Assessing quality of life in pulmonary arterial hypertension: An independent prognostic marker.

Pulmonary arterial hypertension (PAH, or PH Group 1), a disease of aberrant pulmonary vascular remodeling, causing progressive right heart failure (RHF) due to elevation of pulmonary vascular resistance (PVR). Patient mortality risk stratification guides choice and intensity of pharmacological intervention and is assessed by haemodynamics (especially PVR) as well as noninvasive tools including WHO functional class (FC), 6-min walk distance (6MWD), and NT-proBNP levels. Quality of life (QOL) assessment is acknowledged as a central aspect of patient-centered care, but our study sought to extend QOL's role as an additional noninvasive risk marker that could further refine risk stratification and hence therapeutic choices within a "treatment to target" paradigm (aiming to achieve low-risk status). This study found that QOL assessment using the PAH-SYMPACT© physical activity tool provided enhanced, independent mortality risk information, with one unit rise in this score associated with a 41% increase in likelihood risk (odds ratio 1.41, 95% confidence interval: 1.01-1.98 (p < 0.05)) of falling within intermediate versus low-group category. We therefore found further support for additional prognostic value being conferred by measurement of QOL as part of routine PAH evaluation, reinforcing its critical role.

Meeting the wellness needs of emergency department clinicians: A scoping review of interventions.

BACKGROUND: Emergency Departments are stressful work environments that can adversely affect clinicians' wellbeing. The purpose of this scoping review was to report wellness interventions evaluated in Emergency Departments and clinicians' experience of these interventions. METHODS: Five data bases were searched using a modification of Arksey and O'Malley's framework. PRISMA guidelines for scoping reviews were employed to report the findings. The review included only peer-reviewed articles and had no date or language restrictions applied. RESULTS: Nine studies met inclusion criteria. Interventions included tactile massage, hypnosis, mindfulness, happiness practice, resiliency, meditation, and video-based debriefing. Three key themes emerged following data extraction and analysis: The value of mindfulness; One size doesn't fit all; and Enablers and Barriers. CONCLUSIONS: Successful wellness programs must be relevant to Emergency Departments and staff need to be involved in the development and application of these programs to achieve maximum benefit. For long term benefits and sustainability, the strategies must be supported by senior hospital management.

Depression in Australian women: the varied roles of spirituality and social support.

This study investigated the influence of spirituality on depression in Western Australian women. Two hundred and seventy-eight women (aged 18-78) completed an online survey about factors relating to daily spiritual experience, depression, anxiety and social support. Significant correlations were found between spiritual experience and depression, whereby individuals who reported higher spirituality also reported higher rates of social support and lower levels of depression. A major finding from this study was that spirituality accounted for a significant proportion of variance in depressive symptoms beyond the mediating effect of social support.

Personality disorders and spirituality.

PURPOSE OF REVIEW: In order to consider findings about the relationship between spirituality, religiosity and personality disorders, recent research was reviewed and emerging patterns in the latest findings were explored. RECENT FINDINGS: Within the diagnostic category of personality disorders, recent research into the role of spirituality has focused on schizotypy and borderline personality traits and aspects of 'control' relating to antisocial personality disorder. Although the number of studies is quite limited, this review has highlighted an interesting pattern emerging from recent studies that suggests that, while overall psychological well being has previously been reported as low, spiritual well being remains high in studies of personality focusing on schizotypy and borderline personality traits. SUMMARY: The positive link between religious and spiritual well being and mental health has been corroborated by a number of studies. This review of recent research has identified emerging trends suggesting that the dimensions of religious and spiritual well being remain high for individuals displaying schizotypy and borderline personality traits, and is not as reduced as general well being in individuals diagnosed with personality disorders. Although much work remains to be conducted with individuals diagnosed with personality disorders, spirituality appears to be an interesting area to explore clinically.

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I would appreciate any information on models of medical cover in intermediate care services.