Pulmonary vein reconnection and repeat ablation characteristics following cryoballoon-compared to radiofrequency-based pulmonary vein isolation.

BACKGROUND: Despite advances in efficacy and safety of pulmonary vein isolation (PVI), atrial fibrillation (AF) recurrence after PVI remains common. PV-reconnection is the main finding during repeat PVI procedures performed to treat recurrent AF. OBJECTIVE: To analyze pulmonary vein (PV) reconnection patterns during repeat ablation procedures in a large cohort of consecutive patients undergoing radio frequency or cryoballoon-based PVI. METHODS: Retrospective analysis of PV-reconnection patterns and analysis of re-ablation strategies in consecutive index RF- and CB-based PVI and their respective re-ablation procedures during concomitant usage of both energy sources at a single high-volume center in Germany. RESULTS: A total of 610 first (06/2015-10/2022) and 133 s (01/2016-11/2022) repeat ablation procedures after 363 (60%) RF- and 247 (40%) CB-based index PVIs between 01/2015 and 12/2021 were analyzed. PV-reconnection was found in 509/610 (83%) patients at first and 74/133 (56%) patients at second repeat procedure. 465 of 968 (48%) initially via CB isolated PVs were reconnected at first re-ablation but 796 of 1422 initially RF-isolated PV (56%) were reconnected (OR: 0.73 [95% CI: 0.62-0.86]; p < .001). This was driven by fewer reconnections of the left PVs (LSPV: OR: 0.60 [95% CI: 0.42-0.86]; p = .005 and LSPV: 0.67 [0.47-0.95]; p = .026). PV-reconnection was more likely after longer, RF-based index PVI and in older females. Repeat procedures were shorter after CB-compared to after RF-PVI. CONCLUSIONS: Reconnection remains the most common reason for repeat AF ablation procedures after PVI. Our data suggest to preferentially use of the cryoballoon during index PVI, especially in older women.

Spatial correction improves accuracy of catheter positioning during ablation of premature ventricular contractions: differences between ventricular outflow tracts and other localizations.

BACKGROUND: Hybrid activation mapping is a novel tool to correct for spatial displacement of the mapping catheter due to asymmetrical contraction of myocardium during premature ventricular contractions (PVC). The aim of this study is to describe and improve our understanding of spatial displacement during PVC mapping as well as options for correction using hybrid activation mapping. METHODS AND RESULTS: We analyzed 5798 hybrid mapping points in 40 acquired hybrid maps of 22 consecutive patients (age 63 ± 16 years, 45% female) treated for premature ventricular contractions (PVCs). Median PVC-coupling interval was 552 ms (IQR 83 ms). Spatial displacement was determined by measuring the dislocation of the catheter tip during PVC compared to the preceding sinus beat. Mean spatial displacement was 3.8 ± 1.5 mm for all maps. The displacement was 1.3 ± 0.4 mm larger for PVCs with non-outflow-tract origin compared to PVCs originating from the ventricular outflow tracts (RVOT/LVOT; p = 0.045). Demographic parameters, PVC-coupling-interval and chamber of origin had no significant influence on the extent of spatial displacement. CONCLUSION: Ectopic activation of the ventricular myocardium during PVCs results in spatial displacement of mapping points that is significantly larger for PVCs with non-outflow-tract origin. The correction for spatial displacement may improve accuracy of radiofrequency current (RFC)-application in catheter ablation of PVCs.

A Conceptual Model for Home Based Primary Care of Older Refugees.

The needs of refugees in the United States can often optimally be met through home based primary care (HBPC). Until recently, however, there has been little research into the methods of best practice and challenges of providing home based care to refugee groups. The model for the HBPC of refugees proposed here is the result of a comprehensive review of the literature combined with professional practice. Emphasis is placed on the elements of care identified as most affecting health and quality of life outcomes for refugees receiving HBPC. The key inputs for positive health and quality of life outcomes identified are: (1) Linguistic communication; (2) Cultural safety; and (3) Interprofessional team.

Challenges and Strategies in Providing Home Based Primary Care for Refugees in the US.

The recent crisis in the Middle East has prompted the exodus of millions of refugees from the region who are at present seeking shelter across Europe and in the United States. Among the most immediate needs of refugees upon arrival in a host country is health care, and it is one of the most sustained interactions they experience. Home visits are a common form of primary care for refugees. The authors review the literature to identify themes related to challenges and strategies for providing home based primary care to refugees. The literature review was performed by searching cross-disciplinary databases utilizing Onesearch, but focusing primarily on results produced through CINAHL, EBSCOHOST, and Pub Med databases. To maximize the number of studies included, there was no time frame placed upon publication dates of articles within the search. A total of 55 articles were included in this paper.

Physical activity research in nursing.

PURPOSE: To present exemplars of physical activity research in nursing, illustrate the importance of physical activity research across the lifespan, and recommend directions for theory development and research. METHODS: Studies of physical activity and exercise currently being conducted by nurse investigators were reported and critiqued by attendees of the Midwest Nursing Research Society 2000 Preconference session entitled "Promoting Physical Activity Among Diverse Groups Across the Health Continuum." Physical activity and exercise literature during the past decade was reviewed. Databases searched included Medline, CINAHL, Wilson, and ERIC. FINDINGS: Investigators have emphasized the need to evaluate the effects of theory-based physical activity interventions designed to alter key correlates of physical activity identified through descriptive research. CONCLUSIONS: Regular physical activity is necessary for health promotion and disease prevention for all populations. Continued research in this important area of health behavior is critical to identify the most effective interventions to increase physical activity among diverse populations.

Evaluation of an instrument for assessing behavioral change in sedentary women.

PURPOSE: To construct and evaluate a psychometric instrument for the assessment of behavioral change as a means for gaining insight into the development of more effective programs for promoting physical activity in women. DESIGN: A 16-item questionnaire was created and was administered three times (0, 6, and 12 months) to 181, 90, and 82 women, respectively, to determine the validity and reliability of the instrument. Participants were women 30-60 years of age, literate in English, and sedentary. METHODS: The data were analyzed using factor analysis to determine the most appropriate model for evaluating three theoretical constructs: (a) goal setting, (b) restructuring plans, and (c) relapse prevention and maintenance. RESULTS: A 3-factor model was shown to be appropriate; the instrument adequately distinguished the constructs goal setting and relapse prevention and maintenance, but did less well with the concept of restructuring plans, indicating that this concept may not be a separate entity. CONCLUSIONS: This study showed that this new instrument to evaluate behavioral change has important empirical applications. Each subscale can be used independently, depending on the needs of the investigator. This instrument will be useful for public health programs promoting physical activity in a sedentary population.

Race differences in the relationships between dietary nutrients and overweight in women.

Increasingly overweight is a health problem in the United States, especially for African American (AA) women. Height, weight, and 24-hour dietary recall measurements from 46 European American (EA) and 44 AA women were used to assess the relationships between nutrients and overweight and the possible modifying effects of race. Significant race interactions were found when assessing the relationships between overweight and fats and mineral supplements. More EA women were overweight who had excessive fat intake, whereas more AA women were overweight who had appropriate fat intake. This reversed pattern for AA women was unexpected. Another unexpected finding was that overweight EA women used mineral supplements more frequently than nonoverweight EA women. These results were discussed in terms of energy imbalances, metabolic differences, and cultural differences. Additional studies of overweight assessing race and other biological factors that also include measures of energy expenditure and more precise measures of dietary energy intake are recommended.

Teleform: a blessing or burden?

Burgeoning technology has created numerous alternatives for even the most mundane aspect of research, that is, data entry. Our research team is conducting a large NIH NINR clinical trial, and data entry and management are important aspects of this study. Our research team needed to decide whether to use manual data entry or a scannable form of data entry. This article describes some of the advantages and disadvantages related to our decision to use scannable data entry Teleformtrade mark.

Concept analysis of outcomes for advanced practice nursing.

The importance of accurately measuring health care outcomes is mentioned frequently in the literature. To do so, a common understanding of what constitutes a care delivery outcome is needed. In this article, a concept analysis of outcomes is provided, with identification of potential outcomes relevant to advanced practice.

Measures of body size based on height, weight, and reported ideal weight: conceptual distinctions and empirical demonstrations.

Using height, weight, and self-reported weight, eight additional measures of body size were computed. The purpose of this paper was to specify conceptual distinctions and test hypothesized relationships among those newly constructed measures. Using a sample of healthy African American and European American women, correlations among the measures and race differences were assessed. High correlations suggested only two independent constructs, but theoretical considerations would suggest retaining, in addition to the traditional measure of body mass index, three new constructs: ideal body mass, a discrepancy measure, and a desirability measure. The only significant race difference was on ideal body mass. African American women reported a larger ideal body mass index than European American women. The use of actual versus self-report measures of height and weight, different conceptualizations of ideal weight, and clinical implications also were discussed.

Comparison of air-displacement plethysmography with hydrostatic weighing and bioelectrical impedance analysis for the assessment of body composition in healthy adults.

BACKGROUND: Over the past decade, considerable attention has been paid to accurately measuring body composition in diverse populations. Recently, the use of air-displacement plethysmography (AP) was proposed as an accurate, comfortable, and accessible method of body-composition analysis. OBJECTIVE: The purpose of this study was to compare measurements of percentage body fat (%BF) by AP and 2 other established techniques, hydrostatic weighing (HW) and bioelectrical impedance analysis (BIA), in adults. DESIGN: The sample consisted of healthy men (n = 23) and women (n = 24). %BF was measured by AP, HW, and BIA. RESULTS: In the total group, %BF(AP) (25.0+/-8.9%) was not significantly different from %BF(HW) (25.1+/-7.7%) or %BF(BIA) (23.9+/-7.7%), and %BF(AP) was significantly correlated with %BF(HW) (r = 0.944, P < 0.001) and with %BF(BIA) (r = 0.859, P < 0.01). Compared with HW, AP underestimated %BF in men (by -1.24+/-3.12%) but overestimated %BF in women (by 1.02+/-2.48%), indicating a significant sex effect (P < 0.05). The differences in estimation between AP and BIA and between BIA and HW were not significantly different between the sexes. CONCLUSION: AP is an accurate method for assessing body composition in healthy adults. Future studies should assess further the cause of the individual variations with this new method.

African American women's experiences with physical activity in their daily lives.

Sedentary behavior is a major public health problem for African American women. A qualitative study used focus groups to explore African American women's experiences with physical activity in their daily lives. Women aged 35-50 were recruited to participate in the focus groups. Transcripts from the focus groups were coded and analyzed. African American women's facilitators of physical activity were daily routine, practical and convenient activities, personal safety, child care, weight loss, stress reduction, knowledge and commitment, enjoyment, pets, family and peer support, home and work facilities, and daylight and climate conditions. Barriers to physical activity were lack of child care, no person to exercise with, competing responsibilities, lack of space in the home, inability to use exercise facilities at work, lack of motivation, fatigue, and unsafe neighborhood. This information will provide the basis for generating new strategies to increase physical activity for African American women in the community.

Health-promoting lifestyles and exercise: a comparison of older African American women above and below poverty level.

The purpose of this study was to compare the health-promoting behaviors and exercise behaviors of older African American women above and below poverty level. Fifty-eight African American women completed a demographic form and the Health Promoting Lifestyle Profile (HPLP). Results indicated that African American women living above the poverty level had higher overall scores on the total HPLP and higher scores on the exercise subscale of the HPLP than women living below poverty level. Implications include teaching culturally specific, practical, and inexpensive exercise activities in primary care and community settings.

Facilitators, barriers, and strategies for exercise in European American women in the community.

A qualitative study was undertaken to explore the facilitators, barriers, and strategies that contribute to exercise performance in European American (EA) women. Focus groups were used to obtain information about the experiences of EA women concerning physical activity in their daily lives. Sixteen women aged 35-50 were recruited to participate in one of two focus groups. Focus group transcripts were coded and content analyzed. Major facilitators identified were social support, accommodating schedule, self improvement, supportive environment, and individual factors. Major barriers were lack of family support, unaccommodating schedule, consequences of exercise, environmental barriers, and individual barriers. The findings of this study can be used to develop nursing interventions designed to decrease sedentary behavior in EA women.

Comparison of lifestyles among obese and nonobese African American and European American women in the community.

BACKGROUND: Gender and race differences in preventive health behavior have been examined in several studies. A few race- and gender-specific studies of health-promoting activities have been conducted although none of these specifically addresses race, female gender, obesity, and health-promoting activities. Such a study would fill an important gap in the literature. OBJECTIVES: To examine the effects of race and obesity on health-promoting behaviors in women. METHOD: A comparative descriptive design was used with two levels of body size (obese and nonobese) and two levels of race (African American and European American). RESULTS: Obese women scored lower than nonobese women on all Health-Promoting Lifestyle Profile (HPLP) scales. African American women scored lower than European women only on nutrition. CONCLUSIONS: Health promotion counseling should be considered for all obese women because obesity may be a mediating variable between race and health-promoting behaviors.

The effects of daily hassles on exercise participation in perimenopausal women.

Exercise is a key factor in the prevention of many chronic conditions. There are gaps in the research pertaining to social roles, daily hassles women experience, and exercise participation. The purpose of this descriptive study was to examine the effects of daily hassles, age, and race on regular physical activity in perimenopausal women. This study utilized a convenience sample of 35 women aged 35-55 from a large southern university. The Exercise subscale of the Health Promoting Lifestyle Profile (HPLP), a 5-item Likert scale, was used to measure exercise participation. Daily hassles were measured using the 53-item hassles portion of the Hassles and Uplifts Scale. Age and race were also collected from each participant. There was no statistically significant interaction between overall hassles scale scores and Exercise scale scores. There was, however, a statistically significant effect of the Household subscale on exercise. The Environmental and Social Issues subscale with race had an effect on exercise participation, although neither of these variables alone had any effect. Further understanding of the effects of daily hassles on exercise participation in women will help nurses to develop client-centered exercise programs to better assist them in changing lifestyle behaviors.

Effectiveness of counseling in the health promotion of HIV-positive clients in the community.

The purpose of this study was to examine the effects of a nurse's counseling intervention on high-risk sexual behaviors of HIV-positive patients and to explore the relationship of gender, race, age, and education to high-risk sexual behaviors. A convenience sample of 20 adults who were newly diagnosed with HIV and were being treated at an inner-city out-patient clinic was used. Subjects were administered a questionnaire to determine their precounseling AIDS knowledge and precounseling sexual behaviors. A registered nurse then counseled them about safe-sex practices. After 2-3 months the questionnaire was readministered to determine the effects of counseling on AIDS knowledge and high-risk sexual behaviors. Although statistical analysis indicated a significant main effect for change in high-risk sexual behaviors after counseling, there were no significant relationships among change and the individual demographic variables of age, gender, race, and education. Pretest knowledge was not found to influence pretest behavior, nor was posttest knowledge found to affect posttest behavior. Paired t tests indicated a significant change in high-risk sexual behavior scores after counseling but no significant change in knowledge scores.

Knowledge skills of the home healthcare nurse.

As nurses make the transition from acute care settings to home care, it is important to understand their learning needs so that effective orientation and staff-development programs can be planned. This study identifies the knowledge and skills most needed by home care nurses by surveying nurses who currently practice in the field.