Prescription, Compliance, and Burden Associated with Salt-Restricted Diets in Heart Failure Patients: Results from the French National OFICSel Observatory

(1) Background: There is much debate about the use of salt-restricted diet for managing heart failure (HF). Dietary guidelines are inconsistent and lack evidence. (2) Method: The OFICSel observatory collected data about adults hospitalised for HF. The data, collected using study-specific surveys, were used to describe HF management, including diets, from the cardiologists’ and patients’ perspectives. Cardiologists provided the patients’ clinical, biological, echocardiography, and treatment data, while the patients provided dietary, medical history, sociodemographic, morphometric, quality of life, and burden data (burden scale in restricted diets (BIRD) questionnaire). The differences between the diet recommended by the cardiologist, understood by the patient, and the estimated salt intake (by the patient) and diet burden were assessed. (3) Results: Between March and June 2017, 300 cardiologists enrolled 2822 patients. Most patients (90%) were recommended diets with <6 g of salt/day. Mean daily salt consumption was 4.7 g (standard deviation (SD): 2.4). Only 33% of patients complied with their recommended diet, 34% over-complied, and 19% under-complied (14% unknown). Dietary restrictions in HF patients were associated with increased burden (mean BIRD score of 8.1/48 [SD: 8.8]). (4) Conclusion: Healthcare professionals do not always follow dietary recommendations, and their patients do not always understand and comply with diets recommended. Restrictive diets in HF patients are associated with increased burden. An evidence-based approach to developing and recommending HF-specific diets is required.

User-Centric Adaptive Password Policies to Combat Password Fatigue

Today, online users will have an average of 25 password-protected accounts online, yet use, on average, 6.5 passwords. The excessive cognitive burden of remembering large amounts of passwords causes Password Fatigue. Therefore users tend to reuse passwords or recycle password patterns whenever prompted to change their passwords regularly. Researchers have created Adaptive Password Policies to prevent users from creating new passwords similar to previously created ones. However, this approach creates user frustration as it neglects users’ cognitive burden. This paper proposes a novel User-Centric Adaptive Password Policy (UCAPP) Framework for password creation and management that assigns users system-generated passwords based on a cognitive-behavioural agent-based model. The framework comprises a Password Policy Assignment Test (PassPAST), a Cognitive Burden Scale (CBS), a User Profiling Algorithm, and a Password Generator (PassGEN). The framework creates tailor-made password policies that maintain password memorability for users of different cognitive thresholds without sacrificing password strength and entropy. The framework successfully created 30-40% stronger passwords for Critical users and random (non-mnemonic) passwords for Typical users based on each individual’s cognitive password thresholds in a preliminary test.

The reality of the cognitive burden of the methods of teaching physical education for male and female teachers of Al-Karkh Al-Thania Education Directorate

The aim of the research is to build a cognitive load scale for the methods of teaching physical education for male and female teachers of the eduction for male and female teachers of the second karkh Education Directorate , and to identify the details of the leval of cognitive burden for the methods of teaching physical education forthem . Baghdad Al - Karkh /2 numbering (59) individuals , all of them were chosen deliberately at a rate of (100%) , and then they wrer divded into three samples ( contruction , exploratory and application ) according to the requirements of the research , and a specialized cognitive burden scale was built for the sample and the specificity of this The research is according to the determinants of measurement and evaluation , and its application in apaper form with direct measurement , as the time prtiod for procedures and application took from 5l1l2021 to 28l2l2021 and after data was obtained , it was processed using the (SPSS) system to be the only extracts and applicatons from this research in that Teachers of physical education in middle school need to schedule and properly codify the information the receive about how to evaluate , and the need to rely on official sources about virtual classroom information and e-learning by reducing its momentum on their minds , and it is necessary that continuous development courses have reakistic goals and do not cause a cognitive burden . and exhausting them, and it is necessary to find open channels of communication to help them identify useful inforomation from non- improvised scintific sources

Exploratory and Confirmatory Factor Analysis of the Burden Scale for Family Caregivers-Short Form

Caregiver burden describes the physical, psychological, social, and financial demands of providing care to others. Caregiver burden has been investigated in general, and off-time caregiving often specific to chronic, recurring conditions. Despite the substantial research attention to caregiving burden, there have been few studies aimed establishing the psychometric evaluation of measurement tools used to measure the construct ( Pendergrass et al., 2018 ). Accurate measurement of caregiving burden is essential for studying the myriad effects on caregivers’ mental, physical, financial, and relational health. To begin to fill this gap, we conducted an exploratory factor analysis and a confirmatory factor analysis of the Burden Scale for Family Caregivers ( Pendergrass et al., 2018 ) in two distinct samples. Results of an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) indicated a one factor solution. Implications for these findings on the study of caregiver burden are included.

Transitioning Eligible Patients from Warfarin to a Direct Oral Anticoagulant: A Prospective Quality Improvement Study

Background: Direct oral anticoagulants (DOACs) are rapidly replacing alternative agents as the preferred choice for anticoagulation. With extended time on the market and expanded guidelines for indications for use, they are now more accessible and affordable. Qualifying patients previously treated with warfarin for long-term anticoagulation may benefit from transitioning to a DOAC. In this prospective quality improvement study, we seek to identify eligible patients and transition them from warfarin to DOAC via shared decision-making and a multidisciplinary approach. Additionally, we will assess changes in quality of life (QOL) through a validated survey. Methods: Identify patients currently on warfarin who are eligible for transition to a DOAC. Eligibility criteria include patients with age &gt;18 years old. Exclusion criteria includes pregnancy, BMI &gt;50 kg/m2, CrCl &lt;15 L/min, patients receiving anticoagulation for APLS or for mechanical heart valves. With the aid of our pharmacy team, we then ensure long-term medication affordability prior to transition. Eligible patients complete a QOL survey pre-transition and 3 months post-transition. The QOL survey is the validated Anti-Clot Treatment Scale (ACTS), which is a 15 question survey which includes a Burden scale composed of 12 questions and a Benefit scale composed of 3 questions and each question is scored from 1 to 5 (1=not at all, 2=a little, 3=moderately, 4=quite a bit, 5=extremely). The Burden scale is reverse scored so that higher ACTS Burden scores indicate greater satisfaction for a score range of 12-60. The Benefit scale is scored conventionally for a score range of 3-15. The Total score is calculated by the addition of the Burden scale and Benefit scale for a score range of 15-75. Paired T-tests were conducted on the Burden scale, Benefit scale, and Total score using GraphPad Prism version 7 (GraphPad Software, La Jolla, CA). P-values were two-tailed, with a p&lt;0.05 considered statistically significant. Results: 25 patients out of 60 were identified as eligible for DOAC transition. Total score, Burden scale, and Benefit scale mean values were 49.5, 39.5, 10 for warfarin and 66.8, 53.5, and 13.3 for DOAC, respectively. Preliminary conducted analysis revealed statistically significant improvements in Total, Burden, and Benefit scores with p-values of 0.0046, 0.0075, and 0.0319 and mean improvements of 17.3, 14, and 3.25, respectively. Conclusion: Transitioning patients from warfarin to a DOAC has been found to decrease both patients' sense of burden while also improving their sense of benefit, as evidenced by the QOL survey analysis. Transitioning patients from warfarin to a DOAC has the potential to decrease need for routine INR monitoring, dietary limitations, and fewer drug interactions. Additionally, it improves patient satisfaction with their healthcare and reduces utilization of healthcare resources. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Study on the Correlation between Caregiver Burden and Social Support of Low-Income Home-Based Patients with Advanced Cancer

Objective To explore the correlation between caregiver burden and social support of low-income home-based patients with advanced cancer. Methods A self-made questionnaire was used to investigate 110 caregivers of low-income home-based patients with advanced cancer. The questionnaire included general information of patients and caregivers, Zarit Caregiver Burden Scale (ZBI), and social support scale, etc. The survey data were sorted out by Excel software and entered into the database, and the statistical analysis was completed with R3.5.2 software. The data of patients and caregivers were analyzed by frequency, rate, and means ± standard deviation (x±s). The correlation index was used to analyze the relationship between caregiver burden and social support. Results According to the investigation and analysis, the home-based caregivers of low-income cancer patients have a heavy burden. The ZBI score is (33.76 + 13.67) points, with a median of 33.0 points, which belongs to moderate and severe burden; the caregivers of low-income cancer patients received less social support, and the utilization of social support was low, with an average of (32.70 + 7.17) points and a median of 32.5 points, lower than the norm of (34.56 + 3.73) points. There was a negative correlation between caregiver burden and social support and each dimension (P; 0.001). Conclusion There is a close relationship between the burden of home-based caregivers and social support of low-income patients with advanced cancer. More attention should be paid to this group and more practical support and assistance should be provided to help reduce the pressure and burden of caregivers.

Development of the Caregiving Burden Scale for Family Caregivers of Children with Cancer

Due to the burden of caregiving, family caregivers of children with cancer suffer from physical and psychosocial health problems. The aim of this study was to develop a Caregiving Burden Scale for Family Caregivers of Children with Cancer (CBSFC-CC) and to assess its psychometric properties. A methodological, descriptive study design was conducted. The study sample consisted of 217 family caregivers caring for children with cancer between the ages of 0 and 18 years. The item pool of the scale was created using the Delphi Technique. The Cronbach’s alpha coefficient for the overall scale was 0.93. The item-total score correlations ranged from 0.424 to 0.645. The exploratory factor analysis showed that the scale explained 68.34% of the total variance. The confirmatory factor analysis also showed that the factor loadings of the scale ranged from 0.46 to 0.96. NNFI, CFI, and IFI were found to be > 0.90, and RMSEA was found to be < 0.09. The CBSFC-CC was found to be a good multidimensional instrument for evaluating the burden on family caregivers of pediatric cancer patients. It can be used in clinical practice and research. This tool can be considered to tailor interventions aimed at improving caregiver outcomes.

A meta-analysis of observational studies on anticholinergic burden and fracture risk: evaluation of conventional burden scales

Background Anticholinergic burden potentially increases the risk of fracture. Although there are various anticholinergic burden scales, little is known about the inter-scale compatibility regarding the relationship of anticholinergic burden with fracture risk. We performed meta-analysis to examine the association of fracture risk with anticholinergic burden measured using various scales. Methods Primary literature was retrieved from PubMed (1966 to March, 2021), the Cochrane Library (1974 to March, 2021), Scopus (1970 to March, 2021), and Ichushi-web (1983 to March, 2021). Cohort and case-control studies that evaluated the association between any fracture and anticholinergic drugs were included. Additionally, we included studies in which patients were administered anticholinergic drugs included on the anticholinergic risk scale (ARS), anticholinergic cognitive burden (ACB), anticholinergic drug scale, or drug burden index-anticholinergic component. Random effects models were used to calculate pooled relative risk (RR) and 95% confidence interval (CI) due to heterogeneity among the studies. Publication bias was examined by funnel plots and the Begg’s test. Results A total of 49 datasets from 10 studies were included in the meta-analysis. Six of the 10 studies included only patients aged over 65 years, who accounted for 93% of the total study population (453,186/487,247). Meta-analysis indicated a positive relationship between use of anticholinergic drugs and fracture risk, regardless of the anticholinergic burden scale used. However, the relationship between anticholinergic burden and fracture risk varied depending on the scale used. Fracture risk increased linearly with increasing anticholinergic burden measured using ARS. ARS 1 point was associated with 28% increase in fracture risk, ARS 1–2 point(s) with 39%, ARS 2 points with 54%, ARS 3 points with 66%, and ARS ≥ 4 points with 77%. On the other hand, ACB 1 point and ACB 2 points were associated with similar fracture risk (pooled RR [95% CI]: overall; 1.28 [1.18–1.39], 1 point; 1.12 [1.06–1.18], 2 points; 1.15 [1.08–1.23]). Conclusions This result suggests that the relationship between anticholinergic drug burden and fracture risk may differ depending on the anticholinergic burden scale used.

Burden of Diabetic Foot Patients’ Caregivers and Affecting Factors: A Cross-Sectional Study

With the increase in the diabetic foot patients in recent decades, the caregivers of diabetic foot patients increase too. Most of these caregivers are informal caregivers. However, the studies examining the burden of the caregivers and affecting factors are limited. This study was conducted to determine the burden of the caregivers of diabetic foot patients and affecting factors. This cross-sectional study was conducted between the January and October 2020 in a diabetic foot council of a university hospital. Zarit Caregiver Burden Scale and a participant identification form were used for data collection. Most of the caregivers were female (75.2%) and the mean age was 51.27 ± 11.48 years. The burden of the caregivers was at moderate level in the current study. Factors affecting the caregivers’ burden were caregivers’ age, patients’ family structure, caregivers’ education level, caregivers’ income level, hours per week spending for the care of the patients, and lack of choice.