Peak oxygen uptake and left ventricular ejection fraction, but not depressive symptoms, are associated with cognitive impairment in patients with chronic heart failure

BACKGROUND: The aim of the present study was to assess cognitive impairment in patients with chronic heart failure (CHF) and its associations with depressive symptoms and somatic indicators of illness severity, which is a matter of controversy. METHODS AND RESULTS: Fifty-five patients with CHF (mean age 55.3 ± 7.8 years; 80% male; New York Heart Association functional class I-III) underwent assessment with an expanded neuropsychological test battery (eg, memory, complex attention, mental flexibility, psychomotor speed) to evaluate objective and subjective cognitive impairment. Depressive symptoms were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) and a self-report inventory (Hospital Anxiety and Depression Scale [HADS]). A comprehensive clinical dataset, including left ventricular ejection fraction, peak oxygen uptake, and a 6-minute walk test, was obtained for all patients. Neuropsychological functioning revealed impairment in 56% of patients in at least one measure of our neuropsychological test battery. However, the Mini Mental State Examination (MMSE) could only detect cognitive impairment in 1.8% of all patients, 24% had HADS scores indicating depressive symptoms, and 11.1% met SCID criteria for a depressive disorder. No significant association was found between depressive symptoms and cognitive impairment. Left ventricular ejection fraction was related to subjective cognitive impairment, and peak oxygen uptake was related to objective cognitive impairment. CONCLUSION: Cognitive functioning was substantially reduced in patients with CHF and should therefore be diagnosed and treated in routine clinical practice. Caution is advised when the MMSE is used to identify cognitive impairment in patients with CHF

Does Medical Students' Preference of Test Format (Computer-based vs. Paper-based) have an Influence on Performance?

<p>Abstract</p> <p>Background</p> <p>Computer-based examinations (CBE) ensure higher efficiency with respect to producibility and assessment compared to paper-based examinations (PBE). However, students often have objections against CBE and are afraid of getting poorer results in a CBE.</p> <p>The aims of this study were (1) to assess the readiness and the objections of students to a CBE vs. PBE (2) to examine the acceptance and satisfaction with the CBE on a voluntary basis, and (3) to compare the results of the examinations, which were conducted in different formats.</p> <p>Methods</p> <p>Fifth year medical students were introduced to an examination-player and were free to choose their format for the test. The reason behind the choice of the format as well as the satisfaction with the choice was evaluated after the test with a questionnaire. Additionally, the expected and achieved examination results were measured.</p> <p>Results</p> <p>Out of 98 students, 36 voluntarily chose a CBE (37%), 62 students chose a PBE (63%). Both groups did not differ concerning sex, computer-experience, their achieved examination results of the test, and their satisfaction with the chosen format. Reasons for the students' objections against CBE include the possibility for outlines or written notices, a better overview, additional noise from the keyboard or missing habits normally present in a paper based exam. The students with the CBE tended to judge their examination to be more clear and understandable. Moreover, they saw their results to be independent of the format.</p> <p>Conclusions</p> <p>Voluntary computer-based examinations lead to equal test scores compared to a paper-based format.</p

Elementos, tipologías constructivas y rehabilitaciones en la colonia Gassol de Bítem

Estudi d'un edifici colonial emblemàtic de les terres de l'Ebre. Identificació dels elements simbólics de l'edifici, tipologies constructives, patologies en l'edifici i repercussió de les intervencions que es van dur a terme en el transcurs dels anys en l'estat actual de l'edifici

Development of a checklist for evaluating psychiatric reports

Abstract Background Performing a psychiatric interview and documenting the recorded findings in the form of a brief psychiatric report is one of the main learning goals in the psychiatric curriculum for medical students. However, observing and assessing students‘ reports is time consuming and there are no objective assessment tools at hand. Thus, we applied an integrative approach for designing a checklist that evaluates clinical performance, as a tool for the assessment of a psychiatric report. Methods A systematic review of the literature yielded no objective instrument for assessing the quality of written reports of psychiatric interviews. We used a 4-step mixed-methods approach to design a checklist as an assessment tool for psychiatric reports: 1. Development of a draft checklist, using literature research and focus group interviews; 2. Pilot testing and subsequent group discussion about modifications resulting from the pilot testing; 3. Creating a scoring system; 4. Testing for interrater-reliability, internal consistency and validity. Results The final checklist consisted of 36 items with a Cronbach’s alpha of 0.833. Selectivity of items ranged between 0.080 and 0.796. After rater-training, an interrater-reliability of 0.96 (ICC) was achieved. Conclusions Our approach, which integrated published evidence and the knowledge of domain experts, resulted in a reliable and valid checklist. It offers an objective instrument to measure the ability to document psychiatric interviews. It facilitates a transparent assessment of students’ learning goals with the goal of structural alignment of learning goals and assessment. We discuss ways it may additionally be used to measure the ability to perform a psychiatric interview and supplement other assessment formats

Effect of Exercise and Respiratory Training on Clinical Progression and Survival in Patients with Severe Chronic Pulmonary Hypertension

Background: Even though specific agents for the treatment of patients with pulmonary hypertension (PH) are available, in PH patients, physical capacity and quality of life (QoL) are often restricted and survival is reduced. Objectives: This study prospectively investigated the long-term effects of respiratory and exercise training in patients with severe chronic PH regarding safety, time to clinical worsening and survival. Methods: Fifty-eight consecutive patients with severe PH on stable disease-targeted medication received exercise and respiratory training in hospital for 3 weeks and continued at home. They were prospectively followed for 24 ± 12 months. Primary endpoints were time to clinical worsening and survival. Adverse events and changes in the 6-min walking test, QoL, WHO functional class and gas exchange were secondary endpoints and were evaluated at baseline and at weeks 3 and 15. Results: All patients tolerated the exercise training well without severe adverse events. In week 15, 6-min walking test results were significantly improved compared to baseline (by 84 ± 49 m, p < 0.001), as well as QoL scores, WHO functional class (from 2.9 ± 0.5 to 2.6 ± 0.6, p < 0.01), peak oxygen consumption (from 12.5 ± 3.0 to 14.6 ± 3.9 ml/min/kg, p < 0.001), heart rate at rest (from 75 ± 12 to 61 ± 18 beats/min, p < 0.001) and maximal workload (from 65 ± 21 to 80 ± 25 W, p < 0.001). Survival at 1 and 2 years was 100 and 95%, respectively. Fifteen events occurred during the follow-up. Conclusion: This study indicates that exercise and respiratory training as add-on to medical treatment may improve exercise capacity and QoL, and that they have a good long-term safety in the described setting.Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

Gender differences in psychosocial outcomes of psychotherapy trial in patients with depression and coronary artery disease

Introduction: The biological and psychosocial risk profile differs between women and men with coronary artery disease (CAD). Depressive symptoms and Vital Exhaustion (VE) predict an unfavourable course of CAD. The secondary analysis of the SPIRR-CAD trial offered the possibility to examine gender as exposure variable of the clinical and psychological situation at baseline and in a variety of psychosocial measures as outcomes. Methods: In this trial, 450 men (78.9%) and 120 women (21.1%) with CAD (age = 8 on the HADS), were randomized to usual care with or without a stepwise psychotherapy intervention. Beside clinical measures exhaustion and other indicators of depressive symptoms were collected at baseline and 18-month follow up. Results: Men had more signs and symptoms of heart disease at baseline, whereas women had higher psychosocial burden (e.g. negative affect). Women were more likely to live alone, had lower educational levels and employment rates and higher levels of depression and exhaustion. The psychotherapy intervention differed as a function of gender: In women, VE decreased from 29.4 +/- 8.1 to 22.1 +/- 11.7 in the intervention group (IG) and from 29.2 +/- 8.2 to 25.1 +/- 11.3 in the control group (CG). In men VE decreased from 23.3+ -10.8 to 21.2 +/- 9.7 in the IG and from 23.6 +/- 10.7 to 19.3 +/- 11.3 in the CG (time x intervention x gender; F = 4.97; p = .026). Discussion: Women had a higher psychosocial burden than men. VE compared to other rating instruments of depressive symptoms suggested a stronger response to the intervention in women. VE may help to understand gender differences in psychotherapeutic treatment studies of CAD. ISRCTN:76240576; clinicaltrials.go