Cassandra Arroyo

Purpose: Transcatheter aortic valve replacement is a minimally invasive treatment option for patients with aortic stenosis. This study aimed to describe the functional status and determine relationships between patient characteristics, such as age and functional outcomes, following a transcatheter aortic valve replacement procedure in the acute care setting. Methods: Retrospective chart review of 100 patients. Patients were divided into 4 groups: <= 69, 70 to 79, 80 to 89, and 90-plus years of age. General demographics, Functional Status Score for the Intensive Care Unit, and ambulation distance were collected. Results: Mean age was 79.7 (SD = 8.3) years with 56% female. The first day after surgery, 78% were able to participate in out-of-bed activities. Significant improvement in ambulation distance and Functional Status Score for the Intensive Care Unit scores from evaluation to discharge (P < .001) were noted in patients receiving 2 or more visits. No significant differences were found between age groups and outcome variables except that patients in the 90-plus age group were more likely to use an assistive device prior to surgery (P = .004). Conclusions: Patients' status post-transcatheter aortic valve replacement demonstrated improvement in their functional mobility during a short length of stay and were typically discharged home. Age did not appear to significantly impact the patients' ability to participate in early mobility or influence their discharge location.

Purpose: To determine the efficacy of a balance training program for fall risk reduction in outpatient pulmonary rehabilitation (PR). Methods: Forty-nine participants in an outpatient PR program participated in a balance training program in addition to the standard PR exercises. Balance was assessed with the Activities-Specific Balance Confidence (ABC) scale, Mini-BESTest (MBT), and Short Physical Performance Battery (SPPB). Gait speed, 5 times sit to stand test (5TSTS), and Timed Up and Go (TUG) data were extracted for analysis. Progressive lower-extremity strengthening and balance specific exercises were performed during each PR session. Results: Over 90% of participants presented with at least one balance assessment that indicated an increased fall risk and 81% had mobility limitations based on an SPPB score P < .001) were seen in the mean differences from baseline to final in the ABC scale 31.6% (95% CI [24.8, 38.5]), MBT 9.3 (95% CI [7.6, 11.0]), SPPB 4.1 (95% CI [3.4, 4.7]), gait speed 0.37 m/s (95% CI [0.29, 0.46]), 5TSTS −7.8 seconds (95% CI [−10.5, −5.0]), and TUG −4.7 seconds (95% CI [−5.7, −3.7]). Conclusions: Incorporating a balance training program into a PR program may help to decrease fall risk and increase balance confidence in functional activities.

Objectives: Racial residential segregation affects food landscapes that dictate residents’ food environments and is associated with obesity risk factors, including individual dietary patterns and behaviors. We examine if food behaviors and environments mediate the association between segregation and body mass index (BMI). Methods: Non-Hispanic Whites and Blacks living in the St. Louis and Kansas City metro regions from 2012 to 2013 were surveyed on dietary behaviors, food environment, and BMI (n = 1,412). These data were combined with the CDC’s modified retail food environment index and 2012 American Community Survey data to calculate racial segregation using various evenness and exposure indices. Multi-level mediation analyses were conducted to determine if dietary behavior and food environment mediate the association between racial residential segregation and individual BMI. Results: The positive association between racial segregation and individual BMI is partially mediated by dietary behaviors and fully mediated by food environments. Conclusion: Racial segregation (evenness and exposure) is associated with BMI, mediated by dietary behaviors and food environment. Elements of the food environment, which form the context for dietary behaviors, are potential targets for interventions to reduce obesity in residentially segregated areas.

Objective: Intensive care unit patients are at risk for catheter-associated urinary tract infection. Earlier removal of catheters may be possible with accurate measurement of bladder volume. The purpose was to compare measured bladder volumes with bedside ultrasound, bladder scanner, and urine volume. Design: Prospective correlational descriptive study. Setting: Surgical/trauma intensive care unit and medical intensive care unit. Patients: Renal dialysis patients with less than 100 ml of urine in 24 h prior to urinary catheter removal and patients with suspected catheter obstruction. Measurements and main results: A physician trained in ultrasound and an advanced practice registered nurse trained in bladder scanning measured bladder volume; each blinded to the other’s measurement. Device used first (ultrasound or bladder scanner) alternated daily. The intensive care unit team determined need for intermittent catheterization or treatment for suspected obstruction. Fifty-one measurements from 13 patients were obtained with results reported in milliliters. Ultrasound measurements were a mean volume of 72.1 ± 127 (range: 1.7–666) and the bladder scanner measurements were 117 ± 131 (0–529). On six occasions in five dialysis patients, urine volume measurement was available. The mean difference in ultrasound–urine volume mean difference was 0.5 ± 37.8 (range: −68 to 38.2) and the bladder scanner–urine volume was 132 ± 167 (−72 to 397). Two patients with suspected catheter obstructions had ultrasound, bladder scanner, urine volume measurements, respectively: (1) 539, 51, >300 (began voiding before catheter replaced); (2) 666, 68, 1000 with catheter replacement. Conditions leading to greatest differences were obesity, indwelling catheter and ascites. Conclusions: These results demonstrate the inaccuracy of the bladder scanner. Ultrasound measurements appear more accurate. To remove urinary catheters in patients with minimal to low urine output, serial ultrasound measurements can be used to monitor bladder volumes and return of renal function.

The homeless represent an extremely disadvantaged population that fare worse than minority groups in access to preventive services and health, and minority groups fare worse than Whites. Early detection screening for colorectal cancer (CRC) saves lives, but empirical data about CRC screening practices among homeless Blacks and Whites are limited. Psychosocial risk factors may serve as a barrier to CRC screening completion among homeless Black individuals. A secondary data analysis of a randomized clinical trial for smoking cessation among homeless smokers was conducted to determine whether psychosocial factors and sociodemographic factors were more highly associated with CRC screening uptake among homeless Blacks than among their White counterparts. Study participants (N = 124) were surveyed on their CRC screening status, sociodemographic variables, and psychosocial correlate measures including anxiety, depression, hopelessness, depression severity, and perceived stress. Associations between these factors were examined with logistic regression. White participants who were currently disabled/unable to work were 6.2 times more likely to ever receive CRC screening than those who were employed. Black participants with public health insurance coverage were 90% less likely to ever obtain CRC screening than participants without health insurance. Black and White participants had similar levels of anxiety symptoms, depression, and hopelessness, yet depression was the only psychosocial variable negatively associated with CRC screening status. Black and White participants with symptoms of depression were 58% less likely to complete screening than those without depression. Mental health risk and sociodemographic factors may serve as barriers to CRC screening among homeless Blacks and Whites.