Protocol for a telephonic mixed methods study to understand needs and find solutions for bereaved dementia caregivers.

INTRODUCTION: Most caregivers of people living with dementia will experience bereavement within 10 years, but study of and support for their needs rarely persists following the death of their care recipients. A single model that leverages theoretical insights as well as observation from lived experience might help identify who will have greater difficulty following dementia-related bereavement and suggest core mechanisms to target to relieve clinical and subclinical consequences. The millions of existing bereaved dementia caregivers likely have considerable insight into ways to improve experience. Rather than creating interventions from scratch, researchers might leverage those insights to more rapidly improve the lives of bereaved dementia caregivers. METHODS AND ANALYSIS: This study uses a transformative mixed methods approach to explore the needs of caregivers for individuals with Alzheimer's disease (AD) and AD-related dementias, incorporating both quantitative surveys (n=400) and qualitative semistructured interviews (n=45) across diverse subgroups. The study described in this protocol aims to quantitatively test a new model based on self-determination theory to help understand when and why bereaved dementia caregivers experience better and worse outcomes following bereavement. The study also aims to qualitatively explore the ways that bereaved dementia caregivers might meet their needs to inform future interventions. ETHICS AND DISSEMINATION: The study adheres to institutional guidelines, ensuring participant consent and minimising risks through verbal consent procedures and the removal of personal identifiers from survey responses. The study team will share findings widely through academic publications, conferences and targeted outreach to advocacy groups and healthcare professionals, while also providing concise summaries of results to participants and making them accessible through the lab's website.

Diagnostic and prognostic value of heart-type fatty acid-binding protein in the early hours of acute myocardial infarction.

BACKGROUND: Heart-type fatty acid-binding protein (H-FABP) is a cytosolic protein that is released into the bloodstream when the myocardium is injured. The aim was to determine the diagnostic and prognostic value of H-FABP in patients with suspected acute myocardial infarction (AMI) within the first 3-6 hours after the onset of chest pain. METHODS AND RESULTS: A consecutive series of 165 patients with chest pain lasting less than 6 hours were enrolled in a forward observational design in the emergency department.The diagnostic validity of H-FABP was evaluated according to sensitivity, specificity, and predictive values, likelihood ratios, ROC curves, and multivariate logistic regression analyses. The prognostic value of H-FABP at 6 months was checked using survival curves and the multivariate Cox proportional hazards model. The sensitivity of H-FABP was 81% (95% CI: 69.2-92.9). Its area under the ROC curve: 0.729 (95% CI: 0.63-0.83) and negative likelihood ratio (0.38; 95% CI: 0.22-0.65) were significantly better than both troponin (cTnI) and CK-MB, whereas its specificity, 53% (95% CI: 41.1-64.8), was lower than that of the other markers. Increased H-FABP added diagnostic information as it demonstrated independent association with AMI by logistic regression analysis. Increased H-FABP and cTnI were both strong and independent predictors of outcome in the 6-month follow-up (hazard ratio: 2.18; 95% CI: 1.07-4.42; and 2.34; 95% CI: 0.98-5.59, respectively). CONCLUSIONS: H-FABP is, within 6 hours and also within 3 hours, more sensitive than the other markers in the early diagnosis of AMI and it is an independent prediction factor of events within 6 months.