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51.
Amy M. Pastva Christina E. Hugenschmidt Dalane W. Kitzman M. Benjamin Nelson Gretchen A. Brenes Gordon R. Reeves Robert J. Mentz David J. Whellan Haiying Chen Pamela W. Duncan 《Journal of cardiac failure》2021,27(3):286-294
BackgroundOlder adults with acute decompensated heart failure have persistently poor clinical outcomes. Cognitive impairment (CI) may be a contributing factor. However, the prevalence of CI and the relationship of cognition with other patient-centered factors such a physical function and quality of life (QOL) that also may contribute to poor outcomes are incompletely understood.Methods and ResultsOlder (≥60 years) hospitalized patients with acute decompensated heart failure were assessed for cognition (Montreal Cognitive Assessment [MoCA]), physical function (Short Physical Performance Battery [SPPB], 6-minute walk distance [6MWD]), and QOL (Kansas City Cardiomyopathy Questionnaire, Short Form-12). Among patients (N = 198, 72.1 ± 7.6 years), 78% screened positive for CI (MoCA of <26) despite rare medical record documentation (2%). Participants also had severely diminished physical function (SPPB 6.0 ± 2.5 units, 6MWD 186 ± 100 m) and QOL (scores of <50). MoCA positively related to SPPB (ß = 0.47, P < .001), 6MWD ß = 0.01, P = .006) and inversely related to Kansas City Cardiomyopathy Questionnaire Overall Score (ß = –0.05, P < .002) and Short Form-12 Physical Component Score (ß = –0.09, P = .006). MoCA was a small but significant predictor of the results on the SPPB, 6MWD, and Kansas City Cardiomyopathy Questionnaire.ConclusionsAmong older hospitalized patients with acute decompensated heart failure, CI is highly prevalent, is underrecognized clinically, and is associated with severe physical dysfunction and poor QOL. Formal screening may reduce adverse events by identifying patients who may require more tailored care. 相似文献
52.
Michelle Sharp Kristin M. Burkart Mark H. Adelman Rendell W. Ashton Lee Daugherty Biddison Gabriel T. Bosslet Stephen T. Doyle Thomas Eckmann Malik M. Khurram S. Khan Peter H. Lenz Jennifer W. McCallister Jacqueline O’Toole Cynthia S. Rand Kristin A. Riekert Morgan I. Soffler Gretchen R. Winter Sandra Zaeh Michelle N. Eakin 《Chest》2021,159(2):733-742
53.
Catherine K. Floroff Patricia W. Slattum Spencer E. Harpe Perry Taylor Gretchen M. Brophy 《Neurocritical care》2014,21(3):526-533
Background
Limited data suggest that potentially inappropriate medications (PIMs) impact outcomes in critically ill elderly patients. No data are available on the association between PIM use as well as drug burden index (DBI), which is a measure of PIM use, and clinical outcomes in neurocritical care elderly patients. This study evaluates whether PIM use and a higher DBI are associated with poor clinical outcomes in neurocritical care elderly patients.Methods
PIMs were retrospectively identified in critically ill elderly patients admitted to the neuroscience intensive care unit (NSICU) from March to July 2011. DBI was calculated based on PIM doses. Relationships with clinical outcomes were evaluated.Results
PIMs were prescribed to a majority (81.3 %) of the 112 patients. Opioids were most commonly associated with a decrease in Richmond Agitation Sedation Scale (RASS) scores (56 % of PIM doses). Time to recovery was significantly longer in patients with a higher PIM burden (≤2 PIMs: 8 h, >2 PIMs: 29 h; p = 0.02). There was a significantly longer NSICU and hospital length of stay (9 vs 2; 15 vs 5 days; p < 0.0001) as well as a lower Glasgow Coma Scale score upon discharge (14 vs 15, p = 0.02) in patients with a higher DBI after 72 h of hospitalization. There was no difference in mortality.Conclusions
PIM use and higher DBI scores were associated with poor clinical outcomes and longer lengths of stay. Further studies are needed to determine the impact of PIMs and DBI on mortality in neurocritical care elderly patients. 相似文献54.
55.
Courtnee Melton Carolyn Graff Gretchen Norling Holmes Lawrence Brown Jim Bailey 《The Journal of asthma》2014,51(7):703-713
Objective: African-Americans share a disproportionate burden of asthma and low health literacy and have higher asthma morbidity and mortality. Factors that link the relationship between health literacy and health outcomes are unclear. This study aimed to use patients’ experiences of managing asthma to better understand the relationship between health literacy and health outcomes. Methods: This study was the qualitative component of a mixed methods study. Following quantitative data collection, four participants, two with low print-related health literacy and two with adequate print-related health literacy, completed semi-structured interviews. Interview data were analyzed using interpretative phenomenological analysis. Results: Three themes emerged from the analysis: information desired versus information received, trial and error, and expectations of the patient–provider relationship. Individuals with adequate print-related health literacy had different strategies for overcoming barriers related to communicating with their providers, learning about their disease and experiences of discrimination within the healthcare system. Conclusions: Individuals with adequate print-related health literacy may be more equipped to participate in shared decision making and feel more confident to successfully manage their disease. It is also important that health literacy is discussed in the context of the cultural and racial background of the population of interest. This interdependent relationship between health literacy and culture is particularly important for African-Americans. 相似文献
56.
57.
Objectives
Popular discourse on abortion in film and television assumes that abortions are under- and misrepresented. Research indicates that such representations influence public perception of abortion care and may play a role in the production of social myths around abortion, with consequences for women’s experience of abortion. To date, abortion plotlines in American film and television have not been systematically tracked and analyzed.Study design
A comprehensive online search was conducted to identify all representations of pregnancy decision making and abortion in American film and television through January 2013. Search results were coded for year, pregnancy decision and mortality outcome.Results
A total of 310 plotlines were identified, with an overall upward trend over time in the number of representations of abortion decision making. Of these plotlines, 173 (55.8%) resulted in abortion, 80 (25.8%) in parenting, 13 (4.2%) in adoption and 21 (6.7%) in pregnancy loss, and 16 (5.1%) were unresolved. A total of 13.5% (n= 42) of stories ended with the death of the woman who considered an abortion, whether or not she obtained one.Conclusions
Abortion-related plotlines occur more frequently than popular discourse assumes. Year-to-year variation in frequency suggests an interactive relationship between media representations, cultural attitudes and policies around abortion regulation, consistent with cultural theory of the relationship between media products and social beliefs. Patterns of outcomes and rates of mortality are not representative of real experience and may contribute to social myths around abortion. The narrative linking of pregnancy termination with mortality is of particular note, supporting the social myth associating abortion with death.Implications
This analysis empirically describes the number of abortion-related plotlines in American film and television. It contributes to the systematic evaluation of the portrayal of abortion in popular culture and provides abortion care professionals and advocates with an initial accurate window into cultural stories being told about abortion. 相似文献58.
59.
60.
Helen E. Gruber Wei Sha Cory R. Brouwer Nury Steuerwald Gretchen L. Hoelscher Edward N. Jr. Hanley 《International journal of medical sciences》2014,11(7):748-753
Background: Disc degeneration and its associated low back pain are a major health care concern causing disability with a prominent role in this country''s medical, social and economic structure. Low back pain is devastating and influences the quality of life for millions. Low back pain lifetime prevalence approximates 80% with an estimated direct cost burden of $86 billion per year. Back pain patients incur higher costs, greater health care utilization, and greater work loss than patients without back pain.Methods: Research was performed following approval of our Institutional Review Board. DNA was isolated, processed and amplified using routine techniques. Amplified DNA was hybridized to Affymetrix Genome-Wide Human SNP Arrays. Quality control and genotyping analysis were performed using Affymetrix Genotyping Console. The Birdseed v2 algorithm was used for genotyping analysis. 2589 SNPs were selected a priori to enter statistical analysis using lotistic regression in SAS.Results: Our objective was to search for novel single nucleotide polymorphisms (SNPs) associated with disc degeneration. Four SNPs were found to have a significant relationship to disc degeneration; three are novel. Rs165656, a new SNP found to be associated with disc degeneration, was in catechol-O-methyltransferase (COMT), a gene with well-recognized pain involvement, especially in female subjects (p=0.01). Analysis confirmed the previously association between COMT SNP rs4633 and disc degeneration. We also report two novel disc degeneration-related SNPs (rs2095019 and rs470859) located in intergenic regions upstream to thrombospondin 2.Conclusions: Findings contribute to the challenging field of disc degeneration and pain, and are important in light of the high clinical relevance of low back pain and the need for improved understanding of its fundamental basis. 相似文献