Health Status Of Patients Research Articles

Measurability of overall health in patients with chronic gastrointestinal disorders

Abstract Background Chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) patients experience problems in all life areas. The Positive health (PH) concept, based on six different dimensions of health, may hold the answers for a broader understanding of the patients’ well-being. Aim To measure the overall health status of GI-HPB patients, according to the PH concept. Methods In 2019-2021, patients with GI-HPB attending the outpatient clinic of the Maastricht University Medical Center filled in questionnaires before consultation. The six dimensions of PH (bodily functions, mental well-being, meaningfulness, quality of life, participation, daily functioning) were measured by validated questionnaires (Gastrointestinal Symptom Rating Scale, Short Nutritional Assessment Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Short Form-36, Disease Experience Questionnaire, EuroQol-5D-5L). Results were compared to control groups and assessed with McDonald’s Omega, Zero-order Pearson correlations, and t-tests. Results The 235 participating patients scored lower on quality of life, participation, and daily functioning than healthy controls (p ≤ 0.001) but similar to those with other chronic conditions. Malnutrition (moderate-severe 45.6%) and depressive/anxious symptoms (35%/21.6%) were higher in the GI-HPB group compared to those with other chronic conditions. Conclusions Validated questionnaires addressing the six dimensions of PH showed a significant worse health status compared to controls, and malnutrition and depressive symptoms were higher compared to other patient groups. Key messages • GI-HPB patients have a lower quality of life, participate less, and have less daily functioning than healthy controls and higher malnutrition and depression than those with other chronic diseases. • By using validated questionnaires, an impression of the overall health status of patients can be obtained through the concept of Positive Health.

Quality of life in patients with heart failure and improved ejection fraction: one-year follow-up with ARNI and SGLT2i

Abstract Introduction A baseline Heart Failure (HF) with reduced Ejection fraction (HFrEF) <=40% that improved for >=10 points and a second measured left ventricle ejection fraction (LVEF) >40%, can be considered as HF with improved ejection fraction (HFimpEF). The novel therapy for HFrEF and HFimpEF are sacubitril/valsartan (ARNI- angiotensin receptor/neprilysin inhibitor) and Sodium-glucose cotransporter-2 inhibitors (SGLT2i). Purpose Our study aimed to evaluate ARNI and SGLT2i therapy on the health status of HFrEF patients, as well as the prognostic impact of HFimpEF in terms of quality of life and outcomes (mortality and rehospitalization due to HF) during a one-year follow-up. Methods In this prospective study, we included 376 hospitalized HFrEF patients, in whom ARNI and SGLT2i were initiated into regular therapy. A 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) was performed at discharge and after one year. The primary prognostic endpoints were all-cause mortality and HF rehospitalization. Results Initially, about two-thirds of the study population were men (71%), mean age of 61.0±11.5 years, mean LVEF 27.5±5.2 % and mean KCCQ overall summary (KCCQ-OS) score of 48.5±12.5, while quality of life KCCQ-QoL 37.4±10.2. After one year LVEF was increased by 35.6±7.1 %. The total number of 143 patients (38%) met the criteria for HFimpEF, with the improvement of mean LVEF (45.2±8.6 %., p<0.001). Overall, HFimpEF patients experienced an average 5.3 ± 18.6-point improvement in the KCCQ-OS compared with 2.5 ± 17.4 points for non-HFimpEF group (differences in mean changes of 2.9 [95% CI: 1.4 to 4.7). This is largely due to improvements in the domain of KCCQ-QoL (5.8 ± 29.7 points vs. 2.9 ± 22.2 points, respectively). During one year of follow-up, combined SGLT2i + ARNI therapy was represented statistically significantly more in HFimpEF compared to the non-HFimpEF group (86% vs. 34%, p<0.0005), where 45% took only one medicine and 21% none. The HFimpEF group had a significantly better outcome in terms of all-cause mortality (2.8% vs. 18.9%, p<0.005) and HF rehospitalization (3.5% vs. 40%, p<0.0001). The one-year KCCQ-12 was independently associated with outcomes; the hazard ratio for the integrated endpoints (mortality and HF rehospitalization) was 1.08 (95% CI: 1.05–1.11, p = 0.005). Conclusions In routine clinical practice, initiation of the ARNI and SGLT2i therapy was associated with significant improvements in the health status of HFrEF patients, but also change to HFimpEF. The one-year quality of life in patients with heart failure and improved ejection fraction was superior to baseline and compared to the non-HFimpEF group. HFimpEF was associated with a better outcome. All HF patients should undergo KCCQ-12 because it is an independent predictor of outcome.

Changes in mental health and illness perception in patients with hypertrophic cardiomyopathy referred to hybrid cardiac telerehabilitation in comparison to usual care - a randomised-control trial

Abstract Purpose Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder, that influences patients' physical capacity and quality of life, as well as the risk of sudden cardiac death (SCD). Patients with HCM often experience emotional distress due to the uncertainty of their condition and have a threatening illness perception (the way individuals make sense of their illness, which can have a significant impact on adherence to treatment). Current studies suggest that some HCM patients could benefit from hybrid cardiac telerehabilitation (HCTR) in terms of somatic and psychological status. This study is part of a research project investigating the safety and effectiveness of hybrid cardiac telerehabilitation for HCM patients. The specific focus of this part is to evaluate the changes in mental health status and illness perception of HCM patients who have been referred for cardiac telerehabilitation compared to those receiving usual care. Methods An RCT study was conducted, with the inclusion criteria for the study of being above 18 y.o., HCM without LVOT obstruction, NYHA Class II or III, LVEF ≥ 50%, and having CIED. The study involved telerehabilitation (HCTR) and control (CG) groups. Both groups were completing questionnaires assessing illness perception (Brief IPQ) and overall psychosocial distress (GHQ-28) with its 4 domains: somatic symptoms, anxiety, social impairment, and depression. Psychological assessment was performed at the beginning and at the end of telerehabilitation/outpatient care, and at 3, 6 and 12 months after the end of care (T1/T2/T3/T4/T5). Results There was a significant improvement in the overall distress level in the HCTR group (p=0.003) but not in the CG (p=0.559). It remained significant in the HCTR group for the T2 (p<0.001), T3 (p=0.008), and T4 (p<0.001). The positive change was observed in somatic symptoms only in the HCTR group: for T2 (p=0.025) and T3 (p=0.032) compared to the T1. The gradual decrease in anxiety level was observed in the HCTR group, but not in the CG, with a significant difference for T4 (p=0.013) compared to T1. Although there was an improvement in social impairment in both groups (p=0.049 for the CG, and p=0<0.001 for the HCTR group), only in the HCTR group it held a stable pattern after the intervention (p<0.001 for T2; p=0.013 for T3; p=0.032 for T4). There were no changes in the level of depressive symptoms in either of the compared groups. There were also no significant differences in the illness perception (p=0.200 for the HCTR group and p=0.090 for the CG), although the HCTR group showed short-term improvement after three months of HCTR (T2) (p=0.032). Conclusions There are significant benefits of hybrid cardiac telerehabilitation for mental health, level of distress, and illness perception in HCM patients. It is worth noticing that this improvement is short-term, and prolonged effects might require providing additional support during extended care.overall distress in HCTR vs CGsubscales of GHQ_28 in HCTR vs CG

Diabetes mellitus EU comorbidity index: using data from EHIS 2019 and GBD disability weights

Abstract Background Individuals with diabetes mellitus (DM) exhibit several of comorbidity burdens, with lower perceived quality of life also being a factor. Literature on the impact of DM is available, including studies on the index devised by (A. Andreella et al., 2023) for the assessment of comorbidities of health conditions. This study aims to adapt and validate this index for use as a standardized DM comorbidity index within the EU. Methods A cross-sectional study was carried out using microdata from the European Health Interview Survey (EHIS) 2019. The study included adults aged 25 years or older who reported having DM (n = 20,042) from 27 EU member states. Comorbidity index was calculated to assess the comorbidity of having 9 non-communicable diseases using disability weights obtained from the Global Burden of Disease 2019 and self-perceived general health using multiplicative approach. Beta regression analysis was used to evaluate the association between comorbidity index and several demographic, socioeconomic and lifestyle variables. Comorbidity index was calculated for each nomenclature of territorial units for statistics (NUTS 2). Results The comorbidity index ranged from 0.049 to 0.993. The results indicated that having a higher education and residing in urban areas were less likely to have a high comorbidity index. Being unemployed or in other employment statuses demonstrated a significant, positive association with the index. Income exhibited a gradual, positive association with each quintile, while consuming fruits and vegetables less than once a week was found to be associated with an increased index. The highest comorbidity index was observed in Calabria (Italy), followed by Lubuskie (Poland), and the lowest was observed in Antwerp (Belgium), followed by Övre Norrland (Sweden). Conclusions By identifying comorbidity burden, targeted interventions and regional-specific strategies can be implemented to improve the quality of life for individuals with DM. Key messages • Quantifying the burden of comorbidities allows understanding of health status of DM patients. • Comorbidity index shows geographic variation in the EU which contributes to tailored policy interventions.

Mandibular third molar coronectomy in older adults and its effects on oral health-related quality of life.

The purpose of this study was to investigate the effect of coronectomy on postoperative quality of life in older adults. Coronectomy is an alternative to complete surgical removal of a mandibular third molar that lies close to the inferior alveolar nerve. This prospective study included patients >60 years old who had an indication for coronectomy of a mandibular third molar. Patients were asked to complete the Dutch version of the Oral Health Impact Profile-14 (OHIP-14) daily during the first postoperative week. Postoperative pain, swelling, limited mouth opening, chewing ability and infection were also recorded. Furthermore, the effect of the impaction pattern, state of eruption, presence of preoperative pathology, patient health status according to the American Society of Anaesthesiologists score, gender, smoking on the postoperative OHIP-14 and pain scores were investigated. Thirty patients (16 males, 14 females) with a mean age of 71.2 (SD 8.3, range 60-91) years were included in the study. OHIP-14 and pain scores were highest on the first postoperative day and gradually declined during the first postoperative week. Patients who underwent coronectomy of a fully impacted mandibular third molar had significantly higher OHIP-14 scores on the first postoperative day than those who underwent coronectomy on a (partially) erupted mandibular third molar. We did not observe any postoperative complications up to 1 year after the surgery. Mandibular third molar coronectomy seems to present a valid treatment option in older adults.

Readiness for hospital discharge on people after hip replacement surgery in Vietnam: A cross-sectional study

Background & Aim: Readiness for hospital discharge is closely linked to post-operative complications, readmission rates, and the post-discharge health status of patients after hip replacement surgery. This study aimed to assess discharge readiness and identify the factors that predict it in patients undergoing hip replacement surgery. Methods & Materials: This cross-sectional descriptive study included 112 patients who had undergone hip replacement surgery at Hospital X in Middle Vietnam. Participants were selected using a convenience sampling method, and data were collected within 4 hours before hospital discharge. The Readiness for Discharge Scale, developed by Weiss et al. was used to measure discharge readiness. Data analysis was conducted using SPSS 20.0 statistical software. Results: The average discharge readiness score was 6.06± 2.10, indicating a low discharge readiness level. Multivariable linear regression analysis revealed that age, living conditions, planned admission, previous admission for the same diagnosis, and length of hospital stay significantly predicted 78.5% of the variance in discharge readiness (F= 77.626, p< 0.001). Among these factors, the strongest predictor was previous admission for the same diagnosis (β= 0.341, p< 0.001), followed by planned admission (β= 0.324, p< 0.001). Conclusion: The findings indicate that patients' readiness for discharge after hip replacement surgery remains low, with various factors influencing their readiness. Nurses caring for these patients should consider these factors to improve discharge readiness and patient outcomes.

Tumor Biology Hides Novel Therapeutic Approaches to Diffuse Large B-Cell Lymphoma: A Narrative Review

Diffuse large B-cell lymphoma (DLBCL) is a malignancy of immense biological and clinical heterogeneity. Based on the transcriptomic or genomic approach, several different classification schemes have evolved over the years to subdivide DLBCL into clinically (prognostically) relevant subsets, but each leaves unclassified samples. Herein, we outline the DLBCL tumor biology behind the actual and potential drug targets and address the challenges and drawbacks coupled with their (potential) use. Therapeutic modalities are discussed, including small-molecule inhibitors, naked antibodies, antibody–drug conjugates, chimeric antigen receptors, bispecific antibodies and T-cell engagers, and immune checkpoint inhibitors. Candidate drugs explored in ongoing clinical trials are coupled with diverse toxicity issues and refractoriness to drugs. According to the literature on DLBCL, the promise for new therapeutic targets lies in epigenetic alterations, B-cell receptor and NF-κB pathways. Herein, we present putative targets hiding in lipid pathways, ferroptosis, and the gut microbiome that could be used in addition to immuno-chemotherapy to improve the general health status of DLBCL patients, thus increasing the chance of being cured. It may be time to devote more effort to exploring DLBCL metabolism to discover novel druggable targets. We also performed a bibliometric and knowledge-map analysis of the literature on DLBCL published from 2014–2023.

Advancements in the Treatment of Diuretic Resistance in Congestive Heart Failure.

This narrative evaluates the dynamic developments that have significantly transformed treatment strategies in the constantly evolving domain of diuretic resistance (DR) management in congestive heart failure (CHF). The discourse explores historical challenges and the current state of therapeutic approaches as it investigates the crucial matter of DR in patients with CHF. An introduction provides a synopsis of the pivotal function diuretics performed in the management of fluid excess and the intricacies associated with CHF. The narrative explores the progressive exposure of the constraints that traditional treatments face, thus underscoring the persistent issue of DR and the imperative for innovative methodologies. The text underscores advancements in pharmacotherapy that demonstrate efficacy in surmounting resistance, including innovative diuretics and combination therapies. Furthermore, it outlines the pivotal shift towards personalized medicine, an approach that transforms the results of treatments through the integration of genetic knowledge and individualized strategies. Furthermore, the text delves into nonpharmacological strategies, including ultrafiltration and renal denervation, that enhance the overall comprehension of the intricate battle against diuretic resistance. In summary, this narrative exemplifies resolute perseverance in the pursuit of solutions, presenting a promising future wherein various developments converge to restore hope in regard to the control of DR and the improvement of the health status of chronic heart failure patients.

Evaluating a digital tool for supporting people affected by breast cancer: a prospective randomized controlled trial—the ADAPT study

PurposeThis study reports the findings from the ADAPT randomized controlled trial (RCT), concerning the impact of a digital tool for supported self-management in people affected by breast cancer on patient activation as the primary outcome, with health-related quality of life (HRQoL), and health status as secondary outcomes.MethodsWomen with early-stage breast cancer were randomly assigned to standard care (control) or standard care in addition to the breast cancer digital tool (intervention). Data were collected using a demographic questionnaire, the Patient Activation Measure (PAM-13), the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), and the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) at baseline, 6 weeks, 3 months, 6 months, and 1 year from diagnosis. Linear mixed effect model regression was used to assess the effect of the digital tool over the first year from diagnosis while correcting for intra-participant correlation.ResultsA total of 166 participants were included, with 85 being randomized into the intervention. No significant differences (p > 0.05) in the PAM-13 scores, EORTC QLQ-C30 scales (global QoL, physical functioning, emotional functioning, pain, fatigue), and EQ-5D-5L Index between the control and intervention groups were observed. It is important to note that there was significant non-adherence within the intervention group.ConclusionThe breast cancer digital tool had no statistically significant impact on patient activation, HRQoL, and health status over time compared to standard care alone in women with early-stage breast cancer. Future research should focus on identifying and addressing barriers to digital tool engagement to improve efficacy.Clinical trial informationThe study was registered at https://clinicaltrials.gov (NCT03866655) on 7 March 2019 (https://clinicaltrials.gov/study/NCT03866655).

On the Possibilities and Significance of Unmanned Aerial Vehicles for the Pre- Hospital Stage of Medical Care

Unmanned aerial vehicles are an important force in search and rescue operations. They help reduce the time needed to search for and provide assistance to the wounded, sick and injured who are located at a large territorial distance and in hard-to-reach places. With the help of computer “vision” and sensors such as noise sensing, binary sensing, vibration and thermal sensing, drones are able to search for living patients not only in the sea, high in the mountains and in mines, but also buried under the rubble of buildings and structures. Such devices demonstrate advantages in emergency and urgent delivery of medical resuscitation and other medical equipment, medicines, blood products and organs for transplantation to patients, especially those in remote locations. With the help of drones, it is possible to effectively sort patients in case of mass sanitary losses, carry out disinfection and remotely monitor the health status of patients with highly contagious infectious diseases and other pathological conditions, as well as reduce the time for providing other medical and humanitarian services to the population. It is obvious that the use of drones requires further study of their promising capabilities, especially in the actual conditions of emergency medical services.

Psychiatric Comorbidities in Women with Complete Androgen Insensitivity Syndrome or Müllerian Aplasia/Agenesis.

Understanding mental health issues facing individuals with disorders/differences of sex development (DSD) is crucial for optimizing evidence-based practices in this population. To compare the prevalence of psychiatric diagnoses among patients diagnosed with complete androgen insensitivity syndrome (CAIS) or Müllerian duct aplasia/agenesis (MA) to male and female reference groups. Retrospective cohort study. Three large integrated health systems. All individuals with confirmed CAIS or MA enrolled in one of three Kaiser Permanente healthcare systems between January 1, 1988, and January 31, 2017. For each DSD patient, age-, race/ethnicity- and health system-matched male and female referents with typical sex development were randomly selected. Mental health diagnoses and use of psychiatric medications. The prevalence of anxiety and depressive disorders in the CAIS and MA cohorts was approximately twice as high as in male referents without DSD, but the corresponding differences relative to female referents were less evident. A subgroup of MA patients with uterine agenesis had higher prevalence of bipolar disorder than either reference group, but these results were accompanied by wide confidence intervals. Women with CAIS and MA more frequently filled psychiatric medications compared to male but not female referents. On balance, these findings are reassuring, albeit requiring confirmation in other settings. Future studies using longitudinal designs and patient-reported outcomes are needed to evaluate changes in mental health status of CAIS and MA patients at different ages and different intervals following initial diagnosis.

Advancing IoMT security: A two-factor authentication model employing PUF and Fuzzy logic techniques

The rapid integration of Internet of Things technologies in healthcare has catalyzed the development of the Internet of Medical Things, markedly enhanced patient care while posing significant security risks. This paper introduces a comprehensive computational framework to safeguard Internet of Medical Things devices and healthcare providers through a sophisticated registration and authentication process. Our model incorporates cryptographic technologies such as Physical Unclonable Functions, fuzzy extractors, and hash functions to bolster the security during the registration and authentication processes for Internet of Medical Things devices and healthcare providers. The Physical Unclonable Function module enhances device security by producing unique, non-replicable responses for device authentication, significantly reinforcing the system's defense against physical and cloning attacks. Furthermore, the model leverages fuzzy logic for the real-time classification of patient health states, enhancing the decision-making accuracy. A comparative analysis confirms that our model exceeds existing models in communication cost, computational efficiency and security. The proposed scheme has been rigorously tested against various attacks using the Scyther tool. By employing a unique identifier generation method through Physical Unclonable Function and utilizing fuzzy logic for secure data transmission and patient classification, our framework addresses vulnerabilities such as man-in-the-middle, denial of service, impersonation, identity guessing, password guessing and replay attacks, which are prevalent in current Internet of Medical Things frameworks.

Prediction of Health Status in Patients Undergoing Lower Extremity Intervention for Claudication

Identifying predictors of generic and disease-specific health status outcomes in patients with lower extremity peripheral artery disease (PAD) who undergo femoral-popliteal peripheral vascular intervention (PVI) for claudication remains an under-studied area. We aimed to identify important predictors of health status after PVI as the foundation for risk-based approaches to deploying therapies that improve patient outcomes. Baseline characteristics of 468 participants with claudication and femoral/popliteal stenosis treated with either the Stellarex paclitaxel-based drug coated balloon (DCB) or plain balloon angioplasty (PTA) from 2013 -2019 were included. The study examined 59 baseline variables and aimed to identify the most important predictors of generic (EQ-5D-3L and EQ-5D visual analogue scale [VAS]) and disease specific (Walking improvement Questionnaire [WIQ]) health status at 1 year. A random forest model was used to generate a rank variables based on their importance in predicting 1-year health status. Among included patients, mean ± SD age was 68.3 ± 9 years with 67.9% and 87% being male and white respectively. Baseline mean EQ-5D-3L, EQ-5D VAS and WIQ were 0.7 ± 0.3, 64.6± 16.0 and 30.7± 22.1, respectively. The most important variables for predicting EQ-5D-3L, EQ-5D VAS, and WIQ were a history of deep venous thrombosis, chronic lung disease and hypertension, respectively. Among patients undergoing PVI for claudication, comorbidities were the most important predictors of future health status, underscoring the need for an integrated approach for PAD disease management. Utilization of machine learning approaches can facilitate development of models to inform risk-based approaches to treatment.

Including carer health-related quality of life in NICE health technology assessments in the United Kingdom.

The impact of health technologies may extend beyond the patient and affect the health of people in their network, like their informal carers. The National Institute for Health and Care Excellence (NICE) methods guide explicitly allows the inclusion of health-related quality of life (HRQoL) effects on carers in economic evaluations when these effects are substantial, but the proportion of NICE appraisals that includes carer HRQoL remains small. This paper discusses when inclusion of carer HRQoL is justified, how inclusion can be substantiated, and how carer HRQoL can be measured and included in health economic models. Inclusion of HRQoL in economic evaluations can best be substantiated by data collected in (carers for) patients eligible for receiving the intervention. To facilitate combining patient and carer utilities on the benefit side of economic evaluations, using EQ-5D to measure impacts on carers seems the most successful strategy in the UK context. Alternatives to primary data collection of EQ-5D include vignette studies, using existing values, and mapping algorithms. Carer HRQoL was most often incorporated in economic models in NICE appraisals by employing (dis)utilities as a function of the patient's health state or disease severity. For consistency and comparability, economic evaluations including carer HRQoL should present analyses with and without carer HRQoL.

A Comparative Study of Metaheuristic Feature Selection Algorithms for Respiratory Disease Classification.

The correct diagnosis and early treatment of respiratory diseases can significantly improve the health status of patients, reduce healthcare expenses, and enhance quality of life. Therefore, there has been extensive interest in developing automatic respiratory disease detection systems. Most recent methods for detecting respiratory disease use machine and deep learning algorithms. The success of these machine learning methods depends heavily on the selection of proper features to be used in the classifier. Although metaheuristic-based feature selection methods have been successful in addressing difficulties presented by high-dimensional medical data in various biomedical classification tasks, there is not much research on the utilization of metaheuristic methods in respiratory disease classification. This paper aims to conduct a detailed and comparative analysis of six widely used metaheuristic optimization methods using eight different transfer functions in respiratory disease classification. For this purpose, two different classification cases were examined: binary and multi-class. The findings demonstrate that metaheuristic algorithms using correct transfer functions could effectively reduce data dimensionality while enhancing classification accuracy.

Examining the health status of patients with COVID-19 hospitalized in Hajar(S) Shahrekord Medical Education Center after discharge

Background and aims: The emergence of some medium—and long-term outcomes following the acute phase of the disease, known as "long COVID-19," poses a challenge to medical science. This study aimed to determine the health status of COVID-19 patients after discharge. Methods: This is a descriptive-analytical cross-sectional study. The research population included all COVID-19 patients hospitalized at Hajar Educational and Medical Center in Shahrekord over three months. The data collection tool was a questionnaire assessing the health status of patients six weeks after discharge. Data analysis was performed using SPSS23 software and descriptive and analytical statistical tests, including Fisher’s exact test and independent t-test. Results: The total number of hospitalized patients was 160. Among them, 21 patients had died, and 72 patients either did not respond to the phone call or provided unreliable information. Ultimately, data were collected from 67 patients. In examining the complications of COVID-19, 34.4% of the study samples reported weakness and fatigue, 13.4% cough, 8.9% dyspnea, and 1.4% skin complications. A significant correlation was observed between the gender variable with dyspnea and cough variable (P=0.001) and between the gender variable with weakness and lethargy variable (P=0.05). In the correlation analysis between the variables of hypertension, diabetes, lung diseases, overweight, brain diseases, and remdesivir drug injection, a significant relationship was observed with COVID complications. Conclusion: The COVID-19 pandemic is not over, and many sufferers suffer from prolonged covid. Gender and underlying diseases are some of the most important underlying factors in the long-term COVID-19. Creating post-COVID care systems for these patients is highly needed and recommended.

Dealing with assisted suicide-knowledge, attitudes and experiences of members of the German Association for Palliative Medicine

In February 2020, the Federal Constitutional Court declared §217 of the German Criminal Code void. Ever since, assisted suicide services have been legal in Germany. This study aims to describe the knowledge, attitudes and experiences of members of the German Association for Palliative Medicine (DGP) regarding assisted suicide. Online survey with members of the DGP from July to September 2023 using Qualtrics®. The study group developed the questionnaire based on current literature; it was adapted following an initial application among young physicians and an interprofessional panel of experts with consensus voting. Data was analysed using descriptive and explorative statistics. 991 DGP-members (18%) participated, of which physicians made up 57.0% (n = 545/957) and nurses 23.4% (n = 224/957). Of the participants, 197/851 (23.1%) incorrectly stated that assisted suicide is prohibited by professional code, 430/914 (47.1%) rejected arestriction of palliative care teams to suicide prevention measures, and 766/930 (82.4%) rejected personal involvement in assisted suicide regardless of a patient's health status. For patients in palliative situations, 473/926 (51.1%) could imagine participating in assisted suicide, and 71% wantednew legislation regulating assisted suicide. There are gaps in the knowledge of the participating members of the DGP regarding the legal and professional status of assisted suicide. Further educational work is needed in this regard. The participants can more easily imagine assisted suicide for people in palliative disease trajectories. As in surveys of members of other medical societies, the attitudes of more experienced staff are reflected. Compared to younger healthcare professionals, they have amore restrictive attitude towards the concept of assisted suicide.

Depressive symptomatology, NT-proBNP levels and health status in patients with heart failure: a prospective observational study

BackgroundDepressive symptoms frequently occur in patients with heart failure (HF). However, research on the relationship between these symptoms and N-terminal pro-brain natriuretic peptide (NT-proBNP), a key biomarker for HF severity...

Early integration of palliative care versus standard cardiac care for patients with heart failure (EPCHF): a multicentre, parallel, two-arm, open-label, randomised controlled trial

Heart failure is a substantial global health concern that severely affects patients' quality of life. We aimed to compare the effects of early integration of palliative care (EIPC) and standard cardiac care on health status and mood of patients with non-terminal heart failure. EPCHF was a multicentre, parallel, two-arm, open-label, randomised controlled trial carried out at University Hospital Bonn and University Hospital Düsseldorf in Germany. Eligible patients (aged 18years or older) had heart failure, with New York Heart Association class IIor more and NT-proBNP concentrations greater than or equal to 400pg/mL. Patients were randomly assigned (1:1) to receive EIPC with standard cardiac care or standard cardiac care alone. Randomisation was computer-generated with allocation concealment, variable block sizes, and stratification by investigational site. The primary endpoints were health status and mood, measured every 3months over 12months using the Functional Assessment of Chronic Illness Therapy-Palliative Care (FACIT-PAL) and the Kansas City Cardiomyopathy Questionnaire (KCCQ), analysed by intention to treat. This trial is registered with DRKS.de, DRKS00013922. Between May 21, 2019, and Nov 15, 2021, 843patients were assessed for eligibility, 205of whom were enrolled (100 assigned to EIPC and 105assigned to standard cardiac care). 143 (70%) patients were male and 62 (30%) were female. Over 12months, both groups significantly improved in FACIT-PAL and KCCQ Overall Summary Score(OSS) with no significant differences between the groups (FACIT-PAL adjusted mean difference 0·98points [95% CI -1·28to 3·23]; p=0·40; KCCQ-OSS adjusted mean difference -2·06points [-7·89to 3·78]; p=0·49). Nine (9%) patients in the EIPC group and seven (7%) patients in the standard cardiac care group died from any cause, with no significant differences in time to death between the two groups (hazard ratio [HR] 1·32 [95% CI 0·49 to 3·54]; p=0·58). 22 (22%) patients in the EIPC group and 21 (21%) patients in the standard cardiac care group were hospitalised at least once due to heart failure, with no significant differences in time to heart-failure-related hospitalisation between the two groups (HR 1·09 [0·61 to 1·98]; p=0·77). 70 (70%) patients in the EIPC group and 62 (59%) in the standard cardiac care group had any adverse events (p=0·10). In this open-label, randomised clinical trial, standard cardiac care, featuring guideline-directed optimisation of medical therapy and regular 3-monthly follow-ups was found to be as effective as when combined with EIPC in improving health status and mood in patients with non-terminal heart failure. Future clinical practices should consider EIPC based on individual patient needs. Federal Ministry of Education and Research.

Vitamin D combined with whole-body vibration training for the treatment of osteo-sarcopenia: study protocol for a randomized controlled trial.

Osteo-sarcopenia (OS) has become a global public health problem and a frontier research problem, as a combination of sarcopenia (SP) and osteoporosis (OP) diseases. The clinical performances include muscle weakness, systemic bone pain, standing difficulty, even falls and fractures, etc., which seriously affect the patient's life and work. The pathological mechanism of the OS may be the abnormal metabolism which disrupts the equilibrium stability of the musculoskeletal system. Therefore, this study combined vitamin D (Vit. D) and whole-body vibration training (WBVT) to intervene in subjects of OS, aiming to evaluate the effectiveness and safety of the diagnosis and treatment protocol and to explore the efficacy mechanism. We propose a multicenter, parallel-group clinical trial to evaluate the efficacy and safety of Vit. D combined with WBVT intervention in OS. Subjects who met the inclusion or exclusion criteria and signed the informed consent form would be randomly assigned to the WBVT group, Vit. D group, or WBVT+ Vit. D group. All subjects will be treated for 1 month and followed up after 3 and 6 months. The primary outcomes are lumbar bone mineral density (BMD) and appendicular skeletal muscle mass (ASM) measured by dual-energy X-ray absorptiometry (DXA) and handgrip strength measured by grip strength meter. Secondary outcomes include serum markers of myostatin (MSTN), irisin and bone turnover markers (BTM), SARC-CalF questionnaire, 1-min test question of osteoporosis risk, patient health status (evaluated by the SF-36 health survey), physical performance measurement that includes 5-time chair stand test, 6-m walk, and the short physical performance battery (SPPB). If Vit. D combined with WBVT can well relieve OS symptoms without adverse effects, this protocol may be a new treatment strategy for OS. After therapeutic intervention, if the serum marker MSTN/irisin is significant, both have the potential to become sensitive indicators for screening OS effective drugs and treatments, which also indicates that WBVT combined with Vit. D plays a role in improving OS by regulating MSTN/irisin. Chinese Clinical Trial Registry ChiCTR2400082269 . Registered on March 26, 2024.