Conducting quality of life research in people with coronary artery disease in non-English-speaking countries: conceptual and operationalization issues.

BACKGROUND: Health-related quality of life is an important clinical outcome to measure in patients with cardiovascular disease. International nurse researchers with limited English skills and novice cardiovascular nurse researchers face numerous challenges when conducting quality of life research because of the conceptual ambiguity of the construct and subsequent operationalization issues as well as difficulty identifying conceptual models to guide their quality of life research. PURPOSE: The overall purpose of this article was to provide guidance to cardiovascular nurse researchers (using Thailand as an example) who are interested in examining quality of life in their native country but lack access to quality of life conceptual models and instruments because of language barriers. This article will examine definitions of health-related quality of life, selection of a conceptual model to guide quality of life research, use of the conceptual model to guide selection and measurement of variables, and translation of instruments when reliable and valid instruments are not available in the native language. CONCLUSIONS: Ferrans' definition of quality of life and the Wilson and Cleary Revised Model of Patient Outcomes were selected to guide the research. Selection of variables/instruments flowed directly from the conceptualization of constructs identified in this model. Our study, "Examining HRQOL in Thai People With Coronary Artery Disease Following Percutaneous Coronary Intervention," serves as an exemplar to illustrate the conceptual and operational challenges associated with conducting quality of life research in Thailand. CLINICAL IMPLICATIONS: The ultimate goal of cardiovascular nursing is to help patients achieve their optimal quality of life. Thai clinicians implementing quality of life assessment in clinical practice face similar conceptual and operationalization issues, especially when using instruments that are not well established or easily interpreted. Although quality of life assessment in clinical practice improves communication between patients and healthcare providers, clear guidelines for making changes to treatment strategies based on changes in quality of life must be established.

Intra-coronary bone marrow mononuclear cell transplantation in patients with ST-elevation myocardial infarction: a randomized controlled study.

BACKGROUND: Stem cell transplantation is a potential treatment to improve left ventricular ejection fraction (LVEF) after ST elevation myocardial infarction (STEMI). However, the outcomes still are controversial. OBJECTIVE: To determine the 6-month LVEF of the patients who underwent intra-coronary bone marrow mononuclear cell (BMC) transplantation in patients with STEMI compared with controlled subjects. MATERIAL AND METHOD: After successful percutaneous coronary intervention (PCI) in STEMI patients who had LVEF was less than 50% were randomized to intra-coronary BMC transplantation or control. Bone marrow aspiration of 100 cc was performed in the morning. After cellprocessing for three hours, the suspension of BMC about 10 cc were infused to infracted area using standard PCI technique. Balloon occlusion for three minutes was performed during cell infusion. Cardiac magnetic resonance imaging was used to determine LVEF scar volume and LV volume before and six-month follow-up. RESULTS: Between September 2006 and July 2008, 23patients (11 in BMC group and 12 in control group) were enrolled. Mean BMC count before transplant was 420 x 10(6) cell with 96% viability. At six-month follow-up, New York Heart Association function class significantly improved in both groups (2.3 +/- 0.6 to 1.2 +/- 0. 4 for BMC and 2.3 +/- 0.7 to 1.3 +/- 0.5 for control group) but no difference was seen between groups. However, scar volume, wall motion score index, and LVEF did not show improvement after six months in both groups (33.7 +/- 7.7 to 33.5 +/- 7.6 for BMC and 31.1 +/- 7.1 to 32.6 +/- 8.3 for control group). No complication was observed during the procedure. CONCLUSION: BMC transplantation intra-coronary in patients with STEMI in KCMH was feasible and safe but LVEF improvement could not be demonstrated.

Feasibility and safety of intra-coronary bone marrow mononuclear cell transplantation in ST elevation myocardial infarction patients.

BACKGROUND: Stem cell transplantation is a potential treatment to improve left ventricular ejection fraction (LVEF) after ST elevation myocardial infarction (STEMI). However technique and mode of transplantation, type of cells, number of cells, and when to transplant are still unknown. OBJECTIVE: To determine the feasibility and safety of bone marrow mononuclear cell (BMC) intra-coronary transplantation and 6-months results in patients with STEMI. MATERIAL AND METHOD: After successful percutaneous coronary intervention (PCI) in STEMI patients who did not have flow re-established within 12 hours and poor LVEF (less than 50%) by echocardiography were enrolled Bone marrow aspiration of 100 cc was performed in the morning. After cell processing for 3 hours, the suspension of BMC about 10 cc were infused to infarcted area using standard PCI technique. Balloon occlusion for 3 minutes was performed during cell infusion. Cardiac magnetic resonance imaging was used to determine LVEF scar volume and LV volume before and 6 months after transplantation. RESULTS: Five patients were enrolled between May and August 2006. Duration of STEMI before transplantation ranged from 18 days to 14 years. Total amount of BMC ranged from 67 x 10(6) to 335 x 10(6). Number of CD 34 and CD 133+ cells were approximation to be 0.7 x 10(6) to 7.7 x 10(6) and 0.01 x 10(6) to 3.04 x 10(6). LVEF was increased from 36.4 at baseline to 43.3 at 6-month. NT pro-BNP level was decreased from 1105 ng/ml at baseline to 288 pg/ml at 6-month. No complications such as chest pain, no re-flow phenomenon, ventricular arrhythmia, or hypotension was detected during the procedure. CONCLUSION: Intra-coronary BMC transplantation in patients with STEMI in our center is feasible and safe. LVEF was slightly improved; however, a randomized controlled study is needed.

Short-term effects of an intensive lifestyle modification program on lipid peroxidation and antioxidant systems in patients with coronary artery disease.

The purpose of this study was to compare the short-term effects of an intensive lifestyle modification (ILM) program on lipid peroxidation and antioxidant systems in patients with coronary artery disease (CAD). Twenty-two patients in the control group continued to receive their conventional treatment with lipid-lowering drugs, whereas 22 patients in the experimental group were assigned to intensive lifestyle modification (ILM) without taking any lipid-lowering agent. The ILM program comprised dietary advice on low-fat diets, high antioxidants and high fiber intakes, yoga exercise, stress management and smoking cessation. After 4 months of intervention, patients in the experimental group revealed a statistically significant increase in plasma total antioxidants, plasma vitamin E and erythrocyte glutathione (GSH) compared to patients in the control group. There was no significant change in plasma malondialdehyde (MDA), a circulating product of lipid peroxidation, in either group. We concluded that the ILM program increased circulating antioxidants and reduced oxidative stress in patients with CAD.