Boyoung Hwang

In vitro skin permeation of nicotine from proliposomes

Abstract The feasibility of proliposomes as a sustained transdermal dosage form was examined. Proliposomes containing varying amount of nicotine were prepared by a standard method using sorbitol and lecithin. The porous structure of sorbitol in the proliposomes was maintained, indicating that the majority of lecithin and nicotine is deposited within their porous matrix of the sorbitol particles. As a consequence, the flow properties of the proliposome particles was comparable to that of original sorbitol particles. Microscopic observation revealed that proliposomes are converted to liposomes almost completely within minutes following contact with water. It indicates that proliposomes may form liposomes by the sweat when they are applied on the skin under occlusive conditions in vivo. The size distribution of the reconstituted liposomes and nicotine release to pH 7.4 phosphate buffer from them were not significantly affected by the content of nicotine. The release pattern was apparently identical to the Exodus® patch, a commercially available transdermal nicotine formulation. We also studied in vitro permeation of nicotine across rat skin from proliposomes in a modified Keshary–Chien diffusion cell where the experimental set up simulates in vivo application of the proliposomes under an occlusive condition. The nicotine flux from proliposomes was initially retarded compared with that of nicotine powder. The flux from proliposomes appeared to remain constant throughout the experimental period compared with that of nicotine powder, indicating that nicotine may be delivered across the skin in a sustained manner at a constant rate from proliposomes. These results, therefore, indicate that sustained transdermal delivery of nicotine is feasible using proliposomal formulations if the formulations are topically applied under occlusive conditions.

Family Caregiving for Patients With Heart Failure : Types of Care Provided and Gender Differences

BACKGROUND Knowledge about the potential burden for family caregivers related to the care of patients with heart failure (HF) is limited. The aims of the study were to compare the kind and amount of care provided by partners of HF patients and partners of healthy individuals and to examine the associations between gender and the performance of caregiving tasks. METHODS AND RESULTS Caregiving tasks performed by 338 partners of HF patients were compared with those performed by 1202 partners of healthy individuals. Partners (age 70 +/- 9, 76% female) of HF patients were more likely to provide personal care compared with partners (age 65 +/- 7, 66% female) of healthy individuals after controlling for their age. However, the magnitude of the odds ratios (OR) differed by gender of partners (OR for male 6.7; 95% confidence interval [CI] 3.9-11.4; OR for female 3.7; 95% CI 2.7-5.1). Partners of HF patients were more likely to provide emotional care than partners of healthy individuals, controlling for age and gender (OR 2.4; 95% CI 1.5-3.6). Male partners of HF patients were more likely to provide personal care compared to female partners of HF patients (OR 1.9; 95% CI 1.1-3.2). CONCLUSIONS The care performed by partners of HF patients is above and beyond normal spousal assistance. The study underscores the crucial role of family caregivers in the care of HF patients and encourages health care providers to address the needs of both HF patients and their caregivers.

Changes in Depressive Symptoms and Mortality in Patients with Heart Failure: Effects of Cognitive-Affective and Somatic Symptoms

Objectives Depression is an independent predictor of adverse outcomes in patients with heart failure (HF). However, the effect of changes in cognitive-affective and somatic symptoms on mortality of HF patients is not known. The purpose of this study was to examine whether changes in cognitive-affective and somatic depressive symptoms over time were associated with mortality in HF. Methods In this secondary analysis of data from the Rural Education to Improve Outcomes in Heart Failure clinical trial, we analyzed data from 457 HF patients (39% female, mean [standard deviation] age = 65.6 [12.8] years) who survived at least 1 year and repeated the Patient Health Questionnaire at 1 year. Cognitive-affective and somatic depression scores were calculated, respectively, based on published Patient Health Questionnaire factor models. Using Cox proportional hazards regression analyses, we evaluated the effect of changes in cognitive-affective and somatic symptoms from baseline to 1 year on cardiac and all-cause deaths. Results Controlling for baseline depression scores and other patient characteristics, the change in somatic symptoms was associated with increased risk of cardiac death during the subsequent 1-year period (hazard ratio = 1.24, 95% confidence interval = 1.07–1.44, p = .005), but the change in cognitive-affective symptoms was not (hazard ratio = 0.94, 95% confidence interval = 0.81–1.08, p = .38). Similar results were found for all-cause mortality. Conclusions Worsening somatic depressive symptoms, not cognitive-affective symptoms, are independently associated with increased mortality of HF patients. The findings suggest that routine and ongoing assessment of somatic depressive symptoms in HF patients may help clinicians identify patients at increased risk for adverse outcomes. Trial Registration ClinicalTrials.gov NCT00415545.

Cognitive behavioral therapy in depressed cardiac surgery patients: role of ejection fraction.

Aims:The aim of this study was to evaluate the relationship of ejection fraction (EF) and depressive symptoms in cardiac surgery patients assigned to nurse-guided cognitive behavioral therapy (CBT) or usual care (UC). Methods:Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Seventy-seven patients (31% women; mean [SD] age, 63.6 [9.8] years) received 8 weeks of either CBT or UC. Using repeated-measures analysis of variance, changes in depressive symptoms over time were evaluated. Results:There was a significant interaction among time, treatment group, and EF status (p = 0.019). In the patients with preserved EF (≥40%), mean BDI scores in the UC group worsened by 1.9%, whereas those in the CBT group improved by 31.0%. In the patients with low EF (<40%), mean BDI scores worsened by 26.8% and improved by 75.3% in the UC and CBT groups, respectively. Conclusions:Nurse-guided CBT is effective in reducing depressive symptoms after cardiac surgery, particularly in patients with low EF.

Depressive Symptoms among Patients with Heart Failure in Korea: An Integrative Review

This integrative review was conducted to examine studies reporting depressive symptoms among patients with heart failure (HF) in Korea. An extensive search with both English and Korean search terms was conducted using six electronic databases. Publications were screened by both authors independently, and 10 articles meeting the inclusion criteria were reviewed. All 10 studies were data-based, quantitative, and descriptive in nature. In all studies, depressive symptoms were measured at only one point in time. The prevalence of depression reported in these studies ranged from 24% to 68%. Heterogeneity in the study samples and measures of depression was noted. Depressive symptoms have received limited attention in research with HF patients in Korea. Additional studies, especially longitudinal studies and intervention studies, are needed to assess depressive symptoms and to test the effects of pharmacological and non-pharmacological interventions on depression among patients with HF in Korea. Clinicians need to screen patients with HF for depressive symptoms using validated measures and provide proper treatment for those who are depressed.