Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal Study.
- 作者列表："Aamodt IT","Lycholip E","Celutkiene J","von Lueder T","Atar D","Falk RS","Hellesø R","Jaarsma T","Strömberg A","Lie I
BACKGROUND:Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. OBJECTIVE:This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. METHODS:This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals-one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the CardioSet Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. RESULTS:The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. CONCLUSIONS:Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.
背景: 自我护理是慢性心力衰竭日常管理的关键。出院后，患者可能难以识别和响应恶化的HF症状。未能监测和响应HF症状可能导致不必要的住院治疗。 目的: 本研究旨在 (1) 确定肺阻抗测量和症状日记在出院后30天内每天在家监测心力衰竭症状的可行性，(2) 确定肺水肿、肺阻抗测量、如果患者使用这些自我护理监测工具时，自我护理行为随着时间的推移而改善。 方法: 本研究采用前瞻性纵向设计，包括来自2所大学医院 (挪威1所，立陶宛1所) 心内科病房的患者。从10名患有严重HF (纽约心脏协会III和IV级) 的参与者 (平均年龄64.5岁; 90% (9/10) 为男性) 中收集关于HF症状和肺水肿的数据，这些参与者因HF状况住院后出院回家。使用心力衰竭的记忆症状评估量表自我报告HF症状。参与者使用无创肺阻抗监测器 (CardioSet effection Guard监测器) 测量肺水肿。非正式护理人员帮助参与者进行无创测量。 结果: 呼吸急促的患病率和负担从每天经历呼吸急促的参与者到从不经历呼吸急促的参与者有所不同，而肺阻抗测量结果在个体参与者和群体参与者整体上有所不同。自我护理行为评分显著改善 (P =.007)，从出院时的中位数56 (IQR范围22-75) 到30天后的中位数81 (IQR范围72-98)。 结论: 在心力衰竭患者中，每天无创测量肺阻抗和使用症状日记在家中进行30天是可行的。在家中使用症状日记和测量肺阻抗30天后，自我护理行为显著改善。需要进一步的研究来确定HF体征和症状的日常自我护理监测，结合每日肺阻抗测量，是否可以减少再入院。
METHODS::Emotion regulation (ER) strategies are often categorized as universally adaptive or maladaptive. However, it has recently been proposed that this view is overly simplistic: instead, adaptive ER involves applying strategies variably to meet contextual demands. Using data from four experience-sampling studies (Ns = 70, 95, 200, and 179), we tested the relationship between ER variability and negative affect (NA) in everyday life. The constantly changing demands of daily life provide a more ecologically valid context in which to test the role of variability. We calculated 2 global indicators of variability: within-strategy variability (of particular strategies across time) and between-strategy variability (across strategies at one time-point). Associations between within-strategy variability and NA were inconsistent. In contrast, when controlling for mean strategy endorsement, between-strategy variability was associated with reduced NA across both individuals and measurement occasions. This is the first evidence that variably choosing between different strategies within a situation may be adaptive in daily life. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
METHODS::Purpose: Patient self-care tools can improve patient outcomes in chronic disease. In uveitis, there is an unmet need for the innovative Uveitis Patient Passport (UPP). This study aims to evaluate the success of the passport's introduction into a tertiary uveitis service through patient experience.Methods: The UPP, created in consultation with patients and the multidisciplinary team, was evaluated using a patient questionnaire and mixed quantitative and qualitative methodology.Results: Key themes emerged, with the passport used by participants as a self-care resource and an aid for cross-specialty communication. Patient involvement in evaluation identified key areas for passport development in line with patient needs. These included improving clinician engagement and future transference into a smartphone application.Conclusion: The introduction of the first UPP was a success, especially as a self-care tool for supporting patients in managing their uveitis with the potential to improve patient outcomes.
METHODS::A body of research documented that the study of mental health of the oldest individuals may contribute to understand the psychological characteristics of longevity. This study had two related aims. First, to fully characterize the psychological health of Sardinian elders in the very late adult span. Second, to determine the psychological health of long-lived individuals (i.e., centenarians) from this population. Three gender-matched age groups (octogenarian, nonagenarian, centenarian) of cognitively healthy, community dwelling adults were recruited in Sardinia, an Italian island characterized by higher levels of longevity. Comparisons of total and sub-scale levels of psychological well-being and depressive symptomatology were made while controlling for social desirability. There were few differences in any index of psychological health between the groups; only a decrease in the coping strategies sub-scale of psychological well-being was observed between the centenarians and the octogenarians. Social desirability was differentially associated with specific dimensions of depressive symptoms and psychological well-being. These findings highlight that there is minimal age-related decline in the psychological health of a longevous population, even among its very oldest members. The present outcomes suggest that older Sardinians represent an advantageous population for the investigation of the psychological markers of longevity, since they demonstrate positive adaptation to the challenges (e.g., changes related to their social network) of very late adulthood.