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Objectives: In older persons with heart failure (HF), an inability to self-manage their disease condition can result in poor health outcomes and quality of life. With the rise in smartphone use and digital game playing among older adults, digital tools such as sensor-controlled digital games (SCDGs) can offer accessible health-promoting tools that are enjoyable and easy to use. However, designing SCDGs that are compelling and aligned with their life values and self-management needs can be challenging. This article describes a qualitative study with older adults with HF who were recruited from a cardiac rehabilitation laboratory in central Texas to identify their perceptions and expectations regarding a SCDG for HF self-management. Materials and Methods: A low-fidelity prototype that demonstrated the features of a SCDG was used to obtain the participants' perceptions about the value of SCDGs for HF self-management with respect to content, customization, flexibility, and usability through qualitative interviews. Results: We interviewed 15 patients with HF (53% women; age range, 53-90 years; 60% white). The concept of SCDGs for HF self-management was highly acceptable (80%). Participants provided suggestions for game characters, progress in the game, and game notifications and incentives. Perceived benefits included helping users track their behaviors and establish routines, become informed on strategies to manage HF, and empower themselves to take charge of their health. Conclusions: The study's findings will guide personalization of SCDG development to motivate patient engagement in HF self-management behaviors.

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Traditional sternal precautions, given to sternotomy patients as part of their discharge education, are intended to help prevent sternal wound complications. They vary widely but generally include arbitrary load and time restrictions (lifting no more than a specified weight for up to 12 weeks) and may prohibit common shoulder joint and shoulder girdle movements. Having observed the negative effects of restrictive sternal precautions for many years, our research team performed a series of studies that measured the forces exerted during various common activities and their relationship to the sternum. The results, though informative, led us to realize that the goal of identifying "the" appropriate load restriction to prescribe for sternotomy patients was futile. The alternative approach that we introduce applies standard kinesiological principles and teaches patients how to perform load-bearing movements in a way that avoids excessive stress to the sternum.

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BACKGROUND: The role of physicians in the detection, reporting, and response to infectious disease outbreaks, anomalous biologic events, or other public health emergencies is critical to the community's safety. OBJECTIVE/METHOD: In an effort to assess the level of preparedness of local physicians to respond to such events, the City of Fort Worth Public Health Department, the Fort Worth/Tarrant County Health Authority, and the Tarrant County Medical Society collaborated in designing and administering a cross-sectional study in spring 2006. RESULTS: The results serve as a baseline of the local clinical community's preparedness, with 91% of local physicians reporting their knowledge as "fair-poor," 80% desiring more information, and 83% favoring more training opportunities. CONCLUSION: Information obtained through this assessment is used to help cultivate educational interventions that will enhance the participation, integration, and mobilization of clinicians in the event of a community emergency.

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PURPOSE: Hypertension remains uncontrolled in the majority of affected patients despite treatment. Our goal was to identify specific action items in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) guidelines that are not being translated into clinical practice. METHODS: We transformed the major JNC VI tables into a chart review instrument that was used to retrospectively analyze the medical records of 249 patients with newly diagnosed hypertension who had been followed for 18 months at one of six community-based primary care clinics. RESULTS: The practices of physicians deviated from the guidelines in several ways. Hypertension was staged initially on a single blood pressure recording in 85% (n = 212) of patients. No electrocardiogram was ordered for 89% (n = 221) of patients, while other mandatory laboratory tests were ordered for about 50%. After 18 months, 40% (72/179) of patients for whom prescription records were identified were still on monotherapy, and target blood pressure (<140/90 mm Hg) was achieved in only 33% (83/249) of patients. All of the 35 patients with diabetes received an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, but only 1.7 medications were prescribed per patient at study end. CONCLUSION: In this clinic system, staging of blood pressure with multiple measurements, thorough assessment of global cardiovascular risk, and titration of multiple antihypertensive medications to achieve blood pressure goal are components of the JNC VI guidelines that are not well translated into clinical practice. Overcoming these practice defects will require innovative multilevel interventions.

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