Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial

Importance: Adoption of guideline-directed medical therapy for patients with heart failure is variable. Interventions to improve guideline-directed medical therapy have failed to consistently achieve target metrics, and limited data exist to inform efforts to improve heart failure quality of care. Objective: To evaluate the effect of a hospital and postdischarge quality improvement intervention compared with usual care on heart failure outcomes and care. Design, Setting, and Participants: This cluster randomized clinical trial was conducted at 161 US hospitals and included 5647 patients (2675 intervention vs 2972 usual care) followed up after a hospital discharge for acute heart failure with reduced ejection fraction (HFrEF). The trial was performed from 2017 to 2020, and the date of final follow-up was August 31, 2020. Interventions: Hospitals (n = 82) randomized to a hospital and postdischarge quality improvement intervention received regular education of clinicians by a trained group of heart failure and quality improvement experts and audit and feedback on heart failure process measures (eg, use of guideline-directed medical therapy for HFrEF) and outcomes. Hospitals (n = 79) randomized to usual care received access to a generalized heart failure education website. Main Outcomes and Measures: The coprimary outcomes were a composite of first heart failure rehospitalization or all-cause mortality and change in an opportunity-based composite score for heart failure quality (percentage of recommendations followed). Results: Among 5647 patients (mean age, 63 years; 33% women; 38% Black; 87% chronic heart failure; 49% recent heart failure hospitalization), vital status was known for 5636 (99.8%). Heart failure rehospitalization or all-cause mortality occurred in 38.6% in the intervention group vs 39.2% in usual care (adjusted hazard ratio, 0.92 [95% CI, 0.81 to 1.05). The baseline quality-of-care score was 42.1% vs 45.5%, respectively, and the change from baseline to follow-up was 2.3% vs -1.0% (difference, 3.3% [95% CI, -0.8% to 7.3%]), with no significant difference between the 2 groups in the odds of achieving a higher composite quality score at last follow-up (adjusted odds ratio, 1.06 [95% CI, 0.93 to 1.21]). Conclusions and Relevance: Among patients with HFrEF in hospitals randomized to a hospital and postdischarge quality improvement intervention vs usual care, there was no significant difference in time to first heart failure rehospitalization or death, or in change in a composite heart failure quality-of-care score. Trial Registration: ClinicalTrials.gov Identifier: NCT03035474

6. Història i narració. Más verdadero que los hechos: Storytelling como comprensión en los escritos de Hannah Arendt

Arendl sostiene que el totalitarismo manifiesta tanto una crisis moral como un «problema de comprensión». Este problema de comprensión plantea la necesidad de hallar un camino que permita ofrecer una respuesta espontánea y responsable frente al fenómeno de la dominación total. Confrontada con la desaparición de las categorías y los criterios tradicionales que sirven ordinariamente como guías para el pensamiento crítico. Arendt sostiene que dicha respuesta debe orientarse a partir de la «experiencia personal» del pensador Storytelling es el término que utiliza para describir la comprensión crítica que parte de la experienci

Posthuman Feminist Theory

This chapter maps the emergence of a posthuman turn in feminist theory, based on the convergence of posthumanism with postanthropocentrism. The former critiques the universalist posture of the idea of “Man” as the alleged “measure of all things.” The latter criticizes species hierarchy and the assumption of human exceptionalism. Although feminist posthuman theory benefits from multiple genealogical sources and cannot be reduced to a single or linear event, it can be analyzed in terms of its conceptual premises, the methodology and its implications for feminist political subjectivity and for sexual politics, notably in relation to nonhuman agents

Student Functioning, Concerns, and Socio-Personal Well-Being

The following study used the Student Quality of Life and Satisfaction (SQOLAS) instrument and 467 University of Rhode Island undergraduate and graduate students as participants in order to examine relationships among functioning and performance variables, student concern and importance areas, and measures of socio-personal satisfaction and well-being. Canonical correlational analysis revealed two statistically significant canonical correlations between a student functioning/performance variable set and a concern/importance area variable set. A set of variables related to increased concern and importance ratings of socio-sexual behavior, and decreased ratings of crime, violence, multicultural, and gender issues was significantly associated with a second set of variables: increased levels of alcohol use and associated negative consequences, younger age, increased mental health concerns, men more than women, decreased class year, and less positive ratings toward direction in life. Standard multiple regression analysis produced a statistically significant model where positive attitude towards direction in life can be predicted by higher levels of socio-personal satisfaction and deep metacognitive processing, and lower levels of alcohol use and associated negative consequences, and fewer mental health concerns. Implications of the results are discussed in relation to theories of cognitive behavior, phenomenological functioning, life meaning, and well-being