Emotional, mental health and physical symptom experience of patients hospitalized with COVID-19 up to 3 months post-hospitalization: A longitudinal study.

AIMS AND OBJECTIVES: To explore emotional, mental health and physical symptoms up to 3 months after discharge for adults hospitalized with COVID-19. BACKGROUND: 10%-30% of adults with COVID-19 experience physical and psychological symptoms 3 months or more following infection. Knowing symptoms can help direct early intervention. DESIGN: A longitudinal descriptive design to study COVID-related symptoms 2 weeks, 6 weeks and 3 months after hospitalization. METHODS: Sixty-six patients were recruited from a hospital system in Midwestern US (October 2020-May 2021). Participants self-reported demographics, hospital and post discharge symptoms, PROMIS measures (depression, anxiety, fatigue, cognitive function, satisfaction social roles, sleep disturbance) and Impact of Event Scale-Revised (IES-R). Hospital length of stay, comorbidities, lowest oxygen saturation, respiratory support and resources used were collected. Descriptive and nonparametric statistics described the sample and identified correlations between variables. The STROBE checklist was used. RESULTS: Data from 1 (T1) and 3 months (T2) post discharge were analysed (N = 52). A majority were female, white and married; 96% experienced ≥1 COVID-related symptoms at T1; 85% at T2. Fatigue was most prevalent, followed by shortness of breath, muscle weakness and foggy thinking. More physical symptoms during hospitalization correlated positively with number of symptoms at T1 and T2; a majority stated these impacted their normal routine 'somewhat' or 'a lot'. T1 depression highly correlated with all T2 PROMIS and IES-R scores and number of physical symptoms. More symptoms at T1 were associated with worse fatigue, lower cognitive function and lower satisfaction with social roles at T2. CONCLUSION: This study adds to the growing knowledge of mental, physical and emotional symptoms and relationships between these early after hospitalization with COVID-19. RELEVANCE TO CLINICAL PRACTICE: Findings can help identify holistic nursing interventions to improve health and mitigate symptoms for people with long COVID. PATIENT OR PUBLIC CONTRIBUTION: Patients contributed via study participation.

Understanding Women's Cardiovascular Health Using MyStrengths+MyHealth: A Patient-Generated Data Visualization Study of Strengths, Challenges, and Needs Differences.

PURPOSE: The purpose of this data visualization study was to identify patterns in patient-generated health data (PGHD) of women with and without Circulation signs or symptoms. Specific aims were to (a) visualize and interpret relationships among strengths, challenges, and needs of women with and without Circulation signs or symptoms; (b) generate hypotheses based on these patterns; and (c) test hypotheses generated in Aim 2. DESIGN: The design of this visualization study was retrospective, observational, case controlled, and exploratory. METHODS: We used existing de-identified PGHD from a mobile health application, MyStrengths+MyHealth (N = 383). From the data, women identified with Circulation signs or symptoms (n = 80) were matched to an equal number of women without Circulation signs or symptoms. Data were analyzed using data visualization techniques and descriptive and inferential statistics. FINDINGS: Based on the patterns, we generated nine hypotheses, of which four were supported. Visualization and interpretation of relationships revealed that women without Circulation signs or symptoms compared to women with Circulation signs or symptoms had more strengths, challenges, and needs-specifically, strengths in connecting; challenges in emotions, vision, and health care; and needs related to info and guidance. CONCLUSIONS: This study suggests that visualization of whole-person health including strengths, challenges, and needs enabled detection and testing of new health patterns. Some findings were unexpected, and perspectives of the patient would not have been detected without PGHD, which should be valued and sought. Such data may support improved clinical interactions as well as policies for standardization of PGHD as sharable and comparable data across clinical and community settings. CLINICAL RELEVANCE: Standardization of patient-generated whole-person health data enabled clinically relevant research that included the patients' perspective.

Evaluating Systemized Nomenclature of Medicine Clinical Terms Coverage of Complementary and Integrative Health Therapy Approaches Used Within Integrative Nursing, Health, and Medicine.

The use of complementary and integrative health therapy strategies for a wide variety of health conditions is increasing and is rapidly becoming mainstream. However, little is known about how or if complementary and integrative health therapies are represented in the EHR. Standardized terminologies provide an organizing structure for health information that enable EHR representation and support shareable and comparable data; which may contribute to increased understanding of which therapies are being used for whom and for what purposes. Use of standardized terminologies is recommended for interoperable clinical data to support sharable, comparable data to enable the use of complementary and integrative health therapies and to enable research on outcomes. In this study, complementary and integrative health therapy terms were extracted from multiple sources and organized using the National Center for Complementary and Integrative Health and former National Center for Complementary and Alternative Medicine classification structures. A total of 1209 complementary and integrative health therapy terms were extracted. After removing duplicates, the final term list was generated via expert consensus. The final list included 578 terms, and these terms were mapped to Systemized Nomenclature of Medicine Clinical Terms. Of the 578, approximately half (48.1%) were found within Systemized Nomenclature of Medicine Clinical Terms. Levels of specificity of terms differed between National Center for Complementary and Integrative Health and National Center for Complementary and Alternative Medicine classification structures and Systemized Nomenclature of Medicine Clinical Terms. Future studies should focus on the terms not mapped to Systemized Nomenclature of Medicine Clinical Terms (51.9%), to formally submit terms for inclusion in Systemized Nomenclature of Medicine Clinical Terms, toward leveraging the data generated by use of these terms to determine associations among treatments and outcomes.

Factors predicting episodic memory changes in older adults with subjective cognitive decline: A longitudinal observational study.

Episodic memory is affected early in the neuropathological process of Alzheimer's dementia. This study was performed to identify longitudinal associations between baseline vascular/neuropsychiatric risk factors and episodic memory changes over 4.1 ± 2.4 years in 1,401 older adults with subjective cognitive decline (age 74.0 ± 8.2 years). Data were from the National Alzheimer's Coordinating Center-Uniform Data Set and linear mixed effects regression models were used. Reference was those without risk factors. Participants with hypercholesterolemia and with former cigarette smoking had higher episodic memory scores, but current smokers had fewer points than reference at their first and follow-up visits. Despite no difference at baseline, episodic memory scores decreased in those with depressive symptoms relative to reference over time. In older adults with subjective cognitive decline, interventions managing current smoking and depressive symptoms could preserve episodic memory, which may result in delaying the onset of Alzheimer's dementia. Further research is required for the role of cholesterol and smoking.

Influence of Changes in Sedentary Time on Outcomes of Supervised Exercise Therapy in Individuals with Comorbid Peripheral Artery Disease and Type 2 Diabetes.

BACKGROUND: Although supervised exercise therapy (SET) is effective in improving walking distance among adults with symptomatic peripheral artery disease (PAD), some research suggests that individuals with comorbid PAD and type 2 diabetes mellitus (T2DM) may experience a blunted response to SET. It is unknown whether free-living sedentary time changes during SET, and if increases in sedentary time could, in part, explain poor response to SET. The purposes of this pilot study were to (1) determine if older adults with PAD (with and without T2DM) engaging in SET change their sedentary behavior and (2) examine the relationship between changes in sedentary behavior and SET outcomes. We hypothesized that decreased sedentary time during SET would be associated with greater improvements in six-minute walk test (6MWT) total distance and other key SET outcomes. METHODS: Participants (n = 44) initiating a 12-week SET program completed the 6MWT, Short Physical Performance Battery, Walking Impairment Questionnaire, and accelerometer-assessed sedentary behavior at SET initiation, 6 weeks, and 12 weeks. RESULTS: Participants' mean age was 72.3 (7.1) years, mean ankle-brachial index was 0.71 (0.25), and 47.7% were female. On average, sedentary time did not change after SET, although there was substantial variability (-40% to +38% change in minutes of sedentary time/day). Participants with T2DM experienced greater improvements in claudication onset distance than participants without T2DM (mean = 35 m, P = 0.044, 95% confidence interval = 1.6 to 115.4 m). Neither changes in sedentary time from baseline to 6 weeks (P = 0.419) nor T2DM (P = 0.154) predicted changes in 6MWT total distance from baseline to 12 weeks. CONCLUSIONS: As SET availability increases, further examination of factors that may influence SET outcomes will help maximize benefits of this proven therapy.

Appreciation of the Research-Practice Link: Authentic Learning Environments for Writing-Intensive Nursing Courses.

Undergraduate students often perceive a disconnect between research and nursing practice. To support student understanding of this relationship, an innovative, authentic learning environment was created in a writing-intensive, capstone-level nursing course. Authentic learning environments couple real-life situations/simulations with personal, experiential learner engagement. Students completed pre- and postsurveys assessing their beliefs about and confidence in using research to inform practice. Quantitative and open-ended qualitative responses were analyzed with inferential statistics and conventional content analysis techniques, respectively. Findings suggested the learning environment increased student confidence and facilitated connections between research and practice, supporting continued use and further evaluation of this approach.

Variability in Individual Response to Aerobic Exercise Interventions Among Older Adults.

Although a plethora of evidence supports the benefits of exercise among older adults, a majority of studies have emphasized group differences, while giving little, if any, attention to individual differences. Given the lack of data on variability in response, the present review examined how nonresponse to aerobic exercise has been defined in older adult populations and characteristics associated with nonresponse among older adults. The results of this review suggest that interindividual variability in response of maximal oxygen consumption to aerobic exercise interventions is prevalent among older adults (1.4-63.4%); age, sex, race, and body mass index may not be critical determinants of nonresponse; whereas health status, baseline fitness, and exercise dose appear important. Future intervention studies should evaluate and report the variability in individual response of older adults to exercise; investigators should develop programs that allow for modification of components to assist older adults in achieving optimal benefit from exercise programs.

The Relationship Between Peripheral Artery Disease Symptomatology and Ischemia.

BACKGROUND: Fewer than half of individuals with peripheral artery disease (PAD) experience classic claudication, and the relationships between PAD typical or atypical symptom intensity, location, and description (classic or atypical) with ischemic changes have not previously been reported. OBJECTIVE: The primary purpose of this study was to evaluate the relationship between self-reported PAD symptom intensity and calf tissue ischemia measured using the tissue saturation index (TSI) during treadmill exercise. The location and descriptors of atypical PAD symptoms in the presence of calf tissue ischemia were also identified. METHODS: Adults with PAD with exercise-limiting ischemic symptoms were asked to (a) rate symptom intensity using a numerical rating scale (NRS) from 0 to 5 (0 = no pain, 1 = onset of pain, 5 = maximal pain), (b) provide symptom locations and descriptors, and (c) wear a near-infrared spectroscopy device to obtain calf TSI values during treadmill exercise. Multilevel models with TSI as the outcome variable were estimated during exercise and recovery. Covariates included were exercise time, recovery time, baseline TSI, exercise rating, recovery rating, ankle-brachial index (ABI), age, race, gender, body mass index, diabetes, neuropathy, and smoking. RESULTS: During three successive bouts of treadmill exercise for 40 participants (80% Caucasian men; average age = 68 years, SD = 9.2), the most rapid decline in TSI occurred between the start of exercise and symptom onset (when NRS = 1). The TSI nadir was often reached prior to report of maximum discomfort (when NRS = 5), and changes in TSI were related to exercise time (p < .001), baseline TSI (p < .001), exercise ratings (p < .001), and ABI (p < .05). During recovery, TSI increased steadily for most participants as pain eased. In the recovery model, changes in TSI were associated with recovery ratings (p < .001) and ABI (p < .03). Of 120 treadmill exercise tests, 69.2% were stopped due to discomfort in the calf with classic descriptors reported only half the time (55.4%). DISCUSSION: Exploratory analyses revealed ischemic symptoms extended beyond classic claudication locations and descriptors. Future research should evaluate changes in TSI relative to atypical locations and descriptors to improve understanding of the full range of ischemic symptoms experienced by individuals with PAD.

A review of technology-based interventions to maintain weight loss.

BACKGROUND: For many decades, healthcare providers and researchers have developed weight-loss interventions to help people achieve weight loss. Unfortunately, it is typical for people to lose weight quickly during the intervention period but then slowly regain weight until they return to their approximate baseline. Technology-based maintenance interventions are among the newest approaches to long-term weight loss. Several advantages make technology helpful for maintaining weight loss. The purpose of this article was to review and critique the randomized controlled trials of technology-based weight-loss maintenance interventions (WLMIs) for adults. MATERIALS AND METHODS: A systematic search through electronic databases and a manual citation search were conducted. Limited numbers of controlled trials published since 2000 that included randomization, and technology-based WLMIs were identified. RESULTS: The characteristics of the eight studies were diverse. The average score of study design quality was moderate. The results of the effectiveness of technology-based WLMIs were mixed. Technology-based WLMIs are more likely to be effective than usual care but not more effective than personal contact. CONCLUSIONS: Based on the review, guidelines were established for the selection and potential success of technology-based WLMIs. The effectiveness of technology-based maintenance interventions for weight loss varied, and potential strategies and approaches are discussed to improve their effectiveness. Further studies are needed to better evaluate and refine the efficacy of technology-based WLMIs.

Characterization of the peripheral artery disease symptom experience.

Claudication is the most commonly recognized peripheral artery disease (PAD) symptom, but not the most prevalent. Only 7.5%-33% of patients report claudication as being part of their symptom experience. However, there is little evidence supporting atypical symptom reporting. The study purpose was to describe the full spectrum of symptoms experienced by older and younger individuals with PAD. Semistructured interviews were conducted with a purposive sample of 38 community-dwelling adults aged 49-83 years; transcripts were analyzed using content analysis. Six themes emerged: symptom descriptors (claudication and atypical), maintaining equilibrium, temporal fluctuations, the role of exercise, perceived impact on quality of life, and disease presence and treatment. Results suggest heavy reliance on claudication can result in mis- or under-diagnosis of PAD. Further research is needed to validate the correspondence of atypical symptoms with ischemic changes during exercise to broaden currently accepted symptom locations and descriptors associated with PAD.

Feasibility of a Pilot Study of Problem-Solving Therapy for Stroke Survivors.

PURPOSE: The purpose of this pilot study was to assess the feasibility and potential effectiveness of problem-solving therapy (PST) on stroke survivors' depressive symptoms and function in the rehabilitation stage of recovery. DESIGN: This study employed a repeated measures experimental design. METHODS: We recruited a convenience sample of 22 ischemic stroke survivors and randomized to treatment group receiving PST and control group receiving standard care. FINDINGS: Our recruitment and retention rates were 54% and 81%, respectively. Results for depression scores in the treatment group as compared to the control group indicated clinical significance but not statistical significance (p>.05). Function was not statistically significant. CONCLUSION: Problem-solving therapy is potentially therapeutic for stroke survivors. CLINICAL RELEVANCE: Rehabilitation nurses could be educated on the use of PST as a potential intervention for stroke survivors.

Outcome measures of behavioral weight loss programs in perimenopause.

Obesity and being overweight are associated with many comorbid conditions and are major contributing factors to cardiovascular disease. The increased proportion of overweight and obese people in Western societies has been attributed largely to behaviors that include sedentary lifestyle and dietary excess. Women are at particular risk during perimenopause, when hormones change and metabolism slows. The purpose of this review was to examine published studies of weight loss programs for perimenopausal women using behavioral change strategies of diet alone, regular physical activity alone, or both in combination to determine the range of potential outcomes and reduction of cardiovascular risks. Based on the findings from this review, practice applications and recommendations for future research are proposed.

A randomized controlled trial comparing health and quality of life of lung transplant recipients following nurse and computer-based triage utilizing home spirometry monitoring.

BACKGROUND: Lung transplantation is now a standard intervention for patients with advanced lung disease. Home monitoring of pulmonary function and symptoms has been used to follow the progress of lung transplant recipients in an effort to improve care and clinical status. The study objective was to determine the relative performance of a computer-based Bayesian algorithm compared with a manual nurse decision process for triaging clinical intervention in lung transplant recipients participating in a home monitoring program. MATERIALS AND METHODS: This randomized controlled trial had 65 lung transplant recipients assigned to either the Bayesian or nurse triage study arm. Subjects monitored and transmitted spirometry and respiratory symptoms daily to the data center using an electronic spirometer/diary device. Subjects completed the Short Form-36 (SF-36) survey at baseline and after 1 year. End points were change from baseline after 1 year in forced expiratory volume at 1 s (FEV1) and quality of life (SF-36 scales) within and between each study arm. RESULTS: There were no statistically significant differences between groups in FEV1 or SF-36 scales at baseline or after 1 year.: Results were comparable between nurse and Bayesian system for detecting changes in spirometry and symptoms, providing support for using computer-based triage support systems as remote monitoring triage programs become more widely available. CONCLUSIONS: The feasibility of monitoring critical patient data with a computer-based decision system is especially important given the likely economic constraints on the growth in the nurse workforce capable of providing these early detection triage services.

Participant withdrawal: challenges and practical solutions for recruitment and retention in clinical trials.

A major challenge in the conduct of clinical trials is recruiting and retaining adequate numbers of study participants. Pressure for steady recruitment and retention is great. A wide range of strategies are used to retain participants; however, some approaches raise ethical questions. This article examines issues of participant retention, literature addressing the volunteer nature of informed consent, the moral distress surrounding participant withdrawal, and potential ethical implications. Strategies are proposed to resolve issues and reduce participant and investigator distress. Case studies of two patients with complex chronic illnesses illustrate practical solutions and lessons learned.

Eliminating untimely deaths of women from heart disease: highlights from the Minnesota Women's Heart Summit.

Despite national campaigns to increase awareness and reduce cardiovascular disease (CVD) mortality in women, CVD remains their leading cause of death, annually killing more women than men. Although some progress has been made in our understanding and treatment of CVD in women, the causes, extent, and demographic trends of observed sex differences and disparities remain uncertain, and the growing burden of CVD and its risk factors among younger women is concerning. The Minnesota Women's Heart Summit was convened to chart a course to eliminate premature deaths of women from heart disease. The multidisciplinary summit was hosted by the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, University of Minnesota, and Mayo Clinic. Presentations highlighted sex-based differences in symptoms, treatment, and outcomes, and panel experts provided commentary. Invited faculty and summit participants worked in small-group sessions to identify strategies to dissolve barriers, improve primary and secondary prevention, and enhance women's care and outcomes. This report summarizes strategies identified during the conference to serve as springboards for more substantive future initiatives. These include, for example, standardized data collection and use of existing data sets to inform perspectives on sex-related cardiovascular issues, mandatory reporting of sex-specific data, and increased attention to underserved/high-risk women. Participants acknowledged that implementing these ideas would be challenging and recommended key priorities/next action steps such as providing services close to "point-of-life" rather than "point-of-care" and creation of policies and regulations so that resources and environmental modifications encouraging healthier lifestyle choices are promoted. Additional research is needed to improve identification, treatment, and health behaviors and to address continued lack of awareness, symptom recognition delays, barriers to care, and outcome disparities-especially in diverse populations.

Preventing cardiovascular disease in women: how can we do better?

PURPOSE OF REVIEW: This review highlights advances in the primary and secondary prevention of cardiovascular disease (CVD) in women in the preceding 12 months. RECENT FINDINGS: The American Heart Association (AHA) has recently published guidelines on the prevention of CVD in women, which brought new attention to this important topic. Limited progress has been made regarding an awareness of CVD among women, and modest progress has been made on the creation of health behavior change programs that effectively reduce smoking, increase physical activity and improve nutrition. Preventive therapies have been demonstrated to improve outcomes in women with diagnosed disease, but more research that includes women is required to further assess the benefits of primary preventive strategies and therapies. SUMMARY: A review of the literature from the past year confirms the recommendations and direction set in the AHA's updated prevention guidelines. This review illuminates promising new directions for practice and the need for future research focused on strategies to advance early and lasting lifestyle changes to promote cardiovascular health and the prevention of CVD. Adoption of and adherence to the guidelines, continued evaluation and publication of effective practice strategies, and ongoing research are critical to improve efforts to prevent CVD in women.

The PADQOL: development and validation of a PAD-specific quality of life questionnaire.

Understanding the impact of peripheral artery disease (PAD) requires broad evaluation of how functional limitations of PAD affect patients' perceptions of health-related quality of life (HRQL). The objective of this study was to describe the development, testing, and psychometric properties of the PAD Quality of Life Questionnaire (PADQOL). The PADQOL was developed in three steps: (1) interviews of symptomatic PAD patients provided content of the initial questionnaire; (2) co-administration with the SF-36 (a 36-item short-form health survey), Walking Impairment Questionnaire, and Profile of Mood States examined construct validity; and (3) a three-phased factor analysis identified factors and shortened the questionnaire. Data analyses from 297 symptomatic PAD patients resulted in a 38-item questionnaire of five factors: Social relationships and interactions, Self-concept and feelings, Symptoms and limitations in physical functioning, Fear and uncertainty, and Positive adaptation (α = 0.92-0.73) and items related to sexual function, intimate relationships and employment. Between-instrument correlations established construct validity. In conclusion, PADQOL is a validated measure to assess the disease-specific physical, psychosocial and emotional effects of PAD for research and practice.

A call to action: bold ideas from the Minnesota Women's Heart Summit.

Minnesota has the lowest overall coronary heart disease mortality rate in the United States. Yet disparities between men and women persist with regard to prevention, detection, and treatment. This has led to a gender gap not only in terms of care but also in survival rates. In an effort to better understand and close the gender gap, the Minneapolis Heart Institute, the Minneapolis Heart Institute Foundation, the University of Minnesota, and Mayo Clinic hosted a multidisciplinary Women's Heart Summit in April 2010. The goals of the summit were to stimulate dialogue and devise strategies to eliminate untimely deaths of women from heart disease. Summit participants were asked to contribute suggestions--called "Bold Ideas"--to address sex-based differences in the prevention, detection, and treatment of heart disease. Ideas were categorized according to three themes: educational programming, modifications to the health care system, and government involvement and funding. From these, several solutions emerged: 1) Involve obstetric/gynecologic physicians in providing heart-health education; 2) involve mid-level providers (midwives and other advanced practice women's health care providers) and other health professionals in women's heart health education, and 3) maximize the use of social media and online newsfeeds to raise awareness of heart disease in women. This article summarizes the discussion of the main ideas submitted by summit participants.

A Comparison Between Self-Reported and Investigator-Measured Cardiovascular Risk-Related Biometric Numbers.

The purpose of this study was to examine individuals' knowledge of cardiovascular risk-related biometric numbers and to compare self-reported and investigator-measured numbers in a convenience sample of adults in the Midwest region. Sociodemographic data and personal knowledge of cardiovascular risk-related biometric numbers were assessed using self-reported questionnaires. Investigators conducted health assessments to obtain biometric numbers. Among the 224 participants, participants' reported knowledge about their cardiovascular risk-related biometric numbers was low, especially for high-density lipoprotein and fasting blood glucose levels. Participants' knowledge was associated with education level and the recency of their last healthcare visit for health assessment. We found statistically significant mean differences between self-reported and investigator-measured blood pressure, and weight. This study found that there were discrepancies between self-reported and investigator-measured cardiovascular risk-related numbers. Future research is needed to develop educational interventions to improve personal knowledge of cardiovascular risks.