Psychological Characteristics of Patients with Takotsubo Syndrome and Patients with Acute Coronary Syndrome: An Explorative Study toward a Better Personalized Care

During an acute cardiac event, Takotsubo Syndrome (TTS) and Acute Coronary Syndrome (ACS) apparently share very similar clinical characteristics. Since only a few inconsistent studies have evaluated the psychological features that characterize these different patients, the aim of the present explorative research was to investigate if post-recovery TTS and ACS patients present different psychological profiles. We also investigated whether the occurrence of acute psychological stressful episodes that had occurred prior to the cardiac event could be found in either syndrome. Twenty TTS and twenty ACS female patients were recruited. All patients completed self-report questionnaires about anxiety and depressive symptoms, perceived stress, type-D personality and post-traumatic symptoms. Results showed that only three subscales of health anxiety (i.e., Fear of Death/Diseases, Interference and Reassurance) significantly differed between the two groups, while no differences were found in the other psychological measurements. Moreover, personality traits seem to not be associated with the impact of the cardiac traumatic event. Finally, only TTS patients reported the presence of a significant emotional trigger preceding the acute cardiac event. In conclusion, post-recovery TTS patients differ from ACS patients in their level of concern about their health and in their need of reassurance and information only, probably as a result of the different clinical characteristics of the two illnesses.

Can Artificial Intelligence and Big Data Improve Gamified Healthcare Services and Devices?

Systems that aim to maintain and improve the health of citizens are steadily gaining importance. Digital transformation is having a positive impact on healthcare. Gamification motivates individuals to maintain and improve their physical and mental well-being. In the era of artificial intelligence and big data, healthcare is not only digital, but also predictive, proactive, and preventive. Big data and artificial intelligence techniques are called to play an essential role in gamified eHealth services and devices allowing to offer personalized care. This chapter aims to explore the possibilities of artificial intelligence and big data techniques to support and improve gamified eHealth services and devices, including wearable technology, which are essential for digital natives but also increasingly important for digital immigrants. These services and devices can play an important role in the prevention and diagnosis of diseases, in the treatment of illnesses, and in the promotion of healthy lifestyle habits.

Urologic Oncology Patient Perspectives During COVID-19 Treatment Delays

Purpose The COVID-19 pandemic led to delays in urologic cancer treatment. We sought the patient perspective on these delays. Methods We conducted a mixed methods study with an explanatory-sequential design. Survey findings are presented here. Patients from a Midwestern Comprehensive Cancer Center and the Bladder Cancer Advocacy Network provided demographic and clinical data and responded to statements asking them to characterize their experience of treatment delay, patient-provider communication and coping strategies. We quantified patient distress with an ordinal scale (0-10), based on the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT). Results Forty-four consenting patients responded to the survey. Most were older than 61 years (77%) and male (66%). Their diagnoses included bladder (45%), prostate (30%) and kidney (20%) cancers. Median time since diagnosis was 6 months, 95% had plans for surgical treatment. Dominant reactions to treatment delay included fear that cancer would progress (50%) and relief at avoiding COVID-19 exposure (43%). Most patients reported feeling that their providers acknowledged their emotions (70%), yet 52% did not receive follow up phone calls and only 55% felt continually supported by their providers. Patients’ median distress level was 5/10 with 68% of patients reaching a clinically significant level of distress (≥4). Thematically grouped suggestions for providers included better communication (18%), more personalized support (14%), and better patient education (11%). Conclusion During the COVID-19 pandemic, a high proportion of urologic cancer patients reached a clinically significant level of distress. While they felt concern from providers, they desired more engagement and personalized care.

Building a Personalized Medicine Infrastructure for Gynecological Oncology Patients in a High-Volume Hospital

Gynecological cancers require complex intervention since patients have specific needs to be addressed. Centralization to high-volume centers improves the oncological outcomes of patients with gynecological cancers. Research in gynecological oncology is increasing thanks to modern technologies, from the comprehensive molecular characterization of tumors and individual pathophenotypes. Ongoing studies are focusing on personalizing therapies by integrating information across genomics, proteomics, and metabolomics with the genetic makeup and immune system of the patient. Hence, several challenges must be faced to provide holistic benefit to the patient. Personalized approaches should also recognize the unmet needs of each patient to successfully deliver the promise of personalized care, in a multidisciplinary effort. This may provide the greatest opportunity to improve patients’ outcomes. Starting from a narrative review on gynecological oncology patients’ needs, this article focuses on the experience of building a research and care infrastructure for personalized patient management.

Improved cardiovascular risk stratification with PET: [18F]meta-fluorobenzylguanidine as a potential cardiac radiotracer

Background and Hypothesis: Cardiovascular disease is the leading cause of death in the United States each year, exceeding 600,000 deaths and costing over $200B. Sympathetic dysfunction in cardiac tissue has been shown to occur in patients with recent cardiac injury or longstanding disease. The SPECT radiotracer, meta-[123I]iodobenzylguanidine (MIBG), has been used to image neuroendocrine tumors as well as global cardiac sympathetic tone through the human norepinephrine transporter-1. We will determine the utility and improved imaging the PET radiotracer meta-[18F]fluorobenzylguanidine (MFBG) can afford in cardiac care. MFBG has shown several improvements over MIBG in neuroendocrine tumors but has proven difficult to reliably synthesize. Project Methods: A novel synthetic pathway of MFBG utilizing copper accelerated Sandmeyer fluorination conditions is being developed to streamline its radiosynthesis from seven manipulations and an unstable precursor to four with more stable intermediates. We also explored where MFBG may be useful in cardiology by performing a literature review through the PubMed MeSH database published after 2010. Results: We have developed a new MFBG precursor in one step from commercially available compounds and a one-pot automated radiosynthesis is currently in development. This improves upon current methods and may provide increased clinical availability of MFBG for future studies. MIBG has shown prognostic value for the incidence of severe cardiac events but cannot provide any local innervation data. The PET radiotracer, [11C]hydroxyephedrine, can display local denervation within the myocardium. However, its 20.3 minute half-life prevents its widespread use beyond hospitals with direct access to a radiochemistry laboratory. To our knowledge, no cardiac imaging has been investigated using MFBG. Conclusion and Potential Impact: We believe MFBG could provide similar improvements to cardiac imaging as in neuroendocrine tumors. With a novel synthetic method being developed, we hope to begin pre-clinical imaging studies and provide future cardiologists with a new prognostic imaging modality which can direct personalized care to patients with cardiovascular disease.

Psychographic Segmentation: Another Lever for Precision Population Brain Health

Dementia prevention interventions that address modifiable risk factors for dementia require extensive lifestyle and behavior changes. Strategies are needed to enhance engagement and personalization of the experience at a population level. Precision Population Brain Health aims to improve brain health across the lifespan at a population level. Psychographic segmentation is a core component of Precision Population Brain Health with untapped potential. Psychographic segmentation applies behavioral and social sciences to understanding people’s motivations, values, priorities, decision making, lifestyles, personalities, communication preferences, attitudes, and beliefs. Integrating psychographic segmentation into dementia care could provide a more personalized care experience and increased patient engagement, leading to improved health outcomes and reduced costs. Psychographic segmentation can enhance patient engagement for dementia and shift the clinical paradigm from “What is the matter?” to “What matters to you?” Similar benefits of psychographic segmentation can be provided for dementia caregivers. Developing dementia prevention programs that integrate psychographic segmentation could become the basis for creating a shared framework for prevention of non-communicable diseases and brain health disorders at a population level. Integrating psychographic segmentation into digital health tools for dementia prevention programs is especially critical to overcome current suboptimal approaches. Applying psychographic segmentation to dementia prevention has the potential to help people feel a sense of empowerment over their health and improve satisfaction with their health experience—creating a culture shift in the way brain health is approached and paving the way toward Precision Population Brain Health.

A Mismatch Between Theory and Practice in the Transition From Home to a Nursing Home: A Scoping Review

The transition from home to a nursing home is a complex process, existing of three transition phases (pre-, mid- and post-transition). It is often fragmented, leading to negative outcomes for older persons and informal caregivers. To prevent these negative outcomes, knowledge of existing transitional care interventions is paramount. Therefore, a scoping review was performed, summarizing current interventions aiming to improve transitional care. The review identified 17 studies, describing eight multi- and five single-component interventions. From the multi-component interventions, seven main components were identified: education, relationships/communication, improving emotional well-being, personalized care, continuity of care, support provision, and ad hoc counseling. This review identified a clear mismatch between theory on optimal transitional care and current transitional care interventions. All interventions focused on either a specific phase or target population throughout the transition process. This inhibits a continuous transition process in which a partnership between all stakeholders involved exists.

HIV Infection and Risks of Morbidity and Death in Adults with Incident Heart Failure

Aims Human immunodeficiency virus (HIV) increases the risk of heart failure (HF), but whether it influences morbidity and mortality remains unclear. Methods and Results We investigated the risks of hospitalization for HF, HF-related emergency department (ED) visits, and all-cause death in an observational cohort of incident HF patients with and without HIV using data from three large U.S. integrated healthcare delivery systems. We estimated incidence rates and adjusted hazard ratios by HIV status at the time of HF diagnosis for subsequent outcomes. We identified 448 persons living with HIV (PLWH) and 3,429 without HIV who developed HF from a frequency-matched source cohort of 38,868 PLWH and 386,586 without HIV. Mean age was 59.5±11.3 years with 9.8% women and 31.8% Black, 13.1% Hispanic, and 2.2% Asian/Pacific Islander. Compared with persons without HIV, PLWH had similar adjusted rates of HF hospitalization (adjusted hazard ratio [aHR] 1.01 95% confidence interval [CI]:0.81-1.26) and of HF-related ED visits (aHR 1.22 [95%CI:0.99-1.50]), but higher adjusted rates of all-cause death (aHR 1.31 [95%CI:1.08-1.58]). Adjusted rates of HF-related morbidity and all-cause death were directionally consistent across a wide range of CD4 counts but most pronounced in the subset with a baseline CD4 count <200 or 200-499 cells/μl. Conclusions In a large, diverse cohort of adults with incident HF receiving care within an integrated healthcare delivery systems, PLWH were at an independently higher risk of all-cause death but not HF hospitalizations or HF-related ED visits. Future studies investigating modifiable HIV-specific risk factors may facilitate more personalized care to optimize outcomes for PLWH and HF.

Construction and Validation of a Frailty Index in Primary Care in Italy: The Health-Search Frailty Index

Recognizing frailty in primary care is important to implement personalized care pathways and for prognostication. The aim of this study was to build and validate a frailty index based on routinely collected primary care data in Italy. We used clinical data from 308,280 Italian primary care patients 60+ with at least 5 years of follow-up, part of the Health Search Database. A heuristic algorithm was used to select the deficits to be included in a highly performant frailty index. The fitness of the index was assessed through the c-statistics derived by survival models. Results were externally validated using the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). After testing 3.4 million of deficits combinations, 25 deficits were selected to be included in the Health Search Frailty Index (HS-FI). After adjusting by sex, age and geographical area, the HS-FI was associated with 5-year mortality (HR per 0.1 increase 1.99; 95%CI 1.95-2.02) and hospitalization rate (HR per 0.1 increase 1.25; 95%CI 1.23-1.27). In the external validation cohort, HS-FI independently predicted mortality, hospitalization, incident disability, incident dementia, and incident falls. This is the first frailty index built following a data-driven approach, using national representative primary care data. The implementation of such tool – derived by routinely collected data – in primary care software will ease the prompt, comparable and reliable recognition of frailty at the population level.

Hospital at Home for Intrathecal Pump Refills: A Prospective Effectiveness, Safety and Feasibility Study

Continuous Intrathecal Drug Delivery through an implanted pump is a well-known therapeutic option for the management of chronic pain and severe disabling spasticity. To have a successful therapy, pump refills need to be performed at regular time intervals after implantation. In line with the increased applications of Hospital at Home, these refill procedures might be performed at the patient’s home. The aim of this pilot study is to evaluate the feasibility, safety, and effectiveness of intrathecal pump refill procedures at home. Twenty patients were included whereby pump refill procedures were conducted at the patient’s home. To enable contact with the hospital, a video connection was set-up. Tele-ultrasound was used as post-refill verification. All procedures were successfully performed with complete patient satisfaction. Ninety-five percent of the patients felt safe during the procedure, and 95% of the procedures felt safe according to the physician. All patients indicated that they preferred their next refill at home. The median time consumption for the physician/nurse at the patient’s home was 26 min and for the researcher at the hospital 15 min. In light of quality enhancement programs and personalized care, it is important to continue urgent pain management procedures in a safe way, even during a pandemic.