Acute painful stress and inflammatory mediator production.

BACKGROUND: Proinflammatory pathways may be activated under conditions of painful stress, which is hypothesized to worsen the experience of pain and place medically vulnerable populations at risk for increased morbidity. OBJECTIVES: To evaluate the effects of pain and subjective pain-related stress on proinflammatory activity. METHODS: A total of 19 healthy control subjects underwent a single standard cold-pressor pain test (CPT) and a no-pain control condition. Indicators of pain and stress were measured and related to inflammatory immune responses [CD8+ cells expressing the integrin molecule CD11a (CD811a), interleukin (IL)-1 receptor agonist (IL-1RA), and IL-6] immediately following the painful stimulus and compared to responses under no-pain conditions. Heart rate and mean arterial pressure were measured as indicators of sympathetic stimulation. RESULTS: CPT was clearly painful and generated an activation of the sympathetic nervous system. CD811a increased in both conditions, but with no statistically significantly greater increase following CPT (p<0.06). IL-1RA demonstrated a non-statistically significant increase following CPT (p<0.07). The change in IL-6 following CPT differed significantly from the response seen in the control condition (p<0.02). CONCLUSIONS: These findings suggest that CP acute pain may affect proinflammatory pathways, possibly through mechanisms related to adrenergic activation.

Increasing nursing referral to telephone quitlines for smoking cessation using a web-based program.

BACKGROUND: Smokers who make a quit attempt during hospitalization have improved long-term abstinence if they receive follow-up support, including via a telephone quitline, a free resource in the United States. Smokers are referred infrequently to this resource by healthcare providers. OBJECTIVE: The aim of this study was to evaluate the impact of a Web-based educational program (Helping Smokers Quit) on translating the Treating Tobacco Use and Dependence Clinical Practice Guideline: 2008 Update into practice. Using a Web-based survey, frequency of nurses' self-reported referral of smokers to a quitline and performance of the components of a smoking cessation intervention (the 5As: Ask, Advise, Assess, Assist, Arrange) was compared with self-reported performance among nurses who received printed educational materials (control group) at 6 months. METHODS: Nurses from 30 (n = 15 control and n = 15 intervention) randomly selected and assigned hospitals from California, Indiana, and West Virginia participated. Both groups received a toolkit of materials including a state quitline card and access to the Tobacco Free Nurses Web site; the intervention group had additional access to a project-specific Web page and the opportunity to attend a webinar. Only nurses who completed baseline and 6-month surveys were included in the analysis. Mean improvement of the 5As and refer scores and logistic regressions of consistent (usually or always) referral to a quitline were used to examine differences over time by group. RESULTS: Pre-post data were collected for 333 nurses (209 intervention, 124 control). Mean improvement was significantly higher in Advise, Assess, Assist, Arrange, and Referral to a Quitline for the Help Smokers Quit group. Nurses in the control group significantly improved in Advise and Referral to a Quitline. Consistent referral was most likely in the intervention group (OR = 1.74, 95% CI [1.11, 2.72]), especially among those who viewed the webinar (OR = 2.34, 95% CI [1.03, 4.23]). DISCUSSION: After 6 months, nurses in the intervention group had significant improvement in the frequency of interventions and consistency of referral of smokers to the quitline. The improvement of nurses' referral to the quitline among the control group who only received printed materials demonstrates that both are effective strategies in increasing awareness of this resource.

Nurses' treatment of tobacco dependence in hospitalized smokers in three states.

Hospital-based nurses (N = 1,790) from three states reported their interventions to help patients quit smoking. Frequency of nurses' interventions in one low tobacco use state, California (n = 651), were compared to nurses' interventions in two high tobacco use states, Indiana (n = 720) and West Virginia (n = 419). Nurses in California were significantly more likely to Advise smokers to quit (OR 1.34, 95% CI [1.06, 1.69]) and Refer smokers to a Quitline (OR 2.82, 95% CI [1.36, 5.88]) compared with nurses in the high tobacco prevalence states. Other aspects of their interventions did not differ by state. Quitline referral was infrequent (16%) but was quadrupled if nurses arranged for smokers to quit (OR 4.07, 95% CI [3.11, 5.32]).

Effects of ApoE4 and maternal history of dementia on hippocampal atrophy.

We applied an automated hippocampal segmentation technique based on adaptive boosting (AdaBoost) to the 1.5 T magnetic resonance imaging (MRI) baseline and 1-year follow-up data of 243 subjects with mild cognitive impairment (MCI), 96 with Alzheimer's disease (AD), and 145 normal controls (NC) scanned as part of the Alzheimer's Disease Neuroimaging Initiative (ADNI). MCI subjects with positive maternal history of dementia had smaller hippocampal volumes at baseline and at follow-up, and greater 12-month atrophy rates than subjects with negative maternal history. Three-dimensional maps and volumetric multiple regression analyses demonstrated a significant effect of positive maternal history of dementia on hippocampal atrophy in MCI and AD after controlling for age, ApoE4 genotype, and paternal history of dementia, respectively. ApoE4 showed an independent effect on hippocampal atrophy in MCI and AD and in the pooled sample.

Sexual intercourse and oral sex among public middle school students: prevalence and correlates.

CONTEXT: Early sexual initiation is associated with elevated teenage pregnancy and STD risk, yet little is known about the prevalence and correlates of sexual behavior among young adolescents. Better information is needed to guide interventions to prevent early sexual debut. METHODS: Data from a 2005 survey of 4,557 sixth-, seventh- and eighth-grade students at 14 urban public schools in Southern California were analyzed using chi-square tests and logistic regression, to identify correlates of oral sex, intercourse and both. RESULTS: Overall, 9% of youth had ever had sexual intercourse, and 8% had had oral sex. Three percent reported having had oral sex only, 4% intercourse only and 5% both. Among those who reported intercourse, 69% had used a condom at last intercourse, and 43% had had multiple partners. Being male, being black and having at least one friend who had ever been involved in a pregnancy were positively associated with having had intercourse only and both intercourse and oral sex (odds ratios, 1.7-4.2). Being in eighth grade, expecting to have intercourse in the next six months and currently having a boyfriend or girlfriend were positively associated with all three outcomes (2.1-7.2). Intercourse and oral sex were highly correlated. CONCLUSIONS: Interventions addressing oral sex, intercourse and multiple partners should begin before sixth grade and continue throughout the middle school years. Health professionals should target adolescent risk reduction counseling toward males, blacks, youth with a boyfriend or girlfriend, and those with a friend who has been involved in a pregnancy.

Strawberry consumption is associated with increased antioxidant capacity in serum.

Strawberries are known to contain antioxidants, but the significance of ingesting antioxidant-rich fruits remains to be established. In order to determine whether the consumption of strawberries impacted measures of in vivo antioxidant capacity, frozen strawberries (250 g) were administered daily for 3 weeks to 21 healthy female volunteers. Compliance was confirmed by quantitating pelargonidin-glucuronide, urolithin A-glucuronide, and 2,5-dimethyl-4-hydroxy-3-[(2)H]furanone-glucuronide in plasma and urine by liquid chromatography-mass spectrometry and antioxidant capacity in serum measured by the increase in lag phase of low-density lipoprotein after copper sulfate exposure, DNA strand breaks in lymphocytes, and activity of phase II enzymes. Among these measures lipid peroxidation lag time increased by 20% (P < .01), whereas other measures did not change significantly. The potent antioxidant defenses in humans make determination of changes due to dietary ingestion in healthy individuals difficult. In summary, daily consumption of strawberries resulted in a modest but significant increase in antioxidant capacity in a healthy population.

Validation of serum biomarkers for detection of early- and late-stage endometrial cancer.

OBJECTIVE: The objective of this study was to determine the efficacy of 3 previously described ovarian cancer serum biomarkers (apolipoprotein-1 [ApoA-I], prealbumin [TTR], transferrin [TF]) in the detection of endometrioid and papillary serous adenocarcinoma of the endometrium. STUDY DESIGN: ApoA-I, TTR, and TF levels were measured in serum samples that were obtained from 433 individuals that included 90 women with normal endometrium, 210 women with early-stage endometrial cancer, and 133 women with late-stage endometrial cancer. Multivariate regression models were constructed to evaluate the usefulness of the biomarkers in the detection of endometrial cancer. RESULTS: ApoA-I, TTR, and TF distinguished normal samples from early-stage endometrial cancer with a sensitivity of 71% (specificity, 88%) and normal samples from late stage endometrial cancer with a sensitivity of 82% (specificity, 86%). CONCLUSION: The biomarker panel that consists of ApoA-I, TTR, and TF may prove to be a useful clinical tool for the detection of endometrial cancer.

Nurses trying to quit smoking using the Internet.

Nurses QuitNet, an Internet-based smoking cessation program, was created to support nurses' quit attempts. The purposes of this study were to evaluate quit attempts at 3, 6, and 12 months after the use of the program and to determine differences in demographic, professional, and smoking characteristics by smoking status. Differences in the use of quit methods, barriers, and facilitators to quitting also were assessed. Data among 246 smokers who responded to at least 1 follow-up email at 3, 6, or 12 months after registration were analyzed. Quit rates among respondents were 43% (3 months), 45% (6 months), and 53% (12 months). Total time on the website was significantly higher for those who quit. Barriers to quitting included lack of support from colleagues, stress, lack of cessation services, and fear of not getting a work-break. Facilitators included working in a smoke-free facility, support from colleagues, and workplace cessation services. The use of Nurses QuitNet demonstrated promise in supporting quit attempts. Quitting was influenced by workplace factors.

Frequency of nurses' smoking cessation interventions: report from a national survey.

AIMS AND OBJECTIVES: To describe the frequency of nurses' delivery of tobacco cessation interventions ('Five A's': Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses' awareness of the Tobacco Free Nurses initiative. BACKGROUND: Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web-based resources about tobacco control. DESIGN: Cross-sectional survey of nurses (n = 3482) working in 35 Magnet-designated hospitals in the USA (21% response rate). METHOD: A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse's delivery of smoking cessation interventions ('Five A's') was adapted for use on the web. RESULTS: The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy. Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1.55, 95% CI 1.27, 1.90) and recommending medications (OR = 1.81, 95% CI 1.45, 2.24). CONCLUSIONS: Nurses' delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions. Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence-based interventions into clinical practice to help smokers quit. These findings support the value of Tobacco Free Nurses in providing nurses with information to support patients' quit attempts.

Do you need to smoke to get a break?: smoking status and missed work breaks among staff nurses.

INTRODUCTION: The prevalence of missed work breaks by smoking status in healthcare settings is unknown. The work routines of nurses (Registered Nurses [RNs] and Licensed Practical Nurses [LPNs]), who smoke at higher rates than other health professionals, may be influenced by smokers who use breaks to avoid nicotine withdrawal. The purpose of this study was to examine the relationship between nurses' smoking status and work breaks and to explore the relationships among personal, professional, and workplace variables associated with missed work breaks. METHODS: A web-based survey of 2589 staff nurses from 34 hospitals was conducted in 2006. Each hospital had been designated as a Magnet hospital by the American Nurses Credentialing Center. Data analysis included descriptive statistics, chi-square tests, and multivariate logistic regression. RESULTS: The majority (90%) were nonsmokers; 97% were RNs. Missed breaks were common (70%) and differed by smoking status: 59% of smokers and 72% of nonsmokers frequently missed work breaks. Multivariate logistic regression determined that nonsmokers (OR=1.81, 95% CI=1.36, 2.42), LPNs (OR=2.37, 95% CI=1.16, 4.84), older nurses (OR 1.02, 95% CI=1.01, 1.03), those in emergency rooms (OR=1.75, 95% CI=1.25, 2.47), and in intensive care units (OR=1.60, 95% CI=1.22, 2.09) were more likely to miss breaks. CONCLUSIONS: Missed work breaks were common among nurses. Those who did not smoke were almost twice as likely to miss their work breaks as compared to smokers. Inequities in breaks, especially by smoking status, may cause dissension in the workplace and negatively affect patient care. Policies that support work breaks for all nurses are needed.

Validation of serum biomarkers for detection of early-stage ovarian cancer.

OBJECTIVE: Ovarian cancer has the highest mortality of all the gynecologic malignancies with most patients diagnosed at late stages. Serum CA-125 is elevated in only half of patients with stages I-II. We identified 3 serum proteins (apolipoprotein A-1, transthyretin, and transferrin) for the detection of ovarian cancer and reported them combined with CA-125 to effectively detect early-stage mucinous tumors. The objectives of this study were to assess the effectiveness of the panel in detection of early-stage serous and endometrioid ovarian cancers. STUDY DESIGN: In all, 358 serum samples (control, benign adnexal masses, and early-stage and late-stage ovarian cancer) were obtained from the National Cancer Institute. The level of each marker was measured. Multiple logistic regression models were built to calculate sensitivity and specificity. RESULTS: When combined with CA-125, the panel detected early-stage cancer with a sensitivity of 96%. The highest sensitivity was seen for detection of endometrioid subtype of early-stage carcinomas (98%). CONCLUSION: A panel of 4 serum biomarkers effectively detected early-stage ovarian cancers with the highest reported overall sensitivity of 96%. Endometrioid tumors were detected at early stages with a sensitivity of 98%. Prospective clinical analysis of the panel is needed to validate it as an effective screening tool for early-stage ovarian cancer.

Smoking cessation is challenging even for patients recovering from lung cancer surgery with curative intent.

BACKGROUND: Although it is recommended that smokers undergoing surgery for lung cancer quit smoking to reduce post-operative complications, few studies have examined patterns of smoking in the peri-operative period. The goals of this study were to determine: (1) patterns of smoking during post-operative recovery, (2) types of cessation strategies used to quit smoking, and (3) factors related to smoking after lung cancer surgery. METHODS: Data were collected from 94 patients through chart review, tobacco, health status, and symptom questionnaires at 1, 2, and 4 months after surgery. Smoking status was assessed through self-report and urinary cotinine measurement. RESULTS: Eighty-four patients (89%) were ever-smokers and 35 (37%) reported smoking at diagnosis. Thirty-nine (46%) ever-smokers remained abstinent, 13 (16%) continued smoking at all time-points, and 32 (38%) relapsed. Ten (46%) of those who relapsed were former-smokers and had not smoked for at least 1 year. Sixteen (46%) of those who were smoking at diagnosis received cessation assistance with pharmacotherapy being the most common strategy. Factors associated with smoking during recovery were younger age and quitting smoking < or =6 months before the diagnosis of lung cancer. Factors that were marginally significant were lower educational level, male gender, lower number of comorbidities, and the presence of pain. CONCLUSION: Only half of those who were smoking received assistance to quit prior to surgery. Some patients were unable to quit and relapse rates post-surgery were high even among those who quit more than 1 year prior. Innovative programs incorporating symptom management and relapse prevention may enhance smoking abstinence during post-operative care.

The effects of a disease management program on self-reported health behaviors and health outcomes: evidence from the "Florida: a healthy state (FAHS)" Medicaid program.

Premature morbidity and mortality from chronic diseases account for a major proportion of expenditures for health care cost in the United States. The purpose of this study was to measure the effects of a disease management program on physiological and behavioral health indicators for Medicaid patients in Florida. A two-year prospective study of 15,275 patients with one or more chronic illnesses (congestive heart failure, hypertension, diabetes, or asthma) was undertaken. Control of hypertension improved from baseline to Year 1 (adjusted odds ratio = 1.60, p < .05), with maintenance at Year 2. Adjusted cholesterol declined by 6.41 mg/dl from baseline to Year 1 and by 12.41 mg/dl (p < .01) from baseline to Year 2. Adjusted average medication compliance increased by 0.19 points (p < .01) in Year 1 and 0.29 points (p < .01) in Year 2. Patients in the disease management program benefited in terms of controlling hypertension, asthma symptoms, and cholesterol and blood glucose levels.

Smoking among psychiatric nurses: does it hinder tobacco dependence treatment?

BACKGROUND: Data on tobacco dependence treatment for patients with mental illness are limited. OBJECTIVE: Describe factors associated with psychiatric nurses' tobacco interventions. STUDY DESIGN: Survey of 100 psychiatric nurses. RESULTS: The majority "always/usually" asked (87%), advised (70%), and assessed (74%) tobacco use. A minority (49%) assisted with quit attempts, and arranged (21%) for follow-up. Former (56%, odds ratio [OR] = 0.13, 95% confidence interval [CI] = 0.02, 0.88) and current smokers (20%, OR = .08, 95% CI = 0.01, 0.72) were less likely to ask about tobacco use than never smokers. CONCLUSIONS: Efforts are needed to promote tobacco cessation and to support nurses who smoke to quit.

Value-added care: a paradigm shift in patient care delivery.

Spiraling costs in health care have placed hospitals in a constant state of transition. As a result, nursing practice is now influenced by numerous factors and has remained in a continuous state of flux. Multiple changes within the last 2 decades in nurse/patient ratio and blend of front-line nurses are examples of this transition. To reframe the nursing practice into an economic equation that captures the cost, quality, and service, a paradigm shift in thinking is needed in order to assess work redesign. Nursing productivity must be evaluated in terms of value-added care, a vision that goes beyond direct care activities and includes team collaboration, physician rounding, increased RN-to-aide communication, and patient centeredness; all of which are crucial to the nurse's role and the patient's well-being. The science of appropriating staffing depends on assessment and implementation of systematic changes best illustrated through a "systems theory" framework. A throughput transformation is required to create process changes with input elements (number of front-line nurses) in order to increase time spent in value-added care and to decrease waste activities with an improvement in efficiency, quality, and service. The purpose of this pilot study was two-fold: (a) to gain an understanding of how much time RNs spent in value-added care, and (b) whether increasing the combined level of RNs and unlicensed assistive personnel increased the amount of time spent in value-added care compared to time spent in necessary tasks and waste.

Symptom severity 1 to 4 months after thoracotomy for lung cancer.

BACKGROUND: Information about the severity of symptoms during recovery from surgery for lung cancer can be useful in planning and anticipating needs for recovery. OBJECTIVES: To describe symptom severity during the first 4 months after thoracotomy for non-small cell lung cancer and factors associated with overall symptom severity at 1 and 4 months. METHODS: Ninety-four patients were assessed at 1, 2, and 4 months after thoracotomy by using the Lung Cancer Symptom Scale, Brief Pain Inventory, Schwartz Fatigue Scale, Dyspnea Index, and Center for Epidemiology Studies-Depression Scale (CES-D). Clinically meaningful changes, decrease in the proportion of patients with severe symptoms, and relationships among symptoms were determined. Mixed effects models for repeated measures were used to evaluate changes in severity. Multiple regression models were used to examine correlates of overall symptoms. RESULTS: Mean symptom severity significantly decreased over time for most symptoms. Only disrupted appetite, pain, and dyspnea had clinically meaningful improvement at 4 months. Severe symptoms included fatigue (57%), dyspnea (49%), cough (29%), and pain (20%). Prevalence of depressed mood decreased at 4 months. Most patients (77%) had comorbid conditions. Number of comorbid conditions and CES-D explained 54% of the variance in symptom severity at 1 month; comorbid conditions, male sex, neoadjuvant treatment, and CES-D score explained 50% of the variance at 4 months. CONCLUSIONS: Severe symptoms continued 4 months after surgery for some patients, indicating the need for support during recovery, especially for patients with multiple comorbid conditions and depressed mood.

Self-reported health effects among community residents exposed to perfluorooctanoate.

Serious health effects due to perfluorooctanoate (PFOA) exposure are suspected. The aim of this study was to evaluate the health status of nearby residents, with prolonged exposure to PFOA in their drinking water. A population of 566 white residents who were plaintiffs or potential plaintiffs in a lawsuit was evaluated by questionnaire for health history and symptoms. Standardized Prevalence Ratios were estimated using National Health and Examination Survey (NHANES) data files for comparison rates. The exposed subjects reported statistically significant greater prevalence of angina, myocardial infarction, and stroke (SPR=8.07, 95% C.I.=6.54-9.95; SPR=1.91, 95% C.I.=1.40-2.62, and SPR=2.17, 95% C.I.=1.47-3.21, respectively), chronic bronchitis, shortness of breath on stairs, asthma (SPR=3.60, 95% C.I.=2.92-4.44; SPR=2.05, 95% C.I.=1.70-2.46; SPR=1.82, 95% C.I.=1.47-2.25, respectively), and other serious health problems. The increased prevalence of adverse health effects may be due to PFOA. Further study is needed.

The effect of disease management on utilization of services by race/ethnicity: evidence from the Florida Medicaid program.

OBJECTIVE: To measure possible racial/ethnic differences in a Florida disease management (DM) program on utilization of selected healthcare services for 4 chronic illnesses. STUDY DESIGN: Pre-post comparison of utilization among 15,275 high-risk beneficiaries enrolled in DM in the Florida Medicaid program between October 2001 and October 2003. METHODS: Two-part regression analyses of the effect of DM on annualized inpatient days, emergency department (ED) visits, and outpatient visits, controlling for relevant covariates. Annualized rates were used to adjust for differences in length of program enrollment. RESULTS: Disease management patients in the postperiod had significantly lower annual rates of inpatient days, ED visits, and outpatient visits across most racial/ethnic groups. Disease management reduced utilization by a similar absolute amount in each racial/ethnic group. However, baseline disparities in utilization of inpatient days were not reduced by the DM program. CONCLUSIONS: Disease management has a similar effect across different racial/ethnic groups but may not ameliorate important baseline disparities. Evaluations of DM programs should account for baseline disparities in utilization and examine whether those disparities can be reduced through DM.

Rodent allergen in Los Angeles inner city homes of children with asthma.

Recent studies have examined the presence of mouse allergen in inner city children with asthma. Researchers have found high levels of rodent allergen in homes sampled in the northeast and midwest United States, but there has been considerable variation between cities, and there have been few studies conducted in western states. We evaluated the frequency of rodent sightings and detectable mouse allergen and the housing conditions associated with these outcomes in inner city homes in Los Angeles. Two hundred and two families of school children, ages 6-16 living in inner city neighborhoods, participated in the study. Families were predominantly Latino (94%), and Spanish speaking (92%). At study entry, parents completed a home assessment questionnaire, and staff conducted a home evaluation and collected kitchen dust, which was analyzed for the presence of mouse allergen. Fifty-one percent of homes had detectable allergen in kitchen dust. All 33 families who reported the presence of rodents had detectable allergen in the home and were also more likely to have increased levels of allergen compared to those who did not report rodents. Unwashed dishes or food crumbs, lack of a working vacuum, and a caretaker report of a smoker in the home were all significantly associated with a greater risk of rodent sightings or detectable allergen (P<0.05). Detached homes were significantly more likely to have detectable allergen. The prevalence of allergen is common enough that it may have public health implications for asthmatic children, and detectable allergen was not routinely identified based on rodent sightings. Many of the predictors of rodent allergen are amenable to low-cost interventions that can be integrated with other measures to reduce exposure to indoor allergens.

Animal-assisted therapy in patients hospitalized with heart failure.

BACKGROUND: Animal-assisted therapy improves physiological and psychosocial variables in healthy and hypertensive patients. OBJECTIVES: To determine whether a 12-minute hospital visit with a therapy dog improves hemodynamic measures, lowers neurohormone levels, and decreases state anxiety in patients with advanced heart failure. METHODS: A 3-group randomized repeated-measures experimental design was used in 76 adults. Longitudinal analysis was used to model differences among the 3 groups at 3 times. One group received a 12-minute visit from a volunteer with a therapy dog; another group, a 12-minute visit from a volunteer; and the control group, usual care. Data were collected at baseline, at 8 minutes, and at 16 minutes. RESULTS: Compared with controls, the volunteer-dog group had significantly greater decreases in systolic pulmonary artery pressure during (-4.32 mm Hg, P = .03) and after (-5.78 mm Hg, P = .001) and in pulmonary capillary wedge pressure during (-2.74 mm Hg, P = .01) and after (-4.31 mm Hg, P = .001) the intervention. Compared with the volunteer-only group, the volunteer-dog group had significantly greater decreases in epinephrine levels during (-15.86 pg/mL, P = .04) and after (-17.54 pg/mL, P = .04) and in norepinephrine levels during (-232.36 pg/mL, P = .02) and after (-240.14 pg/mL, P = .02) the intervention. After the intervention, the volunteer-dog group had the greatest decrease from baseline in state anxiety sum score compared with the volunteer-only (-6.65 units, P =.002) and the control groups (-9.13 units, P < .001). CONCLUSIONS: Animal-assisted therapy improves cardiopulmonary pressures, neurohormone levels, and anxiety in patients hospitalized with heart failure.