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1.
Health Qual Life Outcomes ; 19(1): 179, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34247645

RESUMO

BACKGROUND: Fatigability has recently emerged in oncology as a concept that anchors patients' perceptions of fatigue to defined activities of specified duration and intensity. This study aimed to examine the psychometric properties of the Korean version of the Pittsburgh Fatigability Scale (K-PFS) for women with breast cancer. METHODS: This cross-sectional study involved 196 women with breast cancer recruited from a tertiary hospital in Seoul, Korea. Reliability was evaluated using Cronbach's alpha, and confirmatory factor analysis was conducted to examine the factor structure of the K-PFS. Four goodness-of-fit values were evaluated: (1) the comparative fit index (CFI), (2) the Tucker-Lewis index (TLI), (3) the root mean square error of approximation (RMSEA), and (4) the standardized root mean square residual (SRMR). RESULTS: Of the 196 survivors, 71.1% had greater physical fatigability (K-PFS Physical score ≥ 15) and 52.6% had greater mental fatigability (K-PFS Mental score ≥ 13). The Cronbach's alpha coefficient for the total K-PFS scale was 0.926, and the coefficients for the physical and mental fatigability domains were 0.870 and 0.864, respectively. In the confirmatory factor analysis for physical fatigability, the SRMR value (0.076) supported goodness of fit, but other model fit statistics did not (CFI = 0.888, TLI = 0.826, and RMSEA = 0.224). For mental fatigability, although three goodness-of-fit values were acceptable (CFI = 0.948, TLI = 0.919, and SRMR = 0.057), the RMSEA value (0.149) did not indicate good model fit. However, each item coefficient was statistically significant (> 0.5), and the K-PFS was therefore found to be valid from a theoretical perspective. CONCLUSION: This study provides meaningful information on the reliability and validity of the K-PFS instrument, which was developed to meet an important need in the context of breast cancer survivors. Additional research should examine its test-retest reliability and construct validity with performance measures.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Fadiga/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Neoplasias da Mama/complicações , Estudos Transversais , Análise Fatorial , Fadiga/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Reprodutibilidade dos Testes , República da Coreia
2.
J Gerontol Nurs ; 47(6): 35-42, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34044686

RESUMO

Older adults with preclinical cognitive impairment can have chronic conditions and lifestyle factors that influence health. Sedentary behavior is common in older adults with and without chronic kidney disease (CKD). The objective of the current study was to determine the differences in sedentary behavior for older adults with preclinical cognitive impairment with and without CKD. Our study evaluated 48 older adults with preclinical cognitive impairment with and without CKD who underwent assessment of sedentary behavior via accelerometry. We found that older adults with preclinical cognitive impairment with and without CKD were sedentary, but there were no significant differences between groups. Fragmentation index was different (p < 0.05), with a lower fragmentation index found in those with CKD. Sedentary behavior should be assessed and evaluated as a potential target for interventions to improve health in these at-risk older adults; however, further investigation is needed. [Journal of Gerontological Nursing, 47(6), 35-42.].


Assuntos
Disfunção Cognitiva , Insuficiência Renal Crônica , Acelerometria , Idoso , Humanos , Insuficiência Renal Crônica/complicações , Comportamento Sedentário
3.
Nurs Outlook ; 69(2): 136-146, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33573826

RESUMO

BACKGROUND: The COVID-19 pandemic highlighted nurses' compassionate presence during stressful conditions. Strategies to reduce workplace stress are needed. PURPOSE: The purpose of this study was to evaluate a stress reduction strategy, an Internet-based Mantram Repetition Program (MRP), for nurses caring for hospitalized Veterans. METHODS: A one group pre-/post-test design was used to assess change in nurses' perceived outcomes after participating in the MRP. A post-test-only design was used to assess hospitalized Veterans' perceptions of nursing presence and satisfaction with care. Qualitative interviews were used to supplement quantitative data. FINDINGS: Patients perceived high levels of presence and satisfaction with care. Post MRP, nurses perceived increased mindfulness, compassion satisfaction, spiritual well-being, and nursing presence. Increased mindfulness was associated with greater compassion satisfaction and less burnout. DISCUSSION: For nurses working on the front lines of patient care, the potential for experiencing stress and burnout is a reality. Participating in a MRP could lessen these effects and facilitate nursing presence.


Assuntos
Intervenção Baseada em Internet , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem no Hospital/psicologia , Estresse Ocupacional/prevenção & controle , Assistência Centrada no Paciente/organização & administração , Terapias Espirituais , Adulto , Idoso , Esgotamento Profissional/prevenção & controle , COVID-19 , Empatia , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Atenção Plena , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Veteranos/psicologia , Adulto Jovem
4.
Res Nurs Health ; 44(2): 279-294, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33428224

RESUMO

Hopelessness is associated with decreased physical activity (PA) and increased adverse events and death in patients with ischemic heart disease (IHD). Rates of PA in patients with IHD continue to be low in both hospital-based cardiac rehabilitation and home settings. While researchers have investigated strategies to increase PA among patients with IHD, interventions to promote PA specifically in IHD patients who report hopelessness are lacking. We describe the protocol for a NIH-funded randomized controlled trial designed to establish the effectiveness of a 6-week intervention (Heart Up!) to promote increased PA in IHD patients who report hopelessness. Participants (n = 225) are randomized to one of three groups: (1) motivational social support (MSS) from a nurse, (2) MSS from a nurse plus significant other support (SOS), or (3) attention control. Aims are to: (1) test the effectiveness of 6 weeks of MSS and MSS with SOS on increasing mean minutes per day of moderate to vigorous PA; (2) determine the effects of change in moderate to vigorous PA on hopelessness; and (3) determine if perceived social support and motivation (exercise self-regulation) mediate the effects of the intervention on PA. A total of 69 participants have been enrolled to date. The protocol has been consistently and accurately used by research personnel. We address the protocol challenges presented by the COVID-19 pandemic and steps taken to maintain fidelity to the intervention. Findings from this study could transform care for IHD patients who report hopelessness by promoting self-management of important PA goals that can contribute to better health outcomes.


Assuntos
Atitude , COVID-19/psicologia , Exercício Físico/psicologia , Motivação , Isquemia Miocárdica/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Apoio Social , Adulto , Humanos , Entrevista Motivacional , Envio de Mensagens de Texto
5.
Heart Lung ; 50(1): 136-145, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33143912

RESUMO

BACKGROUND: Physical activity can optimize patient outcomes after cardiac surgery, but postoperative patients' physical activity generally has been inadequate. No review studies have focused on factors influencing cardiac patients' postoperative physical activity. OBJECTIVES: To identify factors influencing physical activity in patients after cardiac surgery. METHODS: This study was conducted following Whittemore and Knafl's methodology. CINAHL, MEDLINE, PsychINFO, Scopus, and Embase were searched and selected studies were analyzed using the Matrix Method. RESULTS: In 12 studies, factors facilitating physical activity included personal, socio-environmental, and intervention-related factors. Barriers to physical activity included personal, socio-environmental, and cardiac rehabilitation program-related factors. The most common predictor of physical activity was male sex, and the most frequent barrier was comorbidities. CONCLUSIONS: This study revealed facilitators and barriers that significantly influenced physical activity after cardiac surgery. Healthcare providers and exercise guideline developers should consider our findings when devising physical activity strategies for postoperative cardiac patients.


Assuntos
Reabilitação Cardíaca , Procedimentos Cirúrgicos Cardíacos , Exercício Físico , Pessoal de Saúde , Humanos , Masculino
6.
Nurs Res ; 70(1): 72-79, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32956255

RESUMO

BACKGROUND: Investigators conducting studies that include potentially suicidal individuals are obligated to develop a suicide risk management (SRM) protocol. There is little available in the literature to guide researchers in SRM protocol development. OBJECTIVES: The aim of the study was to describe an SRM protocol developed for a randomized controlled trial (RCT) currently enrolling cardiac patients who report moderate to severe levels of hopelessness. METHODS: The SRM protocol identifies suicidal ideation and measures ideation severity through use of the Columbia-Suicide Severity Rating Scale risk factor questions. Based on responses, study participants are deemed safe or at low, moderate, or high risk for suicide. The SRM protocol guides research staff through a plan of action based on risk level. The protocol further guides staff through a plan over the course of this prospective study-from hospital enrollment to home-based visits. RESULTS: Research staff are well trained to identify suicidal ideation risk factors, initiate specific questioning about suicidal intent, determine level of risk, identify protective factors and a safe environment, and make referrals if needed. Of the 51 patients hospitalized with cardiac disease who reported moderate to severe hopelessness, 43 scored at a safe suicide risk level and 8 scored at low risk. Thirty-five of the 51 patients enrolled in the RCT. Of the 35 participants who received home visits to date, there have been three instances of low and one instance of moderate suicide risk. The SRM protocol has been consistently and accurately used by research personnel in both hospital and home settings. One modification has been made to the protocol since study activation, namely, the addition of an assessment of counseling history and encouragement of continued counseling. Booster training sessions of research staff will continue throughout the course of the RCT. DISCUSSION: Use of the SRM protocol identifies study participants who are safe or at risk for suicide in both hospital and home settings, and research staff can refer participants accordingly. CONCLUSION: The SRM protocol developed for this RCT can serve as a model in the development of SRM protocols for future research in acute care, community, or home-based settings.


Assuntos
Cardiopatias/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Gestão de Riscos/métodos , Gestão de Riscos/normas , Estresse Psicológico/prevenção & controle , Suicídio/prevenção & controle , Suicídio/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Estados Unidos
7.
Cancer Nurs ; 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-33003122

RESUMO

BACKGROUND: A culture of serious overwork in South Korea, more than other developed countries, may impact symptoms and quality of life (QOL) experienced by Korean breast cancer survivors (BCS). OBJECTIVES: The aim of this study was to examine health-related QOL and influencing factors in BCS in Seoul, Korea, who have recovered from treatment for at least 1 year and returned to normal life and work. METHODS: In a cross-sectional study, 199 BCS completed a self-administered questionnaire in Seoul, Korea. RESULTS: Mean QOL scores were lower than expected, with 49% of the variance explained by depressive symptoms, physical fatigability, cognitive impairment, and social support. Psychological distress was high (67.8%), along with anxiety (47.2%) and depressive symptoms (36.7%). Participants reported a high prevalence of physical fatigability (71.1%), sleeping an average of only 6 hours per night, with 58.9% reporting poor quality sleep. CONCLUSIONS: Quality of life was lower in Korean BCS than comparable studies in the United States, although participants received care at a premiere medical center. Depressive symptoms and anxiety were common and did not taper off over the 5 years after diagnosis, unlike BCS elsewhere. Korean survivors experienced significant physical fatigability, much higher than reported in a US study of mixed male and female cancer survivors. Overwork was not a significant predictor of QOL, although 30% of employed women reported working 45 to 90 hours weekly. IMPLICATIONS FOR PRACTICE: Findings demonstrate the importance of continued efforts to mitigate these symptoms in clinical survivorship care, as well as future research, to provide avenues for improving QOL for BCS, particularly in Korea.

8.
Aging Clin Exp Res ; 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32902822

RESUMO

BACKGROUND: Cognitive impairment is a common complication of aging that is also associated with chronic kidney disease (CKD). Vascular dysfunction has been implicated as a potential cause of cognitive impairment in older adults, with particular deficits noted in those with CKD. AIMS: To determine the differences in cognitive function and vascular compliance in older adults with and without CKD with preclinical cognitive impairment and the relationship between these factors. METHODS: Utilizing a cross-sectional approach, 48 older adults with preclinical cognitive impairment (24 with and 24 without CKD) were evaluated for performance on a test of global cognition and executive function, and vascular compliance via tonometry and ultrasound. RESULTS: Cognitive function and some indicators of vascular function were significantly different in older adults with and without CKD. Global cognition was correlated with carotid-femoral pulse wave velocity (r = - 0.36, p = 0.02) in the entire sample. Vascular function was not correlated with executive function. DISCUSSION: Older adults with preclinical cognitive impairment and CKD had different cognitive and vascular function than those without CKD, and an indicator of vascular function may have a relationship with cognitive function in older adults. CONCLUSIONS: The findings of this study support the assessment of cognitive and vascular function in older adults with and without CKD with preclinical cognitive impairment.

9.
Geriatr Nurs ; 41(6): 872-877, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32586622

RESUMO

Physical inactivity and sleep disturbance are more problematic in patients with chronic obstructive pulmonary disease (COPD) than in healthy individuals. The purpose of the study was to identify impacts of nighttime sleep on next-day physical activity in COPD patients. The study included 52 COPD patients reporting disturbed sleep. Sleep and physical activity were measured using an accelerometer for 5 days. Increased sleep latency was associated with less next-day physical activity during the afternoon (4-6 p.m.). Greater waking duration/times were associated with less next-morning (6-8 a.m.) physical activity. Greater total sleep time was associated with less next-morning (12-9 a.m.) physical activity, and greater sleep efficiency was associated with less next-morning (1-3 a.m.) and more next-evening (6-7 p.m.) physical activity. Results suggest that sleep disturbance had varying influences on next-day hourly physical activity. These results support the potential value of sleep management in promoting physical activity in COPD patients.

10.
Biol Res Nurs ; 22(2): 197-204, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32008368

RESUMO

OBJECTIVE: Fatigue is a pervasive and serious complaint among aging adults with type 2 diabetes. Anecdotally, hyperglycemia was thought to cause fatigue, but prior cross-sectional analyses failed to find any relationship between glucose levels and fatigue. However, study methodology may have caused this relationship to be missed. Our aim was to use concurrent and continuous data across 5 days to examine real-time momentary relationships between glucose and fatigue levels by week, day, and time of day. Additionally, we explored how these relationships differed by sex. METHOD: Participants (N = 54, 51% male, 54% non-White) wore continuous glucose monitors and wrist actigraphy into which they inputted fatigue ratings 6-8 times daily during waking hours across 5 days. Generalized estimation equation models were used to explore the relationship between glucose and fatigue when averaged by week, day, and time of day. Differences by sex were also explored. RESULTS: HbA1c and baseline and real-time fatigue were higher in women than in men. Baseline HbA1c and self-reported general fatigue were unrelated. Fatigue levels averaged by day and time of day were higher in women than in men (p < .05). Glucose and fatigue were significantly related at all levels of data (weekly, daily, and time of day) in women but not men. CONCLUSIONS: Our findings suggest that, when measured concurrently, glucose excursions may affect fatigue levels in women.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Fadiga/etiologia , Fadiga/fisiopatologia , Hiperglicemia/fisiopatologia , Actigrafia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores de Tempo
11.
Res Nurs Health ; 43(3): 241-254, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32067248

RESUMO

A person's beliefs about their chronic condition (illness representations) influence health and treatment outcomes. Recently, researchers have used clustering approaches to identify subgroups with different patterns of beliefs about their illness, with some subgroups having more favorable health outcomes than others. To date, these findings have not been synthesized. The purpose of this systematic review of the literature was to synthesize results of studies that used clustering approaches to analyze illness representation in chronic disease populations, in order to characterize the clusters and their relationship to health outcomes. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines we searched CINAHL, PsycInfo, and PubMed. To be included, studies had to be (a) peer reviewed, (b) in English, (c) performing a cluster analysis (CA), latent class analysis (LCA), or latent profile analysis (LPA), (d) using only illness representation (IR) subscales to form clusters, (e) measuring illness representation with the Illness Perception Questionnaire (IPQ-R), (f) in a chronic condition sample, and (g) measuring health-related outcomes. Twelve studies were included. Across studies, the number of clusters found ranged from two to three. In all studies, an association was found between illness representation group and at least one of their health outcomes. Illness representation clusters associated with favorable outcomes usually included lower disease-related consequences, fewer symptoms, less negative emotion, and a more stable disease pattern. The results of this review indicate that the relationship between the patterns of the illness representation profiles and health outcomes transcend diseases. Additionally, some dimensions of illness representation may be more important drivers of group membership than others.


Assuntos
Atitude Frente a Saúde , Doença Crônica/psicologia , Avaliação de Resultados em Cuidados de Saúde , Análise por Conglomerados , Emoções , Feminino , Humanos , Comportamento de Doença , Masculino
12.
Heart Lung ; 49(3): 324-328, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32067724

RESUMO

OBJECTIVE: To evaluate if there is an increase in 6-minute walk distance in individuals with chronic obstructive pulmonary disease (COPD) while walking to rhythmically enhanced music. BACKGROUND: Individuals with COPD are less active. Walking with rhythmically enhanced music may help Participant's walk farther while simultaneously distracting from symptoms of dyspnea. METHODS: Twenty-five men (age = 70.7 ± 4.5 yr), with moderate-to-severe COPD (FEV1 = 47.4 ± 9.7% predicted) completed three, 6 min walk tests (6MWT) in random order. Walks were completed with music, with music that was rhythmically enhanced, or without music. Walking distance and perceived dyspnea were measured. RESULTS: Participant's walked 12 m, 95% CI [20.5-, 2.6], p = 0.015 further during the 6MWT when listening to rhythmically enhanced music when compared to no music. Onset of dyspnea was not different between the three walking conditions. CONCLUSIONS: Rhythmically-enhanced music may be a useful tool to increase walking distance in Participant's with COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Caminhada , Estimulação Acústica , Dispneia/etiologia , Teste de Esforço , Tolerância ao Exercício , Humanos , Masculino , Teste de Caminhada
13.
Jpn J Nurs Sci ; 17(2): e12301, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31721460

RESUMO

AIM: During cross-cultural instrument development, a gap commonly exists between the intended meaning of questionnaire items and the extent to which the participant understands that meaning. Because cognitive interviewing can provide such a powerful means for ensuring an accurate interpretation of items, the purpose of this report is to provide a practical guide to encourage its use in nursing research. METHODS: This report provides in-depth information describing: (a) advantages of cognitive interviewing, particularly for cross-cultural instrument development; (b) specific problems it can identify and solve; (c) strategies for performing cognitive interviews, including the four-step model of the question-and-answer process; (d) practical guidance for conducting successful cognitive interviews. RESULTS: To achieve linguistic validity as well as cultural relevance, a variety of factors need to be considered in addition to language, such as cultural interpretations, attitudes, and values. Examples of health-related studies are presented, demonstrating the advantages of cognitive interviewing for instrument development and cross-cultural research. These examples show how cognitive interviewing can be productively used to verify question clarity, patient comprehension, and patients' ease of response and judgment while also helping to establish content validity based on patients' perspectives. CONCLUSIONS: Cognitive interviewing can help nurse researchers discover potential instrument flaws and correct them in advance, subsequently avoiding collection of inaccurate data. Thus, cognitive interviewing should be considered an effective pretesting method for development of accurate instruments, particularly in cross-cultural nursing research.


Assuntos
Comparação Transcultural , Pesquisa em Enfermagem , Inquéritos e Questionários , Adulto , Cognição , Feminino , Humanos , Masculino , Projetos de Pesquisa
14.
Lung ; 197(2): 181-188, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30739217

RESUMO

BACKGROUND: During exercise-training patients with chronic obstructive pulmonary disease (COPD) can entrain their breathing pattern to visual-feedback cues as to achieve a slower respiratory rate and prolong exhalation. The result is an improvement in exercise tolerance and a reduction in dynamic hyperinflation. Acoustic stimuli, including metronome-generated acoustic stimuli, can entrain human movements. Accordingly, we hypothesized that exercise duration and dynamic hyperinflation would be less after exercise-training plus breathing-retraining using a metronome-based acoustic-feedback system than after exercise-training alone. METHODS: Of 205 patients with COPD [FEV1 = 44 ± 16% predicted (± SD)] recruited, 119 were randomly assigned to exercise-training plus breathing-retraining using acoustic feedback (n = 58) or exercise-training alone (n = 61). Patients exercised on a treadmill thrice-weekly for 12 weeks. Before and at completion of training, patients underwent constant-load treadmill testing with inspiratory capacity measures every 2 min. RESULTS: At completion of training, improvements in exercise duration in the breathing-retraining plus exercise-training and exercise-training alone groups were similar (p = 0.35). At isotime, inspiratory capacity increased (less exercise-induced dynamic hyperinflation) by 3% (p = 0.001) in the breathing-retraining plus exercise-training group and remained unchanged in the exercise-alone group. The between-group change in inspiratory capacity, however, was not significant (p = 0.08). CONCLUSIONS: In patients with COPD, breathing-retraining using a metronome-based acoustic feedback did not result in improved exercise endurance or decreased dynamic hyperinflation when compared to exercise-training alone. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT NCT01009099; URL: http://www.clinicaltrials.gov.


Assuntos
Estimulação Acústica , Exercícios Respiratórios/métodos , Tolerância ao Exercício , Retroalimentação Sensorial , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Mecânica Respiratória , Idoso , Sinais (Psicologia) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
15.
Front Neurosci ; 13: 51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804739

RESUMO

Rationale: Physical exercise is an essential adjunct to the management of patients with type 2 diabetes mellitus. Therapeutic interventions that improve blood flow to peripheral nerves, such as exercise, may slow the progression of neuropathy in the diabetic patient. Aims: This randomized clinical trial was conducted to determine whether a structured program of aerobic, isokinetic strength, or the combination of aerobic-isokinetic strength exercise intervention alters peripheral nerve function in glycemic-controlled diabetic patients with advanced length-dependent distal symmetric polyneuropathy. Methods: Forty-five patients with type 2 diabetes mellitus exhibiting tight glycemic control (HbA1c intergroup range 7.2-8.0%) were randomized by block design across four experimental groups: sedentary controls (n = 12), aerobic exercise (n = 11), isokinetic strength (n = 11), or the combination of aerobic-isokinetic strength training (n = 11). Patients randomized to training groups exercised 3× per week for 12 weeks, whereas patients randomized to the sedentary control group received standard of care. To minimize attention and educational bias, all patients attended a 12-session health promotion educational series. At baseline, immediately following intervention, and again at 12-week post-intervention, detailed nerve conduction studies were conducted as a primary outcome measure. At these same intervals, all patients completed as secondary measures quantitative sensory testing, symptom-limited treadmill stress tests, and a Short-Form 36-Veterans Questionnaire (SF-36V). Results: Of the 45 patients randomized into this study, 37 (82%) had absent sural nerve responses, 19 (42%) had absent median sensory nerve responses, and 17 (38%) had absent ulnar sensory nerve responses. By comparison, responses from tibial nerves were absent in only three (7%) subjects while responses from peroneal nerves were absent in five (11%) subjects. Eleven (92%) of 12 patients that had volunteered to be biopsied exhibited abnormal levels of epidermal nerve fiber densities. Exercise, regardless of type, did not alter sensory or motor nerve electrodiagnostic findings among those patients exhibiting measurable responses (ANOVA). There was, however, a modest (p = 0.01) beneficial effect of exercise on sensory nerve function (Fisher's Exact Test). Importantly, the beneficial effect of exercise on sensory nerve function was enhanced (p = 0.03) during the post-intervention interval. In addition, three of six patients that had undergone exercise intervention exhibited a marked 1.9 ± 0.3-fold improvement in epidermal nerve fiber density. By comparison, none of three sedentary patients whom agreed to be biopsied a second time showed improvement in epidermal nerve fiber density. Compared to baseline values within groups, and compared with sedentary values across groups, neither aerobic, isokinetic strength, or the combination of aerobic-isokinetic strength exercise intervention altered peak oxygen uptake. Patients that underwent aerobic or the combined aerobic-isokinetic strength exercise intervention, however, demonstrated an increase in treadmill test duration that was sustained over the 12-week post-intervention period. Conclusion: A 12-week course of physical exercise, regardless of type, does not alter sensory or motor nerve electrodiagnostic findings. In a subset of patients, a short-term structured program of aerobic exercise may selectively improve sensory nerve fiber function. Large-scale exercise lifestyle intervention trials are warranted to further evaluate the impact of aerobic exercise on sensory nerve fiber function in diabetic neuropathic patients. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT00955201.

16.
Am J Respir Crit Care Med ; 199(12): 1508-1516, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30624956

RESUMO

Rationale: Patients managed at a long-term acute-care hospital (LTACH) for weaning from prolonged mechanical ventilation are at risk for profound muscle weakness and disability. Objectives: To investigate effects of prolonged ventilation on survival, muscle function, and its impact on quality of life at 6 and 12 months after LTACH discharge. Methods: This was a prospective, longitudinal study conducted in 315 patients being weaned from prolonged ventilation at an LTACH. Measurements and Main Results: At discharge, 53.7% of patients were detached from the ventilator and 1-year survival was 66.9%. On enrollment, maximum inspiratory pressure (Pimax) was 41.3 (95% confidence interval, 39.4-43.2) cm H2O (53.1% predicted), whereas handgrip strength was 16.4 (95% confidence interval, 14.4-18.7) kPa (21.5% predicted). At discharge, Pimax did not change, whereas handgrip strength increased by 34.8% (P < 0.001). Between discharge and 6 months, handgrip strength increased 6.2 times more than did Pimax. Between discharge and 6 months, Katz activities-of-daily-living summary score improved by 64.4%; improvement in Katz summary score was related to improvement in handgrip strength (r = -0.51; P < 0.001). By 12 months, physical summary score and mental summary score of 36-item Short-Form Survey returned to preillness values. When asked, 84.7% of survivors indicated willingness to undergo mechanical ventilation again. Conclusions: Among patients receiving prolonged mechanical ventilation at an LTACH, 53.7% were detached from the ventilator at discharge and 1-year survival was 66.9%. Respiratory strength was well maintained, whereas peripheral strength was severely impaired throughout hospitalization. Six months after discharge, improvement in muscle function enabled patients to perform daily activities, and 84.7% indicated willingness to undergo mechanical ventilation again.


Assuntos
Enfermagem de Cuidados Críticos/métodos , Enfermagem de Cuidados Críticos/estatística & dados numéricos , Respiração Artificial/enfermagem , Respiração Artificial/estatística & dados numéricos , Desmame do Respirador/estatística & dados numéricos , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
17.
J Nephrol ; 32(2): 211-230, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29802584

RESUMO

INTRODUCTION: Chronic kidney disease (CKD) is a common chronic condition in older adults that is associated with cognitive decline. However, the exact prevalence of cognitive impairment in older adults with CKD is unclear likely due to the variety of methods utilized to assess cognitive function. The purpose of this integrative review is to determine how cognitive function is most frequently assessed in older adult patients with CKD. METHODS: Five electronic databases were searched to explore relevant literature related to cognitive function assessment in older adult patients with CKD. Inclusion and exclusion criteria were created to focus the search to the assessment of cognitive function with standardized cognitive tests in older adults with CKD, not on renal replacement therapy. RESULTS: Through the search methods, 36 articles were found that fulfilled the purpose of the review. There were 36 different types of cognitive tests utilized in the included articles, with each study utilizing between one and 12 tests. The most commonly utilized cognitive test was the Mini Mental State Exam (MMSE), followed by tests of digit symbol substitution and verbal fluency. The most commonly assessed aspect of cognitive function was global cognition. DISCUSSION: The assessment of cognitive function in older adults with CKD with standardized tests is completed in various ways. Unfortunately, the common methods of assessment of cognitive function may not be fully examining the domains of impairment commonly found in older adults with CKD. Further research is needed to identify the ideal cognitive test to best assess older adults with CKD for cognitive impairment.


Assuntos
Transtornos Cognitivos/diagnóstico , Cognição , Testes de Estado Mental e Demência , Testes Neuropsicológicos , Insuficiência Renal Crônica/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Insuficiência Renal Crônica/diagnóstico , Reprodutibilidade dos Testes
18.
BMC Womens Health ; 18(1): 109, 2018 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-29929508

RESUMO

BACKGROUND: Predictors of trust in healthcare providers and the healthcare system have never been studied in Korean Americans (KA) despite the fact that trust plays an important role in health behaviors. The purpose of this study is to examine factors influencing trust in the healthcare system and providers among KA women. METHODS: Data were collected in 196 KA women examining the effects of perceived discrimination and trust on breast cancer screening in the Chicago metropolitan area. Path analysis was used to identify factors influencing trust in the healthcare system and providers. RESULTS: Acculturation was positively related to trust in healthcare providers (ß = .15, p =. 002), and discrimination in the healthcare system was inversely related to trust in healthcare providers (ß = -.60, p <. 001). Length of stay in the US was inversely related to distrust in the healthcare system (ß = -.14, p <. 001), and discrimination in healthcare was positively related to distrust in the healthcare system (ß = .60, p <. 001). Trust in healthcare providers and distrust in the healthcare system were moderately correlated (r = .51, p < .001). CONCLUSION: Higher levels of acculturation and lower levels of perceived discrimination were identified as predictors of higher levels of trust in healthcare providers. A shorter stay in the US and higher levels of discrimination were identified as predictors of higher levels of distrust in the healthcare system. Perceived discrimination is a target for interventions to enhance trust in the healthcare system, and therefore reduce healthcare disparities in KAs.


Assuntos
Americanos Asiáticos/psicologia , Neoplasias da Mama/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Confiança , Aculturação , Idoso , Chicago , Detecção Precoce de Câncer , Feminino , Pessoal de Saúde , Humanos , Mamografia , Pessoa de Meia-Idade , Percepção , República da Coreia/etnologia , Discriminação Social , Fatores de Tempo
19.
Acta Diabetol ; 55(9): 963-970, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29931420

RESUMO

AIMS: Type 2 diabetes (T2D) is a metabolic disorder requiring intensive self-care to maintain optimal glycemic control. Sleep disturbance is common in T2D patients and likely impairs glycemic control. Our aim was to examine the relationship between sleep disturbance and self-care in adults with T2D. METHODS: This study used a correlational design. Sixty-four adults with T2D were recruited. Validated instruments were used to measure self-care, subjective sleep disturbance, and covariates (e.g., diabetes distress, self-efficacy, fatigue, and daytime sleepiness). Over an 8-day period, the ActiGraph-wGT3X was used to measure objective sleep outcomes (e.g., total sleep time and number of awakenings). Bivariate correlation and multiple linear regression analyses were conducted. RESULTS: The mean age of the participants was 60.6 (SD 6.8) years (range 50-78), and 51.6% were women. Controlling for covariates, subjective sleep disturbance (ß = - 0.26), diabetes distress (ß = - 0.39), and daytime sleepiness (ß = - 0.21) were strong predictors of diabetes self-care (R2 = 0.51, p < 0.001). When objective sleep parameters were used, the number of awakenings (ß = - 0.23) also predicted self-care along with diabetes distress, fatigue, and daytime sleepiness (R2 = 0.57, p < 0.001). CONCLUSIONS: Subjective sleep disturbance and frequent nocturnal awakenings are associated with worse diabetes self-care in adults with T2D. Healthcare providers are recommended to include comprehensive sleep assessment at every clinical visit. Diabetes educators may consider including sleep-related education in their diabetes self-management classes and/or counseling sessions.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Autocuidado , Transtornos do Sono-Vigília/epidemiologia , Actigrafia , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autocuidado/normas , Autoeficácia , Sono/fisiologia , Transtornos do Sono-Vigília/complicações
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