Larry Fish

The relationship of perceived self-efficacy to quality of life in chronic obstructive pulmonary disease.

From a biomedical perspective, variations in the quality of life of chronic obstructive pulmonary disease (COPD) patients may be attributed to changes in pulmonary function; thus, an increase in lung function should be correlated with an increased score on a health-related quality-of-life measure. However, inconsistent results regarding correlations between various measures of pulmonary function and quality of life have been reported in the literature. The authors evaluated a social cognitive model of quality of life among persons with COPD by analyzing relationships among biomedical measures, self-efficacy measures, and quality-of-life measures in a recursive path model. Path analysis results indicated that the association of pulmonary function and symptoms with quality of life was mediated by perceived self-efficacy for functional activities.

Contemporary outcomes of intact and ruptured visceral artery aneurysms

OBJECTIVE The treatment outcomes of ruptured visceral artery aneurysms (rVAAs) have been sparsely characterized, with no clear comparison between different treatment modalities. The purpose of this paper was to review the perioperative and long-term outcomes of open and endovascular interventions for intact visceral artery aneurysms (iVAAs) and rVAAs. METHODS This was a retrospective review of all treated VAAs at one institution from 2003 to 2013. Patient demographics, aneurysm characteristics, management, and subsequent outcomes (technical success, mortality, reintervention) and complications were recorded. RESULTS The study identified 261 patients; 181 patients were repaired (77 ruptured, 104 intact). Pseudoaneurysms were more common in rVAAs (81.8% vs 35.3% for iVAAs; P < .001). The rVAAs were smaller than the iVAAs (20.7 mm vs 27.5 mm; P = .018), and their most common presentation was abdominal pain; 29.7% were hemodynamically unstable. Endovascular intervention was the initial treatment modality for 67.4% (75.3% for rVAAs, 61.5% for iVAAs). The perioperative complication rate was higher for rVAAs (13.7% vs 1% for iVAAs; P = .003), as was mortality at 30 days (13% vs 0% for iVAAs; P = .001), 1 year (32.5% for rVAAs vs 4.1% for iVAAs; P < .001), and 3 years (36.4% for rVAAs vs 8.3% for iVAAs; P < .001). Lower 30-day mortality was noted with endovascular repair for rVAAs (7.4% vs 28.6% open; P = .025). Predictors of mortality for rVAAs included age (odds ratio, 1.04; P = .002), whereas endovascular repair was protective (odds ratio, 0.43; P = .037). Mean follow-up was 26.2 months, and Kaplan-Meier estimates of survival were higher for iVAAs at 3 years (88% vs 62% for rVAAs; P = .045). The 30-day reintervention rate was higher for rVAAs (7.7% vs 19.5% for iVAAs; P = .019) but was similar between open and endovascular repair (8.2% vs 15%; P = NS). CONCLUSIONS rVAAs have significant mortality. Open and endovascular interventions are equally durable for elective repair of VAAs, but endovascular interventions for rVAAs result in lower morbidity and mortality. Aggressive treatment of pseudoaneurysms is electively recommended at diagnosis regardless of size.

CHARACTERISTICS OF ENVIRONMENTS, CAREGIVERS, AND CHILDREN IN THREE CENTRAL AMERICAN ORPHANAGES

This study provides descriptive empirical information on the environments, organizational structure, caregivers, caregiver-child interactions, and childrens general behavioral development and problem behaviors from three institutions for young children in Central America. While the institutions were clean, they were physically sparse and had Infant-Toddler Environmental Rating Scale (ITERS; T. Harms, D. Cryer, & R. Clifford, 2006) and Early Childhood Environmental Rating Scale (ECERS; T. Harms, R. Clifford, & D. Cryer, 2005) scores that averaged 1.62 (7 = highest). Caregivers provided routine caregiving with limited emotion, responsiveness, support, empathy, or guidance. Caregivers tended to work long hours and then were off 2 to 3 days, and children periodically graduated to new wards, so there was little stability of caregivers in childrens lives. Childrens average Battelle Developmental Inventory Total Developmental Quotient = 58 to 63, which would be considered mildly-moderately retarded in noninstitutional U.S. populations; no child scored >90, 80% scored <70, and nearly half scored <60. Children displayed high frequencies of indiscriminate friendliness, noncompliance, and provocative and aggressive/violent behaviors. These data and that of a few other studies represent the only comprehensive, empirical description of institutions for young children, which constitutes the independent variable (institutionalization) for a burgeoning literature on postinstitutional adopted children. Results are consistent with the hypothesis that a lack of warm, sensitive, contingently responsive interactions with relatively few consistently available caregivers may be a major contributor to delayed contemporary development and persistent deficits and problems observed in some postinstitutional adopted children and adolescents.

Arteriovenous grafts are associated with earlier catheter removal and fewer catheter days in the United States Renal Data System population

OBJECTIVE Arteriovenous fistulas (AVFs) are associated with improved long-term outcomes but longer maturation times and higher primary failure rates compared with arteriovenous grafts (AVGs). The Fistula First Breakthrough Initiative has recently emphasized tunneled dialysis catheter (TDC) avoidance. We sought to characterize the relationship of AVFs and AVGs to the use of TDCs as well as secondary procedures. METHODS Using the United States Renal Data System (USRDS) database, we identified incident hemodialysis (HD) patients in 2005 that started HD with a TDC and survived at least 1 year. We then monitored them through 2008. Access creation, TDC removal, TDC placement, and secondary procedures were identified by Current Procedural Terminology codes (American Medical Association, Chicago, Ill). Multivariate logistic regression was used to identify risk factors for the primary end points. RESULTS In 2005, HD was initiated in 56,495 patients, 74% with a TDC. Of these, 6286 had an access procedure ≤3 months and 1 year of follow-up (AVF, 4634; AVG, 1652). Mean age was 67.7 years (AVF, 67.3; AVG, 68.7 years; P < .001), 53.3% were men (AVF, 58.1%; AVG, 40.5%; P < .001), and 33.8% were obese (AVF, 33.6%; AVG, 34.4%; P = not significant). AVG placement was associated with a higher TDC removal at 1 (7.9% vs 3.1%; P < .001), 3 (47.8% vs 17.8%; P < .001), and 6 (60.6% vs 47.2%; P < .001) months. There was no difference at 9 months (AVG, 64.9% vs AVF, 62.3%; P = .06). The median time to TDC removal was lower in the AVG group (70 days vs 155 days; P < .001). Multivariable model found AVFs were associated with decreased odds of TDC removal at 3 (odds ratio, 0.22; P < .001) and 6 months (odds ratio, 0.54; P < .001). AVGs required more secondary procedures than AVFs at all time points up to 1 year and specifically had increased thrombectomy procedures (39.8% vs 11.5%; P < .001). CONCLUSIONS In patients starting dialysis with a TDC, AVGs are associated with increased TDC removal and fewer catheter days compared with AVFs at up to 6 months. However, AVGs require more secondary procedures at all time points up to 1 year.

A CAREGIVER-CHILD SOCIOEMOTIONAL AND RELATIONSHIP RATING SCALE

This article reports the construction and pilot reliability, validity, and psychometric properties of a new caregiver-child rating scale that emphasizes caregiver-child socioemotional interactions and relationships. While the scale was developed and studied in orphanages for young children, it potentially could be used in nonresidential early care and education settings as well as for parent-child interactions in the home. The intent was to assess a few dimensions that comprehensively cover the range of caregiver-child socioemotional interactions and relationships, by means of a scale that could be administered in a relatively short time period in a variety of situations and would not require extensive coder training, manuals, or materials. Results showed that the scale can be reliably administered even using observation periods as short as 5 min, that inter-rater reliability was acceptable (based on data from two raters working in two orphanages, and five raters working in another), and that ratings of caregivers were similar across different types of caregiving activities (i.e., feeding, dressing/bathing, free play) and for caregivers attending to children birth to 4 and 4 to 8 years of age. In the orphanage context, factor analyses showed that the scale primarily reflects caregiver-child mutual engagement and relationship with subordinate components of caregiver punitiveness and caregiver- versus child-directed behaviors and intrusiveness.

Evaluation of an intervention for hospitalized African American smokers.

OBJECTIVE To evaluate the effectiveness of a smoking cessation intervention based on the transtheoretical model of change with a sample of low-income African American smokers admitted to an indigent-care hospital. METHODS The intervention incorporated components shown to be effective in increasing cessation in other populations, tailored to a bedside counseling format with follow-up contact postdischarge. RESULTS Intervention patients were significantly more likely to advance in stage than were control patients. CONCLUSION A hospital-offered bedside intervention offers promise in reaching underserved smokers with effective, though limited, cessation assistance.

Long-Term Clinical Outcomes and Cardiovascular Events after Carotid Endarterectomy

BACKGROUND Long-term atherosclerotic adverse events are anticipated in patients undergoing carotid endarterectomy (CEA); however, their incidence and risk predictors remain unknown. METHODS A consecutive cohort of CEAs between 1/1/2000-12/31/2007 was analyzed. End points were any stroke, coronary event (myocardial infarction, coronary bypass, or stenting), vascular interventions for critical limb ischemia, aortic aneurysm or carotid disease, and death. Survival analysis and Cox regression models were used to identify clinical predictors. RESULTS A total of 1,136 CEAs (bilateral, 89; mean age, 71.2 ± 9.2 years; 56.5% male; 36.3% symptomatic, and 3.9% combined with coronary bypass) were performed during the study period with a mean clinical follow-up of 60 months (0-155 months). The postoperative combined stroke and/or death rate was 2.7% and 1.9% for asymptomatic and 4.1% for symptomatic patients. Five and 10-year risks of the end points were 7.2% and 16.1% for stroke, 18.4% and 31.5% for coronary interventions, 20.6% and 28.5% for major vascular interventions, and 25.8% and 50.1% for death. Statins conferred a significant protective effect for stroke (hazard ratio [HR], 0.53; P = 0.016) and death (HR, 0.66; P < 0.0001). Baseline vascular disease predicted future vascular interventions: aortic aneurysm (HR, 1.90; P = 0.003), peripheral arterial disease (HR, 2.03; P < 0.0001), and contralateral internal carotid artery (ICA) stenosis ≥50% (HR, 4.61; P < 0.0001). Renal insufficiency predicted worse outcomes for all other end points (HR, 2.21; P = 0.023 for stroke; HR, 1.62; P = 0.008 for coronary events; HR, 2.38; P < 0.0001 for death). CONCLUSIONS Patients undergoing CEA continue to derive long-term low stroke rate benefit but still sustain major coronary events and require vascular interventions, indicating a need for more intensive medical treatment and rigorous follow-up.

Transtheoretical model of change among hospitalized African American smokers.

OBJECTIVE To examine predicted relationships among transtheoretical model of change measures in a sample of 211 low-income, African American hospitalized smokers. METHODS We used discriminant analysis to examine differences in decisional balance and self-efficacy across stages of change for quitting. RESULTS Differences in decisional balance and self-efficacy were concurrent with stage differences. The function discriminated among all 3 stages with the clearest differences between precontemplation and preparation. CONCLUSION Although results with this specialized sample are not generalizable, they add to the evidence that transtheoretical model of change variables are robust across populations.

Characteristics of children transitioned to intercountry adoption, domestic adoption, foster care, and biological families from institutions in St Petersburg, Russian Federation

Young children (N = 381) from three institutions in St Petersburg (Russian Federation) who were transitioned to intercountry (USA) adoption or to various domestic families in Russia did not differ in birth weight, length, head circumference, and rated condition at birth, nor did they differ upon departure from the institutions with respect to physical growth and behavioral development. These results provide little support to the occasional allegation for the possibility that intercountry adopted children are selected to be developmentally more (or less) advanced, or that outcomes for children in alternative family placements simply may be associated with pre-placement developmental differences. The generality of these results to other institutions and countries is unknown.

The associations of hemodialysis access type and access satisfaction with health-related quality of life

Objective In addition to age and comorbidities, health‐related quality of life (HRQOL) is known to predict mortality in hemodialysis (HD) patients. Understanding the association of vascular access type with HRQOL can help surgeons to provide patient‐centered dialysis access recommendations. We sought to understand the impact of HD access type on HRQOL. Methods We conducted a cross‐sectional prospective study of community‐dwelling prevalent HD patients in Pittsburgh, Pennsylvania. We assessed patient satisfaction with their access using the Vascular Access Questionnaire (VAQ) and HRQOL with the Short Form Health Survey. We compared access satisfaction and HRQOL across access types. We used logistic regression modeling to evaluate the association of access type with satisfaction and multivariate analysis of variance to evaluate the association of both of these variables on HRQOL. Results We surveyed 77 patients. The mean age was 61.8 ± 15.9 years. Arteriovenous fistula (AVF) was used by 62.3%, tunneled dialysis catheter (TDC) by 23.4%, and arteriovenous graft (AVG) by 14.3%. There was a significant difference in satisfaction by access type with lowest median VAQ score (indicating highest satisfaction) in patients with AVF followed by TDC and AVG (4.5 vs 6.5 vs 7.0; P = .013). Defining a VAQ score of <7 to denote satisfaction, AVF patients were more likely to be satisfied with their access, compared with TDC or AVG (77% vs 56% vs 55%; P = NS). Multivariate regression analysis yielded a model that predicted 46% of the variance of VAQ score; important predictors of dissatisfaction included <1 year on dialysis (&bgr; = 3.36; P < .001), increasing number of access‐related hospital admissions in the last year (&bgr; = 1.69; P < .001), and AVG (&bgr; = 1.72; P = .04) or TDC (&bgr; = 1.67; P = .02) access. Mean physical and mental QOL scores (the composite scores of Short Form Health Survey) were not different by access type (P = .49; P = .41). In an additive multivariate analysis of variance with the two composite QOL scores as dependent variables, 25.8% of the generalized variance in HRQOL (effect size) was accounted for by access satisfaction with only an additional 3% accounted for by access type. Conclusions HD patients experience greatest satisfaction with fistula, and access satisfaction is significantly associated with better HRQOL. Controlling for access satisfaction, there is no significant independent association of access type on HRQOL. Future research should investigate the relationship between access satisfaction, adherence to dialysis regimens, mortality, and the consequent implications for patient‐centered care.