How do patients’ values influence heart failure self-care decision-making?: A mixed-methods systematic review

BackgroundValues are central to ethical and effective nursing and health care. However, in relation to heart failure, an extremely common and burdensome syndrome, the role that patients’ values have in influencing self-care is poorly understood.MethodsA mixed methods systematic review was conducted using a critical meta-narrative synthesis approach to synthesizing qualitative and qualitized data. Nine databases were searched (14 March 2014). To be included in the review, studies had to contain data on heart failure patients’ values and self-care behaviors, include adults aged ≥18 years with symptomatic heart failure, and be published ≥2000 as full articles or theses. Study quality was assessed using a mixed-methods appraisal tool.FindingsOf 6467 citations identified, 54 studies were included (30 qualitative, 8 mixed methods, and 16 quantitative; 6045 patients, 38 lay caregivers, and 96 health care professionals). The synthesis identified multiple bi-directional interactions between heart failure, patients’ values, and self-care. Patients are motivated by self-related and other-related values. Self-related values are tied directly to intimate personal feelings (self-direction, pleasure, and being healthy) or related to individuals’ life circumstances (maintaining a healthy lifestyle and financial balance). Other-related values, which are fundamentally socially-based, are related to benefits received from society (social recognition and socialization) and social obligations (responsibility, observing traditions, and obedience). For each decision, several values are involved; some are incompatible and some are in conflict. Patients make their self-care decision based on the values they prioritize and those that are blocked.ConclusionValues are integral to how patients approach and undertake HF self-care. These values both affect and respond to this self-care and the severity of HF symptoms. Values extend to those relating to the self and others and incorporate a range of personal, life, and social dimensions. Values cannot be assumed to be fixed, normative or similar to those held by nurses and other health professionals. Future interventions to improve HF self-care must address and respond to the complexity of patients’ values and how they influence patient behavior in undertaking heart failure self-care.     

老年退行性心脏瓣膜病合并心力衰竭的临床研究

目的 研究老年退行性心脏瓣膜病合并心力衰竭发病的临床特征.方法 将40例合并心力衰竭的老年退行性心脏瓣膜病与同期收治的40例年龄、性别相匹配的、无瓣膜钙化的合并心力衰竭的冠心病患者进行临床对比研究.结果 退行性心脏瓣膜病组在心律失常、充血性心力衰竭的分级及心脏扩大均明显高于冠心病组（P＜0.01）.近期死亡率的发生率略高于对照组,但无统计学意义.结论 老年退行性心脏瓣膜病可导致血液动力学障碍,加重心功能损害,成为老年人充血性心力衰竭、猝死的重要原因之一.     

应用Rodgers演化概念分析法界定慢性心力衰竭患者的自我管理

目的运用Rodgers演化概念分析法界定慢性心力衰竭患者自我管理的概念。方法系统检索Pubmed、CINAL、PsycINFO和万方数据知识服务平台,根据有关标准纳入了36篇文献进行概念分析,从概念的演变史、定义性特征、先决条件、结局、同义词与近义词、测评指标等方面,对当前慢性心力衰竭自我管理的概念进行了分析。结果慢性心力衰竭患者自我管理涉及一个递进的自我调节过程,包括5个定义性特征:疾病知识、寻求支持、自我效能、行为表现和自我感知。其先决条件包括个体因素和环境资源,结局关注再住院率(病死率)、医疗费用、生活质量和自我管理。结论澄清慢性心衰患者自我管理概念有助于临床开发慢性心力衰竭自我管理支持项目,编制有效评价慢性心衰患者自我管理的测评工具是未来的研究方向之一。     

姑息照护在心力衰竭患者中应用效果的系统评价

目的系统评价姑息照护干预心力衰竭患者的疗效。方法计算机检索PubMed、EMbase、CINAHL、The Cochrane Library、VIP、CNKI、CBM和WanFang Data数据库,搜集关于姑息照护干预心衰患者疗效的随机对照试验(RCT),检索时限均为建库至2021年9月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入11个RCT,包括912例患者。Meta分析结果显示,姑息照护可提高心力衰竭患者的生活质量[KCCQ或McGill QoL量表:SMD=0.85,95%CI(0.13,1.58),P=0.02;MLHFQ量表:SMD=-1.32,95%CI(-2.10,-0.54),P=0.0009]、降低患者抑郁水平[SMD=-0.58,95%CI(-0.87,-0.28),P=0.0001]与焦虑水平[SMD=-0.51,95%CI(-0.89,-0.13),P=0.008]、改善不良症状[SMD=-1.46,95%CI(-2.67,-0.24),P=0.02],减少人均住院时间[MD=-0.94,95%CI(-1.28,-0.60),P<0.00001]和降低再入院率[RR=0.64,95%CI(0.42,0.98),P=0.04],但对于患者的死亡率[RR=1.00,95%CI(0.63,1.57),P=0.99]并无明显影响。结论当前有限证据表明,姑息照护可改善心衰患者生活质量、情绪状态、不良症状,减少住院时间和降低再入院率。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。     

慢性心力衰竭患者血清睾酮和雌二醇测定及其意义

目的：探讨慢性心力衰竭患血清睾酮和雌二醇的改变及临床意义。方法：采用放射免疫法测定110例慢性心力衰竭（CHF）患血清睾酮和雌二醇水平。结果：CHF组血清雌二醇、睾酮和雌二醇／睾酮比值均显低于对照组（P均＜0．05）；I、Ⅱ、Ⅲ度心力衰竭组间血清睾酮和雌二醇依次递减，方差检验具有显性差异（P＜0．01）；住院期间死亡组血清雌二醇水平显低于好转出院（P＜0．05），但睾酮无显差异（P＞0．05）。结论：测定血清睾酮、雌二醇水平，有助于慢性心力衰竭发病机理的探讨和预后的判断。     

慢性心力衰竭患者营养不良风险预测模型的构建及验证

目的 构建慢性心力衰竭患者营养不良风险预测模型,并验证该模型的预测效果.方法 2019年1月-2020年1月,选择镇江市某三级甲等医院心血管内科住院的109例患者作为模型建立对象,将其分为营养不良组(40例)和营养正常组(69例).采用Logistic回归建立慢性心力衰竭患者营养不良风险预测模型,采用Hosmer-Le...     

The effects of thiamine supplementation on patients with heart failure: A systematic review and meta-analysis of randomized controlled trials

BackgroundMicronutrients can benefit patients with heart failure (HF). Thiamine is a critical vitamin, while the impact of thiamine supplementation on patients with HF remains unclear. Systematic review and meta-analysis were conducted to evaluate the effects of thiamine supplementation on clinical outcomes in patients with HF.MethodsDatabases including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and CNKI were searched from inception to June 29th 2022. Randomized controlled trials (RCTs) comparing thiamine supplementation with placebo were included. Meta-analysis was conducted with the software Review Manager 5.4. The quality assessment was performed according to Cochrane Risk of Bias Tool 2.0.ResultsEight studies including 384 patients were included in this review. The results of overall systematic review showed no benefit of thiamine supplementation in HF patients. Compared with the control group, the experimental group had no statistically significant improvements in LVEF (Mean Difference, − 0.19; 95 % CI, − 2.78 to 0.96; I² = 49 %; P = 0.10) in patients with chronic heart failure (CHF). Other outcomes including NYHA class, BNP or NT-proBNP, thiamine status, symptom changes, and quality of life were not improved by thiamine supplementation in CHF patients. Similarly, no improvements in clinical outcomes were found in patients with acute heart failure (AHF) in the studies included.ConclusionsThis systematic review and meta-analysis found no evidence to support the effects of thiamine supplementation in patients with HF, though thiamine supplementation is promising in improving cardiac functions, thiamine status and relieving HF-related symptoms. More well-designed RCTs with large sample sizes are required.     

30例慢性心力衰竭患者实施自我管理的效果

目的探讨对慢性心力衰竭(CHF)患者实施规范化自我管理项目的成效。方法选取符合条件的CHF患者30例。在采取常规护理措施和一般随访治疗的基础上,以自我管理模式理论为指导,实施规范化的自我管理项目,包括住院期间系统健康教育、出院健康指导及电话和家庭随访。干预时间10个月,比较干预前后的自我管理水平。结果 10个月后随访,自我管理得分优于干预前,差异有统计学意义(P<0.01)结论规范化的自我管理项目能提高CHF患者的自我管理水平。     

心力衰竭患者家庭关怀度与自我护理状况的相关性研究

目的探讨心力衰竭（心衰）患者的家庭关怀度与自我护理状况的相关性,为促进患者的自我护理提供依据。方法按方便抽样的原则,采用家庭关怀度指数问卷、心衰自我护理指数量表,测量144例住院心衰患者的家庭关怀度和自我护理状况,分析家庭关怀度与自我护理状况的相关性。结果本组心衰患者家庭关际度较好,总得分为（7．49±3．03）分;自我护理总体状况处于低水平,总得分为（156．23±38．51）分;其中,自我护理维持、自我护理管理和自我护理信心的得分分别为（54．38±10．41）分、（49．14±21．33）分和（53．02±13．74）分。家庭关怀度与自我护理状况呈正相关（r=0.21,P〈0.05）。结论心衰患者对症状的处理和信心有待提高。家庭关怀度对心衰患者的自我护理具有一定的促进作用,故在心衰患者自我护理的干预中应充分发挥家庭功能的作用。     

辨证护理提高充血性心力衰竭患者生存质量的效果观察

配合中西医结合治疗充血性心力衰竭 ,对 39例患者采取辨证施护 ,改善患者生存质量 ,取得较好的治疗效果     

Health supplements for allergic rhinitis: A mixed-methods systematic review

Allergic rhinitis is a chronic inflammatory condition caused by an exaggerated response of the immune system to common allergens. Most pharmacological therapies tend to be palliative and in some cases are associated with adverse effects. There is a growing tendency for people to self-medicate with health supplements as they are generally considered safe, however clinical studies relating to their efficacy and safety are limited. This mixed-methods systematic review aims to synthesise the available evidence relating to the treatment of allergic rhinitis with a variety of health supplements. A total of 57 062 articles were derived from searching seven online databases and evidence from 48 RCTs and 10 observational studies were reviewed for methodological quality and risk of bias. No qualitative studies meeting the inclusion criteria could be found, therefore only a quantitative review was performed. Promising evidence for the following single supplements were found: apple polyphenols, tomato extract, spirulina, chlorophyll c2, honey, conjugated linoleic acid, MSM, isoquercitrin, vitamins C, D and E, as well as probiotics. Combination formulas may also be beneficial, particularly specific probiotic complexes, a mixture of vitamin D₃, quercetin and Perilla frutescens, as well as the combination of vitamin D₃ and L. reuteri. Owing to the paucity of good quality evidence, recommendations pertaining to the use of health supplements for allergic rhinitis should involve a shared decision-making process between the healthcare provider and the patient, taking into account their efficacy, safety and cost. Further good quality clinical studies and qualitative research would further our understanding of the role these health supplements may play in future treatment protocols.     

A clinical pathway for heart failure reduces admissions from the ED without increasing congestion in the ED

Background

A multidisciplinary team at a major academic medical center established an Acutely Decompensated Heart Failure Clinical Pathway (ADHFCP) program to reduce inpatient readmission rates among patients with heart failure which, among several interventions, included an immediate consultation from a cardiologist familiar with an ADHFCP patient when the patient presented at the Emergency Department (ED). This study analyzed how that program impacted utilization of services in the ED and its subsequent effect on rates of admission from the ED and on disposition times.

Management of advanced heart failure: a review

ABSTRACT

Introduction: Heart failure (HF) has become a global pandemic. Despite recent developments in both medical and device treatments, HF incidences continues to increase. The current definition of HF restricts itself to stages at which clinical symptoms are apparent. In advanced heart failure (AdHF), it is universally accepted that all patients are refractory to traditional therapies. As the number of HF patients increase, so does the need for additional treatments, with an increased proportion of patients requiring advanced therapies.

Areas covered: This review discusses extensive evidence for the effect of medical treatment on HF, although the data on the effect on AdHF is scare. Authors review the relevant literature for treating AdHF patients. Furthermore, mechanical circulatory devices (MCD) have emerged as an alternative to heart transplantation and have been shown to enhance quality of life and reduce mortality therefore authors also review the current literature on the different MCD and technologies.

Expert commentary: More patients will need advanced therapies, as the access to heart transplantation is limited by the number of available donors. AdHF patients should be identified timely since the window of opportunities for advanced therapy is narrow as their morbidity is progressive and survival is often short.     

Exercise training to reduce sympathetic nerve activity in heart failure patients. A systematic review and meta-analysis

Objective

To determine the effects of exercise training on sympathetic nerve activity in heart failure patients.

A systematic review of heart failure dyadic self-care interventions focusing on intervention components,contexts, and outcomes

BackgroundHaving support from an informal carer is important for heart failure patients. Carers have the potential to improve patient self-care. At the same time, it should be acknowledged that caregiving could affect the carer negatively and cause emotional reactions of burden and stress. Dyadic (patient and informal carer) heart failure self-care interventions seek to improve patient self-care such as adherence to medical treatment, exercise training, symptom monitoring and symptom management when needed. Currently, no systematic assessment of dyadic interventions has been conducted with a focus on describing components, examining physical and delivery contexts, or determining the effect on patient and/or carer outcomes.ObjectiveTo examine the components, context, and outcomes of dyadic self-care interventions.DesignA systematic review registered in PROSPERO, following PRISMA guidelines with a narrative analysis and realist synthesis. Data Sources: PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials were searched using MeSH, EMTREE terms, keywords, and keyword phrases for the following concepts: dyadic, carers, heart failure and intervention. Eligible studies were original research, written in English, on dyadic self-care interventions in adult samples.Review methodsWe used a two-tiered analytic approach including both completed studies with power to determine outcomes and ongoing studies including abstracts, small pilot studies and protocols to forecast future directions.ResultsEighteen papers – 12 unique, completed intervention studies (two quasi- and ten experimental trials) from 2000 to 2016 were reviewed.Intervention components fell into three groups – education, support, and guidance. Interventions were implemented in 5 countries, across multiple settings of care, and involved 3 delivery modes – face to face, telephone or technology based. Dyadic intervention effects on cognitive, behavioral, affective and health services utilization outcomes were found within studies. However, findings across studies were inconclusive as some studies reported positive and some non-sustaining outcomes on the same variables. All the included papers had methodological limitations including insufficient sample size, mixed intervention effects and counter-intuitive outcomes.ConclusionsWe found that the evidence from dyadic interventions to promote heart failure self-care, while growing, is still very limited. Future research needs to involve advanced sample size justification, innovative solutions to increase and sustain behavior change, and use of mixed methods for capturing a more holistic picture of effects in clinical practice.     

Providing culturally appropriate care: A literature review

Objectives

As part of a study that explored how midwives incorporate cultural sensitivity, into their practice, the literature was reviewed to ascertain how the concept of culture has been, defined and what recommendations have been made as to how to provide culturally appropriate care, to individuals from Indigenous and/or ethnic minority backgrounds.

Design

A systematic review of the literature was undertaken.

Data sources

Electronic databases including Medline, Cinahl, Socio-file and Expanded Academic Index, were accessed.

Review methods

Several key search terms were used for example, midwife, midwives, midwifery, nurse, nurses, nursing, culture or cultural, diversity, sensitivity, competency and empowerment. The, results relating to midwifery were few; therefore ‘nursing’ was included which increased the amount, of material. References that were deemed useful from bibliographies of relevant texts and journal, articles were included. The inclusion criteria were articles that provided information about culture, and/or the culturally appropriate care of individuals from Indigenous and/or ethnically, culturally and, linguistically diverse backgrounds.Materials reviewed for this paper satisfied the inclusion criteria.

Results

There are two main approaches to culture; the first focuses on the cognitive aspects of culture, the ‘values, beliefs and traditions’ of a particular group, identified by language or location such as, ‘Chinese women’ or ‘Arabic speaking women’. This approach views culture as static and unchanging, and fails to account for diversity within groups. The second approach incorporates culture within a wider, structural framework, focusing on social position to explain health status rather than on individual behaviours and beliefs. It includes perspectives on the impact of the colonial process on the ongoing relationships of Indigenous and non-Indigenous people and how this affects health and health care.

Conclusion

Most of the literature focuses on the cognitive aspects of culture and recommends learning about the culture of specific groups which is presumed to apply to everyone. This generic approach can, lead to stereotyping and a failure to identify the needs of the individual receiving care. The concept of, cultural safety derived from the second approach to culture and practice has potential but evidence to show how it is being incorporated into practice is lacking and health professionals appear to be unclear about its meaning.     

Symptoms and strategies in heart failure in Turkey

Background: Patients with heart failure can live longer and achieve a better quality of life by learning about the symptoms and management of the disease and about associated changes required in the lifestyle and by controlling symptoms. Objectives: The objective of this study was to determine the symptoms experienced by patients with heart failure and to identify the strategies they use in the management of the disease. Methods: The study was carried out with 64 (53.3%) of patients diagnosed with chronic heart failure [functional class (II–III)] who had been admitted to the cardiology polyclinic. The patients had to be literate and conscious, and had to voluntarily accept to participate in the study. Data were gathered by a questionnaire. The patients were interviewed face to face with the researcher in the polyclinic. Data were evaluated by percentage values, averages and chi‐square. Results: Symptoms identified in the subjects were fatigue in 67.2%, dyspnoea in 60.9% and palpitation in 59.4% of respondents. A statistically significant difference was noted between men and women in the case of fatigue (P = 0.039), with this symptom having a stronger restricting effect on the daily activities of men compared with women. A significant difference between men and women was also observed for the management of dyspnoea (P = 0.004), preferred approach for avoiding this symptom being resting for men, while using medication and oxygen for women. Conclusion: Fatigue was found to be the most common symptom experienced by the subjects, followed by dyspnoea, palpitation and oedema, respectively. A significant difference between men and women was noted in approaches for reducing symptoms.     

浓缩红细胞输注抢救贫血性心脏病心力衰竭疗效分析

目的　改善贫血性心脏病心力衰竭患者生活质量 ,降低病死率 ,探讨最佳治疗方法。方法　对 42例贫血性心脏病心力衰竭患者采用少量多次输注浓缩红细胞 ,并与 40例输全血者对照。结果　心功能 (NYHA)进步 1级以上治疗组90 5 % ,显著高于对照组的 45 % (P <0 0 1) ;病死率治疗组 9 5 % ,显著低于对照组的 5 5 % (P <0 0 1) ;每搏输出量 (SV)治疗组治疗前后分别为 (81 1± 13 6)mL与 (76 7± 11 2 )mL(P >0 0 5 ) ,对照组分别为 (83 2± 12 3 )mL与 (78 2± 12 8)mL(P >0 0 5 ) ;左室射血分数 (LVEF)治疗组治疗前后分别为 (73± 15 ) %与 (71± 12 ) % (P >0 0 5 ) ;对照组分别为 (75± 13 ) %与 (72±13 ) % (P >0 0 5 )。结论　浓缩红细胞输注可改善贫血性心脏病患者心功能 ,降低病死率 ;LVEF不是判断本型心力衰竭转归的敏感指标 ,而血红蛋白、心率、NYHA分级则可客观地反应心功能状况 ;浓缩红细胞输注是治疗贫血性心脏病心衰安全、有效的方法 ,值得推广应用     

Effect of combined interval training on the cardiorespiratory fitness in heart failure patients: a systematic review and meta-analysis

BackgroundThe combination of interval training and resistance training has showed interesting results in chronic heart failure patients, corroborating the benefits of physiological adaptations of both protocols.ObjectiveTo evaluate the effect of the combination of interval training and resistance training program when compared to interval training alone and/or without intervention group on cardiorespiratory fitness in patients with chronic heart failure.MethodsWe search MEDLINE via PubMed, ScienceDirect, Sportdiscus, BIREME and Scielo, from their inception to December 2018. Were included both randomized and non-randomized controlled trials comparing the effect of combined training, interval training alone and/or WI group on VO_2peak (expressed in ml/kg/min), in people with chronic heart failure patients. The meta-analysis was conducted via Review Manager v 5.3 software, using random effect model.ResultsTen articles were selected (nine randomized controlled trial), involving 401 participants. Six studies compared combined training with interval training and six studies compared combined training with the without intervention group. Eighty percent of the trials presented moderate risk of bias and twenty percent low risk of bias. Data showed significant difference and major increase in VO_2peak in favor to combined training group compared to interval training group (SMD = 0.25; CI = 0.04–0.46) and without intervention group (SMD = 0.46; CI = 0.29–0.64), respectively.ConclusionThe combination of interval training and resistance training showed more effective in increasing cardiorespiratory fitness in patients with heart failure than interval training alone and non-exercise therapy. However, further studies should be conducted to increase the understanding of this combined training method.