Pilot Trial of a Licensed Practical Nurse Intervention for Hypertension and Depression.

Pilot trial of a licensed practical nurse intervention for hypertension and depression.

Fam Med. 2013 May; 45(5): 323-9
Bogner HR, de Vries HF, Kaye EM, Morales KH

Depression is a risk factor for hypertension, and risk of depression is increased substantially in patients with hypertension. Our objective was to examine whether an intervention carried out by Licensed Practical Nurses (LPNs) integrating depression treatment into care for hypertension improved blood pressure control and depressive symptoms.In all, 60 patients ages 41 to 92 years with hypertension and depressive symptoms at a large primary care practice in Philadelphia were randomly assigned to an integrated care intervention carried out by LPNs (n=30) or usual care (n=30). Intervention and control groups did not differ statistically on baseline measures. Outcomes assessed at baseline and 12 weeks included standard laboratory procedures to measure blood pressure control and the Patient Health Questionnaire (PHQ-9) to assess depression.Patients in the integrated care intervention had lower diastolic blood pressure (intervention 74.2 mmHg versus usual care 82.0 mmHg) and fewer depressive symptoms (PHQ-9 mean scores, intervention 2.4 versus usual care 7.1) compared with patients in the usual care group at 12 weeks after adjustment for baseline values. Patients in the integrated care intervention also had lower systolic blood pressure (intervention 130.0 mmHg versus usual care 140.6 mmHg) compared with patients in the usual care group at 12 weeks although the results approached but did not reach conventional levels of statistical significance. Conclusion: Training existing primary care practice office staff will facilitate implementation in real world practices with limited resources and competing demands. HubMed – depression


Exercise Capacity Affects Quality of Life in Patients with Pulmonary Hypertension.

Lung. 2013 May 17;
Halank M, Einsle F, Lehman S, Bremer H, Ewert R, Wilkens H, Meyer FJ, Grünig E, Seyfarth HJ, Kolditz M, Wieder G, Höffken G, Köllner V

BACKGROUND: The objective of this prospective study was to evaluate the impact of exercise capacity, mental disorders, and hemodynamics on quality-of-life (QoL) parameters in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Sixty-three patients with invasively diagnosed PAH (n = 48) or CTEPH (n = 15) underwent a broad panel of assessments, including cardiopulmonary exercise testing (CPET), 6-minute walking distance (6-MWD), World Health Organization functional class (WHO-FC), and assessment of hemodynamics. QoL was evaluated by the 36-item Medical Outcome Study Short Form Health Survey Questionnaire (SF-36). Exercise capacity, hemodynamics, age, gender, and mental disorders (anxiety and depression) were assessed for association with QoL subscores by uni- and multivariate regression analyses. RESULTS: Exercise capacity, WHO-FC, oxygen therapy, symptoms of right heart failure, right atrial pressure, and mental disorders were significantly associated with QoL (p < 0.05). In the stepwise backward selection multivariate analysis, depression remained an independent parameter in seven of eight subscales of the SF-36. Furthermore, peak oxygen uptake (peakVO2) during CPET, 6-MWD, anxiety, long-term oxygen therapy, right heart failure, and age remained independent factors for QoL. Hemodynamic parameters at rest did not independently correlate with any domain of the SF-36 QoL subscores. CONCLUSIONS: Mental disorders, exercise capacity, long-term oxygen therapy, right heart failure, and age play important role in the quality of life in patients with PAH and CTEPH. HubMed – depression


Sleep Disorders in U.S. Military Personnel: A High Rate of Comorbid Insomnia and Obstructive Sleep Apnea.

Chest. 2013 May 16;
Mysliwiec V, Gill J, Lee H, Baxter T, Pierce R, Barr TL, Krakow B, Roth BJ

ABSTRACT BACKGROUND: Sleep disturbances are among the most common symptoms of military personnel who return from deployment. The objective of our study was to determine the presence of sleep disorders in U.S. Military Personnel referred for evaluation of sleep disturbances after deployment and examine associations between sleep disorders and service-related diagnoses of depression, mild traumatic brain injury (TBI), pain and post-traumatic stress disorder (PTSD). METHODS: Cross-sectional study of military personnel with sleep disturbances who returned from combat within 18 months. Sleep disorder rendered by clinical evaluation and polysomnogram with validated instruments to diagnose service-related illnesses. RESULTS: Of 110 military personnel included in our analysis, 97.3% were male (mean age 33.6 ± 8.0 years; mean BMI of 30.0 ± 4.3) and 70.9% returned from combat within 12 months. Nearly half, 47.3% met diagnostic criteria for 2 or more service-related diagnoses. Sleep disorders were diagnosed in 88.2% and 11.8% had a normal sleep evaluation and served as controls. Overall, 62.7% met diagnostic criteria for obstructive sleep apnea (OSA) and 63.6% for insomnia. The exclusive diagnoses of insomnia and OSA were present in 25.5% and 24.5% respectively; 38.2% had comorbid insomnia and OSA. Military personnel with comorbid insomnia and OSA were significantly more likely to meet criteria for depression (p <0.01) and PTSD (p<0.01) compared to controls and those with OSA. CONCLUSIONS: Comorbid insomnia and OSA is a frequent diagnosis in military personnel referred for evaluation of sleep disturbances after deployment. This diagnosis, which is difficult to treat, may explain the refractory nature of many service-related diagnoses. HubMed – depression