Gender disparities in psychological distress and quality of life among patients with an implantable cardioverter defibrillator

A subset of patients with an implantable cardioverter defibrillator (ICD) reports psychological distress and poor quality of life (QoL). Gender is one of the factors that has been proposed to explain individual differences in these outcomes. In this viewpoint, we (1) review the evidence for gender disparities in psychological distress and QoL in ICD patients by means of a systematic review, and (2) provide recommendations for future research and clinical implications. A systematic search of the literature identified 18 studies with a sample size ≥ 100 that examined gender disparities in anxiety/depression and QoL in ICD patients (mean prevalence of women = 21%; mean age = 62 years). Our review shows that there is insufficient evidence to conclude that gender per se is a major autonomous predictor for disparities in psychological distress and QoL in ICD patients. Women had a higher prevalence of anxiety and poorer QoL in some studies, but there was no statistically significant gender effect in relation to 80% (26/32) of the outcomes reported in the 18 studies. Studies are warranted that are designed a priori and sufficiently powered to examine gender disparities in distress and QoL outcomes in order to establish the exact gender-specific effect. Due to a need to explore the complexity of this issue further, at this time, caution is warranted with respect to the clinical implications.     

心理护理对老年原发性高血压患者生活质量和心理状态的改善

目的探讨心理护理对老年原发性高血压患者治疗依从性、负性情绪及生活质量的影响。方法 140例高血压患者随机分为对照组和观察组,各70例。2组均给予常规降压治疗,对照组实施常规护理,观察组在此基础上实施心理护理。观察2组护理前后治疗依从性、负性情绪及生活质量的变化。结果对照组依从率82.86%,观察组依从率95.71%,差异有统计学意义(P0.05)。2组护理后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均下降,观察组低于对照组,差异有统计学意义(P0.05或P0.01)。2组护理后SF-36量表中各项维度评分均升高,观察组高于对照组,差异有统计学意义(P0.01)。结论对老年原发性高血压患者实施心理护理,可有效提高治疗依从性,改善负性情绪及生活质量。     

围术期心理护理干预对恶性肿瘤患者负性情绪的影响

目的探讨围术期心理干预护理对恶性肿瘤患者负性情绪的影响。方法选取恶性肿瘤患者86例,随机分为对照组与观察组,各43例。对照组围术期采用常规护理,观察组围术期在对照组基础上进行心理护理干预。采用90项症状自评量表(SCL-90)评价2组护理前后的心理状态;采用焦虑量表(SAS)、抑郁量表(SDS)分别评价2组护理前后的焦虑、抑郁情况;采用SF-36量表评价2组护理后的生活质量。结果护理后,2组SCL-90各项目评分及SAS、SDS评分均显著降低,且观察组显著低于对照组(P0.05或P0.01);干预后,2组SF-36量表中各项目评分显著升高(P0.05或P0.01),且观察组与对照组有显著差异(P0.01)。观察组中重度焦虑、抑郁患者比例显著低于对照组(P0.05)。结论心理干预护理可有效改善恶性肿瘤患者的负性情绪,促进术后康复,提高生活质量。     

老年期抑郁焦虑患者生命质量的研究

目的调查老年抑郁症和焦虑障碍共病患者与老年单纯抑郁症患者的生命质量差异。方法根据美国精神障碍诊断手册第四版(DSM-IV)的诊断标准,连续入组108例老年抑郁症患者,其中58例单纯抑郁症(抑郁症组),50例抑郁症和焦虑障碍共病(共病组)。选用健康状况调查问卷(SF-36)、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)量表对其生命质量进行评定。结果抑郁症组患者的躯体功能(PF)和社会功能(SF)因子分均高于共病组,差异均有统计学意义(t分别=3.95、3.69,P均<0.05)。抑郁症组HAMD和HAMA总分均低于共病组,差异均有统计学意义(t分别=-2.69、-6.16,P均<0.05)。PF与SF呈正相关(r=0.52,P<0.05),与HAMD、HAMA呈负相关(r分别=-0.47、-0.47,P均<0.05);SF与HAMD、HAMA均呈负相关(r分别=-0.45、-0.45,P均<0.05)。结论老年抑郁和焦虑障碍共病患者的生命质量下降,较单纯抑郁患者的抑郁和焦虑症状更重,共病患者的生命质量与其抑郁焦虑症状程度相关。     

产前综合性心理干预对围产期抑郁患者情绪及生活质量的影响

目的：探讨产前综合性心理干预对围产期抑郁患者情绪及生活质量的影响。方法将497例围产期抑郁患者按产检号随机分为两组,研究组251例,对照组246例。两组均接受常规孕期保健宣教,研究组在此基础上联合综合性心理干预,于孕28周、36周及产后1个月采用焦虑自评量表、爱丁堡产后抑郁量表、生活质量量表进行测评分析。结果孕28周两组各量表评分比较差异无显著性（ P＞0．05）。孕36周及产后1个月两组焦虑自评量表、爱丁堡产后抑郁量表总分均较孕28周显著降低（ P＜0．05或0．01）,研究组显著低于对照组（ P＜0．05或0．01）;研究组生活质量量表的精神成分及躯体成分维度分较孕28周显著升高（ P＜0．05或0．01）,对照组仅躯体成分维度分较孕28周显著升高（ P＜0．01）,研究组显著高于对照组（ P＜0．05或0．01）。结论综合性心理干预能显著改善围产期抑郁患者的焦虑抑郁情绪,提高患者的生活质量。     

Comparison of health‐related quality of life and emotional distress among Chinese cancer survivors

The purpose of this study is to compare health‐related quality of life (HRQoL) and emotional distress among diverse cancer survivors who had completed all treatment within the previous year. A convenience sample of 353 cancers survivors (lung, head and neck, breast and prostate cancers) were recruited to complete a survey, which consisted of (i) Hospital Anxiety and Depression Scales; (ii) Chinese version of the Functional Assessment of Cancer Therapy—General version; and (iii) demographic and clinical data. The HRQoL scores were similar among the four types of survivors. Mild anxiety and depression levels were reported, but no significant difference was noted. Younger females with financial burdens and uncertain prognosis were particularly associated with HRQoL and emotional distress. Further studies are essential to identify specific problems that cancer patients experience after cancer diagnosis that might lead to the early detection of those most at risk of ongoing problems.     

Quality of life in patients with multiple sclerosis in Eastern Slovakia

Purpose.?Quality of life (QoL) is an important measure of the burden of disease and could be useful in evaluating patient management and practical interventions. The aim of this study was to explore the association of psychological and clinical variables with QoL in patients with multiple sclerosis (MS).

Methods.?One hundred and fourteen consecutive patients (mean age 36.1 ± 10.3 years, 72%% female) from one MS centre completed the Hospital Anxiety and Depression Scale, the Fatigue Severity Scale and the Short-Form-36 Health Survey (SF-36). Functional disability was assessed using the Expanded Disability Status Scale. Multiple linear regression analyses were performed to analyse demographic, psychological and clinical data.

Results.?Functional disability, depression and fatigue were found to be related inversely to the physical health subscale. Disease course, anxiety and depression were associated negatively with the mental health subscale.

Conclusions.?Functional disability, depression and fatigue were the main variables related to the perceived physical health subscale, and disease course, anxiety and depression to the perceived mental health subscale in the group of patients with MS. Thus, effective treatment of fatigue, anxiety and depression could be assumed to increase a patient's QoL.     

乳腺癌患者术后生活质量与焦虑、抑郁情绪的相关性分析

目的探讨乳腺癌患者术后生活质量与焦虑、抑郁情绪的相关性,为临床护士开展心理护理提供依据。方法采用欧洲癌症研究与治疗组织研制的生活质量核心量表（QLQ-C30）、Zung焦虑自评量表（SAS）和Zung抑郁自评量表（SDS）分别测评147例乳腺癌患者的生活质量及其焦虑和抑郁状况,并分析其相关性。结果乳腺癌患者术后QLQ-C30评分中的躯体功能、角色功能、情绪功能、认知功能、社会功能以及总体健康状况分别与SAS评分和SDS评分呈负相关。而症状维度与SAS评分和SDS评分呈正相关（均P〈0．05）。结论乳腺癌患者术后焦虑、抑郁情绪越严重,其生活质量越差。提示临床护士应对其进行相应的心理辅导,提高患者的生活质量。     

集体运动激励在慢性阻塞性肺疾病稳定期患者中的应用

目的探讨集体运动激励对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者焦虑和抑郁情绪及生活质量的影响。方法选取COPD稳定期患者93例,按照随机数字表法分为干预组47例和对照组46例。对照组行常规护理及运动疗法,干预组在此基础上实施集体运动激励方法。干预前和干预后12周采用汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(hamilton depression scale,HAMD)评定患者的焦虑和抑郁情绪;采用健康状况调查问卷(short form-36health survey,SF-36)评定患者的生活质量。结果干预后,干预组患者HAMA和HAMD评分低于对照组,SF-36评分高于对照组患者,两组比较,均P<0.05,差异具有统计学意义。结论集体运动激励可有效地改善COPD稳定期患者的焦虑和抑郁情绪及生活质量。     

个体化护理对胆结石择期手术患者术前负性情绪及术后生活质量的影响

目的探讨个体化护理对胆结石择期手术患者术前负性情绪及术后生活质量的影响。方法选取胆结石患者168例,按随机数字表法分为观察组84例和对照组84例。对照组实施常规护理,观察组在对照组基础上实施个体化护理方案。观察2组入院时与术前的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分,并观察术后消化系统疾病生活质量评分量表(GIQLI)评分。结果术前,2组患者SAS、SDS评分均较入院时显著下降(P0.01),且观察组显著低于对照组(P0.01)。观察组术后GIQLI量表各因子评分及总分均显著高于对照组(P0.01)。结论对胆结石择期手术患者实施个体化护理方案,能改善患者术前焦虑和抑郁状态,提高术后生活质量。     

Psychological distress in patients with ICD recall

BACKGROUND: Multiple clinical trials have shown that a properly functioning implantable cardioverter-defibrillator (ICD) is capable of interrupting sudden death caused by ventricular tachyarrhythmias. However, ICDs are complex medical devices, and they do not always perform as expected or they may fail completely. Exposure of ICD recipients to professional or media reports that their specific device type is potentially malfunctioning could negatively influence their psychological status. METHODS: This study aimed to evaluate and quantify psychological distress in patients implanted with an ICD-recall device. Thirty patients implanted with ICD-recall devices (ICD-recall group) and 25 patients with unaffected ICD devices (ICD-control group) were interviewed using the Brief Symptom Inventory (a psychological self-report symptom scale). RESULTS: Mean values of all primary psychiatric distress symptom dimensions and global indices were within the normal range for both the ICD-recall and the ICD-control group. New York Heart Association (NYHA)class was a predictor of higher distress symptoms in all categories, independently of the ICD group. NYHA II group patients tended toward higher stress levels than the NYHA I group, but only somatization was significantly different. An upward, but not significant, trend in 7 of the 12 scales was associated with symptomatic shock experience. CONCLUSION: This study demonstrates that psychological distress was not significantly increased in patients recently informed about a potential malfunction of their device.     

化疗对肺癌患者心理痛苦的影响

目的 探讨化疗对肺癌患者心理痛苦的影响.方法 于化疗前后对50例肺癌患者采用心理痛苦温度计进行测评分析.结果 本组患者化疗前显著心理痛苦检出率为26.0％,化疗后为36.0％,二者比较差异无显著性（P＞0.05）.化疗前后显著心理痛苦均未出现占54.0％,均存在占16.0％,化疗后缓解占10.0％,新出现占20.0％.结论 化疗对肺癌患者显著心理痛苦的发生无显著影响.     

Coronary artery bypass graft (CABG) surgery patients in a clinical pathway gained less in health-related quality of life as compared with patients who undergo CABG in a conventional-care plan

Aims and objectives  The aim of this study is to determine the difference between clinical pathway (CP) and conventional care in terms of health-related quality of life (HRQoL) domains, depression and anxiety, as well as to determine the relative contribution of CP towards an improved HRQoL after coronary artery bypass graft (CABG).
Method  A longitudinal quasi-experimental pre-test/post-test design was used to study and compare clinical outcome, HRQoL depression and anxiety for CP versus conventional-care patients after CABG. HRQoL was measured by using Sf-36, while depression and anxiety were measured by using hospital anxiety and depression scale. Length of stay and patient complications were derived from the hospital database.
Results  We found that implementing a CP decreased hospital delay from 2.50 (±7.19) to 1.80 (±1.60), which was statistically significant P  = 0.002. We also found that patients in the conventional-care plan improved more than patients in the CP in HRQoL. Outcomes in favour of patients in the conventional-care trajectory were based on the difference between small effect sizes (ES) (≥0.20 <0.50) for pathway patients and moderate ES (≥0.50 <0.80) for conventional-care patients, except for the domain of physical functioning and physical component summary, where the ES for conventional care was large (>0.80).
Conclusion  The aim of designing and implementing pathways is to decrease length of stay and costs, while maintaining quality of care and improving patient outcomes. Our findings suggest that these aims were not fulfilled in this CABG pathway. We recommend that when designing a CP, all patient-related characteristics, risk indicators, along with physiological status, be taken into consideration.     

个案管理模式在慢性心力衰竭患者中的应用效果

目的:观察分析个案管理模式在慢性心力衰竭(chronic heart failure,CHF)患者中的临床应用效果。方法:选取同济大学附属上海市第十人民医院心内科住院患者为研究对象,其中2017年7月至10月的20例患者作为对照组,2017年11月至2018年2月的20例患者作为实验组,其中对照组接受常规护理进行管理,实验组应用个案管理模式管理,比较两组CHF患者管理结果的差异性。结果:干预前两组患者的焦虑自评量表(Self-rating Anxiety Scale,SAS)和抑郁自评量表(Self-rating Depression Scale,SDS)评分比较,差异无统计学意义(P>0.05)。干预后两组患者的SAS,SDS评分均有所降低,与干预前比较,差异有统计学意义(P<0.05);实验组患者干预后SAS,SDS评分低于对照组,差异有统计学意义(P<0.05);实验组患者生活质量评分高于对照组,差异有统计学意义(P<0.05);两组患者干预后住院时间和住院费用的比较,差异无统计学意义(P>0.05)。结论:个案管理模式能够有效改善CHF患者的生活质量和心理状态,建议临床推广使用。