Effects of a culturally tailored low-glycaemic index dietary educational intervention on reducing cardiometabolic risk among Chinese adults with obesity: a randomised controlled trial.

AIMS: An assessor-blinded randomised controlled trial was conducted to assess the effect of a culturally tailored low-glycaemic index (GI) dietary educational intervention on body mass index and cardiometabolic risks for Chinese people with obesity in Hong Kong. METHODS AND RESULTS: A total of 166 Chinese adults in Hong Kong with obesity were randomised to the intervention group (n=83) or the control group (n=83). The intervention group received the culturally sensitive low-GI dietary educational intervention based on the Health Belief Model, consisting of an educational booklet, one individual interactive educational session, and three follow-up telephone calls. The control group received general advice on a healthy diet, including a pamphlet, one individual education session, and three follow-up telephone calls. Outcome measures included body mass index, cardiometabolic risk-factors, dietary intake variables and sense of satiety. Data collection was conducted at baseline and post-intervention at 12-week. Generalized estimating equation model was used to compare the difference in changes in outcome variables between groups. Compared with the control group, the intervention group exhibited a significant reduction in dietary glycaemic load (ß=-6.963, p=0.026) at post intervention. No significant effects were found on other outcomes. CONCLUSION: A 12-week culturally tailored and Health Belief Model-based low-GI dietary educational intervention significantly reduced the dietary glycaemic load and showed the feasibility of the low-GI dietary intervention in Chinese adults in Hong Kong with obesity. A longer intervention period and follow-up might be required to achieve improvements in reducing cardiometabolic risk factors in people with obesity. REGISTRATION: ClinicalTrials.gov Identifier: NCT04152213.

Effectiveness of a home-based music-paced physical activity programme on exercise-related outcomes after cardiac rehabilitation: a randomized controlled trial.

AIMS: A randomized controlled trial was conducted to examine the effects of a home-based music-paced physical activity programme guided by Information-Motivation-Strategy (IMS) model and Self-determination theory on exercise-related outcomes for patients with coronary heart disease (CHD) after cardiac rehabilitation (CR). METHODS AND RESULTS: A total of 130 patients with CHD from a regional CR centre in Hong Kong were recruited and randomly allocated into intervention (n = 65) or control groups (n = 65). The intervention group received theory-guided practical sessions on performing prescribed home-based physical activity with individualized synchronized music, and follow-up telephone calls. The primary outcome was exercise capacity. Secondary outcomes included exercise self-efficacy, physical activity level, and exercise self-determination. Data were collected at baseline, 3 months, and 6 months after study entry. The generalized estimating equations model was used to assess the intervention effects. Patients with CHD in the intervention group demonstrated significantly greater improvements in exercise capacity at 3 months [ß = 35.68, 95% confidence interval (CI) 2.69-68.68, P = 0.034] and significantly improved exercise self-efficacy at 6 months (ß = 3.72, 95% CI 0.11-7.32, P = 0.043) when compared with the control group. However, no significant group differences were found in physical activity level and exercise self-determination. CONCLUSION: The study findings provide evidence on an innovation on improving the exercise capacity and exercise self-efficacy of patients with CHD. The music-paced physical activity guided by the IMS model and Self-determination theory requires further investigation on its long-term effects in future studies. CLINICAL TRIAL REGISTRATION: ChiCTR-IOR-17011015.

Barriers to cardiac rehabilitation and patient perceptions on the usage of technologies in cardiac rehabilitation: A cross-sectional study.

AIMS AND OBJECTIVES: The study aimed to identify factors associated with participation in Phase II cardiac rehabilitation and to assess patient perceptions towards the usage of technologies in cardiac rehabilitation. BACKGROUND: Despite efforts to promote utilisation of cardiac rehabilitation (CR), participation among patients remains unsatisfactory. Little is known of patient decision to participate Phase II CR in a multi-ethnic country. DESIGN: A cross-sectional study design. METHODS: A consecutive sampling of 240 patients with coronary heart disease completed Coronary Artery Disease Education Questionnaire (CADE-Q) II, Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS) and Cardiac Rehabilitation Barriers Scale (CRBS). RESULTS: Seventy per cent of patients (mean age 60.5 [SD = 10.6] years, 80.8% male) participated in phase II cardiac rehabilitation. Self-driving to cardiac rehabilitation centres, higher barriers in perceived need/health care and logistical factors were significantly associated with decreased odds of participation. Patients with more barriers from comorbidities/functional status, higher perceived social support from friends, and anxiety were more likely to participate. Chinese and Indians were less likely to participate when compared with Malays. More than 80% of patients used both home and mobile broadband internet, and 72.9% of them would accept the usage of technologies, especially educational videos, instant messenger, and video calls to partially replace the face-to-face, centre-based cardiac rehabilitation approach. CONCLUSION: Several barriers were associated with non-participation in phase II cardiac rehabilitation. With the high perceived acceptance of technology usage in cardiac rehabilitation, home-based and hybrid cardiac rehabilitation may represent potential solutions to improve participation. RELEVANCE TO CLINICAL PRACTICE: By addressing the barriers to cardiac rehabilitation, patients are more likely to be ready to adopt health behaviour changes and adhere to the cardiac rehabilitation programme. The high perceived acceptance of using technologies in cardiac rehabilitation may provide insights into new delivery models that can improve and overcome barriers to participation.

A Theory-Based, Technology-Assisted Intervention in a Hybrid Cardiac Rehabilitation Program for Patients with Coronary Heart Disease: A Feasibility Study.

PURPOSE: To assess the feasibility of a technology-assisted intervention in a hybrid cardiac rehabilitation program among patients with coronary heart disease. METHODS: This study was a two-arm parallel randomized controlled trial. Twenty-eight patients with coronary heart disease were randomly assigned to either the intervention group, receiving a 12-week technology-assisted intervention (n = 14), or the control group (n = 14), receiving usual care. Guided by the Health Belief Model, the intervention group received three center-based, supervised exercise training sessions, a fitness watch that served as a cue to action, six educational videos, and a weekly video call. The Self-efficacy for Exercise, exercise capacity, and Health Promoting Lifestyle Profile II were assessed at baseline and immediately post-intervention (12-weeks). RESULTS: Among the 28 patients who participated in this study, 85.7% completed the program, with a relatively low attrition rate (14.3%). The number of exercise training sessions accomplished by the participants in the intervention group was 51.27 ± 19.41 out of 60 sessions (85.5%) compared to 36.46 ± 23.05 (60.8%) in the control group. No cardiac adverse events or hospitalizations were reported throughout the study. Participants in the intervention group showed greater improvement in health-promoting behaviors when compared with the control group at 12 weeks. Within-group effects demonstrated improvement in exercise self-efficacy and exercise capacity among participants in the intervention group. A participant satisfaction survey conducted immediately post-intervention revealed that participants were "very satisfied" (23.1%) and "satisfied" (76.9%) with the technology-assisted intervention. CONCLUSIONS: The findings demonstrated that technology-assisted intervention in a hybrid cardiac rehabilitation program was feasible and suggested to be beneficial in improving exercise self-efficacy, exercise capacity, and health promoting behavior among patients with coronary heart disease. A full-scale study is needed to determine its effectiveness in the long term. TRIAL AND PROTOCOL REGISTRATION: ClinicalTrials.gov NCT04862351. https://clinicaltrials.gov/ct2/show/NCT04862351.

Exercise capacity and its determinants among postcardiac rehabilitation patients with coronary heart disease.

AIM: To investigate the determinants of exercise capacity in postcardiac rehabilitation patients with coronary heart disease (CHD). DESIGN: A cross-sectional design was used. METHODS: This study analysed the cross-sectional data from the baseline assessment of 130 CHD patients who participated in a longitudinal randomized controlled trial of music-paced physical activity intervention for CHD patients (ChiCTR-IOR-17011015) (September 2017 to February 2019). Exercise capacity was measured by using the 10-metre incremental shuttle-walk test. The amount of physical activity, exercise self-determination and exercise self-efficacy were measured by validated instruments. Participants' anthropometric parameters (body mass index, body fat mass percentage and waist circumference) were measured. Hierarchical regression analyses were used to identify the factors influencing exercise capacity. RESULTS: The mean incremental shuttle-walk test distance was 493.00 ± 180.04 m. The factors significantly associated with exercise capacity were age (ß = -.42), female (ß = -.35), body mass index (ß = -.25) and exercise self-efficacy (ß = -.20). These factors accounted for 56.5% of the total variance of exercise capacity.

Effects of visual arts-based interventions on physical and psychosocial outcomes of people with stroke: A systematic review and meta-analysis.

Background: Stroke is the leading cause of disability worldwide. People with stroke face a variety of physical and psychosocial issues as a result of their disability. Visual arts-based interventions refer to providing participants with structured visual arts-based activities and non-judgemental and safe environments to improve their health-related outcomes. Recent evidence showed that visual arts-based interventions had the potential to promote the holistic well-being of people with stroke. However, evidence of the effects of visual arts-based interventions on physical and psychosocial outcomes of people with stroke is limited. Objective: (1) To investigate the effects of visual arts-based interventions on physical and psychological outcomes in people with stroke, and (2) to identify the effective regimen of visual arts-based interventions to improve physical and psychosocial outcomes in people with stroke. Design: A systematic review and meta-analysis. Setting: Not applicable. Participants: 483 people with stroke were included in this review. Methods: Fourteen English and five Chinese databases were searched from the date of their inception to February 2022 using keywords based on the Population, Intervention, Comparison, Outcome, and Study framework. Two reviewers independently assessed trial eligibility and risk of bias and extracted data. Methodological quality was assessed using the revised Cochrane risk of bias tool for randomised trials. Meta-analysis was conducted using Review Manager 5.4. Narrative synthesis was performed when meta-analysis was inappropriate to conduct. The Grading of Recommendations, Assessment, Development, and Evaluation Approach was used to assess the certainty of evidence. Results: Seven randomised controlled trials were included. A meta-analysis reported statistically significant effects of visual arts-based interventions on depressive symptoms (Standardized mean difference [SMD]: -1.14, 95% confidence interval [CI]: -1.67 to -0.61; three studies; moderate quality of evidence), activities of daily living (SMD: 0.96, 95% CI: 0.24 to 1.69; four studies; low quality of evidence), and upper limb function (SMD: 0.83, 95% CI: 0.42 to 1.24; two studies; low quality of evidence). Conclusions: Visual arts-based interventions have favourable effects on depressive symptoms, activities of daily living, and upper limb function of people with stroke. However, the quality of evidence ranged from very low to moderate. Limited evidence suggested the effective regimen of visual arts-based interventions. Further rigorous randomised controlled trials should be developed to strengthen the relevant evidence. Registration: Registered at the International Prospective Register of Systematic Reviews on 11 July 2022 (Number: CRD42022334646).

Vasomotor symptoms, cardiovascular risk factors, and cardiovascular disease risk among Chinese postmenopausal women in Hong Kong.

Vasomotor symptoms are frequently reported by postmenopausal women and linked with unfavorable changes in cardiovascular risk factors, suggesting a likely association with cardiovascular disease (CVD) risk. This study aimed to investigate the characteristics of and associations between vasomotor symptoms, cardiovascular risk factors, and CVD risk among Chinese postmenopausal women. From March 2018 to August 2019, a convenience sample of 288 postmenopausal women who experienced natural menopause for ≥12 months were recruited from district centers of women associations in Hong Kong. We assessed vasomotor symptoms, cardiovascular risk factors, and CVD risk using questionnaires, anthropometric measures, and laboratory testing of fasting blood samples. Data were analyzed using bivariate correlation analyses and linear regression analyses. Over half of the participants experienced vasomotor symptoms (50.3 percent), and 23.3 percent had a high 10-year CVD risk. After adjusting for sociodemographic and clinical variables, flashing (ß = 0.270, P = .002) and sweating (ß = > -0.206, P = .018) were significantly associated with low-density lipoprotein cholesterol and flashing (ß = 0.229, P = .007) were significantly associated with total cholesterol. No statistically significant association was observed between vasomotor symptoms and CVD risk. Vasomotor symptoms were common and associated with several cardiovascular risk factors in Chinese postmenopausal women.

Effectiveness of technology-assisted cardiac rehabilitation: A systematic review and meta-analysis.

OBJECTIVES: The objectives of this review were to identify different technology-assisted interventions in cardiac rehabilitation, to explore and examine the effectiveness of technology-assisted cardiac rehabilitation. DESIGN: A systematic review and meta-analysis. METHODS: A systematic search was performed on six electronic databases: CINALH Complete, Cochrane Library, PubMed, MEDLINE via OvidSP, British Nursing Index and PsycINFO to identify randomised controlled trials from 2010 to 2020. Selection of studies was performed by screening the titles, abstracts and full texts, and two reviewers independently and critically appraised the included studies using the revised Cochrane risk of bias tool for randomized trials (RoB 2). RESULTS: Nine randomised controlled trials met the inclusion criteria; five studies with some bias concerns related to allocation concealment (n = 2) and measurement of outcome (n = 4), and four studies were of low risk of bias. The pooled effect size showed comparable effectiveness between technology-assisted cardiac rehabilitation and conventional/centre-based cardiac rehabilitation on modifiable coronary risk factors (systolic and diastolic blood pressure, total cholesterol, p>0.05), psychological outcomes (anxiety: SMD 0.25, 95% CI -0.11 to 0.62, p = 0.17 and depression: SMD 0.09, 95% CI -0.16 to 0.35, p = 0.47). Narrative synthesis was performed for adherence to prescribed exercise sessions in cardiac rehabilitation. No significant adverse events occurred. The adverse events that did occur were self-reported, mostly unrelated to the interventions with technology and the number of events was comparable between both groups. Inconsistent results were found across the studies. This review revealed lack of self-efficacy and behaviour change theories/strategies, and educational emphasis among studies. CONCLUSIONS: The results in the meta-analysis have indicated that technology-assisted cardiac rehabilitation demonstrated comparable results to conventional/centre-based cardiac rehabilitation. Technology-assisted cardiac rehabilitation is a potential alternative not only to remove cardiac rehabilitation barriers but also in the midst of current prolonged pandemic. Future studies on technology-assisted cardiac rehabilitation with the emphasis behavior change theories/strategies and education are required.

Tai Chi in Chinese adults with metabolic syndrome: A pilot randomized controlled trial.

OBJECTIVE: To determine the feasibility, acceptability and effects of a 12-week Tai Chi exercise program on cardiometabolic risk factors and quality of life in community-dwelling Chinese adults with metabolic syndrome. DESIGN: A single blind, pilot randomized controlled trial. SETTING/LOCATION: A general outpatient clinic of a community-based hospital in Hong Kong. SUBJECTS: Ethnic Chinese, 18 years and older, who had at least three of the five criteria of metabolic syndrome defined by the National Cholesterol Education- Adult Treatment Panel III. INTERVENTION: The Tai Chi group attended a 1 -h Tai Chi class, twice a week for 12 weeks, plus 30-minutes home practice three-times per week. The control group maintained their usual daily activities. OUTCOME MEASURES: Primary outcomes were feasibility and acceptability of the Tai Chi intervention. Secondary outcome measures were cardiometabolic risk factors, quality of life, stress and Tai Chi exercise self-efficacy. RESULTS: Study retention rate was 65% (n = 35). Overall satisfaction of completers with the Tai Chi intervention was 4.5 ±â€¯0.63 (possible range = 1-5). When compared to controls, the Tai Chi group had significantly lower systolic blood pressure (p = 0.037) at 12-weeks. Significant within group changes for the Tai Chi group included lower diastolic blood pressure (p = 0.015), higher fasting blood glucose (p = 0.009), higher waist circumference (females only, p = 0.007), and better perceived mental health (p = 0.046); while controls had significantly higher fasting blood glucose (p = 0.031), and higher waist circumference (females only, p = 0.003). CONCLUSION: The study intervention was feasible and acceptable for Chinese adults with metabolic syndrome. While not powered to find statistically significant differences, positive and negative changes were observed in some cardiometabolic risk factors and quality of life. Further investigation with a larger sample size and longer study period is needed to explore potential environmental factors that may have influenced the study results.

Tai Chi exercise is more effective than brisk walking in reducing cardiovascular disease risk factors among adults with hypertension: A randomised controlled trial.

BACKGROUND: Physical inactivity is a major modifiable lifestyle risk factor associated with cardiovascular disease. Tai Chi is a safe and popular form of physical activity among older adults, yet direct comparisons are lacking between Tai Chi and brisk walking in their ability to reduce cardiovascular disease risk factors and improve psychosocial well-being. METHODS: 246 adults (mean age = 64.4 ± 9.8 years, age range = 30-91 years, 45.5% men) with hypertension and at least two but not more than three modifiable cardiovascular disease risk factors (diabetes, dyslipidaemia, overweight, physical inactivity and smoking) were randomly assigned to either Tai Chi (n = 82), brisk walking (n = 82) or control (n = 82) groups. The Tai Chi and brisk walking groups engaged in moderate-intensity physical activity 150 min/week for 3 months; daily home-based practice was encouraged for another 6 months. The primary outcome was blood pressure. Secondary outcomes were fasting blood sugar, glycated haemoglobin, total cholesterol, triglycerides, high- and low-density lipoprotein, body mass index, waist circumference, aerobic endurance, perceived stress, quality of life and exercise self-efficacy. Data were collected at baseline, post-intervention at 3 months and follow-up assessments at 6 and 9 months. Generalised estimating equation models were used to compare the changes in outcomes over time between groups. RESULTS: At baseline, the participants had an average blood pressure = 141/81 and average body mass index = 26; 58% were diabetics, 61% presented with dyslipidemia and 11% were smokers. No significant difference was noted between groups. Tai Chi significantly lowered blood pressure (systolic -13.33 mmHg; diastolic -6.45 mmHg), fasting blood sugar (-0.72 mmol/L), glycated haemoglobin (-0.39%) and perceived stress (-3.22 score) and improved perceived mental health (+4.05 score) and exercise self-efficacy (+12.79 score) at 9 months, compared to the control group. In the Tai Chi group, significantly greater reductions in blood pressure (systolic -12.46 mmHg; diastolic -3.20 mmHg), fasting blood sugar (-1.27 mmol/L), glycated haemoglobin (-0.56%), lower perceived stress (-2.32 score), and improved perceived mental health (+3.54 score) and exercise self-efficacy (+12.83 score) were observed, compared to the brisk walking group. No significant changes in the other cardiovascular disease risk indicators were observed over time between groups. CONCLUSION: Nurses play a key role in promoting exercise to reduce cardiovascular disease risk and foster a healthy lifestyle among adults. Tai Chi is better than brisk walking in reducing several cardiovascular disease risk factors and improving psychosocial well-being, and can be recommended as a viable exercise for building a healthy life free of cardiovascular disease.

Relationship between sleep quality and cardiovascular disease risk in Chinese post-menopausal women.

BACKGROUND: Menopause is an inevitable stage affecting every middle-aged woman. China has a large and increasing group of post-menopausal women. Most post-menopausal women suffer from increased risks for cardiovascular diseases (CVD) and sleep problems. Previous studies have demonstrated the associations between sleep disorders and increased CVD risks in general population. The current study is to examine the relationship between sleep quality and CVD risks among Chinese post-menopausal women. METHODS: This study was a sub-study nested in a cross-sectional study that investigated the sleep quality of community-dwelling adults in Xian, Shaanxi Province, China. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) and the Framingham 10-year risk score (FRS) were used to measure sleep quality and CVD risk among 154 Chinese post-menopausal women. Multivariate regression and logistic regression were used to determine the association between sleep quality and CVD risk. RESULTS: The participants (age: 63.65 ± 4.47 years) experienced poor sleep quality (mean score of global PSQI = 8.58) and a 10-year risk of CVD of 12.54%. The CVD risk was significantly associated with sleep duration (ß = - 0.18, p = 0.04) and sleep disturbance (ß = 0.33, p < 0.001). Women with good sleep quality (PSQI ≤5) were less likely to be at high risk for CVD (FRS > 10%) (odds ratio = 0.51, p = 0.04). CONCLUSIONS: Poor sleep quality might increase the CVD risk in post-menopausal women. Interventions to promote the cardiovascular health of Chinese post-menopausal women may need to include sleep promotion strategies.

Factors associated with diet barriers in patients with poorly controlled type 2 diabetes.

BACKGROUND: The study was conducted to investigate the diet barriers perceived by patients with poorly controlled type 2 diabetes and examine the associations between diet barriers and sociodemographic characteristics, medical condition, and patient-centered variables. METHODS: Secondary subgroup analyses were conducted based on the responses of 246 adults with poorly controlled type 2 diabetes from a multicenter, cross-sectional study. Diet barriers were captured by the Diet Barriers subscale of the Personal Diabetes Questionnaire. Participants also completed validated measures of diet knowledge, empowerment level, and appraisal of diabetes. Multiple regression techniques were used for model building, with a hierarchical block design to determine the separate contribution of sociodemographic characteristics, medical condition, and patient-centered variables to diet barriers. RESULTS: Diet barriers were moderately evident (2.23±0.86) among Chinese patients with poorly controlled type 2 diabetes. The feeling of deprivation as a result of complying with a diet was the most recognized diet barrier (3.24±1.98), followed by "eating away from home" (2.79±1.82). Significantly higher levels of diet barriers were observed among those with lower levels of diet knowledge (ß=-0.282, P<0.001) and empowerment (ß=-0.190, P=0.015), and more negative appraisal (ß=0.225, P=0.003). CONCLUSION: Culturally tailored, patient-centered intervention programs that acknowledge individuals' preferences and allow for flexibility in diet management should be launched. Interventions programs that could enhance diet knowledge, promote positive appraisal, and improve empowerment level might effectively address diet barriers perceived by patients with poorly controlled type 2 diabetes.

Quasi-experimental evaluation of a home care model for patients with stroke in China.

PURPOSE: To evaluate the effectiveness of a modified home care model in China. METHODS: First-time stroke survivors were recruited from a comprehensive teaching hospital in China. Subjects in the intervention group (n = 168) received modified home care involving detailed pre-discharge preparation and post-discharge follow-up lasting one month. The following outcomes were assessed at the end of follow-up: length of hospital stay, satisfaction with acute hospitalisation, medication compliance, complications and stroke-related re-hospitalisation. The outcomes were compared for the intervention group and a historical control group (n = 173) who received routine care. RESULTS: Modified home care was associated with shorter acute hospitalisation (11.29 ± 2.18 vs. 12.36 ± 4.33 d, p = 0.03), higher compliance [161 (95.83%) vs. 92 (53.18%), p = 0.004] and ability to perform daily activities (38.25 ± 10.22 vs. 32.08 ± 10.32, p = 0.03), and a lower rate of re-hospitalisation [2 (1.19%) vs. 11 (6.36%), p = 0.02]. CONCLUSIONS: Home care may be associated with higher quality of life and reduced dependency among stroke patients in China. Implications for Rehabilitation Home care can be effective method at improving the physical and psychological well-being of stroke survivors in China. The home care model in this study can improve health outcomes as well as reduce healthcare resources utilisation. Home care models for stroke survivors should be adapted to local healthcare policies and resources.

Case-Based Web Learning Versus Face-to-Face Learning: A Mixed-Method Study on University Nursing Students.

BACKGROUND: Case-based learning (CBL) is an effective educational method for improving the learning and clinical reasoning skills of students. Advances in e-learning technology have supported the development of the Web-based CBL approach to teaching as an alternative or supplement to the traditional classroom approach. PURPOSE: This study aims to examine the CBL experience of Hong Kong students using both traditional classroom and Web-based approaches in undergraduate nursing education. This experience is examined in terms of the perceived self-learning ability, clinical reasoning ability, and satisfaction in learning of these students. METHODS: A mixture of quantitative and qualitative approaches was adopted. All Year-3 undergraduate nursing students were recruited. CBL was conducted using the traditional classroom approach in Semester 1, and the Web-based approach was conducted in Semester 2. Student evaluations were collected at the end of each semester using a self-report questionnaire. In-depth, focus-group interviews were conducted at the end of Semester 2. RESULTS: One hundred twenty-two students returned their questionnaires. No difference between the face-to-face and Web-based approaches was found in terms of self-learning ability (p = .947), clinical reasoning ability (p = .721), and satisfaction (p = .083). Focus group interview findings complemented survey findings and revealed five themes that reflected the CBL learning experience of Hong Kong students. These themes were (a) the structure of CBL, (b) the learning environment of Web-based CBL, (c) critical thinking and problem solving, (d) cultural influence on CBL learning experience, and (e) student-centered and teacher-centered learning. CONCLUSIONS: The Web-based CBL approach was comparable but not superior to the traditional classroom CBL approach. The Web-based CBL experience of these students sheds light on the impact of Chinese culture on student learning behavior and preferences.

Factors associated with health-related quality of life among patients with implantable cardioverter defibrillator: identification of foci for nursing intervention.

AIM: To explore factors associated with health-related quality of life of patients with implantable cardioverter defibrillators. BACKGROUND: Substantial evidence indicates that implantable cardioverter defibrillator is proven to increase survival rate by terminating life-threatening arrhythmia. However, this device can negatively affect health-related quality of life. Little is known about factors associated with health-related quality of life of patients with implantable cardioverter defibrillators, particularly in Asian population. DESIGN: A transversal descriptive design was used. METHODS: Data were collected from a convenience sample of 139 adult patients with implantable cardioverter defibrillators from 4 January-30 April 2012 using the structured questionnaires administered by the researcher and medical record reviews. The Short Form-36 Health Survey version 2 was used to measure health-related quality of life. RESULTS: A total of 139 Chinese patients, including 107 (77·0%) males with a mean age of 63·0 (14·6) years, were selected. The physical component summary was relatively lower, whereas the mental component summary was relatively higher than that of the general Hong Kong Chinese population. Multivariable regression analysis revealed gender, self-care dependence, educational level, atrial fibrillation, diabetes mellitus, anxiety and depression significantly associated with physical or mental quality of life. CONCLUSIONS: Depression was a common factor affecting physical and mental quality of life. Self-care dependence, atrial fibrillation, diabetes mellitus, depression and anxiety could be improved. Our findings expand existing knowledge on identifying at-risk patients for having lower quality of life, thus allowing development of appropriate interventions targeting risk factors for improving health-related quality of life of patients with implantable cardioverter defibrillator.

The effects of a transtheoretical model-based exercise stage-matched intervention on exercise behavior in patients with coronary heart disease: a randomized controlled trial.

OBJECTIVE: To determine whether a transtheoretical model-based exercise stage-matched intervention (ESMI) has positive effects on the exercise behavior of sedentary patients with coronary heart disease (CHD). METHODS: The study was a randomized controlled trial with a repeated measures design. Participants (N=196) were randomly allocated to either a conventional (C) group, a patient education (PE) group, or an ESMI group. Exercise behavior was measured by exercise stages of change, exercise self-efficacy, exercise decisional balance, and duration of moderate exercise at baseline, immediate post-intervention, and at 3- and 6-month follow-up. RESULTS: Our results showed that the ESMI group demonstrated a more positive shift in exercise stages of change (p<0.01), higher exercise self-efficacy (p<0.01), greater exercise benefits (p<0.01), fewer exercise barriers (p<0.01), and longer moderate exercise duration (minutes/week) (p<0.01) after completion of the 8-week intervention compared with the C and PE groups. These significantly positive effects were maintained at 3- and 6-month follow-up. CONCLUSION: The transtheoretical model-based ESMI had significantly positive effects on the exercise behavior of sedentary CHD patients. PRACTICE IMPLICATIONS: It is important to provide a structured education program for CHD patients, preferably guided by the transtheoretical model.

The psychological effects of a videotape educational intervention on cardiac catheterization patients.

Coronary artery disease (CAD) is one of the leading causes of death and morbidity worldwide, and cardiac catheterization plays an essential role in its diagnostic evaluation. This quasi-experimental study examined the effectiveness of an educational intervention with the use of videotape and pamphlet among the Chinese patient undergoing the cardiac catheterization, and explored the relationship between anxiety, uncertainty, and other psychological variables. One hundred and thirty two Chinese patients of diagnosed or suspected CAD preparing for the first-time catheterization were recruited. Anxiety level (the Chinese State Anxiety Inventory) and uncertainty (the Chinese version of Mishel Uncertainty in Illness Scale) were measured before the intervention and within 2 hours before receiving cardiac catheterization; while patients' satisfaction and perceived knowledge gain were measured at 20-24 hours after it. The mean age of the participants was 61.3 and 64.8% of them were male. The findings indicated that the use of videotape to prepare patients for the cardiac catheterization is effective in reducing the level of anxiety (p < 0.001) and the uncertainty (p < 0.001), as the patients experienced higher satisfaction and knowledge level after the educational intervention. Therefore, videotape education is suggested for cardiac catheterization care on top of the usual pamphlet education.

Effect of early ambulation after transfemoral cardiac catheterization in Hong Kong: a single-blinded randomized controlled trial.

OBJECTIVE: The purpose of the study was to investigate the effect of early ambulation after cardiac catheterization (CC) on patients' back pain, puncture site pain, vascular complications, urinary discomfort, general well-being perception and satisfaction level. METHODS: This study was a randomized single-blinded controlled trial. Overall, 137 participants were randomly assigned to experimental (63 participants) or control (74 participants) group according to a computer generated random list. Early ambulation (ambulate at 4 hours post-CC) and routine post-procedure care of 12 to 24 hours were used in the experimental and control groups respectively. Independent t-test, Chi-square test, multiple logistic regression and generalized estimation equation model were applied to compare various outcomes between experimental and control groups. RESULTS: Only one patient in the control group experienced puncture site bleeding after CC. Ambulation at 4 hours after CC significantly reduced patients' back pain 8 hours after they returned to the unit (OR=0.19, 95% CI: 0.08-0.45, p<0.001) and in the next morning (OR=0.36, 95% CI: 0.15-0.87, p=0.023), decrease urinary discomfort (OR=0.35, 95% CI: 0.14-0.90, p=0.03 for "very or unbearable urination discomfort" and OR=0.22, 95% CI: 0.06-0.74, p=0.015 for "much difficulty or unable to urinate at all"), and increase general well- being (p=0.005 for vitality subscale and p=0.014 for the total general well-being). However, it made no significant differences on puncture site pain as well as the satisfaction level of patients. CONCLUSION: The study enhanced health providers' understanding about the effects of early ambulation on patient outcomes. Nurses may provide more individualized and appropriate care to post-CC patients in a more competent and cost-effective way.

The experiences of Chinese patients with coronary heart disease.

AIM: To explore the experiences of patients with coronary heart disease in China. BACKGROUND: The morbidity and mortality rates of people with coronary heart disease have been growing rapidly in the past decades in China, yet little is known about the experiences of Chinese patients with the disease. DESIGN: A qualitative descriptive study. METHODS: Face-to-face semi-structured interviews were employed in this study. Using a purposive sample, 11 participants who had been diagnosed with coronary heart disease for at least one month were recruited. A content analysis was used to identify themes. RESULTS: Three themes were identified from the data: experiencing a life-threatening illness, strategies for adapting to living with coronary heart disease and help-seeking behaviour. CONCLUSION: Chinese patients with coronary heart disease experienced the disease as a life-threatening illness related to chest pain. Chinese culture, values and beliefs influenced their adaptation strategies and help-seeking behaviour. Their misconceptions about coronary heart disease and the information needs for lifestyle changes were evident in this study. This study highlights the need for health education to support coronary heart disease patients in China. RELEVANCE TO CLINICAL PRACTICE: The findings provide useful information for Chinese health professionals to develop interventions for Chinese patients with coronary heart disease.