Validation of Predictors of Fall Events in Hospitalized Patients With Cancer.

BACKGROUND: A seven-item cancer-specific fall risk tool (Cleveland Clinic Capone-Albert [CC-CA] Fall Risk Score) was shown to have a strong concordance index for predicting falls; however, validation of the model is needed. OBJECTIVES: The aims of this study were to validate that the CC-CA Fall Risk Score, made up of six factors, predicts falls in patients with cancer and to determine if the CC-CA Fall Risk Score performs better than the Morse Fall Tool. METHODS: Using a prospective, comparative methodology, data were collected from electronic health records of patients hospitalized for cancer care in four hospitals. Risk factors from each tool were recorded, when applicable. Multivariable models were created to predict the probability of a fall. A concordance index for each fall tool was calculated. FINDINGS: The CC-CA Fall Risk Score provided higher discrimination than the Morse Fall Tool in predicting fall events in patients hospitalized for cancer management.

A comparative study of fluid management education before hospital discharge.

OBJECTIVES: We examined if an education intervention [EduI] based on the Common Sense Model theoretical framework and 3-step action plan to control fluid-related symptoms and weight gain, decreased 6-month health care consumption. BACKGROUND: Heart failure (HF) morbidity is often related to fluid overload. METHODS: A 2-group comparative design with convenience sampling was used to assess rehospitalization (Hosp), emergency department (ED) and unplanned office visits. Analyses included regression models. RESULTS: Of 122 usual care [UC] and 122 EduI patients, mean (standard deviation) age was 65.8 (12.6) years. In multivariate analyses, first HF Hosp, total ED visits and ED visits for HF decompensation were lower in EduI compared to UC; p = 0.039, p = 0.025, and p = 0.001 respectively. There were no reductions in 6-month total Hosp or HF-related unplanned office visits. CONCLUSIONS: An EduI with a 3-step action plan to control fluid-related symptoms and weight gain reduced first Hosp, total ED and HF-ED visits.

Understanding physical activity and exercise behaviors in patients with heart failure.

OBJECTIVE: Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). BACKGROUND: Although activity/exercise are HF self-care expectations, perceptions of patients are not well understood. METHODS: Ambulatory adults with HF were interviewed. Data were transcribed, categorized, and themes were developed. RESULTS: Of 48 participants, mean age was 58.8 ± 13.2 years. Themes that emerged were: patients not knowing and physicians not telling; scared into doing or not doing it; life gets in the way; meaningful support versus meaningless talk; emotional connections to exercise; value does not equal motivation to move; and disconnection between self-confidence and actions. Self-confidence in and value of physical activity/exercise were not primary motivators to action. Generally, physicians failed to provide details regarding exercise dose, length, warm-up and cool-down expectations, and usual and adverse effects. CONCLUSIONS: Patient perceptions of what physical activity/exercise means are multi-dimensional; and fears, emotions, priority and participatory social support contribute to adherence.

A randomized controlled pilot study of outcomes of strict allowance of fluid therapy in hyponatremic heart failure (SALT-HF).

BACKGROUND: Currently, fluid restriction recommendations in heart failure (HF) are based on expert opinion. After implementing a 1,000-mL/d fluid restriction for 60 days after discharge, outcomes were examined. METHODS AND RESULTS: In a randomized controlled design, hyponatremic patients (serum sodium ≤137 mg/dL) received usual care (UC; n = 26) or 1,000 mL/d fluid restriction (n = 20) at discharge. Quality of life (QoL), thirst, difficulty following fluid recommendations, adherence to fluid restriction, HF emergency care, HF rehospitalization, and all-cause death were examined. Mean age was 62.8 ± 12.8 years; 46% were white. There were no differences by group in baseline demographics, comorbidities, and QoL, except that more UC patients had New York Heart Association (NYHA) functional class III/IV status (P = .019). Median [interquartile range] QoL scores were better in the 1,000 mL/d group for symptom burden (83.3 [68.8-91.7] vs 50 [29.2-79.2]; P = .018), total symptoms (77.1 [58.1-91.7] vs 54.2 [30.2-73.9]; P = .022), overall QoL summary (72.6 [52.2-86.3] vs 51.0 [37.7-68.5]; P = .038), and clinical QoL summary (75.5 [57.8-92.9] vs 59.1 [35.7-77.3]; P = .039). There were no group differences in thirst, difficulty adhering to fluid recommendations, adherence to fluid restriction, or health care consumption. CONCLUSIONS: The 1,000 mL/d fluid restriction led to improved QoL at 60 days after discharge. Future research in a larger more heterogeneous sample is needed.

Nurses' uniform color and feelings/emotions in school-aged children receiving health care.

Children may fear nurses wearing white uniforms. When emotions and uniform color were studied in 233 children, many positive emotions were most often associated with blue, bold pink-patterned, or yellow-patterned tops (all p ≤ .002). Negative emotions were not associated with uniform top colors (all p < .001). However, after excluding "uniform color does not matter," 8 negative emotions were most often associated with white uniform color (p < .001-.04), and 2 others were most often associated with the yellow-patterned top. Bold pink-patterned and solid blue uniform tops were preferred. In conclusion, children's emotions were associated with nurse uniform color.