Parkinson's Disease: Barriers and Facilitators to Optimizing Function

The purpose of this qualitative study was to explore with caregivers and people with Parkinson's disease (PD) the facilitators and barriers that they encounter in trying to optimize participation in functional activities and exercise. Face‐to‐face interviews were conducted with a purposeful sample of seven caregivers and three people diagnosed with PD. Data analysis was performed using content analysis and yielded 94 codes, which were reduced to five specific themes: personality components, physiological symptoms, communication difficulties, environmental factors, and tricks of the trade to optimize function. Findings from this study provide useful practical techniques for professionals and caregivers to promote optimal function and participation in physical activity among people with PD.     

Emerging concepts in cardiovascular disease risk assessment: Where do women fit in?

Purpose: To highlight the current limitations in the assessment of cardiovascular disease (CVD) risk for women. This article will offer the reader information on the current process for assessing CVD risk in women, the pitfalls associated with this current strategy, and the role of novel risk factors.
Data sources: Extensive review of the medical literature in the area of women's cardiovascular health.
Conclusions: The assessment of CVD risk for women is currently an evolving science. Limitations in the ability of the Framingham score to accurately estimate risk in women from diverse populations are increasingly recognized. Vastly different treatment goals between the genders for similar levels of risk factors have led to a re-evaluation of this strategy in women. While the Framingham score is still useful for guiding cholesterol treatment goals, the current preventive guidelines for women emphasize assessing a woman's risk throughout her lifetime. The future development of tools for improved risk stratification that incorporate novel risk factors may in fact improve our ability to appropriately risk stratify women to evidence-based therapies.
Implications for practice: Utilizing the Framingham Risk Assessment Tool and further CVD risk stratification using novel markers such as high sensitivity C-reactive protein, family history, and functional capacity may identify unique subsets of women at higher risk for CVD. Nurse practitioners can be instrumental in this assessment, education, and treatment of women at risk for CVD.     

Multi-channel electrical bioimpedance: a non-invasive method to simultaneously measure cardiac output and individual arterial limb flow in patients with cardiovascular disease

Background  Cardiac output is the fundamental determinant of peripheral blood flow however; optimal regional tissue perfusion is ultimately dependant on the integrity of the arterial conduits that transport flow. A complete understanding of tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations. Multi-channel electrical bioimpedance (MEB) measures cardiac output and peripheral flow simultaneously. Objectives  Assessment of the accuracy of MEB to measure cardiac output in patients with clinical heart failure (group 1) and to measure regional arterial limb flow in patients with exertional leg pain clinically thought to have peripheral arterial disease (group 2). Methods  Cardiac output was measured by MEB in 44 patients with moderate to severe clinical heart failure (group 1) and was compared to a cardiac output measured by 2D-Echo Doppler. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in another group of 25 patients with exertional leg pain clinically thought to be claudication (group 2). The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index). Results  There was excellent correlation between the mean cardiac index by MEB (2.01 l/min/m²) and by 2D-Echo Doppler (2.06 l/min/m²) and bias and precision was 0.05 (2.4%) and ±0.48 l/min/m² (±23%), respectively. The correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (P < 0.05). Conclusions   MEB accurately measures cardiac output in patients with moderate to severe clinical heart failure and accurately measures regional arterial limb flow in patients with peripheral arterial disease. Stanley AWH, Herald JW, Athanasuleas CL, Jacob SC, Bartolucci AA, Tsoglin AN. Multi-channel electrical bioimpedance: a non-invasive method to simultaneously measure cardiac output and individual arterial limb flow in patients with cardiovascular disease