bluuebunny/crossref_metadata_2025 huggingface dataset:
The Spiritual Exercises of Antonio Cassese and the Re-Forming of a ‘European Tradition’ of International Law
Authors: Hasan Khan Adil
Published: July 2024

This article describes Antonio Cassese’s vital influence on the ‘European tradition of international law’ through an attentiveness to those specific activities through which Cassese, as heir, received this tradition and through which Cassese, as ancestor, transmitted it. The specific activity that the article chooses to describe is that of writing – one of the several activities through which a tradition might be transmitted and received. It does so especially through close readings of several pieces of international legal writing wherein Cassese explicitly sought to dialogically redescribe the practices of an older generation of Euro-American international lawyers, including The Tokyo Trial and Beyond (1994) and Five Masters of International Law (2011). This training repertoire is his ‘spiritual exercises’, and, as the article shows, it invites others to take up their role as international lawyers and to conduct themselves as international lawyers in a specific way by cultivating in them conscience as a capacity to actualize judgment in the world.
Adulthood adiposity affects cardiac structure and function in later life
Authors: Al Saikhan Lamia , Chaturvedi Nish , Ghosh Arjun K , Hardy Rebecca , Hughes Alun
Published: July 2024

Background and Aims

Excess adiposity is associated with poorer cardiac function and adverse left ventricular (LV) remodelling. However, its importance over the adult life course on future cardiac structure and systolic and diastolic function is unknown.

Methods

A total of 1690 participants in the National Survey of Health and Development birth cohort underwent repeated adiposity [body mass index (BMI)/waist-to-hip ratio (WHR)] measurements over adulthood and investigation, including echocardiography at age 60–64 years. The relationship between LV structure [LV mass (LVM), relative wall thickness, and LV internal diameter in diastole (LVIDd)] and function (diastolic: E/eʹ, eʹ, and left atrial volume indexed to body surface area; systolic: ejection fraction, Sʹ, and myocardial contraction fraction) was investigated using multivariable linear regression models.

Results

Increased BMI from age 20 years onwards was associated with greater LVM and LVIDd independent of confounders. Associations remained independent of current BMI for LVIDd and at age 26, 43, and 53 years for LVM. Increased BMI from 43 years onwards was associated with greater relative wall thickness, but not when BMI at age 60–64 years was accounted for. Increased BMI at age 26, 36, and 53 years and at 20 years onwards was associated with lower ejection fraction and myocardial contraction fraction, respectively, but not independently of BMI at 60–64 years. Higher BMI from 20 years onwards was associated with poorer diastolic function independent of confounders. Associations between BMI and left atrial volume indexed to body surface area persisted from 26 years onwards after adjustment for BMI at 60–64 years. Similar relationships were observed for WHR from age 43 years onwards.

Conclusions

Higher adiposity (BMI/WHR) over adulthood is associated with evidence of adverse cardiac structure and function. Some of these associations are independent of adiposity in later life.
Differences and changes: a qualitative study of concerns about self-care among heart failure patients hospitalized for the first time and their multidisciplinary providers
Authors: Shogaki J , Fukuda A , Imai M , Yasuno S , Park S M , Asai M , Umezawa M , Nakayama N , Watanabe M , Miyawaki I
Published: July 2024

Background

Patient-centred multidisciplinary teams must facilitate self-care while addressing the patient’s concerns. Because the concerns of heart failure patients admitted to the hospital for the first time do not always coincide with the principles of self-care for heart failure, providers need to carefully understand their patients’ particular concerns. However, little research has been conducted on the specific concerns of such patients and their providers.

Purpose

This study sought to clarify the concerns of patients with first-time heart failure and their multidisciplinary team of providers during first-time hospitalization and at the first outpatient visit.

Methods

Individual and focus group interviews about self-care for heart failure were conducted with 10 patients hospitalized with heart failure for the first time and their multidisciplinary team of providers (eight physicians, nine nurses, seven physical therapists, two pharmacists, and two dieticians). Patients were interviewed during hospitalization and at the first outpatient visit, while the healthcare providers were interviewed either during hospitalization or at the first outpatient visit. Mayring's qualitative content analysis was used to analyse the interviews.

Results

The analysis identified eight themes. Those extracted from interviews with patients were ‘meaning of symptoms experienced’, ‘continuation of daily life before hospitalization’, ‘healthy living’, and ‘relapse of painful symptoms’. Meanwhile, those extracted from interviews with healthcare providers were ‘improving clinical heart failure status’, ‘health literacy for heart failure self-care’, and ‘post-discharge environment for continued self-care’. The theme ‘self-care to prevent heart failure from worsening’ was extracted from patients and providers. ‘Self-care to prevent heart failure from worsening’ was also more frequently reported during the initial outpatient discharge than during inpatient hospitalization.

Conclusion

This study revealed that the concerns of patients hospitalized with heart failure for the first time generally differ from those of the healthcare providers comprising their multidisciplinary treatment team. Furthermore, the findings showed that patients were more interested in self-care for heart failure during their first outpatient visit than their hospital stay. Ultimately, the study highlights that healthcare providers working in multidisciplinary teams to support first-time inpatients with heart failure should understand patient concerns, which notably include but are not limited to self-care, and work to support their patients’ self-care by remaining attentive and responsive to their patients’ changing concerns, placing them at the centre of treatment.
Nurse-lead ambulatory follow-up of patients with heart failure compared to physician-guided management - experience of a single academic center
Authors: Georgieva M , Rushid M R , Yotov Y T
Published: July 2024

Background

The follow-up of patients with chronic heart failure by a nurse in an outpatient clinic showed to be as effective as physician management for clinical and prognostic improvement of patients with chronic heart failure (CHF). The role of nurses is important and would improve the general condition of patients.

Aim

To determine the effect of nurse-lead ambulatory follow-up of patients with heart failure –when compared with physician-guided management of patients with CHF.

Participants and methods

Overall, 72 patients with HF were included in a structured ambulatory program after hospital discharge following the OptimizeHF Care Program protocol, with the active participation of a nurse in it. The patients were divided into two groups – group A – mostly managed by a trained nurse, and group B – predominantly led by a cardiologist with the helpof the nurse. Advice on diet and physical activity for all patients was provided by the nurse according to an established protocol and in accordance with current recommendations for non-pharmacology behavior in heart failure at the beginning of follow-up and at each visit.We use self-reported readiness of patients to comply with dietary and physical activity guidelines to measure adherence to the program at the end of the follow-up period.

Results

The patients in group A (21) were insignificantly more often females, with slightly higher ejection fraction, and a little bit older tjhn group B (61). After a 6-month follow-up, 61 finished the program. There was no significant difference in the outcomes – death or hospitalizations, between the groups . In group A, the improvement in the NT-pro BNP levels was more pronounced –94.7% vs 74.4% in group B (p=0.024). Numerically, nurse-lead patients had more often improvement in their functional capacity with 1 NYHA class – 95% vs 84% (p=0.23). Both groups had similar improvement in the 6-minute walking test and there was no difference in hemodynamic measurements and laboratory tests.

The majority of the patients followed the advice for diet and physical activity – 81.7%. There was no significant difference in this indicator between the group managed by the nurse and that by the physician. The same similarity was recorded in the drug therapy at the end of the follow–up.

Conclusions

Our results confirm that the nurse-lead program for ambulatory management of patients with CHF is effective and safe compared to physician management and can be applied in various health systems. This will increase the importance of the health care professionals in the HF team.
Finding peace in a new version of oneself- a qualitative study of post operative patients after aorta dissection and their experiences of cardiac rehabilitation
Authors: Rosenstroem S , Anette Sjoel A S
Published: July 2024

Background

Aortic dissection, characterized by a sudden rupture in the carotid artery allowing blood to enter the aortic wall. The mortality rate is 1% per hour, and half of the patients die within 48 hours. Following surgery, patients are advised to limit arm lifting to 2 kg, maintain strict blood pressure control for life, and engage in physical activities that do not strain the aorta. Despite the limited evidence on optimal rehabilitation, our University Hospital in Denmark has established a team that secure patients with aortic dissection a structured post operative rehabilitation program.

Aim

This study aims to explore the experiences and importance of a specialized rehabilitation program for individuals post-surgery for aortic dissection.

Method

A qualitative interview study, analyzed using content analysis inspired by Graneheim & Lundman. Interview participants were recruited through the physiotherapist at the hospital either at the end or shortly after their rehabilitation program. Interviews were conducted over the phone or in a private room at the hospital.

Results

Based on interviews with eight patients (three women and five men aged 43-73), an overarching theme emerged; "Finding peace in a new version of oneself." This theme encapsulates the journey of adapting to a new identity with a changed body that has limitations, combined with a sense of gratitude for being alive. Three subthemes describe the period from surgery to the end of the rehabilitation course: 1) Surviving the operation - the initial miracle and the subsequent uncertainties, 2) The rehabilitation course enhance a sense of security and well-being, and 3) Reclaiming wholeness.

Conclusion

A specialized rehabilitation program proves to be a crucial support in helping individuals with aortic dissection find peace in their altered selves after facing a life-threatening trauma. These patients require comprehensive physical and psychological support through cardiac rehabilitation provided by cardiac nurses, along with prompt initiation of specialized rehabilitation led by physiotherapists with expertise in aortic dissection.
Contrast-induced nephropathy: nursing interventions - a scoping review
Authors: Jesus Coelho M , Santos J O A N A , Alves N U N O
Published: July 2024

Introduction

Contrast-induced nephropathy (CIN) refers to a reduction in renal function following contrast administration, excluding other causes. It is characterized by na increase in creatinine levels of 0.5mg/dl or greater, or a 25% increase over baseline creatinine, occurring 48 to 72 hours post-contrast administration and lasting for 2 to 5 days (Santos et al., 2011). Antunes et al. (2013) refers that the CIN is the 3rd cause of acute renal insufficiency (ARI) and that CIN may develop in up to 55% of patients who receive contrast exposure during coronary angiography and of these may result in 12,6% requiring dialysis among high-risk groups following percutaneous coronary intervention (PCI) (Wu et al., 2022).

Objective

This review aims to map the available evidence regarding nursing interventions to prevent contrast-induced nephropathy in patients undergoing PCI.

Methods

The review follows the methodology proposed by the Joanna Briggs Institute guided by the PCC (Population, Concept, Context) strategy. Were identified 44 articles by MEDLINE Complete (via PubMed), CINAHL Complete (via EBSCO) e SciELO, and analyzed/ selected through PRISMA Scr flowchart. Four articles were included.

Results

These articles revealed that the incidence of CIN varies based on risk factors such as age, hypertension, and pre-existing chronic kidney disease. As there is no specific treatment for contrast-induced nephropathy, prevention strategies are essential. Nursing professionals have a significant and privileged role in the pre-, intra-, and post-procedural phases, and thus, are best positioned to implement prevention strategies for CIN. In general, hospitals that implemented improvement interventions reduced CIN by 21% compared to the pre-intervention phase. Compared to patients with pre-existing CKD, the reduction was 28% (Lambert et al., 2017). Teams also report important successes in implementing improvements, such as changing behavior with greater awareness of CIN prevention strategies, implementing the hydration protocol, standardizing medical prescriptions and minimizing the volume of contrast administered.

Conclusions

Nursing plays a crucial and privileged role in preventing CIN. Key interventions involve conducting a thorough initial assessment to identify individuals at risk for CIN (considering factors such as age, comorbidities, nephrotoxic medication, and dehydration). Pioli et al. (2023) found that oral hydration can be effective in the process of preventing CIN, before and after elective percutaneous procedures. It concluded that the oral hydration protocol carried out by nurses proved to be as effective as the hospital intravenous hydration protocol in protecting the kidneys of individuals at risk of developing CIN associated with elective coronary interventions (Picture 1). By implementing these strategies, nursing professionals can effectively contribute to reducing the incidence of contrast-induced nephropathy in patients undergoing PCI.
Clinical scores associated with immunological biomarker in the assessment of severity in congenital heart surgery
Authors: Batista Cabral J , Silveira M M B M S , Xavier A T X , Oliveira F H P C O , Menezes T M G L A M , Barbosa K T F B , Teodorio D S A T , Nascimento J E A , Moura Junior J F M J , Sobral Filho D C S F , Oliveira D C O
Published: July 2024

Background

Congenital heart disease is a common disorder that often results in surgical procedures and intensive care. In this way, the use of validated scales and biomarkers can be incorporated into care practice as a tool for assessment and care planning.

Purpose

We aimed to investigate the association between the Therapeutic Intervention Scoring System (TISS-28), the risk-adjusted score for surgery in congenital heart disease (RACHS-1) and the triggering receptor expressed on myeloid cells-1 (sTREM-1) in assessing the clinical severity of cardiac surgery in pediatric patients.

Methods

This is an exploratory, translational cross-sectional study of 32 children undergoing cardiac surgical repair between 2021 and 2022. The severity of heart disease was determined using the RACHS-1 score and clinical severity using the TISS-28, the scores were stratified into C4, C3, C2 and C1, with C4 being the highest severity and C1 being the lowest, according to each assessment instrument, and the associations with sTREM-1 (pre- and post-surgery), measured by the ELISA method. The data were analyzed using the Statistical Package for the Social Sciences - SPSS version 29.0 software, considering statistical significance values of p < 0.05.

Results

Regarding the mean sTREM-1 values preoperative in comparison to the RACHS-1 categories, there was a significant difference between category C4 (241.33 pg/mL) and C3 (161.5 pg/mL) (p = 0.019), and postoperatively between C4 (355.82 pg/mL) and C1 (222.53 pg/mL), C2 (291.02 pg/mL) and C3 (296.66 pg/mL) (p = 0.005; 0.040; and 0.040, respectively). Preoperative, compared to the TISS-28 and sTREM-1 categories, there was a significant difference between category C4 (241.33 pg/mL) and C3 (161.5 pg/mL) (p = 0.020), and postoperatively, between categories C4 (355.82 pg/mL) and C2 (275.22 pg/mL) (p = 0.040).

Conclusions

We concluded that, both pre- and postoperatively, the mean sTREM-1 values were higher in the group of patients classified as more severe according to the RACHS-1 and TISS-28, when compared to those in the lower strata, showing that patients with higher sTREM-1 values preoperative evolved to greater severity postoperatively, a fact that was repeated in the post-operative evaluation.Table - RACHS-1 and sTREM-1Table - TISS-28 and sTREM-1
Hypertension management and outcomes during the covid-19 pandemic: diagnosis, blood pressure telemonitoring use and mortality
Authors: Hanley J , Paterson M , Pollock R , Parker R , Neubeck L , Atherton I , Mchale S , Pearsons A , Mckinstry B , Guthrie B
Published: July 2024

Introduction

The effects of COVID-19 on people with hypertension are poorly understood, but potentially severe both due to increased risk of cardiovascular events post covid (1) and by altering the way people accessed healthcare (2). This study aimed to explore the immediate impact of COVID-19 on the hypertensive population in Scotland.

Methods

The study used linked routine clinical data. Hypertensive patients from five NHS Scotland Health Boards were identified through the Prescribing Information System (PIS) between March 2019 and February 2021. Linked data included Blood Pressure (BP) telemonitoring data from the Connect Me BP service, outcome data (cardiovascular events and mortality) from Scottish Morbidity Records, and National Records of Scotland COVID-19 testing and vaccination records from Public Health Scotland (PHS). Follow up was until February 2022.

EDRIS, the research arm of PHS, linked and pseudonymised the data and transferred it to the secure national safe haven analysis platform for access by the research team. The study was approved by the Public Benefit and Privacy Panel for Health and Social Care.

Results

Almost 450,000 people with hypertension were identified across the whole adult age range, 52% male. Of those, 89% had been diagnosed prior to the study. New diagnoses dropped by over 50% during the first year of the COVID-19 pandemic. The use of long term BP telemonitoring increased rapidly during the pandemic from 5000 to over 10,000. Overall mortality was over 8%. Mortality rates showed a similar pattern to the general population during the pandemic and remained above pre-pandemic levels until the end of the follow up period in February 2022.

Discussion

BP telemonitoring supported healthcare delivery at a time when normal services were severely disrupted due to COVID-19. However the data suggests that there may be an increase in the number of people with undiagnosed hypertension with associated raised cardiovascular risk. Mortality in this population was increased by the COVID-19 pandemic and remained above pre-pandemic levels.
Relationship between duration of heart failure and nutritional status in hospitalised patients - preliminary cross-sectional study
Authors: Furtak J , Sawczak F , Gargula D , Garstka J , Szubarga A , Cierzniak M , Soloch A , Krzysztofiak H , Tomaszewska M , Dudek M , Straburzynska-Migaj E , Kaluzna-Oleksy M
Published: July 2024

Introduction

Heart failure (HF) is a chronic disease which is one of the most common causes of hospitalisation of elderly patients. Nutritional status has a crucial impact on the course of disease and survival. HF frequently occurs with nutritional deficits, which may lead to malnutrition and loss of skeletal mass, which makes the prognosis worse. Nutritional status depends also on the patient's economic status, ability to prepare meals, and availability of fresh vegetables and fruits. Knowledge of the connection between the duration of heart failure and nutritional status will enable selection of patients with a higher risk of malnutrition, for which nutritional support should be considered.

Purpose

The study aims to assess the variability of nutritional status in heart failure patients over the duration of the disease, using the Mini Nutritional Assessment (MNA) and Geriatric Nutritional Risk Index (GNRI).

Methods

The nutritional status of 134 patients with HF admitted to the cardiology department was assessed with the MNA questionnaire. Additionally, GNRI has counted from serum albumin concentration, weight and height of patients. Patients were divided according to the duration of HF into two groups, one with patients with equal or less than five years of history of disease and the second with patients with HF lasting more than five years.

Results

The mean age was 52.4±16.9 years, 20.2% of patients were women, and the mean LVEF was 30.3±13.8%. The group of patients with HF lasting equal or less than five years was younger than patients with more than five years of the disease (49.5±16.9 years vs. 57.3 ±16.2 years, p=0.002). There were no significant differences in sex, LVEF and NYHA class between the two groups. According to MNA and GNRI scores, the nutritional status had no differences between the group of patients suffering from HF for more than five years compared with those with HF lasting 5 years or less (p=0.50; p=0.63, respectively). Moreover, the time of HF lasting was not correlated with scores of MNA and GNRI (p=0.33; p=0.22).

Conclusions

The study found no significant association between the nutritional status of patients and duration of heart failure. Therefore, monitoring nutritional status is crucial, irrespective of the duration of HF. It is necessary to analyse this issue in a larger group of patients with heart failure to identify specifically which patients are at risk of malnutrition and how nutritional status changes with the duration of the disease.
Causes and effects of childhood obesity
Authors: Trafalska A , Kulinska J , Krzyzanowski D
Published: July 2024

Background

Childhood and adolescent obesity and overweight is a major public health crisis nationally and internationally.. Obesity in childhood increases the risk of cardiovascular diseases, hypertension, lipid and carbohydrate metabolism disorders, including type 2 diabetes, abnormalities resulting from posture defects, and furthermore obesity in adulthood. Excessive body weight is also the cause of many emotional disorders related with lack of acceptance by oneself, family and peers.

An analysis of the prevalence of obesity among children hospitalized in the Department of Rehabilitation was conducted in 2020-2023. Excessive body weight occurred in 23% of the examined patients.

Purpose

The aim of the study is to show the incidence of obesity and overweight among children hospitalized in the Department of Rehabilitation, to determine the cause of the disease based on the author's survey, which took into account the lifestyle of the examined patients, and to examine the relationship between body weight and elevated blood pressure values. The results were subjected to statistical analysis.

Methods

The clinical trial was conducted on 1,283 pediatric patients. The data were analyzed: weight, height, BMI, blood pressure and then the obtained values were placed on percentile charts. An original questionnaire was also conducted - took into account the age, gender, lifestyle, eating habits and physical activity of the respondents.

Results

23% of hospitalized patients indicated excessive body weight. 10% of patients were obese and 13% were overweight. Back pain was the reason for hospitalization in 76% of overweight and obese children. Among children with excessive body weight, 25% indicated higher blood pressure values, while in the control group, this problem affected only 1% of respondents. A relationship has been shown between lack of physical activity, excessive body weight and problems with the locomotor system - 72% of overweight and obese children didn’t engage in any regular physical activity. After school, children spent their time mainly in a sitting or semi-reclining position. Moreover, 60% of parents reported that they don’t know what their child's diet looks like. Most teenagers admitted to eating meals irregularly, snacking between meals, and drinking sweetened drinks and leaving home without breakfast.

Conclusions

Obesity and overweight among children and adolescents is a significant public health problem in both medical and social dimensions. Counteracting obesity should start in early childhood and should be based on the lifestyle that includes proper nutrition and physical activity. Factors contributing to overweight and obesity include: lack of daily physical activity, avoiding exercise during physical education classes, spending many hours in a sitting position and inappropriate eating habits.
Pediatric nurses in Greece, investigation of knowledge and attitude towards the predisposing factors of coronary heart disease
Authors: Argyropoulos T , Yfanti A M A L I A
Published: July 2024

Introduction

Today, everyone agrees that the best treatment of coronary artery disease is its prevention through understanding the role and, of course, controlling the predisposing factors, i.e. those particular characteristics whose presence predicts the occurrence and progression of the disease. As Health professionals, nurses must know about the predisposing factors, participate in prevention programs, and advise on the Algorithm of Care.

Objective

To investigate pediatric nurses' knowledge about the predisposing factors of coronary Heart disease and assess the degree of risk of developing coronary heart disease based on the prevention measures they take and their lifestyle.

Material and Methods

The study sample consisted of 164 working nurses in our Pediatric hospitals, and its duration was four months. A specially designed questionnaire was used for data collection, which was distributed to employees of different departments and was answered by a total of 164 nurses. The questionnaire was weighted to check its validity, and minor adjustments were made for the study.

Results

Pediatric nurses identify the most important predisposing factors of coronary heart disease as hypertension, smoking, dyslipidemia, and stress as a result of their profession. They have a significantly increased body mass index, poor dietary habits, and appear negligent in preventive cardiac screening.

Conclusions

The level of knowledge of Greek pediatric nurses regarding the prevention of coronary heart disease is satisfactory. Their working environment, stress, lifestyle, and lack of regular check-ups make them extremely vulnerable to the predisposing factors of coronary heart disease.
The development of a disease-specific patient-reported outcome measure (CARD-SARC) to assess the impact of cardiac sarcoidosis on health-related quality of life
Authors: Quijano-Campos J C , Sekhri N , Thillai M , Blower E , Clarke H , Murphy E , Othen-Price L , Whight J , Sanders J
Published: July 2024

Introduction

Sarcoidosis is a rare inflammatory condition caused by the formation of lumps (granulomas) of abnormal tissue in any organ, and can affect physical, functional, mental, social and economic aspects of life. People living with cardiac sarcoidosis (CS) are likely to have worse clinical outcomes and greater impairment on health-related quality of life (HRQoL) than other sarcoidosis manifestations. HRQoL is the main concern for people living with sarcoidosis. However, measuring HRQoL in people with CS is difficult as existing tools focus on other forms of sarcoidosis (for example, lung, eye or skin involvement) or for specific cardiac symptoms (for example, atrial fibrillation, angina or heart failure), but not specifically for CS.

Purpose

To develop a disease-specific patient-reported outcome measure (CARD-SARC) to assess the impact of CS on HRQoL.

Methods

A sequential exploratory mixed-method, multicentre observational cohort study using a clinimetric approach was conducted. The McMaster Framework for evaluative instruments was combined with the consensus-based standards for the selection of health measurement instruments (COSMIN) recommendations, involving three steps: item selection, item scaling and item reduction. The item-generation process used simultaneous triangulation (QUAN+qual) method, connecting quantitative data (theory, research findings and systematic review) with complementary qualitative components (interviews, clinical observations and experts’ opinion). The formatting of items was guided by patient and public involvement (PPI). The item reduction strategy was led by PPI and an international multidisciplinary clinical CS-experts.

Results

740 potential items were generated by converging all the different sources and techniques. After removal of duplicates and simultaneous triangulation, a preliminary list with 111 items was reviewed by the CS-expert panel (including 11 pulmonologists, 7 cardiologists, 5 CS-patients and 3 specialist-nurses). After a consensus meeting, the CARD-SARC included 61 relevant items in six sections for pilot-testing: "functioning", "social, leisure and occupation", "emotional", psychological", "physical" and "healthcare/self-care".

Conclusions

This study used a robust methodology and active PPI involvement to develop the first disease-specific HRQoL tool for CS. The engagement and contributions of the PPI group in each step of the framework enhanced the content validity of the CARD-SARC. The CARD-SARC has the potential to influence clinical management and treatment options, future research and health-economic stakeholders’ decisions for CS.
Prevalence of frailty and associated factors in coronary artery bypass graft surgery patients
Authors: Arikan B , Demir Korkmaz F
Published: July 2024

Background

Frail patients are at increased risk for postoperative delirium, complications, delayed recovery, prolonged hospital and intensive care unit stay, morbidity and mortality. The number of studies examining frailty in cardiovascular surgery patients is limited (1,2). In this context, it is important to determine the prevalence of frailty in cardiac surgery patients (3,4).

Purpose

This research was conducted to examine the prevalence of frailty in coronary artery bypass graft surgery patients and associated factors with frailty.

Methods

The research was descriptive cross-sectional type. It was conducted between 18.02.2021 and 18.02.2022 at the cardiovascular surgery department of a training and research hospital in Turkey. A total of 96 patients who had undergone coronary artery bypass graft (CABG) were included. The "Sociodemographic and Clinical Data Form" which was prepared in accordance with the literature, the "Modified Fried Frailty Index", the "Mini Nutritional Assessment Test-Short Form", the "Barthel Daily Living Activities Index", the "Charlson Comorbidity Index", and the "Montreal Cognitive Assessment Scale" were used to collect data. The data were analyzed using the SPSS 23.0 package program. Descriptive statistics, Kolmogorov-Smirnov test, Chi-square test, One Way ANOVA, Kruskal Wallis test and multinomial logistic regression analysis were used in the evaluation of the data.

Results

As a result of the study, the mean age of the patients was 65.65±8.72 years (min:40-max:85), 62.5% consisted of males. The majority of patients (94.8%) had comorbid diseases, most of whom had hypertension (66.7%) and diabetes mellitus (63.5%). The mean ejection fraction of the patients was normal (54.59±8.70) according to the European Society of Cardiology and the majority (80.2%) were in the preserved LVEF group. The mean EuroSCORE was intermediate (4.79±2.40) and 49% of the patients were at intermediate risk for mortality. The majority of the patients (94.8%) were in the ASA III class according to the American Society of Anaesthesiologists. Of the patients. 14.6% were determined as ‘non-frail’, 45.8% as ‘pre-frail’ and 39.6% as ‘frail’. Age, educational status, income level, beta-blocker use, nutritional status, daily living activities, cognitive status, number of comorbidities, and level of potassium, procalcitonin and creatinine were found to be associated with frailty (p<0.05). Malnutrition, decreased daily living activity, cognitive impairment and creatinine elevation were found to be predictors of frailty (p<0.05). Sociodemographic and Clinical Characteristics by Frailty Status was presented in Table 1.

Conclusions

More than a third of CABG patients were frail. Malnutrition, decreased daily living activity, impaired cognitive status and high creatinine levels increased the risk. It is important to assesment frail cardiac surgery patients and provide them with appropriate nursing management.
Psychometric properties of the KCCQ-12 in an european cohort of patients with heart failure
Authors: Paolo Iovino P I , Hamilton Dollaku H D , Gianluca Pucciarelli P G , Laura Rasero L R , Izabella Uchmanowicz I U , Rosaria Alvaro R A , Ercole Vellone E V
Published: July 2024

Background

Despite medical advances, patients with heart failure continue to suffer from poor quality of life due to worsening symptoms and functional limitations. Therefore, it is important to understand the multidimensional facets of quality of life in these patients. The Kansas City Cardiomyopathy Questionnaire is a commonly used quality of life assessment tool worldwide. However, However, there is still a lack of knowledge about its psychometric properties.

Purpose

The aim of this study was to investigate the psychometric properties of the KCCQ-12 and its measurement invariance in a cohort of European patients with heart failure.

Methods

Participants (n=510, median age=72, IQR=18, 58% males) completed the KCCQ-12 alongside measures of clinical psychosocial severity. A confirmatory factor analysis was used to establish factorial validity; internal consistency was determined using the Omega coefficient and the model-based internal consistency coefficient. Zero-order correlations between the KCCQ-12 scores and clinical and psychosocial measures were performed to test convergent validity. Multigroup confirmatory factor analysis was conducted to test measurement invariance across patients with preserved vs reduced ejection fraction.

Results

Confirmatory factor analysis confirmed a four-factor solution, with the domains of physical limitations, symptom frequency, quality of life, and social interference. Internal consistency was excellent (Omega coefficients ranging from 0.83 and 0.90, and internal consistency index of 0.94). The KCCQ-12 scores significantly correlated with ejection fraction, New York Heart Association class, quality of life, anxiety, depression, symptom burden, and the KCCQ-23 Overall Summary score, which adequately supported the convergent validity of the KCCQ-12. Measurement invariance was confirmed at the partial scalar and strict level.

Conclusions

These findings support the validity and reliability of the KCCQ-12, both in patients with reduced and preserved ejection fraction. Hence, this version can be confidently used both in research and clinical practice to measure quality of life of heart failure patients.
Inequality in continuity of care after hospitalization due to cardiac conditions
Authors: Safstrom E , Stromberg A S
Published: July 2024

Background

Cardiac conditions are a common cause of hospitalization worldwide. The need for follow-up within primary care and/or specialized care continues after discharge. Continuity of care is crucial to enable a seamless chain of care after hospitalization. Research regarding inequality in continuity of care after discharge is lacking.

Purpose

The aim was to investigate how patients’ perceptions of continuity of care vary between age, gender, and diagnosis groups.

Methods

Patients were consecutively included within six weeks after hospitalization due to a cardiac condition. Data were collected with the short version of the Patient Continuity of Care Questionnaire (PCCQ-12).

The independent t-test was used to compare differences between sexes and age groups (< 65 years or ≥ 65 years). Differences between diagnosis groups were evaluated with the one-way analysis of variance (ANOVA) and post-hoc analysis with the least significant difference (LSD) correction. The significance level was set at p <0.05 for all analyses.

Results

A total of 1,000 patients were included (mean age 72 years (SD 10) 66% male). The patients were hospitalized due to myocardial infarction (36%), atrial fibrillation (26%), angina pectoris (21%) or heart failure (17%).

Significant differences between age, gender and diagnosis were found: Patients < 65 years perceived significantly higher levels of continuity of care than patients ≥ 65 years. Men had significantly higher scores than women. Patients hospitalized due to acute myocardial infarction perceived significantly higher levels of continuity of care compared to patients who had been hospitalized due to angina pectoris, atrial fibrillation, or heart failure (Table 1).

Significant differences were also found between men and women. Men <65 years perceived significantly higher levels of continuity of care (mean 48.08) compared to men ≥ 65 years (mean 45.51, p= 0.008 ). Men who had been hospitalized due to myocardial infarction had significantly higher scores on the PCCQ-12 (mean 48.82) compared to men who had been hospitalized due to angina (mean 44.48), atrial fibrillation (mean 44.09) and heart failure (mean 45.24) (Figure 1).

Women <65 years had significantly higher scores on the PCCQ-12 (mean 45.00) compared to women ≥ 65 years (mean 40.71, p 0.018). Women who had been hospitalized due to myocardial infarction or atrial fibrillation had significantly higher scores on the PCCQ-12 (mean 42.48 and 43.02, respectively) compared to women hospitalized due to heart failure (mean 38.00) (Figure 1).

Conclusion

Overall, patients hospitalized due to cardiac conditions perceive a rather high level of continuity of care. However, statistically significant differences were found between men and women, between younger and older patients, and between diagnosis groups, indicating that care inequality exists in continuity of care.
Experience of integrating mobile applications in the self-management of patients with heart failure
Authors: Kinjo M , Higashitsuji A , Sano M , Okada S , Majima T
Published: July 2024

Background

Self-management in patients with heart failure is important in terms of their prognosis and quality of life. The use of mobile applications in the self-management of patients with heart failure has been suggested to improve their knowledge of the disease and quality of life. However, there are limited data on the experiences of patients with heart failure when mobile applications are integrated into their routine as a self-management intervention.

Purpose

We aimed to determine the experiences of patients with heart failure who incorporated the use of mobile applications as a self-management intervention.

Methods

In this qualitative cross-sectional study, participants were purposive-sampled at a university hospital, and semi-structured interviews were conducted with both male and female patients, aged 40–70 years, with a diagnosis of chronic heart failure (ACCF/AHA stage C). Data were collected between December 2022 and April 2023. All interviews were audio-recorded and transcribed verbatim, followed by content analyses. The mobile application used in this study recorded and managed patients’ subjective symptoms and daily life as cloud data and allowed healthcare professionals to access the data using a dedicated terminal.

Results

Four themes were identified from the data: 1) patients used the mobile application in their own way through trial and error; 2) the support of healthcare professionals through the mobile application increased patients’ sense of self-efficacy; 3) using the mobile application made them feel secure as they always felt connected; and 4) some patients struggled to incorporate new technology into their self-management. Most participants in this study had a positive experience of using the mobile application for self-management in their own way with the support of healthcare professionals, including gaining a sense of self-efficacy and security. On the other hand, some patients had a negative experience, such as not looking at the mobile application for a while or discontinuing self-management because they felt burdened by the introduction of this new self-management method.

Conclusions

Both positive and negative aspects of the experiences of patients with heart failure with adopting a mobile application for self-management were identified. Psychological support is essential when patients incorporate mobile applications into their routine as a self-management intervention.
Bidirectional relationship between depression and frailty syndrome in Heart Failure patients
Authors: Wleklik M , Lisiak M , Nowak B , Jedrzejczyk M , Mirkowski K , Uchmanowicz I
Published: July 2024

Introduction

Depression and frailty syndrome (FS) are frequently identified in patients with heart failure (HF) and reported in the literature. The co-occurrence of depression and FS has several pathophysiological mechanisms. Moreover, the two constructs overlap in patients with cardiovascular disease. Depression may be difficult to diagnose in patients with HF due to the co-occurrence of FS, and vice versa. It therefore becomes important to establish the direction of the relationship between the presence of depression and FS in patients with HF. Understanding the relationship and causality between these modifiable variables provides an opportunity to increase patient psychological well-being as well as improve clinical outcomes.

Aim of the study

Determining the direction of the relationship between depression and FS in patients with HF.

Material and Methods

The study included 250 patients with HF (69% male, 31% female, mean age: M±SD=72.32±6.73). Data were collected during hospitalization. 50% of patients with HFrEF and 50% of patients with HFpEF were included. Depression was assessed using PHQ-9 (The Patient Health Questionnaire-9). The frailty phenotype was determined using the FRIED criteria (weight loss, feelings of exhaustion, decreased physical activity, slowed gait speed, weakened handgrip strength). The diagnosis of frailty was established when a minimum of 3 criteria were met. Data were considered statistically significant at p-value < 0.05.

Results

FS was identified in 60% of patients with HF. Patients with FS were older (73.58 ± 6.80 vs. 70.39 ±6.16, p-value=0.0002). In HFrEF patients, the mean PHG-9 score was M±SD=5.97±5.65. In HFpEF patients M±SD=5.85±4.52. There were no differences between patients with preserved and reduced left ventricular fraction in terms of PHQ-9 score (p-value=0.585). Univariate analysis showed that each additional score on the PHQ-9 raised the FRIED score by an average of 0.072 points (0.072; 95% CI: 0.051-0.093, p-value< 0.001) and each additional score on the FRIED scale raised the level of depression according to the PHQ-9 by an average of 2.124 points (2.124; 95% CI: 1.499-2.748, p-value<0.001). In the multivariate model, each additional score on the PHQ-9 raised the FRIED scale score by an average of 0.048 points. (0.048; 95% CI: 0.013-0.083, p-value=0.008) and each additional score on the FRIED scale raised the level of depression according to the PHQ-9 by an average of 0.68 points (0.68; 95% CI: 0.179-1.182, p-value=0.008).

Conclusions

The co-occurrence of FS and mild depression is identified in hospitalized with HF. There is a bidirectional relationship between frailty and depression in patients with HF: depression increases frailty and vice versa. Recognizing these two constructs during hospitalization should involve providing multidisciplinary continuity of care to prevent rehospitalizations.
Evaluation of the compliance of diet plans and nutritional advice generated by artificial intelligence with guidelines for cardiac patients
Authors: Sloma Krzeslak M , Kowalski O
Published: July 2024

Introduction

In response to the increasing demand for personalization in cardiac dietetics, tools based on artificial intelligence (AI) are gaining popularity. We assess the compliance of AI-generated nutritional advice and diet plans with current dietary standards.

Objective

The study aims to evaluate whether nutritional advice and diet plans created by AI for heart disease patients align with the recommended caloric intake and macronutrient ratios, based on current dietary guidelines.

Methods

Using selected AI tools, nutritional advice and diet plans were generated for defined dietary scenarios corresponding to specific cardiac diagnoses. The analysis included assessing the caloric content and macronutrient composition (protein, fat, carbohydrates) compared to current guidelines.

Results

The analysis showed that the majority of the AI-generated diet plans and nutritional advice were compliant with dietary recommendations, with an >75% compliance rate for caloric content and macronutrient ratios. However, instances of non-compliance were discovered, suggesting a need for further adjustment of AI algorithms.

Conclusions

AI tools demonstrate potential in creating personalized diet plans for cardiac patients but require optimization to fully meet current dietary guidelines. The study highlights the importance of integrating dietary knowledge into the design process of AI tools, which is crucial for providing high-quality nutritional support.