Heterogeneous Integration of Atomically-Thin Indium Tungsten Oxide Transistors for Low-Power 3D Monolithic Complementary Inverter.

In this work, the authors demonstrate a novel vertically-stacked thin film transistor (TFT) architecture for heterogeneously complementary inverter applications, composed of p-channel polycrystalline silicon (poly-Si) and n-channel amorphous indium tungsten oxide (a-IWO), with a low footprint than planar structure. The a-IWO TFT with channel thickness of approximately 3-4 atomic layers exhibits high mobility of 24 cm2 V-1 s-1 , near ideally subthreshold swing of 63 mV dec-1 , low leakage current below 10-13 A, high on/off current ratio of larger than 109 , extremely small hysteresis of 0 mV, low contact resistance of 0.44 kΩ-µm, and high stability after encapsulating a passivation layer. The electrical characteristics of n-channel a-IWO TFT are well-matched with p-channel poly-Si TFT for superior complementary metal-oxide-semiconductor technology applications. The inverter can exhibit a high voltage gain of 152 V V-1 at low supply voltage of 1.5 V. The noise margin can be up to 80% of supply voltage and perform the symmetrical window. The pico-watt static power consumption inverter is achieved by the wide energy bandgap of a-IWO channel and atomically-thin channel. The vertically-stacked complementary field-effect transistors (CFET) with high energy-efficiency can increase the circuit density in a chip to conform the development of next-generation semiconductor technology.

Analysis of naloxone access and primary medication nonadherence in a community pharmacy setting.

BACKGROUND: Access to naloxone is a primary public health strategy to prevent opioid overdose death. Factors associated with primary medication nonadherence (PMN) to naloxone are underreported in the literature. OBJECTIVE: The objective of this study was to evaluate naloxone dispensing trends and PMN in a community pharmacy setting. METHODS: This retrospective analysis included patients of a community pharmacy chain in Maine and New Hampshire (57 and 29 pharmacy locations, respectively) for whom a claim for a naloxone prescription was billed between January 1, 2019, and July 31, 2020. RESULTS: A total of 2152 patients associated with 2606 naloxone claims were identified for analysis. A majority of the subjects were women (52.7%) and the mean age of all the subjects was 46.4 ± 16.0 years. Of the 2606 naloxone claims, 565 prescriptions were returned to stock and never dispensed to the patient for a PMN rate of 21.7%. Gender and age were not associated with naloxone PMN. Factors associated with naloxone PMN were urban location [x2(1) = 12.49, P = 0.0004], concomitant opioid analgesic [x2(1) = 4.56, P = 0.0328], and payment method [x2(4) = 251.07, P < 0.0001]. Regarding payment method, nonadherence was higher among cash (138 of 386, 35.8%) and private insurance (191 of 455, 42.0%) transactions whereas lower among Medicare (132 of 681, 19.4%) and Medicaid (89 of 899, 9.9%) transactions. Concomitant buprenorphine [x2(1) = 44.57, P < 0.0001] and the use of a naloxone standing order [x2(1) = 4.79, P = 0.0162] were associated with primary adherence to take-home naloxone. CONCLUSION: A notable portion of naloxone prescribed and filled in the community pharmacy setting was never obtained by the patient. Factors associated with PMN in this study included geographic location, use of a standing order, concomitant prescriptions for buprenorphine or opioid analgesic medications, and payment method. Underlying causes of PMN must be addressed (e.g., removing financial barriers and optimizing the use of standing orders) to increase naloxone access for persons at risk of opioid overdose.

Self-assembled nano-aggregates of fluorinases demonstrate enhanced enzymatic activity, thermostability and reusability.

Three SAP (self-assembling peptide)-tagged fluorinases (FLAs), namely, FLA-ELK16, FLA-L6KD and FLA-18A (named after the SAP used for tagging FLA) were successfully engineered. All three SAP-tagged FLAs could be highly over-expressed using engineered E. coli host cells despite being in the form of aggregates (inclusion bodies). It was noted that all three SAP-tagged FLAs exhibited enzymatic activity. It was also observed that all three SAP-tagged FLAs were capable of self-assembly to form nano-sized particles with different dimensions in aqueous solutions. Strikingly, one of the SAP-tagged FLA (FLA-L6KD) displayed improved enzyme activity, thermostability and reusability, which is potentially ideal for bio-transformation. FLA is an exotic enzyme that is capable of catalysing the formation of C-F bonds using inorganic fluorine ions as substrates. This significant feature enables it to incorporate [18F]-fluoride into different small molecules to generate radiopharmaceuticals in PET (positron emission tomography) labeling. In addition, fluorinase is greatly valuable in synthetic biology for incorporating the fluorine element into building blocks to produce non-natural organofluorines or as a biocatalyst for transforming non-native substrates. Our method would be a further step in making FLA-based biocatalysis even 'greener' by enhancing the enzymatic activity, thermostability and reusability of FLA through the introduction of nano-sized aggregates. Enzymes are such nontrivial biomaterials, which can be manifested in different scenarios. Our research expands their reach and tunes their properties by tagging SAP partners. Thus, this methodology can be put into the 'toolbox' of enzymologists, which can be further explored and generalised for others.

Impact of medication synchronization programs on proportion of days covered (PDC) scores and Medicare Part D medication-related adherence metrics.

OBJECTIVES: This study aimed to determine if patients enrolled in a medication synchronization program have improvements in proportion of days covered (PDC) score for 3 of the Centers for Medicare and Medicaid Services adherence metrics medication classes: statins, renin-angiotensin-aldosterone system antagonists, and noninsulin diabetes medications. METHODS: This retrospective cohort study used data from members of a Medicare Advantage Prescription Drug plan, who took at least 1 of the key metric medications and had sufficient data to calculate a PDC score. The exposed cohort ("sync") consisted of patients who enrolled in the medication synchronization program within the plan's preferred pharmacy network, and the control group consisted of those who did not enroll in the program but met all other criteria. The primary end point was the change in PDC score from 2015 (baseline) to 2017 for each medication class. Secondary end points included the proportion of members with PDC scores of at least 85% and the association of adherence with annual medical and pharmacy costs. RESULTS: The largest PDC score increases for the entire study population were seen in all 3 sync groups (RASA, diabetes, and statin) with corresponding statistically significant PDC score increases of 1.6%, 4.8%, and 2.9%, compared with -0.4%, 0.5%, and 1.3% changes in the control groups. In the multiple linear regression analysis, there were significant PDC score differences in the changes from baseline between the sync and control RASA, diabetes, and statin groups (P = 0.005, P = 0.01, and P < 0.001, respectively). The proportion of members achieving the acceptable PDC score threshold increased by 1.1% in the control group and by 4.1% in the sync group. CONCLUSION: In a population of patients with high baseline adherence, this medication synchronization program was associated with a statistically significant increase in adherence scores for statin, RASA, and noninsulin diabetes medications. There was no significant change in medical or pharmacy costs from the health plan perspective.

Discovery of Myricetin as a Potent Inhibitor of Human Flap Endonuclease 1, Which Potentially Can Be Used as Sensitizing Agent against HT-29 Human Colon Cancer Cells.

Human flap endonuclease 1 (hFEN1) is instrumental in DNA replication and repair. It is able to cleave the 5' single-stranded protrusion (also known as 5' flap) resulting from strand displacement reactions. In light of its crucial functions, hFEN1 is now deemed as a nontrivial target in the DNA damage response system for anticancer drug development. Herein, we report that myricetin and some natural flavonoids are able to inhibit hFEN1. Structure-activity relationship, inhibitory mechanisms, molecular docking, and cancer cell-based assays have been performed. Our original findings expand the activity of flavonoids and may pave the way for flavonoid-assisted targeted cancer therapy.

Comparison of balancing scores using the ANCOVA approach for estimating average treatment effect: a simulation study.

In this article, we conducted a simulation study to evaluate the performance of five balancing scores using the Analysis of Covariance (ANCOVA) approach, for adjusting bias in estimating average treatment effects (ATE) in observational studies. The five balancing scores which we used as the covariate(s) in the ANCOVA model were (1) propensity score (P), (2) prognostic score (G), (3) propensity score estimated by prognostic score (PG), (4) prognostic score estimated by propensity score (GP), and (5) both propensity and prognostic scores (P&G). The results of the five balancing scores using the ANCOVA approach were compared to the results of the classic regression approach, which included all observed covariates as the predictors. Simulation results showed that balancing scores P, GP, and (P&G) had the smallest bias and mean squared error (MSE) when the outcome variable and the observed covariates were linearly associated, and PG had the smallest or close to the smallest bias and MSE when the associations were nonlinear, nonadditive and nonlinear & nonadditive.

A cardiac glycoside HTF-1 isolated from Helleborus thibetanus Franch displays potent in vitro anti-cancer activity via caspase-9, MAPK and PI3K-Akt-mTOR pathways.

Experiments have been undertaken and for the first time, we have identified that a new cardiac glycoside (CG) isolated from Helleborus thibetanus Franch. a plant endemic to China, bears potent anti-cancer activity. We have named it as HTF-1. By using in vitro cell models, we have found that HTF-1 induces apoptosis against several types of cancer cells in a concentration- and time-dependent manner. It is able to inhibit cancer cell in proliferation, migration and invasion. HTF-1 causes S cell cycle arrest. Further-on, we have identified that HTF-1 triggers caspase-9 dependent apoptosis pathway and double strand DNA breaks (DSBs). Additionally, HTF-1 activates JNK, but suppresses ERK and PI3K-Akt-mTOR pathways. Collectively, the above-mentioned mechanisms contribute to the anti-cancer activity of HTF-1. It is rare to discover novel anti-cancer CG during the past couple of decades. We believe that our work will enrich the understanding of CGs; also, pave the way for natural product-based anti-cancer drug development.

Harnessing the affinity of magnetic nanoparticles toward dye-labeled DNA and developing it as an universal aptasensor revealed by lipopolysaccharide detection.

In current study, we have found that several magnetic nanoparticles (MNPs) are able to absorb DNA molecules, and surface engineering would be beneficial to tune such interaction. We then have focused on the assembly of polyethylenimine (PEI) coated MNPs (PEI-MNPs) with ssDNA (single-stranded DNA) and found this assembly is mediated by two forces, namely the electrostatic interactions of surface charges of MNPs and the phosphate backbones of DNA; as well as the coordination of exterior iron ions (especially Fe3+) of MNPs and DNA phosphate backbones. The fluorescence of dye-labeled DNA is significantly quenched when being complexed with PEI-MNPs, which is proved to be caused by static quenching. This PEI-MNPs interact with DNA, which could be harnessed for devising a novel type of aptasensor. This has been examplified by the selective and sensitive detection of lipopolysaccharide (LPS). The LOD (limit of detection) is ∼35 ng/mL and the linear range from 50 ng/mL to 10 µg/mL. Compared with widely used graphene oxide (GO)‒ssDNA aptamer sensors, we also have demonstrated that the PEI-MNPs based sensor is able to better avoid non-specific DNA displacement by interfering proteins, generating more satisfactory signal-to-background ratio. Our proposed sensor could be a supplement to classic GO‒DNA sensors. In summary, our work provides fundamental understanding of MNPs‒DNA interactions and also paves the way for developing novel MNPs based sensing approaches, which would contribute to nano‒bio interface and DNA-assisted bio-analysis, DNA-coordinated nano-materials and DNA-directed assembly.

Using Controlled Substance Receipt Patterns to Predict Prescription Overdose Death.

BACKGROUND: This study evaluates complete state data from controlled substance prescribing trends in the prescription monitoring program (PMP) database and their association with the risk of prescription drug overdose death. SUMMARY: Maine PMP records of individuals who died of prescription overdose deaths between 2006 and 2010 were selected (n = 690). For each subject, an age, gender, and residence matched cohort of PMP users in a 50: 1 ratio was identified (n = 34,500). Key Messages: Prescription opioids contributed to 480 of 690 prescription deaths, many co-ingestions were noted, and OR for overdose death increased with milligram of morphine equivalent (MME)/day >100. The majority who were prescribed MME >100 per day received a prescription within 90 days of overdose matching the toxicology cause of death. CONCLUSIONS: Medication profiles available through state PMP can identify dosing of prescriptions associated with drug overdose death.

Polyethylenimine-coated Fe3O4 nanoparticles effectively quench fluorescent DNA, which can be developed as a novel platform for protein detection.

We report a novel assembly of polyethyleneimine (PEI)-coated Fe3O4 nanoparticles (NPs) with single-stranded DNA (ssDNA), and the fluorescence of the dye labeled in the DNA is remarkably quenched. In the presence of a target protein, the protein-DNA aptamer mutual interaction releases the ssDNA from this assembly and hence restores the fluorescence. This feature could be adopted to develop an aptasensor for protein detection. As a proof-of-concept, for the first time, we have used this proposed sensing strategy to detect thrombin selectively and sensitively. Furthermore, simultaneous multiple detection of thrombin and lysozyme in a complex protein mixture has been proven to be possible.

Medication discrepancies in the dental record and impact of pharmacist-led intervention.

BACKGROUND: Patients frequently use medications with potential implications for oral health and dental procedures, yet little is known about the accuracy of medication lists available to dentists. The aims of this study were to describe the frequency and clinical implications of medication discrepancies in the dental record (phase 1) and to evaluate the impact of pharmacist intervention on medication reconciliation processes in dental practice (phase 2). METHODS: A prospective, single-centre study evaluating adults receiving dental care was conducted. Discrepancies between the dental record and patient-reported medications were identified through a pharmacist-led medication review and were further evaluated for potential clinical significance based on drug-induced orofacial adverse-effect profiles. A multifaceted pharmacist-led intervention was implemented. Data were analysed using Poisson regression with a significance level set at 0.05. RESULTS: One-hundred and thirty patients (48% women; mean age 57 years) were interviewed by a clinical pharmacist (100 before intervention and 30 at follow-up). Of 860 medications reported, 618 discrepancies were identified, medication omission being the most common (71.7%). Of medications omitted, 64.6% had potential oral adverse effects, 7.9% could interact with local anaesthetics/vasoconstrictors and 19.1% had potential bleeding effects. The intervention resulted in a reduction in the number of medication discrepancies and medication omissions (P < 0.001). CONCLUSIONS: Medication discrepancies in the dental record occur at an alarming rate and frequently involve medications known to cause oral health problems or complications with dental procedures. A pharmacist-led intervention targeting medication reconciliation processes is an effective strategy for improving the accuracy of the dentist's medication list.

Prescription Monitoring Program Trends Among Individuals Arrested in Maine for Trafficking Prescription Drugs in 2014.

OBJECTIVE: To evaluate controlled substance prescribing trends available in the Maine Prescription Monitoring Program (PMP) among individuals arrested for prescription drug "trafficking." The demographic characteristics of the individuals who had matching prescription records in the PMP within 90 days of the arrest were identified. STUDY DESIGN: A population-based, retrospective cohort study using data from the Maine Diversion Alert Program (DAP) and the Maine PMP. The study population consisted of persons arrested for trafficking prescription drugs in Maine during the 2014 calendar year from January 1 to December 31. RESULTS: There were 594 trafficking arrests reported by the Maine DAP in 2014. The study population consisted of the 235 persons (40%) with arrests involving controlled prescription medications. The mean age of these persons was 33 years (range 18-77 yrs), and 156 (66%) were male. Arrests involved 154 prescription opioids (65%), seven stimulants (3%), seven benzodiazepines (3%), and 77 unspecified controlled prescription drugs (33%). A minority of individuals (n=57, 24%) had a prescription record in the PMP that matched the substance involved in the arrest. Only one person with matching PMP and arrest records utilized ≥ 5 prescribers, while none used ≥ 5 pharmacies within 90 days before the arrest. Payment methods for matching prescriptions were commercial insurance (n=28, 49%), Medicaid (n=19, 33%), Medicare (n=5, 9%), and cash (n=5, 9%). CONCLUSIONS: The majority (76%) of persons arrested for prescription drug trafficking did not have PMP records and did not directly obtain the diverted medication from a licensed pharmacy. Traditional red flags, like cash payment and using multiple prescribers or pharmacies, were uncommon. Therefore, arrest records for diversion and PMPs are distinct and complementary tools for identifying individuals at risk for substance misuse.

Lower limb moments differ when towing a weighted sled with different attachment points.

Sprinting while towing a sled improves sprinting parameters, however, only kinematic and temporal-spatial variables have been reported. The purpose of this study was to determine how lower extremity joint moment impulses alter when towing a sled compared to normal walking. Twelve participants walked normally, walked while towing a sled with a 50% body weight load attached at the waist, and with a 50% body weight load attached at the shoulders. Joint moment impulses were calculated for the hip, knee, and ankle. A mixed-model ANOVA with a between-subject factor of limb and repeated measures of condition was used to compare differences between limbs and towing conditions for each joint. Towing a sled increased joint moment impulses at the hip, knee, and non-dominant ankle. When compared with normal walking waist attachment increased hip extension moment impulse by 214.5% (-3.31 vs. -10.41Nms/kg), and shoulder attachment increased knee extension moment impulse by 166.9% (4.62 vs. 12.33Nms/kg). The dominant limb produced greater knee extension moment impulse (p < 0.001), while the non-dominant limb produced greater hip extension (p < 0.001) and ankle plantarflexion moment impulse (p < 0.001) across all conditions. Results suggest that walking while towing may increase hip and knee extension strength.

Rural Versus Urban Comparison: Physical Activity and Functioning Following Coronary Artery Bypass Surgery.

PURPOSE: The purpose of this sub-analysis was to compare the early recovery of elderly patients following coronary artery bypass surgery (CABS) by geographic location (urban/rural) on physical functioning and physical activity. METHODS: The sample was 124 subjects who had been in the usual care group (or control group) of a randomized controlled trial. Subjects were categorized into geographic locales using Rural Urban Commuting Area (RUCA) codes: urban n=35, large rural n=17, small rural n=23 and isolated rural n=33. Measures included the Medical Outcomes Study Short-Form 36 and the RT3® accelerometer. Mixed linear models were used to analyze the data. RESULTS: No significant differences were found for physical functioning by RUCA group. However, there was a statistically significant difference for physical activity, for average kcals/kg/ per day (F = 3.01, p < .05) and average daily activity counts (F = 3.95, p <.01), with the subjects in large rural communities having significantly (p < 0.05) more average kcals/kg per day than urban subjects (M = 29.04 and M = 27.25 respectively). Subjects in the large rural also had significantly (p < .005) more average daily activity counts than urban (M = 216635 and M = 161221 respectively). CONCLUSIONS: This is the first study to compare early recovery functioning and activity outcomes of CABS subjects by rural/urban locations. Additional study is warranted to evaluate why these differences exist and the potential need to tailor interventions for CABS based on geographic location.

Medication adherence and attitudes in patients with bipolar disorder and current versus past substance use disorder.

We examined the impact of substance use disorder (SUD) history among patients with bipolar I disorder (BD) in regards to medication-taking behaviors and attitudes. Interviews were conducted with inpatients hospitalized for BD, which included diagnostic instruments and measures of attitudes concerning psychiatric medications. We compared patients with BD and no history of SUD (BD-NH), BD and past history of SUD (BD-PH), and BD and current SUD (BD-C). The primary outcome variable was a standardized medication adherence ratio (SMAR) of [medication taken]/[medication prescribed]. Fifty-four patients with a BD diagnosis participated, which included BD-NH (n=26), BD-PH (n=19), and BD-C (n=9). The SMAR was significantly different among the three groups; post-hoc analyses revealed the SMAR was significantly lower among BD-C (M=0.70) compared to BD-NH (M=0.90) and BD-PH (M=0.97) patients. This finding remained significant after controlling for numerous patient characteristics. Attitudes regarding medications, measured by the Drug Attitude Inventory (DAI), were positive among a significantly higher percentage of BD-PH (89.47%) and BD-NH (65.38%) compared to BD-C (44.44%) patients. In conclusion, patients with BD-C demonstrated poor medication adherence and attitudes concerning medication management. Helping patients with BD achieve remission from SUD may lead to a more successful course of BD pharmacotherapy.

Association of the Bedside Shivering Assessment Scale and derived EMG power during therapeutic hypothermia in survivors of cardiac arrest.

INTRODUCTION: Shivering during therapeutic hypothermia (TH) after cardiac arrest (CA) is common, but the optimal means of detection and appropriate threshold for treatment are not established. In an effort to develop a quantitative, continuous tool to measure shivering, we hypothesized that continuous derived electromyography (dEMG) power detected by the Aspect A2000 or VISTA monitor would correlate with the intermittent Bedside Shivering Assessment Scale (BSAS) performed by nurses. METHODS: Among 38 patients treated with TH after CA, 853 hourly BSAS measurements were compared to dEMG power measured every minute by a frontal surface electrode. Patients received intermittent vecuronium by protocol to treat clinically recognized shivering (BSAS>0). Mean dEMG power in decibels (dB) was determined for the hour preceding each BSAS measurement. dEMG and BSAS were compared using ANOVA. RESULTS: The median dEMG power for a BSAS score of 0 (no shivering) was 27 dB (IQR 26-31 dB), BSAS 1 was 30.5 dB (IQR 28-35 dB), BSAS 2 was 34 dB (IQR 30-38 dB), and BSAS 3 was 34.5 dB (IQR 32-44.25). The dEMG for BSAS≥1 (shivering) was statistically different from BSAS 0 (p<0.0001). dEMG and BSAS correlated moderately (r=0.66, p<0.001). CONCLUSION: dEMG power measured from the forehead with the Aspect A2000 or VISTA monitor during therapeutic hypothermia correlated with the Bedside Shivering Assessment Scale. Given its continuous trending of dEMG power, the A2000 or VISTA may be a useful research and clinical tool for objectively monitoring shivering.

Gender differences in recovery outcomes after an early recovery symptom management intervention.

BACKGROUND: Despite known gender differences in recovery, few studies have examined symptom management (SM) interventions or responses by gender after coronary artery bypass surgery (CABS). OBJECTIVE: The purpose of this subanalysis was to describe and evaluate differences in response by gender to an SM intervention on the presence and burden of symptoms, physical activity, and physical functioning in elderly CABS patients during the early discharge period (3 and 6 weeks after CABS, and 3 and 6 months after CABS). METHODS: The parent study whose data were analyzed to examine gender differences involved a two-group, randomized clinical trial design. The 6-week early recovery SM telehealth intervention was delivered by the Health Buddy. Measures included the Cardiac Symptom Survey, a Modified 7-Day Activity Interview, an RT3 accelerometer, an Activity Diary, and the Medical Outcomes Study Short Form 36. This study was not powered for a gender × group analysis, and we used descriptive statistics, χ(2) tests, t tests, and analysis of variance for statistical analyses. RESULTS: Subjects (n = 232) included 192 men and 40 women, with a mean age of 71.2 SD, 7 years. The intervention group consisted of 86 men and 23 women, and the usual care (UC) group consisted of 106 men and 17 women. Data trends suggest that the SM intervention exerted greater impact on women than on men for symptoms such as fatigue, depression, sleep problems, and pain. Again, men exhibited higher levels of physical activity than did women. However, women in the SM group generally had higher scores than did women in the UC group. CONCLUSION: Although the parent study found no effect of an early recovery SM intervention, this exploratory secondary analysis indicated that women in the intervention group demonstrated more improvement in measures of physical activity than did those in the UC group. Further study, using a larger sample, is necessary to test these preliminary results.

Symptom profiles of coronary artery bypass surgery patients at risk for poor functioning outcomes.

The purpose of this secondary analysis was to profile or cluster 226 patients, who had participated in a randomized controlled trial, on symptoms after coronary artery bypass surgery and to examine how these profiles could potentially be used by clinicians to identify groups at risk for impaired functioning during the first 6 months after surgery. Variables measured were symptom presence and burden and functioning. The model-based clustering method was used for cluster analysis of the symptom burden measure, and analyses of covariance were used to determine if there were differences on functioning (physical functioning and physical activity) by symptom burden group at 6 weeks and at 3 and 6 months after dismissal. The majority of the 226 subjects were married (86%), male (83%), and had a mean age of 71 (SD, 4.96) years. Eight symptoms were used in the model-based clustering method-shortness of breath, fatigue, depression, sleep disturbances, pain, swelling, anxiety, and appetite problems-and demonstrated that there were 3 patient clusters of symptom burden. Cluster 1 had low symptom burden on all 8 symptoms, cluster 3 had moderate symptom burden on all 8 symptoms, and cluster 2 had a combination of low (shortness of breath, fatigue, depression, pain, and anxiety) and moderate symptom burden (sleep problems, swelling, and appetite problems). Analyses of covariance revealed no significant cluster x time interactions for any of the variables. However, there were significant main effects (P < .01) for symptom burden groups for physical functioning (physical and vitality functioning) and physical activity (estimated energy expenditure and mean daily total activity counts). Significant main effects for time indicated physical functioning and physical activity measures, except bodily pain, improved over time (P < .05). Study results indicate that the use of profiling coronary artery bypass surgery patients on their symptoms prior to hospital discharge may assist health care providers to identify patients who could be at risk for having more difficulty with physical functioning and physical activity during the first 6 months after surgery.

Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden.

OBJECTIVE: Older adults with poor functioning preoperatively are at risk for delayed recovery and more impaired outcomes after coronary artery bypass surgery (CABS). The study objective was to determine whether a 6-week early recovery telehealth intervention, designed to improve self-efficacy and management related to symptoms after CABS, was effective in improving outcomes (physical activity, physiologic, and psychologic functioning) for older adults (aged > 65 years) with higher disease burden. METHODS: A descriptive, repeated-measures experimental design was used. Follow-up data were collected at 3 and 6 weeks and 3 months after CABS. Subjects were drawn from a larger randomized clinical trial. Parent study subjects who had high disease burden preoperatively (physical component score of < 50 on the Medical Outcome Study Short Form-36 and RISKO score of > 6) were included (N = 55), with 23 subjects in the early recovery intervention group and 31 subjects in the usual care group (n = 31). Subjects ranged in age from 65 to 85 years (M = 71.6 + 5.1 years). RESULTS: There was a significant main effect by group (F[1,209] = 4.66, P < .05). The intervention group had a least square means of 27.9 kcal/kg/d of energy expenditure compared with the usual care group of 26.6 kcal/kg/d per the RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA). Both groups had significantly improved physical (F[2,171] = 3.26, P < .05) and role-physical (F[2,171] = 6.64, P < .005) functioning over time. CONCLUSION: The subgroup of subjects undergoing CABS with high disease burden were responsive to an early recovery telehealth intervention. Improving patients' physical activity and functioning can reduce morbidity and mortality associated with poor functioning after cardiac events.

Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery.

OBJECTIVE: The study objective was to examine the effect of a symptom management (SM) telehealth intervention on physical activity and functioning and to describe the health care use of older adult patients (aged > 65 years) after coronary artery bypass surgery (CABS) by group (SM intervention group and usual care group). METHODS: A randomized clinical trial design was used. The study was conducted in 4 Midwestern tertiary hospitals. The 6-week SM telehealth intervention was delivered by the Health Buddy (Health Hero Network, Palo Alto, CA). Measures included Modified 7-Day Activity Interview, RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA), physical activity and exercise diary, Medical Outcomes Study Short-Form 36, and subjects' self-report and provider records of health care use. Follow-up times were 3 and 6 weeks and 3 and 6 months after CABS. RESULTS: Subjects (N = 232) had a mean age of 71.2 (+4.7) years. There were no significant interactions using repeated-measures analyses of covariance. There was a significant group effect for average kilocalories/kilogram/day of estimated energy expenditure as measured by the RT3 accelerometer, with the usual care group having a higher estimated energy expenditure. Both groups had significant improvements over time for role-physical, vitality, and mental functioning. Both groups had similar health care use. CONCLUSION: Subjects were able to return to preoperative levels of functioning between 3 and 6 months after CABS and to increase their physical activity over reported preoperative levels of activity. Further study of those patients undergoing CABS who could derive the most benefit from the SM intervention is warranted.