Cognitive Status and Initiation of Lifestyle Changes Following Acute Coronary Heart Syndrome: A Dissertation
Faculty Advisor
Jane S. Saczynski, PhDAcademic Program
Clinical and Population Health ResearchUMass Chan Affiliations
MedicineDocument Type
Doctoral DissertationPublication Date
2014-03-27Keywords
Dissertations, UMMSAcute Coronary Syndrome
Caregivers
Cognition
Cognition Disorders
Life Style
Outcome Assessment (Health Care)
Prospective Studies
Secondary Prevention
Self ReportAcute Coronary SyndromeCaregiversCognitionCognition DisordersLife StyleOutcome Assessment (Health Care)Prospective StudiesSecondary PreventionSelf ReportBehavior and Behavior MechanismsCardiovascular DiseasesCommunity Health and Preventive MedicineHealth PsychologyHealth Services AdministrationMental DisordersPublic HealthSocial Psychology
Metadata
Show full item recordAbstract
Background: Cognitive impairment is prevalent in survivors of acute coronary syndrome (ACS) and increases risk for poor outcomes. Lifestyle changes are recommended to patients after ACS to reduce their risk for recurrent events, but cognitively impaired patients may encounter difficulties initiating these changes. This dissertation had three aims: (1) to examine cognitive status as a predictor of lifestyle changes after ACS, (2) to examine whether caregiver support moderates the association of cognitive status and initiation of lifestyle changes, and (3) to assess the reliability of self-reported lifestyle changes in cognitively impaired patients through comparison of their reports of lifestyle change with those from their caregivers. Methods: For aims 1 and 2, Poisson regression with robust error variance was used to examine the association of cognitive status and caregiver support with patient-reported initiation of five lifestyle changes (improving diet, increasing exercise, quitting smoking, reducing stress, and attending cardiac rehabilitation) in 881 patients from TRACE-CORE, a prospective longitudinal observational study of outcomes in ACS. For aim 3, pilot data from 78 patient-caregiver dyads from TRACE-CARE, an ancillary substudy, were used to examine whether patient-caregiver congruence on reports of lifestyle changes varied according to patients’ cognitive function. Results: Patient-reported rates of lifestyle change did not vary according to cognitive status, except for participation in cardiac rehabilitation. Caregiver support improved patient-reported rates of lifestyle change among cognitively intact patients but not cognitively impaired patients. Patients’ cognitive function was positively associated with patient-caregiver congruence on reports of initiation of lifestyle changes and patients with decreased cognitive function tended to over-report initiation of lifestyle changes compared to reports by their caregivers. Conclusion: Although cognitive status was not associated with initiation of most lifestyle changes and the influence of caregiver support on initiation of lifestyle changes was only beneficial to cognitively intact patients in this cohort of ACS patients, these null findings may be explained by the questionable validity of self-report in cognitively impaired patients. This dissertation yields new knowledge about secondary prevention in ACS patients and provides insight into the challenges of conducting patient-reported outcomes research in cognitively compromised populations.DOI
10.13028/M2KP4TPermanent Link to this Item
http://hdl.handle.net/20.500.14038/32059Rights
Copyright is held by the author, with all rights reserved.Scopus Count
Related items
Showing items related by title, author, creator and subject.
-
The influence of psychosocial maturity on male juvenile offenders' comprehension and understanding of the Miranda warningSelf-report measures of psychosocial maturity and screening measures of achievement and intelligence (Wechsler Abbreviated Scale of Intelligence; WASI) were used to investigate the influence of psychosocial maturity on male juvenile offenders' comprehension and appreciation of the Miranda warning (Grisso's Instruments for Assessing Understanding and Appreciation of Miranda Rights; GUAM). A sample of 67 male juvenile offenders, placed in a short-term detention facility or juvenile boot camp facility, participated in the study. Demographic differences revealed that youths in short-term detention were approximately one year older than boot camp youths. The two groups did not differ in IQ or measures of psychosocial maturity. Detention youths had GUAM subtest scores that were slightly higher than, but comparable to, those of boot camp youths. Consistent with previous research, verbal IQ correlated positively with GUAM subtest scores and was a significant predictor of all four scores after controlling for setting and age in a series of hierarchical regressions. In addition, the psychosocial maturity factor of Responsibility was a significant predictor of two GUAM subtests (CMR and FRI), while the Temperance and Perspective factors were not.
-
Youth Outcomes of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in the Child Trauma Training Center (CTTC)Objectives: Exposure to trauma among youth is common and can cause behavioral, social and functioning problems. Use of evidence-based trauma treatment can reduce post-traumatic stress (PTSD) symptoms and behavioral problems. This poster highlights the outcomes of youth who participated in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) provided by clinicians who were trained through the University of Massachusetts Medical School (UMMS) Child Trauma Training Center (CTTC). Methods: 308 youth ages 6-18 were enrolled into the CTTC evaluation with a mean age of 11.31 years (SD = 3.5); over half were female (58.1%), the majority were white (62.3%) and 37% were Hispanic. Data was collected by clinicians at three different time points: baseline, six-months and discharge through REDCap using the following measures: Child Behavior Checklist (CBCL), UCLA PTSD Index and the Social Connectedness survey. Results: The results of the UCLA PTSD Index indicated that youth experienced significantly fewer Re-experiencing (baseline [M = 9.67]; discharge [M = 6.36]), Avoidance/Numbing (baseline [M = 10.55]; discharge [M = 8.63], and Arousal symptoms (baseline [M = 11.46]; discharge [M = 9.02]), as well as less severe symptoms (baseline [M = 33.43]; discharge [M = 24.71]) overall. The CBCL revealed youth experienced fewer Internalizing (baseline [M = 64.51]; discharge [M = 62.18]), Externalizing (baseline [M = 64.51]; discharge [M = 62.18]) and total problem behaviors (baseline [M = 65.48]; discharge [M = 61.82]) overall compared to baseline. Additionally, youth reported significantly better change in Social Connectedness (M = 4.32) compared to baseline (M = 4.06). Conclusion and Discussion: Results of the youth and parent/caregiver reports of PTSD symptoms, behavioral problems and social connectedness indicates that youth and parent/caregivers noticed significantly fewer and less severe PTSD symptoms, fewer behavioral problems and improvement in social connectedness compared to baseline. These results adequately show positive child outcomes as a result of TF-CBT treatment in the context of CTTC’s framework.
-
Distracted Practice and Patient Safety: The Healthcare Team Experience: A DissertationPurpose: The purpose of this study was to explore the experiences of distracted practice across the healthcare team. Definition: Distracted practice is the diversion of a portion of available cognitive resources that may be needed to effectively perform/carry out the current activity. Background: Distracted practice is the result of individuals interacting with the healthcare team, the environment and technology in the performance of their jobs. The resultant behaviors can lead to error and affect patient safety. Methods: A qualitative descriptive (QD) approach was used that integrated observations with semi-structured interviews. The conceptual framework was based on the distracted driving model and a completed concept analysis. Results: There were 22 observation sessions and 32 interviews (12 RNs, 11 MDs, and 9 Pharmacists) completed between December, 2014 and July 2015. Results suggested that distracted practice is based on the main theme of cognitive resources which varies by the subthemes of individual differences; environmental disruptions; team awareness; and “rush mode”/time pressure. Conclusions and Implications: Distracted practice is an individual human experience that occurs when there are not enough cognitive resources available to effectively complete the task at hand. In that moment an individual shifts from thinking critically, being able to complete their current task without error, to not thinking critically and working in an automatic mode. This is when errors occur. Additional research is needed to evaluate intervention strategies to reduce and prevent distracted practice.
