The effects of an integrated supportive programme on oral health in patients with head and neck cancer undergoing radiotherapy: A randomized controlled trial.

OBJECTIVES: This study determines the effect of an integrated 12-month follow-up support programme on the oral health of patients with head and neck cancer (HNC) who received radiotherapy (RT). METHODS: Participants were randomly assigned to an intervention group (n = 47) or a control group (n = 45). The intervention group received usual care and an integrated supportive programme, which included face-to-face education and telephone coaching. The control group received usual care. After a clinical dental examination, the prevalence of caries, gingival inflammation and plaque were registered. Oral health impact profile (OHIP)-14 and the WHO Oral Health Questionnaire for Adults were used to evaluate oral health in both groups. RESULTS: A total of 79 participants completed a 12-month follow-up. The intervention group had lower caries increment between baseline and the 12-month follow-up compared with controls, although this was not statistically significant. After 12 months, the intervention group had statistically significant better outcomes in the plaque index (p = 0.038) and the OHIP-14 (p = 0.002) than the control group. No statistically significant differences were found between the two groups concerning gingival index. However, the intervention group reported an overall better state of teeth (p = 0.034) and gums after 12 months (p = 0.042). CONCLUSIONS: The integrated supportive programme showed positive effects on improving oral health in patients with HNC regarding plaque control, the state of teeth and gums and oral health-related quality of life during the 12-month follow-up.

Effects of an integrated supportive program on xerostomia and saliva characteristics in patients with head and neck cancer radiated with a low dose to the major salivary glands: a randomized controlled trial.

BACKGROUND: Xerostomia and changes in saliva characteristics are common side-effects in patients with head and neck cancer (HNC) undergoing radiotherapy, which negatively impact their oral health. However, there are no consensus standards for intervention to manage these problems. The aim of this study was to determine the effect of an integrated supportive program on xerostomia and saliva characteristics at a 1-year follow-up of patients with HNC radiated with a low dose to the major salivary glands. METHODS: The CONSORT guidelines for a randomized controlled trial were used. Participants with a low overall dose to major salivary glands were randomly allocated to an intervention group (n = 47) or a control group (n = 45). The intervention group received usual care and an integrated supportive program, which included three steps: face-to-face education; face-to-face coaching at 1 month post-radiotherapy; and four telephone coaching sessions at 2, 3, 6, and 9 months post-radiotherapy. The face-to-face education consisted of oral hygiene instruction, oral self-care strategies, facial and tongue muscle exercises, and salivary gland massage. Adherence to the intervention was evaluated using a questionnaire completed during the 9 months follow-up. The control group received usual care. The unstimulated saliva flow rate and xerostomia were assessed in both groups. RESULTS: A total of 79 participants (40 in the intervention group and 39 in the control group) completed the 12 months follow-up. The intervention group achieved significantly greater relief from xerostomia than the control group after 3 months (intervention group: 35.1 ± 5.9 versus control group: 38.0 ± 5.9, P = 0.027) and 12 months follow-up (intervention group: 18.5 ± 4.1 versus control group: 22.8 ± 4.3, P < 0.001). A higher unstimulated saliva flow rate was observed in the intervention group than the control group at 12 months follow-up (intervention group: 0.16 ± 0.08 versus control group: 0.12 ± 0.07, P = 0.035). Adherence to the intervention was generally good. CONCLUSION: This integrated supportive program with good adherence relieved xerostomia and had a positive effect on unstimulated saliva flow rate among patients with HNC radiated with a low dose to the major salivary glands during the 12 months of follow-up. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100051876 (08/10/2021), retrospectively registered.

Predictors of treatment benefits after enhanced external counterpulsation in patients with refractory angina pectoris.

BACKGROUND: Enhanced external counterpulsation (EECP) is a noninvasive treatment that can decrease limiting symptoms in patients with refractory angina pectoris (RAP). Identifying responders to EECP is important as EECP is not widely available and relatively time intensive. HYPOTHESIS: The effect of EECP treatment on physical capacity in patients with RAP can be predicted from baseline patient characteristics and clinical factors. METHODS: This explorative study includes all patients from a cardiology clinic who had finished one EECP treatment and a 6 min walk test pre and post EECP. Clinical data, including Canadian Cardiovascular Society (CCS) classification and left ventricular ejection fraction (LVEF), were assessed before treatment. If patients increased their 6 min walking distance (6MWD) by 10% post EECP, they were considered responders. RESULTS: Of the 119 patients (men = 97, 40-91 years), 49 (41.2%) were responders. Multinomial regression analysis showed that functional status (i.e., CCS class ≥3) (OR 3.10, 95% CI 1.12-8.57), LVEF <50% (OR 2.82, 95% CI 1.02-7.80), and prior performed revascularization (i.e., ≤ 1 type of intervention) (OR 2.77, 95% CI 1.06-7.20) were predictors of response to EECP (p < .05, Accuracy 63.6%). Traditional risk factors (e.g., gender, smoking, and comorbidities) did not predict response. CONCLUSIONS: EECP treatment should be considered preferentially for patients that have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularization, either PCI or CABG. Improvement in 6MWD post EECP could imply improvement in physical capacity, which is a likely contributor to improved well-being among patients with RAP.

Assessment of Radiation-Induced Xerostomia: Validation of the Xerostomia Questionnaire in Chinese Patients With Head and Neck Cancer.

BACKGROUND: Xerostomia is a common complication in patients with head and neck cancer (HNC) during and after radiotherapy. The lack of a simply-administered and well-validated self-reported instrument has hampered the assessment and management of xerostomia for research and clinical purposes in China. OBJECTIVE: This study aimed to evaluate the content validity and psychometric properties of the Xerostomia Questionnaire (XQ) in Chinese patients with HNC undergoing radiotherapy. METHODS: This psychometric evaluation study enrolled 80 patients and was conducted in 2 stages: translation and evaluation of content validity and psychometric evaluation. Cognitive interviews (n = 10) were conducted using the Participant Interview Form. The psychometric evaluation (n = 80) included score distribution, homogeneity (interitem and item-total correlations), factor structure (exploratory factor analysis), internal consistency (Cronbach's α), criterion-related validity (person correlation), and test-retest reliability (intraclass correlations). RESULTS: Content validity was supported by cognitive interviews. The factor analysis resulted in a 1-factor solution with strong factor loadings (0.84-0.91) that explained 75.6% of the total variance. The internal consistency was excellent, with a Cronbach's α of .95. The XQ correlated strongly with other measures of xerostomia (0.70-0.80), which supports criterion-related validity. The test-retest reliability was excellent (intraclass correlation coefficient = 0.92). CONCLUSIONS: The result provides evidence for the validity and reliability of the XQ in a sample of Chinese patients with HNC. IMPLICATIONS FOR PRACTICE: The XQ can be used in both clinical practice and research as a valuable tool to screen for problems with xerostomia, monitor the xerostomia level, and evaluate the effects of treatment and interventions among patients with HNC.

Experiences of psychological flow as described by people diagnosed with and treated for head and neck cancer.

PURPOSE: To describe flow as experienced by people diagnosed with and treated for head and neck cancer. METHOD: A descriptive design based on a deductive qualitative content analysis was used to explain Csikszentmihalyi's flow theory from the perspective of people living with head and neck cancer. Interviews were conducted with seven participants diagnosed with and treated for different forms and stages of head and neck cancer. RESULTS: Experiences of flow were associated with people's interests, skill levels and actions involving and creating both happiness and the feeling of something worth living for. Optimal flow was a state of consciousness in which mind and body work together, and the people were completely absorbed in an activity related to nature, hobbies or family. Microflow occurred as part of everyday life, relieving stress and anxiety and helping them to focus on their daily routines. This included humming, listening to the radio or watching TV. CONCLUSIONS: The people's inner strength and desire to feel better made flow possible, and they used unknown skills that enhanced self-satisfaction. Managing self-care activities increased feelings of control, participation and enjoyment. This calls for person-centred care with a salutogenic approach based on the people's own interests, skill levels and actions; what makes the person feel happy.

Using co-design to develop an intervention to improve communication about the heart failure trajectory and end-of-life care.

BACKGROUND: The aim of this paper was to describe the development of an intervention that is developed to improve communication about the heart failure (HF) trajectory and end-of-life care. We also present data that provides a first insight in specific areas of feasibility of the intervention. METHODS: Co-design was used and patients, family members and health care professionals were constructive participants in the design process of the intervention. Feasibility of the intervention was tested in two areas; acceptability and limited efficacy. RESULTS: Two communication tools were designed and evaluated; 1) a Question Prompt List (QPL) for patients and family members and 2) a communication course for professionals which was web -based with one face-to-face training day with simulation. Data on feasibility was collected with questionnaires that were developed for this study, from the 13 participants who completed the course (all nurses). They reported improved knowledge, confidence and skills to discuss the HF trajectory and end-of-life care. The QPL was evaluated to be a useful tool in communication with patients and family members. CONCLUSIONS: In a co-design process, future users identified the need for a QPL and a communication course. These communication tools can be used as a dual intervention to improve communication about the HF trajectory and end-of-life care. The QPL can help patients and families to ask questions about the HF trajectory and end-of-life care. The communication course can prepare the professionals to be knowledgeable, confident and skilled to discuss the questions in the QPL. Before the tools are ready for implementation in clinical practice, further studies testing the feasibility of the intervention are needed, including also patients and their families.

Experiences of xerostomia after radiotherapy in patients with head and neck cancer: A qualitative study.

AIMS AND OBJECTIVES: To describe the experiences of radiation-induced xerostomia in patients with head and neck cancer. BACKGROUND: Xerostomia is the most commonly occurring complication during and following radiotherapy. It can persist for several months or years and can have a significant impact on patients' quality of life. DESIGN: This was a qualitative descriptive study. METHODS: Semi-structured interviews were conducted with a sample of 20 participants. Inductive content analysis was used to analyse the qualitative data. RESULTS: Analysis of the manifest content identified five categories: communication problems, physical problems, psychosocial problems, treatment problems and relief strategies. The latent content was formulated into a theme: due to lack of information from professionals, the patients had to find their own solutions for their problems. CONCLUSIONS: Xerostomia is not only a biophysical symptom but also has a profound effect on the emotional, intellectual and sociocultural dimensions of life. The majority of patients continued to suffer from xerostomia and its associated symptoms after radiotherapy, in part, because of a lack of professional support, including the inability of nurses to provide oral health care. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be knowledgeable about the effects of radiotherapy on oral mucosa and about appropriate interventions. The healthcare system requires a symptom management platform for radiation-induced complications, to help patients, their families and healthcare professionals obtain information about self-care, treatments and relief strategies.

Sexual counselling for sexual problems in patients with cardiovascular disease.

BACKGROUND: Sexual problems are common among people with cardiovascular disease. Although clinical guidelines recommend sexual counselling for patients and their partners, there is little evidence on its effectiveness. OBJECTIVES: To evaluate the effectiveness of sexual counselling interventions (in comparison to usual care) on sexuality-related outcomes in patients with cardiovascular disease and their partners. SEARCH METHODS: We searched CENTRAL, MEDLINE, EMBASE, and three other databases up to 2 March 2015 and two trials registers up to 3 February 2016. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs, including individual and cluster RCTs. We included studies that compared any intervention to counsel adult cardiac patients about sexual problems with usual care. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included three trials with 381 participants. We were unable to pool the data from the included studies due to the differences in interventions used; therefore we synthesised the trial findings narratively.Two trials were conducted in the USA and one was undertaken in Israel. All trials included participants who were admitted to hospital with myocardial infarction (MI), and one trial also included participants who had undergone coronary artery bypass grafting. All trials followed up participants for a minimum of three months post-intervention; the longest follow-up timepoint was five months.One trial (N = 92) tested an intensive (total five hours) psychotherapeutic sexual counselling intervention delivered by a sexual therapist. One trial (N = 115) used a 15-minute educational video plus written material on resuming sexual activity following a MI. One trial (N = 174) tested the addition of a component that focused on resumption of sexual activity following a MI within a hospital cardiac rehabilitation programme.The quality of the evidence for all outcomes was very low.None of the included studies reported any outcomes from partners.Two trials reported sexual function. One trial compared intervention and control groups on 12 separate sexual function subscales and used a repeated measures analysis of variance (ANOVA) test. They reported statistically significant differences in favour of the intervention. One trial compared intervention and control groups using a repeated measures analysis of covariance (ANCOVA), and concluded: "There were no significant differences between the two groups [for sexual function] at any of the time points".Two trials reported sexual satisfaction. In one trial, the authors compared sexual satisfaction between intervention and control and used a repeated measured ANOVA; they reported "differences were reported in favour of the intervention". One trial compared intervention and control with a repeated measures ANCOVA and reported: "There were no significant differences between the two groups [for sexual satisfaction] at any of the timepoints".All three included trials reported the number of patients returning to sexual activity following MI. One trial found some evidence of an effect of sexual counselling on reported rate of return to sexual activity (yes/no) at four months after completion of the intervention (relative risk (RR) 1.71, 95% confidence interval (CI) 1.26 to 2.32; one trial, 92 participants, very low quality of evidence). Two trials found no evidence of an effect of sexual counselling on rate of return to sexual activity at 12 week (RR 1.01, 95% CI 0.94 to 1.09; one trial, 127 participants, very low quality of evidence) and three month follow-up (RR 0.98, 95% CI 0.88 to 1.10; one trial, 115 participants, very low quality of evidence).Two trials reported psychological well-being. In one trial, no scores were reported, but the trial authors stated: "No treatment effects were observed on state anxiety as measured in three points in time". In the other trial no scores were reported but, based on results of a repeated measures ANCOVA to compare intervention and control groups, the trial authors stated: "The experimental group had significantly greater anxiety at one month post MI". They also reported: "There were no significant differences between the two groups [for anxiety] at any other time points".One trial reporting relationship satisfaction and one trial reporting quality of life found no differences between intervention and control.No trial reported on satisfaction in how sexual issues were addressed in cardiac rehabilitation services. AUTHORS' CONCLUSIONS: We found no high quality evidence to support the effectiveness of sexual counselling for sexual problems in patients with cardiovascular disease. There is a clear need for robust, methodologically rigorous, adequately powered RCTs to test the effectiveness of sexual counselling interventions for people with cardiovascular disease and their partners.

Sexual counselling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP).

After a cardiovascular event, patients and their families often cope with numerous changes in their lives, including dealing with consequences of the disease or its treatment on their daily lives and functioning. Coping poorly with both physical and psychological challenges may lead to impaired quality of life. Sexuality is one aspect of quality of life that is important for many patients and partners that may be adversely affected by a cardiac event. The World Health Organization defines sexual health as '… a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences ….'(1(p4)) The safety and timing of return to sexual activity after a cardiac event have been well addressed in an American Heart Association scientific statement, and decreased sexual activity among cardiac patients is frequently reported.(2) Rates of erectile dysfunction (ED) among men with cardiovascular disease (CVD) are twice as high as those in the general population, with similar rates of sexual dysfunction in females with CVD.(3) ED and vaginal dryness may also be presenting signs of heart disease and may appear 1-3 years before the onset of angina pectoris. Estimates reflect that only a small percentage of those with sexual dysfunction seek medical care;(4) therefore, routine assessment of sexual problems and sexual counselling may be of benefit as part of effective management by physicians, nurses, and other healthcare providers.

Enhanced external counterpulsation in patients with refractory angina pectoris: a pilot study with six months follow-up regarding physical capacity and health-related quality of life.

BACKGROUND: Refractory angina pectoris (AP) is a persistent, painful condition characterized by angina caused by coronary insufficiency in the presence of coronary artery disease. It has been emphasized that there are possible underlying neuropathophysiological mechanisms for refractory AP but chronic ischemia is still considered to be the main problem. These patients suffer from severe AP and cannot be controlled by a combination of pharmacological therapies, angioplasty or coronary bypass surgery. AP has a negative impact on quality of life and daily life. Enhanced external counterpulsation (EECP) is a therapeutic option for these patients. AIMS: The aim of this study was to evaluate EECP after six months regarding physical capacity and health-related quality of life (HRQoL) in patients with refractory AP. METHODS: This was a study with single case research experimental design involving 34 patients treated with EECP. Six minute walk test (6MWT), functional class with Canadian Cardiological Society (CCS) classification and self-reported HRQoL questionnaires as Short Form 36 (SF-36) were collected at baseline and after treatment. CCS class and SF-36 were repeated at six months follow-up. RESULTS: Patients enhanced walk distance on average by 29 m after EECP (p<0.01). CCS class also improved (p<0.001) and persisted at six months follow-up (p<0.001). HRQoL improved significantly and the effects were maintained at follow-up after the treatment. CONCLUSION: Patients with refractory AP receive beneficial effects from EECP both in physical capacity and HRQoL. As other treatment options for this patient group are scarce, EECP should be offered to improve physical health and HRQoL in these patients.

Health-related quality of life in family members of patients with an advanced cancer diagnosis: a one-year prospective study.

BACKGROUND: Receiving a cancer diagnosis affects family members as well as the person diagnosed. Family members often provide support for the sick person in daily life out of duty and love, and may not always think of their own vulnerability to illness. To individualise support for them, family members who are most at risk for becoming ill must be identified.The aim of this study was to investigate health-related quality of life (HRQOL) in family members of patients with advanced lung or gastrointestinal cancer 3 to 15 months after diagnosis. METHODS: Data on mental and physical dimensions of HRQOL were collected from family members of these patients in this prospective quantitative study. Five assessments using the Short Form 36 Health Survey (SF-36) and EuroQol (EQ-5D) were conducted during a 1-year period starting 3 months after diagnosis. Thirty-six family members completed the study, i.e. participated in all five data collections. RESULTS: No statistically significant changes in physical or mental HRQOL within the study group appeared over the 1-year follow-up. Compared with norm-based scores, family members had significantly poorer mental HRQOL scores throughout the year as measured by the SF-36. Family members also scored statistically significantly worse on the EQ-5D VAS in all five assessments compared to the norm-based score. Findings showed that older family members and partners were at higher risk for decreased physical HRQOL throughout the 1-year period, and younger family members were at higher risk for poorer mental HRQOL. CONCLUSIONS: It is well known that ill health is associated with poor HRQOL. By identifying family members with poor HRQOL, those at risk of ill health can be identified and supported. Future large-scale research that verifies our findings is needed before making recommendations for individualised support and creating interventions best tailored to family members at risk for illness.

Next-of-kin's conceptions of medical technology in palliative homecare.

AIMS AND OBJECTIVES: Describe next-of-kin's conceptions of medical technology in palliative homecare. BACKGROUND: Next-of-kin to palliative patients are in an exposed position with increasing responsibility. The more involved they are in the care, the greater caregiver burden they describe. Medical technology has become increasingly common in palliative homecare, and previous research suggests that the devices transform the homes to a hospital ward, thus shifting responsibility from the personnel to the next-of-kin. DESIGN: An explorative descriptive design with a phenomenographic approach was chosen to describe qualitatively different conceptions of the phenomenon medical technology. METHOD: Interviews with 15 next-of-kin to patients in palliative homecare were analysed in a seven-step process where 10 conceptions emerged in five description categories. RESULTS: Medical technology in palliative homecare required next-of-kin's responsibility in monitoring or providing practical help. It also implied uncertainty among the next-of-kin because of worries about its safety or because of an improper handling. The technology trespassed on daily life because it restricted and affected the private sphere. Medical technology enabled comfort as it implied security and was a prerequisite for the patient to be cared for at home. It also required an adjustment to comprehend and manage the medical technology. CONCLUSIONS: Medical technology resulted in an increased caregiver burden and uncertainty among the next-of-kin. Although it meant restrictions and affected their social life, they had great confidence in its possibilities. RELEVANCE TO CLINICAL PRACTICE: It is important to limit the amount of personnel and materials in the home to avoid trespassing on the family's daily life. Medical personnel also have to be sensitive to what next-of-kin have the strength to do and not use them as informal caregivers.

Anaemia and iron deficiency in cardiac patients: what do nurses and allied professionals know?

BACKGROUND: Cardiac nurses and allied professionals often take care of patients who also have anaemia or iron deficiency. To deliver optimal care, professionals should be knowledgeable about the prevalence, diagnosis, pathophysiology, and therapeutic management of these conditions. We therefore set out a survey to get a first impression on the current knowledge of nurses and allied professionals on anaemia and iron deficiency. METHOD: A questionnaire was designed for this study by the Undertaking Nursing Interventions Throughout Europe (UNITE) Study Group. Data were collected from 125 cardiovascular nurses and allied professionals visiting the 11th Annual Spring Meeting of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology. RESULTS: Most respondents had general knowledge on the definition of anaemia and iron deficiency and 54% of the respondents rated anaemia and iron deficiency as important when evaluating a cardiac patient. Specific knowledge regarding anaemia and more prominently of iron deficiency was not optimal. CONCLUSION: Although cardiac nurses and allied professionals have basic knowledge of anaemia and iron deficiency, they would benefit from additional knowledge and skills to optimally deliver patient care.

District nurses' conceptions of medical technology in palliative homecare.

AIM: The aim of this study was to describe district nurses' conceptions of medical technology in palliative homecare. BACKGROUND: Medical technology has, in recent years, been widely used in palliative homecare. Personnel with varying degrees of training and knowledge must be able to handle the new technology. METHODS: A descriptive design with a phenomenographic approach was chosen to describe qualitatively different conceptions of the phenomenon medical technology. Interviews with 16 district nurses working with palliative homecare were analysed and five descriptive categories emerged. RESULTS: Medical technology in palliative homecare led to vulnerability because of increasing demands and changing tasks. When medical technology was used in the home it demanded collaboration between all involved actors. It also demanded self-reliance and an awareness of managing medical technology in a patient-safe way. Medical technology provided freedom for the palliative patients. CONCLUSIONS: To maintain patient safety, more education and collaboration with palliative care teams is needed. Next-of-kin are considered as an important resource but their participation must be based on their own conditions. IMPLICATIONS FOR NURSING MANAGEMENT: District nurses need regular training on medical devices, must be more specialized in this kind of care and must not fragment their working time within other specialities.

Next-of-kin caregivers in palliative home care--from control to loss of control.

AIM: This paper is a report of a study to describe situations influencing next-of-kin caregivers' ability to manage palliative care in the home. BACKGROUND: Palliative home care often involves major resources from next-of-kin, municipal and county personnel. Next-of-kin caregivers' situation is depicted as so demanding and exhausting that it can affect their mental health and limit their ability to continue as a caregiver. METHODS: A qualitative study using the Critical Incident Technique was conducted. Nine next-of-kin caregivers from palliative home care were strategically chosen and data were collected using audiotaped interviews in 2005. FINDINGS: The analysis resulted in two main areas: 'Maintaining control' and 'Losing control'. Next-of-kin caregivers wanted to maintain control over their lives by being continuously available 24 hours a day and by supporting and taking complete responsibility for all of the patient's needs. They lost this control when professional assistance was lacking and they described feelings of inadequacy when their physical energy or time was insufficient. They felt incapable as the patient's physical or mental persona metamorphosed or as serious symptoms developed that they could not control. CONCLUSION: Next-of-kin caregivers and the patients must feel free to choose where palliative home care will be provided and that their choice at any time can be re-evaluated, due to insecurity or workload changes. When planning for palliative care, they should be informed that having only one caregiver reduces the chances of completing palliative care in the home.

Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced?

OBJECTIVE: To investigate whether treatment with selective serotonin reuptake inhibitors (SSRIs) could be withdrawn for elderly residents who had been on treatment for at least one year and to evaluate a method for systematic drug review. DESIGN: Open, prospective, interventional study. SETTING: Four counties in Sweden. SUBJECTS: Elderly residents at 19 nursing homes, with ongoing treatment with SSRIs for more than one year. MAIN OUTCOME MEASURES: Clinical evaluation, registration of drugs used and rating with Montgomery-Asberg Depression Rating Scale (MADRS). A semi-structured telephone interview with 15 participating physicians and 19 nurses. RESULTS: About one-third of all 822 residents in the nursing homes had ongoing antidepressant treatment, predominantly with SSRIs; 75% of them had been treated with SSRIs for at least one year and 119 (60%) of these were considered eligible for the study. The intervention was judged successful in 52% of these residents of whom 88% had a MADRS rating of less than 20 points. The GPs and the nurses experienced the method as practicable. CONCLUSIONS: Withdrawal of SSRI treatment was successful in the majority of cases. The MADRS may be a valuable addition to clinical evaluation when deciding whether to end or continue SSRI treatment.

Cardiovascular risk estimation by professionally active cardiovascular nurses: results from the Basel 2005 Nurses Cohort.

BACKGROUND: Nurses play a key role in the prevention of cardiovascular disease (CVD) and one would, therefore, expect them to have a heightened awareness of the need for systematic screening and their own CVD risk profile. The aim of this study was to examine personal awareness of CVD risk among a cohort of cardiovascular nurses attending a European conference. METHODS: Of the 340 delegates attending the 5th annual Spring Meeting on Cardiovascular Nursing (Basel, Switzerland, 2005), 287 (83%) completed a self-report questionnaire to assess their own risk factors for CVD. Delegates were also asked to give an estimation of their absolute total risk of experiencing a fatal CVD event in the next 10 years. Level of agreement between self-reported CVD risk estimation and their actual risk according to the SCORE risk assessment system was compared by calculating weighted Kappa (kappa(w)). RESULTS: Overall, 109 responders (38%) self-reported having either pre-existing CVD (only 2%), one or more markedly raised CVD risk factors, a high total risk of fatal CVD (> or =5% in 10 years) or a strong family history of CVD. About half of this cohort (53%) did not know their own total cholesterol level. Less than half (45%) reported having a 10-year risk of fatal CVD of <1%, while 13% reported having a risk > or =5%. Based on the SCORE risk function, the estimated 10-year risk of a fatal CVD event was <1% for 96% of responders: only 2% had a > or =5% risk of such an event. Overall, less than half (46%) of this cohort's self-reported CVD risk corresponded with that calculated using the SCORE risk function (kappa(w)=0.27). CONCLUSION: Most cardiovascular nurses attending a European conference in 2005 poorly understood their own CVD risk profile, and the agreement between their self-reported 10-year risk of a fatal CVD and their CVD risk using SCORE was only fair. Given the specialist nature of this conference, our findings clearly demonstrate a need to improve overall nursing awareness of the role and importance of systematic CVD risk assessment.

Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization.

BACKGROUND: It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularization (EHSCR) provided an opportunity to assess pharmacological treatment and outcome in patients with proven CAD who were ineligible for revascularization. METHODS: We performed a secondary analysis of EHS-CR data. After excluding patients with ST-elevation myocardial infarction and those in whom revascularization was not indicated, 4409 patients remained in the analyses. We selected two groups: (1) patients in whom revascularization was the preferred treatment option (n = 3777, 86%), and (2) patients who were considered ineligible for revascularization (n = 632, 14%). RESULTS: Patient ineligible for revascularization had a worse risk profile, more often had a total occlusion (59% vs. 37%, p < 0.001), were treated more often with ACE-inhibitors (65% vs. 55%, p < 0.001) but less likely with aspirin (83% vs. 88%, p < 0.001). Overall, they had higher case-fatality at 1-year (7.0% vs. 3.7%, p < 0.001). Regarding self-perceived health status, measured via the EuroQol 5D (EQ-5D) questionnaire, these same patients reported more problems on all dimensions of the EQ-5D. Furthermore, in the revascularization group we observed an increase between discharge and 1-year follow up (utility score from 0.85 to 1.00) whereas patients ineligible for revascularization did not improve over time (utility score remained 0.80) CONCLUSION: In this large cohort of European patients with CAD, those considered ineligible for revascularization had more co-morbidities and risk factors, and scored worse on self-perceived health status as compared to revascularized patients in the revascularization group. With the exception of ACE-inhibitors and aspirin, there were no major differences regarding drug treatment between the two groups. Given these clinically significant observations, there appears to be a role for nurse-led, multidisciplinary, rehabilitation teams that target clinically vulnerable patients whose symptoms remain refractory to standard medical care.

Emotions, the meaning of food and heart failure: a grounded theory study.

BACKGROUND: Many patients with heart failure have generalized wasting, referred to as cardiac cachexia. This leads to skeletal muscle wasting, impaired mobility, reduced functional capacity and poor prognosis. Patients with heart failure have symptoms that can affect their food intake, for example breathing difficulties, fatigue, nausea, loss of appetite, early feeling of fullness and ascites. These dietary problems and patients' nutritional status, can be significantly improved by means of simple nursing interventions. AIM: This paper reports a grounded theory study which developed a theoretical model of experiences of food and food intake among patients with heart failure. METHODS: A descriptive and exploratory design, with a grounded theory analysis, was used. Data were collected in 2002 through interviews with 11 patients with heart failure. FINDINGS: Two core categories emerged: emotions and the meaning of food. Psychosocial meaning could be associated with positive feelings of well-being, or negative feelings of sorrow. Physiological meaning could be associated with positive feelings of comfort or negative feelings of burden. Patients' experiences of food and eating changed during the development of the disease. Feelings of fatigue and lack of appetite gave rise to a feeling of deprivation because of missing both eating and the related social environment. This could lead to a loss of personal identity. DISCUSSION: Although the findings of a qualitative study cannot be generalized, they raise important clinical nursing issues. With increasingly shorter hospital stays, these problems will need to be addressed by community healthcare staff and family carers. Therefore, all healthcare professionals need knowledge about heart disease and information techniques if they are to be able to give appropriate care to this group. CONCLUSION: Ignorance about food and eating can easily lead to malnourishment, with an increased risk of the patients falling into a vicious circle. Implications of the study for health care practice and research are identified.