Publications by authors named "Christopher S Lee"

199 Publications

Longitudinal Effects of Left Ventricular Assist Device Implantation on Global and Domain-Specific Cognitive Function.

J Cardiovasc Nurs 2020 Jun 22. Epub 2020 Jun 22.

Kenneth M. Faulkner, PhD, RN, ANP Postdoctoral Research Fellow, Boston College Connell School of Nursing, Chestnut Hill, Massachusetts; and Clinical Assistant Professor, Stony Brook University School of Nursing, New York. Christopher V. Chien, MD, FACC Clinical Assistant Professor of Medicine, University of North Carolina, Chapel Hill. Quin E. Denfeld, PhD, RN Assistant Professor, Oregon Health & Science University School of Nursing, Portland. Jill M. Gelow, MD, MPH Advanced Heart Failure and Transplant Cardiologist, Providence Health Institute, Portland, Oregon. Karen S. Lyons, PhD, FGSA Associate Professor, Boston College Connell School of Nursing, Chestnut Hill, Massachusetts. Kathleen L. Grady, PhD, MS, RN, FAHA, FHFSA, FAAN Professor of Cardiothoracic Surgery and Cardiac Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. James O. Mudd, MD Advanced Heart Disease and Transplant Cardiologist, Providence Spokane Heart Institute, Spokane, Washington. Christopher S. Lee, PhD, FAHA, FHFSA, FAAN Professor and Associate Dean for Research, Boston College Connell School of Nursing, Chestnut Hill, Massachusetts.

Background: Left ventricular assist devices (LVADs) are a common treatment of advanced heart failure, but cognitive dysfunction, which is common in heart failure, could limit the ability to perform postimplantation LVAD care. Implantation of an LVAD has been associated with improved cerebral perfusion and may improve cognitive function post implantation.

Objective: The aim of this study was to quantify longitudinal change in cognitive function after LVAD implantation.

Methods: A secondary analysis of data on 101 adults was completed to evaluate cognitive function before implantation and again at 1, 3, and 6 months post implantation of an LVAD. Latent growth curve modeling was conducted to characterize change over time. Serial versions of the Montreal Cognitive Assessment were used to measure overall (total) cognitive function and function in 6 cognitive domains.

Result: There was moderate, nonlinear improvement from preimplantation to 6 months post implantation in Montreal Cognitive Assessment total score (Hedges' g = 0.50) and in short-term memory (Hedges' g = 0.64). There also were small, nonlinear improvements in visuospatial ability, executive function, and attention from preimplantation to 6 months post implantation (Hedges' g = 0.20-0.28). The greatest improvements were observed in the first 3 months after implantation and were followed by smaller, sustained improvements or no additional significant change.

Conclusions: Implantation of an LVAD is associated with significant, nonlinear improvement in short-term memory and global cognitive function, with the most significant improvements occurring in the first 3 months after implantation. Clinicians should anticipate improvements in cognitive function after LVAD implantation and modify postimplantation education to maximize effectiveness of LVAD self-care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JCN.0000000000000709DOI Listing
June 2020

Prevalence of problematic feeding in young children born prematurely: a meta-analysis.

BMC Pediatr 2021 Mar 6;21(1):110. Epub 2021 Mar 6.

Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA.

Background: Difficulties related to eating are often reported in children born preterm. The objective of this study was to quantitatively synthesize available data on the prevalence of problematic feeding in children under 4 years of age who were born preterm.

Methods: Literature was identified from PubMed, CINAHL, and PsycInfo. The search was limited to English language and publication years 2000-2020. To be included in the meta-analysis, the article had to report the prevalence of problematic oral feeding within a population of children born prematurely (< 37 weeks' gestation), and the child age at the time of study had to be between full-term corrected age and 48 months. For studies meeting inclusion criteria, the following data were extracted: sample size and subsamples by gestational age and/or child age at time of study; definition of problematic feeding; measures used for assessment of feeding; gestational age at time of birth of sample; child age at time of study; exclusion criteria for the study; and prevalence of problematic feeding. Random-effects meta-analyses were performed to estimate the prevalence of problematic feeding across all studies, by gestational age at birth, and by child age at time of study.

Results: There were 22 studies that met inclusion criteria. Overall prevalence of problematic feeding (N = 4381) was 42% (95% CI 33-51%). Prevalence was neither significantly different across categories of gestational age nor by child age at the time of study. Few studies used psychometrically-sound assessments of feeding.

Conclusion: Problematic feeding is highly prevalent in prematurely-born children in the first 4 years of life regardless of degree of prematurity. Healthcare providers of children born preterm should consider screening for problematic feeding throughout early childhood as a potential complication of preterm birth.

Systematic Review Registration Number: Not applicable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12887-021-02574-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936467PMC
March 2021

Gender differences in the prevalence of frailty in heart failure: A systematic review and meta-analysis.

Int J Cardiol 2021 Feb 28. Epub 2021 Feb 28.

Oregon Health & Science University School of Nursing, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR 97239-2941, USA. Electronic address:

Objectives: This study quantitatively synthesized literature to identify gender differences in the prevalence of frailty in heart failure (HF).

Background: The intersection of frailty and HF continues to garner interest. Almost half of patients with HF are frail; however, gender differences in frailty in HF are poorly understood.

Methods: We performed a literature search to identify studies that reported prevalence of frailty by gender in HF. Random-effects meta-analysis was used to quantify the relative and absolute risk of frailty in women compared with men with HF, overall, and by Physical and Multidimensional Frailty measures. Meta-regression was performed to examine the influence of study age and functional class on relative risk in HF.

Results: Twenty-nine studies involving 8854 adults with HF were included. Overall in HF, women had a 26% higher relative risk of being frail compared with men (95% CI = 1.14-1.38, z = 4.69, p < 0.001, I = 76.5%). The overall absolute risk for women compared to men with HF being frail was 10% (95% CI = 0.06-0.15, z = 4.41, p < 0.001). The relative risk of frailty was slightly higher among studies that used Physical measures (relative risk = 1.27, p < 0.001) compared with studies that used Multidimensional measures (relative risk = 1.24, p = 0.024). There were no significant relationships between relative risk and either study age or functional class.

Conclusions: In HF, frailty affects women significantly more than men. Future work should focus on elucidating potential causes of gender differences in frailty in HF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2021.02.062DOI Listing
February 2021

Parents' Perceptions of Emerging Adults With Congenital Heart Disease: An Integrative Review of Qualitative Studies.

J Pediatr Health Care 2021 Feb 10. Epub 2021 Feb 10.

Background: As the primary caregivers for children with congenital heart disease (CHD), parents' perceptions are important for emerging adults to achieve independence. This integrative review of qualitative studies aimed to describe parents' perceptions of emerging adults with CHD.

Method: Seven electronic databases were searched. Data extraction and quality assessment were performed. A meta-synthesis was conducted to inductively develop essential themes from five included studies.

Results: Three essential themes encompassing the parents' perspective of emerging adults with CHD were: (1) concerns about emerging adults' ability to be independent; (2) concerns about emerging adults' future; and (3) impact of disease on family. The themes depicted parents' concerns and worries about their children's ability to successfully achieve independence, especially in disease self-management and life goals.

Discussion: This review highlights parents' concerns about their emerging adult children's independence. Understanding these concerns allows for developing interventions to facilitate emerging adults' independence and ease parents' worries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pedhc.2020.11.009DOI Listing
February 2021

'Real-world' effectiveness of omalizumab in adults with severe allergic asthma: a meta-analysis.

Expert Rev Clin Immunol 2021 Jan 14;17(1):73-83. Epub 2020 Dec 14.

Connell School of Nursing, Boston College William F, Chestnut Hill, MA, USA.

Severe asthma affects 5-10% of the 350 million people with asthma worldwide. Findings from the authors' previous meta-analysis supported omalizumab use as an adjuvant treatment for severe allergic asthma. The publication of fourteen new articles necessitates an update of the meta-analysis. To evaluate the 'real-world' effectiveness of omalizumab in the treatment of acute allergic asthma in adults by calculating pooled effects estimates from data in published articles. Articles on omalizumab effectiveness in 'real-world' settings were identified. Effect sizes, including point estimates of the proportion of patients who met a given criteria, mean improvements relative to baseline, and change in the proportion of patients requiring oral corticosteroids compared to baseline were extracted. Meta-analysis of proportions was conducted to pool effect sizes based on proportions. Standardized mean differences (Hedges' g) were calculated from means and standard deviations. Relative risk was calculated from changes in proportions. Variability within and between studies was evaluated. Omalizumab increases the percentage of individuals rated 'good' or 'excellent' on the Global Evaluation of Treatment Effectiveness Scale. Omalizumab also improves respiratory function, quality-of-life, and asthma control while reducing medication usage, exacerbations, hospitalizations, and adverse events. 'Real-world' evidence continues to support the use of omalizumab as adjuvant treatment for severe allergic asthma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/1744666X.2020.1856658DOI Listing
January 2021

Health-Related Quality of Life in Patients With a Left Ventricular Assist Device (QOLVAD) Questionnaire: Initial Psychometrics of a New Instrument.

J Cardiovasc Nurs 2021 Mar-Apr 01;36(2):172-184

Background: Patients with a left ventricular assist device are a unique and growing population who deserve their own valid, reliable instrument for health-related quality of life.

Objective: We developed and tested the Health-Related Quality of Life with a Left Ventricular Assist Device (QOLVAD) questionnaire.

Methods: In a prospective, descriptive study, patients from 7 sites completed the QOLVAD and comparator questionnaires. Construct validity was tested using confirmatory factor analysis. Convergent validity was tested using correlations of QOLVAD scores to well-established measures of subjective health status, depression, anxiety, and meaning/faith. Reliability and test-retest reliability were quantified.

Results: Patients (n = 213) were 58.7 ± 13.9 years old; 81.0% were male, 73.7% were White, and 48.0% had bridge to transplant. Questionnaires were completed at a median time of 44 weeks post ventricular assist device. The 5 QOLVAD domains had acceptable construct validity (root mean square error of approximation = 0.064, comparative and Tucker-Lewis fit indices > 0.90, weighted root mean square residual = 0.95). The total score and domain-specific scores were significantly correlated with the instruments to which they were compared. Internal consistency reliability was acceptable for all subscales (α = .79-.83) except the cognitive domain (α = .66). Unidimensional reliability for the total score was acceptable (α = .93), as was factor determinacy for multidimensional reliability (0.95). Total test-retest reliability was 0.875 (P < .001).

Conclusion: Our analysis provided initial support for validity and reliability of the QOLVAD for total score, physical, emotional, social, and meaning/spiritual domains. The QOLVAD has potential in research and clinical settings to guide decision making and referrals; further studies are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JCN.0000000000000774DOI Listing
December 2020

The prevalence of ankyloglossia in children aged <1 year: a systematic review and meta-analysis.

Pediatr Res 2020 Nov 13. Epub 2020 Nov 13.

Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.

Background: Despite the low level of evidence supporting the correction of tongue-tie for breastfeeding problems, recognition and treatment has increased substantially over the past 15 years. Prevalence reporting of tongue-tie is variable. The purpose of this study was to quantitatively synthesize the prevalence of tongue-tie in children aged <1 year and to examine the psychometric properties of the assessment tools used for diagnosing tongue-tie in these studies.

Methods: PRISMA and MOOSE guidelines were followed, with selection of studies and data extraction verified by two authors. Random-effects meta-analyses were performed to determine an overall prevalence rate, prevalence by infant sex, and prevalence by diagnostic method.

Results: There were 15 studies that met inclusion criteria. Overall prevalence of tongue-tie (N = 24,536) was 8% (95% CI 6-10%, p < 0.01). Prevalence was 7% in males and 4% in females. Prevalence was 10% when using a standardized assessment tool compared to 7% when using visual examination alone (p = 0.16). Available assessment tools for diagnosis of tongue-tie do not have adequate psychometric properties.

Conclusions: Tongue-tie is a common anomaly, which has the potential to impact infant feeding. Development of a psychometrically sound assessment of tongue-tie is needed.

Impact: The overall prevalence of tongue-tie in infants aged <1 year is 8%. Available diagnostic tools for tongue-tie do not have adequate psychometric testing. Prevalence data can assist health care providers in the recognition of tongue-tie as a potential barrier to infant feeding to promote maternal breastfeeding success.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41390-020-01239-yDOI Listing
November 2020

A Multibiomarker Latent Class Analysis in Moderate to Advanced Heart Failure: Differentiating Factors.

J Cardiovasc Nurs 2020 Oct 26. Epub 2020 Oct 26.

Jessica Harman Thompson, PhD, RN, CCRN-K Postdoctoral Scholar in Applied Quantitative Methods in Cardiovascular Disease, Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, and Lecturer, College of Nursing, University of Kentucky, Lexington. Kenneth M. Faulkner, PhD, RN Associate Clinical Professor, Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, and School of Nursing, Stony Brook University, New York. Christopher S. Lee, PhD, RN, FAHA, FAAN, FHSA Associate Dean of Research, Professor, Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts.

Background: Biomarker science in heart failure (HF) is advancing quickly in our ability to diagnosis and treat patients with this complex syndrome. Researchers are urged to not use single-marker strategies, but instead evaluate biomarkers in patterns to better understand their relationship to one another, as well as disease progression. Latent class mixture modeling allows researchers to determine novel associations between biomarkers.

Objective: The objectives of this study were to identify and compare latent classes of cardiovascular biomarkers among patients with moderate to advanced HF.

Methods: This was a cross-sectional study of 96 participants with moderate to advanced HF. Latent class mixture modeling was used to identify unique classes of biomarkers and their associations to sociodemographic and clinical variables.

Results: The average age of the sample was 54 years, with most of the sample being men (77%) and having an average ejection fraction of 23%. Two unique classes of biomarkers were identified. Latent class 1 had higher levels of all biomarkers, whereas latent class 2 had lower levels. The higher biomarker class had, on average, more neurohormonal activation and fluid retention; however, the higher levels of biomarker class were not more likely to be diagnosed with advanced HF or have more comorbidities.

Conclusion: By identifying classes of biomarkers, providers may be better able to identify patients who are at risk of progressing into advanced HF quicker or those who are more likely to have more severe complications, such as fluid overload or renal disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JCN.0000000000000757DOI Listing
October 2020

Postoperative Pain Management in Pediatric Spinal Fusion Surgery for Idiopathic Scoliosis.

Paediatr Drugs 2020 Dec 23;22(6):575-601. Epub 2020 Oct 23.

Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.

This article reviews and summarizes current evidence and knowledge gaps regarding postoperative analgesia after pediatric posterior spine fusion for adolescent idiopathic scoliosis, a common procedure that results in severe acute postoperative pain. Inadequate analgesia may delay recovery, cause patient dissatisfaction, and increase chronic pain risk. Despite significant adverse effects, opioids are the analgesic mainstay after scoliosis surgery. However, growing emphasis on opioid minimization and enhanced recovery has increased adoption of multimodal analgesia (MMA) regimens. While opioid adverse effects remain a concern, MMA protocols must also consider risks and benefits of adjunct medications. We discuss use of opioids via different administration routes and elaborate on the effect of MMA components on opioid/pain and recovery outcomes including upcoming regional analgesia. We also discuss risk for prolonged opioid use after surgery and chronic post-surgical pain risk in this population. Evidence supports use of neuraxial opioids at safe doses, low-dose ketorolac, and methadone for postoperative analgesia. There may be a role for low-dose ketamine in those who are opioid-tolerant or have chronic pain, but the evidence for preoperative gabapentinoids and intravenous lidocaine is currently insufficient. There is a need for further studies to evaluate pediatric-specific optimal MMA dosing regimens after scoliosis surgery. Questions remain regarding how best to prevent acute opioid tolerance, opioid-induced hyperalgesia, and chronic postsurgical pain. We anticipate that this timely update will enable clinicians to develop efficient pain regimens and provide impetus for future research to optimize recovery outcomes after spine fusion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40272-020-00423-1DOI Listing
December 2020

Frailty and the risk of all-cause mortality and hospitalization in chronic heart failure: a meta-analysis.

ESC Heart Fail 2020 Sep 21. Epub 2020 Sep 21.

Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, Wroclaw, 51-618, Poland.

To estimate the risk of all-cause mortality and hospitalization in frail patients with chronic heart failure (HF), a systematic search and meta-analysis was carried out to identify all prospective cohort studies conducted among adults with HF where frailty was quantified and related to the primary endpoints of all-cause mortality and/or hospitalization. Twenty-nine studies reporting the link between frailty and all-cause mortality in 18 757 patients were available for the meta-analysis, along with 11 studies, with 13 525 patients, reporting the association between frailty and hospitalization. Frailty was a predictor of all-cause mortality and hospitalization with summary hazard ratios (HRs) of 1.48 [95% confidence interval (CI): 1.31-1.65, P < 0.001] and 1.40 (95% CI: 1.27-1.54, P < 0.001), respectively. Summary HRs for all-cause mortality among frail inpatients undergoing ventricular assist device implantation, inpatients hospitalized for HF, and outpatients were 1.46 (95% CI: 1.18-1.73, P < 0.001), 1.58 (95% CI: 0.94-2.22, P = not significant), and 1.53 (95% CI: 1.28-1.78, P < 0.001), respectively. Summary HRs for all-cause mortality and frailty based on Fried's phenotype were 1.48 (95% CI: 1.03-1.93, P < 0.001) and 1.42 (95% CI: 1.05-1.79, P < 0.001) for inpatients and outpatients, respectively, and based on other frailty measures were 1.42 (95% CI: 1.12-1.72, P < 0.001) and 1.60 (95% CI: 1.43-1.77, P < 0.001) for inpatients and outpatients, respectively. Across clinical contexts, frailty in chronic HF is associated with an average of 48% and 40% increase in the hazard of all-cause mortality and hospitalization, respectively. The relationship between frailty and all-cause mortality is similar across clinical settings and comparing measurement using Fried's phenotype or other measures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ehf2.12827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754732PMC
September 2020

Primary total shoulder arthroplasty in the setting of a benign enchondroma.

J Shoulder Elbow Surg 2020 09 9;29(9):e345-e349. Epub 2020 Jun 9.

Lee Sports and Joints Institute, Burbank, CA, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2020.03.054DOI Listing
September 2020

A Multilevel Modeling Approach to Examine Incongruent Illness Appraisals in Family Care Dyads Over Time.

J Fam Nurs 2020 08 4;26(3):229-239. Epub 2020 Aug 4.

Boston College, Chestnut Hill, MA, USA.

Over the past two decades, there has been movement toward a dyadic perspective of the illness experience. Although multilevel models have led to great insights into how dyads are affected by illness as family units, these models are still underutilized for understanding incongruent illness appraisals. Such incongruent appraisals can have implications for how the dyad collaborates to manage illness, the health of the dyad, and clinical outcomes. The focus of this article is to describe and promote the application of multilevel models to longitudinal dyadic data to understand incongruent illness appraisals over time. In particular, we present a data exemplar so researchers can apply these models to their own data and clinical questions to understand the ways care dyads converge and diverge in their appraisals and determine factors associated with such variability. We comment on the implications and extensions of these models for family nursing research and practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1074840720944439DOI Listing
August 2020

Moderator Role of Mutuality on the Association Between Depression and Quality of Life in Stroke Survivor-Caregiver Dyads.

J Cardiovasc Nurs 2021 May-Jun 01;36(3):245-253

Background: Authors of previous research have not yet analyzed the role of potential moderators in the relationship between depressive symptoms and quality of life (QOL).

Aims: The aim of this study was to examine the moderating effect of mutuality between depressive symptoms and QOL in stroke survivor and caregiver dyads.

Methods: This study used a longitudinal design with 222 stroke survivor-caregiver dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed for 12 months. We examined survivor and caregiver QOL dimensions (physical, psychological, social, and environmental), depression, and mutuality at baseline and every 3 months. Hierarchical linear modeling was used to test 4 longitudinal dyadic moderation models (1 for each QOL domain).

Results: Survivors (50% male) and caregivers (65% female) were 70.8 (SD, 11.9) and 52.5 (SD, 13.1) years old, respectively. We observed no significant moderating effects of mutuality for survivors across the 4 dimensions of QOL over time. However, higher survivor mutuality was significantly associated with higher survivor psychological and social QOL at baseline. Regarding caregivers, caregiver mutuality significantly moderated the association between caregiver depressive symptoms and caregiver physical (B = 0.63, P < .05), psychological (B = 0.63, P < .01), and social (B = 0.95, P < .001) QOL at baseline, but not in environmental QOL. Higher caregiver mutuality was significantly associated with less improvement in caregiver physical QOL over time.

Conclusions: Mutuality is a positive variable on the association between depression and QOL for both members of the dyad at discharge but may lead to declines in physical health for caregivers over time. Further work is needed to understand the role of mutuality on long-term outcomes and associations with increased care strain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JCN.0000000000000728DOI Listing
August 2020

Ex Ante Economic Evaluation of Arg389 Genetically Targeted Treatment with Bucindolol versus Empirical Treatment with Carvedilol in NYHA III/IV Heart Failure.

Am J Cardiovasc Drugs 2021 Mar;21(2):205-217

Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Drachman Hall B-306, 1295 N. Martin Ave, Tucson, AZ, 85721, USA.

Objective: The Beta-Blocker Evaluation Survival Trial showed no survival benefit for bucindolol in New York Heart Association (NYHA) class III/IV heart failure (HF) with reduced ejection fraction, but subanalyses suggested survival benefits for non-Black subjects and Arg389 homozygotes. We conducted an ex ante economic evaluation of Arg389 targeted treatment with bucindolol versus carvidolol, complementing a previous ex ante economic evaluation of bucindolol preceded by genetic testing for the Arg389 polymorphism, in which genetic testing prevailed economically over no testing.

Methods: A decision tree analysis with an 18-month time horizon was performed to estimate the cost effectiveness/cost utility of trajectories of 100%, 50%, and 0% of patients genetically tested for Arg389 and comparing bucindolol with empirical carvedilol treatment as per prior BEST subanalyses. Incremental cost-effectiveness/cost-utility ratios (ICERs/ICURs) were estimated.

Results: Race-based analyses for non-White subjects at 100% testing showed a loss of (0.04) life-years and (0.03) quality-adjusted life-years (QALYs) at an incremental cost of $2185, yielding a negative ICER of ($54,625)/life-year and ICUR of ($72,833)/QALY lost; at 50%, the analyses showed a loss of (0.27) life-years and (0.16) QALYs at an incremental cost of $1843, yielding a negative ICER of ($6826)/life-year and ICUR of ($11,519)/QALY lost; at 0%, the analyses showed a loss of (0.33) life-years and (0.30) QALYs at an incremental cost of $1459, yielding a negative ICER of ($4421)/life-year and ICUR of ($4863)/QALY lost. Arg389 homozygote analyses at 100% testing showed incremental gains of 0.02 life-years and 0.02 QALYs at an incremental cost of $378, yielding an ICER of 18,900/life-year and ICUR of $18,900/QALY gained; at 50%, the analyses showed a loss of (0.24) life-years and (0.09) QALYs at an incremental cost of $1039, yielding a negative ICER of ($4329)/life-year and ICUR of ($9336)/QALY lost; at 0%, the analyses showed a loss of (0.33) life-years and (0.30) QALYs at an incremental cost of $1459, yielding a negative ICER of ($4421)/life-year and ICUR of ($4863)/QALY lost.

Conclusion: This independent ex ante economic evaluation suggests that genetically targeted treatment with bucindolol is unlikely to yield clinicoeconomic benefits over empirical treatment with carvedilol in NYHA III/IV HF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40256-020-00425-xDOI Listing
March 2021

The association between longer durations of the latent phase of labor and subsequent perinatal processes and outcomes among midwifery patients.

Birth 2020 12 20;47(4):418-429. Epub 2020 Jul 20.

Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA.

Background/objective: To evaluate the association between the duration of the latent phase of labor and subsequent processes and outcomes.

Methods: Secondary analysis of prospectively collected data among 1,189 women with low-risk pregnancies and spontaneous labor.

Results: Longer latent phase duration was associated with labor dystocia (eg, nulliparous ≥ mean [compared with < mean] aOR 3.95 [2.70-5.79]; multiparous ≥ mean [compared with < mean] aOR 5.45 [3.43-8.65]), interventions to ameliorate dystocia, and epidurals to cope or rest (eg, oxytocin augmentation: nulliparous > 80th% [compared with < 80th%] aOR 6.39 [4.04-10.12]; multiparous ≥ 80th% [compared with < 80th%] aOR 6.35 [3.79-10.64]). Longer latent phase duration was also associated with longer active phase and second stage. There were no associations between latent phase duration and risk for cesarean delivery or postpartum hemorrhage in a practice setting with relatively low rates of primary cesarean. Newborns born to multiparous women with latent phase of labor durations at and beyond the 80th% were more frequently admitted to the NICU (≥80th% [compared with < 80th%] aOR 2.7 [1.22-5.84]); however, two-thirds of these NICU admissions were likely for observation only.

Conclusions: Longer duration of the spontaneous latent phase of labor among women with low-risk pregnancies may signal longer total labor processes, leading to an increase in diagnosis of dystocia, interventions to manage dystocia, and epidural use. Apart from multiparous neonatal NICU admission, no other maternal or child morbidity outcomes were elevated with longer duration of the latent phase of labor.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/birt.12494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755745PMC
December 2020

A longitudinal comparison of health-related quality of life in rural and urban recipients of left ventricular assist devices.

Res Nurs Health 2020 08 6;43(4):396-406. Epub 2020 Jul 6.

William F. Connell School of Nursing, Boston, Massachusetts.

Left ventricular assist devices (LVAD) are a common treatment for advanced heart failure (HF) to improve ventricular function, symptoms, and health-related quality of life (HRQOL). Many LVAD recipients travel long distances from rural areas for LVAD implantation and follow-up care. Individuals with HF in rural settings who have not undergone LVAD implantation have reported poor HRQOL. However, to date, no studies have compared HF-specific or generic HRQOL in rural and urban LVAD recipients. The purpose of this study was to compare generic and HF-specific HRQOL longitudinally from preimplantation to 1-, 3-, and 6- months postimplant in a cohort of rural and urban LVAD recipients (n = 95; rural n = 32 and urban n = 63). We measured generic HRQOL using the European Quality of Life Visual Analog Scale and HF-specific HRQOL with the quality of life domain of the Kansas City Cardiomyopathy Questionnaire (KCCQ). Latent growth curve modeling identified two phases of change in generic and HF-specific HRQOL: the initial response to LVAD between preimplantation and 1-month postimplant and the subsequent change between 1- and 6-months postimplant. Comparable improvements in generic HRQOL were noted in rural and urban LVAD recipients during both phases of change. Urban LVAD recipients had greater initial improvements in HF-specific HRQOL (KCCQ) compared with rural recipients (13.0 ± 5.6, p = .02), but subsequent improvements were similar among rural and urban recipients. Ongoing assessment of generic and HF-specific HRQOL is necessary during LVAD therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/nur.22052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500868PMC
August 2020

Patterns of Dyadic Appraisal of Decision-Making Involvement of African American Persons Living With Dementia.

Gerontologist 2021 Apr;61(3):383-391

Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts.

Background And Objectives: Greater everyday decision-making involvement by persons living with dementia (PLWD) and congruent appraisal between PLWDs and their caregivers have been associated with a better quality of life (QOL) for both members of the dyad. However, no study has examined the association between the appraisals of everyday decision-making involvement of PLWDs and their QOL among African Americans.

Research Design And Methods: A secondary analysis of cross-sectional data from 62 African American dementia dyads was conducted. Multilevel and latent class mixture modeling was used to characterize dyadic appraisal of the decision-making involvement of African American PLWDs and identify distinct patterns thereof.

Results: Three distinct patterns were observed. "Incongruent, PLWD Low Involvement" labeled 19.4% of the sample, 53.2% were labeled "Incongruent, PLWD Moderate Involvement," and 27.4% were labeled "Congruent, PLWD High Involvement." The Congruent, PLWD High Involvement pattern consisted of PLWDs who were significantly younger and had significantly less cognitive impairment than PLWDs in the other patterns. In the Incongruent, PLWD Moderate Involvement pattern, PLWDs had significantly better QOL than PLWDs in the Incongruent, PLWD Low Involvement pattern, but QOL did not significantly differ from PLWDs in the Congruent, PLWD High Involvement pattern.

Discussion And Implications: There is a need to tailor strategies to optimize QOL in African American dementia dyads. While increasing everyday decision-making involvement for PLWDs in the Incongruent, PLWD Low Involvement pattern is an important goal, other strategies may be needed to improve the QOL of PLWDs in the remaining patterns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/geront/gnaa086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023360PMC
April 2021

Patterns of Heart Failure Dyadic Illness Management: The Important Role of Gender.

J Cardiovasc Nurs 2020 Sep/Oct;35(5):416-422

Background: The ways in which patients with heart failure (HF) and their care partners work together to manage HF are often overlooked.

Objective: The aim of this study was to identify and compare different patterns of HF dyadic illness management.

Methods: This was a secondary analysis of data on HF dyads. Heart failure management was measured using patient and care partner versions of the Self-Care of HF Index and European HF Self-care Behavior Scale. Latent class modeling was used to identify patterns of HF dyadic management.

Results: The mean age of the 62 patients and their care partners was 59.7 ± 11.8 and 58.1 ± 11.9 years, respectively. A majority of patients (71.0%) had class III/IV HF, and a majority of the couples (95.2%) were married. Two distinct dyadic patterns were observed, 1 collaborative management type (n = 42, 67.7%) and 1 autonomous management type (n = 20, 32.3%). Dyads in the autonomous pattern were mostly female patients with male care partners; patients in this pattern also were more anxious and depressed, and reported worse relationship quality compared with collaborative dyads.

Conclusion: There is an engendered spectrum of collaboration in how HF patient-care partner dyads work together to manage HF that needs to be considered in clinical care and research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JCN.0000000000000695DOI Listing
June 2020

Role of Spirituality on the Association Between Depression and Quality of Life in Stroke Survivor-Care Partner Dyads.

Circ Cardiovasc Qual Outcomes 2020 06 26;13(6):e006129. Epub 2020 May 26.

William F. Connell School of Nursing, Boston College, MA (C.S.L., K.S.L.).

Background: Little is known about the protective effect of spirituality on the association between known risk factors such as depression and quality of life (QOL) in stroke survivor-care partner dyads. Therefore, the aim of this study was to evaluate the moderating role of spirituality on the association between depressive symptomatology and QOL in stroke survivor-care partner dyads.

Methods And Results: Longitudinal design with 223 stroke survivor-care partner dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed over 12 months. We measured survivors' and care partners' depression, quality of life, and spirituality. Examining the moderating role of spirituality on the association between depressive symptoms and QOL within survivor-care partner dyads, we used a traditional Actor-Partner-Interdependence Model and a basic Actor-Partner-Interdependence Model moderation model for a mixed variable. Survivors (51% male) and care partners (66% female) were 70.7 and 52.3 years old, respectively. The survivor's spirituality significantly moderated the association between care partner depressive symptomatology and survivor psychological QOL (B=0.03, <0.05) and moderated the association between care partner depressive symptoms and care partner physical (B=0.05, <0.001) and psychological (B=0.04, <0.001) QOL. The care partner's own level of spirituality was significantly positively associated with their physical QOL (B=0.28, <0.001).

Conclusions: The findings from this study have broad implications for the role of spirituality in relation to QOL in medical-health contexts and the importance of examining such concepts within a dyadic framework. Greater awareness of the importance of spirituality among clinicians and nurses may improve cultural competence in healthcare services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCOUTCOMES.119.006129DOI Listing
June 2020

Identifying unique profiles of perceived dyspnea burden in heart failure.

Heart Lung 2020 Sep - Oct;49(5):488-494. Epub 2020 May 18.

William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Maloney Hall, Chestnut Hill, MA  02467, United States. Electronic address:

Background: Dyspnea is a common symptom of heart failure (HF) but dyspnea burden is highly variable.

Objectives: Identify distinct profiles of dyspnea burden and identify predictors of dyspnea symptom profile.

Methods: A secondary analysis of data from five studies completed at Oregon Health and Science University was conducted. The Heart Failure Somatic Perception Scale was used to measure dyspnea burden. Latent class mixture modeling identified distinct profiles of dyspnea burden in a sample of HF patients (n = 449). Backwards stepwise multinomial logistic regression identified predictors of latent profile membership.

Results: Four profiles of dyspnea burden were identified: no dyspnea/not bothered by dyspnea, mild dyspnea, moderate exertional dyspnea, and moderate exertional dyspnea with orthopnea and PND. Higher age was associated with greater likelihood of not being bothered by dyspnea than having moderate exertional dyspnea with orthopnea and PND. Higher NYHA class, anxiety, and depression were associated with greater likelihood of greater dyspnea burden.

Conclusions: Burden of dyspnea is highly variable among HF patients. Clinicians should account for the nuances of dyspnea and the activities that induce dyspnea when assessing HF patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrtlng.2020.03.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483352PMC
March 2021

Physical and Mental Quality of Life in Patients With End-Stage Liver Disease and Their Informal Caregivers.

Clin Gastroenterol Hepatol 2021 Jan 11;19(1):155-161.e1. Epub 2020 Apr 11.

William F. Connell School of Nursing, Boston College, Boston, Massachusetts.

Background & Aims: Management of end-stage liver disease (ESLD) has implications for not only patients' quality of life (QOL), but also their caregivers'. We aimed to identify characteristics of patients with ESLD and their caregivers that are associated with QOL.

Methods: We obtained cross-sectional baseline data from patients and their caregivers (132 dyads; 62% were married or partners), recruited from outpatient hepatology clinics within 2 healthcare centers. Patients were included if their model for end-stage liver disease score was 15 or more; caregivers were identified by the patient as the primary informal caregiver. QOL was measured by the SF-36 and relationship quality using the mutuality scale. We measured uncertainty using the uncertainty in illness scales for patients and caregivers. Multilevel modeling was used to analyze the data.

Results: Refractory ascites was associated with worse physical QOL for patients (unstandardized beta [B], -9.19; standard error [SE], 2.28) and caregivers (B, -5.41; SE, 2.33); history of hepatic encephalopathy was associated with worse patient physical QOL (B, -3.86; SE, 1.65). High levels of uncertainty were associated with worse physical and mental QOL for both members of the dyads; relationship quality was significantly associated with patient mental QOL (B, 2.73; SE, 1.19).

Conclusions: Clinicians and researchers should consider the effects of ESLD on caregivers as well as their patients to optimize the QOL for both.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cgh.2020.04.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554075PMC
January 2021

Predicting Postpartum Hemorrhage After Vaginal Birth by Labor Phenotype.

J Midwifery Womens Health 2020 Sep 14;65(5):609-620. Epub 2020 Apr 14.

Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.

Introduction: Postpartum hemorrhage (PPH) is an important contributor to maternal morbidity and mortality. Predicting which laboring women are likely to have a PPH is an active area of research and a component of quality improvement bundles. The purpose of this study was to identify phenotypes of labor processes (ie, labors that have similar features, such as duration and type of interventions) in a cohort of women who had vaginal births, estimate the likelihood of PPH by phenotype, and analyze how maternal and fetal characteristics relate to PPH risk by phenotype.

Methods: This study utilized the Consortium for Safe Labor dataset (2002-2008) and examined term, singleton, vaginal births. Using 16 variables describing the labor and birth processes, a latent class analysis was performed to describe distinct labor process phenotypes.

Results: Of 24,729 births, 1167 (4.72%) women experienced PPH. Five phenotypes best fit the data, reflecting labor interventions, duration, and complications. Women who had shorter duration of admission after spontaneous labor onset (admitted in latent or active labor) had the lowest rate of PPH (3.8%-3.9%). The 2 phenotypes of labor progress characterized by women who had complicated prolonged labors (spontaneous or induced) had the highest rate of PPH (8.0% and 12.0%, respectively). However, the majority of PPH (n = 881, 75%) occurred in the phenotypes with fewer complications. Prepregnancy body mass index did not predict PPH. Overall, the odds of PPH were highest among nulliparous women (odds ratio [OR], 1.52; 95% CI, 1.30-1.77), as well as Black women (OR, 1.39; 95% CI, 1.13-1.73) and Hispanic women (OR, 1.85; 95% CI, 1.56-2.20). Within phenotypes, maternal race and ethnicity, nulliparity, macrosomia, hypertension, and depression were associated with increased odds of PPH.

Discussion: Women who were classified into a lower-risk labor phenotype and still experienced PPH were more likely to be nulliparous, a person of color, or diagnosed with hypertension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jmwh.13104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554079PMC
September 2020

Patient and caregiver contributions to self-care in multiple chronic conditions: A multilevel modelling analysis.

Int J Nurs Stud 2020 Mar 14:103574. Epub 2020 Mar 14.

Campus Bio-Medico University of Rome, Rome, Italy. Electronic address:

Background: Multiple chronic conditions (MCC) are highly prevalent worldwide, especially among older populations. Patient self-care and care partner (or caregiver) contributions to self-care are recommended to reduce the impact of MCC and improve patients' outcomes.

Objectives: To describe patient self-care and care partner contributions to self-care and to identify determinants of patient self-care and care partner contributions to self-care at the patient and care partner level.

Design: Multicentre cross-sectional study.

Setting: Outpatient and community settings in Italy.

Participants: A sample of 340 patients with MCC and care partner dyads was recruited between 2017 and 2018.

Methods: We measured patient's self-care and care partner contributions to self-care in dyads using the Self-care of Chronic Illness Inventory and the Caregiver Contribution to Self-care of Chronic Illness Inventory. To control for dyadic interdependence, we performed a multilevel modelling analysis.

Results: Patients' and care partners' mean ages were 76.65 (± 7.27) and 54.32 (± 15.25), respectively. Most care partners were female and adult children or grandchildren. The most prevalent chronic conditions in patients were diabetes (74%) and heart failure (34%). Patients and care partners reported higher levels of self-care monitoring than self-care maintenance and management behaviours. Important patient clinical determinants of self-care included cognitive status, number of medications and type of chronic condition. Care partner determinants of self-care contributions included age, gender, education, perceived income, care partner burden, caregiving hours per week and the presence of a secondary care partner.

Conclusions: Our findings support the importance of taking a dyadic approach when focusing on patients with MCC and their care partners. More dyadic longitudinal research is recommended to reveal the modifiable determinants of self-care and the complex relationships between patients and care partners in the context of MCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijnurstu.2020.103574DOI Listing
March 2020

Predictors of emergency medical services use by adults with heart failure; 2009-2017.

Heart Lung 2020 Sep - Oct;49(5):475-480. Epub 2020 Apr 3.

Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Indianapolis, IN 46202, United States. Electronic address:

Background: Heart failure (HF) necessitates frequent transport by emergency medical services (EMS), but few studies have been conducted to evaluate predictors of EMS use and of multiple EMS transports that are amenable to intervention.

Objectives: To characterize prehospital clinical status of community-dwelling adults with reported HF who used EMS across 8 years and to evaluate predictors of EMS use and multiple EMS transports.

Methods: Data were from a database in a large Midwestern county. Descriptive statistics, logistic and negative binomial regression were used for analysis.

Results: EMS transports were evaluated for 6582 adults with 16,905 transports. The most common chief complaints were respiratory problems, feeling sick, and chest pain. Shortness of breath, chest pain, level of consciousness, age, gender, race, and hospital site predicted multiple transports.

Conclusions: Clinicians need to educate patients with HF about ways to manage shortness of breath and chest pain and when to activate EMS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrtlng.2020.03.002DOI Listing
March 2021

Caregiver Strain and Heart Failure Patient Clinical Event Risk: An Extension of Previous Work.

J Cardiovasc Nurs 2020 May/Jun;35(3):262-267

Background: In a study of Italian heart failure patient-caregiver dyads, greater caregiver strain significantly predicted lower patient clinical event risk.

Objective: The purpose of this secondary analysis was to examine this relationship in a sample from the United States.

Methods: Data came from 92 dyads who participated in a self-care intervention. Logistic regression was used to test the relationship between baseline strain (Bakas Caregiving Outcomes Scale, divided into tertiles) and patient likelihood of events (heart failure hospitalization/emergency visit or all-cause mortality) over 8 months.

Results: Nearly half of patients (n = 40, 43.5%) had an event. High (vs low) caregiver strain was associated with a 92.7% event-risk reduction, but with substantial variability around the effect (odds ratio, 0.07; 95% confidence interval, 0.01-0.63; P = .02).

Conclusions: Although findings were similar to the Italian study, the high degree of variability and contrasting findings to other studies signal a level of complexity that warrants further investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JCN.0000000000000665DOI Listing
March 2020

Older Adults Can Successfully Monitor Symptoms Using an Inclusively Designed Mobile Application.

J Am Geriatr Soc 2020 06 10;68(6):1313-1318. Epub 2020 Mar 10.

Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York.

Objectives: Patient-Reported Outcomes Measurement Information System (PROMIS) measures can monitor patients with chronic illnesses outside of healthcare settings. Unfortunately, few applications that collect electronic PROMIS measures are designed using inclusive design principles that ensure wide accessibility and usability, thus limiting use by older adults with chronic illnesses. Our aim was to establish the feasibility of using an inclusively designed mobile application tailored to older adults to report PROMIS measures by examining (1) PROMIS scores collected with the application, (2) patient-reported usability of the application, and (3) differences in usability by age.

Design: Cross-sectional feasibility study.

Setting: Inpatient and outpatient cardiac units at an urban academic medical center.

Participants: A total of 168 English- and Spanish-speaking older adults with heart failure.

Intervention: Participants used an inclusively designed mobile application to self-report PROMIS measures.

Measurements: Eleven PROMIS Short-Form questionnaires (Anxiety, Ability to Participate in Social Roles and Activities, Applied Cognition-Abilities, Depression, Emotional Distress-Anger, Fatigue, Global Mental Health, Global Physical Health; Pain Interference, Physical Function, Sleep Disturbance), and a validated health technology usability survey measuring Perceived Ease-of-Use and Usefulness of the application.

Results: Overall, 27% of participants were between 65 and 74 years of age, 10% were 75 years or older, 63% were male, 32% were white, and 96% had two or more medical conditions. There was no missing PROMIS data, and mean PROMIS scores showed the greatest burden of pain, fatigue, and physical function in the sample. Usability scores were high and not associated with age (Perceived Ease-of-Use P = .77; Perceived Usefulness P = .91).

Conclusion: It is feasible for older adults to use an inclusively designed application to report complete PROMIS data with high perceived usability. To ensure data completeness and the opportunity to study multiple domains of physical, mental, and social health, future work should use inclusive design principles for applications collecting PROMIS measures among older adults. J Am Geriatr Soc 68:1313-1318, 2020.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jgs.16403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323569PMC
June 2020

Identifying subgroups: Part 2: Trajectories of change over time.

Eur J Cardiovasc Nurs 2020 06 4;19(5):444-450. Epub 2020 Mar 4.

Boston College William F. Connell School of Nursing, USA.

Methods to identify multiple trajectories of change over time are of great interest in nursing and in related health research. Latent growth mixture modeling is a data-centered analytic strategy that allows us to study questions about distinct trajectories of change in key measures or outcomes of interest. In this article, a worked example of latent growth mixture modeling is presented to help expose researchers to the use and appeal of this analytic strategy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1474515120911330DOI Listing
June 2020

Identifying subgroups: Part 1: Patterns among cross-sectional data.

Eur J Cardiovasc Nurs 2020 04 3;19(4):359-365. Epub 2020 Mar 3.

Boston College William F. Connell School of Nursing, USA.

Non-experimental designs are common in nursing and allied health research wherein study participants often represent more than a single population or interest. Hence, methods used to identify subgroups and explore heterogeneity have become popular. Latent class mixture modeling is a versatile and person-centered analytic strategy that allows us to study questions about subgroups within samples. In this article, a worked example of latent class mixture modeling is presented to help expose researchers to the nuances of this analytic strategy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1474515120911323DOI Listing
April 2020

Understanding the family care dyad: A comparison of two multilevel models.

Eur J Cardiovasc Nurs 2020 02;19(2):178-184

William F. Connell School of Nursing, Boston College, USA.

Although there has been increasing attention on a dyadic perspective of illness, contemporary dyadic research methods are still rarely utilized in cardiovascular disease. The focus of this paper is to describe the advantages of two types of multilevel dyadic models (the matched pairs model and the lesser known incongruence model). Data exemplars in a sample of heart failure family dyads are used to illustrate the distinct advantages of these two related multilevel dyadic models with particular emphasis on alignment with research questions. The more commonly known matched pairs model examines separate outcomes for each member of the dyad, controlling for the interdependent nature of the data. By re-parameterizing this model into a univariate dyadic outcomes model, researchers can address distinct, and sometimes more appropriate, research questions (e.g. incongruent appraisals of the illness experience). This paper promotes greater application of these methods in cardiovascular research to further understanding of the dyadic experience and more appropriately target interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1474515120902368DOI Listing
February 2020

The role of symptom appraisal, concealment and social support in optimizing dyadic mental health in heart failure.

Aging Ment Health 2021 Apr 10;25(4):734-741. Epub 2020 Jan 10.

Boston College, Chestnut Hill, MA, USA.

Heart failure patients and their family care partners experience poor mental health, yet the majority of the research focuses on patients and care partners separately. Guided by the Theory of Dyadic Illness Management, the purpose of the current study was to identify distinct patterns of dyadic mental health in heart failure and identify the individual, dyadic and familial factors associated with group membership. Fifty nine heart failure community-dwelling patients and their spouse care partners were recruited from an outpatient heart failure clinic. Mental health was operationalized by depressive symptoms, measured with the Patient Health Questionnaire-9 (PHQ-9) measure of depression. Distinct groups of dyadic mental health were determined by categorizing depression scores within dyads. Three groups of dyadic mental health were identified: an optimal dyadic mental health group (31%), a poor dyadic mental health group (32%) and an incongruent dyadic mental health group (37%). Patient age, patient fatigue, patient concealment, incongruent dyadic appraisal of pain interference and social/familial support were significantly associated with group membership. Findings underscore the salience of a dyadic approach to health and the clinical relevance of identifying patterns of dyadic mental health so we may determine those most in need of intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13607863.2020.1711866DOI Listing
April 2021