Randall, Lindsey

Abstract Depressive symptoms and poor quality of life (QoL) are common among over 65% of older adults living with multimorbidity. Community-based interventions have the potential for scalability and may be more accessible for older adults with complex needs compared to interventions delivered in healthcare settings. This scoping review aims to describe the literature on community-based interventions targeting depressive symptoms and QoL for adults with multimorbidity. Six databases were searched for studies published in 2015 or later, focusing on interventions in community-based settings (e.g., community-based organizations, senior centers, retirement communities). Studies focusing on a single condition or an index condition with comorbidities were excluded. Of 7,829 screened studies, 173 articles were included in full-text review. About half of the studies were conducted in high-income English-speaking countries and 11% in low and middle-income countries (LMIC). Study samples consisted mostly of older adults with varied multimorbidity profiles that included diabetes, cardiovascular disease, mental health disorders, and frailty. Nearly 40% of studies reported physical activity and patient education interventions, while peer-led/community health worker interventions were the least reported intervention. This review highlights a gap in studies conducted in LMIC where the burden of multimorbidity is high and resources are limited, and a gap in interventions that are community member-led. More research is needed to understand how these scalable, cost-effective community-based interventions may address the needs of multimorbidity patients in LMIC and how leveraging community members may strengthen interventions in addressing depressive symptoms and QoL in patients with multimorbidity.

Abstract A 2003 survey revealed the scope of mothers' dissatisfaction with their postnatal support following a diagnosis of Down syndrome (DS). Substantial proportions of mothers reported that providers conveyed diagnoses with pity, emphasized negative aspects of DS, and neglected to provide adequate materials explaining DS. This study follows up on the 2003 survey by assessing whether parents' experiences have improved. Four DS nonprofit organizations, which participated in the original study, distributed a mixed‐methods survey to families who have had children with DS between 2003 and 2022. Quantitative analysis assessed correlations among responses and differences between the 2003 and 2022 survey groups. Open‐ended responses were qualitatively analyzed. Compared to the 2003 findings, parents' perceptions of their postnatal care have not improved ( N = 89). Parents are increasingly likely to report that their providers pitied them, omitted positive aspects of DS, and provided insufficient materials describing DS. Substantial proportions of parents reported fear (77%) and anxiety (79%), only 24% described receiving adequate explanatory materials, and parents were 45% likelier to report that physicians discussed negative aspects of DS than positive aspects. Qualitatively, substantial numbers of parents recounted insensitive conduct by providers. These results suggest that despite interventions, parents' experiences of postnatal diagnoses of DS have not improved over time. Certain provider behaviors—such as describing positive aspects of DS and providing comprehensive explanatory materials—can reduce fear and anxiety, pointing to directions for reform.

Abstract Cardiac surgeries often require the use of cardiopulmonary bypass to allow visualization and manipulation of tissues. Vascular anomalies may impose challenges with access configuration. A patient was evaluated for robot-assisted mitral valve repair and found to have an atretic inferior vena cava secondary due to chronic occlusion. The patient was cannulated arterially through the left common femoral artery, and two cannulation sites were applied for venous drainage: the right intrajugular vein and a second percutaneous access site directly into the right atrium through the chest wall. The procedure was completed without immediate complications, and the patient’s perioperative course was unremarkable.