IntroductionAmbulatory patients with advanced heart failure (HF) are often considered for mechanical circulatory support. Because of their variable trajectory, patients may have changes in their ...functional status and quality of life over a relatively short period. We assessed the impact of such short-term changes on longer-term outcomes.MethodsREVIVAL, a prospective, observational study, enrolled 400 outpatients from 21 VAD/transplant centers in 2015-16. Subjects had NYHA Class II-IV HF despite optimal therapy, as well as a recent HF hospitalization or another high-risk marker. Baseline A occurred at informed consent. Baseline B occurred 8 weeks (± 30 days) later. At both visits, patients underwent assessment of functional status and quality of life. We compared indices of disease severity at Baseline A vs B, and determined the impact of changes on 1-year outcomes.ResultsOf the 400 patients, 258 completed the Baseline B visit within the study window. Using defined thresholds (Table), roughly one quarter had a worse INTERMACS profile, NYHA Class, 6-minute walk test distance, gait speed, or EuroQOL Health State visual analog scale after 2 months up. Patients with worse INTERMACS profiles after 2 months had a 2-fold increased risk of transplant, LVAD, or death at 1 year.ConclusionsA significant minority of heart failure patients exhibit short-term worsening in functional status and quality of life. A worse INTERMACS profile after 2 months is associated with worse outcomes at 1 year. These results demonstrate the dynamic nature of heart failure and suggest that frequent re-assessment is important. Understanding the impact of such short-term changes on the longer-term trajectory of the patient’s illness should allow more effective triage of HF patients to advanced therapies.
Depression, child abuse histories, and current attributions were investigated for 80 mothers of boys in three abuse referral groups (victimized perpetrators, nonvictimized perpetrators, and victim ...only) in comparison with a group of boys showing externalizing behaviors. During semistructured interviews with mothers, child abuse histories were elicited and the Beck Depression Inventory (BDI) was administered. The Leeds Attributional Coding System (LACS) was used to code spoken attributions from verbatim interview transcripts. Sexual victimization in their own childhood was reported by 55% of mothers of perpetrators and 30% of mothers of victims; high rates of domestic violence were reported by both mothers of perpetrators (72%) and mothers of victims (50%). There were no significant group differences on BDI scores. Mothers of the externalizing comparison group showed “low perceived control” in their attributions for negative events and blamed their sons for negative events significantly more than those of the three case groups (p < .05). The findings are discussed in terms of their implications for clinical interventions and research.
A flurry of best-selling works has recently urged us to rescue and protect boys. They have described how boys are failing at school, acting out, or shutting down emotionally. Lost in much of the ...ensuing public conversation are the boys themselves—the texture of their lives and the ways in which they resist stereotypical representations of them. Most of this work on boys is based primarily on middle class, white boys. Yet boys from poor and working class families as well as those from African American, Latino, and Asian American backgrounds need to be understood in their own terms and not just as a contrast to white or middle class boys. Adolescent Boys brings together the most up-to-date empirical research focused on understanding the development of boys from diverse racial, ethnic, and socioeconomic backgrounds. The authors show how the contexts of boys' lives, such as the schools they attend shape their identities and relationships. The research in this book will help professionals and parents understand the diversity and richness of boys' experiences.
Objective
To determine whether LJP 394 delays or prevents renal flare in patients with systemic lupus erythematosus (SLE) and a history of renal disease.
Methods
In a 76‐week, double‐blind, ...placebo‐controlled study, 230 SLE patients were randomized to receive 16 weekly doses of 100 mg of LJP 394 or placebo, followed by alternating 8‐week drug holidays and 12 weekly doses of 50 mg of LJP 394 or placebo. An assay measuring the affinity of the serum IgG fraction for the DNA epitope of LJP 394 identified a high‐affinity population of patients (189 of 213 patients; 89% taking LJP 394 and 90% taking placebo). Analyses were performed on both the intent‐to‐treat population and the high‐affinity population.
Results
Anti–double‐stranded DNA antibodies decreased and C3 levels tended to increase during treatment with LJP 394. In the intent‐to‐treat population, the time to renal flare was not significantly different between treatment groups, but patients taking LJP 394 had a longer time to institution of high‐dose corticosteroids and/or cyclophosphamide (HDCC) and required 41% fewer treatments with HDCC. In the high‐affinity population, the LJP 394 group experienced a longer time to renal flare, 67% fewer renal flares, longer time to institution of HDCC, and 62% fewer HDCC treatments compared with the placebo group. In patients with serum creatinine levels ≥1.5 mg/dl at study entry, those taking LJP 394 had 50% fewer renal flares; no renal flares were observed in the high‐affinity group taking LJP 394. Serious adverse events were observed in 25 of the 114 LJP 394–treated patients (21.9%) and 34 of the 116 placebo‐treated patients (29.3%).
Conclusion
Treatment with LJP 394 in patients with high‐affinity antibodies to its DNA epitope prolonged the time to renal flare, decreased the number of renal flares, and required fewer HDCC treatments compared with placebo. The study drug appeared to be well tolerated.
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