Increase In Quality Of Life Research Articles

A retrospective analysis on epidemiological characteristics of home enteral nutrition: results from a Chinese tertiary hospital in 2018.

The use of home enteral nutrition (HEN) has increased enormously. HEN has been shown to decrease length of stays, improve clinical outcomes, and increase quality of life. Literature on HEN epidemiology has also sprouted recently. Nevertheless, studies on Chinese HEN users are hardly seen. The objective of this study was thus to describe the epidemiological characteristics of HEN users from a Chinese tertiary hospital in 2018. Data were retrospectively analyzed using the personal patient profiles we created upon each HEN initiation. In the year of 2018, 2007 patients and a cumulative total of 3375 episodes were recorded. The median age was 61 (IQR 46-75) years, and 63 (IQR 49-75) for males and 55 (IQR 43-72) for females. The most frequent indication for HEN implementation was oncological diseases (35.8%), followed by digestive diseases (13.4%), and neurological diseases (9.0%). Overall, 90.0% of the episodes were prescribed for oral nutrition supplement (ONS) and 9.5% for tube feeding (TF). Majority (70.8%) of the episodes comprised standard commercial formula. Our study revealed some fundamental epidemiological characteristics of Chinese HEN patients. This preliminary single-center study has multiple limitations but still possesses revelatory and referential significance for other Chinese practitioners in the field of HEN. In future, multicenter studies and qualified HEN registries are widely needed in China.

Evaluation of the Impact of Self-Efficacy-Based Training on Depression, Self-Care Behaviors, and Quality of Life in Patients with Irritable Bowel Syndrome

Background and Objectives: Irritable bowel syndrome is the most common diagnosis among patients with gastrointestinal diseases and can adversely affect their quality of life. In this regard, the present study aimed to evaluate the effectiveness of self-efficacy-based training on depression, self-care behaviors, and the quality of life of patients with irritable bowel syndrome. Materials and Methods: This applied quasi-intervention study was conducted based on a pretest-posttest design with a control group and follow-up. The statistical population included all patients with irritable bowel syndrome who referred to Khorshid Hospital in Isfahan, Iran from September to November 2019. The samples were selected using the convenience sampling method. In total, 30 patients with irritable bowel syndrome were included in the study and randomly divided into two groups of intervention and control. The data were collected using Beck depression inventory, self-care questionnaire, and quality of life questionnaire. The intervention group received four sessions of self-efficacy training (one session per week for 90 min), while the control group did not receive any training. Two months later, the follow-up period was completed. The collected data were analyzed using repeated measures of analysis of variance in SPSS software (version 22). Results: The results showed that self-efficacy training was effective in decreasing depression (P<0.0001, F=35.39) and increasing quality of life (P<0.0001, F=120.30) and self-care behaviors (P<0.0001, F=70.50) in patients with irritable bowel syndrome. Conclusion: It can be concluded that training based on self-efficacy theory can effectively reduce depression and increase self-care behaviors and quality of life in patients with irritable bowel syndrome.

Music Playlists for People with Dementia: Trialing A Guide for Caregivers.

Background:Music programs have the potential to provide an effective non-pharmacological tool for caregivers to reduce depression and agitation and increase quality of life in people with dementia. However, where such programs are not facilitated by a trained music therapist, caregivers need greater access to information about how to use music most effectively in response to key challenges to care, and how to pre-empt and manage adverse responses.Objective:This study reports on the trial of a Guide for use of music with 45 people with dementia and their caregivers in residential care facilities and home-based care.Methods:The study used a pre-post experimental design in which participants were randomly allocated to a treatment group or a waitlist control group.Results:Improvements to quality of life were found in the experimental group over the 6-week period. Significant increases in Interest, Responsiveness, Initiation, Involvement, and Enjoyment were reported for individual listening sessions.Conclusion:The Guide can provide an effective protocol for caregivers to follow in selecting music to manage particular challenges to care, confirming the need for caregivers to be prepared to monitor and manage potential negative responses.

Ethnomedicobotany: Exploration of wild biodiversity for immune boosting and others in communities of dry districts of Karnataka, India

Bidar, Raichur and Vijayapura are the three dry districts among others of eastern planes of Karnataka. The forest divisions are corresponding to the districts. They are comparatively backward districts with poverty abundant and with poor medical infrastructure to deal with epidemics like Covid-19 and likewise. The districts experience dry spells frequently but traversed with the major Krishna, Tungabhadra rivers and experience floods, makes population more vulnerable to diseases and epidemics. In spite of dry and rocky terrains, they are abundantly rich in ethnic floral biodiversity. Large numbers of highly traded medicinal plants have been reported. The districts are prone with the biotic pressure on wild herbals mainly of sheep and goats. About 381 species in Bidar; 273 Species in Raichur and 127 species in Vijayapura have been recorded. Many rare and threatened species as per the International Union for Conservation of Nature (IUCN) have also been reported from these divisions. Large numbers of taxa of medicinal properties including highly traded species are found in the districts. The medicinal efficacy of dry zone wild species is considered as very high. The use of herbal combinations for immunity boosting will reduce the pressure from medical infrastructure and increase quality of life. The forests of Bidar district are found having better wild herbal biodiversity, site quality and may be considered immune boosting centre. Ocimum sanctum, considered as one of the best immune boosters of high efficacy is widely found in all the forests of three divisions. The Ayush department of the State may take note of it. Based on the assessment certain areas have been recommended for gene pool conservation for medicinal plants. The percentages of herbs of medicinal value in the floral population are found high in these districts. The study has also laid stress on estimation of herbal medicinal resources for better management.

Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease.

Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease.

The relationship between false hopes and misleading expectations in the progress of science

With the growing scientific knowledge, we are beginning to understand that several phenomena which used to be explained by non physical entities (e.g., demonic possessions) are being logically and systematically explained through the scientific method (e.g., epileptic seizures). The development of the scientific method strongly contrasts with centuries of false beliefs and esoteric ideas which had no logic or were irrational. Nowadays, it is undeniable that science helped increase life expectancy and life quality. Neuroscience is now contemplating problems that used to belong to the philosophical field (e.g. consciousness). Nevertheless, the problem of death makes some scientist exceptical to the principles of science because that would imply for example to accept death as the end of the consciousness. With the apprehension that we are no more than an extraordinary unique combination of matter and energy, it follows that when we die, matter and energy reorganize in a different way and we ceased to exist as individuals. In this article, I attempt to explain that many pseudo scientific approaches trying to unify science with religion are actually based on emotional rather than rational thinking. I propose that, even though accepting the end of our consciousness is something hard to manage, it only have but positive effects in our quality of life and also benefits science by focusing all the efforts of intelligent and capable people into something that might have real effects in our present life and future generations to come

Conceptualising disability: Health and legal perspectives related to psychosocial disability and work

Background: Work has been found to improve health outcomes and increase quality of life. It is also a vehicle through which people develop personally, earn an income and meet other needs; as such work is recognised as a social determinant of health. However, persons with psycho-social disability face many barriers in their quest to achieve equality, thus experiencing ongoing marginalisation and exclusion from full participation in work. Objectives: The aim of this article is to explore the nexus between South Africa’s progressive constitutional and legislative context, employers and the provision of health- and law-related services facilitating participation of persons with psycho-social disability in work. Methods: The authors, with diverse professional backgrounds namely law, psychiatry and occupational therapy, developed a synthesised perspective to highlight issues that require consideration and develop guiding principles from which practitioners can draw to support the participation of persons with psycho-social disability in work. Results: A perspective is shared to provide direction and inform practice aimed at promoting participation of persons with disability in work. Conclusions: Health professionals are reminded of their ethical duty to support persons with psycho-social disability to either stay at work or return to work as soon as possible. The potential dangers of sick leave in the absence of a return to work plan are highlighted and the need for a multi-professional approach is emphasised.

Preference of individuals in the treatment strategies of acute myocardial infarction in China: a discrete choice experiment

BackgroundAcute myocardial infarction (AMI) is a significant cause of mortality and morbidity worldwide. Today, with increasing life quality and social economy, people pay much attention to the cost-effectiveness of a treatment strategy. This study investigated the preferences of individuals who would be potential caregivers or patients for AMI treatment in order to provide liable and instructive information for cardiologists and other related physicians.MethodsA discrete choice experiment was conducted among people to assess preferences for hypothetical AMI treatment scenarios characterized by the attributes of treatment method, mortality within 5 years, complication rate within 1 year, treatment duration and expense. A conditional logit regression model and latent class analysis were used to interpret the collected data systematically. The relative importance of each attribute and willingness to pay of people on the trade-offs between different treatment strategies were estimated.ResultsParticipants valued mortality within 5 years most highly (average importance: 40.9, 95%CI 0.447–0.530). Three classes of participants were identified: Class 1 placed the most importance on treatment duration, class 2 corresponded with the overall result while expense was regarded as the most important attribute in class 3. Individuals favored an intermediate treatment duration of about 10 days instead of the shortest (95% CI 1.044–1.248, P < 0.001). People’s characteristics (sex, age, marriage, education and income) affected their preferences (P < 0.01).ConclusionPeople considered a mortality rate within 5 years as the most crucial attribute in the MI treatment and preferred an intermediate treatment duration of about 10 days. Furthermore, the findings estimated the trade-offs acceptable to patients and heterogeneity in preferences for AMI treatment.

Gastroenterologist-Lead Management of Iron Deficiency Anemia in Inflammatory Bowel Disease Is Effective, Safe, and May Increase Quality of Life.

BackgroundThe effectiveness and safety of gastroenterologist (GI)-lead treatment of iron deficiency anemia (IDA) in inflammatory bowel disease (IBD) have not been well-studied.MethodsA retrospective chart review of patients with IBD, IDA, and evidence of treatment with iron at a tertiary IBD center was conducted.ResultsIn 351 patients, hemoglobin and quality of life scores increased significantly after treatment with iron. Twelve of 341 patients treated with intravenous iron had an adverse effect. Twenty-seven patients required a hematology referral.ConclusionGIs should consider treating patients with IBD and IDA with intravenous iron as it is safe and effective.

The World Small Animal Veterinary Association (WSAVA): List of Essential Medicines for Cats and Dogs.

The World Small Animal Veterinary Association (WSAVA): List of Essential Medicines for Cats and Dogs.

Ropivacaine 75\u2009mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women \u2013 the ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trials

BackgroundPerineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother–infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy but have only focused on the immediate postpartum period (at 24 and 48 h after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid- and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended.Methods/designThe ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial being conducted in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (≥ 37 weeks). Perineal infiltration (ropivacaine 75 mg or placebo) will be administrated just after vaginal birth and before episiotomy repair. The primary outcome will be the analgesic efficacy at day 7 postpartum (midterm), defined by the Numeric Pain Rating Scale (NPRS) strictly superior to 3/10 on the perineal repair area. Secondary outcomes will be the analgesic efficacy (NPRS) and the impact of pain on daily behavior, on the quality of life (36-item Short Form Health Survey), on the occurrence of symptoms of postpartum depression (Edinburgh Postnatal Depression Scale), and on sexual health (Female Sexual Function Index) at 3 and 6 months (long-term) using validated online questionnaires. This study will have 90% power to show approximately 30% relative risk reduction in the incidence of perineal pain at day 7, from 70.0% to 50.0%.DiscussionRopivacaine is a promising candidate drug, inexpensive, and easy to administer, and it would be suitable to include in the routine management of deliveries in labor ward. This study will investigate if perineal ropivacaine infiltration just after birth can reduce mid- and long-term postpartum pain and increase quality of life in women with mediolateral episiotomy.Trial registrationClinicalTrials.gov, NCT03084549. Registered on 14 April 2017.

Findings from a pilot randomised trial of a social network self-management intervention in COPD

BackgroundSelf-Management Support (SMS), refers to the actions taken by individuals to recognise and manage their own health. It is increasingly recognised that individuals with chronic obstructive pulmonary disease (COPD) require additional support with their Self-management. Emerging evidence suggests that the use of a social network intervention can improve health outcomes and increase quality of life. In order to understand the potential benefits of SMS in COPD, the GENIE (Generating Engagement in Network Support) SMS tool was implemented and evaluated in a COPD primary care context. The GENIE intervention is a social networking tool that consists of 3 parts; a concentric circle modelling to map existing social networks; a questions sections to elicit preferences for activities; a map of selected resources is then produced, aligned with the user’s interests and suggestions for connections to existing network members and to new resources.MethodsA pilot, parallel, single blind, block randomised controlled trial. Patients with COPD ranging from mild-very severe were recruited. Participants provided written consent and were then randomised to either the intervention or usual care. The primary aim was to understand the clinical benefit through the analysis of health status, symptom burden and quality of life. The secondary outcome measure was health utilisation. NHS cost differences were reported between groups using the GENIE intervention over usual care.ResultsThe GENIE pilot results demonstrate maintenance in health status and clinical symptoms with a decrease in anxiety. An overall increase in quality of life was observed, these findings did not reach significance. A cost reduction was demonstrated in inpatient stay with no difference in primary care costs. Overall a cost reduction in NHS service utilisation was indicated in the intervention group.ConclusionThis pilot study indicated that using a social network intervention can encourage the development of new social connections and extend existing support networks for COPD patients. Increasing network support in this population is of benefit to both patients and NHS providers in terms of cost reductions and enhancing wellbeing. This broadens the understanding of possible new approaches to SMS in community COPD patients, which could now be investigated in a larger population over a longer period.Trial registrationClinical Trials.gov PRS National Library of Medicine. Protocol ID number: 19175, Clinical Trial ID: NCT02935452.

Feasibility of mHealth Devices in Monitoring of Heart Rate, Physical Activity and Respiratory Function in Smokers with and without Respiratory Symptoms and COPD

Background: Chronic obstructive pulmonary disease (COPD) is a global public health problem, and continuous monitoring is essential for both its management as well as the management of other chronic diseases. Telemonitoring using mobile health (mHealth) devices has the potential to promote self-management, improve control, increase quality of life, and prevent hospital admissions. Objective: This proof-of-concept study aims to assess feasibility, accuracy, and reproducibility of biosensing (mHealth) devices in monitoring of heart rate, physical activity and respiratory function in smokers with and without respiratory symptoms and COPD. Methods: A total of 3 cohorts, with 9 participants in each, used mHealth devices for 90 days while undergoing the current standard of care. These groups were: 9 “non-COPD,” otherwise healthy, smokers; 9 “grey zone” smokers (forced expiratory volume in 1 second/ forced vital capacity ?0.70 after bronchodilator treatment; COPD Assessment Test ?10); and 9 smokers diagnosed with Stage 1-3 COPD. Two mHealth devices were utilized in the study: (1) the AnaMed Original Equipment Manufacturer device (OEM) that measures distance, energy expenditure, heart rate, and heart rate variability by using photoplethysmographic method and displays the results on a watchface, smartphone or a tablet, and (2) the Air Next mobile spirometry portable device that performs spirometric measurements (FEV1, FVC and FEV1/FVC ratio) by a turbine mechanism and displays the results on a smartphone or a tablet. The mHealth devices were compared against industry standards. Recruitment, retention and adherence rates were 35%, 100%, and 63% respectively. Additionally, a questionnaire was administered to assess the participants’ perceptions of the mHealth technologies used. Results: The AnaMed device was demonstrated as precise in measuring heart rate, and less so when measuring number of steps and meters. It is unreliable in measuring SpO2. It is easy to use, requires no significant technical support. The Air-Next Spirometer is a simple and very precise instrument for detecting obstructive airway diseases which was confirmed when compared to the industry standard. It is easy to use, which could make it especially useful for non-specialized care and in-home setting and other areas. Conclusion: We demonstrated that both devices, AnaMed and AirNext can provide precise measurements or heart rate and spirometric data, and it is feasible to incorporate them into a routine clinical practice for remote monitoring of chronic conditions such as COPD. However, such task would require some efforts to take care of technical and logistical issues, i.e. sending reminders, synching devices with smartphones, communication efforts.

Abstract D059: Bridge to Good Living: Thriving beyond lung cancer in West Virginia

Abstract Introduction: The goal of the Bridge Program is to improve the overall coordination of care, increase quality of life, and decrease the consequences of treatment for patients diagnosed with lung cancer. Brief Description: Patients diagnosed with late stage lung cancer are often referred to supportive or palliative care programs that provide symptom management, psychosocial support and follow up, as well as advanced planning. In contrast, the needs of patients diagnosed at a curable or early stage often go unaddressed. The focus of the Bridge Program is to develop and implement a comprehensive survivorship program for Stage 1-3 lung cancer patients completing curative treatment. The Bridge Program enrolls and assesses patients at the end of cancer treatment utilizing a multidisciplinary team approach. The Program’s goal is to improve patient and caregiver quality of life in the major life domains of physical, social, psychological, and spiritual. We see this program bridging patients from active cancer care to the next step on their journey in life. Using a multidisciplinary team approach creates an opportunity for collaboration and information sharing that leads to the development of an enhanced survivorship care plan. Summary of Data: Between March 2017 and June 2019, the Bridge Program enrolled 81 patients across three locations. At the end of cancer care, 100% of these patients had at least one unmet need and nearly half had seven or more. Assessment identified a total of 540 unmet needs which resulted in 132 clinician referrals. When categorizing unmet needs into physical, practical, and emotional domains, Bridge patients identified more unmet needs in the physical category than any other. The most common referrals were for Physical Therapy and Occupational Therapy. Following enrollment into the Program, 93% of Bridge patients showed a decrease in the number of unmet needs at their first recurrence and monitoring visit. When comparing a cohort of Bridge enrolled verses non-Bridge patients, we found that prior to visiting the Emergency Department, Bridge patients contacted their treatment team at a higher rate than non-Bridge patients and that the completion of Survivorship Care Plans was 100% for Bridge patients and only 38% for non-Bridge patients. Conclusion: Lung cancer patients have many unmet needs following active treatment for lung cancer. The Bridge Program addresses a cancer that is not frequently talked about in survivorship care: lung cancer. With increased screening and improvements in treatment, we can anticipate an increase in the number of lung cancer survivors. The Bridge Program provides a novel patient-centered model that addresses a cohort of patients that are often older and sicker than other cancer patients. Note: This abstract was not presented at the conference. Citation Format: Stephenie K Kennedy-Rea, Anne Swisher, Adrienne Duckworth, Tara Miller, Salman Osmon, Abby Starkey, Megan Burkart, Garth Graebe, Mary Anne Yanosik, Rachel Harper, Amy Allen. Bridge to Good Living: Thriving beyond lung cancer in West Virginia [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D059.

Exploring Participant Perceptions of a Community-Based Program for People With Brain Injury.

An acquired brain injury presents complex challenges to survivors returning to the community, and as more individuals survive, the need for programs that support optimal quality of life increases. To explore participant perceptions of a community-based program. To accomplish objectives, 10 individuals living with chronic brain injury who were attendees of the community program were interviewed. Applying qualitative study procedures, all narrative data were transcribed and analyzed. All participants expressed that the program positively impacted several personal life satisfaction factors as well as their participation within their respective communities. Themes included (1) Acceptance, (2) Sense of Community, (3) Sense of Purpose, (4) Autonomy, and (5) Personal Development. Discussion includes analysis of program elements that help explain participant responses. Description of the occupational therapy grounded program offers a guide to others wishing to develop similar programs for individuals living with brain injury.

Breast density notification with adjunctive digital breast tomosynthesis (DBT): A cost-effectiveness analysis.

7072 Background: Dense breasts increase a woman's risk of developing cancer while also raising the likelihood of a missed diagnosis from traditional mammography screening. Digital Breast Tomosynthesis (DBT) has been shown to identify positive breast cancer more accurately in women with dense breasts, but no study has estimated the cost-effectiveness of this screening mode under a notification requirement. Methods: Taking the perspective of a healthcare system, we estimated the incremental cost-effectiveness ratio (ICER) of providing DBT as an alternative to mammography for 40-year old women. Model parameters reflecting risk of breast cancer, detection rates, and costs were estimated from recent meta analyses, Tufts’ CEA registry, and Medicare Fee Schedules. We used probabilistic Markov Models to estimate the ICER under uncertainty, and a time-variant model in which breast density and cancer risk change over time. Additionally, a heterogeneity analysis included all women between the ages of 40-65, while also using 1st and 2nd degree family history to calculate cancer risk. Results: In the probabilistic model, adjunctive DBT has a cost differential of $12,203, with an increase of 0.0382 quality-adjusted life years (ICER = $319,491/QALY) compared to mammography. This result was most sensitive to the probability of a missed diagnosis for women with dense breasts. At a willing-ness to pay of $50,000, adjunctive DBT had a 57% chance of being more costly and less effective than standard mammography. Conversely, DBT only had a 20% chance of being cost-effective and a 9.9% chance of being less costly and more effective. The time-variant model reported an ICER of $174,218, but adjunctive DBT became even more cost-effective after expanding the population and including family history of cancer (ICER_All Ages = $157,146; ICER_FamHist = $153,388). Conclusions: Breast density notification laws which provide additional screening via DBT are not cost-effective at a willingness to pay of $50,000. Policymakers, however, should note that many modern cancer therapeutics also exceed this threshold. As an adjunctive screening technique, DBT would result in fewer deaths and increase quality of life, but the effect is minimal and carries a high cost. Including breast density within greater risk stratification protocols, however, may prove highly cost-effective, especially for older women with a family history of cancer.

Deep brain stimulation in Parkinson's disease - the review

Introduction: Parkinson’s disease (PD) is a common neurodegenerative disorder and is the second most common neurodegenerative disease after Alzheimer’s disease. The clinical features are associated with motor symptoms: tremor, rigidity, and bradykinesia with postural instability. PD is also associated with many non-motor symptoms, and these often precede the motor symptoms by years or even decades. In general, treatment is based on usage of medicaments which increase a level of dopamine. Surgical therapy is reserved for more advanced cases. Objective: To review currently available data on PubMed about a surgical treatment of Parkinson’s disease and future prospects. Abbreviated description of the state of knowledge: Surgical therapy is typically reserved for bradykinesia, rigidity and tremor in patients who no longer respond to medication in a predictable manner or who suffer medication-induced dyskinesias. Currently, the most common surgical treatment for Parkinson's disease is deep brain stimulation (DBS). Ablative procedures like radiofrequency, radiosurgery and focused ultrasound are also utilized for select tremor symptoms. We also analyzed future prospects including cells transplantation. DBS decreases a level of disability, depression and increases quality of life. It should to take under consideration in early as well as advanced PD. Conclusions: PD is still incurable, however both pharmacological and surgical treatment can stifle the progression of disease for years and increase quality of life. New methods of treatment are promising. However, the further research about possible therapy is required.

A randomized clinical trial of mindfulness-based cognitive therapy for women with irritable bowel syndrome-Effects and mechanisms.

Irritable bowel syndrome (IBS) is a chronic disorder of brain-gut interaction. Previous studies suggest that mindfulness could be therapeutic for IBS patients, however no study has evaluated the effects of mindfulness-based cognitive therapy adapted for patients with IBS (MBCT-IBS). A 6-week MBCT-IBS course was designed to reduce symptoms and increase quality of life. This study aimed to evaluate the effects of MBCT-IBS and to investigate its therapeutic mechanisms in a randomized controlled trial. Sixty-seven female patients with IBS were randomized to MBCT-IBS (MG; n = 36) or a waitlist (WL; n = 31) control condition. Patients completed standardized self-report measures of IBS symptom severity, IBS quality of life, maladaptive illness cognitions (catastrophizing, visceral anxiety sensitivity) and mindfulness at baseline, after 2 treatment sessions, at posttreatment, and at 6-week follow-up. Self-referential processing of illness and health was measured with an implicit association test (IAT). The MG reported significantly greater reductions in IBS symptoms (p = .003) and improvements in quality of life (p < .001) at follow-up compared with the WL. Changes in visceral anxiety sensitivity and pain catastrophizing at posttreatment and reductions in the IAT-score after 2 sessions combined with increases in nonjudgmental awareness at posttreatment mediated reductions in IBS symptoms. MBCT-IBS has the potential to reduce IBS symptoms and increase quality of life. MBCT-IBS may exert its effect on IBS symptoms via reducing maladaptive illness cognitions and activating changes in self-processing (reducing biases in self-referent processing of illness and health and increasing nonjudgmental awareness). (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Major Adverse Events with an LVAD: Patient-Reported Outcome Trajectory Changed

Left ventricular assist devices (LVAD) are being implanted at a higher rate than ever before to treat end stage heart failure, and are known to decrease mortality and increase quality of life (QOL) for patients. However, major adverse events, including major bleeding and infection (INTERMACS definitions), are common in patients with an LVAD. These events have great potential to impair patient experiences of living with an LVAD.The purpose of this analysis was to examine whether having a major adverse event would alter patient-reported outcomes over time, including depressive symptoms and QOL. Using latent growth modeling, in a sample of 96 patients, with data pre-implant, and at 30, 90 and 180 days post LVAD implantation, we compared changes over time in patient-reported outcomes between patients who had had and those who did not have major adverse events. Twenty two percent of the sample had had adjudicated major bleed within 180 days of implantation, and 53% had an infection. Patients who had a major bleed post-LVAD had more depressive symptoms and lower QOL at baseline compared to those without a major bleed. Both depressive symptoms and QOL improved for those with and without a major bleed, however, those with a major bleed had smaller improvements in QOL and depressive symptoms over time compared to those who did not experience a bleed. Similarly, patients who had an infection post-LVAD had more depressive symptoms and lower QOL at baseline compared to patients who never had an infection within 180 days. Both groups saw a slight decline in QOL at six months, however, those who did not have an infection saw a smaller decline in QOL over time. Pre-implant patient-reported outcomes may help identify patients who are at risk of major adverse events post-LVAD. Moreover, patients experiencing an adverse event are not likely to have as much improvement in patient-reported outcomes compared with those who are major adverse event-free. Our approaches to evaluating and managing LVAD patients need to address the whole person, and not just objective metrics and clinical events.

Evaluating Mobile Apps and Biosensing Devices to Monitor Physical Activity and Respiratory Function in Smokers With and Without Respiratory Symptoms or Chronic Obstructive Pulmonary Disease: Protocol for a Proof-of-Concept, Open-Label, Feasibility Study.

BackgroundChronic obstructive pulmonary disease (COPD) is a global public health problem, and continuous monitoring is essential for both its management as well as the management of other chronic diseases. Telemonitoring using mobile health (mHealth) devices has the potential to promote self-management, improve control, increase quality of life, and prevent hospital admissions.ObjectiveThis study aims to demonstrate whether a large-scale study assessing the use of mHealth devices to improve the treatment, assessment, compliance, and outcomes of chronic diseases, particularly COPD and cardio-metabolic syndrome, is feasible. This will allow our team to select the appropriate design and characteristics for our large-scale study.MethodsA total of 3 cohorts, with 9 participants in each, will use mHealth devices for 90 days while undergoing the current standard of care. These groups are: 9 “non-COPD,” otherwise healthy, smokers; 9 “grey zone” smokers (forced expiratory volume in 1 second/ forced vital capacity ≥0.70 after bronchodilator treatment; COPD Assessment Test ≥10); and 9 smokers diagnosed with Stage 1-3 COPD. Rates of recruitment, retention, and adherence will be measured. Overall, two mHealth devices will be utilized in the study: the AnaMed Original Equipment Manufacturer device (measures distance, energy expenditure, heart rate, and heart rate variability) and the Air Next mobile spirometry device. The mHealth devices will be compared against industry standards. Additionally, a questionnaire will be administered to assess the participants’ perceptions of the mHealth technologies used.ResultsThe inclusion of participants started in June 2019. Study results will be published in peer-reviewed scientific journals.ConclusionsThis study will demonstrate whether a large-scale study to assess the use of mHealth devices to improve the treatment, assessment, compliance, and outcomes of chronic diseases, particularly COPD and cardio-metabolic syndrome, is feasible. It will also allow the research team to select the appropriate design and characteristics for the large-scale study.Trial RegistrationClinicalTrials.gov NCT04081961; https://clinicaltrials.gov/ct2/show/NCT04081961International Registered Report Identifier (IRRID)DERR1-10.2196/16461