These findings suggest that PDE and SES factors are associated with early readmission. Considering these findings may enhance the targeting of pre-discharge and postdischarge interventions to avert early readmission. Such interventions may include home health services, patient activation, and comprehensive discharge planning.

No abstract

No abstract

Non-metastatic breast cancer patients often experience psychological distress which may influence disease progression and survival. Cognitive-behavioral stress management (CBSM) improves psychological adaptation and lowers distress during breast cancer treatment and long-term follow-ups. We examined whether breast cancer patients randomized to CBSM had improved survival and recurrence 8–15 years post-enrollment. From 1998 to 2005, women (N = 240) 2–10 weeks post-surgery for non-metastatic Stage 0–IIIb breast cancer were randomized to a 10-week, group-based CBSM intervention (n = 120) or a 1-day psychoeducational seminar control (n = 120). In 2013, 8–15 years post-study enrollment (11-year median), recurrence and survival data were collected. Cox Proportional Hazards Models and Weibull Accelerated Failure Time tests were used to assess group differences in all-cause mortality, breast cancer-specific mortality, and disease-free interval, controlling for biomedical confounders. Relative to the control, the CBSM group was found to have a reduced risk of all-cause mortality (HR = 0.21; 95 % CI [0.05, 0.93]; p = .040). Restricting analyses to women with invasive disease revealed significant effects of CBSM on breast cancer-related mortality (p = .006) and disease-free interval (p = .011). CBSM intervention delivered post-surgery may provide long-term clinical benefit for non-metastatic breast cancer patients in addition to previously established psychological benefits. Results should be interpreted with caution; however, the findings contribute to the limited evidence regarding physical benefits of psychosocial intervention post-surgery for non-metastatic breast cancer. Additional research is necessary to confirm these results and investigate potential explanatory mechanisms, including physiological pathways, health behaviors, and treatment adherence changes.

No abstract

EC volunteers reported a sustained increase in physical activity as compared with the comparison cohort. Baseline physical activity for individuals with a median propensity score was 420 kcal/wk for both groups. At 36 months, EC volunteers reported 670 kcal/week compared with 410 kcal/week in WHAS (p = .04). Discussion These findings suggest that high-intensity senior service programs that are designed as health promotion interventions could lead to sustained improvements in physical activity in high-risk older adults, while simultaneously addressing important community needs.

Objectives To describe the prevalence of co-existing conditions that affect clinical decision-making among adults with coronary heart disease (CHD). Design Cross-sectional Setting NHANES, 1999–2004 Participants 8654 people aged ≥ 45; 1259 with CHD. Measurements Co-existing conditions relevant to clinical decision-making and implementing therapy for CHD across 3 domains: 1)chronic diseases; 2) self-reported and laboratory-based clinical measures; 3) health status factors of self-reported and observed function. We estimated prevalence by gender and age, examined mutually exclusive patterns, and modeled the odds ratios (OR) of having incurred repeated hospitalization in the last year among participants with CHD and each complexity pattern, versus CHD alone. Results The prevalence of comorbid chronic diseases among subjects with CHD was: arthritis (56.7%), chronic lower respiratory tract disease (25.5%), diabetes (24.8%), stroke (13.8%), and congestive heart failure (29.0%); clinical factors adding to complexity of clinical decision-making for CHD were: use of > 4 meds (54.5%), UI (48.6%), dizziness or falls (34.8%), low GFR (24.4%), anemia (10.1%), high ALT (5.9%), use of warfarin (10.2%), and health status factors were: cognitive impairment (29.9%), mobility difficulty (40.4%), frequent mental distress (14.3%), visual impairment (16.7%), and hearing impairment (17.9%). Several comorbidity patterns were associated with elevated odds of hospitalization. Conclusion Co-existing conditions that may modify the effectiveness of or interact with CHD therapies, influence the feasibility of CHD therapies, or alter patients' priorities concerning their healthcare should be considered in the development of trials and guidelines in order to better inform real-world clinical decision-making.

Older adults often receive suboptimal care during hospitalizations and transitions to postacute settings. Inpatient geriatric services have been shown to increase care quality but have not improved patient outcomes consistently. Acute Care for the Elderly units improve patient outcomes but are resource intensive. Transitional care has been shown to reduce hospital readmissions and healthcare costs. This article describes the Geriatric Floating Interdisciplinary Transition Team (Geri-FITT), a model that combines the strengths of inpatient geriatric evaluation and comanagement and transitional care models by creating an inpatient comanagement service that also delivers transitional care. The Geri-FITT model is designed to improve the hospital care of older adults and their transitions to postacute settings. In Geri-FITT, a geriatrician-geriatric nurse practitioner team assesses patients, comanages geriatric syndromes, provides staff education, encourages patient self-management, communicates with primary care providers, and follows up with patients soon after discharge.This pilot cohort study of Geri-FITT included hospitalized patients aged 70 and older on four general medicine services (two Geri-FITT, two usual care) at an academic medical center (N 5 717). The study assessed the effect of Geri-FITT on patients' care transition quality (Care Transitions Measure) and their satisfaction with hospital care (four questions). The results indicate that Geri-FITT is associated with slightly higher, though not statistically significantly so, quality care transitions and greater patient satisfaction with inpatient care.Geri-FITT may be a feasible approach to enhancing inpatient management and transitional care for older adults. Further study of its effect on these and other outcomes in other healthcare settings seems warranted. J Am Geriatr Soc 58:364-370, 2010.