7 research outputs found
Development and initial testing of the selfâcare of chronic illness inventory
Aim
The aim was to develop and psychometrically test the selfâcare of chronic illness Inventory, a generic measure of selfâcare.
Background
Existing measures of selfâcare are diseaseâspecific or behaviourâspecific; no generic measure of selfâcare exists.
Design
Crossâsectional survey.
Methods
We developed a 20âitem selfâreport instrument based on the Middle Range Theory of SelfâCare of Chronic Illness, with three separate scales measuring SelfâCare Maintenance, SelfâCare Monitoring, and SelfâCare Management. Each of the three scales is scored separately and standardized 0â100 with higher scores indicating better selfâcare. After demonstrating content validity, psychometric testing was conducted in a convenience sample of 407 adults (enrolled from inpatient and outpatient settings at five sites in the United States and ResearchMatch.org). Dimensionality testing with confirmatory factor analysis preceded reliability testing.
Results
The SelfâCare Maintenance scale (eight items, two dimensions: illnessârelated and healthâpromoting behaviour) fit well when tested with a twoâfactor confirmatory model. The SelfâCare Monitoring scale (five items, single factor) fitted well. The SelfâCare Management scale (seven items, two factors: autonomous and consulting behaviour), when tested with a twoâfactor confirmatory model, fitted adequately. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model.
Conclusion
The selfâcare of chronic illness inventory is adequate in reliability and validity. We suggest further testing in diverse populations of patients with chronic illnesses
COVID-19-Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease.
BACKGROUND
Altered coagulation is a striking feature of COVID-19. Adult patients with congenital heart disease (ACHD) are prone to thromboembolic (TE) and bleeding complications.
OBJECTIVES
The purpose of this study was to investigate the prevalence and risk factors for COVID-19 TE/bleeding complications in ACHD patients.
METHODS
COVID-19-positive ACHD patients were included between May 2020 and November 2021. TE events included ischemic cerebrovascular accident, systemic and pulmonary embolism, deep venous thrombosis, myocardial infarction, and intracardiac thrombosis. Major bleeding included cases with hemoglobin drop >2Â g/dl, involvement of critical sites, or fatal bleeding. Severe infection was defined as need for intensive care unit, endotracheal intubation, renal replacement therapy, extracorporeal membrane oxygenation, or death. Patients with TE/bleeding were compared to those without events. Factors associated with TE/bleeding were determined using logistic regression.
RESULTS
Of 1,988 patients (age 32 [IQR: 25-42] years, 47% male, 59 ACHD centers), 30 (1.5%) had significant TE/bleeding: 12Â TE events, 12 major bleeds, and 6 with both TE and bleeding. Patients with TE/bleeding had higher in-hospital mortality compared to the remainder cohort (33% vs 1.7%; PÂ <Â 0.0001) and were in more advanced physiological stage (PÂ =Â 0.032) and NYHA functional class (PÂ =Â 0.01), had lower baseline oxygen saturation (PÂ =Â 0.0001), and more frequently had a history of atrial arrhythmia (PÂ <Â 0.0001), previous hospitalization for heart failure (PÂ <Â 0.0007), and were more likely hospitalized for COVID-19 (PÂ <Â 0.0001). By multivariable logistic regression, prior anticoagulation (OR: 4.92; 95%Â CI: 2-11.76; PÂ =Â 0.0003), cardiac injury (OR: 5.34; 95%Â CI: 1.98-14.76; PÂ =Â 0.0009), and severe COVID-19 (OR: 17.39; 95%Â CI: 6.67-45.32; PÂ <Â 0.0001) were independently associated with increased risk of TE/bleeding complications.
CONCLUSIONS
ACHD patients with TE/bleeding during COVID-19 infection have a higher in-hospital mortality from the illness. Risk of coagulation disorders is related to severe COVID-19, cardiac injury during infection, and use of anticoagulants
COVID-19 in Adults With Congenital Heart Disease.
BACKGROUND
Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications.
OBJECTIVES
This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes.
METHODS
Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined.
RESULTS
From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not.
CONCLUSIONS
COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity