Little is known about frailty in people with chronic obstructive pulmonary disease (COPD). The purposes of this study were to describe frailty, to identify, which demographic and clinical characteristics contributed to frailty, and to examine the relationship between frailty and health-related outcomes in people with COPD.This was a secondary cross-sectional study, using data from the National Health and Nutrition Evaluation Survey. The frailty index and outcome measures were derived primarily from survey responses.The prevalence of frailty was 57.8%. Multivariate logistic regression showed that individuals with COPD who had self-reported shortness of breath and comorbid diabetes were more likely to be frail than those who did not. Frail people tended to have a greater number of disabilities.The findings support the importance of frailty in the COPD population. Further study is needed to understand frailty in people with COPD, using objective measures for criteria of frailty.

This qualitative study describes the experiences of spousal caregivers of a patient with end-stage heart failure (HF) from pre-LVAD to post-LVAD-DT implantation.LVAD-DTs are implanted as permanent devices for end-stage HF patients with the goal of improving the length and quality of life. LVADs create new demands for both patients and caregivers.In-depth, semi-structured interviews of 10 spousal caregivers were thematically analyzed.Throughout the process of caregiving, pre-implant through post-implant, all caregivers discussed their ability to adapt within the role as a caregiver. Adaptation as a caregiver occurred through three distinct time frames following the progression of the patient's HF and subsequent LVAD implantation: caring for a spouse with HF, decision for LVAD implantation made, and caring for a spouse with the LVAD-DT.Caregivers were able to adapt and develop effective strategies to incorporate the demands of caring for a spouse with an LVAD-DT, but the role remained challenging. The findings underscore the need for continued research that may be translated into effective interventions to support patient and caregivers as they live through this end-of-life trajectory.

Uhl's anomaly is a myocardial disorder of unknown cause that is characterized by complete or partial absence of the myocardium of the right ventricle. The disease may represent a cause of right heart dilatation and failure. Although most cases of Uhl's anomaly end fatally in infancy or childhood, an initial presentation during adulthood has been reported in rare cases. We report a very rare case of partial absence of the right ventricular musculature or partial Uhl's anomaly that incidentally found in asymptomatic adult man.

Statistics estimated from a 2 × 2 contingency table, such as sensitivity, specificity, and likelihood ratios, are usually presented in contexts of diagnostic decision making or evaluation of screening tests. However, their use is not restricted to those contexts. The purpose of this article is to summarize for clinicians and researchers in nursing and other health care disciplines the conceptual basis, calculation, application, and limitations of statistics derivable from a 2 × 2 table and to provide a worked example based on previous research. It will be shown that these statistics can potentially be used for analyzing any binary outcome (e.g., occurrence vs. nonoccurrence of some event) with a binary predictor (e.g., present vs. absent or above vs. below some cut point). Most can be estimated with a hand-held or online calculator, and, apart from chi-square statistics, without first converting observed data to a test-statistic. Clearer understanding of the derivation and clinical meaning of these statistics will encourage their wider use in health research and clinical practice.

BACKGROUND:

Patients with acute decompensated heart failure (ADHF) often wait a considerable amount of time before going to the hospital. Prior studies have examined the reasons why such delays may occur, but additional studies are needed to identify modifiable factors contributing to these delays.

PURPOSE:

To describe care-seeking delay times, factors associated with prolonged delay, and patient's thoughts and actions in adult men and women hospitalized with ADHF.

METHODS:

We surveyed 1271 patients hospitalized with ADHF at 8 urban medical centers between 2007 and 2010.

RESULTS:

The average age of our study population was 73 years, 47% were female, and 72% had prior heart failure. The median duration of pre-hospital delay prior to hospital presentation was 5.3 h. Patients who delayed longer than the median were older, more likely to have diabetes, peripheral edema, to have symptoms that began in the afternoon, and to have contacted their medical provider(s) about their symptoms. Prolonged care seekers were less likely to have attributed their symptoms to ADHF, less likely to want to have bothered their doctor or family, and were more likely to be concerned about missing work due to their illness (all p values < 0.05).

CONCLUSIONS:

Care-seeking delays are common among patients with ADHF. A variety of factors contribute to these delays, which in some cases may represent efforts to manage ADHF symptoms at home. More research is needed to better understand the detrimental effects of these delays and how best to encourage timely care-seeking behavior in the setting of ADHF.

OBJECTIVES:

To identify young adults' stated reasons for not taking asthma medication and to determine the significance of personality, asthma control and health-related quality of life in relation to these stated reasons.

BACKGROUND:

Reasons for non-adherence to asthma medication treatment have previously been studied, but research on the significance of personality in relation to stated reasons for not taking asthma medication is limited.

METHODS:

Young adults with asthma (age 22 years; n = 216) stated their most common reasons for not taking asthma medication and completed postal questionnaires on personality, asthma control and health-related quality of life (HRQL).

RESULTS:

The most common reason for non-adherence was "No perceived need" (n = 141). Participants giving this reason for not taking asthma medication scored lower on the personality trait Negative Affectivity and reported both higher asthma control and higher mental HRQL. "Insufficient routines" was the second most common reason (n = 66), and participants stating it scored higher on Negative Affectivity and reported lower asthma control. An increase in asthma control increased the odds of stating "No perceived need" as the reason for not taking asthma medication. An increase in Negative Affectivity was associated with an increase in the odds of giving "Insufficient routines" as a reason.

CONCLUSIONS:

The personality trait Negative Affectivity and perceived asthma control played a role in the young adults' stated reasons for not taking asthma medication, which indicates that these parameters are of importance to young adults' medication management.

To evaluate the efficacy and safety of a new device (BreatheMAX) that humidifies and oscillates inspired air to increase secretion clearance in mechanically ventilated patients.Poor secretion clearance is a serious problem for intubated patients leading to lung complications and delayed weaning.Double blinded crossover; fifteen patients, median age 60 years, range 16-75. Interventions consisted of spontaneous deep breathing with (treatment) and without (sham) humidification and oscillation of inspired air. Airway secretions were aspirated for 3 h before and after each intervention and wet weight and viscosity determined.The sham intervention caused no change in secretion clearance (95% CI: -1.8, 1.8 g) but after treatment secretions increased by 4.0 g (95% CI: 1.3, 6.7; p < 0.05). Viscosity decreased 30% after treatment and was unchanged after sham. Changes in cardiopulmonary function were not clinically significant and the patients reported only mild perceptions of breathlessness.Breathing exercise with a device that includes vibration and humidification of inspired air is effective for increasing secretion clearance with patients dependent on mechanical ventilation and was without any adverse effects.