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Advancing medicine with food and nutrients
\"This book features chapters leading physicians in disease management applying the latest scientific advances linking nutrition to the clinical practice of medicine. Each chapter offers adjuncts to standard care, fewer side-effects, improved risk-reduction or added quality of life\"-- Provided by publisher.
Book
Comparison of symptomatic and functional responses to vagus nerve stimulation in ANTHEM‐HF, INOVATE‐HF, and NECTAR‐HF
Aims Clinical studies of vagal nerve stimulation (VNS) for heart failure with reduced ejection fraction have had mixed results to date. We sought to compare VNS delivery and associated changes in symptoms and function in autonomic regulation therapy via left or right cervical vagus nerve stimulation in patients with chronic heart failure (ANTHEM‐HF), increase of vagal tone in heart failure (INOVATE‐HF), and neural cardiac therapy for heart failure (NECTAR‐HF) for hypothesis generation. Methods and results Descriptive statistics were used to analyse data from the public domain for differences in proportions using Pearson's chi‐square test, differences in mean values using Student's unpaired t‐test, and differences in changes of mean values using two‐sample t‐tests. Guideline‐directed medical therapy recommendations were similar across studies. Fewer patients were in New York Heart Association 3, and baseline heart rate (HR) was higher in ANTHEM‐HF. In INOVATE‐HF, VNS was aimed at peripheral neural targets, using closed‐loop delivery that required synchronization of VNS to R‐wave sensing by an intracardiac lead. Pulse frequency was low (1–2 Hz) because of a timing schedule allowing ≤3 pulses of VNS following at most 25% of detected R waves. NECTAR‐HF and ANTHEM‐HF used open‐loop VNS delivery (i.e. independent of any external signal) aimed at both central and peripheral targets. In NECTAR‐HF, VNS delivery at 20 Hz caused off‐target effects that limited VNS up‐titration in a majority of patients. In ANTHEM‐HF, VNS delivery at 10 Hz allowed up‐titration until changes in HR dynamics were confirmed. Six months after VNS titration, significant improvements in both HR and HR variability occurred only in ANTHEM‐HF. When ANTHEM‐HF and NECTAR‐HF were compared, greater improvements from baseline were observed in ANTHEM‐HF in standard deviation in normal‐to‐normal R‐R intervals (94 ± 26 to 111 ± 50 vs. 146 ± 48 to 130 ± 52 ms; P < 0.001), left ventricular ejection fraction (32 ± 7 to 37 ± 0.4 vs. 31 ± 6 to 33 ± 6; P < 0.05), and Minnesota Living with Heart Failure mean score (40 ± 14 to 21 ± 10 vs. 44 ± 22 to 36 ± 21; P < 0.002). When compared with INOVATE‐HF, greater improvement in 6‐min walk distance was observed in ANTHEM‐HF (287 ± 66 to 346 ± 78 vs. 304 ± 111 to 334 ± 111 m; P < 0.04). Conclusions In this post‐hoc analysis, differences in patient demographics were seen and may have caused the differential responses in symptoms and function observed in association with VNS. Major differences in technology platforms, neural targets, VNS delivery, and HR and HR variability responses could have also potentially played a very important role. Further study is underway in a randomized controlled trial with these considerations in mind.
Journal Article
Nina Mcintosh's the educated heart : professional boundaries for massage therapists and bodyworkers
\"Now including an all-new chapter on professional boundaries and the Internet, this fully updated 4th Edition of Nina McIntosh's The Educated Heart, by Laura Allen provides a conversational style, easy-to-understand explanations of complex psychological dynamics, and practical suggestions for handling everyday boundary situations. Packed with real-world examples, and compelling online videos, this practical, compassionate book explores common situations bodyworkers and massage therapists encounter on the job and provides compassionate support and up-to-date information to help readers establish the solid professional boundaries they need for career success and personal well-being. The Fourth Edition includes enhanced coverage of the dynamics of the client-practitioner relationship, including specific suggestions for what to say to clients in difficult situations, as well as integrated coverage of the many boundary and confidentiality issues related to social media. New Consider This.
Book
The effect of kidney function on guideline‐directed medical therapy implementation and prognosis in heart failure with reduced ejection fraction
Background Kidney dysfunction (KD) is a main limiting factor of applying guideline‐directed medical therapy (GDMT) and reaching the recommended target doses (TD) in heart failure (HF) with reduced ejection fraction (HFrEF). Hypothesis We aimed to assess the success of optimization, long‐term applicability, and adherence of neurohormonal antagonist triple therapy (TT:RASi [ACEi/ARB/ARNI] + βB + MRA) according to the KD after a HF hospitalization and to investigate its impact on prognosis. Methods The data of 247 real‐world, consecutive patients were analyzed who were hospitalized in 2019−2021 for HFrEF and then were followed‐up for 1 year. The application and the ratio of reached TD of TT at hospital discharge and at 1 year were assessed comparing KD categories (eGFR: ≥90, 60−89, 45−59, 30−44, <30 mL/min/1.73 m2). Moreover, 1‐year all‐cause mortality and rehospitalization rates in KD subgroups were investigated. Results Majority of the patients received TT at hospital discharge (77%) and at 1 year (73%). More severe KD led to a lower application ratio (p < .05) of TT (92%, 88%, 80%, 73%, 31%) at discharge and at 1 year (81%, 76%, 76%, 68%, 40%). Patients with more severe KD were less likely (p < .05) to receive TD of MRA (81%, 68%, 78%, 61%, 52%) at discharge and a RASi (53%, 49%, 45%, 21%, 27%) at 1 year. One‐year all‐cause mortality (14%, 15%, 16%, 33%, 48%, p < .001), the ratio of all‐cause rehospitalizations (30%, 35%, 40%, 43%, 52%, p = .028), and rehospitalizations for HF (8%, 13%, 18%, 20%, 38%, p = .001) were significantly higher in more severe KD categories. Conclusions KD unfavorably affects the application of TT in HFrEF, however poorer mortality and rehospitalization rates among them highlight the role of the conscious implementation and up‐titration of GDMT. The implementation and maintenance of guideline‐directed medical therapy (GDMT) were possible in a real‐world population with heart failure with reduced ejection fraction (HFrEF) throughout a broad spectrum of kidney dysfunction (KD). KD unfavorably affected triple therapy application, but poorer prognosis highlights the role of the optimization of GDMT in KD. ACEI, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor‐neprilysin inhibitor; βB, beta‐blocker; eGFR, estimated glomerular filtration rate; GDMT, guideline‐directed medical therapy; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; MRA, mineralocorticoid receptor antagonist; RASi, renin‐angiotensin system inhibitor.
Journal Article
Potassium reduction with sodium zirconium cyclosilicate in patients with heart failure
Aims Several patients with heart failure and reduced ejection fraction (HFrEF) do not receive renin–angiotensin–aldosterone system (RAAS) inhibitors at the recommended dose or at all, frequently due to actual or feared hyperkalaemia. Sodium zirconium cyclosilicate (SZC) is an orally administered non‐absorbed intestinal potassium binder proven to lower serum potassium concentrations. Methods and results PRIORITIZE‐HF was an international, multicentre, parallel‐group, randomized, double‐blind, placebo‐controlled study to evaluate the benefits and risks of using SZC to intensify RAAS inhibitor therapy. Patients with symptomatic HFrEF were eligible and randomly assigned to receive SZC 5 g or placebo once daily for 12 weeks. Doses of study medication and RAAS inhibitors were titrated during the treatment period. The primary endpoint was the proportion of patients at 12 weeks in the following categories: (i) any RAAS inhibitor at less than target dose, and no MRA; (ii) any RAAS inhibitor at target dose and no MRA; (ii) MRA at less than target dose; and (iv) MRA at target dose. Due to challenges in participant management related to the COVID‐19 pandemic, the study was prematurely terminated with 182 randomized patients. There was no statistically significant difference in the distribution of patients by RAAS inhibitor treatment categories at 3 months (P = 0.43). The proportion of patients at target MRA dose was numerically higher in the SZC group (56.4%) compared with the placebo group (47.0%). Overall, SZC was well tolerated. Conclusions PRIORITIZE‐HF was terminated prematurely due to COVID‐19 and did not demonstrate a statistically significant increase in the intensity of RAAS inhibitor therapies with the potassium‐reducing agent SZC compared with placebo.
Journal Article
Mindfulness : a kindly approach to being with cancer
\"Mindfulness: A Kindly Approach to Being with Cancer offers people with cancer a means to bring mindfulness and kindliness into their lives, to help them cope with the challenge of a life-threatening illness. Adapts Mindfulness-Based Cognitive Therapy (MBCT), an approach with a strong evidence base for people with recurrent depression, for the needs and challenges of people with cancer Presents the standard 8-week course of MBCT for cancer in a flexible format that is designed to suit each readers own particular timescale, context and situation Based on more than 15 years of program development and clinical application by the author, and the work and experience of mindfulness teachers in other cancer centres around the world. Provides specific practices and approaches tailored to support the different phases of a cancer experience from diagnosis and treatment to living with uncertainty and managing life with cancer Features five extended stories from people personally affected by cancer who have used mindfulness-based practices to support them in their own experience of illness, life and treatment\"-- Provided by publisher.
Book
Personalized Nutrition as Medical Therapy for High-Risk Diseases
Personalized nutrition involves the formulation of individualized nutritional recommendations to promote and maintain health based on an individual's genetic makeup and other unique intrinsic and extrinsic factors. Implementing personalized nutrition plans for individuals with certain diseases or who are in danger of developing health conditions could help control the onset and severity of symptoms. Personalized Nutrition as Medical Therapy for High-Risk Diseases offers a practical guide for physicians seeking to provide tailored dietary recommendations to their patients with disease treatment, modulation and prevention in mind.
The book focuses on the biological mechanisms of specific diseases and provides evidence for how personalized nutrition positively impacts them. It explores conditions including cardiovascular diseases, hypertension, hypercholesterolemia, diabetes, obesity and Crohn's disease, as well as multiple pediatric, renal and psychological disorders.
Features:
Includes studies that document how people respond differently toward food depending on their genetic structure and other factors.
Discusses genome-wide association studies (GWAS) to understand the interplay between genetic susceptibility and dietary interactions.
Provides users with information to effectively implement personalized nutrition into practice.
Identifies possible challenges to the implementation of personalized nutritional interventions in a clinical setting.
This book is aimed at medical practitioners and will also appeal to researchers and students.
eBook
Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction
Heart failure (HF) is a chronic, progressive, and increasingly prevalent syndrome characterized by stepwise declines in health status and residual lifespan. Despite significant advancements in both pharmacologic and nonpharmacologic management approaches for chronic HF, the burden of HF hospitalization—whether attributable to new‐onset (de novo) HF or worsening of established HF—remains high and contributes to excess HF‐related morbidity, mortality, and healthcare expenditures. Owing to a paucity of evidence to guide tailored interventions in this heterogeneous group, management of acute HF events remains largely subject to clinician discretion, relying principally on alleviation of clinical congestion, as‐needed correction of hemodynamic perturbations, and concomitant reversal of underlying trigger(s). Following acute stabilization, the subsequent phase of care primarily involves interventions known to improve long‐term outcomes and rehospitalization risk, including initiation and optimization of disease‐modifying pharmacotherapy, targeted use of adjunctive therapies, and attention to contributing comorbid conditions. However, even with current standards of care many patients experience recurrent HF hospitalization, or after admission incur worsening clinical trajectories. These patterns highlight a persistent unmet need for evidence‐based approaches to inform in‐hospital HF care and call for renewed focus on urgent implementation of interventions capable of ameliorating risk of worsening HF. In this review, we discuss key contemporary and emerging therapeutic strategies for patients hospitalized with de novo or worsening HF.
Journal Article