Heart & Lung: The Journal of Acute and Critical Care

Information for Authors

2012-01-01

Into the New Year

Nancy S. Redeker — 2012-01-01

The New Year brings a great opportunity to evaluate progress and consider plans for the future of Heart & Lung. It is my pleasure to inform you that in 2011, Heart & Lung earned its highest impact factor (1.508) and ranked 7th among the 88 journals in the Nursing category. This accomplishment would not have been possible without the high standards and commitment of our reviewers, authors, and readers, and Heart & Lung's previous editor in chief, Dr Kathleen Stone.

Meeting the health challenges of the 21st century workforce: Future directions for cardiovascular research

Victoria Vaughan Dickson — 2012-01-01

The American workforce represents a challenging yet increasingly important target for cardiovascular disease (CVD) programs. Nearly a third of America's 140 million workers have hyperlipidemia, 15% have hypertension, and 3.5 million workers have coronary heart disease. Although the United States Department of Health and Human Services' Healthy People 2010 includes the goal of wellness programs to decrease cardiovascular risk at 75% of worksites, only 11.4% of large employers and fewer than 5% of small worksites offer such programs. The evidence that these often costly worksite initiatives improve cardiovascular health is very limited. Conversely, a growing body of evidence indicates that occupational stressors, ranging from exposure to environmental toxins to job-level stressors (eg, job strain and shift work), contribute to CVD. Research to date has either focused on the identification of occupational heart hazards, or emphasized factors associated with a return to work.

Heart failure nurses play a pivotal role in linking clinical research to clinical practice: Translational research

Connie M. Lewis — 2011-11-07

There are approximately 6 million Americans living with heart failure and more than 670,000 patients with newly diagnosed heart failure annually who depend on heart failure nurses to combine the science and art of nursing/medicine to improve patient outcomes and quality of life, while decreasing readmissions, length of stay, and cost. Translational research is often described as the translation of the evidence from clinical trials into real-world practice. We know from numerous studies that it may take 1 or 2 decades for original research to be implemented into everyday practice. Because “patients are the heart of what we do,” heart failure nurses have to recognize their significant roles in research. Few of us are involved in basic science research, although many play integral roles in nursing research initiatives and clinical trials. All of us should participate in the challenge to narrow the gap between interpreting results from clinical studies and changing our clinical practice to reflect the dissemination of that knowledge. We play a pivotal role in assessing that our patients are receiving the lifesaving medical and device therapies that are appropriate. A goal of translational research is to rapidly diffuse available knowledge, interventions, and innovations into daily practice while understanding the barriers to practice. Fontanarosa and colleagues stated that “effective translation of the new knowledge, mechanisms, and techniques generated by advances in basic science research into new approaches for prevention, diagnosis, and treatment of disease is essential for improving health.” Heart failure nurses from novice to expert and from research roles to clinic practice, academics, and administrative roles are uniquely positioned to make a difference in the health care of our patients. We can have a positive influence on the health care delivery systems, the decisions of policy makers, and the public awareness of the challenges our patients with heart failure and their families and caregivers face on a day-to-day basis. We must not be complacent. We are the best advocate for our patients. We can make a difference.

The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease

Victoria Vaughan Dickson, Alexandra Howe, Joshua Deal, Margaret M. McCarthy — 2011-11-14

Abstract: Objective: The study objective was to describe the self-care behaviors of adherence to medication, diet, exercise, and symptom monitoring of older workers with cardiovascular disease (CVD) and explore the relationship among job characteristics (job demands, job control, and workplace support), self-care, and quality of life. More than 3.5 million workers have CVD with significant work limitations and increased disability. Workers must meet the challenges of today’s work processes that include increased stress and intense production demands while managing the complexities of their CVD.Methods: A total of 129 workers (aged ≥ 45 years) with CVD completed standardized instruments about self-care (Specific Adherence Scale α = .74), job characteristics (Job Content Questionnaire α = .71), and quality of life (MacNew health-related quality of life α = .84). Regression analyses were used to examine relationships between variables.Results: The sample had a mean age of 59.16 ± 8.83 years, 56.3% were female, and 36.5% were African-American. Self-care behaviors varied. Most workers (71.4%) reported medication adherence, and few adhered to diet (27%), exercise (18%), or symptom monitoring (31.3%). Psychologic job demands were negatively correlated to self-care (r = −.217, P = .02). Better adherence was reported by those with workplace support (r = .313, P = .001). Job characteristics explained 22% of variance in self-care adherence behaviors. Adherence was a significant determinant of general quality of life.Conclusion: Because job characteristics may interfere with self-care, clinicians should assess job demands and discuss stress management with employed patients. Interventions that foster worksite programs and facilitate self-care among workers with CVD are needed.

Effects of home-based rehabilitation on health-related quality of life and psychological status in Chinese patients recovering from acute myocardial infarction

Wenru Wang, Sek Ying Chair, David R. Thompson, Sheila F. Twinn — 2011-10-05

Abstract: Objective: This study evaluated the effects of a home-based rehabilitation program for Chinese patients with myocardial infarction in terms of health-related quality of life and psychological status.Methods: This was a randomized, controlled trial with data collected at 2 university-affiliated public general hospitals in Xian (Shaanxi Province, People's Republic of China). One hundred and sixty patients with a myocardial infarction were randomly assigned to either the interventional group (a home-based cardiac rehabilitation program using a self-help manual) or the control group (usual care). Health-related quality of life (generic, Chinese Short Form 36-Item Health Survey; disease-specific, Chinese Myocardial Infarction Dimensional Assessment Scale) and psychological status (the Chinese Hospital Anxiety and Depression Scale) were measured at baseline, program completion (6 weeks), and 3 and 6 months after hospital discharge.Results: Significant differences were evident in the main outcomes when the home-based group was compared with the usual care group at 6 weeks, 3 months, and 6 months. The home-based group had significantly higher scores on 4 of the 8 domains of the Chinese Short Form 36-Item Health Survey and on 3 of the 7 dimensions of the Chinese Myocardial Infarction Dimensional Assessment Scale, with significantly lower scores on the anxiety, but not the depression, subscale of the Chinese Hospital Anxiety and Depression Scale.Conclusions: A simple, home-based cardiac rehabilitation program for patients with acute myocardial infarction, using a self-help manual, improves health-related quality of life and reduces anxiety. It appears feasible and acceptable, and does not produce inferior outcomes compared with usualcare in China.

Family caregiving in pulmonary arterial hypertension

2011-05-19

Abstract: Background: Pulmonary arterial hypertension (PAH) is a devastating disease that places a significant burden on patients and their families. However, family caregiving, to the best of our knowledge, has never been described in this population. This study sought to describe depressive symptoms, types of performed care tasks, social support, and the impact of caregiving among family caregivers of patients with PAH.Methods and Results: Data were obtained from 35 dyads of patients with PAH (mean age, 51 years; 63% were female; 54% had World Health Organization functional class III symptoms) and their family caregivers (mean age, 52 years; 60% were female; 68% were spouses). Five caregivers (14%) were identified as manifesting moderate to severe depressive symptoms. The majority of caregivers reported that their daily activities were centered around caregiving responsibilities. More than 85% of caregivers were involved in managing care for the patient, and more than half helped the patient with self-management activities. The level of caregivers’ perceived social support was low, especially for emotional and informational support. Lower levels of social support were significantly associated with more severe depressive symptoms in caregivers (r = −.50, P = .002).Conclusion: Caregivers of patients with PAH play a significant role in patients’ medical care and self-management, yet they lack sufficient emotional support or information to meet the demands of caregiving. These findings underscore the importance of supporting family caregivers of patients with PAH.

The experiences of patients with pulmonary arterial hypertension receiving continuous intravenous infusion of epoprostenol (Flolan) and their support persons

Heather Hall, Joanne Côté, Althea McBean, Margaret Purden — 2011-07-26

Abstract: Objective: Little is known about the day-to-day experiences of patients and their support persons during the course of epoprostenol treatment for pulmonary arterial hypertension (PAH). The study objective was to describe the experiences of patients and their support persons adjusting to PAH and continuous intravenous epoprostenol.Methods: A qualitative descriptive design with semistructured interviews was conducted jointly with the patient and his/her support person. Seven patients and their support persons (spouse, child, friend) were included.Results: Patients demonstrated personal growth and resilience as they adapted to PAH. Four patient themes emerged: initial shock, figuring it out, giving life, and ongoing struggles. Themes specific to the support person included “their life is in my hands,” pressure to perform, and continuation of my role.Conclusion: Nurses may assist these patients and support persons by teaching technical skills, problem-solving and troubleshooting strategies, mobilizing social support, and providing opportunities to reflect on lifestyle changes and long-term adjustment to PAH.

Validation of a three-factor measurement model of dyspnea in hospitalized adults with heart failure

Mark B. Parshall, Adam C. Carle, Unchalee Ice, Robert Taylor, Joyce Powers — 2011-07-28

Abstract: Objective: The purpose of this study was to validate a 3-factor measurement model of dyspnea sensory quality (WORK-EFFORT, TIGHTNESS, SMOTHERING-AIR HUNGER) originally derived in patients with exacerbated chronic obstructive pulmonary disease.Methods: In this validation study, adult patients with heart failure were enrolled after hospital admission (median hospital day 1) and asked to rate the intensity of dyspnea sensory quality descriptors on the day of enrollment (study day 1; N = 119) and in a recall version for the day of admission (study day 0; n = 97).Results: Confirmatory factor analysis demonstrated good model fit for both days. Cronbach’s α for each factor was greater than .87 for both study days.Conclusion: This is the first study to validate a previously specified measurement model of dyspnea sensory quality in an independent sample. Results indicate that measurement of dyspnea sensory quality in exacerbated cardiopulmonary disease does not necessarily require disease-specific questionnaires.

Reliability and validity of the Korean version of the Minnesota Living with Heart Failure Questionnaire

2012-01-01

Abstract: Objective: The aim of this study was to verify the reliability and validity of the Korean language version of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) before using this version in clinical practice to assess the quality of care in patients with heart failure in a cardiology clinic.Methods: The Korean versions of the MLHFQ, 36-Item Short Form Health Survey, and Center for Epidemiologic Studies Depression Scale were administered to evaluate the psychometric properties among 154 patients with heart failure in a major cardiac center in Korea. Cardiac function was assessed by evaluating left ventricular ejection fraction values, N-terminal pro-brain natriuretic peptide levels, and New York Heart Association classifications.Results: The questionnaire content and construct validity were supported by factor analysis. Three factors explained 70.7% of the variance. Total and subtotal scales had correlations with the mental and physical component scores of the 36-Item Short Form Health Survey and Center for Epidemiologic Studies Depression Scale, supporting the convergent validity of the Korean version of the MLHFQ. We also found that the New York Heart Association classification was associated with the MLHFQ score. The internal consistency of both total and subtotal scales was greater than .80.Conclusion: The Korean version of the MLHFQ demonstrated excellent psychometric properties. These results support the use of the MLHFQ in Korean patients with heart failure. Further studies are recommended to assess the responsiveness to change of the Korean version of the MLHFQ.

Endotracheal tube exchangers: Should we look for safer alternatives?

Kassem Harris, Michel Chalhoub, Rabih Maroun, Dany Elsayegh — 2011-08-11

Abstract: Endotracheal tube exchange is considered a simple procedure, performed in cases of endotracheal tube malfunction. It usually involves the use of airway exchange catheters (AECs). The procedure, however, can lead to major complications that require prompt intervention for optimal outcomes. We report on a case of endotracheal tube exchange with AECs complicated by pneumothorax, without evidence of tracheal or bronchial injury demonstrable via bronchoscopy. Increasing rates of AEC-related complications highlight the need for alternative methods to exchange malfunctioning endotracheal tubes safely.

Clinical diagnostic utility of adenosine deaminase, interferon-γ, interferon-γ–induced protein of 10 kDa, and dipeptidyl peptidase 4 levels in tuberculous pleural effusions

Hongxiu Wang, Jun Yue, Jinghui Yang, Rongliang Gao, Jinming Liu — 2011-09-16

Abstract: Objective: Current tools for the diagnosis of tuberculous pleural effusions are suboptimal. The study was undertaken to evaluate the accuracy of pleural fluid adenosine deaminase (ADA), interferon (IFN)-γ, interferon-γ–induced protein of 10 kDa (IP-10), and dipeptidyl peptidase (DPP) 4 levels in differentiating tuberculous pleural effusion (TPE) and non-TPE.Methods: A total of 122 samples of pleural effusion were studied. Pleural fluid ADA activity was measured with the colorimetric method, and IP-10, IFN-γ, and DPP4 levels were measured with enzyme-linked immunosorbent assay.Results: ADA activity and IP-10, IFN-γ, and DPP4 levels were significantly higher in TPE than in non-TPE (88.9 ± 62.7 U/L vs 18.1 ± 16.2 U/L, P < .05; 147.5 ± 117.3 ng/L vs 24.9 ± 19.7 ng/L, P < .05; 627.2 ± 345.3 ng/L vs 152.6 ± 71.4 ng/L, P < .05; and 560.6 ± 451.2 vs 56.8 ± 57.7, P < .05, respectively). The diagnostic sensitivity and specificity of ADA activity (cutoff value of 40 U/L) were 93.6% and 90.9%, respectively, and higher than those of IFN-γ (91.0% and 88.6% at the cutoff value of 225 ng/L, respectively), DPP4 (88.5% and 81.8% at the cutoff value of 75 ng/L, respectively), and IP-10 (83.3% and 86.4% at the cutoff value of 44 ng/L, respectively).Conclusion: The roles of ADA and IFN-γ in the differential diagnosis of tuberculous pleurisy are pivotal. ADA or IFN-γ in combination with DPP4 or IP-10 can aid in differentiation between TPE and non-TPE with improved specificity and diagnostic efficiency.

Respiratory syncytial virus (RSV) community-acquired pneumonia (CAP) in a hospitalized adult with human immunodeficiency virus (HIV) mimicking influenza A and Pneumocystis (carinii) jiroveci pneumonia (PCP)

Burke A. Cunha, Uzma Syed, Jean E. Hage — 2011-10-17

Abstract: Background: Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infections in young children, the elderly, and immunocompromised hosts, but RSV is a rare cause of community-acquired pneumonia (CAP) in hospitalized adults with human immunodeficiency virus (HIV). In patients with HIV, CAP is most frequently attributable to the usual bacterial respiratory pathogens that cause CAP in immunocompetent hosts, eg, Streptococcus pneumoniae or Hemophilus influenzae. Adults with HIV are also predisposed to intracellular CAP pathogens, ie, Mycoplasma tuberculosis, Salmonella spp., Pneumocystis (carinii) jiroveci (PCP), cytomegalovirus, and Legionella spp. This year, co-circulating in the community during influenza season were strains of human seasonal influenza A (H3N2) and swine influenza A (H1N1). During the influenza season, in adults hospitalized with HIV, the diagnostic possibilities should include influenza-like illnesses, eg, human parainfluenza virus types 3 and 4, human metapneumovirus, and pertussis.Case Report: We present an adult with HIV, hospitalized for an influenza-like illness during influenza season. The differential diagnosis of CAP in this patient included influenza A and PCP.Conclusion: We report on an adult patient with HIV with CAP that mimicked influenza and PCP, and was attributable to RSV.

Bronchoalveolar carcinoma (adenocarcinoma) mimicking recurrent bacterial community-acquired pneumonia (CAP)

Burke A. Cunha, Uzma Syed, Nardeen Mikail — 2011-04-12

Abstract: Depending on the community-acquired pneumonia (CAP) pathogen, host factors, and immune status, CAPs resolve on chest x-rays at different rates. CAPs that resolve more slowly than expected, or not at all, are termed “slowly or non-resolving CAPs.” In contrast, recurrent CAPs may be due to host defense defects (eg, multiple myelomas) or post-obstructive bronchogenic carcinomas. There are a variety of noninfectious disorders that may mimic CAPs on chest x-ray: alveolar hemorrhage, pulmonary drug reactions, radiation pneumonitis, Wegener’s granulomatosis, bronchiolitis obliterans organizing pneumonia, bronchogenic carcinomas, and lymphomas. Noninfectious mimics of recurrent CAPs include congestive heart failure, pulmonary emboli, infarctions, sarcoidosis, and systemic lupus erythematosus pneumonitis. We present the case of a middle-aged man who presented with recurrent right middle lobe and right lower lobe CAPs. Diagnostic bronchoscopy showed no bronchial obstruction, but open lung biopsy showed bronchoalveolar carcinoma (well-differentiated adenocarcinoma). Bronchoalveolar carcinomas presenting as post-obstructive or recurrent CAPs are rare because the spread is along tissue planes and not endobronchially. The case described demonstrates a rare cause of bronchogenic carcinoma mimicking recurrent CAP.

Endovascular therapy for radiation-induced pulmonary artery stenosis: A case report and review of the literature

Steven R. Bruhl, Mujeeb Sheikh, Satjit Adlakha, Samer J. Khouri, Utpal Pandya — 2011-03-23

Abstract: Although pulmonary artery stenosis and its treatment has been well characterized in pediatric populations, its diagnosis and even how to determine the significance of a stenosis can be difficult and optimal management is currently unknown. This case report and review of the literature outlines how we successfully diagnosed, evaluated, and stented a patient with radiation induced pulmonary artery stenosis. This case further adds support to a very limited data pool suggesting that percutaneous angioplasty of pulmonary artery stenosis may be a safe and effective treatment option for this unique patient population.

Aortic stenosis and angiodysplastic gastrointestinal bleeding: Heyde’s disease

2011-10-13

Abstract: Obscure gastrointestinal (GI) bleeding can be a perplexing and difficult problem in elderly patients, especially if they are hemodynamically unstable. If aortic stenosis is also present, the cause of the GI bleeding may be explained. We present a 66-year-old man with a medical history of coronary artery disease who presented with acute GI bleeding. During his hospital course, the patient had a colonoscopy showing diffuse angiodysplasia and an echocardiogram showing severe aortic stenosis. This combination of angiodysplasia and aortic stenosis is known as Heyde’s syndrome. It has been hypothesized that the aortic stenosis causes an acquired von Willebrand factor deficiency that leads to GI bleeding. Aortic valve replacement, when possible, can prevent recurrent GI bleeding in these cases, but medical decisions in these cases are complex and difficult.

A case for immediate-release niacin

Mayer Bassan — 2011-03-18

Abstract: Niacin is currently a favored drug for increasing high-density lipoprotein, especially in patients with ischemic heart disease or at high risk of developing it. In addition, niacin further decreases low-density lipoprotein in statin-treated patients and has been shown to reduce morbidity and mortality. Among the available niacin preparations, crystalline, immediate-release niacin is the most effective for increasing high-density lipoprotein and is relatively free of hepatic toxicity. We present the case of a patient who had an excellent clinical and laboratory response to 3 g daily of immediate-release niacin, but who later developed clinical hepatitis when he inadvertently switched to the same dose of slow-release niacin. We encourage the use of niacin in general, immediate-release niacin in particular, and caution that niacin is a drug and not a dietary supplement. We also present practical steps for starting niacin, including close patient contact and support, and beginning with a therapeutic dose of 2 g per day right from the start.

Reply to “Fever myths and misconceptions: The beneficial effects of fever as a critical component of host defenses against infection” by Cunha et al

Panagiotis Kiekkas — 2011-09-07

My co-authors and I thank Dr. Cunha et al for their interest in our study and their reply to our Letter to the Editor. We absolutely agree that fever should not be routinely treated in patients, and that current evidence has not revealed any beneficial effects of aggressive fever suppression. Unfortunately, nurses continue to trust traditional practices more than research data. The suppression of fever, however, may be justified in the presence of specific conditions, such as acute brain injury, limited cardiorespiratory reserve, or fevers of very high temperature. As stated in my previous response, prospective, randomized trials (such as that of Schulman et al) are needed for defining temperature thresholds above which antipyretic treatment will be beneficial for particular patient groups.

Fever myths and misconceptions: The beneficial effects of fever as a critical component of host defenses against infection

Burke A. Cunha — 2011-10-21

I read with interest the comments by Dr Kiekkas about Schulman and colleagues’ article on the effects of antipyretic treatments on outcomes in critically ill patients. Fever is the most misunderstood host defense. Traditionally, fevers have been treated aggressively as if fevers were bad and lowering fever was somehow beneficial to the patient. Not only is there is no basis for this, but quite the opposite is true.

Post discharge follow up phone call

Aster Naffe — 2011-10-03

My current role in nursing includes making postdischarge follow-up phone calls and reviewing medication reconciliation forms to provide continuity of care and prevent unnecessary readmissions to our hospital. My experience in making follow-up phone calls has given me the opportunity to prevent multiple patients with differing diagnoses from being readmitted, as was similarly reported by Sawyer et al. Sawyer et al stated an intent to improve communication with patients before and after discharge by including patient interviews to assess their understanding of discharge instructions and postdischarge follow-up phone calls. This multidisciplinary team approach for improved patient communication can be of benefit to all patients, as was found for patients with congestive heart failure.

2012-01-01

Board of Directors

2012-01-01

Information for Readers

2012-01-01

Heart & Lung: The Journal of Acute and Critical Care

Information for Authors

Into the New Year

Meeting the health challenges of the 21st century workforce: Future directions for cardiovascular research

Heart failure nurses play a pivotal role in linking clinical research to clinical practice: Translational research

The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease

Effects of home-based rehabilitation on health-related quality of life and psychological status in Chinese patients recovering from acute myocardial infarction

Family caregiving in pulmonary arterial hypertension

The experiences of patients with pulmonary arterial hypertension receiving continuous intravenous infusion of epoprostenol (Flolan) and their support persons

Validation of a three-factor measurement model of dyspnea in hospitalized adults with heart failure

Reliability and validity of the Korean version of the Minnesota Living with Heart Failure Questionnaire

Endotracheal tube exchangers: Should we look for safer alternatives?

Clinical diagnostic utility of adenosine deaminase, interferon-γ, interferon-γ–induced protein of 10 kDa, and dipeptidyl peptidase 4 levels in tuberculous pleural effusions

Respiratory syncytial virus (RSV) community-acquired pneumonia (CAP) in a hospitalized adult with human immunodeficiency virus (HIV) mimicking influenza A and Pneumocystis (carinii) jiroveci pneumonia (PCP)

Bronchoalveolar carcinoma (adenocarcinoma) mimicking recurrent bacterial community-acquired pneumonia (CAP)

Endovascular therapy for radiation-induced pulmonary artery stenosis: A case report and review of the literature

Aortic stenosis and angiodysplastic gastrointestinal bleeding: Heyde’s disease

A case for immediate-release niacin

Reply to “Fever myths and misconceptions: The beneficial effects of fever as a critical component of host defenses against infection” by Cunha et al

Fever myths and misconceptions: The beneficial effects of fever as a critical component of host defenses against infection

Post discharge follow up phone call

Table of Contents

Board of Directors

Information for Readers