Background-Medications endorsed by clinical practice guidelines, such as cardiovascular medications, could still have risks that outweigh potential benefits, and could thus warrant deprescribing. Objectives-The objective of this study was to develop a framework of facilitators and barriers specific to deprescribing cardiovascular medications in the setting of uncertain benefit. Given the

BackgroundParents have significant responsibility in the care of their critically ill children who have been admitted to the intensive care unit (ICU). When staying with their children in the hospital, they also have particular needs that should be adequately acknowledged and responded to by healthcare providers. Moreover, when their needs are not identified and addressed, parents may experience stress and anxiety as a result. This study describes the needs of parents caring for hospitalized critically ill children, as perceived by parents and nurses.MethodsThis study used a descriptive qualitative research design. Five focus group discussions with nurses and parents of critically ill children, who were purposefully recruited, were conducted at the Kilimanjaro Christian Medical Centre Hospital. A qualitative content analysis guided the analysis of the data.ResultsTwo themes emerged from the perceptions of parents and nurses about the needs of parents caring for hospitalized critically ill children. These were: “engaging parents in the care of their children” and “receiving psychosocial support”. Both parents and nurses identified the importance of providing adequate information about their children’s progress, encouraging and involving parents in the care of their children and having flexible visiting time for parents was vital when caring for critically ill children.ConclusionsThis study provides an in-depth understanding of parents’ needs when caring for critically ill children in the hospital setting. Nurses caring for these children should understand the needs of parents and integrate the parents into the daily care of their children. Nurses should also continuously support, inform and engage parents during child-caring procedures. Finally, visiting times for intensive care units should be flexible and allow more time for parents to connect with their hospitalized children.

Introduction: The domain management approach to caring for heart failure patients outlines the importance of considering deficits from multiple health domains including: medical, mental and emotional, physical, and social. The extent to which these deficits exist in patients with HFpEF is unknown. We sought to characterize deficits across multiple domains among patients seen in an outpatient HFpEF program. Hypothesis: We hypothesized that HFpEF patients would have a high prevalence of deficits across multiple domains. Methods: We conducted a retrospective study of 134 patients with HFpEF seen between July 2018 and December 2019 in the Weill Cornell HFpEF Program, which incorporates the domain management approach through several assessments. The medical domain includes an assessment of multimorbidity (≥ 2 comorbid conditions), polypharmacy (≥ 5 medications), malnutrition (Mini Nutritional Assessment < 12), and hearing and vision impairment (self-report). The mental and emotional domain includes cognitive impairment (Mini-Cog < 3), depression (PHQ-9 ≥ 10), and anxiety (GAD-7 ≥ 10). The physical function domain includes frailty (Short Physical Performance Battery < 10), functional impairment (Katz Index < 6), and fall within the past year (self-report). The social domain includes loneliness (UCLA 3-Item Loneliness Scale ≥ 6) and living situation (self-report). Results: The median age was 75 years (IQR 69-82), 60% were women, and 64% were White. The Figure shows the prevalence for each deficit across the four domains. The most common deficits were multimorbidity (100%), polypharmacy (98%), frailty (79%), and loneliness (62%). Notably, 13% of patients had deficits in all four domains, 31% in three domains, 47% in two domains, and 9% in one domain. Conclusions: HFpEF patients have deficits spanning multiple domains. This supports the importance of considering issues such as multimorbidity, polypharmacy, frailty, and loneliness when caring for these patients.

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