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The financial difficulties of parents have a negative impact on the health of their children. This problem is more pronounced in single mother families. There is limited research on low-income, single mothers and how interventions to help them address financial difficulties may also benefit their children. The purpose of this study was to evaluate the effect of a year-long financial education and coaching program on school absenteeism and health care utilization of children in employed, low-income, single mother households. This was a post hoc analysis of the Finances First study, a randomized controlled trial conducted in 2017–2020 examining the impact of a financial coaching and education program on economic stability and health outcomes in 345 low-income, single mothers. Either generalized estimating equations (GEEs) or generalized linear mixed models (GLMMs) were used to account for relationships between participants. For the continuous outcomes of child absenteeism, physician visits, emergency room visits, and hospitalization days, a linear mixed-effects model was used. The Finances First study demonstrated improvements in various financial strain measures. Compared to the control group, children of intervention group participants experienced 1 fewer day of school absence (p = 0.049) and 1 fewer physician visit (p = 0.032) per year, but no impact was seen on emergency room visits (p = 0.55) or hospitalizations (p = 0.92). Addressing social determinants of health in parents is necessary for improving child health outcomes. [ABSTRACT FROM AUTHOR]

Objectives. Evaluate the health impact of a novel financial education and coaching program in single mothers of low-income in Omaha, Nebraska. Methods. Employed, single mothers earning no more than 200% of the 2017 Federal Poverty Level (n = 345) enrolled in the study between April 2017 and August 2020 and were randomized to receive a novel financial education and coaching program, the Financial Success Program (FSP) or no intervention control. Demographics, biometrics, financial strain, health behaviors and healthcare utilization were assessed at baseline and the 12-month study visits. Results. Participants who completed the FSP demonstrated significantly reduced financial strain, an increased rate of smoking cessation, and a reduction in avoidance of medical care due to cost compared to participants in the control group. Conclusions. The FSP represents an effective model in promoting economic stability in vulnerable individuals through a reduction in financial strain. Health behavior changes including an increased rate of smoking cessation were demonstrated within the first 12 months of intervention. [ABSTRACT FROM AUTHOR]

Financial behaviors play an important role in promoting or reducing financial stability and may have an impact on health outcomes, in general. Hope theory is a framework applicable to promoting behavior change, including financial behavior change. This article describes the hope promoting components of a novel financial education and coaching program and the significant improvement in hopefulness demonstrated by women who participate in the program, as measured in the Finances First randomized controlled trial. [ABSTRACT FROM AUTHOR]

Background: Fish oils are the most widely used nonvitamin, nonmineral dietary supplements in the United States. They are not over-the-counter medications and are neither approved nor indicated for treating disease. Patient knowledge and patterns of fish oil use are not well defined. Objective: To determine cardiac patients' knowledge and patterns of fish oil use. Methods: One thousand consecutive patients admitted to an in-patient cardiology service (2015-2017) taking fish oil dietary supplements or prescription omega-3 fatty acids were asked to complete an anonymous questionnaire concerning product knowledge and use. Results: A total of 711 (71%) patients completed the questionnaire. Primary reasons for use included general health (34%), heart health (28%), arthritis (9%), and lipid disorders (8%). Few patients (14%) were advised to take fish oil products by a health-care provider. Only 2.5% were taking prescription omega-3 fatty acids. Only 26% knew the active ingredient in their fish oil product. Supplements were purchased through a nonpharmacy retail seller by 81% of respondents. Conclusions: Most cardiac patients consuming fish oil dietary supplements do so without medical supervision and without knowledge of the active ingredients. As most patients obtain supplements outside of a pharmacy, opportunities to monitor and educate patients remain a major challenge. [ABSTRACT FROM AUTHOR]

Economic stability is a well-documented social determinant of health, and financial stress is an important driver for the health disparities observed in the poor. Persons under financial stress are more likely to engage in smoking, alcohol consumption, overspending, poor diet, and reduced exercise. Financial education and coaching is one strategy that can be used to reduce financial stress and potentially improve engagement in healthy lifestyle behaviors, quality of life, and objective health outcomes. A conceptual model describing the link between financial education/coaching and health is described along with preliminary data from a randomized controlled trial evaluating this intervention. [ABSTRACT FROM AUTHOR]

Background: Increasing rates of medical errors necessitate incorporation of patient safety education for health professions students. Institutions must address the needs of both campus- and distance-based learners to meet interprofessional education (IPE) accreditation requirements. The purpose of this project was to evaluate a synchronous interprofessional patient safety simulation to train students on interprofessional teamwork and communication through recognition of patient safety and medical hazards. Method: Students from health care professions participated in a Haunted Hospital/Heartbreak Hospital patient hazard/medical error simulation. A total of 201 students in 41 teams, both campus and distance, participated over three semesters. Results: Mean Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) scores significantly improved from 44.81 ± 3.59 to 47.08 ± 3.31 (Mean Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) scores significantly improved from 44.81 ± 3.59 to 47.08 ± 3.31 (p <.0001). Qualitative responses indicated that students appreciated working with other health care students through collaborative practice and recognized the importance of discipline-specific expertise. Conclusion: This simulation provided campus and distance learners with a collaboration opportunity that improved their perceptions of IPE. This simulation provided campus and distance learners with a collaboration opportunity that improved their perceptions of IPE. [[J Nurs Educ. 2019;58(10):577–582.] [ABSTRACT FROM AUTHOR]

Financial stress is implicated in poor health and decreased Quality of Life (QOL). The purpose of this project was to assess the 2-year effect of a financial education program on the health of single, low-income women. A total of 30 women were enrolled and 20 continued through follow-up. Two years following intervention, women demonstrated a $8,026 increase in mean annual income and significant improvements in health-related QOL and hopefulness. Half of the participants lost weight, and while not statistically significant, mean weight decreased by 2.2 pounds. Trends in decreased fast food consumption were observed. The results suggest that financial education has a significant, sustained effect on the health and health-related QOL of single, women of low income. [ABSTRACT FROM AUTHOR]

Aim Suboptimal adherence to medications taken chronically for secondary prevention of cardiovascular disease ( CVD, e.g., aspirin) continues to burden the healthcare system despite the well-established benefits of prevention. We conducted a literature search to examine patient adherence to medications for secondary prevention of CVD-as evaluated by prescription refill data, electronic medication monitors, pill counts, and physiologic markers-to better identify an unmet need for measures to improve patient adherence to these therapies. Methods English-language articles were obtained from the PubMed database using the following key words or combinations thereof 'adherence,' 'compliance,' 'secondary prevention,' and 'cardiovascular disease.' Publications that provided adherence data only for primary prevention, lacked data on medication adherence (e.g., focus on guideline adherence), emphasized quality-of-care outcomes, or focused on outcomes of acute interventions were excluded. Results Multiple patient-, disease-, and treatment-related factors may contribute to poor adherence to treatment regimens, and therefore, a multifactorial approach will likely be needed to improve compliance with prescribed treatments for CVD. Although no magic bullet exists to assure full adherence, adherence programs coupled with patient counseling and education (inclusive of over-the-counter therapies), along with treatments that are less complex or avoid bothersome adverse effects, are more likely to be associated with successful outcomes. Conclusion Given the burden of CVD to the community and the healthcare system, nonadherence to CVD-preventative medications such as aspirin remains a substantial area of unmet need and represents a key opportunity for the development of quality-of-care enhancement programs to improve health outcomes in this patient population. [ABSTRACT FROM AUTHOR]

Depressed patients are at increased risk of cardiovascular (CV) disease (CVD) and those with concomitant depression and CVD are at increased risk of death. The safety and efficacy of antidepressants in patients with CVD varies greatly between the agent used and type of disease. This review will summarize the CV adverse effect and drug interaction profile of antidepressants and discuss the use of antidepressants in CVD patients. We searched MEDLINE, PubMed, CINAHL, Web of Science, PsycINFO, and The Cochrane Library from inception to June 2014 to identify studies relevant to antidepressant use in patients with CVD. Primary references from the identified articles were also evaluated for inclusion. Descriptive analysis was performed for the included studies in this review. Orthostatic hypotension was more common with tricyclic antidepressants (TCAs), trazodone and monoamine oxidase inhibitors (MAOIs). Hypertension can be significant with serotonin norepinephrine reuptake inhibitors (SNRIs) and MAOIs. The potential for QT prolongation is present with TCAs, certain selective serotonin reuptake inhibitors (SSRIs), certain SNRIs and mirtazapine. Due to its low risk of drug-drug interactions, adverse effect profile and potential for beneficial antiplatelet activity, sertraline could be considered the choice antidepressant for patients with ischemic heart disease. SSRIs and potentially SNRIs are relatively safe and effective options for patients with heart failure. In patients at high risk for ventricular arrhythmias, bupropion has the overall lowest risk for QT prolongation. TCAs and MAOIs should be avoided in patients with concomitant CVD. In conclusion, due to the increased morbidity and mortality associated with comorbid CVD and depression, practitioners should readily assess and initiate management of depression in such patients. The choice of antidepressant should take into account the potential CV impact of the various agents balancing safety and efficacy. [ABSTRACT FROM AUTHOR]

Background: This pilot study evaluated the efficacy of the Interprofessional Team Reasoning Framework (IPTRF) to facilitate teaching and learning case studies with health professions students. Methods and Findings: Eighteen interprofessional students were randomized to teams of six and were videotaped while completing a case. Team 1 (control) received only the case; team 2 received the case plus framework; and team 3 received the case, framework, and was shown videotaped examples of interprofessional interactions. The primary endpoint was students' perceptions of interprofessional skills as measured pre and post intervention using a modified Team Skills Scale. The secondary endpoint was student performance as assessed by blinded individuals using a standardized rubric. The results revealed that students' perceptions of team skills were significantly improved in team 2 and team 3 but not team 1. Students' performance of their case as assessed by blinded faculty was significantly better in team 3 compared with teams 1 and 2. Conclusions: In this study of six disciplines, the IPTRF, in combination with modeled examples of interprofessional communication, was an effective tool to teach skills necessary to workup a patient case, which included collaboration, communication, and values/ethics. As the landscape of interprofessional education evolves, tools like the IPTRF will facilitate incorporation of these skills into health professions education. [ABSTRACT FROM AUTHOR]

Study Objective. To compare the efficacy of amlodipine and valsartan in African-American patients with hypertension using ambulatory blood pressure monitoring (ABPM). Design. Prospective, randomized, double-blind, crossover comparison study. Setting. University-affiliated cardiac center clinic. Patients. Twenty African-Americans (12 men, 8 women), with a history, of uncomplicated hypertension (blood pressure > 140/90 mm Hg). Intervention. Patients were randomized to receive amlodipine 5 or 10 mg/day or valsartan 80 or 160 rag/day for 8-10 weeks, depending on response. Dosages were titrated to achieve a blood pressure of 140/90 nun Hg or below. For patients whose blood pressures were not controlled, hydrochlorothiazide 12.5 mg/day was added to their regimens. Patients then underwent 24-hour ABPM. After an intervening washout period during which baseline blood pressure was reestablished, patients received the other treatment. Measurements and Main Results. Mean ± SD baseline blood pressure before the two ABPM periods were 155 ± 12/100 ± 8 man Hg and 156 ± 11/101 ± 9 mm Hg, respectively. Fifteen (75%) patients achieved goal blood pressure with amlodipine and 14 (70%) with valsartan (p=0.62). Final daily dosages were as follows: amlodipine 5 mg in nine patients, 10 mg in five patients, and 10 mg plus hydrochlorothiazide in six patients; valsartan 80 mg in nine patients, 160 mg in four patients, and 160 mg plus hydrochlorotbiazide in seven patients. Ambulatory blood pressure monitoring was not completed in three patients due to adverse effects: headache and dizziness (one patient each, amlodipine and valsartan) and hyperkalemia (one patient, valsartan). Four patients (20%) in each treatment group had drug-related adverse effects. Results of ABPM including averages for 24-hour, daytime, nighttime, first 4 hours, and last 8 hours, and trough:peak ratios were not significantly different between the amlodipine- and valsartan-based treatments. Conclusion. Based on both clinic blood pressure measurements arid ABPM data, amlodipine and valsartan produced similar reductions in blood pressure in African-American patients with uncomplicated hypertension. [ABSTRACT FROM AUTHOR]

Fingernail clubbing and discoloration frequently indicate serious pulmonary, cardiovascular, and gastrointestinal pathologies. A 70-year-old Caucasian man developed clubbing of the fingernails and discoloration of both the fingernails and toenails after 27 days or treatment with the angiotensin II receptor blocker (ARB) losartan 50 mg/day. Even though this therapy was switched to valsartan, the nail changes persisted for another 6 months. The patient's therapy then was changed to captopril, and the changes gradually subsided over 17 months. An extensive literature search revealed no reports of this effect in association with ARBs. However, one manufacturer had received spontaneous reports. Despite careful consideration of other possible causes or the patient's symptoms, the temporal association with the start and discontinuation of ARB therapy suggests a possible drug-related adverse event. [ABSTRACT FROM AUTHOR]

The Core Competencies for Collaborative Practice identify the skills needed by every health care provider to be successful in implementing interprofessional practice. Health professions students need to build skills for interprofessional practice as emerging professionals. Reflection is a core skill needed for successful interprofessional practices. This study identifies themes from an interprofessional education research project and discusses their congruency with the Competencies. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the health impact of a novel financial education and coaching program in single mothers of low-income in Omaha, Nebraska., Methods: Employed, single mothers earning no more than 200% of the 2017 Federal Poverty Level (n = 345) enrolled in the study between April 2017 and August 2020 and were randomized to receive a novel financial education and coaching program, the Financial Success Program (FSP) or no intervention control. Demographics, biometrics, financial strain, health behaviors and healthcare utilization were assessed at baseline and the 12-month study visits., Results: Participants who completed the FSP demonstrated significantly reduced financial strain, an increased rate of smoking cessation, and a reduction in avoidance of medical care due to cost compared to participants in the control group., Conclusions: The FSP represents an effective model in promoting economic stability in vulnerable individuals through a reduction in financial strain. Health behavior changes including an increased rate of smoking cessation were demonstrated within the first 12 months of intervention., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2022 The Author(s).)

Financial behaviors play an important role in promoting or reducing financial stability and may have an impact on health outcomes, in general. Hope theory is a framework applicable to promoting behavior change, including financial behavior change. This article describes the hope promoting components of a novel financial education and coaching program and the significant improvement in hopefulness demonstrated by women who participate in the program, as measured in the Finances First randomized controlled trial., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2020 The Author(s).)

Rivaroxaban is a direct oral anticoagulant (DOAC) indicated to reduce risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). A discrepancy exists between the recommended dosage and real-world use of DOACs, especially rivaroxaban, thus putting patients at risk of thromboembolic events., Methods: This retrospective study assessed real-world prescribing and patient adherence to dietary requirements during use of rivaroxaban in 116 patients with AF. Associations between prescriber specialty and the correct dosing and administration were assessed using the Chi-Square test., Results: Most rivaroxaban prescriptions were ordered by cardiologists (50.9%). Sixty-nine patients (59.5%) were taking the right dose at the correct time with an adequate meal. Of the 47 (40.5%) taking rivaroxaban incorrectly, 39 (33.6%) had not been administered an adequate meal and eight (6.9%) were not prescribed the correct dose. Compared with other prescribers, patients were most likely to be taking the correct dose and administration when prescribed by cardiologists (72.9% versus 45.6%; p=0.003). Patients were least likely to be taking the correct dose and administration when prescribed by primary care providers (44.4% versus 69.0%; p=0.009). This difference was driven by patients who did not take the treatment with an adequate meal., Conclusion: Inappropriate prescribing, administration and non-adherence to DOACs can have devastating consequences. This highlights the importance of formal systematic education of patients prescribed DOACs across the whole health system. Future studies are warranted to explore the impact of non-adherence to rivaroxaban dietary requirements on clinical outcomes., Competing Interests: Disclosure: Steven K Krueger is on the Speaker's Bureau for Amgen, Boehringer Ingelheim, Novartis, Regeneron Pharmaceuticals, Sanofi, Orexigen Therapeutics, Janssen, Kowa Pharmaceuticals, Pfizer, Bristol Myers Squibb and Amarin. Madeline R Leiter, Kathleen A Packard and Yongyue Qi have no conflicts of interest to declare., (© Touch Medical Media 2019.)

Background: Heart failure is one of the most common reasons for hospital admissions in patients aged 65 years and older, with an estimated 1 million hospitalizations annually. In 2010, health care expenditures for heart failure were estimated to be $32 billion. Nonadherence to medications and lifestyle contributes to hospital admissions in up to one-third of patients. Efforts to reduce readmissions are of critical importance. Pharmacist involvement in the management of heart failure patients has been shown to reduce heart failure hospitalizations, with trends towards a reduction in mortality. Literature is scarce on instruments that clinicians can use to identify patients at risk for medication nonadherence., Objectives: To (a) describe factors that predict medication adherence for patients with heart failure, (b) evaluate the impact and value of pharmacist interventions on adherence and outcomes, and (c) assess tools to predict medication nonadherence in heart failure patients., Methods: From inception to September 2013, a search was conducted in the databases MEDLINE, PubMed, CINAHL, and The Cochrane Library to identify relevant studies for 3 separate searches, identifying predictors of medication adherence in heart failure patients, pharmacist involvement to impact medication adherence, and tools to predict medication nonadherence in this population., Results: Many significant predictors of both medication adherence and nonadherence have been identified in heart failure patients. Studies evaluating the effect of pharmacist involvement in the management of heart failure demonstrated improvements in medication adherence that dissipated once the intervention was withdrawn. The Morisky Medication Adherence Scale and the Merck Adherence Estimator are simple and practical tools that may be useful for identifying nonadherence in heart failure patients., Conclusions: Clinicians should be cognizant of factors that may affect medication adherence in heart failure patients and be aware of instruments available to predict the risk for medication nonadherence. Pharmacist interventions should be part of a multidisciplinary system of care initiated at discharge that involve personal contact and are continued indefinitely in order to sustain these benefits.

An important component to optimal health is quality of life (QOL). Several healthy lifestyle behaviors have independently shown to improve QOL. The simultaneous implementation of multiple lifestyle behaviors is thought to be difficult, and the current literature lacks the assessment of multiple lifestyle behaviors simultaneously with respect to the effect on QOL. This current pilot study sought to develop a method to quantify multiple lifestyle behaviors into a single index value. This value was then measured with QOL for a possible correlation. The results showed that it is possible to convert multiple raw healthy lifestyle data points into a composite value and that an improvement in this value correlates to an improved QOL. After 12 months of participation in a cardiovascular risk reduction program, study participants (N = 35) demonstrated a 37.4% (P < 0.001) improvement in the composite lifestyle index (CLI). The improved CLI demonstrated a correlation with a statistically significant improvement in how participants rated their overall health in 12 months (r = 0.701, P < 0.001) as well as the number of self-reported unhealthy days per month in 12 months (r = -0.480, P = 0.004).