepsy-specialist-nurse, its competencies, its impact on patients and healthcare system and its relevance in patient and medical-staff perceptions, to give new suggestions on how it can be useful in epilepsy teams. METHOD: Literature review to analyse epilepsy-specialist-nurse role; a quantitative research with descriptive approach to examine patients' (11) perceptions using a novel-questionnaire; applied qualitative analysis of medical staff (4) perceptions through semi-structured interviews. RESULTS: The epilepsy-specialist-nurse has the competences to manage the epilepsy-related issues that extend beyond medications. Patients value the ability of specialist-nurses to answer their multifaceted needs, to dedicate them enough time to discuss the impact of epilepsy on everyday-life and their feelings, giving suggestions. Doctors collaborating with specialist-nurses recognize their valuable contribute. Doctors give more information on epilepsy and medication-issues: patients prefer to consult a doctor for these issues. CONCLUSION: The holistic way adopted by specialist-nurses in addressing patients' needs is fundamental to improve patients' health and well-being. Medical and nursing ability to address epilepsy-related issues in a very similar way - in the items analysed - may reveal that specialist-nurses can provide high-quality assistance while achieving cost-savings. It is needed to develop a structured pathway that allows the progression of specialist-nursing, to define a clear job description, and to obtain government recognition.