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

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

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

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'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

Safety Evaluation of Yukmijihwang-tang: Assessment of Acute and Subchronic Toxicity in Rats

Yukmijihwang-tang (YMJ; Liu wei di huang tang (China), Rokumigan (Japan)) has been used in the treatment of diseases including renal disorder, cognitive vitality, and diabetes mellitus. However, there is very little information regarding the toxicity of YMJ to give an assurance of safety for clinical treatment. To provide safety information for YMJ, we evaluated its acute and sub-chronic toxicity in rats. The single-dose toxicity of YMJ was examined using Sprague-Dawley rats. Rats were treated with YMJ extract orally at 0, 500, 1000, or 2000 mg/kg body weight. After a single administration, clinical signs were observed every day for two weeks, and body weights were measured five times, including an initial measurement on day 1 (the day of administration). In the sub-chronic oral toxicity study, YMJ was administered to rats at 0, 500, 1000, or 2000 mg/kg/day for 13 weeks. Mortalities, clinical signs, body weight changes, food and water consumption, ophthalmologic findings, urinalysis, hematological and biochemical parameters, gross findings, organ weights, and histological examination were monitored during the study period. We found no mortality and no abnormalities in clinical signs, body weights, and necropsy findings for any of the animals in the acute and sub-chronic studies following oral administration in the rat at up to 2000 mg/kg/day YMJ. YMJ may not have any single-dose toxicity; the LD50 of YMJ was over 2000 mg/kg, and it is safe for rats. The no-observed-adverse-effect-level (NOAEL) was considered to be 2000 mg/kg/day

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

Air-stable n-type operation of Gd-contacted carbon nanotube field effect transistors

We report air-stable n -type operations of the single-walled carbon nanotube field effect transistors (SWNT-FETs) fabricated with Gd electrodes. Unlike previously reported n -type SWNT-FETs, our devices maintained their n -type operation characteristics in ambient atmosphere for more than two months. The shallow Gd films with a thickness below 20 nm are corroded by environmental oxygen, whereas the well-contacted Gd-SWNT interfaces underneath the thick Gd layers are protected from contaminations by air molecules. Theoretical studies based on the first-principles electronic structure calculations confirm that Gd layers have an excellent binding affinity to the SWNTs.open8