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Two major themes emerged that characterized patients' experiences navigating lifestyle changes and navigating the emotional reaction to the event-consisting of various subthemes.
Although AMI tends to be seen as a discrete event, participants are left with little professional guidance as to how to negotiate significant, and often discordant, psychosocial changes that have long-lasting effects on their lives, similar to persons with chronic illnesses but without research in place to figure out how to best support them.
Although AMI tends to be seen as a discrete event, participants are left with little professional guidance as to how to negotiate significant, and often discordant, psychosocial changes that have long-lasting effects on their lives, similar to persons with chronic illnesses but without research in place to figure out how to best support them.
Depressive symptoms are common among patients with heart failure and are associated with poor quality of life. Vitamin D plays a role in the regulation of mood and depressive symptoms levels. Patients with heart failure can have lower levels of vitamin D.
The aim of this study was to explore the relationship between vitamin D deficiency, depressive symptoms, and quality of life among patients with heart failure in Jordan.
A cross-sectional correlational comparative design was used in this study. Depressive symptoms were measured by the Arabic subscale of the Hospital Anxiety and Depression Scale, quality of life was measured by the 36-item Short Form Health Survey questionnaire, and vitamin D was measured in plasma. Data were analyzed by independent-sample t test and multiple regression.
A total of 220 patients participated in this study, 70.5% of whom were men, and 57.3% had vitamin D deficiency (<30 ng/mL). Patients with vitamin D deficiency had higher levels of depressive symptoms compared with those with normal levels (mean [SD], 16.2 [4.3] vs 6.3 [2.3]; P ≤ .001). In multiple regression, according to the Baron and Kenny approach, depressive symptoms predicted quality of life and vitamin D levels. Vitamin D deficiency and higher levels of depressive symptoms were associated with poor quality of life.
Vitamin D levels partially mediated the relationship between depressive symptoms and quality of life. Therefore, further research is needed to better understand the nature of the relationship between vitamin D deficiency, depressive symptoms, and quality of life among patients with heart failure.
Vitamin D levels partially mediated the relationship between depressive symptoms and quality of life. Therefore, further research is needed to better understand the nature of the relationship between vitamin D deficiency, depressive symptoms, and quality of life among patients with heart failure.
The Braden Scale (BS) is a routine nursing measure used to predict pressure ulcer events; it is recommended as a frailty identification instrument.
We aimed to evaluate the predictive utility of the BS in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention.
We enrolled 2285 patients with AMI from the Retrospective Multicenter Study for Early Evaluation of Acute Chest Pain. The patients were divided into 3 groups (B1, B2, and B3) according to their BS score (≤12 vs 13-14 vs ≥15). The primary endpoint was all-cause death.
There were 264 (12.0%) all-cause deaths during the median follow-up period of 10.5 (7.9-14.2) months. In-hospital and midterm mortality and other adverse outcomes increased with decreases in the BS score. The Kaplan-Meier survival analysis showed that patients with a lower BS score had a lower cumulative survival rate (P < .001). The multivariate Cox regression analysis showed that a decreased BS score was an independent predictor for all-cause mortality (B2 vs B1 hazard ratio, 0.610; 95% confidence interval, 0.440-0.846; P = .003; B3 vs B1 hazard ratio, 0.345; 95% confidence interval, 0.241-0.493; P < .001).
The BS at admission may be a useful routine nursing measure to evaluate the prognosis of patients with AMI. The BS may be used to stratify risk at early stages and to identify those who may benefit from further assessment and intervention due to frailty syndrome.
The BS at admission may be a useful routine nursing measure to evaluate the prognosis of patients with AMI. The BS may be used to stratify risk at early stages and to identify those who may benefit from further assessment and intervention due to frailty syndrome.
Patients with heart failure with preserved ejection fraction (HFpEF) experience poor exercise tolerance and quality of life. Little is known about the feasibility or effects of HFpEF exercise training (ET) in a community hospital setting.
The aim of this study was to examine the feasibility and pilot data of a community-based HFpEF ET intervention.
This was a single-group (n = 16), pretest-posttest, 9-week ET intervention. The Minnesota Living With Heart Failure Questionnaire, Patient Health Questionnaire-9, cardiopulmonary exercise test (peak VO2), and 6-minute walk test were used for evaluation.
Participants (n = 16) attended 88% of prescribed ET sessions and 94% completed all pretest-posttest assessments. Significant improvements in Minnesota Living With Heart Failure Questionnaire (P = .01), Patient Health Questionnaire-9 (P ≤ .01), exercise test time (P = .01) and 6-minute walk test (P = .001), but not in peak VO2 (P = .16), were found.
The ET intervention was feasible and safe, and findings support improved quality of life, depressive symptoms, and exercise tolerance. Larger controlled trials are warranted.
The ET intervention was feasible and safe, and findings support improved quality of life, depressive symptoms, and exercise tolerance. Larger controlled trials are warranted.
The causal link between cigarettes and cardiovascular disease is well known. The long-term effects of e-cigarettes are yet unknown, although early studies show biomarkers indicating inflammation and damage to endothelial cells associated with later development of cardiovascular disease. With the rapid rise in e-cigarette use, especially in young adults, it is imperative that health professionals understand the knowledge, perceptions, and motivations for use among young adults.
The purpose of this integrative review is to explore existing literature on young adults' knowledge, attitudes, values, and perceptions about e-cigarettes, as well as the social norms they experience.
The Whittemore and Knafl model for integrative review guided the methodology. Three databases were searched from January 2010 through December 2018. The study selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion and exclusion criteria were applied. Studies were evaluan of identity and the current technology-focused culture.
Direct oral anticoagulants (DOACs) are variably eliminated by the kidneys rendering their use potentially problematic in patients with chronic kidney disease (CKD) or necessitating appropriate dose adjustment.
Both observational and limited randomized trial data for DOACs compared with no treatment or with warfarin for patients with atrial fibrillation on maintenance dialysis were recently published. In a randomized trial in patients on hemodialysis, there was no significant difference in vascular calcification between patients who received rivaroxaban with or without vitamin K2 or vitamin K antagonists. A randomized trial of apixaban versus warfarin was terminated owing to poor enrollment and preliminary results identified no difference in clinical outcomes between groups. However, valuable pharmacodynamic data will be forthcoming from that trial. selleckchem In observational research, among patients newly diagnosed with atrial fibrillation, there were opposing trends in the associations of apixaban initiation versus no oral anticoagulation with ischemic versus hemorrhagic stroke and no association was present with the overall risk of stroke or embolism. In another study comparing apixaban with warfarin initiation, apixaban was associated with less bleeding. Regular-dose apixaban (5 mg twice daily) associated with reduced rates of ischemic stroke or systemic embolism, whereas no such association was present for those prescribed the reduced dose (2.5 mg twice daily).
DOACs may be used after appropriate dose adjustment for an established clinical indication in patients with advanced CKD. Quality evidence for oral anticoagulation, with any specific agent or dose, for stroke prevention in hemodialysis continues to be lacking.
DOACs may be used after appropriate dose adjustment for an established clinical indication in patients with advanced CKD. Quality evidence for oral anticoagulation, with any specific agent or dose, for stroke prevention in hemodialysis continues to be lacking.
This article provides a focused update on uremic pruritus, highlighting the latest evidence concerning the epidemiology, pathophysiology, and treatment options for this common and bothersome condition.
Half of dialysis patients and a quarter of those with nondialysis chronic kidney disease experience bothersome itch that reduces quality of life and is increasingly recognized to be associated with poor outcomes including mortality. The KALM-1 trial, which reported effective symptomatic relief with difelikefalin, has bolstered support for the role of an imbalance of μ and κ-opioid receptor activity in pruritogenesis. The role of a chronic inflammatory state, increased cytokine levels and altered immune signaling in pruritogenic nerve activation continues to be elucidated with basic science, which paves the wave for future novel therapeutics. In the meantime, gabapentin appears to be the most evidence-based widely available uremic pruritus treatment, as long as care is taken with dosing and monitoring of side-effects.
Uremic pruritus remains a top research priority. Patients with uremic pruritus may be able to look forward to a new decade of understanding, knowledge, and novel treatment options for this burdensome condition. As difelikefalin and other potential agents come to market, cost-effectiveness assessments of these interventions will help determine if the widespread use of them is feasible amongst renal programs.
Uremic pruritus remains a top research priority. Patients with uremic pruritus may be able to look forward to a new decade of understanding, knowledge, and novel treatment options for this burdensome condition. As difelikefalin and other potential agents come to market, cost-effectiveness assessments of these interventions will help determine if the widespread use of them is feasible amongst renal programs.
Thermal burn scars can have catastrophic impact on the quality of life and personal image, and over time can lead to profound physical and psychological debilitation. There are no established treatments to significantly improve burn scars.
To demonstrate the safety, efficacy, and tolerability of fractionally ablative ErYAG resurfacing of mature burn scars.
Sixteen subjects were enrolled and received 3 treatments of fractionally ablative ErYAG resurfacing at monthly intervals. Twelve completed the study. Scars were scored with the Vancouver Scar Scale (VSS) by the patient and physician before and after treatment. Blinded photographic analysis (Visual Analog Scale [VAS]) and blinded histologic analysis of tissue before and after treatment was also performed.
Significant Improvement in VSS scores were seen in all 12 patients, reported by patients and the evaluating physician alike. Photographic analysis demonstrated subjective improvement in all 12 patients. Histologically, there was significant improvement in collagen architecture and the number of vessels per high-power field.
