Differences in brain volumes among males and female hormone-therapy users and nonusers

Numerous studies have shown gender differences in the brain volumes of elderly adults. Some evidence shows that higher estrogen levels may be neuroprotective, suggesting that hormone therapy (HT) may in part be responsible for these gender differences; however, few studies have examined the relation between HT and brain volumes. Brain volumes of caudate, putamen, hippocampus, gray matter, white matter, white-matter lesions, and cerebrospinal fluid were measured on magnetic resonance imaging scans. A comprehensive neuropsychological battery was administered. Women were separated into two groups based on HT use, and we used multiple regression analyses to compare these groups with one another and with men. Results of brain-volume measurements showed that HT users had significantly less gray matter and more cerebrospinal fluid than nonusers. Results of the neuropsychological testing showed that HT users performed better on the Shipley Vocabulary Test than males did.     

“Kiss myAsthma”: Using a participatory design approach to develop a self-management app with young people with asthma

Objective: Young people with asthma often lack engagement in self-management. Smartphone apps offer an attractive, immediate method for obtaining asthma information and self-management support. In this research we developed an evidence-based asthma app tailored to young peoples needs, created using a participatory design approach to optimize user engagement. This paper describes the participatory design process. Methods: This multi-phased research included concept generation and ideation of app design by young people with asthma, and development of asthma information by the research team. Clinical review was sought regarding safety and accuracy of app content. Participants suggestions for improvement and any problems with the app were logged throughout. Our young co-designers were invited back to test a high fidelity prototype app using a “think aloud” process and completed a usability questionnaire. Results: Twenty asthma patients aged 15-24 years contributed to the initial app design. Three respiratory specialists and two pharmacists suggested minor corrections to clinical terminology in the app which were all incorporated. Nine co-designers acted as expert reviewers of the prototype app, of whom eight completed a usability questionnaire. Median usability scores (maximum score 6) indicated high satisfaction with app content, usefulness and ease of use [median item score 5.3 (range 4.7-6.0)]. All feedback was incorporated to create an updated prototype app. Conclusions: A clinically sound asthma app has been developed which is considered highly acceptable to the young co-designers. A six-week test of the engagement, acceptability, and usefulness of the app in young people not involved in the participatory design will follow.     

Features of High Quality Discharge Planning for Patients Following Acute Myocardial Infarction

BACKGROUND

Hospital discharge planning is required as a Medicare Condition of Participation (CoP), and is essential to the health and safety for all patients. However, there have been no studies examining specific hospital discharge processes, such as patient education and communication with primary care providers, in relation to hospital 30-day risk standardized mortality rates (RSMRs) for patients with acute myocardial infarction (AMI).

OBJECTIVE

To identify hospital discharge processes that may be associated with better performance in hospital AMI care as measured by RSMR.

DESIGN

We conducted a qualitative study of U.S. Hospitals, which were selected based on their RSMR reported by the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website for the most recent data available (January 1, 2005 – December 31, 2007). We selected hospitals that ranked in the top 5 % and the bottom 5 % of RSMR for the two consecutive years. We focused on hospitals at the extreme ends of the range in RSMR, known as deviant case sampling. We excluded hospitals that did not have the ability to perform percutaneous coronary intervention in order to decrease the heterogeneity in our sample.

PARTICIPANTS

Participants included key hospital clinical and administrative staff most involved in discharge planning for patients admitted with AMI.

METHODS

We conducted 14 site visits and 57 in-depth interviews using a standard discussion guide. We employed a grounded theory approach and used the constant comparative method to generate recurrent and unifying themes.

KEY RESULTS

We identified five broad discharge processes that distinguished higher and lower performing hospitals: 1) initiating discharge planning upon patient admission; 2) using multidisciplinary case management services; 3) ensuring that a follow-up plan is in place prior to discharge; 4) providing focused education sessions for both the patient and family; and 5) contacting the primary care physician regarding the patient’s hospitalization and follow-up care plan.

CONCLUSION

Comprehensive and more intense discharge processes that start on admission continue during the patient’s hospital stay, and follow up with the primary care physician within 2 days post-discharge, may be critical in reducing hospital RSMR for patients with AMI.     

Unilateral pulmonary artery branch stenosis: Diastolic prolongation of forward flow appears to maintain flow to the affected lung if the pulmonary valve is competent

Background

We sought to improve understanding of the diastolic prolongation of forward flow seen through a unilateral branch pulmonary artery (PA) stenosis.

Methods and Results

Of patients studied by cardiovascular magnetic resonance (CMR) for congenital heart disease, we reviewed right and left PA flow to find 10 cases with a diastolic prolongation of flow in a stenosed branch PA. They were aged 20 years (median, range = 14–40 years, 7 males). Seven had transposition of the great arteries corrected by arterial switch (TGA-AS) and 3 had repaired tetralogy of Fallot (rToF). All had at least moderate unilateral stenosis and competent pulmonary valves. For comparison, we identified 10 patients with unilateral stenosis and at least moderate pulmonary regurgitation, 9 rTOF and 1 TGA-AS, aged 23.5 years (range = 14–42 years, 6 males). Flow in each PA was measured, and in 10 healthy volunteers aged 27 years (range = 20–42 years, 5 males). The curves of flow through stenosed and non-stenosed arteries were averaged for each patient group and compared with those from controls. In competent pulmonary valve patients, the minimum diameters of the stenosed versus non-stenosed branches were as follows (median [range]): 4 [3–8] mm versus 13.5 [10–28] mm, p < 0.001, although their flows differed a little: 2.5 [1.5–6.8] L/min versus 3.2 [1.2–8.8] L/min, p = 0.6. No diastolic tail was identifiable in the patients with unilateral PA stenosis and pulmonary regurgitation, where stenosed versus non-stenosed diameters were 7 [4–12] mm versus 20.5 [13–33] mm, p < 0.001, and flows differed: 1.3 [0.4–2.9] L/min versus 3.8 [3.0–5.0] L/min, p < 0.001. No controls showed stenosis or diastolic tail.

Conclusions

Beyond a competent pulmonary valve, flow through a unilateral PA stenosis, although limited in systole, can continue into diastole, maintaining flow to the lung.     

N'Balance: A Community-Based Fall-Prevention Intervention With Older Adults—Lessons Learned

An examination of a community-based fall-prevention intervention, N'Balance, for adults age 55 and older was completed. N'Balance is a multidimensional intervention. A quasi-experimental intervention trial with a control group, using two sites, was the research design. This 6-week intervention met twice weekly for 50 minutes and included pre- and post-tests of physical and psychosocial aspects. Results indicated that N'Balance was associated with improved balance, a reduction in the fear of falling, and approached significance with leisure self-efficacy. The RE-AIM model was used with this intervention to explore its reach, efficacy, adoption, implementation, and maintenance in community recreation settings.     

Exploiting intracellular iron and iron-rich compounds to effect tumor cell lysis

The regimen outlined in this brief paper focuses on therapeutically utilizing iron and iron compounds in transferrin receptor-rich tumor cells in ways that inhibit and lyse same.