Search

BACKGROUND: Currently, fluid restriction recommendations in heart failure (HF) are based on expert opinion. After implementing a 1,000-mL/d fluid restriction for 60 days after discharge, outcomes were examined. METHODS AND RESULTS: In a randomized controlled design, hyponatremic patients (serum sodium <=137 mg/dL) received usual care (UC; n = 26) or 1,000 mL/d fluid restriction (n = 20) at discharge. Quality of life (QoL), thirst, difficulty following fluid recommendations, adherence to fluid restriction, HF emergency care, HF rehospitalization, and all-cause death were examined. Mean age was 62.8 ± 12.8 years; 46% were white. There were no differences by group in baseline demographics, comorbidities, and QoL, except that more UC patients had New York Heart Association (NYHA) functional class III/IV status (P = .019). Median [interquartile range] QoL scores were better in the 1,000 mL/d group for symptom burden (83.3 [68.8-91.7] vs 50 [29.2-79.2]; P = .018), total symptoms (77.1 [58.1-91.7] vs 54.2 [30.2-73.9]; P = .022), overall QoL summary (72.6 [52.2-86.3] vs 51.0 [37.7-68.5]; P = .038), and clinical QoL summary (75.5 [57.8-92.9] vs 59.1 [35.7-77.3]; P = .039). There were no group differences in thirst, difficulty adhering to fluid recommendations, adherence to fluid restriction, or health care consumption. CONCLUSIONS: The 1,000 mL/d fluid restriction led to improved QoL at 60 days after discharge. Future research in a larger more heterogeneous sample is needed. [ABSTRACT FROM AUTHOR]

Objectives: This study examined short-term cardiac catheterization rates and medication changes after cardiac imaging.Background: Noninvasive cardiac imaging is widely used in coronary artery disease, but its effects on subsequent patient management are unclear.Methods: We assessed the 90-day post-test rates of catheterization and medication changes in a prospective registry of 1,703 patients without a documented history of coronary artery disease and an intermediate to high likelihood of coronary artery disease undergoing cardiac single-photon emission computed tomography, positron emission tomography, or 64-slice coronary computed tomography angiography.Results: Baseline medication use was relatively infrequent. At 90 days, 9.6% of patients underwent catheterization. The rates of catheterization and medication changes increased in proportion to test abnormality findings. Among patients with the most severe test result findings, 38% to 61% were not referred to catheterization, 20% to 30% were not receiving aspirin, 35% to 44% were not receiving a beta-blocker, and 20% to 25% were not receiving a lipid-lowering agent at 90 days after the index test. Risk-adjusted analyses revealed that compared with stress single-photon emission computed tomography or positron emission tomography, changes in aspirin and lipid-lowering agent use was greater after computed tomography angiography, as was the 90-day catheterization referral rate in the setting of normal/nonobstructive and mildly abnormal test results.Conclusions: Overall, noninvasive testing had only a modest impact on clinical management of patients referred for clinical testing. Although post-imaging use of cardiac catheterization and medical therapy increased in proportion to the degree of abnormality findings, the frequency of catheterization and medication change suggests possible undertreatment of higher risk patients. Patients were more likely to undergo cardiac catheterization after computed tomography angiography than after single-photon emission computed tomography or positron emission tomography after normal/nonobstructive and mildly abnormal study findings. (Study of Perfusion and Anatomy's Role in Coronary Artery [CAD] [SPARC]; NCT00321399). [ABSTRACT FROM AUTHOR]

BACKGROUND: Patient education of self-care is an integral component of nursing care. Promoting self-care is important for patients with diabetes because day-to-day decision making has a tremendous impact on health. PURPOSE: To examine diabetes knowledge of nurses working on medical cardiology and cardiovascular surgical intermediate care units. METHODS: In this prospective, cross-sectional, correlational study, 90 registered nurses working on medical cardiology and cardiovascular surgical units completed a 20-item survey on diabetes survival skill education. Correlational and comparative statistics were used to analyze data. RESULTS: Subjects (N = 90) were more often female (n = 73; 83.0%) and worked full time (n = 76; 84%); mean (SD) RN experience was 5.6 years (SD, 7.6 years). Total mean score on the Diabetes Survival Skills Knowledge Test (DKSST) was 10.4 (SD, 2.6), reflecting 50% mastery of diabetes survival skill content. Test scores were higher in nurses with greater general comfort in teaching patients about diabetes (P =.04), more years of experience as a nurse (P =.004), more years of work at the current workplace (P <.001), and more years in their current work unit (P <.001). By age, nurses in the oldest quartile (> or =37 years) had higher DKSST content area scores in oral glucose-lowering agents (P =.02) and symptom management (P =.01) and had a trend toward higher overall DKSST score (P =.06) and score on blood glucose self-monitoring (P =.06). Sex, formal education level, work commitment, and previous diabetes education were not associated with higher DKSST scores. CONCLUSION: Nurse's knowledge and comfort related to diabetes survival skill teaching were low. The strongest correlate of higher DKSST score was length of time as a nurse. Because previous education and other nurse characteristics were not associated with higher test scores, nurse educators and advanced practice nurses must modify education delivery modalities to improve retention of information used in the delivery of patient education about diabetes survival skills. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate compression, illumination enhancement, registration, segmentation, automated classification and steganography using digitized cervical images.Materials and Methods: The Hybrid Multi-Scale Vector Quantization algorithm developed at Texas Technological University and other automated systems were used to improve digitized cervical images.Results: We demonstrated high levels of image compression, illumination enhancement, registration, automated segmentation and classification and steganography of digitized cervical images.Conclusions: Digitized cervical images can be altered to facilitate research of cervical neoplasia. [ABSTRACT FROM AUTHOR]

Objective: Visual assessment of digitized cervigrams through the Internet needs to be optimized. The National Cancer Institute and National Library of Medicine are involved in a large effort to improve colposcopic assessment and, in preparation, are conducting methodologic research.Materials and Methods: We selected 50 cervigrams with diagnoses ranging from normal to cervical intraepithelial neoplasia 3 or invasive cancer. Those pictures were scanned at 5 resolution levels from 1,550 to 4,000 dots per inch (dpi) and were presented to 4 expert colposcopists to assess image quality. After the ideal resolution level was determined, pictures were compressed at 7 compression ratios from 20:1 to 80:1 to determine the optimal level of compression that permitted full assessment of key visual details.Results: There were no statistically significant differences between the 3,000 and 4,000 dpi pictures. At 2,000 dpi resolution, only one colposcopist found a slightly statistically significant difference (p = 0.02) compared with the gold standard. There was a clear loss of quality of the pictures at 1,660 dpi. At compression ratio 60:1, 3 of 4 evaluators found statistically significant differences when comparing against the gold standard.Conclusions: Our results suggest that 2,000 dpi is the optimal level for digitizing cervigrams, and the optimal compression ratio is 50:1 using a novel wavelet-based technology. At these parameters, pictures have no significant differences with the gold standard. [ABSTRACT FROM AUTHOR]

A robust stereoscopic method is presented for rapid identification of hidden 3D objects by extracting edge and other features from computed depth planes using only a small number of X-ray projections acquired with a low-cost portable X-ray imager. The portable X-ray imager acquires X-ray projections with a single fixed sensor from different viewing angles by rotating an X-ray source attached to the end of a pivot arm. Knowing the geometry of the X-ray imaging system, a series of depth planes are computed to extract the significant features of the hidden objects for quick identification. The proposed hidden object identification algorithm can be easily parallelised and embedded in portable devices for real-time applications. [ABSTRACT FROM AUTHOR]