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ies the effect of sleep apnoea on cardiovascular outcomes. The findings that undiagnosed sleep apnoea impairs diastolic function in a middle-aged coronary artery disease patient underscore the importance of early diagnosis and treatment of sleep apnoea. It is recommended to train and educate cardiac rehabilitation staff on the importance of sleep disorders in this population.

Age modifies the effect of sleep apnoea on cardiovascular outcomes. The findings that undiagnosed sleep apnoea impairs diastolic function in a middle-aged coronary artery disease patient underscore the importance of early diagnosis and treatment of sleep apnoea. It is recommended to train and educate cardiac rehabilitation staff on the importance of sleep disorders in this population.

Chronic illness management is increasingly carried out at home by individuals and their informal caregivers (dyads). Although synergistic in concept, the nuances of dyadic congruence in caring for patients with heart failure are largely unexamined.

The purpose of this study was to examine the role of dyadic-type congruence on patient self-care (maintenance, symptom perception, and management) while controlling for actor and partner effects.

This secondary data analysis of 277 dyads consisted of a series of multilevel models to examine the impact of dyadic congruence on a patient's self-care maintenance, symptom perception, and self-care management. Patient-level and caregiver-level data were input into each model simultaneously to account differential appraisals of factors related to the dyad.

Bivariate analyses yielded dyad congruence which was associated with better patient self-care maintenance, symptom perception and management. However, after multilevel models were constructed, dyad congruence waredict patient self-care performance. Since symptom perception is the key to preventing heart failure exacerbation, screening heart failure patient and caregiver dyads for congruence is important in clinical settings.

To describe how a pharmacist-managed and pharmacist-administered penicillin allergy skin testing (PAST) service was incorporated into an antimicrobial stewardship program at a community hospital.

A pharmacist-managed/administered PAST service was initiated in October 2015. Patients 18 years of age or older were considered for PAST if they had a reported history of a type I or unknown type of allergic reaction to penicillin that occurred more than 5 years previously. Patients with a vague allergy history were considered for PAST if the provider was uncomfortable prescribing a preferred β-lactam out of concern for penicillin allergy. Patients were excluded if they were pregnant, had a history of a non-type I allergic reaction, or recently received antihistamines. The primary outcome was the percentage of patients who underwent PAST and were subsequently transitioned to a preferred β-lactam.

PAST was initiated in 90 patients from October 2015 to December 2019. Eighty-five out of 90 patients (94%) completed PAST. Seventy-six out of 90 patients (84.4%) who underwent PAST were transitioned to a preferred β-lactam. The most commonly administered antibiotics prior to PAST were vancomycin, cefepime, and metronidazole. The most commonly used antibiotics after PAST were penicillin, piperacillin/tazobactam, and ampicillin/sulbactam. Among the 90 patients who underwent PAST, alternative antibiotics were avoided for a total of 1,568 days, with a median of 11 days (interquartile range, 6-18 days) avoided per patient.

Incorporating a pharmacist-managed/administered PAST service into a community hospital's antimicrobial stewardship program can improve the utilization of preferred antimicrobial therapy and help avoid use of more toxic, costly antimicrobials.

Incorporating a pharmacist-managed/administered PAST service into a community hospital's antimicrobial stewardship program can improve the utilization of preferred antimicrobial therapy and help avoid use of more toxic, costly antimicrobials.

Hostility is associated with greater risk for cardiac disease, cardiac events and dysrhythmias. Investigators have reported equivocal findings regarding the association of hostility with acute coronary syndrome (ACS) recurrence and mortality. Given mixed results on the relationship between hostility and cardiovascular outcomes, further research is critical.

The aim of our study was to determine whether hostility was a predictor of ACS recurrence and mortality.

We performed a secondary analysis of data (N = 2321) from a large randomized clinical trial of an intervention designed to reduce pre-hospital delay among patients who were experiencing ACS. Hostility was measured at baseline with the Multiple Adjective Affect Checklist (MAACL) and patients were followed for 24 months for evaluation of ACS recurrence and all-cause mortality. We used Cox proportional hazards modeling to determine whether hostility was predictive of time to ACS recurrence or all-cause mortality.

The majority of patients were married (73%), Caucasian (97%), men (68%), and had a mean age of 67 ± 11 years. learn more Fifty-seven percent of participants scored as hostile based on the established MAACL cut point (mean score = 7.56 ± 3.8). Hostility was an independent predictor of all-cause mortality (p = < 0.039), but was not a predictor of ACS recurrence (p = 0.792).

Hostility is common in patients with ACS and its relationship to clinical outcomes is important to the design of future interventions to improve long-term ACS mortality.

Hostility is common in patients with ACS and its relationship to clinical outcomes is important to the design of future interventions to improve long-term ACS mortality.

In general, adults with congenital heart disease have reduced exercise capacity and many do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and to counteract acquired cardiovascular disease, therefore enablers and barriers for being physically active are important to identify.

To describe what adults with complex congenital heart diseases consider as physical activity, and what they experience as enablers and barriers for being physically active.

A qualitative study using semi-structured interviews in which 14 adults with complex congenital heart disease (seven women) participated. The interviews were analysed using qualitative content analysis.

The analysis revealed four categories considered enablers and barriers - encouragement, energy level, approach and environment. The following is exemplified by the category encouragement as an enabler if one had experienced support and encouragement to be physically active as a child, they were more positive to be physically active as an adult.