Psychoeducation for chronic cognitive impairment and reduced early readmissions amongst pulmonary inpatients.

Patients with chronic pulmonary disease have been found to have among the highest rates of early (30 days) readmissions by the Center for Medicare and Medicaid Services. Proactive identification and psychoeducational intervention for the effect of chronic cognitive impairment on readmission have not been tested in this population. This is a pre-post quality improvement study for service-wide inpatient pulmonary readmission rates in chronic pulmonary disease.

Family Consultation to Reduce Early Hospital Readmissions among Patients with End Stage Kidney Disease: A Randomized Controlled Trial.

Background And Objectives: The US Centers for Medicare and Medicaid Services have mandated reducing early (30-day) hospital readmissions to improve patient care and reduce costs. Patients with ESKD have elevated early readmission rates, due in part to complex medical regimens but also cognitive impairment, literacy difficulties, low social support, and mood problems. We developed a brief family consultation intervention to address these risk factors and tested whether it would reduce early readmissions.

Prospective correlates of early (30 day) readmissions on a Cardiothoracic Surgery Service.

Known to vary widely among hospitals for unclear reasons, early readmissions are associated with higher mortality and are suspected to frequently be due to inadequate discharge preparation/planning. It has been previously documented that the strongest and most consistent predictor of early readmissions in CHF patients is chronic cognitive impairment, and compensatory assistance with adherence on discharge improves early readmission rates. Prospective observational study.

Indicators of Cognitive Impairment From a Medical Record Review: Correlations With Early (30-d) Readmissions Among Hospitalized Patients in a Nephrology Unit.

Background: Patients with end-stage renal disease have the highest 30-day hospital readmission rates of any medical condition. Previous research suggests that cognitive impairment contributes to readmission. It is important to identify patients at risk for early readmission, and this might be accomplished efficiently using medical record data.

"Alert and Oriented × 3?" Correlates of Mini-Cog Performance in a Post/Nondelirious Intensive Care Unit Sample.

Background: Cognitive impairment has been found to be a predictor of adverse medical outcomes, including nonadherence, recurrent medical crises resulting in early readmissions, and death.

Objective: The Mini-Cog has been proposed for bedside/clinic cognitive testing. Its validity as a measure of central nervous system (CNS) impairment has never been tested against measures of CNS-medical history, CNS scans, selected laboratory findings, observed in-hospital nondelirious memory impairment, or collateral history from family.

Behavioral factors and hospital admissions/readmissions in patients with CHF.

Background: Wasted health care resources have become a central concern in American health care. Heart failure has one of the highest readmission rates amongst all conditions studied in Medicare/Medicaid populations.

Objective: The present study was an attempt to cross-sectionally identify correlates of number of past-year admissions and 30-day readmissions in patients with congestive heart failure.

Psychological and physiological predictors of angina during exercise-induced ischemia in patients with coronary artery disease.

Objective: This study compares sensory-biological, cognitive-emotional, and cognitive-interpretational factors in predicting angina on an exercise treadmill test (ETT).

Methods: A total of 163 patients with ETT-induced ischemia and coronary artery disease in the National Heart, Lung, and Blood Institute Psychophysiological Investigations of Myocardial Ischemia study were given an ETT, during which 79 patients reported angina. We assessed the following as potential predictors of self-reported anginal pain: sensory-biological factors (β-endorphin reactivity, hot pain threshold, and maximal ST-segment depression), cognitive-emotional factors (negative affect and symptom perception), and cognitive-interpretational factors (self-reported history of exercise-induced angina).

Symptoms of anxiety and depression are correlates of angina pectoris by recent history and an ischemia-positive treadmill test in patients with documented coronary artery disease in the pimi study.

Objective. We tested the association of specific psychological characteristics in patients having stable coronary disease with the reporting of anginal symptoms during daily activities, and positive exercise testing. Methods.

Healthcare utilization and emotional distress in coronary artery disease patients.

Background: No studies to-date have examined the various types of emotional distress (ED) for their relative power at predicting costs in patients with coronary artery disease (CAD).

Objective: The authors investigated the association between expenditure for CAD patients and various measures of emotional/psychological functioning.

Method: The authors assessed dollars spent in relation to dimensions of the Symptom Checklist 90-Revised and traditional risk factors in the year preceding referral of 164 CAD patients for stress management.

Cardiovascular symptoms in coronary-artery disease patients are strongly correlated with emotional distress.

Background: The relationship of cardiovascular events and cardiovascular symptoms is unclear, and physical symptoms, including most cardiovascular symptoms, are known to be influenced by emotional distress.

Objective: Authors examined the relative strength of association of multiple measures of emotional distress and accepted cardiac risk factors with five common cardiac symptoms (chest pain, fatigue, palpitations, presyncope, and dyspnea).

Method: The authors tested the association of multiple cardiovascular symptoms with various measures of emotional distress (i.

Screening, diagnosis & monitoring of depression/distress in CHF patients.

Objective and validated measures of depression/distress (anxiety and anger) are available and readily usable at the bedside or in clinic. Foremost among these is the Patient's Health Questionnaire--an adaptation of DSM IV criteria for Major Depressive Disorder that permits administration and scoring by nursing or physician personnel, and quantification of the intensity of depression. A score of 10 or greater indicates a need for evaluation/treatment.

Empirically derived psychometric screening for emotional distress in coronary artery disease patients: efficiency, efficacy, and source.

Background And Research Objectives: Multiple types of evidence implicate emotional distress as a cause of adverse outcomes in individuals with coronary artery disease. The present study was intended to determine the most accurate and user-friendly means of screening patients with coronary artery disease for emotional distress using age at initial diagnosis as the criterion.

Subjects And Methods: Two clinical databases consisting of patients with documented coronary artery disease, each contained multiple measures of emotional distress, were used.

Do others really know us better? Predicting migraine activity from self- and other-ratings of negative emotion.

Objective: The validity of self-reported negative emotion to predict health status is limited by response biases, introspection limitations, and methodological confounds. The reports of significant others about the patients' negative emotion may circumvent these limitations. This study sought to compare the validity of self- versus other-reported negative emotion as a correlate of migraine headache activity.

What's "unstable" in unstable angina?

The role of emotional distress (e.g., anger, depression, and anxiety) in anginal chest discomfort (ACD) may have been underestimated.

Health-related interactions and the self in marriage.

This study investigated the association between self processes and married partners' (N = 59 couples) perspectives of their health-related social interactions. Findings revealed that wives' self processes were associated with their social behavior from the perspective of each partner. The wives' self processes differentially predicted wives' and husbands' perspectives of their interactions, however.

The big mush: psychometric measures are confounded and non-independent in their association with age at initial diagnosis of Ischaemic Coronary Heart Disease.

The present study uses early diagnosis of ischaemic coronary heart disease (ICHD) as a proxy for disease malignancy in testing the statistical strength of association, and uniqueness/confounding, of several psychometric scales that have previously been found to prospectively predict death in cardiac samples (Beck Depression Inventory, Crown-Crisp Phobic Anxiety Scale, Type D Scale & Ketterer Stress Symptom Frequency Checklist). Eighty-three patients (no. of females = 35) with documented ICHD were assessed for traditional and psychometric risk factors.

Mental stress-induced ischemia and all-cause mortality in patients with coronary artery disease: Results from the Psychophysiological Investigations of Myocardial Ischemia study.

Background: Ischemia during laboratory mental stress tests has been linked to significantly higher rates of adverse cardiac events. Previous studies have not been designed to detect differences in mortality rates.

Methods And Results: To determine whether mental stress-induced ischemia predicts death, we evaluated 196 patients from the Psychophysiological Investigations of Myocardial Ischemia (PIMI) study who had documented coronary artery disease and exercise-induced ischemia.