Relationship and communication characteristics associated with agreement between heart failure patients and their Carepartners on patient depressive symptoms

Objectives: Informal caregivers who recognize patients’ depressive symptoms can better support self-care and encourage patients to seek treatment. We examined patient-caregiver agreement among patients with heart failure (HF). Our objectives were to (1) identify distinct groups of HF patients and their out-of-home informal caregivers (CarePartners) based on their relationship and communication characteristics, and (2) compare how these groups agree on the patients’ depressive symptoms.

Method: We used baseline data from a comparative effectiveness trial of a self-care support program for veterans with HF treated in outpatient clinics from 2009-2012. We used a cross-sectional design and latent class analysis (LCA) approach to identify distinct groups of patient-CarePartner dyads (n?=?201) based on relationship and communication characteristics then evaluated agreement on patients’ depressive symptoms within these groups.

Results: The LCA analysis identified four groups: Collaborative (n?=?102 dyads, 51%), Avoidant (n?=?33 dyads, 16%), Distant (n?=?35 dyads, 17%), and Antagonistic (n?=?31 dyads, 15%). Dyadic agreement on the patients’ depressive symptoms was highest in the Distant (Kappa (κ)?=?0.44, r?=?0.39) and Collaborative groups (κ?=?0.19, r?=?0.32), and relatively poor in the Avoidant (κ?=?–0.20, r?=?0.17) and Antagonistic (κ?=–0.01, r?=?0.004) groups. Patients in Avoidant (61%) and Antagonistic groups (74%) more frequently had depression based on self-report than patients in Collaborative (46%) and Distant (34%) groups.

Conclusion: Caregiver relationships in HF tend to be either Collaborative, Avoidant, Distant, or Antagonistic. Patients’ depressive symptoms may negatively affect how they communicate with their caregivers. At the same time, improved patient-caregiver communication could enhance dyadic consensus about the patient’s depressive symptoms.     

Impact of a community pharmacy transitions-of-care program on 30-day readmission

Objectives

The primary objective of this study was to evaluate the impact of a transitions-of-care (TOC) program on both all-cause and related 30-day hospital readmission. The secondary objective was to evaluate which patient-specific factors, if any, are predictive of 30-day hospital readmissions.

Did a Goals-of-Care Discussion Happen? Differences in the Occurrence of Goals-of-Care Discussions as Reported by Patients,Clinicians, and in the Electronic Health Record

Context

Goals-of-care discussions are associated with improved end-of-life care for patients and therefore may be used as a process measure in quality improvement, research, and reimbursement programs.

Possible role of glial cells in the onset and progression of Lyme neuroborreliosis

Background  

Lyme neuroborreliosis (LNB) may present as meningitis, cranial neuropathy, acute radiculoneuropathy or, rarely, as encephalomyelitis. We hypothesized that glia, upon exposure to Borrelia burgdorferi, the Lyme disease agent, produce inflammatory mediators that promote the acute cellular infiltration of early LNB. This inflammatory context could potentiate glial and neuronal apoptosis.     

Socioemotional Functioning in Bipolar Disorder Versus Typical Development: Behavioral and Neural Differences

Socioemotional dysfunction is a core feature of bipolar disorder (BD) across the lifespan. Recent evidence indicates associations between this atypical functioning and the presence of neurally based anomalies. This article critically reviews the literature on two types of core socioemotional skills that may represent endophenotypes for BD, with a focus on differences between individuals with BD, both youth and adults, and their typically developing peers. First, it examines studies of social cue perception and interpretation, with an emphasis on behavioral and neural studies of facial expression processing. Second, it shifts to examine behavioral and neural differences in cognitive and behavioral flexibility. Finally, the article summarizes potential future directions for research in this area.     

A robust protocol for regional evaluation of methacholine challenge in mouse models of allergic asthma using hyperpolarized 3He MRI

Hyperpolarized (HP) ³He magnetic resonance imaging has been recently used to produce high‐resolution images of pulmonary ventilation after methacholine (MCh) challenge in mouse models of allergic inflammation. This capability presents an opportunity to gain new insights about these models and to more sensitively evaluate new drug treatments in the pre‐clinical setting. In the current study, we present our initial experience using two‐dimensional (2D), time‐resolved ³He MRI of MCh challenge‐induced airways hyperreactivity (AHR) to compare ovalbumin‐sensitized and challenged (N = 8) mice to controls (N = 8). Imaging demonstrated that ovalbumin‐sensitized and challenged animals exhibited many large ventilation defects even prior to MCh challenge (four out of eight) compared to no defects in the control animals. Additionally, the ovalbumin‐sensitized and challenged animals experienced a greater number of ventilation defects (4.5 ± 0.4) following MCh infusion than did controls (3.3 ± 0.6). However, due to variability in MCh delivery that was specific to the small animal MRI environment, the difference in mean defect number was not statistically significant. These findings are reviewed in detail and a comprehensive solution to the variability problem is presented that has greatly enhanced the magnitude and reproducibility of the MCh response. This has permitted us to develop a new imaging protocol consisting of a baseline 3D image, a time‐resolved 2D series during MCh challenge, and a post‐MCh 3D image that reveals persistent ventilation defects. Copyright © 2009 John Wiley & Sons, Ltd.     

Beta-blockers alprenolol and carvedilol stimulate beta-arrestin-mediated EGFR transactivation

Recent evidence suggests that binding of agonist to its cognate receptor initiates not only classical G protein-mediated signaling, but also beta-arrestin-dependent signaling. One such beta-arrestin-mediated pathway uses the beta(1)-adrenergic receptor (beta(1)AR) to transactivate the EGFR. To determine whether beta-adrenergic ligands that do not activate G protein signaling (i.e., beta-blockers) can stabilize the beta(1)AR in a signaling conformation, we screened 20 beta-blockers for their ability to stimulate beta-arrestin-mediated EGFR transactivation. Here we show that only alprenolol (Alp) and carvedilol (Car) induce beta(1)AR-mediated transactivation of the EGFR and downstream ERK activation. By using mutants of the beta(1)AR lacking G protein-coupled receptor kinase phosphorylation sites and siRNA directed against beta-arrestin, we show that Alp- and Car-stimulated EGFR transactivation requires beta(1)AR phosphorylation at consensus G protein-coupled receptor kinase sites and beta-arrestin recruitment to the ligand-occupied receptor. Moreover, pharmacological inhibition of Src and EGFR blocked Alp- and Car-stimulated EGFR transactivation. Our findings demonstrate that Alp and Car are ligands that not only act as classical receptor antagonists, but can also stimulate signaling pathways in a G protein-independent, beta-arrestin-dependent fashion.