Spontaneous coronary artery dissection; a systematic review of physical and psychosocial recovery following discharge from hospital

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Edinburgh Napier University

Introduction

Spontaneous coronary artery dissection (SCAD) is increasingly recognised as an important cause of myocardial infarction, particularly among women. SCAD survivors may not know what physical activity is safe and effective and there may be a psychosocial burden of living with a SCAD diagnosis. This review aimed to determine the evidence regarding physical activity, cardiovascular risk factors, or associated factors, and the psychosocial impact of SCAD for SCAD survivors after hospital discharge.

Methods

A systematic review completed in accordance with PRISMA guidelines

Results

The review included 28 studies. These used a range of methods. None were randomised controlled trials. There were 4167 SCAD participants although some were sourced from the same SCAD registries, so may not be unique. They were mainly female (n=3897 93.5%, range=57.7%-100%), with mean age 48.0±9.8 years at index event. Participants mostly came from the USA, Canada, or the Netherlands. We found very limited evidence for cardiorespiratory fitness improvements following cardiac rehabilitation (CR). Existing CR was not tailored to SCAD specific needs and SCAD survivors lacked guidance about appropriate physical activity. Some participants had high levels of psychosocial distress. SCAD survivors highlighted the need for tailored support that included family members. Many SCAD survivors have traditional risk factors including hypertension, hyperlipidaemia and overweight/obesity. Chest pain following SCAD is common.

Conclusions

There is an urgent need to develop physical and psychological recovery programmes for SCAD survivors, and test effectiveness via randomised controlled trials. Psychosocial support is particularly required, given the high burden of psychosocial issues.

European Society of Cardiology Quality Indicators for Cardiovascular Disease Prevention: developed by the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with the European Association for Preventive Cardiology of the European Society of Cardiology

AIMS

To develop a set of quality indicators (QIs) for the evaluation of the care and outcomes for atherosclerotic cardiovascular disease (ASCVD) prevention.

METHODS AND RESULTS

The Quality Indicator Committee of the European Society of Cardiology (ESC) formed the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with Task Force members of the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice and the European Association of Preventive Cardiology (EAPC). We followed the ESC methodology for QI development, which involved (i) the identification of the key domains of care for ASCVD prevention by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. In total, 17 main and 14 secondary QIs were selected across six domains of care for ASCVD prevention: (i) structural framework, (ii) risk assessment, (iii) care for people at risk for ASCVD, (iv) care for patients with established ASCVD, (v) patient education and experience, and (vi) outcomes.

CONCLUSION

We present the 2021 ESC QIs for Cardiovascular Disease Prevention, which have been co-constructed with EAPC using the ESC methodology for QI development. These indicators are supported by evidence from the literature, underpinned by expert consensus and aligned with the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice to offer a mechanism for the evaluation of ASCVD prevention care and outcomes.

TrueNTH sexual recovery study protocol: a multi-institutional collaborative approach to developing and testing a web-based intervention for couples coping with the side-effects of prostate cancer treatment in a randomized controlled trial

BACKGROUND

Over half of men who receive treatment for prostate suffer from a range of sexual problems that affect negatively their sexual health, sexual intimacy with their partners and their quality of life. In clinical practice, however, care for the sexual side effects of treatment is often suboptimal or unavailable. The goal of the current study is to test a web-based intervention to support the recovery of sexual intimacy of prostate cancer survivors and their partners after treatment.

METHODS

The study team developed an interactive, web-based intervention, tailored to type of treatment received, relationship status (partnered/non-partnered) and sexual orientation. It consists of 10 modules, six follow the trajectory of the illness and four are theme based. They address sexual side effects, rehabilitation, psychological impacts and coaching for self-efficacy. Each includes a video to engage participants, psychoeducation and activities completed by participants on the web. Tailored strategies for identified concerns are sent by email after each module. Six of these modules will be tested in a randomized controlled trial and compared to usual care. Men with localized prostate cancer with partners will be recruited from five academic medical centers. These couples (N = 140) will be assessed prior to treatment, then 3 months and 6 months after treatment. The primary outcome will be the survivors' and partners' Global Satisfaction with Sex Life, assessed by a Patient Reported Outcome Measure Information Systems (PROMIS) measure. Secondary outcomes will include interest in sex, sexual activity, use of sexual aids, dyadic coping, knowledge about sexual recovery, grief about the loss of sexual function, and quality of life. The impact of the intervention on the couple will be assessed using the Actor-Partner Interaction Model, a mixed-effects linear regression model able to estimate both the association of partner characteristics with partner and patient outcomes and the association of patient characteristics with both outcomes.

DISCUSSION

The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that-if found efficacious-will improve access to much needed specialty care in prostate cancer survivorship.

TRIAL REGISTRATION

Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.

Low incidence of plastics in food loads delivered to nestlings by a zooplanktivorous seabird over a 21-year period

We quantified the amount of plastic found in food loads delivered to nestlings in Cassin's Auklet (Ptychoramphus aleuticus), a small, zooplanktivorous seabird, on Triangle Island, British Columbia, in 1996-2016. The density of plastic in surrounding waters is moderately high, yet few food loads contained any plastic (3 of 850), and none more than two pieces. That result accords well with previous observations on the other four North Pacific auklets (Aethia spp.), leading us to conclude that true auklets rarely transfer plastic to nestlings. However, many hatch-year Cassin's Auklets found dead in coastal British Columbia, Washington and Oregon during the mass mortality event of fall and winter 2014-15 had plastic in their ventriculi. We suggest that these plastic particles would have been obtained at sea after fledging, perhaps while the birds transited south through a region of high plastic density off the west coast of Vancouver Island, Washington and Oregon.

Spatial and temporal variation in the diet of the Pacific sand lance Ammodytes hexapterus in waters off the coast of British Columbia, Canada

Variation in the diet of the Pacific sand lance Ammodytes hexapterus was examined in three years (2009-2011) at four sites in British Columbia, Canada. There were 12 major taxa of prey in diets, eight of which were Crustacea, with copepods being by far the dominant taxon in all 12 site-years. Of the 22 copepod taxa recorded, only Calanus marshallae and Pseudocalanus spp. occurred in all collections, and these two calanoid species dominated diets in terms of frequency of occurrence and total numbers of prey (Pseudocalanus spp. in most collections), and total prey biomass (C. marshallae in all collections). Based on an index of relative importance, C. marshallae was the primary prey at the two southerly sampling sites (Pine and Triangle Islands) and Pseudocalanus spp. at the two northerly sites (Lucy Island and S'Gang Gwaay). Based on an index of dietary overlap, the species composition of the copepod component of A. hexapterus diets overlapped very strongly at the northerly and the southerly pairs of sites in both a cold-water La Niña year (2009) and a warm-water El Niño year (2010), but overall there was more homogeneity amongst all four sites in the La Niña year.

Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States

From October 4 to November 2, 2001, the first 10 confirmed cases of inhalational anthrax caused by intentional release of Bacillus anthracis were identified in the United States. Epidemiologic investigation indicated that the outbreak, in the District of Columbia, Florida, New Jersey, and New York, resulted from intentional delivery of B. anthracis spores through mailed letters or packages. We describe the clinical presentation and course of these cases of bioterrorism-related inhalational anthrax. The median age of patients was 56 years (range 43 to 73 years), 70% were male, and except for one, all were known or believed to have processed, handled, or received letters containing B. anthracis spores. The median incubation period from the time of exposure to onset of symptoms, when known (n=6), was 4 days (range 4 to 6 days). Symptoms at initial presentation included fever or chills (n=10), sweats (n=7), fatigue or malaise (n=10), minimal or nonproductive cough (n=9), dyspnea (n=8), and nausea or vomiting (n=9). The median white blood cell count was 9.8 X 10(3)/mm(3) (range 7.5 to 13.3), often with increased neutrophils and band forms. Nine patients had elevated serum transaminase levels, and six were hypoxic. All 10 patients had abnormal chest X-rays; abnormalities included infiltrates (n=7), pleural effusion (n=8), and mediastinal widening (seven patients). Computed tomography of the chest was performed on eight patients, and mediastinal lymphadenopathy was present in seven. With multidrug antibiotic regimens and supportive care, survival of patients (60%) was markedly higher (<15%) than previously reported.

Assumptions and beliefs in adolescents with anorexia nervosa and their mothers

A pilot study examined the specific cognitive content of female adolescents with anorexia nervosa. The relationship between daughter and mother concerns, and concerns in mothers, also were investigated. All participants completed a measure of assumptions and negative self-beliefs related to eating disorders. Adolescents with anorexia nervosa scored more highly on all subscales of the measure than nonclinical adolescent controls. There were significant daughter-mother relationships on two subscales in the clinical, but not the nonclinical, group. However, the two groups of mothers did not differ on any subscale. Possible explanations for the findings, and implications for treatment and research, are briefly considered.

Factors related to recovery in coronary artery bypass graft surgery patients

Many studies have examined the experiences of patients who have had coronary artery bypass graft (CABG) surgery. Research has suggested a relationship between patients' feelings of powerlessness and their recovery rate. This study examined recovery indicators and the degree of powerlessness CABG patients experienced, and identified ways nurses can encourage patients to participate in their recovery and feel back in control.

United States passenger-vehicle crashes by crash geometry: direct costs and other losses

The personal and societal losses caused by motor-vehicle crashes are significant. This paper provides tools that describe these losses for 30 different crash geometries. Persons involved with the development and implementation of crash countermeasures can use these tools to prioritize their countermeasure approach. Multiple vehicle crashes currently account for much larger direct costs but only slightly more years lost than single vehicle crashes. Direct expenditures on multiple vehicle crashes exceed $41 billion per year; they claim 974,000 years of life and functioning. Direct expenditures on single vehicle crashes exceed $18 billion per year; they claim 937,000 years of life and functioning.

Estimating the costs of occupational injury in the United States

This article estimates workplace injury costs in the U.S. These costs have been studied in less detail than most injury costs. Our methods, which mostly use regularly published data, produce order-of-magnitude estimates. Overall, workplace injuries cost the U.S. an estimated $140 billion annually. This estimate includes $17 billion in medical and emergency services, $60 billion in lost productivity, $5 billion in insurance costs, and $62 billion in lost quality of life. One sixth of the societal costs result from the 3% of workplace injuries in motor vehicle crashes. Motor vehicle costs per injury are almost 6 times the workplace injury average.

Injury prevention counseling by pediatricians: a benefit-cost comparison

OBJECTIVES

The American Academy of Pediatrics believes that health education, through office-based counseling, can contribute to childhood injury prevention. This report extends previously published work on the effectiveness of primary care-based counseling and compares the costs and estimated monetary value of the benefits of safety counseling targeting children ages 0 to 4 years.

METHODS

We estimate the savings achievable with comprehensive childhood injury prevention counseling organized around the three Framingham Safety Surveys used in The Injury Prevention Program (TIPP) developed by the American Academy of Pediatrics. We verify the estimated savings by comparing them with the effects of pediatrician counseling from separate analyses of the most fully evaluated interventions--in child motor vehicle occupant injuries, burns, and falls.

RESULTS

TIPP pediatrician injury counseling sessions between the ages of 0 and 4 years can achieve estimated savings of $880 per child or $80 per visit. If all 19.2 million children ages 0 to 4 years completed TIPP, we estimate that $230 million would be saved annually in medical spending, and injury costs would decline $3.4 billion. each dollar spent on TIPP childhood injury prevention targeting children ages 0 to 4 years returns nearly $13.

CONCLUSION

TIPP pediatrician injury counseling is a cost-effective method of preventing childhood injuries and should be more widely adopted.

Barriers to well child care for homeless children under age 13

Barriers perceived by homeless families to preventive health care for their children under age 13 have been underdocumented. This descriptive study was designed to identify perceived barriers to care and to determine if there was a relationship between perceived barriers and duration of the family's homelessness. Using an investigator-modified version of Melnyk's Barrier Scale and a demographic measure, a convenience sample of homeless families (n = 53) from three transitional shelters was surveyed via questionnaire. Four barriers were cited most frequently by the respondents as greatly affecting their children's care. These barriers involved provider-selection difficulties, waiting for well child appointments, waiting during well child appointments, and the high cost of transportation and/or parking. No relationship was found between duration of homelessness and perceived barriers. These findings confirm the reality of potential barriers to care suggested by earlier studies. Innovative forms of health care delivery that may reduce or eliminate these barriers include the use of shelter-site clinics, mobile units, and the use of a nurse liaison between family shelters and hospital-based clinics.

Negative recall bias and neuroticism: state vs trait effects

Incidental recall of positive and negative trait adjectives was assessed in high and low N (neuroticism) Ss in whom depressed or neutral mood had been induced. Results indicated that the negative recall bias is an interactive function of trait vulnerability (as reflected by N scores) and current mood state. In the depressed mood condition, there was a trend for high N to be associated with relatively better recall of negative material, as expected. However, in neutral mood, high levels of N predicted relatively poorer recall of negative information. This unexpected finding was discussed in relation to previous research into mood-incongruent recall effects and sex differences.

Attracting Men to Nursing: What Will They Find Important in Their Career?

This study was designed to increase understanding of the career choices of men in nontraditional careers such as nursing by exploring what they find important in their career, their sex role identity, and their personality components. The instruments used in the study were the Important Components of a Career Scale, Bem Sex Role Inventory, and the Cattell 16 Personality Factor measure. Questionnaire packets were mailed to a total of 1,000 potential respondents in the following five groups: male and female nurses and early educators, and male engineers. The response rate was 46%. The men in nursing (n = 57) and early education (n = 76) valued relationship-oriented components of their careers more than the men in engineering (n = 103) (F [2,233] = 35.39, p less than .01).

Progressive vertebral collapse in diffuse angiomatosis

A case of vanishing bone disease is presented, with radiologic, endoscopic, and peritoneoscopic evidence of angiomatous involvement of the bones, surrounding soft tissues, and gastrointestinal tract. The diagnosis was made by a combination of radiologic techniques and endoscopy. Areas of absent bone were shown to opacify after intralymphatic injections of contrast material, providing in vivo demonstrations that these areas of vanishing bone are occupied by abnormal lymphatics. The etiology remains obscure, but our review of the literature suggests that this condition may be one of a large spectrum of disorders due to a basic underlying endothelial dysplasia. The lymphatic system, vascular system, or both may be involved, and the condition may manifest itself as an abnormality of the bones, soft tissues, viscera, or a combination of these.

Moulting Hormones. LIII. the Synthesis and Biological Activity of Some Ecdysone Analogues

A number of ecdysone analogues were prepared to study the effect of structural changes on biological activity. It was found that analogues with the 5α-configuration or a 3,5-cyclo structure were inactive, that a 3β-hydroxy group enhances activity but is not essential for activity, and that 3β-substituents decrease activity as follows: OMe (60%), OAc (25%) and OEt (10%). The keto diol (3), keto alcohol (9) and amide (36) were found to be highly toxic to mosquito larvae.

Insect Moulting Hormones: The Synthesis of Ecdysone Analogues From a Bile Acid

A new general synthesis of 2-deoxyecdysone analogues starting from the bile acid, chenodeoxycholic acid, has been developed and used to prepare a number of ecdysones for structure-biological activity studies.

Insect Moulting Hormones: The Synthesis of Possible Ecdysone Precursors for Metabolic Studies

The possible biological precursors of ecdysones, 3β-hydroxy-5β-cholest-7-en-6-one (2) and 3β,14α-dihydroxy-5β-cholest-7-en-6-one (3), are prepared from 7-dehydrocholesterol through their 5α-epimers.The corresponding 3α-[3H] derivatives of high specific activity are prepared in a similar way via 5α-cholest-7-ene-3β,6α-diol[3α-3H] 6-acetate which is obtained by reducing the corresponding 3-keto derivative with sodium borotritide.