Does mindfulness meditation improve attention in attention deficit hyperactivity disorder?

Attention deficit hyperactivity disorder(ADHD) manifests by high levels of inattention, impulsiveness and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. While hyperactivity declines over time, inattention and executive function difficulties persist, leading to functional deficits. Adolescents and adults with ADHD have pervasive impairment in interpersonal and family relationships. They may develop addiction, delinquent behavior and comorbid psychiatric disorders. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. Mindfulness training, derived from Eastern meditation practices, may improve self-regulation of attention. It may also be a useful strategy to augment standard ADHD treatments and may be used as a potential tool to reduce impairments in patients with residual symptoms of ADHD. Clinically, this would manifest by an increased ability to suppress task-unrelated thoughts and distractions resulting in improved attention, completion of tasks and potential improvement in occupational and social function.

Analysis of daily activity data from implanted cardiac defibrillators: The minimum clinically important difference and relationship to mortality/life expectancy

Background: Daily activity is a potentially important measure for assessing prognosis in individuals with chronic heart failure (CHF), and few studies have investigated the prognostic value of daily activity measurement. The present study sought to determine whether there is an association between daily activity and mortality/mean life expectancy as predicted by the Seattle Heart Failure Model (SHFM), and to provide an estimate of the anchor-based minimum clinically important difference (MCID) for daily activity measured by single-axis accelerometers in implanted cardiac defibrillators. Methods: This study utilized a retrospective chart review of 102 medical records of patients with CHF and Medtronic? implanted cardiac defibrillators (ICDs). Mean daily activity was calculated for a two week period prior to both a baseline and follow-up routine clinical visit. Clinical characteristics from the baseline clinic visit were used for calculating SHFM estimates of mean life expectancy, 1-year mortality, and 5-year mortality. A five-point global rating scale was scored based on documented clinician impression, patient self-report, and laboratory and cardiographic tests for determining the MCID. Results: There was a moderate correlation between baseline daily activity and each of the SHFM prognostic indicators: 1-year mortality (r = 0.36, p < 0.001, 5-year mortality (r = 0.40, p < 0.001), and life expectancy (r = 0.43, p < 0.001). The MCID for a decline in daily activity was approximately 0.5 hours and was approximately 1.0 hours for improvement in daily activity. Conclusions: Although previous re- search has established the short-term predictive value of ICD-measured daily activity for CHF-related clinical events, no prior study has examined the longer-term prognostic value of ICD-based daily activity. The results of the present study suggest that low daily activity, as recorded by ICDs in patients with CHF, should prompt a more formal evaluation of prognosis using the SHFM. Furthermore, changes of 0.5 to 1.0 hours of activity per day appear to be clinically mean- ingful.

Is Preoperative Functional Status Associated with Postoperative Mortality and Morbidity in Elective Open Heart Patients?

Background: Cardiac surgery, even when planned, has the potential for adverse outcomes, such that several factors are taken into consideration to help surgeons and their patients discuss the potential risks weighed against the expected recovery. Preoperative functional status and its influence on cardiac surgery, if any, have not been adequately evaluated to date. This study aimed to examine the relationship between preoperative functional status and postoperative mortality and morbidity in elective open heart patients. Methods: Preoperative baseline data (n = 43 subjects) were obtained to calculate Society of Thoracic Surgeons (STS) mortality and morbidity risk scores and preoperative functional status was measured using the Late-Life Function and Disability Instrument (LLFDI). Follow-up data were abstracted at one year postoperative to calculate actual mortality and morbidity events. Ordinary least squares and negative binomial regression analyses were conducted to assess the relationship between the LLFDI preoperative score to the STS mortality and morbidity risk scores. Results: Mortality risk was significant, F (1, 39) = 4.75, p = 0.035, with an adjusted R2 = 0.086, and Function Total (measured by LLFDI) yielded a significant negative association with mortality risk, β = &minus;0.329. Morbidity was found to be significant, F (1, 40) = 4.89, p = 0.033, with an adjusted R2 = 0.087 and Function Total yielded a significant negative association with morbidity risk, β = &minus;0.328, as well. Estimation of the counts for postoperative complications as estimated by Function Total failed to reach significance (Wald χ2 = 0.34, p = 0.56), which provided a pseudo R2 = 0.009. Probabilities for frequencies of adverse events (major complications), therefore, could not be reliably calculated. Conclusion: Preoperative diminished functional status, as measured by the LLFDI, is associated with an increased risk of mortality and morbidity in patients undergoing elective cardiac surgery. The risks and benefits of cardiac surgery should be weighed carefully and include a patient's preoperative functional status, especially in the case of an elective procedure.

The Impact of Hearing Loss on Health: Interprofessional Guidance for Health and Primary Care Providers (PCPs)

In the United States, approximately one in eight (13 percent, or 30 million)individuals aged 12 years or older has bilateral hearing loss. Whenunaddressed and untreated, hearing loss is associated with and contributesto other significant health issues;specifically, social isolation, depression,stress, and anxiety, incidental falls, dementia and impaired cognition, andreduced quality of life. This is a public health concern. Health and primarycare providers are in a unique position to have a positive impact by probingthe hearing of the patients they see, providing information, and makingappropriate referrals to reduce deleterious effects when this impairmentoccurs.Abbreviations: Hertz (Hz);High frequency hearing loss (HFHL);Personallistening devices (PLDs);Sensorineural hearing loss (SNHL)Format: Small group discussion, classroom and clinical practicum settings.Target audience: The student and practicing health professions (e.g.occupational and physical therapy, psychologists, physician assistants,nursing, and medical) involved and the relevant point in their training andpractice.