Cardiorespiratory fitness and incidence of type 2 diabetes in United States veterans on statin therapy

Impact of cardiorespiratory fitness on statin-related incidence of type 2 diabetes has not been assessed. We assessed the cardiorespiratory fitness and diabetes incidence association in dyslipidemic patients on statins.We identified dyslipidemic patients with a normal exercise test performed during 1986 and 2014 at the Veterans Affairs Medical Centers in Washington, DC or Palo Alto, Calif. The statin-treated patients (n\ua0= 4092; age\ua0= 58.8 ± 10.9 years) consisted of 2701 Blacks and 1391 Whites. None had evidence of type 2 diabetes prior to statin therapy. We formed 4 fitness categories based on age and peak metabolic equivalents achieved: Least-fit (n\ua0= 954), Low-fit (n\ua0= 1201), Moderate-fit (n\ua0= 1242), and High-fit (n\ua0=\ua0695). The non-statin-treated cohort (n\ua0= 3001; age\ua0= 57.2 ± 11.2 years) with no evidence of type 2 diabetes prior to the exercise test served as controls.Diabetes incidence was 24% higher in statin-treated compared with non-statin-treated patients (

Using a board game to reinforce learning

Experiential gaming strategies offer a variation on traditional learning. A board game was used to present synthesized content of fundamental catheter care concepts and reinforce evidence-based practices relevant to nursing. Board games are innovative educational tools that can enhance active learning. © SLACK Incorporated

Upper extremity weakness: A novel risk factor for non-cardiovascular mortality among community-dwelling older adults

BACKGROUND: Aging-associated upper extremity weakness has been shown to be associated with adverse health outcomes in older adults, but less is known about the association between impaired upper extremity function and cause-specific mortalities. METHODS: Among the 5512 prospective community-based longitudinal Cardiovascular Health Study participants, 1438 had difficulty with one of the three upper extremity functions of lifting, reaching, or gripping. We assembled a propensity score-matched cohort in which 1126 pairs of participants with and without difficulty with upper extremity function, balanced on 62 baseline characteristics including geriatric and functional variables such as physical and cognitive function. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortalities associated with upper extremity weakness were estimated in the matched cohort. RESULTS: Matched participants had a mean age of 73.1 years, 72.5% were women, and 17.0% African American. During 23 years of follow-up, all-cause mortality occurred in 83.7% (942/1126) and 81.2% (914/1126) of participants with and without upper extremity weakness, respectively (HR, 1.11; 95% CI, 1.01-1.22; p = 0.023). Upper extremity weakness was associated with a higher risk of non-cardiovascular mortality, occurring in 595 (52.8%) and 553 (49.1%) of participants, respectively (HR, 1.17; 95% CI, 1.04-1.31; p = 0.010), but had no association with cardiovascular mortality (30.8% vs 32.1% in those with and without upper extremity weakness, respectively; HR, 1.03; 95% CI, 0.89-1.19; p = 0.70). CONCLUSION: Among community-dwelling older adults, upper extremity weakness had a weak, albeit independent, significant association with all-cause mortality, which was primarily driven by a higher risk of non-cardiovascular mortality. Future studies need to replicate these findings and understand the underlying reasons for the observed associations

Cardiorespiratory Fitness and Health Outcomes: A Call to Standardize Fitness Categories

An inverse association between physical activity or fitness status and health outcomes has been reported by several cohort studies. When fitness categories are established in quartiles or quintiles based on the peak exercise capacity achieved, the association is graded. Although significant health benefits of increased cardiorespiratory fitness (CRF) have been uniformly reported, the degree of protection has varied substantially between studies. This variability is likely due to varying methods used to define CRF categories, and not considering age, despite its strong effect on CRF. To ameliorate these methodological discrepancies, we propose standardized guidelines by which age-specific CRF categories should be defined

Changing Behavior among Nurses to Track Indwelling Urinary Catheters in Hospitalized Patients

Catheter-associated urinary tract infections (CAUTIs) are preventable complications of hospitalization. An interdisciplinary team developed a curriculum to increase awareness of the presence of indwelling urinary catheters (IUCs) in hospitalized patients, addressed practical, primarily nurse-controlled inpatient risk-reduction interventions, and promoted the use of the IUC labels (“tags”). Five thirty-minute educational sessions were cycled over three daily nursing shifts on two inpatient medical floors over a 1-year period; participants were surveyed (n=152) to elicit feedback and provide real-time insight on the learning objectives. Nurse self-reported IUC tagging was early and sustained; after the IUC tag was introduced, there was a significant increase in tagging reported by the end of the block of educational sessions (from 46.2% to 84.6%, P=0.001). Early engagement combined with a targeted educational initiative led to increased knowledge, changes in behavior, and renewed CAUTI awareness in hospitalized patients with IUCs. The processes employed in this small-scale project can be applied to broader, hospitalwide initiatives and to large-scale initiatives for healthcare interventions. As first-line providers with responsibility for the placement and daily maintenance of IUCs, nurses are ideally positioned to implement efforts addressing CAUTIs in the hospital setting

Understanding Demographic Risk Factors for Adverse Outcomes in COVID-19 Patients: Explanation of a Deep Learning Model

© 2021, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply. This study was to understand the impacts of three key demographic variables, age, gender, and race, on the adverse outcome of all-cause hospitalization or all-cause mortality in patients with COVID-19, using a deep neural network (DNN) analysis. We created a cohort of Veterans who were tested positive for COVID-19, extracted data on age, gender, and race, and clinical characteristics from their electronic health records, and trained a DNN model for predicting the adverse outcome. Then, we analyzed the association of the demographic variables with the risks of the adverse outcome using the impact scores and interaction scores for explaining DNN models. The results showed that, on average, older age and African American race were associated with higher risks while female gender was associated with lower risks. However, individual-level impact scores of age showed that age was a more impactful risk factor in younger patients and in older patients with fewer comorbidities. The individual-level impact scores of gender and race variables had a wide span covering both positive and negative values. The interaction scores between the demographic variables showed that the interaction effects were minimal compared to the impact scores associated with them. In conclusion, the DNN model is able to capture the non-linear relationship between the risk factors and the adverse outcome, and the impact scores and interaction scores can help explain the complicated non-linear effects between the demographic variables and the risk of the outcome

Cardiorespiratory fitness, body mass index and heart failure incidence

AimsObesity is associated with increased risk of heart failure (HF). This risk may be modulated by improved cardiorespiratory fitness (CRF) as CRF is associated with favourable health outcomes. Thus, we assessed the interaction between body mass index (BMI), CRF and HF.Methods and resultsCardiorespiratory fitness and BMI were assessed in 20 254 US male veterans (mean age 58.0 11.3 years), who completed a maximal exercise treadmill test between 1987 and 2017. All had no evidence of ischaemia or HF prior to the exercise test. They were classified based on age-stratified quartiles of peak metabolic equivalents (METs) achieved as: least-fit (4.5 +/- 1.3), low-fit (6.7 +/- 1.3), moderate-fit (8.1 +/- 1.1), and high-fit (11.2 +/- 2.4); and according to BMI as normal weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese ( 30.0 kg/m(2)). During a median follow-up of 13.4 years, there were 2979 HF events (10.8 events/1000 person-years). HF risk was significantly higher in the obese category [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.10-1.36; P < 0.001], but was no longer significant after further adjustment for METs. When compared to the least-fit, HF risk declined progressively with increased CRF within all BMI categories. The risk was 63% (HR 0.37, 95% CI 0.30-0.47; P < 0.001), 66% (HR 0.37, 95% CI 0.28-0.40; P < 0.001), and 73% (HR 0.27, 95% CI 0.22-0.34; P < 0.001) lower for high-fit individuals within normal weight, overweight and obese categories, respectively.ConclusionsIncreased CRF was associated with progressively lower HF risk regardless of BMI, suggesting that the elevated HF risk associated with obesity may be modulated by improved CRF

Exercise capacity and atrial fibrillation risk in veterans: a cohort study

Objective To assess the association between exercise capacity and the risk of developing atrial fibrillation (AF). Patients and Methods A symptom-limited exercise tolerance test was conducted to assess exercise capacity in 5962 veterans (mean age, 56.8±11.0 years) from the Veterans Affairs Medical Center, Washington, DC. None had evidence of AF or ischemia at the time of or before undergoing their exercise tolerance test. We established 4 fitness categories based on age-stratified quartiles of peak metabolic equivalent task (MET) achieved: least fit (4.9±1.10 METs; n=1446); moderately fit (6.7±1.0 METs; n=1490); fit (7.9±1.0 METs; n=1585), and highly fit (9.3±1.2 METs; n=1441). Multivariable Cox proportional hazards regression models were used to compare the AF-exercise capacity association between fitness categories. Results During a median follow-up period of 8.3 years, 722 (12.1%) individuals developed AF (14.5 per 1000 person-years; 95% CI, 13.9-15.9 per 1000 person-years). Exercise capacity was inversely related to AF incidence. The risk was 21% lower (hazard ratio, 0.79; 95% CI, 0.76-0.82) for each 1-MET increase in exercise capacity. Compared with the least fit individuals, hazard ratios were 0.80 (95% CI, 0.67-0.97) for moderately fit individuals, 0.55 (95% CI, 0.45-0.68) for fit individuals, and 0.37 (95% CI, 0.29-0.47) for highly fit individuals. Similar trends were observed in those younger than 65 years and those 65 years or older. Conclusion Increased fitness is inversely and independently associated with the reduced risk of developing AF. The decrease in risk was graded and precipitous with only modest increases in exercise capacity. These findings counter previous suggestions that even moderate increases in physical activity, as recommended by national and international guidelines, increase the risk of AF, with marked protection against AF noted with increasing levels of fitness