Implications of stroke for caregiver outcomes: findings from the ASPIRE-S study.

BACKGROUND: Informal caregivers are vital to the long-term care and rehabilitation of stroke survivors worldwide. However, caregiving has been associated with negative psychological outcomes such as anxiety and depression, which leads to concerns about caregiver as well as stroke survivor well-being. Furthermore, caregivers may not receive the support and service provision they require from the hospitals and community. AIMS: This study examines caregiver psychological well-being and satisfaction with service provision in the context of stroke. METHODS: Caregiver data were collected as part of the ASPIRE-S study, a prospective study of secondary prevention and rehabilitation which assessed stroke patients and their carers at six-months post stroke. Carer assessment included measurement of demographics, satisfaction with care (UK Healthcare Commission National Patient Survey of Stroke Care), psychological distress (Hospital Anxiety and Depression Scale), and vulnerability (Vulnerable Elders Scale). Logistic regression analyses and chi-squared tests were performed using stata version 12. RESULTS: Analyses from 162 carers showed substantial levels of dissatisfaction (37·9%) with community and hospital services, as well as notable levels of anxiety (31·3%) and depressive symptoms (18·8%) among caregivers. Caregiver anxiety was predicted by stroke survivor anxiety (OR = 3·47, 95% CI 1·35-8·93), depression (OR = 5·17, 95% CI 1·83-14·58), and stroke survivor cognitive impairment (OR 2·35, 95% CI 1·00-5·31). Caregiver depression was predicted by stroke survivor anxiety (OR = 4·41, 95% CI 1·53-12·72) and stroke survivor depression (OR = 6·91, 95% CI 2·26-21·17). CONCLUSION: Findings indicate that caregiver and stroke survivor well-being are interdependent. Thus, early interventions, including increased training and support programs that include caregivers, are likely to reduce the risk of negative emotional outcomes

Targeting cystic fibrosis pathophysiology is changing the future for children worldwide

Cystic fibrosis (CF) is an autosomal recessive genetic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene on chromosome 7, most commonly diagnosed at birth via heel prick testing. Patients with CF suffer from a variety of complications including lung disease, gastrointestinal disease and pancreatic dysfunction leading to malabsorption and secondary diabetes mellitus. To date, treatment has been largely symptomatic, but the recent development of a new class of drug, the CFTR modulator, may be a game-changer for children with CF. CFTR modulators target the underlying pathophysiological process of CF itself, either the misfolding of protein channels (correctors) or the length of time functional channels remain open (potentiators). This study aims to review the literature to date on ivacaftor, a CFTR potentiator approved for use in CF patients two years and older with G551D mutation; lumacaftor, a CFTR corrector with as-yet unproven benefit; and, lumacaftor/ivacaftor combination (Orkambi), which shows modest but significant improvement in patients with the F508del mutation, specifically focusing on efficacy, safety profiles and current guidelines. </p

Continuous glucose monitoring: a sweet deal for paediatric type 1 diabetics

Children diagnosed with type 1 diabetes mellitus (T1DM) are at particular risk for long-term complications, including diabetic retinopathy, neuropathy, and nephropathy. Over the last few decades, clinical advancements in glucose monitoring and methods of insulin delivery have improved quality of life in T1DM, making strict glycaemic control, which can reduce long-term complication risk, more achievable. The continuous glucose monitor (CGM) is a minimally invasive subcutaneous device, which assesses subcutaneous interstitial glucose levels at five-minute intervals. Used in conjunction with multiple daily insulin injections, or continuous subcutaneous insulin infusion via insulin pump, the CGM has been proven to enhance metabolic control, reducing HbA1c levels as well as time spent in hypoglycaemia. Furthermore, CGM allows for retrospective analysis of blood glucose trends by clinicians, leading to individualised and precise management strategies. However, limitations to its use include cost efficacy, sensor accuracy, and insertion site irritation. This review will discuss the potential benefits and limitations of CGM use in a paediatric population, and the recommendation that CGM be made available to any paediatric diabetic who requests its use. </p

Experiences and Perspectives of Individuals with Cystic Fibrosis and Their Families Related to Food Insecurity

Food insecurity (FI) rates among people with cystic fibrosis (CF) are significantly higher than in the general US population. This study explored the experiences and perceptions of adults and parents of children with CF surrounding FI. We recruited parents of children with CF ages 0&ndash;18 years and adults with CF ages 18 years and older from a large, accredited U.S. CF care center and the Cystic Fibrosis Foundation Community Voice to participate in a qualitative study using semi-structured telephone interviews to explore experiences and preferences related to food insecurity. Two coders independently reviewed each transcript to apply the codebook and identify any emerging codes using an ongoing, iterative process to identify central themes. We interviewed 20 participants (six adults with CF and 14 parents of children with CF) and identified five major themes: (1) FI in CF is influenced by a variety of factors, ranging from nutritional demands to competing financial barriers; (2) FI impacts CF health outcomes; (3) Open patient-provider communication around FI is vital; (4) FI screening and discussions should be normalized in CF care; (5) Comprehensive FI resources are vital. FI is an important topic that should routinely be addressed with the CF care team to destigmatize and encourage individuals to be more forthcoming about their FI status. Results from this study will inform future larger investigations on the impact of FI on CF health and aid in the design and planning of targeted interventions and advocacy efforts

Determining rates of smoking cessation advice delivered during hospitalisation and smoking cessation rates 3 months post discharge: a two-hospital survey

Background: Hospitalisation is an ideal time to implement smoking cessation interventions. However, little is known about the extent to which inpatients receive such advice, or the impact it has on motivation to quit and quitting behaviours post-hospitalisation. Aims: This study aimed to determine the prevalence of smoking and cessation advice received by inpatients in two teaching hospitals in Ireland, and the impact of cessation advice on smoking at 3 months post discharge. Methods: We surveyed 1001 inpatients across two hospital sites, over a six-month period. Demographic details, clinical history, smoking history, motivation to quit, cigarette dependence, and recent quitting history were assessed. Results: Prevalence of smoking within the sample was 23.4% (235/1001). Only 32% (75/235) of smokers reported that smoking cessation was discussed during admission. Smokers’ mean Fagerström nicotine-dependence score was 3.7 (SD = 2.7), indicating low dependence levels. At 3 months, 17% (25/146) of smokers reported smoking cessation. Provision of smoking cessation advice during hospitalisation was associated with higher motivation to quit (OR = 2.79, 95% CI 2.12–3.68), and successful quit behaviour for confirmed (OR = 1.98, 95% CI 1.55–2.53) and self-reported quitters (OR = 1.47, 95% CI 1.3–1.66) Conclusions: This observational study finds that provision of brief cessation advice and smoking status documentation was suboptimal. Where advice was given, it was associated with enhanced motivation to quit and increased quit rates. These findings, along with low dependence scores, suggest that systematic provision of low-intensity cessation interventions could significantly enhance quit rates in hospitalised smokers

Determining rates of smoking cessation advicedelivered during hospitalisation and smokingcessation rates 3 months post discharge: a twohospitalsurvey

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