Home Blood Pressure Monitoring: An Integrated Review of the Literature

Home blood pressure monitoring (HBPM) is a self-management tool that advanced practice nurses can incorporate into care for patients with hypertension. Evidence supports the benefits of patient HBPM compared to office-based monitoring by providers alone. HBPM is a method for patients to partner with providers with their self-care management. The goals of incorporating HBPM into practice include improving quality and outcomes and controlling costs. HBPM interventions include team-based care, patient education and self-management skills, and evidence-based guidelines, concepts that are consistent with Wagner’s Chronic Care Model. HBPM should be considered as policy guideline for hypertensive patients.     

Differential effects of right hemisphere injection during the wada procedure on the primary and secondary languages in a bilingual speaker

Abstract

A Wada procedure was performed on a bilingual seizure surgery candidate. Immediately after the injection of barbiturate into the right internal carotid artery the patient spontaneously switched from counting in English (the language he indicated that he used most often) to Spanish (the language he learned first). He named in Spanish spontaneously as well. After injection of the left ICA the patient exhibited a global aphasia, with no evidence for differential recovery of language as the aphasia cleared. These observations are discussed in relation to the hypothesis that a language learned later in life may be more likely to be bilaterally represented than the first language learned.     

A Review of Experimental Work on Radio-yttrium Comprising 1. The Tissue Distribution, 2. The Mechanism of Deposition in Bone,and 3. The State in the Blood

The author reviews the literature covering the deposition of injected radio-yttrium in soft tissues and bone. It is clear that when injected in a carrier-free form yttrium is a bone-seeking isotope. In the presence of carrier, aggregates of larger particle size are formed, and these show greater affinity for the soft tissues which have the highest proportion of reticulo-endothelial cells. The effect of chelating agents is to render the yttrium more soluble, thus increasing excretion; they reduce the extent of colloid formation and reduce the size of the colloidal particles formed. Contradictory reports as to the site of deposition of yttrium can be explained by the fact that the authors have not appreciated the radiocolloidal properties of yttrium and that insufficient attention has been paid to the form in which it is present in the blood-stream.     

Guidebook for Nutrition Counselors

Background: Because accurate measures of recumbent length are essential to assess growth and energy requirements of mobility-impaired individuals with cerebral palsy (CP), a reliable and simple method of estimating recumbent length is required. Prediction of recumbent length from knee height in this population has not yet been investigated.

Objectives: i) To correlate direct measures of recumbent length in mobility-impaired individuals having lower leg extremity cerebral palsy (LECP) involvement with indirect measures of recumbent length calculated using knee-height prediction equations and ii) to determine if knee height is a reliable predictor of recumbent length in this population.

Methods: Subjects (n=34; 15F, 19M), aged 6 to 30 years, were participants in a six-month nutrition rehabilitation program. All subjects had varying degrees of LECP involvement. Recumbent length to the nearest 0.5 cm was measured by standardised techniques. Knee height was measured to the nearest 0.5 centimetre using sliding callipers. Equations based on normal, healthy individuals with application to mobility-impaired or handicapped individuals were used to predict recumbent length from knee height.

Results: Direct measures of recumbent length of subjects significantly correlated with indirect measures calculated using knee height prediction equations (R=0.88, p≤0.0001). In addition, knee height of these subjects was a reliable predictor of recumbent length (R²=0.78, p<0.0001).

Conclusions: Results suggest that knee height may be a reliable predictor for recumbent length in this population.     

Beliefs about fetal alcohol spectrum disorder among men and women at alcohol serving establishments in South Africa

Background: South Africa has one of the highest rates of fetal alcohol spectrum disorder (FASD) in the world. However, little is known about what men and women who attend alcohol serving establishments believe about alcohol use during pregnancy and how these beliefs may be related to alcohol use. Objectives: To understand FASD beliefs and related behaviors among men and women attending alcohol-serving establishments. Methods: We surveyed 1047 men (n?=?565) and women (n?=?482) -including pregnant women and men with pregnant partners- attending alcohol serving establishments in a township located in Cape Town, South Africa. Results: Among both pregnant (n?=?53) and non-pregnant (n?=?429) women, 54% reported drinking alcohol at least 2–4 times per month, and 57% reported having at least 3–4 alcohol drinks during a typical drinking session. Pregnant women were less likely to believe that they should not drink alcohol and that alcohol can harm a fetus when compared to non-pregnant women. Similar findings were observed between men with pregnant partners compared to men without pregnant partners. Among women, beliefs about how much alcohol pregnant women can safely drink were associated with self-reported alcohol use. Conclusions: Efforts to address FASD need to focus on understanding how men and women perceive alcohol use during pregnancy and situational factors that contribute to alcohol consumption among pregnant women attending alcohol serving establishments. Structural and individual-level interventions targeting women at alcohol serving establishments should be prioritized to mitigate alcohol use during pregnancy.     

Psychosocial predictors of long-term mortality among women with suspected myocardial ischemia: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation

This paper evaluated long-term associations between psychosocial factors and premature mortality among women with suspected coronary artery disease (CAD). We tracked total mortality events over a median 9.3 years in a cohort of 517 women [baseline mean age = 58.3 (11.4) years]. Baseline evaluations included coronary angiography, psychosocial testing, and CAD risk factors. Measures included the Spielberger Trait Anxiety Scale, Beck Depression Inventory, self-rated health, and Social Network Index. Cox regression analysis was used to assess relationships. Covariates included age, CAD risk factors, and CAD severity. BDI scores (HR 1.09, 95 % CI 1.02–1.15), STAI scores (HR .86, 95 % CI .78–.93), and very good self-rated health (relative to the poor self-rated health group; HR .33, 95 % CI .12–.96) each independently predicted time to mortality outcomes in the combined model. SNI scores (HR .91, 95 % CI .81–1.06) and other self-rated health categories (i.e., fair, good, and excellent categories) were not significant mortality predictors after adjusting for other psychosocial factors. These results reinforce and extend prior psychosocial research in CAD populations.     

Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers

Objective

Explore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value.

Data Sources

In Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits.

Study Design

A cross-sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges.

Data Collection

We conducted 30 semi-structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach.

Principal Findings

Participants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns. Perceived benefits included improved patient health; increased patient and caregiver understanding and confidence around symptom management; and greater feelings of empowerment, hopefulness, and support. Challenges included difficulty accessing some recommended programs and services, uncertainty related to instructions or follow-up, and not receiving as much information or treatment as desired. The content of visits was well aligned with the domains of the Age-Friendly Health Systems and Geriatric 5Ms frameworks (Medication, Mentation, Mobility, what Matters most, and Multi-complexity).

Conclusions

Alignment of patient and caregiver experiences with widely-used models of comprehensive geriatric care indicates that high-quality geriatric care can be provided through virtual modalities. Additional work is needed to develop strategies to address challenges and optimize and expand access to geriatric specialty telemedicine.