Impact of Relationship and Communication Variables on Ambulatory Blood Pressure in Advanced Cancer Caregivers

2021 ◽  
Author(s):  
Amy K Otto ◽  
Emily C Soriano ◽  
Wendy C Birmingham ◽  
Susan T Vadaparampil ◽  
Richard E Heyman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Interpersonal Relationship ◽  
Future Research ◽  
Role Perceptions ◽  
Psychosocial Experiences ◽  
Random Intervals ◽  
Thoracic Cancer ◽  
Lagged Effects ◽  
Behavioral Mechanisms ◽  
Patient Disclosure

Abstract Background Cancer impacts both patients and their family caregivers. Evidence suggests that caregiving stress, including the strain of taking on a new role, can elevate the risk of numerous health conditions, including high blood pressure (BP). However, the caregiver’s psychosocial experiences, including their interpersonal relationship with the patient, may buffer some of the negative physiological consequences of caregiving. Purpose To examine the influence of psychosocial contextual variables on caregiver ambulatory BP. Methods Participants were 81 spouse–caregivers of patients with advanced gastrointestinal or thoracic cancer. For an entire day at home with the patient, caregivers wore an ambulatory BP monitor that took readings at random intervals. Immediately after each BP reading, caregivers reported on physical circumstances (e.g., posture, activity) and psychosocial experiences since the last BP measurement, including affect, caregiver and patient disclosure, and role perceptions (i.e., feeling more like a spouse vs. caregiver). Multilevel modeling was used to examine concurrent and lagged effects of psychosocial variables on systolic and diastolic BP, controlling for momentary posture, activity, negative affect, and time. Results Feeling more like a caregiver (vs. spouse) was associated with lower systolic BP at the same time point. Patient disclosure to the caregiver since the previous BP reading was associated with higher diastolic BP. No lagged effects were statistically significant. Conclusions Caregivers’ psychosocial experiences can have immediate physiological effects. Future research should examine possible cognitive and behavioral mechanisms of these effects, as well as longer-term effects of caregiver role perceptions and patient disclosure on caregiver psychological and physical health.

scholarly journals Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
M. Ostermann ◽  
A. Schneider ◽  
T. Rimmele ◽  
I. Bobek ◽  
M. van Dam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Critical Care ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Future Research ◽  
Knowledge Gaps ◽  
Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

scholarly journals Prevalence and Risk Factors of Postprandial Hypotension Among Japanese Older Adults in a Facility

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 222-222
Author(s):  
Noriko Suzuki ◽  
Masahiko Hashizume ◽  
Hideyuki Shiotani
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Older Adults ◽  
Older People ◽  
Future Research ◽  
Baseline Body Mass Index ◽  
Term Care ◽  
Postprandial Hypotension ◽  
Before And After ◽  
Japanese Older Adults

Abstract Postprandial hypotension (PPH) is an unrecognized sudden drop of blood pressure (BP) after meals and a hidden problem among older people including those living in long-term care facilities (LTCFs). Though PPH causes dizziness, falls, and syncope, it has received little attention from¬¬¬ healthcare workers (HCW) including caregivers, nurses and physicians, and risk factors of PPH should be carefully assessed to improve quality of life. Therefore, we aimed to examine the prevalence and risk factors of PPH in a LTCF in Japan. Participants were 114 older adults living in a LTCF in Japan (mean age 85.9 years old; 85 female (74%)). To examine PPH, blood pressure (BP) was measured before and after lunch. BP after meal was measured four times every 30 minutes. PPH is defined as a BP drop of 20 mmHg or more and we also defined a BP drop within a range of 19 to 15 mmHg as potential-PPH. As risk factors, we compared systolic and diastolic BP at baseline, body mass index, pulse rate, disease and complications between groups with/without PPH. The prevalence of PPH was 41% (47/114) and 52% with potential-PPH; 11% (13/114) added. Among risk factors, systolic BP was significantly higher in those with PPH (142.6 vs 123.5 mmHg, p <0.001). This study revealed that PPH & potential-PPH occurred in half of the subjects in a LTCF in Japan. HCW need to focus on high systolic BP to predict PPH and future research is necessary to prevent and cope with PPH for older people.

Abstract 53: Results Of The Nashville Barber-pharmacist Hypertension Management Pilot Study

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Jarod Parrish ◽  
Ciantel A Blyler ◽  
Henry E Okafor ◽  
L. Cindy Chang ◽  
Devika Nair ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
Los Angeles ◽  
Care Delivery ◽  
Medication Management ◽  
Lessons Learned ◽  
Future Research ◽  
Hypertension Management ◽  
Male Clients ◽  
Community Stakeholders

Background: The Los Angeles Barbershop Blood Pressure Study (LABBPS) demonstrated that collaboration between barbers and pharmacists delivering hypertension management could significantly improve blood pressure as well as access to care. It is unknown if this model can be translated to other locations. This single-arm, proof-of-concept pilot study tested the development and implementation of a similar protocol in Nashville, TN (NCT04232124). Methods: Between 2019 and 2021, community stakeholders, clinicians, investigators, and the LABBPS team convened to adapt the study design and protocol. Established barbershops with barbers willing to be trained on study procedures were recruited as study sites. Non-Hispanic Black male clients, aged 35-79 years with systolic blood pressure (SBP) > 140 mmHg on two screening days were eligible for participation. Enrolled participants met with a pharmacist for lifestyle and medication management at least once monthly for a six-month period. Barbers measured blood pressure during haircuts for additional monitoring. Results: Eight barbershops in business for an average of 20 (± 5) years participated in the trial. Barbers from each shop (range: 1-4) were trained. A total of 419 clients completed screening visit 1, 82 were eligible and 52 (12%) completed visit 2. We enrolled 36, with 30 completing the initial clinical visit and 27 had complete data at 6-months. Participants were on average age 50 (± 10) years, had a body mass index 33 (± 6), 44% were currently smoking, 52% with high school or less education, and 56% reported current primary care. Baseline BP 157.7±17.1/ 95.1±13.9 mmHg improved to 125.7±11.9/75.6±9.5, a change of -32.1±21.6/ -19.5±14.1, respectively. At 6-months 85% of the group had a BP<140/90, 74% BP<135/85, and 67% BP<130/80. At baseline 15% of participants reported health as excellent/very good and this increased to 56% at 6-months (p=0.002). Adverse reactions reported were minimal. Conclusion: Implementation of the barber-pharmacist model of hypertension management and care delivery improved BP control among hypertensive Black men in Nashville. Lessons learned regarding adaptation overcoming unforeseen barriers will inform expansion into additional naïve locations for future research.

scholarly journals “Impact of Training on Employees Performance” (Evidence from Pharmaceutical Companies in Karachi, Pakistan)

2015 ◽  
Vol 6 (1) ◽  
pp. 49 ◽  
Author(s):  
Uzma Hafeez ◽  
Waqar Akbar
Keyword(s):  
Customer Service ◽  
New Technologies ◽  
Employee Performance ◽  
Interpersonal Relationship ◽  
Sampling Technique ◽  
Business Environment ◽  
Team Work ◽  
Future Research ◽  
Pharmaceutical Companies ◽  
The Impact

Employees are major assets of every organization. The accomplishment of the industry depends on its employee performance. Therefore, upper management knows the significance of expense in training for the advantage of improving employee performance and also places them to get the challenges of the today’s competitive business environment. This research also aims to see the “Impact of Training on Employee Performance in Pharmaceutical Industry in Karachi Pakistan”, in which Training consider as independent whereas dependent variable ‘Employee Performance‘ having its Performance areas i.e.; demonstrating team work, communication skill, customer service, interpersonal relationship and reduced absenteeism and its Developments areas i.e.; job-satisfaction, employee motivation, new technologies, efficiencies in process and innovation in strategies as its levers. The paper presents a concise summary of the literature on the value of training in improving the performance of the employees. Four pharmaceutical companies are selected. A survey of 356 employees via self administrated questionnaire with the help of random sampling technique is conducted with the response rate of 96%. Two sets of hypothesis are developed which relate directly to the research questions. SPSS 19 is used to perform reliability, descriptive, correlation and regression analysis. The analysis shows a positive significant relationship between them and the results reveal that the more the employee gets training, the more efficient their level of performance would be. The last section of the paper concludes along with recommendation to give guidelines for future research.

The Parent–Child Relationship and Sport Parents’ Experiences of Burnout and Engagement

2018 ◽  
Vol 12 (2) ◽  
pp. 218-233
Author(s):  
J.D. DeFreese ◽  
Travis E. Dorsch ◽  
Travis A. Flitton
Keyword(s):  
Youth Sport ◽  
Self Report ◽  
Future Research ◽  
Parent Child Relationship ◽  
Psychosocial Experiences ◽  
Child Relationship ◽  
Study Results ◽  
The Impact ◽  
Parents Experiences ◽  
Parent Child

Burnout and engagement are important psychological outcomes in sport with potential to impact athletes as well as sport parents. The present study examined associations among markers of the sport-based parent child-relationship (warmth and conflict) and parent burnout and engagement in organized youth sport. Youth sport parents (N = 214) aged 26–66 years (M = 43.2,SD = 6.2) completed valid and reliable self-report assessments of study variables. Study results showcased warmth, but not conflict, in the parent–child relationship as a significant negative contributor to global burnout and a significant positive contributor to global engagement in sport parents. Results offer preliminary insight into the impact of parent–child warmth in sport on parents’ experiences of burnout and engagement. Findings have implications for future research and practice designed to promote positive psychosocial experiences for sport families.

scholarly journals Personalized Hypertension Management Based on Serial Assessment and Telemedicine: a Cluster Randomize Controlled Trial Protocol in Anhui, China

2020 ◽  
Author(s):  
Siyi Xiao ◽  
Xingrong Shen ◽  
Rong Liu ◽  
Guixian Tong ◽  
Tongzhu Liu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Low Cost ◽  
Controlled Trial ◽  
Population Based ◽  
Future Research ◽  
Hypertension Management ◽  
Intervention Package ◽  
Self Monitoring ◽  
Intervention Measures ◽  
Cluster Randomized

Abstract Background: Despite tremendous investment worldwide, hypertension treatment and control rates remain low, suggesting that contemporary population-based hypertension management may have reached its efficacy ceiling. The complexity and long-term dynamics of influencing factors make personalized management inevitable and challenging. This protocol describes Personalized Hypertension Management in Anhui, China (PHMA), a project that uses a package of innovative approaches in tailoring interventions to individual patient’s dynamic complications and contexts.Methods/design: PHMA strives to reduce hypertension harms by eight proven “objective behaviors” (e.g., self-monitoring and reporting, healthy diet, physical exercise/activities). These objective behaviors are promoted through five intervention measures: support for self- monitoring, supervised machine communications, daily education or reminder messages, weekly blood pressure notification, and quarterly signed feedback. PHMA uses ten categories and over 300 variables in selecting and refining intervention procedures and content for individual patients. Efficacy of the intervention package is evaluated using a cluster randomized controlled trial design involving a total of 60 site communities and 3352 hypertension patients. Primary measure for the evaluation is systolic and diastolic blood pressure; while secondary evaluation measures include quality of life (EQ5D-5L), occurrence of hypertension-related complications (such as cerebral hemorrhage, coronary heart disease, myocardial or cerebral infarction), healthcare utilization and scores of objective behaviors.Discussion: PHMA uses novel, low cost and sustainable approaches to tailor interventions to the dynamic conditions and contexts of individual patients. Unlike contemporary approaches to hypertension management which are mainly population based, each participant patient in PHMA applies a unique intervention package and all messages, feedbacks and other materials sent out to individual patients are different from each other. PHMA is the first project that adopts so comprehensive tailoring and if proved effective, it should have important implications for future research, practice and policy-making.Trial registration: Registered July 17, 2020. ISRCTN10999269.

333 Associations Between Insomnia and Health Correlates in Nurses

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A133-A133
Author(s):  
Samantha Nagy ◽  
Jessica Dietch ◽  
Danica Slavish ◽  
Brett Messman ◽  
Camilo Ruggero ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sleep Apnea ◽  
High Blood Pressure ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Health Conditions ◽  
Future Research ◽  
Evidence Based ◽  
Insufficient Sleep ◽  
Gastrointestinal Problems

Abstract Introduction Insomnia, shiftwork (i.e., circadian rhythm disruptions) and insufficient sleep are common among nurses and healthcare workers. Each of these sleep problems can contribute to physical (e.g., inflammation, musculoskeletal pain, cardiovascular disease and heart rate variability, indigestion, and menstrual cycle irregularity) and mental (e.g., depression, anxiety, suicidality) health problems as well as daytime fatigue and sleepiness among nurses and may contribute to burnout and job change. Methods Participants (N=458) were nurses recruited for a parent study, “Sleep and Vaccine Response in Nurses (SAV-RN)” (Taylor & Kelly: R01AI128359-01). Most identified as female (90.5%), White/Caucasian (77.2%), and non-Hispanic (88.6%) with an average age of 39.03 (SD = 11.07). Participants completed baseline measures online via Qualtrics survey. The Sleep Condition Indicator (SCI; Espie et al., 2014) was used to identify a probable diagnosis of insomnia (score of ≤16 = Insomnia; endorsement of each of the primary DSM-5 criteria on the measure). In addition, a checklist of current major health conditions (high blood pressure, sleep apnea, GI issues, HIV/AIDS, cancer, etc.) was also completed. A Chi square test of Independence was conducted using SPSS to determine if insomnia detected by the SCI was associated with reported health conditions. Results At baseline, 25.4% of nurses had a probable insomnia diagnosis. Insomnia was associated with a greater likelihood of diagnosed sleep apnea, cancer (all types), high blood pressure, chronic pain, gastrointestinal problems, an autoimmune disease, and/or an endocrine problem at Month 11 of the study (all ps &lt;.05). Data cleaning is ongoing, but similar analyses will be presented examining shift work sleep disorder and insufficient sleep (i.e., average &lt; 6hrs per night) as individual and simultaneous predictors of physical and mental health at baseline and change from baseline to Month 11 (if available). Conclusion These results help to identify associations between insomnia and health conditions in nurses and may contribute to future research that supports evidence-based intervention and prevention strategies for this population. While evidence-based interventions for sleep disturbances and insomnia exist (CBT-I), accessibility and feasibility of scaling such interventions to reach the nursing community at large remains challenging. Support (if any):

Abstract P216: Elevated Blood Glutathione Does Not Reduce Arterial Stiffness or Central Blood Pressure in Healthy Males and Females

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Brianna K Bruggeman ◽  
Katharine E Storo ◽  
Haley M Fair ◽  
Andrew J Wommack ◽  
James M Smoliga ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Antioxidant Capacity ◽  
Pulse Wave ◽  
Central Blood Pressure ◽  
Future Research ◽  
Double Blind ◽  
Mixed Effect ◽  
Males And Females ◽  
Healthy Males

Intro: Glutathione is endogenous within human plasma, erythrocyte lysate and is also bound to the protein within plasma. Glutathione mediates redox chemistry and prevents oxidative damage within and around cellular components via reduction of reactive species (e.g. reactive oxygen, nitrogen, or sulfur species). Polyphenols and antioxidants have been shown to improve NO bioavailability which may reduce long term incidence of endothelial dysfunction. Less is known about whether changes in antioxidant capacity augments the risk of developing hypertension. Hypothesis: We hypothesized that acute glutathione supplementation would decrease arterial stiffness and reduce both brachial (bBP) and central blood pressure (cBP) in healthy male and female volunteers. Methods: Six males and six females (25 ± 3 and 22 ± 1 years, respectively) participated in a randomized, double blind, placebo controlled, crossover protocol. On two visits separated by 1 week, following a 12-hour fast, participants consumed either a placebo or glutathione (negligible and 200 mg, respectively) supplement via 90 second sublingual absorption which was then swallowed. Concentrations of oxidized (GSSG) and reduced glutathione (GSH) were spectrophotometrically measured in plasma (protein-bound) and erythrocyte lysate using a kinetic, enzymatic assay. Arterial stiffness was measured via pulse wave velocity (PWV) using applanation tonometry, and cBP was determined non-invasively using pulse wave analysis. All data were recorded before supplementation (baseline) and at 10, 30, 60 and 120 minutes post-consumption. Results: Linear mixed effect models revealed a significant (p<0.01) increase in total glutathione (GSH+GSSG) in the supplement group compared to placebo across all post-supplementation time points with the greatest increase occurring at 120 minutes (mean 99.0; 95%CI: 7.9,190.1). At 120 minutes post-consumption, no difference was present between glutathione and placebo groups for PWV (5.86 ± 1.19 and 6.08 ± 1.25 m/s, respectively; p=0.43), resting heart rate (52.95 ± 3.55 and 55.83 ± 6.36, respectively; p=0.16), systolic bBP (123.05 ± 12.75 and 123.13 ± 14.52 mmHg; p=0.22), diastolic bBP (71.81 ± 7.87 and 74.21 ± 6.53; p=0.48), systolic cBP (108.05 ± 10.45 and 108.68 ± 11.14 mmHg, respectively; p=0.11) and diastolic cBP (72.03 ± 7.82 and 74.94 ± 6.42 mmHg, respectively; p=0.46). Conclusion: Young healthy males and females experienced an increase in circulating humoral antioxidants in response to glutathione supplementation. However, supplementation had minimal effects on resting hemodynamics. Future research should examine glutathione supplementation’s effect in participants with decreased antioxidant capacity and increased oxidative stress including patients with known disease such as hypertension or peripheral artery disease.

scholarly journals P803 Myocardial work in acutely decompensated heart failure patients differs between HFrEF and HFpEF

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Sahiti ◽  
C Morbach ◽  
C Henneges ◽  
M Hanke ◽  
R Ludwig ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Future Research ◽  
Lv Function ◽  
Acutely Decompensated Heart Failure

Abstract OnBehalf AHF Registry Background & Aim A novel echocardiographic method to non-invasively determine left ventricular (LV) myocardial work (MyW) based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated against invasive reference measurements. MyW is considered less load-dependent than LV ejection fraction (EF) and LV longitudinal strain. We investigated MyW indices in patients with reduced ejection fraction (LVEF &lt;40%; HFrEF) and patients with preserved ejection fraction (LVEF ≥50%, HFpEF) admitted for acutely decompensated heart failure (AHF). Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed on the day of admission. MyW assessment was performed off-line using EchoPAC (GE, version 202). Here we present MyW indices and performed two-sided t-tests to analyze differences in numerical baseline covariates. Results We analyzed the echocardiograms of 94 AHF patients (72 ± 10 years; 36% female). 46 patients (49%) had an LVEF &lt;40%, while 48 patients (51%) presented with LVEF ≥50%. HFrEF patients were younger, less often female, and hat lower blood pressure (table). Consistent with lower LVEF, HFrEF patients had less negative global longitudinal strain and lower global constructive work, when compared to HFpEF patients. Since HFrEF patients also had higher global wasted work, this yielded a lower myocardial work efficiency compared to HFpEF patients (table). Conclusions This analysis in patients with AHF exhibited marked differences in MyW indices according to subgroups with HFrEF and HFpEF, thus adding information to the classical measures of LV function. Future research has to determine whether constructive and/or wasted MyW are valuable diagnostic or therapeutic targets in patients with AHF. Abstract P803 Figure.

scholarly journals Continuous and less invasive central hemodynamic monitoring by blood pressure waveform analysis

2010 ◽  
Vol 299 (3) ◽  
pp. H584-H599 ◽  
Author(s):  
Ramakrishna Mukkamala ◽  
Da Xu
Keyword(s):  
Blood Pressure ◽  
Hemodynamic Monitoring ◽  
Waveform Analysis ◽  
Future Research ◽  
Pressure Waveform ◽  
Less Invasive ◽  
Hemodynamic Variables ◽  
Blood Pressure Waveform ◽  
Central Hemodynamic ◽  
Clinically Significant

Blood pressure waveform analysis may permit continuous (i.e., automated) and less invasive (i.e., safer and simpler) central hemodynamic monitoring in the intensive care unit and other clinical settings without requiring any instrumentation beyond what is already in use or available. This practical approach has been a topic of intense investigation for decades and may garner even more interest henceforth due to the evolving demographics as well as recent trends in clinical hemodynamic monitoring. Here, we review techniques that have appeared in the literature for mathematically estimating clinically significant central hemodynamic variables, such as cardiac output, from different blood pressure waveforms. We begin by providing the rationale for pursuing such techniques. We then summarize earlier techniques and thereafter overview recent techniques by our collaborators and us in greater depth while pinpointing both their strengths and weaknesses. We conclude with suggestions for future research directions in the field and a description of some potential clinical applications of the techniques.

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