Tag Archives: Chronic Diseases

What role does inflammation play in congestive heart failure?

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Chapater 26  Pathophysiology of heart failure.  In:  Hurst’s the Heart [AccessMedicine].
This section includes a section entitled, “Inflammatory Responses: The Inflammatory Hypothesis.”

“Heart Failure/physiopathology”[majr] AND inflammat*
Filters (Limits):  English, Review articles

This search includes the following references:
The role of monocytes and inflammation in the pathophysiology of heart failure.
Wrigley BJ, Lip GY, Shantsila E.
Eur J Heart Fail. 2011 Nov;13(11):1161-71. Epub 2011 Sep 27. Review.
PMID:21952932

Immune modulation in heart failure: past challenges and future hopes.
Flores-Arredondo JH, García-Rivas G, Torre-Amione G.
Curr Heart Fail Rep. 2011 Mar;8(1):28-37. Review.
PMID:21221862

Reviewed JKN 4/14

What is the correlation of cancer and persons on plant based diets?

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A search of CINAHL and PubMed on the concepts of cancer and plant based diets located these articles. The general conclusion was that genetics may play a part in some individuals not receiving the same cancer prevention benefits from a plant based diet as others.

Lampe, Johanna. Interindividual differences in phytochemical metabolism and disposition. Seminars in cancer biology 2007 vol:17 iss:5 pg:347 -353

Lampe, Johanna, Interindividual differences in response to plant-based diets: implications for cancer risk. The American journal of clinical nutrition 2009 vol:89 iss:5 pg:1553S -1557S

Lampe, Johanna, Brassica, biotransformation and cancer risk: genetic polymorphisms alter the preventive effects of cruciferous vegetables. The Journal of nutrition 2002 vol:132 iss:10 pg:2991 -2994

Higdon, Jane, Cruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis. Pharmacological research 2007 vol:55 iss:3 pg:224 -236

Reviewed JKN 4/14

For patients with coronary artery disease, does patient education affect lifestyle/behavior or patient satisfaction?

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Many of the papers describe multi-faceted interventions that include patient education as one component.

Cardiac Rehabilitation: Interventions. In: Joanna Briggs JBI+Connect. Updated September 2, 2014.

Arch Gerontol Geriatr. 2008; 46 (2): 227-44
In this trial of 173 patients age ≥ 65 years and post CABG randomized to a multi-faceted intervention by a multidisciplinary team of professionals and which included education or usual care, the intervention group was more likely to engage in physical activity

Schadewaldt V, et al. Nurse-led clinics as an effective service for cardiac patients: results from a systematic review.  Int J Evid Based Healthc. 2011 Sep;9(3):199-214.
Review of seven randomized studies on nurse-led clinics, but the major intervention was patient education and behavior counseling.   Clinics were associated with limited effects on behaviors, such as smoking cessation and diet adherence.

PubMed search:  (“coronary artery disease” OR coronary artery bypass) AND (rehabilitation OR “secondary prevention”) AND patient education AND (behavior OR lifestyle OR satisfaction) AND (clinical trial OR randomized)
Other clinical trials on patient education interventions. To see quasi-experimental studies, change modify the search above replacing the terms for study type with these terms:  (comparative study OR before and after study OR pilot) or remove all terms for the study methodology from the search.

CINAHL search:  (cornoary artery disease OR corornary artery bypass) AND patient education AND (rehabilitation OR “secondary prevention”) AND (satisfaction OR lifestyle OR behavior)
Identified papers, such as Barnason S, et al. A comparison of patient teaching outcomes among postoperative coronary artery bypass graft (CABG) patients. Prog Cardiovasc Nurs. 1995; 10(4): 11-20.
While this is an older study, it does reference a tool for measuring patient satisfaction that might be useful.

Reviewed by John Nemeth 4/14

Is hemoglogin A1c associated with wound healing in the orthopedic population?

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Bottom line:  For patients undergoing orthopedic procedures, there is some evidence suggesting an association between perioperative HbA1c levels and complications involvoing the surgical site.

PubMed search:  (orthopedic procedures OR orthopedic surgery) AND (hemoglobin A1c OR hba1c)
The following references from the search results provided data on HbA1c in patients undergoing orthopedic procedures.

Jamsen (2010):  prospective cohort study of 1565 elective knee surgeries for which preoperative plasma glucose was recorded. Patients followed 20 months.  Mean HbA1c

Younger (2009):  Case-control study matching 21 patients with failed transmetatarsal amputation (TMA) with 21 successful TMAs.  HbA1c was the factor most closely associated with success of the TMA.

Marchant (2009):  Retrospective study of >1 million patients undergoing joint replacement surgery 1988-2005 as recorded in the Nationwide Inpatient Sample.  Patients with controlled diabetes mellitus (determined by combination of patient-measured blood glucose and HbA1c) had increased risk of  wound infection (adjusted odds ratio = 2.28 compared to patients with controlled diabetes mellitus.

Lamloum (2009):  Retrospective study of 318 consecutive diabetic patients undergoing surgery at an orthopedic hospital.   Table 3 compares rates of surgical site infections (SSI) for patients with HbA1c < 7.0 compared to rate for patients with HbA1c ≥ 7.0.  High HbA1c was associated with higher rate of SSI

Reviewed by John Nemeth 4/14

Does patient education for cardiac rehabilitation patients affect mortality (all-cause or CV-related), cardiovascular morbidity, revascularization, or hospitalization?

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•    DynaMed.  Coronary Artery Disease.  Use the navigation pane on the left side of the page to select Treatment>Counseling.  Cites this systematic review.

Cochrane Database Syst Rev. 2011 Dec 7;(12):CD008895.  Brown JP, et al.  Patient education in the management of coronary heart disease.

Reviews 13 RCTs of educational interventions in over 68,000 CAD patients.  Interventions used various methods.  Results for effect on health-related quality of life were inconsistent.  No statistically significant evidence for reduction of mortality, cardiac morbidity, revascularization, or hospitalization.  Educational interventions varied in format.  See the review for descriptions of individual interventions.

•    Joanna Briggs JBI+Connect.  Cardiac Rehabilitation: Interventions

JBI also cites the Brown (2011) review above, as well as:

Kummel M, et al. Effects of an intervention on health behaviors of older coronary artery bypass (CAB) patients. Arch Gerontol Geriatr. 2008; 46 (2): 227-44
RCT of 117 patients randomized to usual care or an intervention consisting of multiple sessions of health counseling, guidance, and adjustment education.  Intervention positively impacted physical activity and functional abilities.  No evaluation of effect on mortality or morbidity.

Reviewed by John Nemeth 4/14

What are the benefits and risks of ultrafiltration in managing patients with decompensated heart failure and is there evidence of this procedure being performed on a cardiac step down unit?

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DynaMed includes information about ultrafiltration in the Acute Heart Failure article.

For the outcome of readmission rate:
DynaMed references ACC/AHA 2009 practice guideline recommending use in patients with refractory congestion. Evidence suggests that ultrafiltration may be associated with reduction in hospital readmission. For a summary of evidence, in the DynaMed article, use links on left side of page – Treatment section>Other management>ultrafiltration.  For details of the evidence, including cited studies see 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults.

For the outcome of length of stay:
A search of PubMed’s Clinical Queries (Therapy filter, heart failure AND length of stay AND ultrafiltration) retrieved 2 RCTs (Hanna, 2012 and Costanzo, 2005) that included length of stay as an outcome. Both studies reported evidence that ultrafiltration may be associated with reduction in length of stay. See individual studies for details on population size and other aspects of the methodology.

For the outcome of kidney function:
Revising the PubMed Clinical Queries to  Therapy/narrow filter, heart failure AND ultrafiltration AND (kidney function OR renal function OR creatinine)  Retrieves studies and reviews discussing kidney function. If there are other actual markers that would be used to measure renal function, those can be added to the Clinical Query.

Use in cardiac step down units:
Searches of PubMed (“step down” OR “progressive care”) AND ultrafiltration AND heart failure and CINAHL (step down OR progressive care) AND heart failure, did not identify any studies specifically discussing ultrafiltration on step down units.

For risks PubMed Clinical Queries for Therapy/Broad filter, heart failure AND (adverse effects OR risk) AND ultrafiltration. There are reviews of evidence by Freda (2011) and Dandamudi (2011) and a retrospective analysis (Flythe, 2011) of data from an RCT to examine morbidity and mortality.  These results include systematic reviews as well.

Do nurse managed heart failure clinics have an effect on readmission or cost avoidance for hospital systems?

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Bottom line:  Results from some quasi-experimental studies (mostly quality improvement projects) reported reductions in readmissions, cost, or length of stay for patients participating in nurse-directed heart failure clinics.

Details:  Search results in CINAHL for search of (MH “Nurse-Managed Centers”) AND heart failure AND (readmission OR readmissions OR cost OR costs)

Display relevant references in PubMed.

Reviewed and updated 5/1/2014 ldt