Improvement in Heart Failure Self-Care and Patient Readmissions with Caregiver Education: A Randomized Controlled Trial.

Caregivers support heart failure (HF) self-care with little HF education. The purpose of this study was to evaluate the effectiveness of a caregiver-only educational intervention aimed at improving caregiver self-efficacy, perceived control, and HF knowledge, as well as patient self-care and 30-day cardiac readmission. In total, 37 patients and their caregivers were randomly assigned to a control condition or a caregiver-only educational intervention with telephone follow-up. Outcomes included patient 30-day cardiac readmission, patient self-care, caregiver self-efficacy, caregiver perceived control, and caregiver HF knowledge. Linear mixed model, Kaplan-Meier, and Cox regression analyses were used to determine the effects of the intervention on outcomes. Self-care maintenance (p = 0.002), self-care management (p = 0.005), 30-day cardiac readmission (p = 0.003), and caregiver perceived control (p < 0.001) were significantly better in the intervention group. The results suggest that interventions targeting caregiver HF education could be effective in improving HF patients' 30-day cardiac readmissions, patient self-care, and caregiver perceived control.

Pilot study of autologous fecal microbiota transplants in nursing home residents: Feasibility and safety.

Introduction: Antibiotic resistant bacterial infections (ARBIs) are extremely common in nursing home residents. These infections typically occur after a course of antibiotics, which eradicate both pathological and beneficial organisms. The eradication of beneficial organisms likely facilitates subsequent ARBIs. Autologous fecal microbiota transplant (aFMT) has been proposed as a potential treatment to reduce ARBIs in nursing home residents. Our objective was to determine the feasibility and safety of aFMT in a nursing home population. Methods: Pilot clinical trial. We evaluated feasibility as total number of stool samples collected for aFMT production and safety as the number and relatedness of serious (SAE) and non-serious adverse events (AE). Results: We screened 468 nursing home residents aged ≥18 years for eligibility; 67 enrolled, distributed among three nursing homes. Participants were 62.7% female and 35.8% Black. Mean age was 82.2 ± 8.5 years. Thirty-three participants underwent successful stool collection. Seven participants received antibiotics; four participants underwent aFMT. There were 40 SAEs (17 deaths) and 11 AEs. In the aFMT group, there were 3 SAEs (2 deaths) and 10 AEs. All SAEs and AEs were judged unrelated to the study intervention. Conclusions: In this pilot study of aFMT in nursing home residents, less than half were able to provide adequate stool samples for aFMT. There were no related SAEs or AEs during the study. In sum, we conclude aFMT has limited feasibility in a nursing home population due to logistic and technical challenges but is likely safe. Trial registration: ClinicalTrials.gov Identifier: NCT03061097.

The Psychometric Properties of the Brief Symptom Inventory Hostility and Anxiety Subscales in a Prison Population.

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the psychometric properties of the Brief Symptom Inventory (BSI) hostility and anxiety subscales in prison inmates. METHODS: Reliability and construct validity of the BSI hostility and anxiety subscales were examined using Cronbach's alphas, factor analysis, and hypothesis testing. RESULTS: Of the 373 male inmates, 63% were White with a mean age of 36 years. Cronbach's alphas for hostility and anxiety were 0.83 and 0.81, supporting internal consistency. Factor analysis demonstrated two dimensions, hostility and anxiety. Supporting construct validity, inmates with higher hostility as well as those with higher anxiety had a greater number of mentally unhealthy days and lower perceived control. CONCLUSION: The BSI hostility and anxiety subscales are reliable and valid for use in prison inmates.

Hostility predicts mortality but not recurrent acute coronary syndrome.

BACKGROUND: Hostility is associated with greater risk for cardiac disease, cardiac events and dysrhythmias. Investigators have reported equivocal findings regarding the association of hostility with acute coronary syndrome (ACS) recurrence and mortality. Given mixed results on the relationship between hostility and cardiovascular outcomes, further research is critical. AIMS: The aim of our study was to determine whether hostility was a predictor of ACS recurrence and mortality. METHODS: We performed a secondary analysis of data (N = 2321) from a large randomized clinical trial of an intervention designed to reduce pre-hospital delay among patients who were experiencing ACS. Hostility was measured at baseline with the Multiple Adjective Affect Checklist (MAACL) and patients were followed for 24 months for evaluation of ACS recurrence and all-cause mortality. We used Cox proportional hazards modeling to determine whether hostility was predictive of time to ACS recurrence or all-cause mortality. RESULTS: The majority of patients were married (73%), Caucasian (97%), men (68%), and had a mean age of 67 ± 11 years. Fifty-seven percent of participants scored as hostile based on the established MAACL cut point (mean score = 7.56 ± 3.8). Hostility was an independent predictor of all-cause mortality (p = < 0.039), but was not a predictor of ACS recurrence (p = 0.792). CONCLUSION: Hostility is common in patients with ACS and its relationship to clinical outcomes is important to the design of future interventions to improve long-term ACS mortality.

Depressive Symptoms Predict Delayed Ambulation After Traumatic Injury.

BACKGROUND: Impaired psychological state, such as anxiety and depressive symptoms, occurs in up to 40% of patients hospitalized for traumatic injury. These symptoms, in the acute period, may delay engagement in activity, such as ambulation, following injury. The purpose of this study was to determine whether baseline anxiety and depressive symptoms predicted delayed (>48 hr from admission) ambulation in patients hospitalized for major traumatic injury. METHODS: Adults (n = 19) admitted for major trauma (Injury Severity Score [ISS] = 15) provided a baseline measure of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]). Logistic regression was used to determine the predictive power of baseline HADS Anxiety and HADS Depression subscale scores for delayed ambulation while controlling for ISS. RESULTS: At baseline, anxiety was present in 32% of patients; 21% reported depressive symptoms. Baseline HADS Anxiety score did not predict the ambulation group. However, for each 1 point increase in baseline HADS Depression score, the likelihood of patients ambulating after 48 hr from admission increased by 67% (odds ratio = 1.67; 95% CI [1.02, 2.72]; p = .041). CONCLUSION: Worsening depressive symptoms were associated with delayed ambulation in the acute period following injury. Future, larger scale investigations are needed to further elucidate the relationship between psychological symptoms and the acute recovery period from trauma to better inform clinicians and guide development of interventions to improve patient outcomes.

The Mediator Effects of Depressive Symptoms on the Relationship between Family Functioning and Quality of Life in Caregivers of Patients with Heart Failure.

BACKGROUND: Caregivers of patients with heart failure (HF) report depressive symptoms and poor quality of life (QOL) related to caregiving and poor family functioning, placing them at risk for poor health. OBJECTIVES: The purpose of this study was to examine the effect of depressive symptoms on the relationship between family functioning and quality of life in the HF caregiver. METHODS: A sample of 92 HF caregivers were enrolled from an ambulatory clinic at a large academic medical center. A mediation analysis was used to analyze data obtained from the Family Assessment Device (FAD), the Patient Health Questionaire-9 (PHQ-9), and the Short Form-12 Health Survey Version 2 (SF-12v2). RESULTS: Depressive symptoms were found to be a significant mediator in the relationship between family functioning and caregiver quality of life. CONCLUSIONS: The results of this study suggest that interventions targeting caregiver depression and family functioning could be effective in enhancing HF caregivers' physical and mental QOL.

Early Ambulation After Injury Is Associated With Increased Muscle Size and Strength.

BACKGROUND: Trauma and management of injuries can result in reduction or loss of mobility, which can lead to skeletal muscle deconditioning and sustained disability. Prior investigators have examined changes in skeletal muscle due to injury and immobility separately. The muscular consequences of combined immobility and trauma have not been systematically investigated. OBJECTIVE: The purpose of this study was to explore the association of time to first ambulation with skeletal muscle size and strength in patients after major trauma. METHODS: Adults (N = 19) admitted for major trauma (Injury Severity Score [ISS] > 15) provided daily measures of muscle size (ultrasound) and strength (dynamometry) during hospitalization. Participants were grouped based on time to first ambulation. Repeated measures analysis of variance was used to compare muscle measures between the groups across 5 days while controlling for age and gender. RESULTS: Participants were primarily male (63%) aged 40 ± 17 years with a mean ISS of 21 ± 4. Early ambulation was associated with a 10% increase from baseline in bicep size on Days 3 and 4 and a 15% increase from baseline on Day 5. There were no changes in rectus femoris size in either group. The early ambulation group was significantly stronger than the delayed ambulation group throughout the study in measures taken with the biceps (22%-37%) and quadriceps (26%-46%). CONCLUSION: Early ambulation following major trauma was associated with increased bicep size and greater muscle strength in the biceps and quadriceps muscles over time.

Effects of a Digital Self-care Intervention in Adults with COPD: A Pilot Study.

Self-care improves quality of life, and reduces exacerbations and mortality risk in people with chronic obstructive pulmonary disease (COPD). The purpose of this report is to describe the development and testing of the feasibility and acceptability of a digital, educational self-care intervention designed to improve self-care ability, adherence, knowledge, somatic symptoms, anxiety, and depressive symptoms.This pilot study was a quasi-experimental, repeated measures design. Self-care behaviors were identified, and educational modules were developed and built into a web-based platform. Twenty participants were enrolled to determine feasibility, acceptability, and preliminary efficacy.The intervention was deemed acceptable and feasible as evidenced by > 95% completion rates and high degree of participation. Overall, the intervention was well received and is feasible for future home-based interventions in those with COPD. Results included significant improvements in adherence and knowledge, and significant associations between self-care ability, adherence, and depressive symptoms.

A Randomized Controlled Trial of Anesthesia Guided by Bispectral Index Versus Standard Care: Effects on Cognition.

Postoperative cognitive dysfunction, a subtle deterioration of cognitive function after exposure to anesthetics, is reported in 10% to 50% of surgical cases. Delivery of excessive inhalation anesthetics based on minimum alveolar concentration produces greater deep hypnotic times, which may contribute to postoperative cognitive dysfunction. This study tested the impact on cognitive function of balanced anesthetic using electroencephalographic (EEG) guidance vs usual anesthesia. We studied 88 surgical patients: 45 randomly assigned to balanced anesthetic technique with EEG guidance and 43 to standard treatment. Cognitive function was evaluated with the Cambridge Neuropsychological Test Automated Battery-Mild Cognitive Impairment at 3 intervals (preoperatively, 3-5 days postoperatively, and 3-5 months postoperatively). Additionally, 37 age- and sex-matched individuals not undergoing surgery or anesthesia were evaluated at the same intervals. Better outcomes were seen in the intervention group compared with usual care in the short-term/visual memory cognitive domain (P = .02) at 3 to 5 days, but not at 3 to 5 months. Delivery of anesthesia using EEG monitoring systems can reduce cumulative deep hypnotic time without negatively affecting patient physiologic stress, surgical conditions, or cognitive function. Our findings provide data to support optimal anesthetic approaches to improve cognitive function after anesthesia with volatile anesthetics.

Airflow limitation more than doubles the risk for hospitalization/mortality in patients with heart failure.

BACKGROUND: Comorbid chronic obstructive pulmonary disease is found in approximately one-third of patients with heart failure. Survival in patients with chronic obstructive pulmonary disease generally decreases as lung function declines. However, the association between lung function, hospitalization and survival is less clear for patients with heart failure. AIM: The purpose of this study was to determine the predictive power of spirometry measures for event-free survival (combined all-cause hospitalization and/or mortality) in patients with heart failure. METHODS: In this secondary analysis of data from three prospective, longitudinal studies, we selected patients with a confirmed diagnosis of heart failure who completed airflow limitation assessment using spirometry measures ( n=137): forced vital capacity, forced expiratory volume/second, and forced expiratory volume/second/forced vital capacity. Cox proportional hazards modeling was used to determine the relationship between spirometry and all-cause hospitalization/mortality with and without adjusting for demographic and clinical covariates over a four-year follow-up period. RESULTS: A majority (74%) exhibited some degree of airflow limitation (forced expiratory volume/second<80% predicted value) and 26 (19%) met the spirometric criterion for chronic obstructive pulmonary disease (forced expiratory volume/second/forced vital capacity⩽0.70). Cox proportional hazards regression models compared all-cause hospitalization/mortality between those with and without airflow limitation. Patients with airflow limitation were 2.2 times more likely to be hospitalized or die compared to those without airflow limitations (hazard ratio: 2.20, 95% confidence interval 1.06-4.53, p=0.03). CONCLUSION: Patients with comorbid heart failure and airflow limitation were at more than double the risk for an event. Spirometric measures may be useful to patients with heart failure, as tailored management of airflow limitation may impact event-free survival.