Family Consultation To Reduce Early Hospital Readmissions Among Patients With End-Stage Renal Disease: A Randomized Clinical Trial

Background: The U.S. Centers for Medicare and Medicaid Services have mandated reducing early hospital readmissions (i.e., within 30 days of discharge) to both improve patient care and reduce expenses. Patients with end-stage renal disease (ESRD) have relatively high early readmission rates, due in part to their complex medical regimens but also cognitive impairment, health literacy problems, and lack of social support. We developed a brief family consultation intervention to address these problems and tested its ability to reduce early readmissions among patients with ESRD. Method: 120 hospitalized adults with ESRD (M age = 57.5 years; 50% male; 86% Black, 12% White) were recruited from an urban, inpatient nephrology unit. Patients were randomized to family consultation (FC; n = 60) or treatment-as-usual (TAU) control (n = 60) conditions. Family consultations, conducted either bedside or via telephone, were conducted with 57 of the 60 assigned patients and covered psychoeducation about cognitive and behavioral risk factors for readmission and how to compensate for them. Blinded medical record review was conducted later to determine readmissions within 30 days. Results: Chi-square tests and logistic regressions tested intervention effects. Per protocol analyses (excluding three FC patients who received no consultation) indicated that FC reduced early readmission (18%) after discharge, compared to TAU (32%; χ = 3.13, p = .039), and reduced any early hospital return visit (emergency department, brief observation, or readmission) compared to TAU (28% vs. 47%; χ = 4.31, p = .019). Intent-to-treat analyses revealed that FC marginally reduced readmission (20%) compared to TAU (32%; χ = 2.13, p = .077), but FC still significantly reduced any hospital visit (32%) compared to TAU (47%; χ = 2.83, p = .046). Discussion: A brief psychosocial intervention with family members can decrease readmissions in patients with ESRD, thereby improving health outcomes and reducing costs

Anger Expression: Evaluating The Construct Validity Of Several Emotion Regulation Measures

Researchers have used the Anger Expression Inventory (AEI), Ambivalence of Emotional Expression Questionnaire (AEQ), and Toronto Alexithymia Scale 20 (TAS) self-report measures to draw conclusions about relationships between emotion regulation and many other variables, but there is an insufficient amount of validation evidence about these measures. After first filling out the self-report measures, 75 participants with chronic low back pain completed a videotaped anger induction paradigm, in order to provoke the naturalistic experience of anger. Participants were next given the opportunity to express their anger to the experimenter, in either a guided or unguided condition. We then coded the videos to rate the amount of anger and anxiety expressed by the participants both verbally and non-verbally. Correlations among the predictor variables and behavioral variables showed that Anger-Out and TAS were positively correlated with anger, and Anger-In and AEQ were independent of anger. The findings support the validity of Anger-Out, suggest that Anger-In and TAS measure slightly different constructs that than theorized, and calls into question the validity of the AEQ

Exploration of the Ice Giant Systems: A White Paper for NASA's Planetary Science and Astrobiology Decadal Survey 2023-2032

Ice giants are the only unexplored class of planet in our Solar System. Much that we currently know about these systems challenges our understanding of how planets, rings, satellites, and magnetospheres form and evolve. We assert that an ice giant Flagship mission with an atmospheric probe should be a priority for the decade 2023-2032

Solar System Ice Giants: Exoplanets in our Backyard.

International audienc

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes