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A Pilot Randomized Controlled Trial Testing the Feasibility and Acceptability of a SystemCHANGE Intervention to Improve Medication Adherence in Older Adult Stroke Survivors.
Wessol, JL, Russell, CL, Olds, KE
The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses. 2019;(5):259-265
Abstract
BACKGROUND Adhering to an antithrombotic medication regimen is essential to reducing recurrent stroke in adult stroke survivors. The purpose of this study was to evaluate the feasibility and acceptability of the SystemCHANGE (SC) and attention control (AC) intervention in older adult, nonadherent ischemic stroke patients. METHODS A pilot randomized controlled trial was conducted to determine the feasibility and acceptability of an SC versus AC intervention in older adult, nonadherent stroke survivors in the management of antithrombotic medication. Participants were masked to group assignment. Stroke survivors 50 years or older, taking at least 1 once-a-day antithrombotic medication, were recruited from a Midwest Comprehensive Stroke Center-affiliated neurology office. They were screened electronically using the Medication Event Monitoring System for 2 months to determine baseline medication adherence. Nonadherent stroke survivors (medication adherence < 0.97) were randomized to SC or AC intervention and monitored for 3 months. SC focused on redesigning the interpersonal environmental system and daily routines. The AC group was provided education materials on stroke that consisted of stroke risk factor reduction, stroke facts, rehabilitation, and nutrition with the primary investigator. Participation and intervention experience interviews were evaluated for themes. RESULTS Thirty participants were recruited: median age was 64 years, 46.7% of them were male, and they took an average of 7.77 (SD, 3.191; range, 3-15) prescribed medications. The number of over-the-counter medications taken (excluding aspirin) on a regular basis averaged 1.9 (SD, 0.8; range, 1-4). Two participants were nonadherent and were randomized to the 2 arms. Both participants had positive feedback and were not inconvenienced by their participation in the study. Neither participant voiced concerns about the intervention, survey demands, time requirement, or completing the surveys on the primary investigator's laptop. CONCLUSION The SC and AC intervention protocols were feasible and acceptable to the participants in this study. Additional pilot testing is needed to further evaluate the intervention and its effect on medication adherence in this population.
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Holocaust Survival and the Long-term Risk of Cardiovascular Disease in the Elderly.
Kagansky, N, Knobler, H, Stein-Babich, M, Voet, H, Shalit, A, Lindert, J, Knobler, HY
The Israel Medical Association journal : IMAJ. 2019;(4):241-245
Abstract
BACKGROUND Reports of longevity in Holocaust survivors (HS) conflict with excess prevalence of chronic diseases described among them. However, data on their long-term risk of cardiovascular diseases (CVD) are limited. Clinical data on large representative groups of HS who were exposed to severe persecution are also limited. OBJECTIVES To determine the prevalence of CVD and the risk factors in a large cohort of elderly HS compared to elderly individuals who were not exposed to the Holocaust (NHS). METHODS CVD prevalence rates and risk factors data from the computerized system of the central district of Clalit Health Services, the largest Israeli health maintenance organization (HMO) in Israel were evaluated in a retrospective observational study. The study was comprised of 4004 elderly HS who underwent direct severe persecution. They were randomly matched by identification numbers to 4004 elderly NHS. RESULTS HS were older than NHS and 51% of them were older than 85 years. The prevalence rate of ischemic heart disease (IHD) was significantly higher among HS. HS underwent significantly more cardiac interventions (20% vs. 15.7%, P < 0.05). HS status was an independent risk factor for increased IHD and for more coronary interventions. CONCLUSIONS Despite having a higher prevalence of CVD, a substantial number of HS live long lives. This finding may imply both unique resilience and ability to cope with chronic illness of the survivors as well as adjusted medical services for this population. These findings may help in planning the treatment of other mass trauma survivors.
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Hoarding among Jewish Holocaust Survivors: Moving Toward a Theoretical Model.
Porat-Katz, BS, Johnson, TW, Katz, I, Rachman-Elbaum, S
The Israel Medical Association journal : IMAJ. 2018;(11):670-673
Abstract
BACKGROUND Previously described as a subcategory of obsessive compulsive disorder (OCD), hoarding disorder was added to the fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as a stand-alone diagnosis for the first time. The first formal research in the 1990s surprisingly found no connection between material deprivation early in life and hoarding; however, later studies linked early traumatic life experiences with hoarding. Subsequent familial studies demonstrated a genetic predisposition for hoarding. Emerging evidence suggests a link between a post-traumatic stress disorder (PTSD) and hoarding in Jewish Holocaust survivors. OBJECTIVES To evaluate the literature on PTSD among Jewish Holocaust survivors for associations between PTSD and hoarding. METHODS A systematic search of selected databases, including PubMed, Google Scholar, NCBI, Psych Info, and EBSCO Host was conducted from 1 March 2017 to 15 July 2018 using the following search terms: hoarding, hoarding disorder, obsessive compulsive disorder, OCD, compulsive hoarding, Jewish Holocaust survivors, Shoa, post-traumatic stress disorder, and PTSD. Inclusion criteria included peer reviewed research published on adults in English since 1990. Because no publications linking hoarding and PTSD in Jewish Holocaust survivors were found, references in retained papers were also searched for any relevant published work. RESULTS Seven articles linking PTSD and hoarding were identified for this review. However, no articles were found linking PTSD and hoarding in Jewish Holocaust survivors. CONCLUSIONS A relationship between PTSD and hoarding in Jewish Holocaust survivors is conceivable and should be explored to effectively diagnose and care for affected individuals.
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Long-term renal function and hypertension in adult survivors of childhood sarcoma: Single center experience.
Schiavetti, A, Pedetti, V, Varrasso, G, Marrucci, O, Celani, C, Andreoli, G, Bonci, E
Pediatric hematology and oncology. 2018;(3):167-176
Abstract
AIM: Little data is available on long-term renal impairment in survivors from childhood sarcoma. We investigated the prevalence of renal impairment and hypertension after very long-term follow-up in survivors who reached adulthood after treatment for childhood sarcoma. METHODS A cross-sectional single center study was performed. Outcomes included estimating glomerular filtration rate (eGFR), albuminuria, glycosuria, serum phosphate and magnesium, tubular reabsorption phosphate (TRP), chronic kidney disease (CKD) according to the "Kidney Disease: Improving Global Outcomes" (KDIGO) guidelines and blood pressure (BP). RESULTS Out of 87 > 5-year sarcoma survivors, 30 adults (10F/20M, median age at diagnosis 9 years, median age at investigation 26 years, median follow-up 16 years, mean 19 years) were identified. Renal impairment was detected in four cases (13.3%); three of these fulfilled the criteria for CKD. Among the adult survivors, a subgroup of 15 cases (50%) had received ifosfamide without confounding factors such as a diagnosis of genito-urinary rhabdomyosarcoma or administration of other potentially nephrotoxic chemotherapy (platinum-based drugs or methotrexate); no renal dysfunction was detected in this subgroup. In the whole cohort of sarcoma survivors, hypertension was diagnosed in four cases (13.3%); BP was significantly correlated with body mass index [p .014]. CONCLUSION In our series of adult survivors treated for a diagnosis of sarcoma in their childhood, the prevalence of CKD was 10%. We found survivors treated with ifosfamide as the only nephrotoxic agent did not present glomerular or tubular toxicity at long term follow-up, but further studies including a larger number of cases are required to confirm it.
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Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study.
Gayat, E, Cariou, A, Deye, N, Vieillard-Baron, A, Jaber, S, Damoisel, C, Lu, Q, Monnet, X, Rennuit, I, Azoulay, E, et al
Critical care (London, England). 2018;(1):8
Abstract
BACKGROUND Intensive care unit (ICU) survivors have reduced long-term survival compared to the general population. Identifying parameters at ICU discharge that are associated with poor long-term outcomes may prove useful in targeting an at-risk population. The main objective of the study was to identify clinical and biological determinants of death in the year following ICU discharge. METHODS FROG-ICU was a prospective, observational, multicenter cohort study of ICU survivors followed 1 year after discharge, including 21 medical, surgical or mixed ICUs in France and Belgium. All consecutive patients admitted to intensive care with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 h following ICU admission and discharged from ICU were included. The main outcome measure was all-cause mortality at 1 year after ICU discharge. Clinical and biological parameters on ICU discharge were measured, including the circulating cardiovascular biomarkers N-terminal pro-B type natriuretic peptide, high-sensitive troponin I, bioactive-adrenomedullin and soluble-ST2. Socioeconomic status was assessed using a validated deprivation index (FDep). RESULTS Of 1570 patients discharged alive from the ICU, 333 (21%) died over the following year. Multivariable analysis identified age, comorbidity, red blood cell transfusion, ICU length of stay and abnormalities in common clinical factors at the time of ICU discharge (low systolic blood pressure, temperature, total protein, platelet and white cell count) as independent factors associated with 1-year mortality. Elevated biomarkers of cardiac and vascular failure independently associated with 1-year death when they are added to multivariable model, with an almost 3-fold increase in the risk of death when combined (adjusted odds ratio 2.84 (95% confidence interval 1.73-4.65), p < 0.001). CONCLUSIONS The FROG-ICU study identified, at the time of ICU discharge, potentially actionable clinical and biological factors associated with poor long-term outcome after ICU discharge. Those factors may guide discharge planning and directed interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT01367093 . Registered on 6 June 2011.
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Determinants of Health-Related Quality of Life After ICU: Importance of Patient Demographics, Previous Comorbidity, and Severity of Illness.
Griffith, DM, Salisbury, LG, Lee, RJ, Lone, N, Merriweather, JL, Walsh, TS, ,
Critical care medicine. 2018;(4):594-601
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Abstract
OBJECTIVES ICU survivors frequently report reduced health-related quality of life, but the relative importance of preillness versus acute illness factors in survivor populations is not well understood. We aimed to explore health-related quality of life trajectories over 12 months following ICU discharge, patterns of improvement, or deterioration over this period, and the relative importance of demographics (age, gender, social deprivation), preexisting health (Functional Comorbidity Index), and acute illness severity (Acute Physiology and Chronic Health Evaluation II score, ventilation days) as determinants of health-related quality of life and relevant patient-reported symptoms during the year following ICU discharge. DESIGN Nested cohort study within a previously published randomized controlled trial. SETTING Two ICUs in Edinburgh, Scotland. PATIENTS Adult ICU survivors (n = 240) who required more than 48 hours of mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We prospectively collected data for age, gender, social deprivation (Scottish index of multiple deprivation), preexisting comorbidity (Functional Comorbidity Index), Acute Physiology and Chronic Health Evaluation II score, and days of mechanical ventilation. Health-related quality of life (Medical Outcomes Study Short Form version 2 Physical Component Score and Mental Component Score) and patient-reported symptoms (appetite, fatigue, pain, joint stiffness, and breathlessness) were measured at 3, 6, and 12 months. Mean Physical Component Score and Mental Component Score were reduced at all time points with minimal change between 3 and 12 months. In multivariable analysis, increasing pre-ICU comorbidity count was strongly associated with lower health-related quality of life (Physical Component Score β = -1.56 [-2.44 to -0.68]; p = 0.001; Mental Component Score β = -1.45 [-2.37 to -0.53]; p = 0.002) and more severe self-reported symptoms. In contrast, Acute Physiology and Chronic Health Evaluation II score and mechanical ventilation days were not associated with health-related quality of life. Older age (β = 0.33 [0.19-0.47]; p < 0.001) and lower social deprivation (β = 1.38 [0.03-2.74]; p = 0.045) were associated with better Mental Component Score health-related quality of life. CONCLUSIONS Preexisting comorbidity counts, but not severity of ICU illness, are strongly associated with health-related quality of life and physical symptoms in the year following critical illness.
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Cardiovascular disease in cancer survivors.
Okwuosa, TM, Anzevino, S, Rao, R
Postgraduate medical journal. 2017;(1096):82-90
Abstract
Certain cancer therapies, including radiation therapy and some types of chemotherapies, are associated with increased risk of cardiovascular disease (CVD) and events. Some of these effects such as those presented by anthracyclines, radiation therapy, cisplatin, as well as those presented by hormone therapy for breast cancer-usually taken for many years for some breast and prostate cancers-are long-lasting and associated with cardiovascular events risk more than 20 years after cancer treatment. Cardiovascular testing, diagnostic assessment of suspected cardiovascular symptomatology, as well as laboratory tests for CVD risk factors are imperative. The early recognition and treatment of CVD processes that arise in survivorship years is pivotal, with specific attention to some CVD processes with specific suggested treatment modalities. Preventive measures include adequate screening, the use of medications such as ACE inhibitors/angiotensin receptor blockers and/or beta blockers, statin therapy and aspirin in persons who warrant these medications, as well as therapeutic lifestyle modifications such as exercise/physical activity, weight loss and appropriate diet for a healthy lifestyle. Periodic follow-up with a good primary care physician who understands the risks associated with cancer therapy is important, and referral to onco-cardiology for further management of cardiovascular risk in these survivors is based on a patient's cardiovascular risk level and the type, amount and duration of cancer therapies received during the patient's lifetime.
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Prognostic factors associated with 15-year mortality in patients with hospitalized systolic HF: Results of the observational community-based EPICAL cohort study.
Agrinier, N, Thilly, N, Briançon, S, Juillière, Y, Mertes, PM, Villemot, JP, Alla, F, Zannad, F, ,
International journal of cardiology. 2017;:940-947
Abstract
AIMS: Little data on very long-term survival and associated prognostic factors in heart failure (HF) are available. The aim was to describe 15-year survival and to identify the baseline prognostic factors associated with mortality in a community-based sample of patients hospitalized for systolic HF. METHODS Vital status was collected 15years after inclusion of 352 patients hospitalized for systolic HF born in France from the prospective cohort EPICAL. The prognostic value of baseline socioeconomic, clinical and biological characteristics on 15-year mortality was assessed using Cox models. RESULTS The mean (±SD) age was 63.9 (±10.8)years, 76% of the patients were male, median left ventricular ejection fraction (LVEF) was 23% IR [18-27]. Overall, the mean (±SD) follow-up was 1826 (±111)days. A total of 290 (82.4%) deaths and 22 heart transplantations occurred during the follow-up. The 15-year survival rate was 13.2% (95% CI [9.0-16.3]), i.e. 4.7 times lower than the one observed in the general population. Baseline characteristics associated with 15-year mortality were: age older than 65years (HR=1.48, CI 95% [1.15-1.90]), diabetes mellitus (1.31 [1.00-1.72]), chronic kidney disease (1.73 [1.23-2.43]), serious comorbidity (1.29 [1.02-1.64]), time from first HF diagnosis exceeding 1year at inclusion (1.68 [1.26-2.24]), HF hospitalization during the previous 12months (1.36 [1.04-1.78]), heart rate higher than 110 beats per minute (1.87 [1.26-2.76]), LVEF % (0.88 per quartile increase [0.80-1.98]), and serum sodium below 130mmol/L (3.14 [1.76-5.61]. CONCLUSIONS Only 13% of patients hospitalized for HF survived at 15years. The usual mid-term prognostic factors are also predictive of very long-term survival.
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Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients.
Høxbroe Michaelsen, S, Grønhøj, C, Høxbroe Michaelsen, J, Friborg, J, von Buchwald, C
European journal of cancer (Oxford, England : 1990). 2017;:91-102
Abstract
Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is rapidly increasing in incidence and has a favourable prognosis compared with HPV-negative disease. Current combined therapies include significant risks of morbidity for the growing group of survivors. This systematic review and meta-analysis investigates how treatment affects quality of life (QoL) in survivors of oropharyngeal cancer. PubMed, EMBASE and the Cochrane Library were systematically searched for all studies reporting patient-assessed QoL at least 1 year after treatment for OPC. In a meta-analysis, weighted average QoL scores from the four most commonly utilised QoL instruments were compared with baseline and reference group scores using the concept of minimal clinically important difference. The meta-analysis included data from 1366 patients from 25 studies and 12 countries. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) was answered by 704 patients, 644 patients answered the EORTC QLQ Head and Neck-35 (H&N-35), 474 patients answered the University of Washington Quality of Life Questionnaire, and 381 patients answered the M. D. Anderson Dysphagia Inventory. Moderate to large clinically important deteriorations in QoL were found in the domains dry mouth and sticky saliva for the EORTC QLQ-H&N35, saliva, chewing, swallowing, speech, taste, appearance and shoulder for the University of Washington Quality of Life Questionnaire, and the global, physical and emotional subscales for the M. D. Anderson Dysphagia Inventory. In conclusion, survivors of OPC face clinically important deteriorations in QoL that most markedly centre on xerostomia, dysphagia and chewing. These ailments indicate a potential for improvement in patient management.
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Successful aging in community seniors and stroke survivors: current and future strategies.
Kamat, R, Depp, CA, Jeste, DV
Neurological research. 2017;(6):566-572
Abstract
There is growing evidence to suggest that aging is accompanied by enhancement in psychosocial well-being, despite age-related declines in physical and cognitive functioning. A small but growing body of research has reported on positive trajectories of well-being, and its determinants, among community-dwelling seniors as well as in people with specific diseases such as stroke. Current strategies for promoting successful aging include physical, cognitive and social activities, healthy lifestyle, social support, and positive traits such as resilience and optimism. These strategies have typically been employed in samples without serious illnesses, but an emerging body of evidence suggests that they are as relevant in cohorts with neurologic and other diseases. Future strategies will include those that work at the community level and not just at individual level, and will focus on use of technology as well as group interventions to enhance resilience and building age-friendly communities.