Self-management in heart failure: where have we been and where should we go?

Chronic conditions such as heart failure (HF) place a tremendous strain on patients, their families, the community, and the health care system because there are no real “cures”. Adding to the burden are longer life expectancies and increased numbers of people living with multiple chronic conditions. Today, whether engaging in a health-promoting activity, such as exercise, or living with a chronic disease such as HF, the individual is responsible for actively managing day-to-day activities, a concept referred to as self-management. Self-management emerged as the cornerstone for chronic care models and multidisciplinary disease-management strategies in chronic illness care. Moreover, self-management has been prioritized as a central pathway for improving the quality and effectiveness of most chronic HF care. Adherence to self-management is vital to optimize the treatment outcomes in HF patients, but implementing chronic disease self-management (CDSM) strategies and identifying the difficulties in self-management has proved to be a challenge. Understanding both where we have been and the future direction of self-management in HF care is not only timely, but a crucial aspect of improving long-term outcomes for people with HF and other chronic diseases

How do SYMPtoms and management tasks in chronic heart failure imPACT a person's life (SYMPACT)? Protocol for a mixed-methods study.

AIMS: Patients with chronic heart failure (CHF) struggle to follow self-care plans, which may lead to worsening illness and poor quality of life. Burden of treatment (BoT) describes this workload and its impact on patients' lives. Suggesting the balance between a patient's treatment workload and their capability to manage it is crucial. If BoT is reduced, self-care engagement and quality of life may improve. This article describes the SYMPACT study design and methods used to explore how symptoms and management tasks impact CHF patients' lives. METHODS AND RESULTS: We used a sequential exploratory mixed-methods design to investigate the interaction between symptoms and BoT in CHF patients. CONCLUSIONS: If symptoms and BoT are intrinsically linked, then the high level of symptoms experienced by CHF patients may lead to increased treatment burden, which likely decreases patients' engagement with self-care plans. SYMPACT may identify modifiable factors to improve CHF patients' experience

Functional Changes in Single Muscle Fibers Following Disuse Atrophy

The purpose of this investigation was to determine how muscle atrophy produced by the hindlimb suspension (HS) model alters the contractile function of slow and fast single fibers. Following 2 wks of HS, small bundles of fibers were isolated from the soleus, and the deep and superficial regions of the lateral and medial heads of the gastrocnemius, respectively. The bundles were placed in skinning solution and stored at -20°C until studied. Single fibers we\u27re isolated and suspended between a motor arm and force transducer, the functional properties were studied, and subsequently the fiber type was established by myosin heavy chain (MHC) analysis on 1-D SDS PAGE. Following HS, slow fibers of the soleus showed a significant reduction in fiber diameter (68±2 vs 41±1 um) and peak tension (1.37±0.01 vs 0. 99±0.06 Kg/cm2), while the Vmax increased ( 1.49±0.11 vs 1.92±0.14 fiber lengths/sec). A histogram showed two populations of fibers, one with Vmax values identical to control slow fibers, and a second with significantly elevated Vmax values. This latter group frequently contained both slow and fast MHC\u27s. The pCa-force relation of the soleus slow fibers was shifted to the right, consequently, the free ca2+ required for the onset of tension and for 50% of peak tension was significantly higher following HS.. Slow fibers isolated from the gastrocnemius following HS showed a significant reduction in diameter (67±4 vs 44±3 um) and peak tension (1.2±0.06 vs 0.96±0.07 Kg/cm2), but Vmax was unaltered (1 .70±0.13 vs 1.65±0.18 Kg/cm2). Fast fibers from the red gastrocnemius showed a significant reduction in diameter (59±2 vs 49±3 um), but no change in peak tension or Vmax. Fast fibers from the white superficial region of the medial head of the gastrocnemius were uneffected by HS. Collectively, these data suggest that HS produces a sequence of change beginning with fiber atrophy (slow and fast fibers) which is followed by a decline in peak tension (slow fibers) and finally an elevated Vmax

Composite skin grafts for basal cell carcinoma defects of the nose

Basal cell carcinoma is the most frequent cutaneous cancer of the nose and is characterized by its local spreading and exceptionally rare tendency to metastasize. Since a significant advantage has been seen in surgery compared to other treatments, surgical excision ensuring the highest chance of cure is frequently employed. Excision defects of the nose may be covered with either local flap or a full-thickness skin graft. In resurfacing such defects following excision of basal cell carcinomas, we favor the technique of composite-skin grafting which involves the harvesting of composite-skin graft including the epidermis, dermis and superficial layers of subcutaneous tissue to obtain the required thickness in the recipient site. This technique was used for defects remaining after the excision of basal cell carcinomas in a series of 15 patients. The areas involved were lateral nasal region (5 cases), nasal tip (4 cases), dorsum (3 cases), alar lobule (2 cases), and soft triangle (1 case). The mean follow-up was 14.2 months. The color, texture and thickness of the composite-skin graft harvested from the preauricular site and the neck compare favorably with the skin of the nose region. Satisfactory results, both clinically and in patient appreciation, have been obtained in both the reconstruction site and the appearance of the donor site in all patients

The Liability of a Dentist

This thesis on The Liability of a Dentist should serve as a reminder to any student who may be interested in it, that negligence and carelessness while at school, will lead to liabilities and loss of patients while engaged in the practice of dentistry after leaving school. A knowledge of dental jurisprudence should lessen the chances of damage suits considerably in future years. A law suit against a dentist may ruin his reputation to such an extent as to necessitate his departure from the location in which the accident occured