Therapeutic effects of targeted nursing interventions combined with auricular-plaster therapy on anxiety level and life quality of Hepatitis B patients.

Mood disorders are common problems in patients with chronic hepatitis B virus (HBV) infection, most clinical treatment focus on anti-viral and anti-fibrosis rather than taking care of mood disorders. In the past decades, we have developed a Chinese medicine treatment method together with nursing intervention, which shows a positive treatment effect on patients. 158 cases of hepatitis B patients were randomly divided into one control group (78 cases), and one observation group (80 cases). The patients in control group received hepatology nursing, liver protecting and transaminase lowering medicine, and ear acupoint bean pressing treatment. In addition to the nursing and treatment as the control group, the patients in observation group were given targeted nursing interventions, including psychological intervention, emotional intervention, cognitive intervention, and systematic family and community support intervention. The anxiety level and sleep quality of patients in both groups were compared. The improvement of hepatic indexes was checked and life qualities in both groups were also compared. Compared to the control group, the patients in the observation group provided have statistically significant mprovement on anxiety control, sleep quality, and hepatic indexes changes (P<0.05). The observation group also showed remarkably better life quality scores (GQLI-64) than the control group (P<0.01). This research confirmed that targeted nursing intervention coupled with ear acupoint bean pressing showed effective improvement on the anxiety control and sleep quality of chronic hepatic B patients, and demonstrated better hepatic index recovery. Patients in the observation group also have higher life quality scores than the control group.

Development and preliminary validation of the chronic hepatitis B self-management scale.

BACKGROUNDS: Chronic hepatitis B (CHB) patients may face many problems resulted from their conditions. To delay the progress of CHB, patients should be responsible for the management of their conditions. There is no dedicated scale for assessing self-management behaviors of CHB patients. OBJECTIVES: This study aimed to develop and validate a self-report measure designed to assess the self-management behaviors for CHB patients (CHBSMS). DESIGN: A cross-sectional descriptive study design. SETTING: Participants were recruited from the infectious disease department of two hospitals in China. PARTICIPANTS: A sample of 248 and 346 CHB patients for item analysis and test for validity and reliability, respectively. METHODS: An initial 45-item scale developed based on item generation and a two-round Delphi survey was assessed by CHB patients for item analysis to develop a final scale. Construct validity was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Chronic Disease Self-Management Behavior Scale (CDSMBS) was used to test the criterion validity. Internal consistency and test-retest reliability were assessed by Cronbach's α coefficient and intraclass correlation coefficient (ICC), respectively. RESULTS: A 25-item scale was developed. EFA indicated a four-factor structure (symptom management, lifestyle management, psychosocial coping and disease information management), which accounted for 58.149% of the total variance. CFA indicated appropriate fit of the four-factor model. The total scores of CHBSMS was correlated with that of CDSMBS (r = 0.634, P < 0.01). The Cronbach's α coefficient (α = 0.887) and the test-retest correlation coefficient (ICC = 0.871) showed good internal consistency and stability of the scale. CONCLUSIONS: The 25-item CHBSMS is a reliable and valid measure that can be used to assess the self-management behaviors of CHB patients for improving patient education and health-related outcomes.

Use of telehealth to treat and manage chronic viral hepatitis in regional Queensland.

For regional and rural Queenslanders, chronic viral hepatitis treatment is a major unmet health need, with restricted access to specialists outside of tertiary, largely metropolitan hospitals. To increase treatment of chronic viral hepatitis in regional Queensland, a team-based telehealth model was expanded. This expansion embedded an initial nursing consultation prior to specialist telehealth consultation. We conducted a retrospective audit of the introduction and expansion of hepatology telehealth services. Activity from July 2014-June 2015 (pre-expansion) was compared with July 2015- June 2016 (post-expansion). Interviews were conducted with key staff to determine factors contributing to success of the service and identify ongoing challenges to the service model. A greater than four-fold increase in clinical consultation was observed (131 telehealth consultations pre-expansion vs 572 post-expansion; p < 0.001). The failure to attend rate decreased (13.0% vs 6.5%, pre vs post-expansion respectively; p = 0.030), suggesting engagement with the service increased. Staff cited nurse-conducted primary assessment prior to specialist consultation and personalised patient treatment packs as key contributors to increased patient flow and engagement. This expanded team approach appears effective in delivering specialised treatment to an underserved area in regional Central Queensland. It may serve as a model to further expand telehealth management of chronic disease for regional Queenslanders.

Feasibility, acceptability and safety of a nurse led hepatitis B clinic based in the community.

AIM: The aim of this study was to investigate if a community based hepatitis B (HBV) nurse clinic is a feasible, acceptable and safe strategy to improve access to best practice chronic hepatitis B care (CHB) in Sydney Local Health District. METHODS: The weekly clinic commenced in an Inner West Sydney Health Centre in November 2012. The CNC responsibilities included patient assessment, management, education, triage, the development of care plans for GPs and GP support. Nursing practice was guided by recommendations from internationally and nationally endorsed CHB Guidelines. Information on patient demographics, clinical findings, triage decisions and sources of referral were collected and used to assess the feasibility, acceptability and safety of the nurse clinic. Patients were also invited to complete a self-administered survey. The survey included questions on attitudes towards the clinic and opinions on barriers to accessing treatment and care. Data was collated and analysed in both Excel and SPPS. RESULTS: In the first 18 months of the clinic 66 people attended, 56 (80%) had CHB, 51 (77%) were born in an Asian country. An equal number of males and females attended. 11 (17%) required further management at a hospital based liver clinic and were referred. 5 (8%) have commenced anti-viral treatment. 24 (36%) met the criteria for six monthly HCC screening and were commenced on HCC surveillance. Twenty-two GPs referred patients. 11 (17%) patients returned the survey and they reported a high level of satisfaction with the clinic and willingness to engage in future CHB care. CONCLUSIONS: This study of a community based CHB nurse clinic shows it is a feasible, acceptable, and safe initiative. The nurse improved access to best practice care and supported patients to effectively manage their CHB. We have confirmed a nurse can have a central role in triage, case management and GP support. Given the high CHB prevalence in our LHD a higher number of GP referrals were expected. Further research on how to increase engagement with GPs and people living with CHB is needed. We plan to expand our model with the CHB nurse conducting assessments and education in GP practices.

Addressing viral hepatitis in the opiate substitution setting: an integrated nursing model of care.

Despite the availability of effective therapies for hepatitis C virus (HCV) and B virus (HBV), only a minority of infected patients receive treatment. In the general population, morbidity and mortality associated with chronic HCV is now successfully being addressed through the use of antiviral therapy. In Australia, an estimated 41% to 68% of people who inject drugs (PWID) are HCV positive, and between 28% and 59% of users are estimated to have been exposed to HBV. Although current treatment guidelines suggest that active drug use should not preclude people from HCV treatment, uptake of therapy thus far has been low. Patient, physician, social, and logistical-related barriers contribute to the low uptake of HCV treatment among PWID. Traditional means of managing HCV infection­referral to secondary or tertiary health centers­historically has a poor track record in increasing therapy uptake among this population. The same is true for people with chronic HBV who inject drugs. Close to 50,000 Australians receive opioid substitution therapy (OST) through a range of services, including public and private clinics, thus this setting is an ideal target for identifying and treating people at risk for and already infected with HBV and HCV. Over the last 11 years, a nursing model of care initiated by a teaching hospital in Sydney, Australia that integrates viral hepatitis screening, assessment, and treatment into the OST setting has enhanced access to services among the marginalized injecting drug use population.

Management of chronic hepatitis B virus.

The management of chronic hepatitis B is complex due to its four disease stages. Monitoring is often required to inform future management; not all patients will require interventions. The long-term goals of treatment are to halt disease progression and to prevent cirrhosis, hepatocellular carcinoma and liver failure. A number of guidelines are available, including those issued by the European Association for the Study of Liver Disease and recently published National Institute of Health and Care Excellence guidelines. This article, the second in a two-part series, discusses the assessment and management of chronic hepatitis B in light of recent guidelines and the role of nurses in caring for patients with CHB. Part 1 looked at the prevalence and pathophysiology of chronic hepatitis B, recommendations for screening high-risk groups and immunisation.

Correlates of hepatitis B virus health-related behaviors of Korean Americans: a situation-specific nursing theory.

PURPOSE: The purpose of this article is to explain the evolution of a situation-specific theory developed to enhance understanding of health-related behaviors of Korean Americans (KAs) who have or are at risk for a chronic hepatitis B virus (HBV) infection. ORGANIZING CONSTRUCT: The situation-specific theory evolved from an integration of the Network Episode Model, studies of health-related behaviors of people with HBV infection, and our studies of and practice experiences with Asian American individuals with HBV infection. FINDINGS: The major concepts of the theory are sociocultural context, social network, individual-level factors, illness experience, and health-related behaviors. CONCLUSIONS: The major propositions of the theory are that sociocultural context, social network, and individual-level factors influence the illness experience, and that sociocultural context, social network, individual-level factors, and the illness experience influence health-related behaviors of KAs who have or are at risk for HBV infection. CLINICAL RELEVANCE: This situation-specific theory represents a translation of abstract concepts into clinical reality. The theory is an explanation of correlates of health-related HBV behaviors of KAs. The next step is to develop and test the effectiveness of a nursing intervention designed to promote behaviors that will enhance the health of KAs who have or are at risk for HBV infection, and that takes into account sociocultural context, social network, individual-level factors, and illness experience.

Managing chronic hepatitis B in children.

Hepatitis B virus (HBV) remains a significant problem worldwide. Despite years of research on this disease, the treatment and management of children with chronic HBV remains a veritable challenge. Although it is less evident in developed countries, HBV still affects immigrants and adopted children from endemic countries. This article discusses the role of the pediatric nurse practitioner in the management of children with chronic hepatitis B in the primary care setting.

[Treatment of chronic hepatitis B in children]. / Die Behandlung der chronischen Hepatitis B bei Kindern.

Hepatitis B virus (HBV) infection is an important health problem. It's believed that there are now at least 400 million carriers of HBV in the world. Infants born to HBeAg-positive carrier mothers have a 60% to 90% chance of contracting chronic hepatitis B infection and of possible subsequent progression to cirrhosis and hepatocellular carcinoma. Treatment of chronic hepatitis B is aimed at sustained suppression of HBV replication and remission of liver disease. Treatment with interferon alpha has a 36% to 45% remission rate after a four-month course of treatment in selected patients. The criteria of good response for the treatment include elevated aminotranspherase levels, the presence of HBV DNA but a level of less than 200 pg/mL, and a liver biopsy suggesting moderate or severe inflammatory activity. Interferon can be used alone or concurrently with lamivudine in chronic hepatitis patients. Although there were hopeful data about the efficacy of lamivudine therapy, the combination of more than one antiviral agent needs to be assessed to improve the actual response rate obtained with interferon-alpha. Preliminary reports suggest that 73% to 86% of patients remained HBeAg-negative after HBeAg seroconversion in clinical trials, but some responders who had early relapse were not included in these follow-up studies, so these results may be overly optimistic.

Individualizing care of hepatitis B in older adults and Asians.

PURPOSE: To review the pathophysiology of hepatitis B virus (HBV) as it relates to special groups such as older adults and Asian populations and to stratify preventive services relative to these particular populations. DATA SOURCES: Selected scientific literature and practice guidelines. CONCLUSIONS: The HBV is one of the most common causes of viral hepatitis. Acute infection is mostly self-limiting with nonspecific symptoms. Chronic infection is characterized by persistent serum levels of Hepatitis B surface antigen (HBsAg) for more than six months. IMPLICATIONS FOR PRACTICE: Chronic HBV is a major risk factor for hepatocellular carcinoma. Special populations, such as older adults with decreased immune response and Asians from places with high endemic HBV infection, are at particularly high risk for progression of HBV infection to chronic states and serious liver damage.