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Derivation and Validation of a Scale Assessing Constructive and Destructive Styles of
Mental Adjustment to Heart Failure Based on the Mini-MAC Scale Used in Psychooncology:
The Results of Multicenter Caps-Lock-HF (Complex Assessment of Psychological Status
Located in Heart Failure) Study
Objectives: We aimed to derivate and validate a scale assessing constructive and destructive styles of mental adjustment to heart failure (HF) based on a scale used in psychooncology. Background: Mental adjustment to severe disease is commonly assessed in cancer patients, as it strongly determines quality of life and survival, implying some therapeutic interventions. There is no reliable tool for the assessment of mental adjustment to HF. Methods: We applied the modified 29-item Mini-MAC scale (assessing constructive and destructive styles of mental adjustment to the disease, where ‘cancer’ appearing in only 2 items was replaced by ‘heart failure’) in 717 patients with systolic HF without a history of cancer, participating in the Polish multicentre Caps-Lock-HF study (mean age: 64 ± 11 years, men: 80%, NYHA class III-IV: 41%). Patients were randomly divided in 2 groups. In the first derivation group, 2 sets (factors) from 30 items of the original scale were extracted using factor analysis, and the derived assignment was performed in the second validation group. Cronbach’s α were calculated for both factors, and compared between the derivation and validation groups. This procedure was repeated 100 times. Results: Cronbach’s α for factor 1 were 0.88 ± 0.01 (range: 0.83-0.90) vs. 0.88 ± 0.01(0.84-0.89) and for factor 2 were 0.75 ± 0.03 (0.67-0.81) vs. 0.74 ± 0.02 (0.70-0.78) (derivation vs. validation groups, respectively, both p>0.05). Based on consistently high Cronbach’s α values, indicating a high reliability of 2 derived sets of items, we have formed a scale, where factor 1 and 2 (including 13 and 6 items) reflected destructive and constructive styles of mental adjustment to HF, respectively. Factor reflecting the destructive style, was more pronounced in patients with more severe HF and depressive symptoms. Conclusions: We propose a scale for the assessment of mental adjustment to HF, which can be implemented in clinical practice.
Keywords: Heart failure; Psychoonchology; Cancer
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Urinary Indices: Their Diagnostic Value in Current Nephrology
Urinary indices consist basically of urinary concentration, urine/serum ratio or fractional excretion of electrolytes or nitrogen products. They are useful for the decision making process for handling renal diseases such as acute kidney injury, chronic kidney disease, or nephrotic syndrome, as well as for internal milieu disorders such as hyponatremia, dyskalemia, metabolic alkalosis, and hyperchloremic metabolic acidosis. The main urinary indices used in clinical practice are: fractional excretion of sodium and urea which are used for interpreting acute renal injury and hyponatremia; fractional excretion of potassium, and transtubular potassium concentration gradient for evaluating dyskalemias, fractional excretion of uric acid for interpreting hyponatremia, as well as urine chloride for evaluating acid-base disorders such as metabolic alkalosis, and hyperchloremic metabolic acidosis. In conclusion, urinary indices are effective tools for the decision making process involved in treating renal diseases and internal milieu disorders.
Keywords: Urinary indexes; Acute renal injury; Hyponatremia; Nephrotic syndrome; Chronic kidney disease
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Contrast-induced Acute Kidney Injury: A Review
Contrast-induced acute kidney injury (CI-AKI) is a transient impairment of renal function which occurs after intravascular administration of iodinated contrast media (CM). Because of the increasing number of procedures requiring CM and the relevant impact on prognosis and costs, CI-AKI has become a subject of interest for researchers and physicians. In the last years many efforts have been made to better understand CI-AKI pathophysiology and to find new measures of prevention and management. This review aims to provide an overview of epidemiology, diagnostic criteria and tools, pathophysiology, clinical implications and prevention measures of CI-AKI.
Keywords: Acute kidney injury; Nephropathy
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The Different “Ageings” and their Importance to Achieve an Adequate Chronic Disease Assessment and Treatment
There are many “ageings”: normal ageing, successful ageing, and pathological ageing or senescence, which should be clearly differentiated since they have different impact on elderly health. Senescence implies the presence of frailty status, and its combination with some chronic disease (eg: chronic kidney disease, etc.) can lead to a senescent variety of these conditions (eg: senescent nephropahy, etc.) which have worse evolution and prognosis compared to the original condition, and requires not only to treat the patient´s basal chronic disease but also his/her frailty phenotype. Therefore, is crucial to evaluate frailty phenotype in every patient, independently of his/her age, who suffers from a systemic chronic disease in order to distinguish chronic disease from its senescent form since they could have different prognosis, as well as diagnostic tests and therapeutic requirements.
Keywords: Ageing; Senescence; Frailty