Seated Tai Chi versus usual activities in older people using wheelchairs: A randomized controlled trial

ObjectiveCompare the effect of seated Tai Chi exercise (intervention) to usual activities on quality of life and depression symptoms in older people using wheelchairs.DesignRandomized controlled trial.SettingOne long-term care facility in Taiwan.Participants86 long-term care residents were screened; 60 were eligible and randomized to Tai Chi group (n = 30), or usual activity (n = 30).InterventionOne certified trainer provided the intervention group with 40 min of seated Tai Chi exercise, three times a week for 26 weeks. Trial registration ACTRN12613000029796.Main outcome measuresQuality of Life (WHOQOL (BREF)); depression symptoms (GDS-SF)ResultsParticipants in the Tai Chi group (M = 3.76, SD = 3.65) recorded significantly lower GDS-SF scores than participants in the control (M = 7.76, SD = 5.15) and the Tai Chi group registered significantly higher scores across overall QOL [p = 0.03], general health [p = 0.04], and the associated domains: physical health [p = 0.00], psychological health [p = 0.02], social relations [p = 0.00], and environment [p = 0.00].ConclusionsThe findings highlight the importance of Tai Chi in improving QOL and depression in this population.     

The effects of Tai Chi on physical and psychosocial function among persons with multiple sclerosis: A systematic review

ObjectivesConduct a systematic review to evaluate the effects of Tai Chi on physical and psychosocial function among individuals with Multiple Sclerosis.MethodsAn electronic literature search of 12 databases using controlled vocabulary function and keywords from inception through August 2016. All Tai Chi intervention studies assessing physical and psychosocial function among persons with Multiple Sclerosis were included. Study quality was scored using an established tool examining 16 study elements (range = 0–32).ResultsA total of 91 articles were retrieved, with 3 additional articles identified through reviewing bibliographies of relevant articles. A total of 8 studies (randomized controlled trials, n = 3; quasi-experimental, n = 5) enrolled 193 participants with Multiple Sclerosis. Studies were conducted in the USA (n = 3), Europe (n = 3), Iran, (n = 1), and India (n = 1). A total of 3 studies reported using the Yang style of Tai Chi (not specified, n = 5 studies). The Tai Chi intervention averaged 27 sessions over 11 weeks. Study quality scores for the randomized controlled trials had a mean score of 23 (range 19–26), while quality scores for quasi-experimental studies had a mean score of 20 (range 13–26). Overall, participants enrolled in Tai Chi had better balance, gait and flexibility, less fatigue and depression, and better quality of life after the intervention; though mixed results were reported.ConclusionThe results indicate that Tai Chi is likely safe and may provide physical and psychosocial benefits in individuals with Multiple Sclerosis. Further research is needed using more rigorous study designs to assess the benefits of Tai Chi for individuals with Multiple Sclerosis.     

Effects of a 12-week program of Tai Chi exercise on the kidney disease quality of life and physical functioning of patients with end-stage renal disease on hemodialysis

BackgroundPrevious studies have shown that exercise training in patients with end-stage renal disease could improve their physical functioning and quality of life. Nevertheless, few studies have evaluated the effects of Tai Chi exercise in patients on hemodialysis.ObjectiveTo investigate the effects of a Tai Chi exercise intervention on the quality of life and physical functioning in end-stage renal disease patients on hemodialysis.DesignA pre-post experimental design.SettingPatients, aged 20 years or older, on hemodialysis recruited from the hemodialysis unit at a medical center in central Taiwan were assigned, based on their own preference, to either a control group (n = 25) or an intervention group (n = 21).InterventionA weekly one-hour short-form Yang style Tai Chi session for a total of 12 weeks.Main outcome measuresPhysical functioning and Kidney Disease Quality of Life (KDQOL) at the baseline and at the end of the intervention.ResultsThe least square means of repetition of sit-to-stand cycles in one minute (STS-60), 6-min walk test, and gait speed test were significantly improved in the intervention group. In addition, the least square means of the five different dimensions of the KDQOL were all significantly higher in the intervention group, except the SF-12 physical health score.ConclusionsImprovements in the kidney disease quality of life and physical functioning were observed in Taiwanese patients on hemodialysis with a 12-week Tai Chi exercise intervention.     

Practicing Tai Chi had lower energy metabolism than walking but similar health benefits in terms of aerobic fitness,resting energy expenditure,body composition and self-perceived physical health

ObjectiveTo examine the effects of Tai Chi and walking training on aerobic fitness, resting energy expenditure (REE), body composition, and quality of life; as well as analyzing the energy metabolism during exercises, to determine which one had better advantage in improving health status.MethodsThree hundred seventy-four middle-aged Chinese subjects who were recruited from nine geographic areas in Sha Tin were randomized into Tai Chi, walking, or control groups at area level. The 12-week (45 min per day, 5 days per week) Tai Chi or brisk walking training were conducted in respective intervention groups. Measures were performed at baseline and end of trial. Another 30 subjects were recruited to compare the energy metabolism between practicing Tai Chi and walking.ResultsThe between-group difference of VO₂max was 3.3 ml/min/kg for Tai Chi vs. control and 3.7 ml/min/kg for walking vs. control (both P < 0.001). BMI, skinfold thicknesses, and SF-12 physical component scores all improved significantly compared with the control group (all P < 0.01). Tai Chi had higher effect on improving REE-VO₂ and REE-kilocalorie expenditure than walking. Regarding to energy metabolism test, the self-paced walking produced approximately 46% higher metabolic costs than Tai Chi.ConclusionPracticing Tai Chi consumes a smaller amount of energy metabolism but similar health benefits as self-paced brisk walking.     

A systems biology approach to studying Tai Chi,physiological complexity and healthy aging: Design and rationale of a pragmatic randomized controlled trial

IntroductionAging is typically associated with progressive multi-system impairment that leads to decreased physical and cognitive function and reduced adaptability to stress. Due to its capacity to characterize complex dynamics within and between physiological systems, the emerging field of complex systems biology and its array of quantitative tools show great promise for improving our understanding of aging, monitoring senescence, and providing biomarkers for evaluating novel interventions, including promising mind–body exercises, that treat age-related disease and promote healthy aging.Material and methodsAn ongoing, two-arm randomized clinical trial is evaluating the potential of Tai Chi mind–body exercise to attenuate age-related loss of complexity. A total of 60 Tai Chi-naïve healthy older adults (aged 50–79) are being randomized to either six months of Tai Chi training (n = 30), or to a waitlist control receiving unaltered usual medical care (n = 30). Our primary outcomes are complexity-based measures of heart rate, standing postural sway and gait stride interval dynamics assessed at 3 and 6 months. Multiscale entropy and detrended fluctuation analysis are used as entropy- and fractal-based measures of complexity, respectively. Secondary outcomes include measures of physical and psychological function and tests of physiological adaptability also assessed at 3 and 6 months.DiscussionResults of this study may lead to novel biomarkers that help us monitor and understand the physiological processes of aging and explore the potential benefits of Tai Chi and related mind–body exercises for healthy aging.     

Heart Healthy and Ethnically Relevant (HHER) Lifestyle trial for improving diet and physical activity in underserved African American women

BackgroundAfrican American women are at increased risk for CVD morbidity and mortality relative to white women. Physical inactivity and poor dietary habits are modifiable health behaviors shown to reduce CVD risk. Community health centers have the potential to reach large numbers of African Americans to modify their risk for CVD, yet few lifestyle counseling interventions have been conducted in this setting.MethodsThe HHER Lifestyle trial is a randomized controlled trial to compare the effects of a standard care intervention (provider counseling, nurse goal setting, and educational materials) to a comprehensive intervention (standard care intervention plus 12 months of telephone counseling and tailored print materials) on changes in physical activity and dietary fat consumption in financially disadvantaged African American women at 6 and 12 months. Secondary outcomes are body mass index, central adiposity, and total cholesterol. Potential mediators of outcome are self-efficacy for overcoming barriers, social support, and decisional balance.ResultsAfrican American women (N = 266; 130 standard care, 136 comprehensive intervention) 35 years and older from nine clinics within two community health centers were enrolled. Most participants were overweight or obese with existing chronic health conditions.ConclusionThe HHER Lifestyle trial is unique in that it targets financially disadvantaged African American women from community health centers, incorporates a standard care intervention into a routine clinical appointment, and includes a comprehensive process evaluation. The design will permit further research examining the added effect of regular telephone counseling and tailored print materials to a primary care provider and nurse intervention.     

Tai Chi with mental imagery theory improves soleus H-reflex and nerve conduction velocity in patients with type 2 diabetes

ObjectivesDiabetes is a disease that leads to damage to the peripheral nerves which may eventually cause balance instability. The purpose of this study was to determine the effect of 8 weeks of Tai Chi (TC) training combined with mental imagery (MI) on soleus H-reflex and nerve conduction velocity (NCV) of the sural and superficial peroneal nerves in people with diabetes.DesignsQuasi-experimental, one group pretest-posttest design.SettingHuman Research Laboratory.InterventionsA series of Yang style of Tai Chi classes with mental imagery, one hour, two sessions per week for 8 weeks was done.Main outcome measuresThe Activities-specific Balance Confidence (ABC) Scale, Functional Reach Test (FRT), and One Leg Standing Test (OLS) were measured as functional data. Hoffman reflex (H-reflex), and sural and superficial peroneal NCV were measured as main outcomes.ResultsAll functional outcomes measures were significantly improved after the intervention (p < 0.01). In the H-reflex, there was a significant increase in amplitude (μV) after completing 8 weeks of TC exercise (p = 0.02). In the sural nerve, the velocity (p = 0.01), amplitude (p = 0.01), and latency (p = 0.01) were significantly improved between pre and post-test. In the superficial peroneal nerve, significant improvements were observed in (p = 0.02) and latency (p = 0.01), but not in amplitude (μV) (p > 0.05).ConclusionsCombining TC intervention with MI theory showed an improvement in the H-reflex and NCV tests, which suggests improved balance and walking stability.     

Feasible modalities and long-term effects of elastic band exercises in nursing home older adults in wheelchairs: A cluster randomized controlled trial

BackgroundPhysical activity holds promise for mobility-impaired older adults to prevent further disabilities and improve their health. However, staffing constraints have made it challenging to promote physical activity in long-term care facilities.ObjectivesTo test the feasibility and effects of 12 months Wheelchair-bound Senior Elastic Band (WSEB) group-exercises that were led by volunteers for the first six months followed by the DVD-guided for another six months on functional fitness, activities of daily living (ADL), and sleep quality of nursing home older adults in wheelchairs.DesignCluster randomized controlled trial with two groups, pre-test and post-tests.SettingsTen nursing homes, Taiwan.Participants127 participants participated voluntarily; 107 of them completed the study. Inclusion criteria: (1) aged 65 years and over, (2) using wheelchairs for mobility, (3) living in facility for at least three months, (4) cognitively intact, and (5) heavy or moderate dependency in ADL. Majority of participants were middle-old older adults (75–84 years old, 53.2%), female (51.4%), and had chronic illnesses (98.1%).MethodsParticipants were randomly assigned by facility to either the experimental (five nursing homes, n = 56) or control group (five nursing homes, n = 51). The WSEB program was conducted three times per week and 40 min per session in two stages: volunteer-led for the first six months (stage I) followed by the DVD-guided modality for another six months (stage II). The primary outcomes (functional fitness: lung capacity, body flexibility, range of joint motion, and muscle strength and endurance) and the secondary outcomes (ADL measured by the Barthel Index; sleep quality measured by the Pittsburgh Sleep Quality Index) of the participants were measured at three time points: pre-test, at the six-month interval, and at the end of 12 months of the study. No blinding was applied.ResultsAll of the functional fitness indicators of the experimental group participants improved significantly (p < .05), and were all better than the control group at six-month and 12-month of the study (p < .05). No symptoms of discomfort occurred during interventions.ConclusionsNursing home older adults in wheelchairs who received WSEB exercise training had better functional fitness, ADL, and sleep quality than those who did not. It was a feasible way of carrying out this exercise program by using the volunteer-led followed by the DVD-guided modalities. The program can be applied in institutional settings routinely.     

A Pilot Cluster-Randomized Trial of a 20-Week Tai Chi Program in Elders With Cognitive Impairment and Osteoarthritic Knee: Effects on Pain and Other Health Outcomes

ContextBecause Tai Chi (TC) is beneficial to elders without cognitive impairment (CI), it also may benefit elders with CI. But elders with CI have generally been excluded from TC studies because many measurement tools require verbal reports that some elders with CI are unable to provide.ObjectivesTo test the efficacy of a TC program in improving pain and other health outcomes in community-dwelling elders with knee osteoarthritis (OA) and CI.MethodsThis pilot cluster-randomized trial was conducted between January 2008 and June 2010 (ClinicalTrials.gov Identifier: NCT01528566). The TC group attended Sun style TC classes, three sessions a week for 20 weeks; the control group attended classes providing health and cultural information for the same length of time. Measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, physical function and stiffness subscales; the Get Up and Go test; the Sit-to-Stand test; and the Mini-Mental State Examination (MMSE), administered at baseline, every four weeks during the intervention and at the end of the study (post-test).ResultsEight sites participated in either the TC group (four sites, 28 participants) or control group (four sites, 27 participants). The WOMAC pain (P = 0.006) and stiffness scores (P = 0.010) differed significantly between the two groups at post-test, whereas differences between the two groups in the WOMAC physical function score (P = 0.071) and the MMSE (P = 0.096) showed borderline significance at the post-test. WOMAC pain (P = 0.001), physical function (P = 0.021), and stiffness (P ≤ 0.001) scores improved significantly more over time in the TC group than in controls. No adverse events were found in either group.ConclusionPracticing TC can be efficacious in reducing pain and stiffness in elders with knee OA and CI.     

Content and factor validation of the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations

Background and PurposeNursing education programs have responsibilities to their stakeholders to prepare graduates who can provide safe, effective patient centered care while leading health care changes. Empowered nurses have been associated with low nurse turnover and higher patient satisfaction; however, less is currently known about group empowerment in nursing education. In order to examine group empowerment in schools of nursing, the Sieloff-King Assessment of Group Empowerment in Organizations (SKAGEO©) was adapted and tested for content validity and confirmatory factor analysis.Methods/ResultsThe adapted instrument, the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations (SKFAGEEO) was first reviewed by nurse experts who provided quantitative and qualitative data regarding each item. A total of 320 nurse deans and faculty comprised the final sample for the second order confirmatory 8 factor analysis. Findings revealed factor loadings ranging from .455 to .960.The overall fit of the propose model was Chi Square = 1383. 24, df = 566, p < .001; GFI = .786, RMSEA = 0.69.ConclusionsThe study results indicated that the SKFAGEEO has acceptable psychometric properties.     

Preventing belt restraint use in newly admitted residents in nursing homes: A quasi-experimental study

BackgroundPhysical restraints are commonly used in psychogeriatric nursing home residents despite reports of negative consequences. Most research has focused on restraint reduction without addressing methods to prevent initiation of restraints in nursing homes. EXBELT has been found to decrease belt restraint use but should also be evaluated for its use in preventing restraints.ObjectiveTo investigate the effectiveness of the EXBELT intervention to prevent the use of belt restraints on psychogeriatric residents newly admitted to nursing homes.DesignQuasi-experimental study design.SettingTwenty-six nursing home wards from thirteen Dutch nursing homes.ParticipantsNewly admitted residents (n = 104) during a four month period.InterventionsFifteen wards (intervention group) implemented the EXBELT intervention, which consisted of four components: a policy change, education, consultation and the availability of alternative interventions.MethodsData on the use of belt restraints, other types of physical restraints, falls and fall-related injuries and psychoactive drug use were collected at T2 (4 months) and T3 (8 months) after baseline (T1) for those resident who were newly admitted after baseline and before T2 (4 months). Physical restraint use data were collected by a trained, blinded observer four times during a 24-h period.ResultsA total of 104 residents were newly admitted after baseline (T1) and before T2. Of those, 82 were present on T2 and T3. Informed consent was obtained from legal representatives of 49 out of the 82 residents. In the control group (n = 20), 15% and 20% used belts at T2 (4 months) and T3 (8 months), respectively. In the intervention group (n = 29), these proportions were 3% and 0%, respectively (OR = 0.08; 95% CI (0.01–0.76); p = 0.03). There was no increase in the intervention group in the use of other physical restraints, falls and fall-related injuries or psychoactive drug use.ConclusionThe EXBELT intervention effectively seems to prevent the use of belt restraints in newly admitted residents in psychogeriatric nursing homes.     

Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial

BackgroundUp to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients’ sleep quality. An effective educational programme was important to improve patients’ sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan.ObjectivesTo examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure.Designrandomised controlled trial.Participants and settingEighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n = 43) or the control group (n = 41).MethodsPatients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients’ enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression.ResultsThe intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p < .001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p > .05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β = −2.22, p < .001), daytime sleepiness (β = −4.23, p < .001), anxiety (β = −1.94, p < .001), and depression (β = −3.05, p < .001) after 12 weeks of the intervention.ConclusionThis study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing.     

Association between home-visit nursing utilization and all-cause hospitalization among long-term care insurance beneficiaries: A retrospective cohort study

BackgroundEnsuring and improving long-term care services that use limited healthcare resources more efficiently is a major concern for many aging societies.ObjectivesThe aim of this study was to investigate the relationship between use of home-visit nursing services and all-cause hospitalization in a home-visit nursing-recommended group.DesignA retrospective cohort study.SettingPopulation-based sample of long-term care insurance beneficiaries from the long-term care insurance 2002–2013 claims database in South Korea.ParticipantsLong-term care insurance beneficiaries who need one or more types of nursing care were defined as the home-visit nursing −recommended group (n = 4173).MeasurementsThe dependent variable in this study was all-cause hospitalization in the home-visit nursing-recommended population. Multivariate Cox proportional hazards regression analysis was used to identify the association between home-visit nursing service use and all-cause hospitalization.ResultsA total of 3.8% of the subjects used home-visit nursing services. When participants who used home-visit nursing services were set as the reference group, participants who did not use home-visit nursing services had a higher risk of hospitalization (hazard ratio [HR] = 1.25, 95% confidence interval [CI] = 1.07–1.47). Additionally, participants who did not use home-visit nursing services and who did not have a caregiver showed a marked increase in the risk of hospitalization (HR = 6.81, 95% CI = 1.17–39.66). Participants who did not use home-visit nursing services with greater comorbidity showed a considerable increase in risk of hospitalization (HR = 1.36, 95% CI = 1.09–1.70).ConclusionsNon-use of home-visit nursing services was associated with an increased risk of all-cause hospitalization in the home-visit nursing-recommended population. The present results suggest that the use of home-visit nursing services reduced the risk of hospitalization. Moreover, home-visit nursing may play an essential role in reducing hospitalization risk in the absence of caregiver support.     

Using simulated family presence to decrease agitation in older hospitalized delirious patients: A randomized controlled trial

BackgroundSimulated family presence has been shown to be an effective nonpharmacological intervention to reduce agitation in persons with dementia in nursing homes. Hyperactive or mixed delirium is a common and serious complication experienced by hospitalized patients, a key feature of which is agitation. Effective nonpharmacological interventions to manage delirium are needed.ObjectivesTo examine the effect of simulated family presence through pre-recorded video messages on the agitation level of hospitalized, delirious, acutely agitated patients.DesignSingle site randomized control trial, 3 groups × 4 time points mixed factorial design conducted from July 2015 to March 2016.SettingAcute care level one trauma center in an inner city of the state of Connecticut, USA.ParticipantsHospitalized patients experiencing hyperactive or mixed delirium and receiving continuous observation were consecutively enrolled (n = 126), with 111 participants completing the study. Most were older, male, Caucasian, spouseless, with a pre-existing dementia.MethodsParticipants were randomized to one of the following study arms: view a one minute family video message, view a one minute nature video, or usual care. Participants in experimental groups also received usual care. The Agitated Behavior Scale was used to measure the level of agitation prior to, during, immediately following, and 30 min following the intervention.ResultsBoth the family video and nature video groups displayed a significant change in median agitation scores over the four time periods (p < 0.001), whereas the control group did not. The family video group had significantly lower median agitation scores during the intervention period (p < 0.001) and a significantly greater proportion (94%) of participants experiencing a reduction in agitation from the pre-intervention to during intervention (p < 0.001) than those viewing the nature video (70%) or those in usual care only (30%). The median agitation scores for the three groups were not significantly different at either of the post intervention time measurements. When comparing the proportion of participants experiencing a reduction in agitation from baseline to post intervention, there remained a statistically significant difference (p = 0.001) between family video(60%) and usual care (35.1%) immediately following the interventionConclusionThis work provides preliminary support for the use of family video messaging as a nonpharmacological intervention that may decrease agitation in selected hospitalized delirious patients. Further studies are necessary to determine the efficacy of the intervention as part of a multi-component intervention as well as among younger delirious patients without baseline dementia.     

Qigong/Tai Chi Easy for fatigue in breast cancer survivors: Rationale and design of a randomized clinical trial

IntroductionBreast cancer survivors (BCSs) often report fatigue that persists for years following treatment. Despite a growing body of evidence for meditative movement practices to improve symptoms among BCSs, few studies have explored using Qigong/Tai Chi to reduce fatigue. Additionally, few have examined the biological mechanisms through which fatigue may be reduced using Qigong/Tai Chi.Methods/study designWe will recruit 250 fatigued, post-menopausal women diagnosed with breast cancer (stage 0-III), between 6 months and 5 years past primary treatment and randomize to a standardized Qigong/Tai Chi Easy (QG/TCE) intervention, a “sham” Qigong group (movements without a focus on the breath and meditative state) (SQG), or an educational support (ES) group. The primary outcome (fatigue), secondary outcomes (anxiety, depression, sleep quality, cognitive function, physical activity), and a biomarker of HPA axis dysregulation (diurnal cortisol) will be assessed at baseline, post-intervention and 6 months postintervention, and biomarkers of inflammation (IL1ra, IL6, TNFα and INFᵧ) at pre/post-intervention. We hypothesize that QG/TCE will reduce fatigue (and improve other symptoms associated with fatigue) in BCSs experiencing persistent cancer-related fatigue more than SQG and ES. Biomarkers will be examined for relationships to changes in fatigue.ConclusionsFindings from this study may reveal the effects of the unique mind-body aspects of QG/TCE on fatigue in BCSs with a complex design that separates the effects of low-intensity physical activity (SQG) and social support/attention (ES) from the primary intervention. Further, results will likely contribute greater understanding of the biological mechanisms of these practices related to improved symptoms among BCSs.     

Barriers and facilitators in providing oral care to nursing home residents,from the perspective of care aides: A systematic review and meta-analysis

BackgroundOral health of nursing home residents is generally poor, with severe consequences for residents’ general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents.MethodsWe systematically searched the databases MEDLINE, Embase, Evidence Based Reviews—Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence.ResultsWe included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care = 45% (15%–77%); care providers’ lack of knowledge, education or training in providing oral care = 24% (7%–47%); general difficulties in providing oral care = 26% (19%–33%); lack of time = 31% (17%–47%); general dislike of oral care = 19% (8%–33%); and lack of staff = 22% (13%–31%).ConclusionsWe found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents’ responsive behaviors and to improve care aides’ oral care knowledge are especially needed.     

Efectividad de un programa de mejora para la calidad de los registros enfermeros en ginecología y obstetricia

ObjectivesTo evaluate the effect of a program to improve nursing documentation on the quality and quantity of the nursing records in the Obstetrics and Gynecology Units of the Hospital Clínico San Carlos (Madrid, Spain).MethodA quasi-experimental, pretest-posttest study was performed. The medical records of patients in the Obstetrics and Gynecology Unit were analyzed. The intervention was developed from January to May, 2005. The medical records of discharged patients were evaluated from January to December 2004 and from January to May 2005. In addition, the medical records of 50% of the patients admitted in December 2004 and June 2005 were randomly selected and audited. The variables analyzed were: 1) the number of records with a nursing discharge report, nursing care plan, and evaluation of the aims set, and 2) the number of nursing care plans and the coherence of these plans.ResultsStatistically significant differences were found in obstetrics (OBS) and gynecology (GYN) in the following variables: “discharge with evaluation of the aims set”: OBS, 2004 (20.6%), 2005 (57.6%), p < 0.001; GYN, 2004 (14.4%) and 2005 (54.6%), p < 0.001; “patients discharged with nursing care plans”: OBS, 2004 (95.5%), 2005 (98.8%), p < 0.001; GYN, 2004 (84.2%), 2005 (88.8%), p < 0.001; “coherence of the nursing care plan”: OBS, December 2004 (15.4%), June 2005 (93.7%), p < 0.001; GYN, December 2004 (28,6%), June 2005 (73%) p < 0.02.ConclusionsThe intervention was effective. Variables indicating quality (discharge with evaluation of the aims set and coherence of the nursing care plan) were significantly increased. The number of patients discharged with a nursing care plan also increased.     

An evaluation of involving family caregivers in the self-care of heart failure patients on hospital readmission: Randomised controlled trial (the FAMILY study)

BackgroundThe prevalence of heart failure is increasing in Lebanon but to date there is no systematic evaluation of a disease management intervention.ObjectiveThe aim of this study was to evaluate the effect of involving family caregivers in the self-care of patients with heart failure on the risk of hospital readmission.DesignA multi-site, block randomised controlled trial.SettingsThe study was conducted over a 13-month period in three tertiary medical centres in Beirut and Mount Lebanon, Lebanon.ParticipantsAdult patients presenting for an exacerbation of heart failure to one of the study centres were included. Patients with limited life expectancy or physical functionality, planned cardiac bypass or valve replacement surgery, living alone or in nursing homes, or aged less than 18 years were excluded.MethodsPatients allocated to the intervention group and their family caregivers were provided with a comprehensive, culturally appropriate, educational session on self-care maintenance and symptom management along with self-care resources. The usual care group received the self-care resources only. Follow-up phone calls were conducted 30 days following discharge by a research assistant blinded to treatment assignment. The primary outcome was hospital readmission and the secondary outcomes were self-care, quality of life, major vascular events and healthcare utilization.ResultsThe final sample included 256 patients hospitalized for heart failure randomised into control (130 patients) and intervention (126 patients) groups. The mean age was 67 (SD = 8) years, and the majority (55%) were male. Readmission at 30 days was significantly lower in the intervention group compared to the control group (n = 10, 9% vs. n = 20, 19% respectively, OR = 0.40, 95% CI = 0.02, 0.10, p = 0.02). Self-care scores improved in both groups at 30 days, with a significantly larger improvement in the intervention group than the control group in the maintenance and confidence sub-scales, but not in the self-care management sub-scale. No differences were seen in quality of life scores or emergency department presentations between the groups. More patients in the control group than in the intervention group visited health care facilities (n = 24, 23% vs. n = 12, 11% respectively, OR = 0.39, 95% CI = 0.18, 0.83, p = 0.01).ConclusionThe trial results confirmed the potential of the family-centred self-care educational intervention under evaluation to reduce the risk of readmission in Lebanese patients suffering from exacerbated heart failure. Further research is needed to validate these findings with longer periods of follow-up and to identify the intervention components and intensity required to induce sustained benefits on patients' self-care management and quality of life.