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Purpose To compare elders' self-ratings of the impact of their chronic conditions with healthcare providers' estimates of the impact of the same conditions on older adults. The effect of length of time in clinical practice and rural or urban clientele on healthcare providers' impact ratings was also explored. Data sources A pen-and-paper survey was administered to 122 community-dwelling adults aged 55 years and older, attending health education or exercise programs held by a hospital in a city of approximately 60,000 people. Elders were asked to identify which of 11 common chronic conditions they had and then to rate the impact each condition had on their daily lives. A sample of 290 healthcare providers who are members of the Gerontological Society of America completed a mailed survey asking them to estimate the impact that each of the 11 conditions had on older adults. Conclusions Healthcare providers consistently overestimated the impact that chronic health conditions had on older adults when compared with the elders' self-ratings of impact. Greater levels of experience were not significantly related to providers' impact ratings of chronic conditions. Implications for practice Nurse practitioners, as primary care providers, must understand the impact of chronic conditions on older adults' daily lives in order to provide effective, efficient, and evidence-based health care. This study points to the need for more research to discover why older adults and healthcare providers have such different perspectives on the impact of chronic health conditions. [ABSTRACT FROM AUTHOR]

The primary purpose of conducting this study was to determine if there is a significant relation between health motivation and participation in health promotion programs in a sample of community-dwelling older adults (n = 106). Health motivation was measured using Cox's (1985) Health Self-Determinism Index, and participation in health promotion programs was measured by tallying the self-reported number of programs attended within the past year by each individual. The effects of selected demographic variables on these two variables were also examined. The conceptual framework guiding the study was the Health-Promoting Self-Care System Model (Simmons, 1990). Intrinsically motivated older persons attended fewer programs (p < .01) than those who were more extrinsically motivated. Higher educational level (p < .001) and fewer health problems (p < .01) emerged as significant predictor variables for intrinsic health motivation, and those with less formal education attended more health promotion programs (p < .05). [ABSTRACT FROM AUTHOR]

Purpose: Cone Beam Computed Tomography (CBCT) offers a valid alternative to conventional Computed Tomography (CT). A possible radiation dose reduction with the use of CBCT in postoperative imaging of CIs is of great importance. Whether the visualization of Cochlear Implant (CI) electrodes in CBCT correlates with the radiation dose applied was investigated in this study. Methods: We compared the visualization quality of Contour Advance CIs to Straight CIs from Cochlear using CBCT with varying tube parameters on whole-head specimen. Results: The internal diameter of the cochlea decreases from base to apex, resulting in a significantly different intracochlear positioning of the two tested CI models. While electrodes of the Contour Advance series are located close to the modiolus, thus closer to the spiral ganglion neurons, those of the Straight series are located further away. The artifact portion of the electrode amounts to 50–70% of the radiological diameter of the electrode. An increase in artifact portion from the base (electrode #1 approx. 50%) to the apex (electrode #20 approx. 70%) of the cochlea was observed. The visualization of electrodes in the medial and apical part of the cochlea is limited due to artifact overlapping. There was no correlation between the artifact size and the applied radiation dose. Conclusion: The results indicate that a reduction of the radiation dose by up to 45% of the currently applied radiation dose of standard protocols would be possible. Investigations of the effects on subjective image quality still need to be performed. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a history of cerebrovascular disease (CVD) increases risk of severe coronavirus disease 2019 (COVID-19). Methods: In a retrospective multicenter study, we retrieved individual data from in-patients treated March 1 to April 15, 2020 from COVID-19 registries of three hospitals in Saxony, Germany. We also performed a systematic review and meta-analysis following PRISMA recommendations using PubMed, EMBASE, Cochrane Library databases and bibliographies of identified papers (last search on April 11, 2020) and pooled data with those deriving from our multicenter study. Of 3762 records identified, 11 eligible observational studies of laboratory-confirmed COVID-19 patients were included in quantitative data synthesis. Risk ratios (RR) of severe COVID-19 according to history of CVD were pooled using DerSimonian and Laird random effects model. Between-study heterogeneity was assessed using Cochran's Q and I2-statistics. Severity of COVID-19 according to definitions applied in included studies was the main outcome. Sensitivity analyses were conducted for clusters of studies with equal definitions of severity. Results: Pooled analysis included data from 1906 laboratory-confirmed COVID-19 patients (43.9% females, median age ranging from 39 to 76 years). Patients with previous CVD had higher risk of severe COVID-19 than those without [RR 2.07, 95% confidence interval (CI) 1.52–2.81; p < 0.0001]. This association was also observed in clusters of studies that defined severe manifestation of the disease by clinical parameters (RR 1.44, 95% CI 1.22–1.71; p < 0.0001), necessity of intensive care (RR 2.79, 95% CI 1.83–4.24; p < 0.0001) and in-hospital death (RR 2.18, 95% CI 1.75–2.7; p < 0.0001). Conclusion: A history of CVD might constitute an important risk factor of unfavorable clinical course of COVID-19 suggesting a need of tailored infection prevention and clinical management strategies for this population at risk. [ABSTRACT FROM AUTHOR]

Background: Regional mechanical characterization of pulmonary arteries can be useful in the development of computational models of pulmonary arterial mechanics. Objective: We performed a biomechanical and microstructural characterization study of porcine pulmonary arteries, inclusive of the main, left, and right pulmonary arteries (MPA, LPA, and RPA, respectively). Methods: The specimens were initially stored at −20 °C and allowed to thaw for 12–24 h prior to testing. Each artery was further subdivided into proximal, middle, and distal regions, leading to ten location-based experimental groups. Planar equibiaxial tensile testing was performed to evaluate the mechanical behavior of the specimens, from which we calculated the stress at the maximum strain (S55), tensile modulus (TM), anisotropy index (AI), and strain energy in terms of area under the stress-strain curve (AUC). Histological quantification was performed to evaluate the area fraction of elastin and collagen content, intima-media thickness (IMT), and adventitial thickness (AT). The constitutive material behavior of each group was represented by a five-constant Holzapfel-Gasser-Ogden model. Results: The specimens exhibited non-linear stress-strain characteristics across all groups. The MPA exhibited the highest mean wall stress and TM in the longitudinal and circumferential directions, while the bifurcation region yielded the highest values of AI and AUC. All regions revealed a higher stiffness in the longitudinal direction compared to the circumferential direction, suggesting a degree of anisotropy that is believed to be within the margin of experimental uncertainty. Collagen content was found to be the highest in the MPA and decreased significantly at the bifurcation, LPA and RPA. Elastin content did not yield such significant differences amongst the ten groups. The MPA had the highest IMT, which decreased concomitantly to the distal LPA and RPA. No significant differences were found in the AT amongst the ten groups. Conclusion: The mechanical properties of porcine pulmonary arteries exhibit strong regional dissimilarities, which can be used to inform future studies of high fidelity finite element models. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series.Methods: We performed 374 sialendoscopies between 2008 and 2015 and evaluated all patients regarding clinical symptoms, clinical findings, therapy and outcome. We performed 109 procedures of holmium laser-assisted lithotripsy in 64 patients whose sialoliths measured 5 mm or more in diameter. In addition to retrospective case note reviews, we performed telephone interviews of all patients in January 2017.Results: We performed 374 consecutive submandibular gland sialendoscopy procedures in 276 patients between 2008 to 2015. Sialolithiasis had either previously been diagnosed, or symptoms highly suggestive of sialolithiasis of the submandibular gland presented in 197 patients. Holmium laser-assisted Laser lithotripsy was performed in 109 cases (64.9%). Smaller mobile concrement was removed directly either by forceps or wire basket, or following marsupialisation of the submandibular duct. This was the case in 88 patients (29.1%). Three patients (0.8%) required surgical removal of the submandibular gland due to early abscess. The majority of patients (n = 374 procedures; 90.1%) remained symptom-free after two or more years following intervention. In the remaining procedures (n = 37 procedures; 9.9%), patients reported discreet postprandial problems but did not seek medical attention. In total, we managed to preserve the submandibular gland and avoid open surgery in 99% of patients through endoscopic management of submandibular concrement and duct stenosis.Conclusion: Holmium laser-assisted lithotripsy is a simple, safe, and effective procedure for treating patients with sialolithiasis of the submandibular gland. Removal of the gland is rarely required, and removing the gland without prior sialendoscopy is no longer recommended. It should be offered to all patients with submandibular gland sialolithiasis, or such patients should be referred to the appropriate centre for sialendoscopy before submandibulectomy is considered. [ABSTRACT FROM AUTHOR]

Living with chronic co-morbidities implies long-lasting, always present conditions associated with highly variable health trajectories. In this study, ecological momentary assessment was used to explore nine older women's experiences of living with co-morbidities. Each participant completed a daily diary, which focused on 10 variables related to energy, pain, effort expended, and an overall health rating, for 21 days. Hierarchical linear modeling was used to explore intra -individual variation in daily health experiences and health-related burden, and determine the extent to which health-related burden was related to daily health experiences. Each of the daily health experience variables significantly predicted health-related burden. Over half of the variation was attributed to the predictor variables. These findings reveal the dynamic nature of living with multiple chronic conditions and demonstrate the utility of daily diaries for measuring fluctuating states of health in community-dwelling older women. [ABSTRACT FROM AUTHOR]

Abstract: A working party, comprising two animal welfare organisations and some 12 pharmaceutical companies in Europe, was established to minimise the use of the dog in safety testing. As first step, the participants defined the major objectives of preliminary dose-range finding/MTD toxicity studies in non-rodents, defined the principles and requirements for this study type and agreed on a proposal for an optimised study design, based on collective experience of conducting such studies in industry, involving an evaluation of 100 individual study data sets. The suggested study design is explained and described, and reflects current best practice in the pharmaceutical industry in Europe. The implementation of such an optimised design is believed to result in a reduction in the overall numbers of animals used for this purpose, without jeopardising the scientific rationale and usefulness of the studies for informing the conduct of later regulatory studies. [Copyright &y& Elsevier]

HANSKY, B.,et al. Endocardial Pacing After Fontan-Type Procedures. Background:Sinus node dysfunction is a frequent complication of Fontan-type procedure. Epicardial pacing is considered as the standard treatment for these patients.Methods and Results:We evaluated an endocardial approach in seven patients using a 4.1 French bipolar lumenless lead (SelectSecure) that is positioned through a steerable guiding catheter. Either a purely transvenous or an open transatrial approach can be used for lead placement. The smallest child weighed 12 kg. Individual anatomy was assessed preimplantation using magnetic resonance imaging and injection of radiographic contrast agent through the guiding catheter. A pullback pressure recording was used to confirm unimpaired blood flow into the pulmonary artery. Five of our seven patients underwent de novo transvenous atrial lead implantation for AAIR pacing. In the remaining two patients, both atrial and ventricular leads were inserted. One patient with an intraatrial tunnel underwent transvenous-lead placement. The remaining patient with an extracardiac conduit received atrial and ventricular leads implanted through a guiding catheter inserted through an atriotomy. The postoperative management included short- or long-term oral anticoagulation.Conclusions:Transvenous endocardial lead implantation avoids the problem of increasing capture thresholds typically observed with epicardial leads. Due to its high tensile strength and lumenless design, the isodiametric lead is expected to remain extractable for an extended period of time.(PACE 2005; 28:140–148) [ABSTRACT FROM AUTHOR]

This qualitative study was conducted using focus groups to explore the strategies commonly employed by older adults (N = 37) to manage multiple chronic conditions. Key strategies identified were relating with health care providers, medicating, exercising, changing dietary patterns, seeking information, relying on spirituality and/or religion, and engaging in life. Although social support was not mentioned as a discrete strategy, the participants 'social networks were embedded in alt of the categories. This study supports building a partnership of care in which nurses and other health care professionals function in supportive and educative roles to enhance the older person's lifelong self-care management and ability lo stay in control of multiple chronic health conditions. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to increase the awareness of gerontological nurse researchers about methodological, theoretical and ethical issues that are unique and critical to the study of frail elderly people. Discussion focuses on: (a) sampling, recruitment, informed consent and retention of subjects; (b) selection and adaptation of measurement instruments; (c) implementation of treatment modalities and data collection protocols; (d) theoretical shortcomings; and (e) ethical concerns. Such issues must be resolved if answers are to be found for multiple health problems that pose such a heavy burden for many frail elderly people. As the number in this highly vulnerable group increases, gerontological nurse scientists, like all health care researchers, must better understand their needs and discover their strengths. We must design innovative research protocols to capture that information. [ABSTRACT FROM AUTHOR]