Application of a glycaemic control optimization programme in patients with stress hyperglycaemia.

BACKGROUND: Stress-induced hyperglycaemia (SHG) can be observed in as high as 75% of critically ill patients, which can induce severe complications or adverse events. However, conventional intensive insulin therapy (CIIT) tends to induce hypoglycaemia and glucose variability. AIMS: This study investigated the clinical effects of a blood glycaemic control optimization programme (BGCOP) in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery. DESIGN: This study is a randomized, controlled, prospective clinical observation. METHODS: Eighty-six patients with postoperative SHG were randomly divided into a control and experimental groups. Participants in the control group underwent CIIT, while participants in the experimental group underwent blood glycaemic control optimization programme (BGCOP). A range of 7·8-10·0 mmol/L was designated as the target range for effective control of blood sugar. The validity index, adverse events and complications were compared between two groups. RESULTS: Compared to participants treated with CIIT, participants treated with BGCOP reached the target range of blood sugar levels more quickly (p = 0·000). The high glycaemic index (p = 0·000), incidence of hypoglycaemia (p = 0·011), and other adverse events as well as the incidence of abdominal infection (p = 0·026), incision infection (p = 0·044), and lung infection (p = 0·047) were significantly lower in participants who underwent the BGCOP than in patients treated with CIIT. CONCLUSION: BGCOP can more effectively control blood sugar levels compared with CIIT in patients with SHG after hepatobiliary or pancreatic surgery. RELEVANCE TO CLINICAL PRACTICE: This study provides a direction for blood glycaemic control in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery.

Motivational interviewing: a useful approach to improving cardiovascular health?

AIM: To review and synthesise, systematically, the research findings regarding motivational interviewing and to inform education, research and practice in relation to cardiovascular health. BACKGROUND: Motivational interviewing is designed to engage ambivalent or resistant clients in the process of health behaviour change, and it has been widely used in different clinical conditions such as substance abuse, dietary adherence and smoking cessation. Motivational interviewing has also been proposed as a method for improving modifiable coronary heart disease risk factors of patients. DESIGN: Systematic review. METHOD: Eligible studies published in 1999-2009 were identified from the following databases: CINAHL, Medline, PsycINFO, Cochrane Library, EBSCO, Web of Science, Embase and British Nursing Index. A manual search was conducted of bibliographies of the identified studies and relevant journals. Two researchers independently reviewed the studies. RESULTS: Four meta-analyses, one systematic review and three literature reviews of motivational interviewing and five primary studies of motivational interviewing pertaining to cardiovascular health were identified. Despite a dearth of primary studies in cardiovascular health settings, there appears to be strong evidence that motivational interviewing is an effective approach focusing on eliciting the person's intrinsic motivation for change of behaviour. CONCLUSION: Motivational interviewing is an effective approach to changing behaviour. It offers promise in improving cardiovascular health status. RELEVANCE TO CLINICAL PRACTICE: This review indicates that motivational interviewing is a useful method to help nurses improve health behaviour in people with coronary risk factors.

Quality of life outcomes in chinese patients with implantable cardioverter defibrillators.

BACKGROUND: Patient-centered outcomes for Chinese implantable cardioverter defibrillator (ICD) patients have not been previously studied. This study examined health-related quality of life (HRQL) and its relation with ICD shock-related anxiety, ICD shock, patient acceptance of the ICD, and demographic and clinical characteristics among a sample of Chinese ICD patients. METHODS: Eighty-five ICD recipients completed the Chinese versions of the Short Form (SF-12) Health Survey, Florida Patient Acceptance Survey (FPAS), and Florida Shock Anxiety Scale (FSAS), and a demographic sheet during their follow-up visit. RESULTS: The mean scores of physical component summary and mental component summary (MCS) of ICD patients (41.7 and 46.6, respectively) were lower than the Hong Kong Chinese normative data. As expected, MCS was negatively correlated with shock anxiety (r =-0.38, P < 0.01) and positively correlated with patient acceptance (r = 0.50, P < 0.01). Shock anxiety was negatively correlated with patient acceptance of the ICD (r =-0.58, P < 0.01). Age was positively associated with FPAS (r = 0.55, P = 0.014) while negatively related with FSAS (r =-0.28, P = 0.003). The experience of ICD shock (yes/no) was not associated with any differences but shock frequency groups (no shocks, 1-2 shocks, and ≥3) and gender were significantly different on shock anxiety but not on general mental functioning. CONCLUSION: Higher ICD shock anxiety was associated with lower HRQL and lower ICD acceptance. Age, female, and clinical characteristics such as diabetes, coronary heart disease, and ICD shock experience can influence patient-centric outcomes of HRQL, FPAS, and FSAS. These results extend the evidence for increased clinical attention in Chinese patients to specific outcomes such as shock anxiety and its impact on HRQL.

Gender differences on chest pain perception associated with acute myocardial infarction in Chinese patients: a questionnaire survey.

AIMS: To investigate gender differences in chest pain perception among Chinese patients with acute myocardial infarction. BACKGROUND: Thrombolytic therapy is beneficial to outcomes of acute myocardial infarction if administered within 12 hours from the onset of chest pain. However, cardiac symptom interpretation may impact time of presentation to hospital. Differences in cardiac symptom reports by gender partly explain misdiagnoses and delays in treatment, particularly among women. Whether, such trends apply to Chinese patients with myocardial infarction is unknown. DESIGN: A descriptive prospective study. METHODS: Using questionnaires, data on demographic variables, the number of patients reporting chest pain and other chest sensations at the onset of acute myocardial infarction and chest pain intensity, description, location and radiation across the chest were collected. RESULTS: A total of 128 participants equally divided by gender were recruited. Chest pain was more prevalent among men than women (84.37% vs. 67.19%, p < 0.05). Although no statistical significance was found, Chinese men had higher mean chest pain intensity scores (7.54 SD 2.35 vs. 7.51 SD 2.25) and reported less atypical chest pain (0.00% vs. 9.3%) compared with women. Men had more upper right sided chest pain (40.74% vs. 20.93%, p = 0.038) whereas women experienced increased neck pain and pain to the upper central chest, middle central chest, upper central back, middle central back and middle right back regions. CONCLUSIONS: Discreet gender differences in chest pain perceptions exist between Chinese men and women, with the latter group, who may be considered as a high-risk group for missed and delayed diagnosis from myocardial infarction, reporting more atypical presentations. RELEVANCE TO CLINICAL PRACTICE: Irrespective of culture, women with myocardial infarction tend to present with atypical chest pain symptoms and therefore they should be aggressively investigated.

Chinese couples' experiences during convalescence from a first heart attack: a focus group study.

AIM: This paper is a report of a study to explore Chinese patients' and partners' experiences during early convalescence from a first heart attack. BACKGROUND: There are important socio-cultural differences between Chinese and western populations and comparatively little is known about the experiences of Chinese patients and partners living with a first heart attack. METHOD: A qualitative study using focus groups was conducted in 2005 with 17 Chinese patients and their partners during convalescence from a first heart attack. The interviews were tape-recorded and transcribed. Analysis was used to identify categories using established qualitative phenomenological techniques. FINDINGS: Content analysis of the data revealed five major categories: enduring uncertainty; coping with changes; experiencing emotional reactions; living with medications and needing professional help. CONCLUSION: The experiences of Chinese patients and partners during early convalescence from a first heart attack are different from their western counterparts and are affected by cultural traditions. Findings from this study may provide useful pointers for health professionals to deliver culturally sensitive and appropriate support and education during early convalescence.