Effects of a Full-Body Massage on Pain Intensity,Anxiety, and Physiological Relaxation in Taiwanese Patients with Metastatic Bone Pain: A Pilot Study

Bone involvement, a hallmark of advanced cancer, results in intolerable pain, substantial morbidity, and impaired quality of life in 34%–45% of cancer patients. Despite the publication of 15 studies on massage therapy (MT) in cancer patients, little is known about the longitudinal effects of MT and safety in cancer patients with bone metastasis. The purpose of this study was to describe the feasibility of MT and to examine the effects of MT on present pain intensity (PPI), anxiety, and physiological relaxation over a 16- to 18-hour period in 30 Taiwanese cancer patients with bone metastases. A quasi-experimental, one-group, pretest-post-test design with repeated measures was used to examine the time effects of MT using single-item scales for pain (PPI-visual analog scale [VAS]) and anxiety (anxiety-VAS), the modified Short-Form McGill Pain Questionnaire (MSF-MPQ), heart rate (HR), and mean arterial pressure (MAP). MT was shown to have effective immediate [t(29) = 16.5, P = 0.000; t(29) = 8.9, P = 0.000], short-term (20–30 minutes) [t(29) = 9.3, P = 0.000; t(29) = 10.1, P = 0.000], intermediate (1–2.5 hours) [t(29) = 7.9, P = 0.000; t(29) = 8.9, P = 0.000], and long-term benefits (16–18 hours) [t(29) = 4.0, P = 0.000; t(29) = 5.7, P = 0.000] on PPI and anxiety. The most significant impact occurred 15 [F = 11.5(1,29), P < 0.002] or 20 [F = 20.4(1,29), P < 0.000] minutes after the intervention. There were no significant time effects in decreasing or increasing HR and MAP. No patient reported any adverse effects as a result of MT. Clinically, the time effects of MT can assist health care providers in implementing MT along with pharmacological treatment, thereby enhancing cancer pain management. Randomized clinical trials are needed to validate the effectiveness of MT in this cancer population.     

Effect of goal attainment theory based education program on cardiovascular risks,behavioral modification,and quality of life among patients with first episode of acute myocardial infarction: Randomized study

Effect of goal-attainment-theory-based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: randomized studyBackgroundThe behavioral modification strategies should be explored at the time of admission to lead the maximum effect of cardiovascular risk management.AimsThis randomized study aimed to elucidate the effects of a nurse-led theory-based education program in individuals with a first episode of acute myocardial infarction on cardiovascular risks, health behaviors, and quality of life over 6 months.MethodsThe study involved a convenience sample of 64 patients with acute myocardial infarction who were randomly assigned to either the education group or the control group. The goal-attainment-based education program was designed to set the mutually agreed goals of risk management and the behavioral modification strategies for achieving those goals. Those in the control group received routine management only. The participants in both groups were contacted at 6–8 weeks and at 6 months after discharge to measure outcome variables. Repeated measure ANOVA was conducted using SPSSWIN (version 20.0) to determine the significance of differences in outcome variables over 6 months between the groups.ResultsBoth groups showed significant positive changes in cardiovascular risks, health behaviors, and quality of life over 6 months. The 2-year risk of cardiovascular disease was significantly reduced in both study groups, but with no significant interaction effect (F = 2.01, p = 0.142). The performance and maintenance of health behaviors (F = 3.75, p = 0.029) and the mental component of quality of life (F = 4.03, p = 0.020) were significantly better in the education group than the control group.ConclusionApplying a goal-oriented education program at an early stage of hospital management improved and maintained blood glucose, health behaviors, and mental component of the quality of life up to six months in individuals with a first episode of myocardial infarction. Further studies are warranted to explore the role of behavioral modification mediating between cardiovascular risk management and quality of life in this population.     

Evaluation of apolipoprotein M as a biomarker of coronary artery disease

ObjectiveTo investigate the possible role of apolipoprotein M (ApoM) in the development of coronary artery disease (CAD).Design and methodsCase-controlled study, which consisted of 118 CAD patients and 255 unrelated subjects used as control group. Plasma concentration of ApoM was determined by dot blot, severity of CAD was expressed with Gensini score or the numbers of lesioned coronary arteries, and serum lipid levels were also measured.Results and discussionOur study shows the mean level of plasma ApoM is 1.3757 ± 0.1493 ODu mm^? 2 in CAD patients, while it is 1.3502 ± 0.1288 ODu mm^? 2 in control group, and there are significant differences in plasma level of ApoM between two groups (t = 0.032, P < 0.05). Concentration of plasma ApoM is positively associated with plasma total cholesterol (r = 0.38, P = 0.025), high density lipoprotein cholesterol (r = 0.29, P = 0.03), low density lipoprotein cholesterol (r = 0.16, P = 0.03) and apolipoproein A–I (r = 0.24, P = 0.03). Multiple logistic and linear regression analysis showed that plasma concentration of ApoM did not correlate either with the number of lesioned coronaries or the Gensini score after adjusted for conventional cardiovascular risk factors (P > 0.05, respectively).ConclusionThe findings suggest that ApoM could not be an independent risk factor but a biomarker of CAD.     

Is the Life Space Assessment Applicable to a Palliative Care Population? Its Relationship to Measures of Performance and Quality of Life

ContextThe spatial environments that palliative care patients frequent for business and leisure constrict as their disease progresses and their physical functioning deteriorates. Measuring a person's movement within his or her own environment is a clinically relevant and patient-centered outcome because it measures function in a way that reflects actual and not theoretical participation.ObjectivesThis exploratory study set out to test whether the Life-Space Assessment (LSA) would correlate with other commonly used palliative care outcome measures of function and quality of life.MethodsThe baseline LSA, Australia-modified Karnofsky Performance Status Scale (AKPS), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative (EORTC QLQ-C15-PAL) scores from two large clinical trials were used to calculate correlation coefficients between the measures. Convergent validity analysis was undertaken by comparing LSA scores between participants with higher (≥70) and lower (≤60) AKPS scores.ResultsThe LSA was correlated significantly and positively with the AKPS, with a moderate correlation coefficient of 0.54 (P < 0.001). There was a significant weak negative correlation between the LSA and the EORTC QLQ-C15-PAL, with a small coefficient of −0.22 (P = 0.027), but a strong correlation between the LSA and the EORTC QLQ-C15-PAL item related to independent activities of daily living (r = −0.654, P < 0.01). A significant difference in the LSA score between participants with higher (≥70) and lower (≤60) AKPS scores t(97) = −4.35, P < 0.001) was found.ConclusionThe LSA appears applicable to palliative care populations given the convergent validity and capacity of this instrument to differentiate a person's ability to move through life-space zones by performance status. Further research is required to validate and apply the LSA within community palliative care populations.     

Feeding Tubes and Health Costs Postinsertion in Nursing Home Residents With Advanced Dementia

ContextThe best evidence suggests that feeding tubes are ineffective in persons with advanced dementia. Little is known about their health care costs.ObjectivesTo estimate Medicare costs attributable to inpatient care among nursing home (NH) residents with advanced dementia during the year following the placement of a percutaneous endoscopic gastrostomy (PEG) tube during an index hospitalization.MethodsMedicare claims (1999–2009) and Minimum Data Set data (1999–2009) were used to estimate Medicare costs attributable to inpatient care among NH residents with advanced dementia during the year following the placement of a PEG tube and compared with those who did not get a PEG tube. The study used a 3:1 propensity-matched cohort design.ResultsMatched residents with (n = 1924, 68.9% female, 28.8% African American, average age 83.1 years) and without (weighted n = 1924, unique n = 4337) PEG insertion showed comparable sociodemographic characteristics, similar rates of feeding tube risk factors, and similar mortality (51.9% 180 day mortality among those with a feeding tube vs. 49.8% among those without a feeding tube, P = 0.11). One year hospital costs were $2224 higher in NH residents with a feeding tube ($10,191 vs. $7967, 95% CI of difference = $1514, $2933), with those with a feeding tube likely to spend more time in an intensive care unit (1.92 vs. 1.29 days, 95% CI of difference = 0.34, 0.92 days).ConclusionIn an analysis controlling for selection bias, PEG tube insertion is associated with a small but significant increase in annual inpatient health care costs, as well as in hospital and intensive care unit days, postinsertion.     

Use of a facilitated discussion model for antenatal care to improve communication

BackgroundAchieving health literacy is a critical step to improving health outcomes and the health of a nation. However, there is a lack of research on health literacy in low-resource countries, where maternal health outcomes are at their worst.ObjectivesTo examine the usefulness and feasibility of providing focused antenatal care (FANC) in a group setting using picture cards to improve patient–provider communication, patient engagement, and improve health literacy.DesignAn exploratory, mixed methods design was employed to gather pilot data using the Health Literacy Skills Framework.SettingsA busy urban district hospital in the Ashanti Region of Ghana was used to gather data during 2014.ParticipantsA facility-driven convenience sample of midwives (n=6) aged 18 years or older, who could speak English or Twi, and had provided antenatal care at the participating hospital during the previous year prior to the start of the study participated in the study.MethodsData were collected using pre-test and post-test surveys, completed three months after the group FANC was implemented. A semi-structured focus group was conducted with four of the participating midwives and the registered nurse providing support and supervision for the study (n=5) at the time of the post-test. Data were analyzed concurrently to gain a broad understanding of patient communication, engagement, and group FANC.ResultsThere were no significant differences in the mean communication (t(df = 3) = 0.541, p = 0.626) and engagement (t(df = 3) = −0.775, p = 0.495) scores between the pre- and post-test. However, the focus group revealed the following themes: (a) improved communication through the use of picture cards; (b) enhanced information sharing and peer support through the facilitated group process and; and (c) an improved understanding of patient concerns.ConclusionsThe improved communication noted through the use of picture cards and the enhanced information sharing and peer support elicited through the group FANC undoubtedly provided patients with additional tools to invoke self-determination, and carry out the behaviors they thought were most important to improve pregnancy outcomes.     

The Glu298ASP polymorphism of the endothelial nitric oxide synthase gene is associated with premature ST elevation myocardial infarction in Mexican population

BackgroundThe polymorphism Glu298Asp of endothelial nitric oxide (eNOS) gene has been associated with hypertension and coronary artery disease in several populations worldwide, but results are still controversial. We examined the possible association of the Glu298Asp with premature ST elevation myocardial infarction (STEAMI) in young Mexican population.MethodsIn a case–control study 180 unrelated patients with STEAMI ≤ 45 years who were admitted to a cardiovascular intense care unit and 180 apparently healthy controls matched by age and gender were recruited from January 2006 to June 2009. The polymorphism Glu298Asp was determined in all participants by a polymerase chain-reaction-restriction fragment length polymorphism assay (PCR-RFLP).ResultsThere was a significant difference in the genotype distribution between 2 groups (P = 0.001). The allele Asp occurred more frequently in the patients group (P = 0.001). There were independent factors for STEAMI: the Asp allele (OR 2.2, 95% CI 1.1–3.5, P = 0.03), smoking (OR 5.0, 95% CI 3.1–8.2, P < 0.001), hypertension (OR 2.0, 95% CI 1.0–3.5, P = 0.03), family history of cardiovascular disease, (OR 3.7, 95% CI 2.0–4.6, P = 0.02), and dyslipidemia (OR 3.4, 95% CI 2.0–6.3, P = 0.02).ConclusionsThe Asp allele from the Gu298Asp polymorphism represents an independent risk factor for premature STEAMI in Mexican Mestizo population.     

Measurement of oxidized lipoprotein (a) in patients with acute coronary syndromes and stable coronary artery disease by 2 ELISAs: Using different capture antibody against oxidized lipoprotein (a) or oxidized LDL

ObjectiveTo evaluate clinical value of oxidized lipoprotein(a) [ox-Lp(a)] levels.Design and methodsOx-Lp(a) were measured by 2 ELISAs using antibodies against ox-Lp(a) [ox-Lp(a)1] or oxidized low-density lipoprotein [ox-Lp(a)2], and studied in 161 acute coronary syndromes (ACS) patients, 114 stable coronary artery disease (CAD) and 100 control subjects.ResultsOx-Lp(a)1 was found related with ox-Lp(a)2 (r = 0.864, P = 0.000). Controlling for plasma lipids, Lp(a) and clinical characteristics, odds ratios of ox-Lp(a)1 on ACS and stable CAD were 5.06 (95% confidence interval 1.82–14.04) and 2.20 (0.78–6.22); those of ox-Lp(a)2 were 3.37 (1.07–10.63) and 1.35 (0.41–4.48), respectively. Receiver-operating characteristic curve analysis confirmed that performances of ox-Lp(a)1 were significantly superior to those for ox-Lp(a)2 in ACS (area: 0.803 vs. 0.723, P < 0.001) and stable CAD (area: 0.670 vs. 0.607, P < 0.01).ConclusionOx-Lp(a) levels using antibodies against ox-Lp(a) may represent a better risk marker than those using antibodies against oxidized low-density lipoprotein for ACS and stable CAD.     

Percutaneous coronary intervention results in acute increases in native and oxidized lipoprotein(a) in patients with acute coronary syndrome and stable coronary artery disease

ObjectiveTo investigate possible changes of native and oxidized lipoprotein(a) [ox-Lp(a)] levels after percutaneous coronary intervention (PCI).Design and methodsLp(a), ox-Lp(a), and Lp(a) immune complexes (IC) and autoantibody levels were studied in 111 patients with acute coronary syndrome (ACS) and 68 patients with stable coronary artery disease (CAD) before and after PCI.ResultsCompared with pre-PCI, Lp(a), ox-Lp(a), and Lp(a)-IC levels acutely increased, while the autoantibody decreased in both the ACS and stable CAD patients. They all returned toward baseline by 1 to 2 days. The absolute change of ox-Lp(a) was found positively related with both the diameter of stenosis (R = 0.273, P = 0.004) and the number of vessel disease (R = 0.312, P = 0.001) in the ACS patients, while not in the stable CAD patients.ConclusionPCI results in acute plasma increases of ox-Lp(a) and Lp(a). Ox-Lp(a) may be present in ruptured or permeable plaques and be released into the circulation by PCI.     

Effects of lifestyle modification on oxidized LDL,reactive oxygen species production and endothelial cell viability in patients with coronary artery disease

ObjectivesWe evaluated the effects of lifestyle modification (LM) on lipid profile, oxidative stress and serum-stimulated human coronary artery endothelial cell (HCAEC) viability in coronary artery disease (CAD) patients after 6 months.Design and methodsThirty patients with CAD were randomly assigned to LM intervention (n = 15) and usual care control (n = 15) groups. LM-intervened patients were instructed to consume low-fat, high-antioxidants and fiber diets. Moderate exercise and stress management were also advised. Group support to maintain patients' compliance was applied.ResultsSerum cholesterol, triglyceride, oxidized LDL and protein carbonyl were decreased in LM group. Serum triglyceride was increased in control group. HCAEC viability was increased, while intracellular reactive oxygen species was decreased, by serum from the LM group.ConclusionLM is capable of improving lipid profile, reducing oxidative stress and increasing HCAEC survival in the patients with CAD, hence lowering a risk for the future cardiovascular event.     

The relationship between the levels of gonadotropic hormones and OPG,leptin, TGF-β1 and TGF-β2 in Chinese adult women

BackgroundThe relationship between the levels of gonadotropic hormones and bone metabolism-related cytokines in Chinese women is unclear. We investigated the relationship between FSH and LH and OPG, leptin, TGF-β1, and TGF-β2 in Chinese women.MethodsA cross-sectional study of 694 Chinese women, aged 20 to 82 y was conducted. Levels of serum FSH, LH, OPG, leptin, TGF-β1, and TGF-β2 were determined.ResultsIn premenopausal females, serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels seemly showed no correlation with the cytokine levels. In perimenopausal females, serum FSH and LH levels showed significant positive correlation with osteoprotegerin (OPG) and transforming growth factor-β2 (TGF-β2) levels (r = 0.286 to 0.405, all P = 0.000), whereas they showed negative correlation with TGF-β1 levels (r = ? 0.413 and ? 0.354, all P = 0.000). In postmenopausal females, FSH and LH levels showed positive correlation with OPG levels (r = 0.247 and 0.241, all P = 0.000), negative correlation with leptin and TGF-β1 levels (r = ? 0.234 to ? 0.319, all P = 0.000), and no correlation with TGF-β2 levels. Multiple linear regression stepwise analysis revealed the following results. In premenopausal females, 2.0% and 1.5% of the changes in LH could be explained by OPG and leptin, respectively, while 1.9% of the changes in OPG could be explained by LH. In perimenopausal females, the determinants of OPG and TGF-β1 on FSH were 10.9% and 17.0%, respectively, and the determinants of OPG, TGF-β1 and TGF-β2 on LH were 4.5%, 4.9% and 16.4%, respectively. The determinants of FSH and LH on OPG were 14.5% and 2.5%, respectively. The determinant of FSH on TGF-β1 was 4.5%, while the determinant of LH on TGF-β2 was 16.4%. In postmenopausal females, the determinants of leptin and OPG on FSH were 10.2% and 2.8%, respectively, and the determinants of OPG and TGF-β1 on LH were 5.8% and 2.3%, respectively. The determinant of FSH on OPG, leptin and TGF-β1 were 6.1%, 3.4% and 9.2%.ConclusionsThese results indicate that age-related gonadotropic hormone levels are associated with changes in OPG, TGF-β1, TGF-β2 and leptin, and change with menopausal status.     

A Home-Based Exercise Program to Improve Function,Fatigue, and Sleep Quality in Patients With Stage IV Lung and Colorectal Cancer: A Randomized Controlled Trial

ContextExercise benefits patients with cancer, but studies of home-based approaches, particularly among those with Stage IV disease, remain small and exploratory.ObjectivesTo conduct an adequately powered trial of a home-based exercise intervention that can be facilely integrated into established delivery and reimbursement structures.MethodsSixty-six adults with Stage IV lung or colorectal cancer were randomized, in an eight-week trial, to usual care or incremental walking and home-based strength training. The exercising participants were instructed during a single physiotherapy visit and subsequently exercised four days or more per week; training and step-count goals were advanced during bimonthly telephone calls. The primary outcome measure was mobility assessed with the Ambulatory Post Acute Care Basic Mobility Short Form. Secondary outcomes included ratings of pain and sleep quality as well as the ability to perform daily activities (Ambulatory Post Acute Care Daily Activities Short Form), quality of life (Functional Assessment of Cancer Therapy-General), and fatigue (Functional Assessment of Cancer Therapy-Fatigue).ResultsThree participants dropped out and seven died (five in the intervention and two in the control group, P = 0.28). At Week 8, the intervention group reported improved mobility (P = 0.01), fatigue (P = 0.02), and sleep quality (P = 0.05) compared with the usual care group, but did not differ on the other measures.ConclusionA home-based exercise program seems capable of improving the mobility, fatigue, and sleep quality of patients with Stage IV lung and colorectal cancer.     

Association of angiotensin-converting enzyme polymorphism with coronary artery disease in Iranian patients with unipolar depression

ObjectivesMajor depressive disorder (MDD) is an increasingly recognized risk factor of coronary artery disease (CAD). The aim of this study was to assess the relationship between renin-angiotensin system (RAS) genetic polymorphisms and CAD in a sample of depressed Iranian patients.Design and methodsA total of 191 patients with a history of unipolar depression were enrolled in a case/control study. The presence of MDD was reconfirmed at study entry using DSM-IV criteria and CAD was diagnosed by coronary angiography. Genotyping of six RAS genes polymorphisms was performed by a modified PCR-RFLP method.ResultsDD genotype of ACE I/D was independently associated with the incidence of CAD in depressed patients (P = 0.011, OR = 9.41, 95% CI: 1.68–17.81). Moreover, serum creatinine (P = 0.033, OR = 11.91, 95%CI: 7.23–15.62) was an independent predictor of CAD among depressed individuals.ConclusionACE I/D polymorphism may play a major role in the development of CAD amongst Iranian depressed patients.     

Serum adipocyte fatty acid binding proteins and adiponectin in patients with coronary artery disease: The significance of A-FABP/adiponectin ratio

BackgroundAdipocyte fatty acid binding protein (A-FABP) and adiponectin have been shown to play important roles in atherosclerosis. We investigated serum A-FABP, adiponectin and A-FABP/adiponectin ratio in patients with coronary artery disease (CAD).MethodsA total of 340 subjects who underwent coronary angiography (CAG) were classified into CAD group (n = 211) and non-CAD group (n = 129) according to the CAG. Serum A-FABP and adiponectin concentrations were determined by enzyme-linked immunosorbent assays.ResultsCAD patients tend to have higher A-FABP concentrations than non-CAD subjects, the difference is significant only between female CAD patients and controls [22.8 (18.6–25.7) ng/ml vs 18.1 (15.6–21.8) ng/ml, P = 0.008]. Serum A-FABP concentration was independently associated with Gensini scores in female subjects (P = 0.018). CAD patients have significant higher serum A-FABP/adiponectin ratio [1.51 ± 0.05 vs 0.89 ± 0.03 ng/μg, P < 0.01] than controls in both genders.ConclusionsSerum A-FABP is associated with CAD more closely in female than in male. The A-FABP/adiponectin ratio may be a more useful indicator for CAD than A-FABP or adiponectin alone.     

Music listening alleviates anxiety and physiological responses in patients receiving spinal anesthesia

ObjectiveThe aim of this study was to explore the effects of listening to music on the anxiety levels and physiological responses of surgical patients receiving spinal anesthesia.MethodsAn experimental design was used in the study with an experimental group (n = 50) and a control group (n = 50). The experimental group received 30 min of musical intervention and routine nursing care in the Post-Anesthesia Care Unit (PACU) while the control group received only routine nursing care.ResultsThe study found significant differences in both anxiety and physiological indices between the two groups. The mean score of the State-Trait Anxiety Inventory (STAI) in the study group decreased from a pre-test score of 59.0 to a post-test score of 31.20 (t = 28.63, p < 0.001). Physiological indices such as heart rate (t = 2.61, p = 0.012), respiration rate (t = 2.29, p = 0.026), systolic blood pressure (t = 2.30, p = 0.026), and diastolic blood pressure (t = 3.02, p = 0.004) decreased significantly as well. Control group was not seeing significant changes from pre-op values.ConclusionListening to music while in the recovery room may decrease the level of anxiety in surgical patients receiving spinal anesthesia. The results of this study can serve as a reference for PACU nurses in utilizing music listening programs to achieve the goal of holistic care.     

Parents' Experiences of Pediatric Palliative Care and the Impact on Long-Term Parental Grief

ContextApproximately 25% of children diagnosed with cancer eventually die. Losing a child puts parents at increased risk for developing psychological problems.ObjectivesTo explore parents' perceptions of the interaction with health care professionals (communication, continuity of care, and parental involvement) and symptom management during the pediatric palliative phase, and to investigate the influence on long-term grief in parents who lost a child to cancer.MethodsA total of 89 parents of 57 children who died of cancer between 2000 and 2004 participated in this retrospective cross-sectional study by completing a set of questionnaires measuring grief (Inventory of Traumatic Grief), parents' perceptions of the interaction with health care professionals (communication, continuity of care, and parental involvement), and symptom management during the palliative phase. Care was assessed on a five point Likert scale (1 = disagree and 5 = agree).ResultsParents highly rated communication (4.6 ± 0.6), continuity of care (4.3 ± 0.6), and parental involvement (4.6 ± 0.7) during the palliative phase. Parents' most often reported physical and psychological symptoms of their child during the palliative phase were fatigue (75%), pain (74%), anxiety to be alone (52%), and anger (48%). Higher ratings of parents on communication (β = −9.08, P = 0.03) and continuity of care (β = −11.74, P = 0.01) were associated with lower levels of long-term parental grief. The severity of the child's dyspnea (β = 2.96, P = 0.05), anxiety to be alone (β = 4.52, P < 0.01), anxiety about the future (β = 5.02, P < 0.01), anger (β = 4.90, P < 0.01), and uncontrolled pain (β = 6.60, P < 0.01) were associated with higher levels of long-term parental grief. Multivariate models combining the interaction with health care professionals and symptom management showed a significant influence of both aspects on long-term parental grief.ConclusionBoth interaction with health care professionals, especially communication and continuity of care, and symptom management in children dying of cancer are associated with long-term parental grief levels.     

Serum cystatin C levels are associated with coronary artery disease and its severity

ObjectivesSerum cystatin C has been established as a predictor of cardiovascular events. The aim of this study was to evaluate the role of cystatin C in determining the presence and the severity of patients with coronary artery disease (CAD).Design and methodsA total of 936 subjects without overt renal disease were included in this cross-sectional study. Among them were 714 patients with CAD and 222 without based on coronary angiography. Subjects were further divided into four groups according to cystatin C quartile. Serum cystatin C was measured using particle-enhanced immunoassay method. The study analyzed the relationship of cystatin C levels with the presence and severity of CAD, including the number of stenotic vessels involved and Gensini score.ResultsSerum cystatin C levels were significantly higher in patients with CAD than those without (P < 0.001), and significantly increased as the involvement of coronary vessels increased (P < 0.001). The prevalence of CAD and its severity assessed by Gensini score were also significantly greater in the highest quartile of cystatin C (P < 0.001). Moreover, cystatin C levels were independently correlated with the presence of CAD in a multivariate logistic regression model (P = 0.023) and were positively correlated with Gensini score by linear regression analysis (standardized β = 0.083, P = 0.010).ConclusionsElevated serum cystatin C levels were significantly associated with the presence and severity of CAD in patients with normal renal function. It is suggested that cystatin C might play a role in CAD diagnosis and serve as a marker of CAD severity.     

Effectiveness of a role-play simulation program involving the sbar technique: A quasi-experimental study

BackgroundAccurate, skilled communication in handover is of high priority in maintaining patients' safety. Nursing students have few chances to practice nurse-to-doctor handover in clinical training, and some have little knowledge of what constitutes effective handover or lack confidence in conveying information.ObjectivesThis study aimed to develop a role-play simulation program involving the Situation, Background, Assessment, Recommendation technique for nurse-to-doctor handover; implement the program; and analyze its effects on situation, background, assessment, recommendation communication, communication clarity, handover confidence, and education satisfaction in nursing students.DesignNon-equivalent control-group pretest-posttest quasi-experimental.ParticipantsA convenience sample of 62 senior nursing students from two Korean universities.MethodThe differences in SBAR communication, communication clarity, handover confidence, and education satisfaction between the control and intervention groups were measured before and after program participation.ResultsThe intervention group showed higher Situation, Background, Assessment, Recommendation communication scores (t = − 3.05, p = 0.003); communication clarity scores in doctor notification scenarios (t = − 5.50, p < 0.001); and Situation, Background, Assessment, Recommendation education satisfaction scores (t = − 4.94, p < 0.001) relative to those of the control group. There was no significant difference in handover confidence between groups (t = − 1.97, p = 0.054).ConclusionsThe role-play simulation program developed in this study could be used to promote communication skills in nurse-to-doctor handover and cultivate communicative competence in nursing students.     

The impact of training program on nurses' attitudes toward workplace violence in Jordan

BackgroundNurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence.ObjectiveTo study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan.MethodsOne group before–after design was employed. A stratified random sample of 100 nurses working in three shifts was recruited. Data were collected earlier and after the preparation program using the Attitudes Toward Patient Physical Assault Questionnaire. “The Framework Guidelines for addressing workplace violence in the health sector”, was adopted in this work. The preparation sessions were for one day each week over five weeks. The post-test assessment was over five weeks using the same questionnaire.ResultsA total of 97 nurses completed the survey. The outcomes demonstrated the significant impact of the training program on nurses' attitudes towards workplace violence (t = 6. 62, df = 96, p = 0.000). The prevalence of verbal abuse by patients and visitors was 63.9% and for physical abuse, 7.2% were from patients and 3.1% of visitors. Most violent incidents occurred during day duty and during delivering nursing care (40.2% and 32%, respectively). Major source of emotional support for abused nurses was from the nursing team (88.7%), while the legal support was from nursing management (48.5%).ConclusionThe study highlights a general concern among nursing staff about workplace violence. Confirming that violence prevention education for staff is a necessary step forward to deescalate the problem. A significant effect of the training program was evident in this study.