Eugene S. Smith

Effects of Muscle Strength Training and Megestrol Acetate on Strength, Muscle Mass, and Function in Frail Older People

OBJECTIVES: To determine the independent and combined effects of progressive resistance muscle strength training (PRMST) and megestrol acetate (MA) on strength, muscle mass, and function in older recuperative care patients.

Modifiable correlates of physical symptoms and health-related quality of life in patients with heart failure: A cross-sectional study

BACKGROUND Heart failure is associated with high rates of hospitalization and mortality. The majority of patients with heart failure suffer from physical symptoms, and these symptoms are strongly associated with poor health-related quality of life. To improve physical symptoms and health-related quality of life, the modifiable factors associated with physical symptoms need to be examined. PURPOSE To examine modifiable psychosocial and behavioral factors associated with physical symptoms and health-related quality of life, and the mediator effects of physical symptoms on the relationships between the modifiable factors and health-related quality of life in patients with heart failure. METHODS Data on potential correlates of physical symptoms (i.e., depressive symptoms, perceived control, social support, medication adherence, sodium intake, and self-care management) were collected from 109 patients with heart failure (mean age 58 ± 14 years, 46% male, 89% New York Heart Association class II/III). Data on physical symptoms (Symptom Status Questionnaire-Heart Failure) and health-related quality of life (Minnesota Living with Heart Failure) also were collected. Simple and multiple regression analyses were used to analyze the data. RESULTS Among the potential correlates, depressive symptoms and sodium intake were associated with physical symptoms (F=11.63, p<.001), and depressive symptoms and perceived control were associated with health-related quality of life (F=9.917, p<.001). Physical symptoms mediated the relationship between depressive symptoms and health-related quality of life. CONCLUSION Improving depressive symptoms and eating the appropriate amount of sodium may be primary intervention targets to improve physical symptoms. To improve health-related quality of life, depressive symptoms as well as physical symptoms need to be managed appropriately.

Forearm Endothelial Response in Smokeless Tobacco Users Compared with Cigarette Smokers and Nonusers of Tobacco

Study Objective. To compare brachial artery flow‐mediated dilation (FMD) in subjects who use smokeless tobacco, smoke cigarettes, or do not use any tobacco product.

Prevention of heart failure.

Purpose of review Chronic heart failure imposes a significant health burden and remains a substantial and increasing problem despite advances in therapy. Hence, prevention of heart failure is a priority. Recent findings Various risk factors have been identified that contribute to the development of heart failure. In this review, we will discuss the various recently reported clinical trials, epidemiological studies, meta-analyses, and subanalyses that have identified these risk factors and have provided evidence regarding the strategies to prevent heart failure. Summary Heart failure is a costly, disabling, and potentially fatal disease. It is therefore important to incorporate the strategies for prevention of heart failure on the basis of the current available evidence into routine clinical practice.

Trends in the Care of Patients With Acute Myocardial Infarction at a University-Affiliated Veterans Afffairs Medical Center:

Background: Acute cardiac care of the veterans at Veterans Administration (VA) hospitals has been thought of as poor in quality. We examined the use of life-saving, evidence-based medical therapy in patients admitted with acute myocardial infarction to the University of Arkansas for Medical Sciences-affiliated VA Medical Center in Little Rock and compared the use of this therapy with other hospitals in Arkansas and in the rest of the nation. Methods: Use of life-saving medical therapy in 117 patients admitted with acute myocardial infarction from January 2002 to December 2002 was compared with the National Registry of Myocardial Infarction database for the identical period. Results: Heparin/low-molecular-weight heparin and glycoprotein IIb/IIIa inhibitors were used in 88% and 66% of patients, respectively. Aspirin, β adrenergic-blocking agents, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) were used in 92%, 93%, 62%, and 79% of the patients, respectively. The use of these therapies was better than in similar patients in Arkansas (P < .001) and the United States as a whole (P < .01). Calcium-channel blockers were used in 16% of the patients. At a mean follow-up period of 1.5 years, use of β blockers and aspirin had decreased, whereas the use of statins and ACE inhibitors/ARBs was unchanged. Conclusion: This study shows that patients with acute myocardial infarction admitted to this university-affiliated VA Medical Center receive evidence-based life-saving medical therapy more often than in the rest Arkansas or in the entire United States. More important, patients at this federal institution continue to receive life-saving medical therapy during follow-up. Better use of evidence-based therapy may be related to affiliation of this VA Medical Center with a teaching institution where board certified cardiologists are involved in short- and long-term care of these patients.