Effects of calorie restriction therapy on health-related outcomes in patients with heart failure, a systematic review and meta-analysis.

AIMS: We conducted this systematic review to comprehensively assess the impact of CRT on health-related outcomes among patients with HF. DATA SYNTHESIS: In order to find studies investigating the effect of CRT on health-related outcomes among patients with HF, we performed a systematic search of PubMed, Cochrane Library, Embase, and Cumulative Index to Nursing and Allied Health Literature databases (inception until February 12th, 2023). A total of 10 studies including 933 individuals met the inclusion criteria. The systematic review indicated that 8 to 24 weeks of CRT intervention offered some health advantages for patients with HF. CRT significantly reduced patients' body weight (SMD = - 0.52, 95 % CI = - 0.99 to -0.04, P = 0.03, I2 = 77 %) and improved their quality of life (SMD = 0.35, 95 % CI = 0.12 to 0.58, P = 0.003, I2 = 0 %). However, CRT significantly increased the risk of mortality and HF-related rehospitalization, including combined events of all-cause mortality and HF-related rehospitalization within a year (CRT group: 20 % vs. control group: 5 %), mortality rate within 1.52 years (CRT group: 34 % vs. control group: 22 %), readmission rate (CRT group: 52 % vs. control group: 17 %), and length of stay after readmission (CRT group: 124 days vs. control group:18 days). CONCLUSION: CRT provides no significant benefits in terms of health-related outcomes among patients with HF, hence most patients with HF might not be eligible for CRT treatments. Meanwhile, there are several methodological issues among the studies included in the review, resulting in a low-to-moderate quality of evidence. REGISTRATION: The PROSPERO registration number of this review is CRD 42023413992.

The Impact of Inadequate Energy Intake on Readmission Burden of Patients With Heart Failure.

BACKGROUND: Adequate energy intake is essential for good clinical outcomes. The association between energy intake and readmission burden of patients with heart failure (HF) still needs to be clarified. OBJECTIVE: In this study, our aim was to determine the association between energy intake and readmission in patients with HF. METHODS: A total of 311 inpatients with HF were recruited. Demographic and clinical information were collected during hospitalization; the daily diets of the participants were collected in the second week after discharge using the 3-day diet record, and the energy intake was calculated using a standardized nutrition calculator. The inadequate energy intake was defined as <70% × 25 kcal/kg of ideal body weight. The participants were followed up for 12 weeks after discharge. The number, reasons, and length of stay of unplanned readmissions were collected. Regression analyses were used to evaluate the associations between inadequate energy intake, and readmission rate and readmission days. RESULTS: The median of the energy intake of participants was 1032 (interquartile range, 809-1266) kcal/d. The prevalence of inadequate energy intake was 40%. Patients with inadequate energy intake had a higher risk of unplanned readmission (odds ratio, 5.616; 95% confidence interval, 3.015-10.462; P < .001) and more readmission days (incidence rate ratio, 5.226; 95% confidence interval, 3.829-7.134, P < .001) after adjusting for potential confounders. CONCLUSIONS: Patients with HF had a high incidence of inadequate dietary energy intake, and it increases the burden of readmission.

The Influence of Informal Caregivers' Preparedness on Psychological Symptoms and Quality of Life Among Patients With Heart Failure And Insufficient Self-care.

BACKGROUND: Most patients with heart failure find self-care difficult to perform and rely on family caregivers for support. Informal caregivers, however, often face insufficient psychological preparation and challenges in providing long-term care. Insufficient caregiver preparedness not only results in psychological burden for the informal caregivers but may also lead to a decline in caregiver contributions to patient self-care that affects patient outcomes. OBJECTIVE: Our objective was to test (1) the association of baseline informal caregivers' preparedness with psychological symptoms (anxiety and depression) and quality of life 3 months after baseline among patients with insufficient self-care and (2) the mediating effects of caregivers' contributions to self-care of heart failure (CC-SCHF) on the relationship of caregivers' preparedness with patients' outcomes at 3 months. METHODS: A longitudinal design was used to collect data between September 2020 and January 2022 in China. Data analyses were conducted using descriptive statistics, correlations, and linear mixed models. We used model 4 of the PROCESS program in SPSS with bootstrap testing to evaluate the mediating effect of CC-SCHF of informal caregivers' preparedness at baseline with psychological symptoms or quality of life among patients with HF 3 months later. RESULTS: Caregiver preparedness was positively associated with CC-SCHF maintenance ( r = 0.685, P < .01), CC-SCHF management ( r = 0.403, P < .01), and CC-SCHF confidence ( r = 0.600, P < .01). Good caregiver preparedness directly predicted lower psychological symptoms (anxiety and depression) and higher quality of life for patients with insufficient self-care. The associations of caregiver preparedness with short-term quality of life and depression of patients with HF with insufficient self-care were mediated by CC-SCHF management. CONCLUSIONS: Enhancing the preparedness of informal caregivers may improve psychological symptoms and quality of life of heart failure patients with insufficient self-care.

Sleep profile and the risk of cardiovascular events in patients undergoing percutaneous coronary intervention.

A significant proportion of patients with coronary artery disease (CAD) who undergo percutaneous coronary intervention (PCI) suffer from physical and mental disorders which lead to the decline of sleep profile. Sleep disorders are highly prevalent in these patients. But the effect of sleep on the outcomes of post-PCI patients remains unclear. We aim to examine the individual and joint effects of sleep quality and sleep duration on the risk of adverse cardiovascular events in post-PCI patients. We included 314 participants who were diagnosed with a first CAD and underwent PCI with drug-eluting stents and followed up for a mean duration of 341 days to assess major adverse cardiovascular events (MACEs). Sleep quality, based on the Pittsburgh Sleep Quality Index, was categorized as good (a score of ≤7) or poor (>7). Sleep duration was categorized into three classes: ≤ 5, 6-8 (reference group) and ≥ 9 hours per day. The log-rank test and the Cox regression model were used for data analysis. MACEs occurred in 26 (8.3%) patients. Subjects whose sleep duration was ≤ 5 hours per day had a shorter time to MACEs than those whose sleep duration was 6-8 hours (p = 0.036). A significantly increased risk for MACEs was observed for participants with a ≤ 5 hours sleep duration (HR = 2.18, 95% CI = 1.02-4.64) after adjustment for demographic and clinical confounders. Associations between long sleep duration (≥ 9 hours), sleep quality, or their joint effect and MACEs were not found. This suggests the importance of considering sleep loss when developing strategies to improve health outcomes of PCI patients. And further researches are needed to examine the effects of different aspects of sleep quality on the prognosis of PCI patients and explore the reasons that lead to the decline of sleep profile.

Effect of Dietary Sodium Restriction on the Quality of Life of Patients With Heart Failure: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Dietary salt restriction is recommended by many guidelines for patients with heart failure (HF). Quality of life (QoL) is an important end point of this intervention. However, the literature is still limited regarding the effect of dietary salt restriction on QoL in patients with HF. AIMS: We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of dietary sodium restriction on QoL in patients with HF. METHODS: We searched PubMed (MEDLINE), the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and Cumulative Index to Nursing and Allied Health from the establishment of each database to December 20, 2020. We included randomized controlled trials with sodium restriction as an intervention. The primary outcome was QoL, and the secondary outcomes were mortality, readmission, and fatigue. We obtained the full text of potentially relevant trials, extracted data from the included trials, assessed their risk of bias, and performed a meta-analysis. RESULTS: We included 10 trials (1011 participants with HF) with 7 days to 83 months of follow-up. Dietary sodium restriction did not improve QoL over the long term (>30 days) ( P = .61). The pooled effects showed that this intervention might increase mortality risk ( P < .00001). It did not reduce the readmission rate within the short term (≤30 days) ( P = .78) but increased the readmission rate over the long term ( P = .0003). CONCLUSION: Our study did not show that interventions to restrict dietary sodium had a positive effect on patients with HF in terms of QoL, mortality, or readmission.

The association between poor sleep quality and anxiety and depression symptoms in Chinese patients with coronary heart disease.

Poor sleep quality might be a potentially modifiable predictor of prognosis in patients with coronary heart disease (CHD). Anxiety and depression symptoms are highly prevalent in these patients. Whether anxiety and depression symptoms are risk factors for poor sleep quality in Chinese patients with CHD is unclear. This study is intended to examine the prevalence of poor sleep quality in Chinese patients with CHD and its associations with anxiety and depression symptoms, and to explore whether sex, obesity and CHD type modify these associations. Three hundred and forty-eight participants were included. The Pittsburgh Sleep Quality Index (PSQI, >7 was defined as poor sleep quality) and Hospital Anxiety and Depression Scale (HADS) were used to assess sleep quality and psychological symptoms. 47.1% of the participants had poor sleep quality. Logistic regression analysis showed that poor sleep quality was independently associated with anxiety and depression symptoms adjusting for demographic and clinical factors. However, adjusted for anxiety symptoms, poor sleep quality was no longer associated with depression symptoms. Subgroup and interaction analysis showed that poor sleep quality was associated with markedly higher HADS anxiety and depression scores among patients with stable angina than those with acute coronary syndrome (ACS). These findings suggest that poor sleep quality was associated with both anxiety and depression symptoms in Chinese patients with CHD. However, in the case of concurrent anxiety and depression, anxiety was the main related factor of a high prevalence of poor sleep quality. The association between poor sleep quality and psychological symptoms was influenced by CHD type.

The Role of Dietary Fiber Supplementation in Regulating Uremic Toxins in Patients With Chronic Kidney Disease: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVES: The results of previously published meta-analyses showed that dietary fiber could reduce the levels of p-cresyl sulfate, blood urea nitrogen, and creatinine in patients with chronic kidney disease (CKD). However, these results were based on some trials with pre-post design and randomized controlled trials of low quality. Additionally, it has been suggested that the dosage and duration of fiber supplementation and patients' characteristics potentially influence the effect of dietary fiber in reducing uremic toxins, but it would appear that no research has provided reliable evidence. DESIGN AND METHODS: We searched PubMed, Web of Science, and Cochrane Library. Data were pooled by the generic inverse variance method using random effects models and expressed as standardized mean difference (SMD) with 95% confidence interval (CI). Heterogeneity was quantified by I2. Publication bias was evaluated by Egger's test. RESULTS: Ten randomized controlled trials involving 292 patients with CKD were identified. Dietary fiber supplementation can significantly reduce the levels of indoxyl sulfate (SMD = -0.55, 95% CI = -1.04, -0.07, P = .03), p-cresyl sulfate (SMD = -0.47, 95% CI = -0.82, -0.13, P < .01), blood urea nitrogen (SMD = -0.31, 95% CI = -0.58, -0.03, P = .03), and uric acid (SMD = -0.60, 95% CI = -1.02, -0.18, P < .01), but not on reducing creatinine (SMD = -0.31, 95% CI = -0.73, 0.11, P = .14). In subgroup analyses, the reduction of indoxyl sulfate was more obvious among patients on dialysis than patients not on dialysis (P for interaction = .03); the reduction of creatinine was more obvious among patients without diabetes than those with diabetes (P for interaction <.01). CONCLUSIONS: This meta-analysis indicates that dietary fiber supplementation can significantly reduce the levels of uremic toxins in patients with CKD, with evidence for a more obvious effect of patients on dialysis and without diabetes. These findings inform recommendations for using dietary fiber to reducing the uremic toxin among CKD patients in clinical practice.

Short report: depression and anxiety symptoms as predictors of adverse cardiovascular events in Chinese patients after percutaneous coronary intervention.

Depression and anxiety often co-occur in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI). This study was conducted to examine the predictive value of depression, anxiety, and their combination on the prognosis of Chinese PCI patients. A multicenter prospective study was undertaken with a sample of 309 primary PCI patients. The Hospital Anxiety and Depression Scale (HADS) was completed at baseline to assess anxiety and depression symptoms. Major adverse cardiovascular events (MACEs) were recorded for 12 months after PCI . Days from baseline to the first MACE was the outcome variable. MACEs occurred in 26 (8.4%) patients. After adjustments for socio-demographic and clinical characteristics, a Cox proportional hazards regression model revealed that depression (HR = 2.70, 95% confidence interval [CI] 1.22-5.95; p =.014) and anxiety (HR = 2.56, 95% CI 1.18-5.54; p =.017) symptoms were independent predictors of MACEs. A subanalysis showed that the cumulative event-free survival curves did not differ among depressed and anxious patients and depressed but non-anxious patients (Log Rank p =.52). In conclusion, depression is associated with an increased risk for MACEs post-PCI, independent of anxiety. Although anxiety is associated with MACEs, it has no additional predictive value when co-occurring with depression.

The differences in self-perceptions of aging, health-related quality of life and their association between urban and rural Chinese older hypertensive patients.

BACKGROUND: Most hypertensive clients are elderly, whose health-related quality of life (HRQL) may be associated with self-perceptions of aging (older individuals' beliefs about their own aging). Meanwhile, culture and health disparities between rural and urban populations are substantial. Whether there are differences in self-perceptions of aging, HRQL, and their association among elderly hypertensive clients in urban and rural areas remains unknown. The objective of this study was to investigate and compare self-perceptions of aging and HRQL and their association among urban and rural older Chinese hypertensive clients. METHODS: A cross-sectional investigation was conducted in 15 urban community clinics and 22 village clinics from Suzhou, China. Older hypertensive adults were invited to complete a self-administered questionnaire addressing socio-demographic and clinical information, HRQL and self-perceptions of aging. RESULTS: There were 492 urban participants and 537 rural participants included in the analyses. The physical (40.0 ± 12.1 vs. 30.9 ± 8.9, P <  0.001) and mental (51.5 ± 8.3 vs. 46.0 ± 7.8, P <  0.001) HRQL scores of urban participants were all higher than those of rural ones. Urban participants' scores on dimensions of "timeline cyclical", "consequences negative", and "control negative" of self-perceptions of aging questionnaire (APQ) were lower than those of rural participants (P <  0.001, respectively), while the scores on dimensions of "consequences positive" and "control positive" were higher (P <  0.001, respectively). Adjusted multivariate linear regression showed that participants who had worse self-perceptions of aging had poorer HRQL. Some APQ dimensions associated with urban or rural hypertensive elders' HRQL were different. CONCLUSIONS: Older hypertensive clients in rural areas have poorer self-perceptions of aging and HRQL than those in urban areas. Health care professionals should pay more attention to HRQL and self-perceptions of aging of older hypertensive clients in rural areas.

The self-perceptions of aging were an important factor associated with the quality of life in Chinese elderly with hypertension.

BACKGROUND: In China, quality of life (QOL) of the elderly with hypertension was lower than that of normal elderly and lower self-perceptions of aging (SPA) in the elderly with chronic diseases have been shown. Previous studies showed that SPA played a key role in QOL of the elderly. We hypothesised that SPA were associated with QOL in Chinese elderly with hypertension, with more negative SPA predicting lower QOL. METHODS: A cross-sectional survey was conducted in one comprehensive hospital, 15 urban community clinics and 22 rural village clinics in Suzhou. In total, 1029 Chinese elderly with hypertension completed the self-administered questionnaires, including socio-demographic and clinical characteristics, aging perceptions questionnaire which contained seven dimensions and Medical Outcomes Study 36-item Short Form Health Survey evaluating QOL which included physical component summary (PCS) and mental component summary (MCS). RESULTS: Correlation analysis between SPA and QOL showed that most dimensions of SPA were correlated with PCS and MCS, except for Emotional Representations not correlated with MCS. The results of multivariate logistic regression analysis showed: the dimensions Timeline Chronic (B = -2.651, P < 0.001), Consequences Negative (B = -2.155, P < 0.001) and Emotional Representations (B = -2.672, P < 0.001) had a negative association with PCS, while Timeline Cyclical (B = 1.401, P = 0.023), Consequences Positive (B = 1.200, P = 0.011) and Control Positive (B = 1.425, P = 0.004) had a positive association with PCS; the dimensions Timeline Cyclical (B = -1.734, P < 0.001) and Consequences Negative (B = -1.646, P < 0.001) had a negative association with MCS, while Timeline Chronic (B = 1.313, P < 0.001), Consequences Positive (B = 0.962, P = 0.012), Control Positive (B = 2.453, P < 0.001) and Control Negative (B = 1.860, P < 0.001) had a positive association with MCS. CONCLUSIONS: Our results suggest that negative SPA tended to be associated with lower QOL in Chinese elderly with hypertension. Some measures to improve unhealthy negative SPA should be delivered to improve QOL in Chinese elderly with hypertension.

The association between self-perceptions of aging and antihypertensive medication adherence in older Chinese adults.

BACKGROUND: Approximately one billion adults worldwide are hypertensive and most aged 60 or above. Poor adherence with medication treatment is still one of the main causes of failure in achieving blood pressure control. Compared to younger individuals, aging perception may be the main factor influencing elders receiving preventive care. Some studies have investigated the impact of self-perceptions of aging on some preventive health behaviors including "followed the directions for taking prescription medications" in developed countries in the West. However, there is a scarcity of studies evaluating the self-perceptions of aging and its association with antihypertensive adherence among Chinese older adults. AIM: This study aimed to identify the association between aging perceptions and antihypertensive drug adherence among Chinese older adults. METHODS: A cross-sectional investigation was conducted in wards and outpatient clinic of a University Hospital and communities in Suzhou, China. Older adults who were taking at least one antihypertensive drug currently were invited to complete a self-administered questionnaire, including basic socio-demographic and clinical information, self-reported medication adherence and self-perceptions of aging. RESULTS: From 585 old patients, 34.2 % was determined to have good medication adherence. Logistic regression analysis demonstrated that good adherence to antihypertensive agents was more common among those with lower scores on "timeline cyclical" (p = 0.004) and "identity" (p < 0.001) dimensions, and higher scores on "control positive" (p = 0.004) dimension of aging perceptions. CONCLUSION: Self-perceptions of aging, being significantly associated with medication adherence, are an important starting point when conducting intervention programmes for elder patients.

The Content and Nature of Rumination in Chinese Young and Middle-Aged Patients with Acute Coronary Syndrome: A Qualitative Study.

Individuals have different rumination patterns after experiencing traumatic events in different cultural backgrounds and situations. This study aimed to explore the experience of Chinese young and middle-aged patients with acute coronary syndrome (ACS) to understand the content and nature of their rumination. Sixteen participants were selected using the purposive sampling method in the First Affiliated Hospital of Soochow University from May 2023 to December 2023. Data were collected using semi-structured interviews and analyzed using Colaizzi's seven-step phenomenological method. The participants went through two successive stages: non-adaptive rumination and adaptive rumination. During the initial admission phase, all the participants experienced varying degrees of non-adaptive rumination. Non-adaptive rumination included four sub-themes: worry or anxiety of daily activities and medical therapy (37.50%), fear of unpredictable outcomes and death (37.50%), sadness of maladjustment (25.00%), and remorse of carelessness (12.50%). During the period of stable condition and pre-discharge, the participants received health education and gradually all transitioned to adaptive rumination. Adaptive rumination included four sub-themes: tracing of disease processes (100%), enhancement of disease cognition (81.25%), improvement of health awareness (62.50%), and adjustment of lifestyle cognition (100%). In conclusion, although the Chinese young and middle-aged patients with ACS experienced negative emotions after a traumatic cardiac event, they gradually made positive changes, and optimism and information support played important roles in this transition. The results of this study provide a fundamental understanding of rumination experiences in Chinese young and middle-aged patients with ACS and provide new data for healthcare providers when designing intervention programs to enhance post-traumatic growth in these patients.

Effects of psychological interventions on clinical outcomes in patients with cardiovascular diseases: A systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis to evaluate the effects of psychological interventions on the clinical outcomes of patients with cardiovascular diseases (CVDs). METHODS: We searched PubMed, Web of Science, Embase, the Cochrane Library, and CINAHL from the establishment of each database to August 1, 2023. Randomized controlled trials (RCTs) on psychological interventions in patients with CVDs were included. Statistical analyses were performed using Review Manager 5.3 and Stata 17.0, and pooled measures were presented as the relative risk (RR) and 95 % confidence interval (CI). RESULTS: A total of 32 studies were included, involving 15,814 patients. Our results showed that psychological interventions could reduce cardiac mortality (RR = 0.81, 95 % CI = 0.68 to 0.96) and the occurrence of myocardial infarction (MI) (RR = 0.79, 95 % CI = 0.69 to 0.89), arrhythmia (RR = 0.61, 95 % CI = 0.42 to 0.89) and angina (RR = 0.92, 95 % CI = 0.87 to 0.97). However, no statistically significant differences were detected in the risk of all-cause mortality, all-cause rehospitalization rates, cardiac rehospitalization rates, revascularization, heart failure (HF), or stroke between the psychological intervention and control groups. CONCLUSIONS: Psychological interventions can reduce cardiac mortality and the occurrence of MI, arrhythmia, and angina in patients with CVDs. It is crucial to incorporate psychological interventions into the existing treatment and management of patients with CVDs. High-quality RCTs should be conducted to explore the optimal psychological intervention methods and the maximum beneficiaries.

Effects of weight loss in heart failure patients with overweight and obesity: a systematic review and meta-analysis.

AIMS: To perform a systematic review and meta-analysis to evaluate the impact of weight loss (WL) on the prognosis of overweight and obese patients with heart failure (HF). METHODS AND RESULTS: We reviewed the literature up to 1 February 2023 from PubMed, Web of Science, Embase, Cochrane Library, and Chinese databases for cohort studies, and randomized controlled trials (RCTs). Data from eligible studies were extracted, and statistical analyses were performed using Review Manager 5.3. A total of 19 studies (involving 449 882 patients) were included in the systematic review and meta-analyses. The results showed that WL did not reduce the mortality and rehospitalization rates in overweight and obese HF patients, but could improve the quality of life (P = 0.002), cardiac function (P = 0.0001), and exercise capacity (P = 0.03). The subgroup analysis showed that WL from bariatric surgery (BS) reduced the risk of death (P < 0.00001), WL from medication or exercise was not significantly associated with the risk of death (P = 0.18), and WL was associated with a higher mortality in the subgroup with unspecified WL modality or unintentional WL (P < 0.00001). In addition, it did not reduce the risk of short-term rehospitalization (P = 0.11), but reduced the rehospitalization rates over the long-term (P = 0.03). CONCLUSION: WL improves the long-term rehospitalization (>3 months), quality of life, cardiac function, and exercise capacity in overweight and obese HF patients. Although overall WL is not proven effective, subgroup analysis shows that BS can reduce mortality.

We used mortality, rehospitalization rates, quality of life, the New York Heart Association (NYHA), and 6-min walk test (6 MWT) to assess the impact of weight loss (WL) on the prognosis of overweight and obese heart failure (HF) patients. Key findings: WL is associated with improvements in long-term rehospitalization rates, quality of life, cardiac function, and exercise capacity.Bariatric surgery (BS) may reduce mortality in overweight and obese HF patients. Unintentional WL of more than 5% may mean a bad condition and could increase mortality.

The impact of informal caregivers' preparedness on short-term outcomes of heart failure patients with insufficient self-care.

AIMS: Even though self-care is essential in the long-term management of heart failure (HF), it is often not performed adequately in HF populations. Mobilizing informal caregivers may be one way to help patients perform self-care, support individual needs, and maintain health. However, informal caregivers often face insufficient preparation for providing long-term care. This insufficient caregiver preparedness may lead to a decline in caregiver contributions and affect the outcomes of care in patients with HF. This study aimed to explore whether informal caregivers' preparedness is a predictor that influences short-term outcomes of HF patients; to analyse whether caregiver contribution to self-care of HF (CC-SCHF) plays a mediating role between informal caregivers' preparedness and HF short-term outcomes. METHODS AND RESULTS: A prospective observational study was conducted in China. After controlling for covariates, higher levels of informal caregivers' preparedness were significantly associated with lower 3-month mortality [odds ratio (OR) = 0.919, 95% confidence interval (CI) = (0.855-0.988), P = 0.022] and 3-month readmission rate [OR = 0.883, 95% CI = (0.811-0.961), P = 0.004] and shorter length of hospital stay (ß = -0.071, P < 0.001). The informal caregiver's preparedness was positively associated with CC-SCHF maintenance (r = 0.708, P < 0.01), CC-SCHF management (r = 0.431, P < 0.01), and CC-SCHF confidence (r = 0.671, P < 0.01). The CC-SCHF management was a mediator in the relationship between informal caregivers' preparedness and 3-month readmission rate [effect 95% CI = (-0.054 to -0.001)] and length of hospital stay [effect 95% CI = (-0.235 to -0.042)]. CONCLUSION: A higher level of informal caregivers' preparedness is associated with better short-term outcomes of HF patients with insufficient self-care.

Implementation of the Flipped Classroom Combined with Problem-Based Learning in a Medical Nursing Course: A Quasi-Experimental Design.

Background: Medical Nursing is one of the most important core courses in nursing education, and the emergence of the flipped classroom has made up for the shortcomings of traditional teaching and improved the effectiveness of teaching. However, it is worth exploring how to maximize the effect of students' self-study before class while making full use of classroom teaching to promote the cultivation of students' abilities, so that the flipped classroom can have a maximal teaching effect. Therefore, this study explored the effect of a flipped-classroom teaching mode based on a small private online course (SPOC) combined with problem-based learning (PBL) in a course of Medical Nursing. Methods: Nursing undergraduates from the years 2018 (control group) and 2019 (experimental group), respectively, used the traditional lecture method and the flipped-classroom teaching mode based on a SPOC combined with PBL. The teaching effect was evaluated by teaching-mode-recognition evaluation, critical thinking measurement, and academic achievement. Results: The scores of teaching-mode recognition evaluated by the students in the experimental group were higher than those in the control group in the following five aspects: "helping to improve learning interest" (p = 0.003), "helping to improve autonomous learning ability" (p = 0.002), "helping to improve communication and cooperation ability" (p < 0.001), "helping to cultivate clinical thinking" (p = 0.012), and "helping to promote self-perfection and sense of achievement" (p = 0.001). Compared with the control group, the score on the "analytical ability" dimension of the Critical Thinking Disposition Inventory in the experimental group was higher (p = 0.030). The excellent rates of the final theoretical examination (p = 0.046) and comprehensive case analysis (p = 0.046) in the experimental group were higher than those in the control group. Conclusions: The flipped-classroom teaching mode based on a SPOC combined with PBL can promote students' abilities of autonomous learning, communication and cooperation, and clinical and critical thinking; improves their academic performance; and is recognized and welcomed by them. However, to extend the flipped-classroom teaching model of a SPOC combined with PBL to other nursing education courses, more optimization and evaluation are required.

Association between Dietary Fiber Intake and Incidence of Depression and Anxiety in Patients with Essential Hypertension.

(1) Background: Our previous study found that the dietary fiber supplement in patients with hypertension increased SCFA-producers, Bififidobacterium and Spirillum in the gut microbiota, which may be associated with improvement of depression and anxiety through the gut-brain axis. However, only a few studies have explored the association between dietary fiber intake (DFI) and the incidence of depression and anxiety in hypertensive patients. (2) Methods: A cross-sectional survey was conducted in one comprehensive hospital and one community clinic aimed at understanding the status of DFI and the association between DFI and incidences of depression and anxiety in hypertensive patients. Levels of DFI were obtained through a two-24 h diet recall. According to the levels of DFI from low to high, the participants were divided into Q1, Q2, Q3 and Q4 groups. The Reported Outcomes Measurement Information System short form v1.0-Depression 8b and Anxiety 8a were used to assess patients' levels of depression and anxiety. (3) Results: A total of 459 hypertensive patients were recruited and the daily DFI was 10.4 g. The incidences of hypertension combined with depression and anxiety were 19.6% and 18.5%, respectively. Regression analysis showed statistically significant associations between DFI and depression (B = -0.346, p = 0.001) and anxiety score (B = -0.565, p < 0.001). In logistic regression, after the covariates were adjusted, DFI was associated with the incidence of depression in Q3 (OR 2.641, 95% CI 1.050-6.640) and with that of anxiety in Q1 (OR 2.757, 95% CI 1.035-7.346), compared with Q4. (4) Conclusions: A higher consumption of DF was a protective factor for depression and anxiety in hypertensive patients.

An Almond-Based Low Carbohydrate Diet Improves Depression and Glycometabolism in Patients with Type 2 Diabetes through Modulating Gut Microbiota and GLP-1: A Randomized Controlled Trial.

BACKGROUND: Alow carbohydrate diet (LCD) is more beneficial for the glycometabolism in type 2 diabetes (T2DM) and may be effective in reducing depression. Almond, which is a common nut, has been shown to effectively improve hyperglycemia and depression symptoms. This study aimed to determine the effect of an almond-based LCD (a-LCD) on depression and glycometabolism, as well as gut microbiota and fasting glucagon-like peptide 1 (GLP-1) in patients with T2DM. METHODS: This was a randomized controlled trial which compared an a-LCD with a low-fat diet (LFD). Forty-five participants with T2DM at a diabetes club and the Endocrine Division of the First and Second Affiliated Hospital of Soochow University between December 2018 to December 2019 completed each dietary intervention for 3 months, including 22 in the a-LCD group and 23 in the LFD group. The indicators for depression and biochemical indicators including glycosylated hemoglobin (HbA1c), gut microbiota, and GLP-1 concentration were assessed at the baseline and third month and compared between the two groups. RESULTS: A-LCD significantly improved depression and HbA1c (p <0.01). Meanwhile, a-LCD significantly increased the short chain fatty acid (SCFAs)-producing bacteria Roseburia, Ruminococcus and Eubacterium. The GLP-1 concentration in the a-LCD group was higher than that in the LFD group (p <0.05). CONCLUSIONS: A-LCD could exert a beneficial effect on depression and glycometabolism in patients with T2DM. We speculate that the role of a-LCD in improving depression in patients with T2DM may be associated with it stimulating the growth of SCFAs-producing bacteria, increasing SCFAs production and GPR43 activation, and further maintaining GLP-1 secretion. In future studies, the SCFAs and GPR43 activation should be further examined.

Effect of voluntary breathing exercises on stable coronary artery disease in heart rate variability and rate-pressure product: a study protocol for a single-blind, prospective, randomized controlled trial.

BACKGROUND: At present, China has more than 11 million patients with stable coronary heart disease and this is becoming a major public health problem. The pathological changes of coronary heart disease can lead to dysfunction of the cardiac autonomic nervous system, which increases the risk of complications such as malignant arrhythmia (ventricular flutter, ventricular fibrillation, etc.), heart rate, systolic blood pressure, and rate-pressure product (RPP), which is highly correlated with myocardial oxygen consumption and indirectly reflects myocardial blood supply and oxygen consumption. Although the guidelines recommend that such patients take drugs to reduce heart rate and myocardial oxygen consumption, the clinical control of heart rate is still not ideal. Thus, in this trial, we will use voluntary breathing exercises as the strategy of exercise rehabilitation for patients with stable coronary artery disease (SCAD), in order to increase the vagus nerve activity and/or reduce the sympathetic nervous activity, help maintain or rebuild the balance of plant nerve system, improve the time-domain index of heart rate variability, reduce the burden on the heart, and relieve patients' anxiety and other negative emotions. METHODS: This is a 6-month single-blind, randomized controlled clinical trial that will be conducted in the First Affiliated Hospital of Soochow University. A total of 140 patients who fill out the Informed Consent Form are registered and randomized 1:1 into the Voluntary Breathing Exercises (VBE)-based clinical trial monitoring group (n = 70) or the Routine follow-up group (n = 70). The VBE-based clinical trial monitoring group is given VBE training on the basis of conventional treatment and health education, while the control group received conventional health education and follow-up. The primary outcomes will be measured heart rate variability and RPP. Secondary outcomes will include changes in Self-rating Anxiety Scale, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, weight, and body mass index. DISCUSSION: This trial will carry out scientific respiratory exercise for patients with SCAD, which belongs to the category of active secondary prevention for patients, and changes from remedial to pre-protective. VBE is easy to operate and is not limited by time and place. It is important and meaningful to carry out VBE for patients with SCAD. This study will provide considerable evidence for further large-scale trials and alternative strategies for the rehabilitation nursing of patients with SCAD. TRIAL REGISTRATION: Chinese Clinical Trials Registry, 1900024043 . Registered on 23 June 2019.

Brief, one-on-one, telephone-adapted mindfulness-based stress reduction for patients undergoing percutaneous coronary intervention: a randomized controlled trial.

Psychological distress and negative conditions are highly frequent in patients with percutaneous coronary intervention (PCI). Mindfulness-based stress reduction (MBSR) has been shown to be effective in reducing psychological symptoms in patients with chronic diseases. The available evidence has supported the potential benefit of MBSR for PCI patients. However, the traditional group classroom format and long exercise times of MBSR were deemed as barriers to access for these patients. The aim of this study was to examine the short-term effectiveness of a brief, one-on-one, telephone-adapted MBSR on psychological distress of PCI patients. A randomized controlled trial was conducted. Seventy consecutive PCI patients who met the inclusion criteria were randomized to a three-session mindfulness intervention group (N = 35) or a waitlist control group (N = 35). The Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), and short form of the Freiburg Mindfulness Inventory (FMI-s) were used to assess anxiety and depression, stress, and mindfulness before and after the intervention. Sixty-two patients completed the study. Compared with the waitlist group, the MBSR group showed greater decreases in HADS (p = .006) and PSS (p = .035) scores. The intention-to-treat (ITT) analysis also demonstrated that HADS (p = .018) and PSS (p = .037) scores decreased significantly in the MBSR group compared with those in the waitlist group at Week 6. These effects were mediated by an increase in mindfulness. The brief, one-on-one, telephone-adapted mindfulness intervention can improve psychological symptoms in PCI patients.