Psychodynamic Motivation and Training program (PMT) for the secondary prevention in patients with stable coronary heart disease: study protocol for a randomized controlled trial of feasibility and effects

cfDNA as a surrogate marker for COVID-19 severity in patients with influenza-like symptoms with and without SARS-CoV-2 infections in general practice: a study protocol for a prospective cohort study

INTRODUCTION

The clinical course of patients with a SARS-CoV-2 (COVID-19) infection varies widely, from symptom-free to severe courses that can lead to death. Laboratory values of SARS-CoV-2 patients such as lymphocyte counts or C-reactive protein (CRP) do not allow a prediction of the actual course of the disease. To identify a possible predictive marker for the differentiation and prognosis of illness with influenza-like symptoms with and without SARS-CoV-2 infections in general practice, we will analyse the concentrations of cell-free DNA (cfDNA) levels, laboratory and clinical parameters, temperature, oxygen saturation, breathing rate and concomitant symptoms in patients with flu-like symptoms with and without a SARS-CoV-2 infection.

METHODS AND ANALYSIS

This is a single-centre, two-arm, parallel longitudinal cohort study with a total of 44 patients. 22 patients with flu-like symptoms without a SARS-CoV-2 infection and 22 patients with flu-like symptoms with a SARS-CoV-2 infection will be recruited. The primary objective is to compare cfDNA levels in ambulatory patients in general practice with flu-like symptoms with SARS-CoV-2 infection with those with influenza like symptoms without a SARS-CoV-2 infection during the disease (day 7 and day 14). The secondary objective is to determine whether there is a correlation between cfDNA concentrations on the one hand, and laboratory and clinical parameters on the other hand. cfDNA, differential blood count, high-sensitive CRP and erythrocyte sedimentation rate will be measured in blood samples, concomitant symptoms will be surveyed via a self-assessment questionnaire, and oxygen saturation, breathing rate and examination of the lungs will be reported by treating physicians.

ETHICS AND DISSEMINATION

Ethical approval was issued on 1 March 2021 by the Ethics Committee Essen under the number 21-9916-BO. Findings will be published in peer-reviewed open-access journals and presented at national and international conferences.

TRIAL REGISTRATION NUMBER

DRKS00024722.

Canonical Correlation between Behavioral-Psychological Variables and Predictors of Coronary Artery Disease Prognosis

Metabolic syndrome (MetS) and severity of coronary artery disease (CAD) are considered predictors of CAD prognosis. Unhealthy lifestyles and type-D personality are associated with MetS and are potential causes of primary and secondary CAD. In this cross-sectional descriptive study, we aimed to investigate the relationship between behavioral-psychological variables and predictors of CAD prognosis. The behavioral-psychological variable set contained six lifestyle categories and two type-D personality categories. Descriptive analyses, t-tests, analysis of variance, Pearson’s correlation, and canonical correlation were used. The behavioral-psychological variable set was related to the predictor set for CAD prognosis, with a significant canonical variate of 0.67 (45% overlapping variance). Significant pairs of canonical variates indicated that poor physical activity and weight control (−0.77), poor dietary habits (−0.78), alcohol consumption and cigarette smoking (−0.37), lack of sleep and rest (−0.40), stress (−0.64) in the lifestyle set, higher negative affectivity (0.52), and social inhibition (0.71) in the type-D personality set were associated with a high MetS score (0.59) and severity of CAD (0.91). A combination of behavioral and psychological variables was found to be important in predicting the prognosis of CAD; therefore, interventions aimed at preventing combinations of these variables may be effective in improving CAD prognosis.

The Cardiac Rehabilitation Psychodynamic Group Intervention (CR-PGI): An Explorative Study

Objective: An explorative study focusing on the process of a Cardiac Rehabilitation Psychodynamic Group Intervention (CR-PGI) addressed to myocardial infarction (MI) patients is discussed. The study aimed at analyzing whether the treatment based on CR-PGI serves as a communicational context within which MI patients are enabled to explore new interpretations of their post-infarction condition.

Methods: The intervention, divided into 12 weekly one-hour group sessions, was addressed to MI patients recruited within a Public Hospital of southern Italy. Each session was audio-recorded and lexical correspondence analysis (LCA) was applied to the verbatim transcripts, in order to provide a map of the evolution of the communication exchange occurring over the 12 sessions.

Results: The findings showed that the discourses associated to the first eight sessions differed from the discourses of the last four sessions. Two main transitions occurred. The first concerns the response to the infarction, first interpreted as a process of affective elaboration and afterwards as practical management of the functional aspects associated with the condition of MI patients. The second concerns the nature of the change and contrasts a lifestyle-oriented model with a social role approach, which refers to social, legal, and medical practices related to the acknowledgment of being an MI patient.

Conclusion: The findings offer preliminary support to the capacity of CR-PGI to work as a context where new meanings for the biographical rupture of the MI can be explored. Consistently with the rationale of the model, the intervention seems to have promoted the emergence of new ways of feeling and understanding one’s condition.

Auswirkung motivierender Gesprächsführung auf die Krankheitswahrnehmung bei stabiler koronarer Herzkrankheit. Eine randomisiert-kontrollierte Studie

Zusammenfassung.Hintergrund: Koronare Herzkrankheit ist eine der häufigsten Todesursachen für Menschen > 60 Jahre. Vom Lebensstil abhängige Risikofaktoren sind wesentlich beteiligt. Kardiale Rehabilitation ist daher essenziell für eine optimale Behandlung. Leider verstehen die Betroffenen ihre Krankheit kaum. Motivierende Gesprächsführung kann die Krankheitswahrnehmung verbessern. Ziel / Methode: In einer randomisiert-kontrollierten Studie wurde die Wirksamkeit einer Intervention mit motivierender Gesprächsführung auf die Krankheitswahrnehmung untersucht. Personen mit stabiler koronarer Herzkrankheit wurden konsekutiv nach perkutaner transluminaler Koronarangioplastie (PTCA) in die Studie aufgenommen. Die Interventionsgruppe erhielt ein kurzes motivierendes Gespräch zur Erkrankung und den Risikofaktoren als Intervention. Die Kontrollgruppe erhielt die Standardbetreuung. Vor der Intervention und sechs Monate später wurden Daten zur Krankheitswahrnehmung (Illness Perception Questionnaire-Revised) erhoben. Ergebnisse: Total wurden 312 Personen (n = 148 Intervention, n = 164 Kontrollgruppe) in die Studie aufgenommen (Durchschnittsalter: 66,2 Jahre). Nach der Intervention zeigte sich eine signifikante Veränderung im Bereich der emotionalen Reaktionen auf die Erkrankung. Schlussfolgerung: Um die Krankheitswahrnehmung bei Personen mit stabiler koronarer Herzkrankheit zu verbessern, ist eine kurze Intervention mit motivierender Gesprächsführung möglicherweise wirksam. Ob eine Intensivierung der Intervention das Resultat weiter verbessert, muss noch untersucht werden.

Internet-based interventions for the secondary prevention of coronary heart disease

BACKGROUND

The Internet could provide a means of delivering secondary prevention programmes to people with coronary heart disease (CHD).

OBJECTIVES

To determine the effectiveness of Internet-based interventions targeting lifestyle changes and medicines management for the secondary prevention of CHD.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, in December 2014. We also searched six other databases in October 2014, and three trials registers in January 2015 together with reference checking and handsearching to identify additional studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating Internet-delivered secondary prevention interventions aimed at people with CHD.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risk of bias and extracted data according to the Cochrane Handbook for Systematic Reviews of Interventions. We assessed evidence quality using the GRADE approach and presented this in a 'Summary of findings' table.

MAIN RESULTS

Eighteen trials met our inclusion criteria. Eleven studies are complete (1392 participants), and seven are ongoing. Of the completed studies, seven interventions are broad, targeting the lifestyle management of CHD, and four focused on physical activity promotion. The comparison group in trials was usual care (n = 6), minimal intervention (n = 3), or traditional cardiac rehabilitation (n = 2).We found no effects of Internet-based interventions for all-cause mortality (odds ratio (OR) 0.27, 95% confidence interval (CI) 0.04 to 1.63; participants = 895; studies = 6; low-quality evidence). There was only one case of cardiovascular mortality in a control group (participants = 895; studies = 6). No incidences of non-fatal re-infarction were reported across any of the studies. We found no effects for revascularisation (OR 0.69, 95% CI 0.37 to 1.27; participants = 895; studies = 6; low-quality evidence).We found no effects for total cholesterol (mean difference (MD) 0.00, 95% CI -0.27 to 0.28; participants = 439; studies = 4; low-quality evidence), high-density lipoprotein (HDL) cholesterol (MD 0.01, 95% CI -0.06 to 0.07; participants = 437; studies = 4; low-quality evidence), or triglycerides (MD 0.01, 95% CI -0.17 to 0.19; participants = 439; studies = 4; low-quality evidence). We did not pool the data for low-density lipoprotein (LDL) cholesterol due to considerable heterogeneity. Two out of six trials measuring LDL cholesterol detected favourable intervention effects, and four trials reported no effects. Seven studies measured systolic and diastolic blood pressure; we did not pool the data due to substantial heterogeneity. For systolic blood pressure, two studies showed a reduction with the intervention, but the remaining studies showed no effect. For diastolic blood pressure, two studies showed a reduction with the intervention, one study showed an increase with the intervention, and the remaining four studies showed no effect.Five trials measured health-related quality of life (HRQOL). We could draw no conclusions from one study due to incomplete reporting; one trial reported no effect; two studies reported a short- and medium-term effect respectively; and one study reported both short- and medium-term effects.Five trials assessed dietary outcomes: two reported favourable effects, and three reported no effects. Eight studies assessed physical activity: five of these trials reported no physical activity effects, and three reported effectiveness. Trials are yet to measure the impact of these interventions on compliance with medication.Two studies measured healthcare utilisation: one reported no effects, and the other reported increased usage of healthcare services compared to a control group in the intervention group at nine months' follow-up. Two trials collected cost data: both reported that Internet-delivered interventions are likely to be cost-effective.In terms of the risk of bias, the majority of studies reported appropriate randomisation and appropriate concealment of randomisation processes. A lack of blinding resulted in a risk of performance bias in seven studies, and a risk of detection bias in five trials. Two trials were at risk of attrition bias, and five were at risk for reporting bias.

AUTHORS' CONCLUSIONS

In general, evidence was of low quality due to lack of blinding, loss to follow-up, and uncertainty around the effect size. Few studies measured clinical events, and of those that did, a very small number of events were reported, and therefore no firm conclusions can be made. Similarly, there was no clear evidence of effect for cardiovascular risk factors, although again the number of studies reporting these was small. There was some evidence for beneficial effects on HRQOL, dietary outcomes, and physical activity, although firm conclusions cannot yet be made. The effects on healthcare utilisation and cost-effectiveness are also inconclusive, and trials are yet to measure the impact of Internet interventions on compliance with medication. The comparison groups differed across trials, and there were insufficient studies with usable data for subgroup analyses. We intend to study the intensity of comparison groups in future updates of this review when more evidence is available. The completion of the ongoing trials will add to the evidence base.

Psychological interventions in cardiovascular disease: an update

PURPOSE OF REVIEW

To evaluate recent literature on psychological interventions in cardiovascular disease.

RECENT FINDINGS

Mindfulness-based stress reduction did not reduce blood pressure, and a self-management programme in heart failure patients (HART), showed no improvement in health-related quality of life. Web-based decision aids are as effective as individually tailored counseling at reducing cardiovascular risk. Among health attack survivors, the ProActive Heart study involving telephone delivered counseling reduced anxiety whereas integrated motivational interviewing cognitive behavioral therapy (Beating Heart Problems) reduced depression and anger with no physiological or behavioral benefits.

SUMMARY

Psychological conditions increase cardiovascular risk as well as complicate cardiovascular disease. Psychological interventions are, however, far less studied compared with pharmacological and device therapies for cardiovascular disease. Interventions can either be delivered in isolation or in combination with other interventions including education, exercise, and medications, whereas outcomes measured could include psychometrics, behavior, risk scores, cardiovascular endpoints, and mortality. Due to the large variety of possible interventions and outcomes, published studies have reported mixed results and it remains unclear which modes of delivery and which types of intervention are most appropriate.

The Impact of Clinical Pharmacist Support on Patients Receiving Multi-drug Therapy for Coronary Heart Disease in China

The study determined pharmacist support on patients receiving multi-drug therapy for coronary heart disease by evaluating patient self-care ability, quality of life, and drug therapy compliance. In this study, ninety patients were randomly assigned to an experimental group (n=45) and a control group (n=45). The control group received conventional clinical care. The experimental group received clinical care plus pharmacist support that included medication review, patient education, lifestyle management, discharge guidance, and telephone follow-up. Eighty-five patients completed the study. Self-care ability and quality of life were evaluated before hospital discharge. The experimental group understood their condition better than the control group (P<0.05), the differences between the groups in understanding treatment goals, drug regimens, lifestyle modifications, psychogenic disorders, and satisfaction evaluations were more pronounced (P<0.01). At six-month follow-up, the difference between the groups in drug therapy compliance was P<0.01, as was success rate by intention-to-treat (77.8% vs. 48.9%) and per-protocol (81.4% vs. 52.4%). Two adverse drug reactions occurred in the experimental group and three in the control group. Pharmacist support improved self-care ability, quality of life, drug therapy compliance, and treatment success rate in coronary heart disease patients.

[Psychodynamic psychotherapy, lifestyle and prevention]

OBJECTIVES

Patients with mental disorders frequently manifest unhealthy behavior, which contributes to their increased risk for chronic mental and somatic diseases as well as excess mortality rates of 10 years and more. It also impairs their well-being and the course of mental disorders.We analyzed whether by addressing unhealthy behavior prevention can be integrated into psychodynamic psychotherapy.

METHODS

We reviewed the literature on the role of unhealthy behavior for mental disorders, on the role of lifestyle risk factors in psychodynamic theory, and on barriers to the integration of addressing lifestyle in psychodynamic psychotherapy.

RESULTS

Smoking, unhealthy dietary habits, and physical inactivity constitute dysfunctional behavior, resulting from maladaptive self-representations and an impairment of emotion-regulation capacities. In psychodynamic psychotherapy this maladaptive behavior can be addressed and treated as a kind of defensive behavior and resistance.

CONCLUSION

We believe that by addressing unhealthy behavior prevention can become a crucial task for psychodynamic psychotherapists today.

The association between different kinds of exercise and quality of life in the long term. Results of a randomized controlled trial on the elderly

INTRODUCTION

Quality of Life (QoL) tends to decrease with age. Exercise has been shown to be effective in improving some psychosocial features related to QoL. We carried out a randomized controlled trial to verify the long-term efficacy of an intensive fitness program versus a lighter program on the QoL of an elderly sample, compared to QoL of a large normative sample.

METHODS

Participants aged ≥65 years were randomly assigned in a 1:1 fashion either to a vigorous physical activity program group (VAG) or to a postural gymnastic group (PGG). Depressive symptoms were screened by PHQ-9. QoL assessment was done by SF-12. Multivariate analysis of variance (MANOVA) was conducted to test differences between the two groups over time. Comparison with the normative sample was carried out by means of ANOVA 1-way.

RESULTS

Both VAG and PGG showed low PHQ9 scores at the beginning and at the end of the trial, indicating the absence of depressive symptoms. At the end of the study, both groups had a higher level of QoL, measured by means of SF-12, than the normative standardized sample. While SF-12 scores for both groups decreased slightly 12 weeks after the end of the trial, only the VAG group maintained significantly-higher scores than those of the normative sample.

CONCLUSIONS

A vigorous physical activity program group might be associated with better maintenance of results over time as compared to a postural gymnastic program. These results require future confirmation by further studies on large samples.