SYMPTOM ASSESSMENT AND MANAGEMENT IN PATIENTS WITH HEART FAILURE

Patients with heart failure (HF) must monitor and recognize escalating symptoms to manage worsening HF in a timely manner. However, routine symptom monitoring is not commonly performed by this population. Providing a symptom diary along with an education and counseling session may help HF patients promote symptom monitoring and interpretation. The accumulated information about changes in daily symptoms will allow patients to easily compare current symptom status to the past without depending on memory and can rapidly capture worsening HF. To date, few studies have tested the effect of a daily symptom diary. The purpose of this dissertation was to develop and test a symptom diary intervention to improve outcomes in HF patients. Prior to testing the intervention, preliminary work included: (1) determining the impact of symptom clusters on cardiac event-free survival; (2) evaluating the quality of existing symptom measures designed for HF patients; (3) evaluating the effect of physical symptom items that were often included in a depressive symptom instrument on cardiac event-free survival; and (4) evaluating the association between symptom monitoring and self-care management. Based on this information, a randomized, controlled pilot study was conducted to test the effect of a symptom diary with an education and counseling intervention on prognosis, healthrelated quality of life (HRQOL), and self-care maintenance at 3 months follow-up. A total of 44 hospitalized patients with HF were randomly assigned to either usual care or intervention providing a daily symptom diary with education and counseling. There were trends toward fewer HF events and improved self-care maintenance in the intervention group compared to the usual care group. However, there was no difference in HRQOL between the two groups. The results of this dissertation suggest the importance of assessing symptom clusters and further studies to improve the quality of existing HF symptom measures. Results from this dissertation also provided the evidence of the advantages of regular symptom monitoring to facilitate early identification of worsening HF and initiation of timely responses. However, further studies are needed to provide additional evidence of the positive impact of a use of daily symptom diary in patients with HF

Withdrawal of antihypertensive medication in young to middle-aged adults: a prospective, single-group, intervention study

Background Although antihypertensive drug therapy is commonly believed to be a life-long therapy, several recent guidelines have suggested that antihypertensive medications can be gradually reduced or discontinued for some patients whose blood pressure (BP) is well-controlled for an extended period. Thus, this pilot study aimed to describe the success rate of antihypertensive drug discontinuation over 6months among young and middle-aged patients with hypertension. Methods This was a prospective, single-group, intervention study. Patients were eligible for inclusion if their cardiologist judged them to be appropriate candidates for this study, their BP had been controlled both in the office (< 140/90mmHg) and 24-h ambulatory BP monitoring (< 135/85mmHg) for at least 6months with a single tablet dose of antihypertensive medication. A total of 16 patients withdrew their antihypertensive medications at baseline after they received the education, and were followed up over 6months. After the follow-ups, six patients participated in the in-depth interview. Results The likelihood of remaining normotensive at 30, 90, 180, and 195days was 1.00, 0.85, 0.51, and 0.28, respectively. There were also no significant differences in baseline characteristics and self-care activities over time between normotensive (n = 8) and hypertensive groups (n = 8). In the interview, most patients expressed ambivalent feelings toward stopping medications. Psychological distress (e.g., anxiety) was the primary reason for withdrawal from this study although the patients BP was under control. Conclusions We found that only a limited portion of antihypertensive patients could stop their medication successively over 6months. Although we could not identify factors associated with success in maintaining BP over 6months, we believe that careful selection of eligible patients may increase success in stopping antihypertensive medications. Also, continuous emotional support might be essential in maintaining patients off-medication.This work was supported by the Korean Society of Hypertension (2018)

Biological and structural characterizations of mutations in X-linked spondyloepiphyseal dysplasia tarda

Spondyloepiphyseal dysplasia tarda (SEDT), an X-linked genetic disease manifesting itself in a disproportionate skeletal structure, is caused by mutations in the SEDL gene. Four missense mutations (S73L, V130D, F83S, and D47Y) have been identified by molecular diagnosis as disease-causing SEDT. Nevertheless, how SEDL mutations disrupt the skeletal structure and cause disease remains unknown. We report here the cloning, expression, and characterization of three different missense mutations (S73L, V130D, and D47Y) in mouse SEDL. The overexpression of the D47Y mutation was mainly observed in the supernatant but those of the S73L and V130D mutations are shown in the insoluble pellets. The substitution of the S73L mutation induces the exposure to hydrophobic amino acids and causes aggregation. That of V130D might break hydrophobic interaction and decrease the secondary structure. The CD spectra of three mutants (S73L, V130D, and D47Y) showed that the a-helices decreased more than that of wild-type SEDL. The F83S (stop) mutant might suggest a large conformational change as the mutant V130D. In order to visualize conformational changes in mutated structures, we used molecular modeling techniques minimizing the total energy. These results could provide the biological characterization and conformational information of the SEDL mutants and suggest the clinical severity of the disorder among human SEDL patients

Prospective Evaluation of Association between Negative Emotions and Heart Failure Symptom Severity

Background: Prior studies of symptoms in heart failure (HF) were largely cross-sectional and symptoms were measured using retrospective recall. Because negative emotions influence information processing, retrospective symptom reports by patients with depressive symptoms and anxiety may be biased. The purpose of this study was to determine whether there are differences in patterns of symptom changes, measured prospectively, over 15 days by levels of depressive symptoms and anxiety. Methods: HF patients (N=52) rated daily symptom severity for shortness of breath (SOB), fatigue, sleep disturbance, and edema over 15 days on a 10-point visual analogue scale. Patients were grouped into higher vs lower levels of depressive symptoms and anxiety, respectively, based on median scores of Brief Symptom Inventory subscales. Latent growth curve modeling was used to examine whether patterns of symptom changes over 15 days differed in higher vs lower levels of depressive symptom and anxiety groups. Results: Those in the higher depressive symptom group had lower levels of baseline symptom severity in SOB (β: -1.46), fatigue (β: -1.71), sleep disturbance (β: -1.78), and edema (β: -1.97) than those in the lower depressive symptom group. However, there were no significant differences in rates of changes in the severity of any of the four symptoms between groups. Anxiety was not associated with baseline severity of symptoms or rates of changes in any of the four symptoms. Conclusion: Depressive symptoms, but not anxiety, were associated with daily symptom experience. HF patients with higher levels of depressive symptoms may perceive their symptom severity differently than patients with lower levels of depressive symptoms

Gender and Measuring-position Differences in the Radial Pulse of Healthy Individuals

AbstractIn this research, radial pulse differences according to gender and measuring positions in healthy individuals were investigated in an objective manner. A total of 372 healthy volunteers (189 males and 183 females) participated in this study. The radial pulse was measured at six different measuring positions using a multistep tonometry system. The pulse data were compared between males and females and between different measuring positions. Compared to the pulses in females, those in males were deeper and slower, with a longer diastolic proportion and a shorter systolic proportion. Amplitude of the radial pulse increased as it went distal. The pulse was deepest at the Cheock position and shallowest at the Gwan position. Compared to the right pulse, the radial augmentation index was higher and the main peak angle was larger in case of the left pulse. The results of this research show that the radial pulses in healthy individuals differ significantly according to gender and measuring positions

The association between comorbidities and self-care of heart failure: a cross-sectional study

Background Because heart failure (HF) is a debilitating chronic cardiac condition and increases with age, most patients with HF experience a broad range of coexisting chronic morbidities. Comorbidities present challenges for patients with HF to successfully perform self-care, but it is unknown what types and number of comorbidities influence HF patients self-care. The purpose of this study was to explore whether the number of cardiovascular and non-cardiovascular conditions are associated with HF self-care. Methods Secondary data analysis was performed with 590 patients with HF. The number of cardiovascular and non-cardiovascular conditions was calculated using the list of conditions in the Charlson Comorbidity Index. Self-care was measured with the European HF self-care behavior scale. Multivariable linear regression was performed to explore the relationship between the types and number of comorbidities and self-care. Results Univariate analysis revealed that a greater number of non-cardiovascular comorbidities was associated with poorer HF self-care(β=-0.103), but not of more cardiovascular comorbidities. In the multivariate analysis, this relationship disappeared after adjusting for covariates. Perceived control and depressive symptoms were associated with HF self-care. Conclusion The significant relationship between the number of non-cardiovascular comorbidities and HF self-care was not independent of perceived control and depressive symptoms. This result suggests a possible mediating effect of perceived control and depressive symptoms on the relationship between HF self-care and the number and type of comorbidities.RO1HL083176 Improving Self-Care Behavior and Outcomes in Rural Patients with Heart Failure; National Research Foundation of Korea grants funded by the Korea government (2016R1A2B4008495, 2021R1C1C100849812)

HCO + dissociation in a strong laser field: An ab initio classical trajectory study

a b s t r a c t We have investigated the photodissociation of HCO + in a strong field with a wavelength of 10 lm using ab initio molecular dynamics. Classical trajectories were calculated at three field intensities. At 2.9 Â 10 14 W/cm 2 and phase / = 0, protons have two distinct dissociation times, mainly due to the reorientation of HCO + relative to the field direction prior to dissociation. The kinetic energy distribution at this intensity agrees with Wardlaw&apos;s wagging tail model, suggesting that dissociation occurs through barriersuppression. At 1.7 Â 10 14 and 8.8 Â 10 13 W/cm 2 , barrier suppression is incomplete and the maximum kinetic energy is less than predicted by the wagging tail model

Living Arrangements Modify the Relationship Between Depressive Symptoms and Self-care in Patients With Heart Failure

BACKGROUND: Depressive symptoms hinder heart failure patients' engagement in self-care. As social support helps improve self-care and decrease depressive symptoms, it is possible that social support buffers the negative impact of depressive symptoms on self-care. OBJECTIVE: The purpose of this study is to examine the effect of living arrangements as an indicator of social support on the relationship between depressive symptoms and self-care in heart failure patients. METHODS: Stable heart failure patients (N = 206) completed the Patient Health Questionnaire-9 to measure depressive symptoms. Self-care (maintenance, management, and confidence) was measured with the Self-Care of Heart Failure Index. Path analyses were used to examine associations among depressive symptoms and the self-care constructs by living arrangements. RESULTS: Depressive symptoms had a direct effect on self-care maintenance and management (standardized β = -0.362 and -0.351, respectively), but not on self-care confidence in patients living alone. Depressive symptoms had no direct or indirect effect on any of the 3 self-care constructs in patients living with someone. CONCLUSIONS: Depressive symptoms had negative effects on self-care in patients living alone, but were not related to self-care in patients living with someone. Our results suggest that negative effects of depressive symptoms on self-care are buffered by social support

DIRECT CAROTID WALL SHEAR STRESS IN ACUTE CORONARY SYNDROME PATIENTS DECREASED AFTER ONE MONTH MEDICAL MANAGEMENT

Fuente Fuente, Carlos;Montes Gil, Antonio;Periel Piquer, Montserra