Background: In patients with heart failure (HF), malnutrition and dietary sodium excess are common and may worsen outcomes. No prior studies have provided low-sodium, nutritionally-complete meals following HF hospitalization. Methods and Results: The Geriatric OUt-of-hospital Randomized MEal Trial in Heart Failure (GOURMET-HF) study randomized patients discharged from HF hospitalization to four weeks of home-delivered sodium-restricted Dietary Approaches to Stop Hypertension meals (DASH/SRD; 1,500 mg sodium/day) vs. usual care. The primary outcome was the between-group change in the Kansas City Cardiomyopathy Questionnaire (KCCQ) Summary Score from discharge to four weeks post-discharge. Additional outcomes included changes in the KCCQ Clinical Summary Score and cardiac biomarkers. All patients were followed 12 weeks for death/all-cause readmission and potential diet-related adverse events (symptomatic hypotension, hyperkalemia, acute kidney injury). 66 patients were randomized 1:1 at discharge to DASH/SRD vs. usual care (age 71±8 years, 30% female, ejection fraction 39±18%). The KCCQ Summary Score increased similarly between groups (DASH/SRD 46±23 to 59±20 vs. usual care 43±19 to 53±24, p=0.38) but the KCCQ Clinical Summary Score increase tended to be greater in DASH/SRD participants (47±22 to 65±19 vs. 45±20 to 55±26, p=0.053). Potentially diet-related adverse events were uncommon; 30-day HF readmissions (11% vs. 27%, p=0.06) and days rehospitalized within that timeframe (17 vs. 55, p=0.055) trended lower in DASH/SRD participants. Conclusions: Home-delivered DASH/SRD following HF hospitalization appeared safe in selected patients, and had directionally favorable effects on HF clinical status and 30-day readmissions. Larger studies are warranted to clarify the effects of post-discharge nutritional support in patients with HF. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02148679

Community profiling of the oral microbiome requires the recovery of quality sequences in order to accurately describe microbial community structure and composition. Our objective was to assess the effects of specimen collection method, storage medium, and storage conditions on the relative abundance of taxa in saliva and plaque identified using 16S rRNA genes. We also assessed short-term changes in taxon composition and relative abundance and compared the salivary and dental plaque communities in children and adults. Over a 2-week period, four successive saliva and dental plaque specimens were collected from four adults with no dental decay (108 samples), and two successive specimens were collected from six children with four or more erupted teeth (48 samples). There were minimal differences in community composition at the phylum and operational taxonomic unit levels between dental plaque collection using a scaler and collection using a CytoSoft brush. Plaque samples stored in OMNIgene medium showed higher within-sample Shannon diversity, were compositionally different, and were more similar to each other than plaque stored in liquid dental transport medium. Saliva samples stored in OMNIgene recovered similar communities for at least a week following storage at room temperature. However, the microbial communities recovered from plaque and saliva stored in OMNIgene were significantly different in composition from their counterparts stored in liquid dental transport medium. Dental plaque communities collected from the same tooth type over four successive visits from the same adult did not significantly differ in structure or composition. IMPORTANCELarge-scale epidemiologic studies require collection over time and space, often with multiple teams collecting, storing, and processing data. Therefore, it is essential to understand how sensitive study results are to modest changes in collection and storage protocols that may occur with variation in personnel, resources available at a study site, and shipping requirements. The research presented in this paper measures the effects of multiple storage parameters and collection methodologies on the measured ecology of the oral microbiome from healthy adults and children. These results will potentially enable investigators to conduct oral microbiome studies at maximal efficiency by guiding informed administrative decisions pertaining to the necessary field or clinical work. The human oral microbiome includes the microbial communities that live on the tooth enamel, tongue, cheek, palate, tonsils, and gums; each of these niches hosts compositionally diverse microorganisms: viruses, fungi, archaea, bacteria, and protozoa (1-3), in a variety of community structures. Perturbations of oral microbiota are associated with many common dental conditions, including periodontal disease (4), gingivitis (5, 6), and dental caries (7). A number of studies show statistical associations between poor oral health and coronary heart disease (8), endocarditis, preterm birth (9), and exac...

Background The integration of complementary and alternative medicine (CAM) therapies into a large organization such as the Veterans Health Administration (VHA) requires cultural change and deliberate planning to ensure feasibility and buy-in from staff and patients. Currently, there is limited knowledge of VHA patient care providers’ and administrators’ viewpoints regarding CAM therapies and their implementation. Objectives Our purpose was to qualitatively examine knowledge, attitudes, perceived value and perceived barriers and/or facilitators to CAM program implementation among VHA providers and administrators at a large VHA facility. Research design We are reporting the qualitative interview portion of a mixed-methods study. Subjects Twenty-eight participants (patient care providers or administrators) were purposely chosen to represent a spectrum of positions and services. Participants’ experience with and exposure to CAM therapies varied. Measures Individual interviews were conducted using a semi-structured format and were digitally recorded, transcribed, and coded for themes. Results Recurrent themes included: a range of knowledge about CAM; benefits for patients and staff; and factors that can be facilitators or barriers including evidence based practice or perceived lack thereof, prevailing culture, leadership at all levels, and lack of position descriptions for CAM therapists. Participants rated massage, meditation, acupuncture, and yoga as priorities for promotion across the VHA. Conclusions Despite perceived challenges, providers and administrators recognized the value of CAM and potential for expansion of CAM within the VHA. Interview results could inform the process of incorporating CAM into a plan for meeting VHA Strategic Goal One of personalized, proactive, patient-driven healthcare across the VHA.

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