OBJECTIVE:Survivors of severe critical illness frequently develop substantial and persistent physical complications, including muscle weakness, impaired physical function, and decreased ...health-related quality of life. Our objective was to determine the longitudinal epidemiology of muscle weakness, physical function, and health-related quality of life and their associations with critical illness and ICU exposures.
DESIGN:A multisite prospective study with longitudinal follow-up at 3, 6, 12, and 24 months after acute lung injury.
SETTING:Thirteen ICUs from four academic teaching hospitals.
PATIENTS:Two hundred twenty-two survivors of acute lung injury.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:At each time point, patients underwent standardized clinical evaluations of extremity, hand grip, and respiratory muscle strength; anthropometrics (height, weight, mid-arm circumference, and triceps skin fold thickness); 6-minute walk distance, and the Medical Outcomes Short-Form 36 health-related quality of life survey. During their hospitalization, survivors also had detailed daily evaluation of critical illness and related treatment variables. Over one third of survivors had objective evidence of muscle weakness at hospital discharge, with most improving within 12 months. This weakness was associated with substantial impairments in physical function and health-related quality of life that persisted at 24 months. The duration of bed rest during critical illness was consistently associated with weakness throughout 24-month follow-up. The cumulative dose of systematic corticosteroids and use of neuromuscular blockers in the ICU were not associated with weakness.
CONCLUSIONS:Muscle weakness is common after acute lung injury, usually recovering within 12 months. This weakness is associated with substantial impairments in physical function and health-related quality of life that continue beyond 24 months. These results provide valuable prognostic information regarding physical recovery after acute lung injury. Evidence-based methods to reduce the duration of bed rest during critical illness may be important for improving these long-term impairments.
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium ...channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the “white-coat effect” (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
Dennison Himmelfarb and Baptiste discuss the implications of coronavirus disease (COVID-19) for cardiovascular and socially at-risk populations. COVID-19 is an infectious respiratory disease caused ...by the newly discovered pathogen, SARS-CoV-2, a novel RNA-dependent RNA polymerase betacoronavirus that is thought to derive from bats. At this time, there are no specific vaccines or treatments for COVID-19. The best way to prevent and slow transmission is to be well informed about the COVID-19 virus, the disease it causes, and how it spreads.
Mobile health (mHealth) technology has the potential to support shared decision-making (SDM) and improve hypertension control. However, our understanding of the variations in individuals’ involvement ...in SDM and mHealth usage across different racial and ethnic groups in the United States is still limited. This study aimed to investigate the extent of involvement in SDM and the usage of mHealth technology in health-related activities among US adults with hypertension from diverse racial and ethnic backgrounds and to examine whether the mHealth usage differed by individuals’ level of engagement in SDM. This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey, which was conducted on US adults with self-reported hypertension, and race and ethnicity data were included. The exposure of interest was race and ethnicity. The outcomes were SDM and mHealth usage. SDM was assessed using an item: “In the past 12 months, how often did your health professional: involve you in decisions about your healthcare as much as you wanted?” mHealth usage was defined as using a smartphone or tablet to engage in (1) making health decisions, (2) discussing health decisions with health providers, (3) tracking health progress, and (4) sharing health information. Weighted multivariable logistic regression models were used to examine the association between race and ethnicity and SDM or mHealth usage adjusted for covariates and stratified by the level of engagement in SDM. This study included 4893 adults with hypertension, and the mean age was 61 (SD 13) years. The sample was 53% female, 61% (n=3006) non-Hispanic White, 19% (n=907) non-Hispanic Black or African American, 12% (n=605) Hispanic, 4% (n=193) non-Hispanic Asian, and 4% (n=182) non-Hispanic other. Compared to the non-Hispanic White adults, non-Hispanic Black adults were more likely to use mHealth to make health decisions (adjusted odds ratio aOR 1.70, 95% CI 1.23-2.34), share health information (aOR 1.46, 95% CI 1.02-2.08), and discuss health decisions with health providers (aOR 1.38, 95% CI 1.02-1.87). Significant associations were observed specifically among those who were always involved in SDM. Asian adults were less likely to be involved in SDM (aOR 0.51, 95% CI 0.26-0.99) and were more likely to use mHealth to track progress on a health-related goal (aOR 2.07, 95% CI 1.28-3.34) than non-Hispanic White adults. Hispanic adults were less likely to use mHealth to share health information (aOR 0.47, 95% CI 0.33-0.67) and discuss health decisions with health providers (aOR 0.65, 95% CI 0.46-0.94) compared to non-Hispanic White adults. This study observed racial and ethnic disparities in SDM and mHealth usage among US adults with hypertension. These findings emphasize the significance of comprehending the involvement of SDM and the usage of mHealth technology within racially and ethnically diverse populations.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The burden and presentation of post-acute sequela of SARS-CoV-2 infection (PASC) are a developing major public health concern.
To characterize the burden of PASC in community-dwelling individuals and ...understand the experiences of people living with PASC.
This mixed-methods study of COVID-19 positive community-dwelling persons involved surveys and in-depth interviews. Main outcome was self-report of possible PASC symptoms 3 weeks or longer after positive COVID-19 test. In-depth interviews were guided by a semi-structured interview guide with open-ended questions and probes based on emerging literature on PASC and the impact of COVID-19.
With a survey response rate of 70%, 442 participants were included in this analysis, mean (SD) age 45.4 (16.2) years, 71% female, 12% Black/African American. Compared to those with no PASC symptoms, persons who reported PASC symptoms were more likely to be older (mean age: 46.5 vs. 42; p = 0.013), female (74.3% vs. 61.2%; p = 0.010), to have pre-existing conditions (49.6% vs. 34%; p = 0.005), and to have been hospitalized for COVID-19 (14.2% vs. 2.9%; p = 0.002). About 30% of the participants experienced severe fatigue; the proportion of persons reporting severe fatigue was 7-fold greater in those with PASC symptoms (Adjusted Prevalence Ratio aPR 6.73, 95%CI: 2.80-16.18). Persons with PASC symptoms were more likely to report poor quality of life (16% vs. 5%, p<0.001) and worse mental health functioning (Mean difference: -1.87 95%CI: -2.38, -1.37, p<0.001). Themes from in-depth interviews revealed PASC was experienced as debilitating.
In this study, the prevalence of PASC among community-dwelling adults was substantial. Participants reported considerable coping difficulties, restrictions in everyday activities, invisibility of symptoms and experiences, and impediments to getting and receiving PASC care.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
7.
Cardiovascular Disease in Incarcerated Populations Wang, Emily A., MD, MAS; Redmond, Nicole, MD, PhD, MPH; Dennison Himmelfarb, Cheryl R., PhD, ANP, RN ...
Journal of the American College of Cardiology,
06/2017, Volume:
69, Issue:
24
Journal Article
Peer reviewed
Open access
Abstract Currently, 2.2 million individuals are incarcerated, and more than 11 million have been released from U.S. correctional facilities. Individuals with a history of incarceration are more ...likely to be of racial and ethnic minority populations, poor, and have higher rates of cardiovascular risk factors, especially smoking and hypertension. Cardiovascular disease is a leading cause of death among incarcerated individuals, and those recently released have a higher risk of being hospitalized and dying of cardiovascular disease compared with the general population, even after accounting for differences in racial identity and socioeconomic status. In this review, the authors: 1) present information on the cardiovascular health of justice-involved populations, and unique prevention and care conditions in correctional facilities; 2) identify knowledge gaps; and 3) propose promising areas for research to improve the cardiovascular health of this population. An Executive Summary of a National Heart, Lung, and Blood Institute workshop on this topic is available.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The Self‐Care of Heart Failure Index: A psychometric study Koirala, Binu; Budhathoki, Chakra; Dennison‐Himmelfarb, Cheryl R. ...
Journal of clinical nursing,
February 2020, 2020-Feb, 2020-02-00, 20200201, Volume:
29, Issue:
3-4
Journal Article
Peer reviewed
Background
The Self‐Care of Heart Failure Index is an empirically tested instrument to measure self‐care of heart failure patients across different populations and cultures.
Aims
To develop and ...evaluate the psychometric properties of the Nepali Self‐Care of Heart Failure Index.
Design
This psychometric study used a cross‐sectional, observational, study design to collect data. The study was guided and reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline.
Methods
To develop and culturally validate Nepali Self‐Care of Heart Failure Index, a combination of the recommended methods for cross‐cultural validation studies were applied such as translation, back translation, expert committee review of the translated version and validity/reliability testing. Face and content validity were ensured using expert review. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis. Composite reliability scores were calculated for each sub‐scale of the Nepali Self‐Care of Heart Failure Index.
Results
A total of 221 heart failure patients in Nepal were enrolled in the study. Adequate face and content validity were ensured through expert review. Exploratory factor analysis and confirmatory factor analysis supported the original three‐factor model. Although the three factors explained only 41% of the variance, confirmatory factor analysis fit indexes and error measures were found reasonable. The composite reliability coefficients for self‐care maintenance, management and confidence scale were 0.6, 0.7 and 0.8, respectively.
Conclusions
The Nepali Self‐Care of Heart Failure Index is a theoretically based, culturally acceptable and appropriate instrument for use among Nepali heart failure patients. However, further studies are needed to refine its psychometric properties.
Relevance to clinical practice
Access to reliable, valid and culturally appropriate instruments is crucial in describing the state of the problem as well as for developing and evaluating tailored and targeted self‐care practice interventions for Nepali patients living with heart failure.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Education about patient safety has historically been limited in health professionals curricula and largely inaccessible to the general public. We developed a massive open online course (MOOC), The ...Science of Safety in Healthcare, to present the foundational patient safety principles to a broad global audience of health professionals, learners, and patients interested in patient safety.
To describe the Science of Safety in Healthcare MOOC, its effects on patient safety competence, and the satisfaction of course participants.
The five-week video-based course was delivered in 2013 and 2014, and was organized in five modules: 1) overview of science of safety and safety culture, 2) enabling and contextual factors that influence patient safety and quality, 3) methods to improve safety and quality, 4) translating evidence intro practice and leading change, and 5) summary and opportunities for capacity building. Each module had three or four segments. Participants were introduced to key concepts, and tools and skills to promote patient safety. Participants completed the Health Professional Education in Patient Safety Survey (H-PEPSS), which measures patient safety competence, and a course satisfaction survey. Pre- and post- course H-PEPSS scores were compared using paired t-tests. Course satisfaction surveys were administered at the completion of the course and six months later.
A total of 20,957, and 9679 participants enrolled in the course in 2013 and 2014, respectively. About half of participants were 25–44 years old (57%), and female (54%). Participants joined from over 100 countries. The majority were health professionals (61%) or health professionals in training (7%). Mean H-PEPSS scores improved after course completion, with significant increases on all survey domains in both years (p < 0.01). Mean score differences were: Teamwork 0.68 (95% CI: 0.64, 0.71), Communication 0.70 (95% CI: 0.66, 0.73), Managing Risk 0.79 (95% CI: 0.76, 0.82), Human Environment 0.64 (95% CI: 0.61, 0.68), Recognizing and Responding 0.64 (95% CI: 0.61, 0.68), and Culture 0.72 (95% CI: 0.68, 0.75). About 8% of participants in each cohort earned a certificate of completion. At 6-months post-course, the majority of the participants agreed or agreed strongly that the course content was useful (93%) and that the course positively influenced their clinical practice (69%) and communication (84%).
The MOOC course allowed educators to reach a large, diverse audience. The course was well-received and participants reported a significant increase in patient safety competence. As with most MOOCs, rates of completion were low.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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