Congestive Heart Failure: The Danger of Medical Jargon

Congestive heart failure (CHF) has shifted from a terminal diagnosis to a chronic disease. However, the nomenclature, specifically the inclusion of the term “failure”, leads patients to believe that the diagnosis is lethal and thus can cause anxiety and depression. Several cardiology foundations have called for a nomenclature change based on wide variations in pathophysiology of the disease and also on patient perceptions of the terminology (Patel et al. 2018; Stocker et al. 2017; Rogers et al. 2000; Tayler and Ogden 2005; Lehman et al. 2005). The purpose of this study was to gain further understanding of lay people’s perception of the disease congestive heart failure. Free listing interviews were conducted with 100 community members who were asked to list all thoughts and feelings regarding the term “congestive heart failure” and three other medical diagnoses. Data were cleaned and salience was derived using Smith’s S defined as: S = ((L − Rj + 1)/L)/N, where L is the length of each list, Rj is the rank of item J in the list, and N is the number of lists in the sample. Despite the fact that CHF, like high blood pressure or diabetes, is not a death sentence, terms like death, severe, and fear proved to be most salient when respondents were asked to reflect on CHF . Contrasted to this were diet, treatment, and family history which were among the salient terms collected when respondents reflected on diabetes or high blood pressure. Even though providers can help people process the diagnosis and defuse their immediate concerns, this study documents the impact language has on lay members of the community and supports a need for public health and healthcare professionals to address common perceptions of language

Perceptions of pregnant women about influenza vaccine: What do we know?

Seasonal influenza is a highly contagious disease which can lead to complications such as exacerbation of chronic conditions, hospitalization and even death. Influenza is particularly dangerous when it strikes those who are immunosuppressed, elderly, very young (children \u3c 6 months old) or pregnant. Vaccination is recommended for everyone and especially for these vulnerable populations. Despite recommendations, vaccine uptake is lower than recommended with only 53.6% of pregnant women reporting vaccination. A systematic review on this topic was performed by Yuen et al. in 2014. A rapid systematic review was conducted to update Yuen’s findings and shed light on which factors play a role in flu vaccine decision making for pregnant women. The review resulted in the identification of eleven papers published between 2014 and 2019. Data extraction was informed by the Health belief Model (HBM). Results were organized into 5 categories--perceived susceptibility, perceived severity, perceived benefits, perceived barriers and cues to action, all elements of the HBM. Results showed that women who perceived risk as “high”, had higher knowledge about disease, wanted to protect their babies and themselves from the disease, received a provider recommendation, along with an opportunity to receive the vaccine at the time of an office visit were more likely to be vaccinated. Unvaccinated women had more perceived barriers, such as lower knowledge, had concerns about safety of vaccine and perceived risk as low. Based on the findings, cues to action impacted vaccination status the most. To increase influenza vaccine uptake by pregnant women, health care providers need to recommend vaccination and offer it at the time of an office visit, additionally, providers need to provide education about vaccine safety, effectiveness and risks of the disease

Post-Discharge Nutrition Care Instructions for Malnourished Adults

Malnutrition remains an insidious yet common ailment among hospitalized adults, with prevalence estimates ranging from 4-45%. Multiple studies confirm the adverse effects of malnutrition, which include prolonged length of stay, readmissions, higher hospitalization costs, and mortality. Malnutrition is frequently associated with chronic disease. For nutrition interventions to be successful, they must continue to support the long-term nutritional needs of patients beyond the hospital stay. Few studies, however, examine the receipt of recommendations for oral nutrition supplementation (ONS) or basic nutrition care instructions at the time of discharge. There is a need to better understand what post-discharge nutrition care instructions are documented in the electronic medical record (EMR) and how they are communicated to patients once they leave the hospital. This study sought to describe the malnourished adult patient population and the standard of nutrition-focused discharge care they receive at Christiana Hospital in Newark, DE. The investigation revealed that a majority of these patients received inappropriate or inadequate nutrition care instructions at time of discharge. Preliminary survey data suggest that some patients may be unaware of their malnutrition diagnosis, and may receive care instructions that are never documented. Clinician education and redesign of nutrition care options in the EMR may aid in the provision of discharge instructions to treat and prevent malnutrition after patients leave the hospital

Running Out: Food Insecurity in the LGBT Older Adult Community

While food insecurity has been shown to affect Americans across the lifespan, older adults, defined as individuals over age 65, have one of the highest subpopulation rates of food insecurity. Approximately one out of ten senior only households experience food insecurity nationally (Rabbitt, et al., 2017; Chung et al., 2012). A smaller, less researched faction of the older adult population is the lesbian, gay, bisexual and transgender (LGBT) older adult community. Research has shown that LGBT seniors are significantly poorer than their heterosexual counterparts (Emlet, 2016). LGBT older Americans also experience higher rates of isolation and lower rates of familial and other social support as LGBT seniors are three times more likely to enter older adulthood without having children nor a spouse (Goldberg & Mawn, 2014). Research on general food insecurity has uncovered that low income and reduced social support have been defining indicators for experiencing food insecurity (Rabbitt, et al., 2017) However, less is known regarding food access challenges faced by older adults who identify as LGBT. This qualitative study explores the experiences of ten LGBT older adult community members who self-identify as food insecure. All interviews were audiotaped, transcribed verbatim, and analyzed using common coding techniques. Results highlighted a variety of barriers that limited access and multiple enabling factors. A key finding is the need for food programs that take into account the needs of the older adult population, particularly in regards to food access for individuals with mobility issues. The results can inform program implementation and evaluation to make food access programs equally as effective for older program participants

Characteristics of Continuous EEG Programs in the Critical Care Setting

Introduction. The use of cEEG in the care of critically ill patients is increasing. A 2014 survey of neurophysiologists described cEEG practices (Gavvala et al, 2014), but further characterization has been lacking. This study explores the structure of cEEG programs in the adult critical care setting. Methods. We conducted 21 in-depth interviews from 13 institutions that use cEEG in the adult critical care setting and additionally surveyed 36 physicians to provide information about their institutions. The interview and survey questions addressed cEEG program structure and processes. Interviews were recorded, transcribed, and analyzed using a directed content analysis approach. Results. The interviewees and survey respondents reported the characteristics of their institutions, fellowship programs, and their own practices in reading cEEG. There was variability between institutions in terms of resources available and structure of the programs. Most interviewees and respondents reported use of the ACNS nomenclature for cEEG reporting but consistency of use was variable. The majority reported using quantitative EEG with variable application. The process of communication regarding cEEG varied, with some institutions utilizing a more defined structure of communication. Conclusion. Despite the growing demand for cEEG, program structure and practices varied between institutions. There remains a need for defining parameters for cEEG program structures between institutions with different characteristics. The lack of uniformity between programs must be considered given the widespread use of cEEG in clinical decision-making for critically ill patients. In order to ensure health equity and effective systems, there must be standardization across hospitals

Human Trafficking Legal Service Providers Respond to COVID-19

Human trafficking spans the globe, existing in every country and in every U.S. state. Traffickers may have lured survivors to the U.S. using manipulation and coercion, leaving survivors in a vulnerable legal status post-trafficking. Survivors may have also been convicted of crimes during their trafficking experience and need their records vacated. Organizations that provide legal services to trafficking survivors face numerous hurdles with and on behalf of their clients. The Novel Coronavirus pandemic amplified obstacles that these organizations face. Much like the rest of the workforce, these organizations quickly went virtual and had to adapt to new ways to communicate and serve their clients. Through key informant interviews, representatives from five legal service providers in the Greater Philadelphia Area shared challenges that their organization and clients faced from the start of the pandemic to August 2020. Additionally, they shared how they adjusted to accommodate the needs of their clients. Several of the organizations highlighted the need for viable work-from-home strategies, including funding for technology; and the need for self-care to be a priority when adapting to rapidly changing external environments. On a client level, the participants found themselves advocating for technology access for their clients, the importance of client privacy and safety, and the recognition that with a pandemic comes an increased need in social service support. Data from the interviews was analyzed and used to create a Business Impact Assessment to assist the organizations in identifying themes that contributed to the disruption of business-as-usual caused by the Coronavirus pandemic

COVID-19 and Individuals Living with Cardiovascular Disease: A Rapid Review

In 2019, a deadly disease referred to as coronavirus disease 2019 (COVID-19) appeared in Wuhan, China. The viral infection spread worldwide and is now a declared pandemic by the World Health Organization. Individuals living with cardiovascular disease who rely on specific treatments are a particularly vulnerable population that are more likely to suffer from severe disease and death (Tan & Aboulhosn, 2020). This deadly virus can affect the heart in different ways causing the risk of morbidity and mortality to strike for those with coronary artery disease, congestive heart failure, and hypertension (Goha, Mezue, Edwards, Nunura, Baugh, & Madu, 2020). As the number of publications increase, there is still a huge gap on the impact of COVID-19 and individuals living with cardiovascular disease. With this being said, there is a need for greater awareness of the immediate and long-term effects of COVID-19 on cardiovascular health and the significant gaps in knowledge that future research needs to address. In this review, we explore the impact of pre-existing cardiovascular diseases and the risk of mortality from COVID-19. This review summarizes key findings from the literature on the impact of COVID-19 on coronary artery disease (CAD), congestive heart failure (CHF), and hypertension (HBP)

My bitterness is deeper than the ocean : understanding internalized stigma from the perspectives of persons with schizophrenia and their family caregivers.

Background: It is estimated that 8 million of the Chinese adult population had a diagnosis of schizophrenia. Stigma associated with mental illness, which is pervasive in the Chinese cultural context, impacts both persons with schizophrenia and their family caregivers. However, a review of the literature found a dearth of research that explored internalized stigma from the perspectives of both patients and their caregivers. Methods: We integrated data from standardized scales and narratives from semi-structured interviews obtained from eight family-dyads. Interview narratives about stigma were analyzed using directed content analysis and compared with responses from Chinese versions of the Internalized Stigma of Mental Illness Scale and Affiliated Stigma Scale. Scores from the two scales and number of text fragments were compared to identify consistency of responses using the two methods. Profiles from three family-dyads were analyzed to highlight the interactive aspect of stigma in a dyadic relationship. Results: Our analyses suggested that persons with schizophrenia and their caregivers both internalized negative valuation from their social networks and reduced engagement in the community. Participants with schizophrenia expressed a sense of shame and inferiority, spoke about being a burden to their family, and expressed self-disappointment as a result of having a psychiatric diagnosis. Caregivers expressed high level of emotional distress because of mental illness in the family. Family dyads varied in the extent that internalized stigma were experienced by patients and caregivers. Conclusions: Family plays a central role in caring for persons with mental illness in China. Given the increasingly community-based nature of mental health services delivery, understanding internalized stigma as a family unit is important to guide the development of cultural-informed treatments. This pilot study provides a method that can be used to collect data that take into consideration the cultural nuances of Chinese societies

Natural Disasters in the Americas, Dialysis Patients, and Implications for Emergency Planning: A Systematic Review

INTRODUCTION: Natural hazards are elements of the physical environment caused by forces extraneous to human intervention and may be harmful to human beings. Natural hazards, such as weather events, can lead to natural disasters, which are serious societal disruptions that can disrupt dialysis provision, a life-threatening event for dialysis-dependent people. The adverse outcomes associated with missed dialysis sessions are likely exacerbated in island settings, where health care resources and emergency procedures are limited. The effect of natural disasters on dialysis patients living in geographically vulnerable areas such as the Cayman Islands is largely understudied. To inform predisaster interventions, we systematically reviewed studies examining the effects of disasters on dialysis patients and discussed the implications for emergency preparedness in the Cayman Islands. METHODS: Two reviewers independently screened 434 titles and abstracts from PubMed, Scopus, CINAHL, and Cochrane Library. We included studies if they were original research articles published in English from 2009 to 2019 and conducted in the Americas. RESULTS: Our search yielded 15 relevant articles, which we included in the final analysis. Results showed that disasters have both direct and indirect effects on dialysis patients. Lack of electricity, clean water, and transportation, and closure of dialysis centers can disrupt dialysis care, lead to missed dialysis sessions, and increase the number of hospitalizations and use of the emergency department. Additionally, disasters can exacerbate depression and lead to posttraumatic stress disorder among dialysis patients. CONCLUSION: To our knowledge, this systematic review is the first study that presents a synthesis of the scientific literature on the effects of disasters on dialysis populations. The indirect and direct effects of disasters on dialysis patients highlight the need for predisaster interventions at the patient and health care system levels. Particularly, educating patients about an emergency renal diet and offering early dialysis can help to mitigate the negative effects of disasters