Unusual Fatigue and Failure to Utilize EMS Are Associated With Prolonged Prehospital Delay for Suspected Acute Coronary Syndrome.

Background: Rapid reperfusion reduces infarct size and mortality for acute coronary syndrome (ACS), but efficacy is time dependent. The aim of this study was to determine if transportation factors and clinical presentation predicted prehospital delay for suspected ACS, stratified by final diagnosis (ACS vs. no ACS).

Symptom Profiles of Latina Breast Cancer Survivors: A Latent Class Analysis.

Background: Symptom research among Latinas with breast cancer is limited-especially as it relates to multiple co-occurring symptoms.

Objective: The aim of the study was to identify subgroups (latent classes) of Latinas who have distinct symptom profiles while receiving radiation, chemotherapy, and/or hormonal therapy for breast cancer.

Methods: This secondary analysis included intake data from three randomized trials of supportive care psychosocial interventions for Latinas treated for breast cancer (n = 290).

Stroke Survivors' Feelings and Perceptions of Their Recovery After a Tai Chi Exercise Intervention: A Qualitative Descriptive Study.

Background: Most tai chi studies conducted among stroke survivors have focused on physical functioning, whereas inclusion of stroke survivors' feelings and perceptions of participating in tai chi is lacking.

Objective: The aim of this study was to identify stroke survivors' feelings and perceptions of participating in a tai chi intervention during their poststroke recovery.

Methods: This qualitative descriptive study examined stories from community-dwelling stroke survivors, collected as part of a larger randomized clinical trial.

Protein Cytokines, Cytokine Gene Polymorphisms, and Potential Acute Coronary Syndrome Symptoms.

The purpose of this study was to determine whether relationships exist among protein cytokines, cytokine gene polymorphisms, and symptoms of potential acute coronary syndrome (ACS). Participants included 438 patients presenting to the emergency department (ED) whose symptoms triggered a cardiac evaluation (206 ruled in and 232 ruled out for ACS). Presence or absence of 13 symptoms was recorded upon arrival.

Trajectories of Depression and Anxiety in Latina Breast Cancer Survivors.

Objectives: To identify subgroups of Latina breast cancer survivors with unique trajectories of depression and anxiety and examine predictors associated with these subgroups.

Sample & Setting: Secondary analysis of Latina breast cancer survivors (N = 293) from three psychosocial intervention studies.

Methods & Variables: Depression and anxiety were assessed at intake and at weeks 8 and 16.

Acute Myocardial Infarction Experience Among Mexican American Women.

Introduction: Health disparities in cardiovascular disease risk factors affect a burgeoning segment of the U.S. population-Mexican American (MA) women.

Using cognitive interviews to improve a Psychological-Social-Spiritual Healing instrument: Voices of aging African Americans with serious illness.

Aim: The purpose of this study was to contribute to content validity, by providing input into the linguistic and pragmatic validities, of a 53 item Psychological-Social-Spiritual Healing instrument.

Background: Discovery of cultural values and beliefs from African American elders' experiences of illness provides insight for development of more culturally sensitive instruments.

Methods: Through an exploratory descriptive design, this study used cognitive interviewing methods to examine linguistic and pragmatic validity of the Psychological-Social-Spiritual Healing instrument, from the perspectives of aging seriously ill AAs.

Impact of comorbidities by age on symptom presentation for suspected acute coronary syndromes in the emergency department.

Background: It is estimated half of acute coronary syndrome (ACS) patients have one or more associated comorbid conditions.

Aims: Aims were to: 1) examine the prevalence of comorbid conditions in patients presenting to the emergency department with symptoms suggestive of ACS; 2) determine if comorbid conditions influence ACS symptoms; and 3) determine if comorbid conditions predict the likelihood of receiving an ACS diagnosis.

Methods: A total of 1064 patients admitted to five emergency departments were enrolled in this prospective study.

Symptom Trajectories After an Emergency Department Visit for Potential Acute Coronary Syndrome.

Background: Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) continue to experience troubling symptoms after discharge-regardless of their ultimate medical diagnosis. However, comprehensive understanding of common post-ED symptom trajectories is lacking.

Objectives: The aim of this study was to identify common trajectories of symptom severity in the 6 months after an ED visit for potential ACS.

Symptoms Suggestive of Acute Coronary Syndrome: When Is Sex Important?

Background: Studies have identified sex differences in symptoms of acute coronary syndrome (ACS); however, retrospective designs, abstraction of symptoms from medical records, and variations in assessment forms make it difficult to determine the clinical significance of sex differences.

Objective: The aim of this study is to determine the influence of sex on the occurrence and distress of 13 symptoms for patients presenting to the emergency department for symptoms suggestive of ACS.

Methods: A total of 1064 patients admitted to 5 emergency departments with symptoms triggering a cardiac evaluation were enrolled.

African American Elders' Serious Illness Experiences: Narratives of "God Did," "God Will," and "Life Is Better".

The foundation of culturally sensitive patient-centered palliative care is formed from one's social, spiritual, psychological, and physical experiences of serious illness. The purpose of this study was to describe categories and patterns of psychological, social, and spiritual healing from the perspectives of aging seriously ill African American (AA) elders. Using narrative analysis methodology, 13 open-ended interviews were collected.

Symptom clusters in patients presenting to the emergency department with possible acute coronary syndrome differ by sex, age, and discharge diagnosis.

Objectives: To identify classes of individuals presenting to the ED for suspected ACS who shared similar symptoms and clinical characteristics.

Background: Describing symptom clusters in undiagnosed patients with suspected ACS is a novel and clinically relevant approach, reflecting real-world emergency department evaluation procedures.

Methods: Symptoms were measured using a validated 13-item symptom checklist.

The association of pain with protein inflammatory biomarkers: a review of the literature.

Background: Pain is a key diagnostic criterion in many medical conditions. In the absence of self-reported pain, measurement of a proxy for pain, such as an inflammatory biomarker, could aid in diagnosis and disease management.

Objectives: The aim was to determine if there is an association between inflammatory biomarkers and self-reported pain in individuals with medical conditions associated with the symptom of pain and to clarify whether inflammatory biomarkers might aid in the diagnostic process.

Lives forever changed: family bereavement experiences after sudden cardiac death.

Aim: To describe the bereavement experiences of families who survived the sudden cardiac death of a family member and identify meanings of loss.

Background: Approximately 325,000 people experience sudden cardiac death (SCD) annually. It is important to examine family experiences after SCD because of the life altering impact of death on surviving family members.

Implementing clinical research in the high acuity setting of the emergency department.

Introduction: Clinical research in the emergency department provides supporting evidence needed for the development of practice guidelines, such as door-to-needle and door-to-balloon times for treatment of acute coronary syndromes, and is vital to improvements in patient outcomes. The purpose of this article is to describe barriers and lessons learned in launching a multisite clinical research study of symptoms of acute coronary syndromes in the emergency department.

Methods: Participants included ED and research staff in 4 busy emergency departments in 3 states.

Symptoms of acute coronary syndrome in women with diabetes: an integrative review of the literature.

Objective: To review studies comparing multiple acute coronary syndrome (ACS) symptoms in white and Latina women with and without diabetes.

Methods: This empirical integrative review summarizes 8 studies and identifies the limitations of research to date.

Results: There are conflicting results about acute coronary syndrome (ACS) symptoms in women with diabetes.

Rural women walking for health.

The purpose of this qualitative study is to describe rural women's barriers and motivators for participation in a walking program. Twenty rural women, ages 22 to 65, participated in a 12-week walking program. Data from field notes and focus groups were analyzed using qualitative content analysis.

Heart-to-Heart: promoting walking in rural women through motivational interviewing and group support.

Background: Walking can significantly increase cardiorespiratory fitness and thereby reduce the incidence of heart disease in women. However, there is a paucity of research aimed at increasing walking in rural women, a high-risk group for heart disease and one for which exercise strategies may pose particular challenges.

Purpose: This study tested Heart-to-Heart (HTH), a 12-week walking program, designed to increase fitness through walking in rural women.

State of the heart: building science to improve women's cardiovascular health.

Cardiovascular disease is the No. 1 killer of women in the United States, and marked disparities in cardiovascular health exist between women and men and among groups of women. Coronary heart disease is underdiagnosed, undertreated, and under-researched in women.

Determining severe respiratory distress in older out-of-hospital patients.

Objectives: This preliminary investigation represents the first step in developing a clinical decision rule (CDR) to assist out-of-hospital providers in caring for older patients in respiratory distress. The specific aims of the study were: 1) to identify up to ten candidate clinical indicators of severe respiratory distress in older out-of-hospital patients and 2) to determine the feasibility of obtaining data on these indicators from out-of-hospital treatment records, and of obtaining a measure of severe respiratory distress from the emergency department (ED) medical record.

Methods: This mixed-methods study included a qualitative component to list possible clinical indicators of severe respiratory distress, and a Delphi survey N = six experts) to reduce the comprehensive list that resulted (aim 1).

Understanding treatment-seeking delay in women with acute myocardial infarction: descriptions of decision-making patterns.

Background: Women delay seeking treatment for symptoms of acute myocardial infarction longer than men delay. Women's delay time has not been thoroughly characterized.

Objectives: To qualitatively describe the period between the onset of symptoms of myocardial infarction and enactment of the decision to seek care (decision time) and to identify common patterns of cognitive, affective, and behavioral responses to the symptoms (decision trajectories).