Pamela S. Miller

Overweight and obesity in the context of heart failure: implications for practice and future research.

Heart failure (HF) is a major cardiovascular disorder, public health concern, and growing epidemic that affects approximately 5,000,000 people in the United States with 550,000 new cases reported annually. The clinical and economic impact of HF is associated with high hospitalization and early readmission rates. Recognizing factors that contribute to increasing the risk for HF, particularly the persistent rise in prevalence of overweight and obesity, may be imperative to reducing the burdens of this poorly prognostic disease process. Overweight and obesity have been associated with increased morbidity and mortality, and have incited extensive interest in therapeutic interventions. However, within the last decade, studies have illustrated the positive effects of overweight and obesity on survival after the onset of HF, which has prompted a variance of opinion within the healthcare community. This article reviews data supporting both the negative and positive effects of overweight and obesity in relationship to HF with implications for future research, and describes recommendations for practice as it relates to lifestyle modification through diet, exercise, and cognitive-behavioral therapy.

Advancing Nursing Research Through a Mentorship Program for Staff Nurses

This article describes a unique model of implementing unit-based research teams to provide staff nurses with knowledge, skills, and mentoring. The essential elements of designing and conducting a research study are emphasized in an effort to improve nursing practice and the quality of patient care. The research education and practicum are incorporated into team meetings. This unique model provides greater efficiency and effectiveness of resources and allows for more interactive education than occurs in traditional models. Unit-based nursing teams learn together to design research studies, test hypotheses, and answer clinically relevant research questions, using the scientific process.

Effect of high-frequency chest wall oscillation versus chest physiotherapy on lung function after lung transplant

PURPOSE The aim of this study is to compare the effects of chest physiotherapy (CPT) and high-frequency chest wall oscillation (HFCWO) on lung function in lung transplant recipients. BACKGROUND Chest physiotherapy and HFCWO are routinely used after lung transplant to attenuate dyspnea, increase expiratory flow, and improve secretion clearance. METHODS In a two-group experimental, crossover design with repeated-measures, 45 lung transplant recipients (27 single, 18 bilateral; 64% male; mean age, 57 years) were randomized to receive CPT at 10:00 AM and 2:00 PM followed by HFCWO at 6:00 PM and 10:00 PM (n=22) or vice versa (n=23) on postoperative day 3. Dyspnea (modified Borg score), Spo2/FiO2, and peak expiratory flow (PEF) were measured pre-treatment and post-treatment. Data were analyzed using chi-square tests, t tests, and linear mixed effects models. RESULTS There was no statistically significant treatment effect for dyspnea or PEF in patients who received HFCWO versus CPT. However, there was a significant treatment effect on the Spo2/FiO2 ratio (p<0.0001). CONCLUSIONS Preliminary results suggest that lung function (measured by Spo2/FiO2) improves with HFWCO after lung transplantation. Although dyspnea and PEF did not differ significantly between treatment types, HFCWO may be an effective, feasible alternative to CPT.

CNE Article: Pain After Lung Transplant: High-Frequency Chest Wall Oscillation vs Chest Physiotherapy

Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n=22) or vice versa (group 2, n=23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ(2) and t tests and repeated-measures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P =.04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] vs 2 [15%], P=.01). However, single lung recipients showed no significant difference in preference between the 2 treatments (11 [42%] vs 14 [54%]). Conclusions HFCWO seems to provide greater decreases in pain scores than does chest physiotherapy. Bilateral lung transplant recipients preferred HFCWO to chest physiotherapy. HFCWO may be an effective, feasible alternative to chest physiotherapy. (American Journal of Critical Care. 2013;22:115-125).

Exhaustion, immuno-inflammation, and pathogen burden after cardiac surgery: An exploratory study

Background: Exhaustion, a consequence of prolonged stress characterized by unusual fatigue, is associated with increased risk of cardiac morbidity and mortality. In patients recovering from coronary artery bypass (CABG), little is known about the relationship of 1) immune-mediated inflammation and resultant endothelial activation, and 2) cumulative exposure to infectious pathogens (pathogen burden (PB)) implicated in coronary atherosclerosis to exhaustion. Aim: The aim of this exploratory study was to investigate the association of PB, inflammatory markers (interleukin (IL)-6, IL-10) and a marker of endothelial activation (soluble intercellular adhesion molecule-1 (sICAM-1)) to exhaustion. Methods: One to two months post-CABG, 42 individuals who met inclusion criteria were assessed for exhaustion using the Maastricht Interview for Vital Exhaustion. Serum IgG antibodies to herpes simplex virus (HSV)-1, HSV-2, cytomegalovirus, Epstein Barr virus, and inflammatory and endothelial activation markers were measured by enzyme-linked immunosorbent assay. Pathogen burden was defined as the total number of seropositive exposures: low (0-1), moderate (2-3), and high (4). Results: Prevalence of exhaustion was 40.5%. Relative to non-exhausted patients, exhausted patients demonstrated a higher frequency of moderate PB (h=0.73, p=0.04) but lower frequency of high PB (h=1.05, p=0.03). Exhaustion showed a non-significant trend for positive correlations with IL-6 and sICAM-1 levels, and inverse relation to PB. In subgroup analysis, exhausted patients had stronger correlations with IL-6 and IL-6:IL-10 and a tendency towards higher serum IL-10 concentrations compared with their non-exhausted counterparts. Conclusion: This hypothesis-generating study provides preliminary evidence that elevated post-CABG exhaustion may be associated with PB, inflammation, and endothelial activation.

DOES AGE CHANGE THE EFFECT OF DEPRESSIVE SYMPTOMS ON MORTALITY IN PATIENTS WITH CORONARY HEART DISEASE

In coronary heart disease (CHD) patients, depression is associated with increased mortality. Given limited research, we aimed to determine whether depressive symptoms predict 2-year all-cause mortality among younger and older CHD age groups. In secondary analysis of a longitudinal randomized