Validity and reliability of a localized nursing assessment guide for symptoms of anxiety and depression among admitted adult cardiac Filipino patients

@#One of the most commonly used tools by clinicians to identify cases of anxiety and depression in medically ill patients is the Hospital Anxiety and Depression Scale, or the HADS Filipino version. However, there were some “gray areas” with its use, particularly for those who are in the non-psychiatric setting. Some translated items may pertain to something else which could influence patients' responses. Furthermore, local studies showed differences in the conception, understanding, and expression of depression unique to Filipino culture and could be potentially missed during the assessment. This paper determined the validity and reliability of the Anxiety and Depression Symptom Assessment Guide or ADSAto a sample of 91 adult cardiac Filipino patients in the in-patient setting.@*@#In addition to the 29-item ADSAtool that was generated from HADS, the review of literature and other sources was also reviewed by experts from two rounds of Delphi Survey. It was written in a yes-or-no format and available in both English and Filipino versions. The tool was tested for internal consistency, intra-class and inter-item reliability. Another test used was criterion-based validity utilizing HADS to identify cases of anxiety and depression. The results showed that ADSAis highly reliable with Cronbach's alpha of 0.97, poor-to-moderate intra-class correlation (0.670 for anxiety, 0.440 for depression), and consistent/acceptable interitem correlation (0.528 for anxiety, 0.382). Both HADS and ADSAwere positively correlated with correlation coefficients of 0.667 and 0.391 (p-value<0.5) for anxiety and depression respectively. Using a cut-off score of 5, ADSA has moderate sensitivity and specificity of 72.5% and 78.4% for anxiety, and 66.7% and 64.3% for depression. Further research is needed to strengthen ADSA's validity by increasing the sample size and the multi-center sites.

A percepção de portadores de insuficiência cardíaca sobre seu suporte social / Heart failure patients' perceptions about their social support / La percepción de los pacientes con insuficiencia cardiaca sobre su apoyo social

A Insuficiência Cardíaca (IC) é definida como uma incapacidade do coração de manter o bombeamento cardíaco adequado. A doença traz consequências como mudanças na rotina para adaptação, o que pode gerar isolamento social nos portadores. O artigo descreveu o suporte social percebido pelos pacientes com IC. Trata-se de um estudo qualitativo exploratório-descritivo, com 12 participantes com idades entre 65 e 80 anos, integrantes de Programa de Reabilitação Cardiorrespiratória, atendidos por equipe multidisciplinar. Foram aplicadas a Escala de Satisfação com Suporte Social (ESSS) e uma entrevista semiestruturada. Os participantes apresentaram resultados variados de 75, próximo do máximo até 29 pontos na ESSS. Quanto às percepções, relataram receber apoio emocional pela maior parte da família e apresentaram cuidado em termos de saúde física. Alguns mencionaram dificuldade nas relações sociais devido à IC. A partir dessa pesquisa, intervenções específicas para esse público podem ser melhor delineadas, assim como novos estudos com população maior (AU).

Heart Failure (HF) is defined as an inability of the heart to maintain adequate cardiac output. The disease leads patients to consequences such as changes in adaptation routine, which might lead to social isolation. The aim of the study is to describe the social support perceived by patients with HF. This is a qualitative exploratory and descriptive study, with 12 participants aged between 65 and 80 years old, member of a Cardiorespiratory Rehabilitation Program, assisted by a multidisciplinary team. The Social Support Satisfaction Scale (ESSS) and a semistructured interview were applied. Participants had scores ranging from 75, close do the maximum to 29 points on the ESSS. The patients' perceptions reported emotional support received by their families, and they showed care regarding their physical health. Some mentioned difficulties in social relations due to HF. Considering this research, specific interventions for this audience can be better designed, as well as other studies with a larger population (AU).

La insuficiencia cardíaca (IC) se define como la incapacidad del corazón para mantener un bombeo cardíaco adecuado. La enfermedad trae consecuencias como cambios en la rutina, lo que puede generar aislamiento social. El objetivo del estudio fue describir el apoyo social percibido por los pacientes portadores de la IC. Es un estudio cualitativo, exploratorio descriptivo, en el que participaron 12 participantes de entre 65 y 80 años, integrantes del Programa de Rehabilitación Cardiorrespiratoria, atendidos por un equipo multidisciplinario. Se aplicó la Escala de Evaluación de Apoyo Social (ESSS) y una entrevista semiestructurada. Los participantes tuvieron resultados variados desde 75, cerca del máximo a 29 puntos en la ESSS. En cuanto a las percepciones ellos reportaron el apoyo emocional en gran parte por la familia y presentando atención en términos de salud física. Algunos mencionaron dificultades en las relaciones sociales debido a la IC. Con base em esta investigación, se pueden diseñar mejores intervenciones específicas para esta audiencia, así como nuevos estudios con una población más grande (AU).

Factors Contributing For Noncompliance Of Follow-Up Care Among Post Cardiac Patients

Objective: Compliance in following healthy diet, physical activity schedule, cessation of smoking and alcohol, medication adherence and regular follow up is very essential component in the management of patients with cardiovascular disease to prevent reoccurrence and reduce mortality. Hence the study was conducted with the aim to assess the factors contributing for noncompliance of follow-up care among post cardiac patients. Methods: Cross-sectional research design was employed with 50 samples who matched the inclusion criteria were selected by convenience sampling technique. Demographic variables data were collected by using structured questionnaire followed by assessed the factors contributing for noncompliance using checklist. Results: The findings of the current study revealed that all physical, psychological, economical, social and spiritual factors were highly influenced the noncompliance. Of these, the highest percentage 80% reported lack of accessibility as well financial support and around 70% percentage reported side effects of medication and low health literacy. Conclusion: Health care providers need to be focussed on interventional strategies especially health education in discharge plan to ensure that these patients adhere to follow up including medication adherence, following physical activity plan, dietary modification, lifestyle changes and regular follow up visit to prevent readmission and lead a successful life.

Medication non-adherence related to patients’ attitudes and knowledge rather than socio-cultural factors: a study of cardiac clinic attendees at a public healthcare institute

Background: Medication non-adherence contributes significantly to sub-optimum care, for reasons that could be unique to specific localities. The study sought to identify reasons for non-adherence and associated factors in cardiac clinic attendees at a leading tertiary health institution in Trinidad and Tobago.Methods: This cross-sectional study included a convenience sample of cardiac clinic attendees. The data collection instrument was a questionnaire comprising items regarding socio-demographic characteristics, medical history, social support and reasons for medication non-adherence. Data were collected between March and July, 2016. Non-adherence was identified with total scores of >1 using selected similar questions to that used in the Morisky four-item adherence instrument. Data analyses involved both descriptive and inferential methods.Results: Non-adherent patients represented the largest proportion of participants (n=270, 78.3%). Participants were predominantly women, aged >50 years, of Indo-Trinidadian descent, married, and unemployed. Carelessness (n=251, 93.0%), ceasing medication use when feeling well (n=217, 80.4%), forgetfulness (n=187, 69.3%), and ceasing medication use when feeling worse (n=151, 50.6%) were the leading reasons for non-adherence, followed by unpleasant effects of medication and cost (n=144, 53.3%). Associated factors included feeling that one would become more ill upon ceasing medication use (p=0.003), the importance of understanding the reasons for taking medication (p=0.017), the importance of following physicians’ instructions (p=0.023), and educational level (p=0.040).Conclusions: Effective communication regarding patients’ concerns and potential adverse medication effects between patients and healthcare providers could promote greater adherence

Complejo ira - hostilidad y mecanismos de afrontamiento en pacientes que han sufrido un evento cardiovascular / Anger - hostility - aggression syndrome: mechanisms of coping in patients who have suffered a cardiovascular event

Introducción: Se ha relacionado el complejo ira - hostilidad - agresión con la enfermedad cardiovascular. Asimismo, los mecanismos de afrontamiento juegan un papel central en el proceso de rehabilitación cardiaca. El propósito de este estudio fue valorar la presencia del complejo ira - hostilidad - agresividad y sus mecanismos de afrontamiento en personas con enfermedad coronaria. Materiales y métodos: Se estudió un grupo de 19 pacientes que asisten al Programa de Rehabilitación Cardiaca de la Escuela Ciencias del Deporte de la Universidad Nacional. Se aplicó el cuestionario de agresión, para identificar el complejo ira - hostilidad - agresión, y el cuestionario COPE, para identificar mecanismos de afrontamiento. Ambos cuestionarios fueron aplicados en dos momentos: en versión retrospectiva, antes de sufrir el evento cardiovascular y una semana después. Resultados: En la evaluación retrospectiva del complejo ira-hostilidad se registraron promedios que oscilaron entre 1.84 y 2.51; los valores más altos fueron para las dimensiones hostilidad, 2.51, y agresividad verbal 2.49. En la evaluación actual, los promedios variaron entre 1.73 y 3.0, siendo los valores más altos para las dimensiones hostilidad, 2.28, e ira, 3.01. La única diferencia significativa se encontró en la dimensión ira, la cual en la evaluación actual fue superior a la retrospectiva, p menor 0.05. Por otro lado, los mecanismos de afrontamiento más utilizados fueron: la religión, el apoyo social, la aceptación, la planificación y afrontamiento activo y la reinterpretación positiva. Conclusión: Este estudio mostró un perfil de reacción emocional y de afrontamiento en los pacientes cardiópatas encuestados, que evidencia la necesidad de considerar los aspectos psicológicos en el proceso de rehabilitación cardiaca

Usefulness of Troponin-I, Lactate, C-reactive protein as a Prognostic Markers in Critically Ill Non-cardiac Patients / 결핵및호흡기질환

BACKGROUND: The severity scoring system is useful for predicting the outcome of critically ill patients. However, the system is quite complicated and cost-ineffective. Simple serologic markers have been proposed to predict the outcome, which include troponin-I, lactate and C-reactive protein(CRP). The aim of this study was to evaluate the prognostic values of troponin-I, lactate and CRP in critically ill non-cardiac patients. METHODS: From September 2003 to June 2004, 139 patients(Age: 63.3+/-14.7, M:F=88:51), who were admitted to the MICU with non-cardiac critical illness at Gyeongsang National University Hospital, were enrolled in this study. This study evaluated the severity of the illness and the multi-organ failure score (Acute Physiologic and Chronic Health Evaluation II, Simplified Acute Physiologic Score II and Sequential Organ Failure Assessment) and measured the troponin-I, lactate and CRP within 24 hours after admission in the MICU. Each value in the survivors and non-survivors was compared at the 10th and 30th day after ICU admission. The mortality rate was compared at 10th and 30th day in normal and abnormal group. In addition, the correlations between each value and the severity score were assessed. RESULTS: There were significantly higher troponin-I and CRP levels, not lactate, in the non-survivors than in the survivors at 10th day(1.018+/-2.58ng/ml, 98.48+/-69.24mg/L vs. 4.208+/-10.23ng/ml, 137.69 +/-70.18 mg/L) (p<0.05). There were significantly higher troponin-I, lactate and CRP levels in the non-survivors than in the survivors on the 30th day (0.99+/-2.66ng/ml, 8.02+/-9.54ng/dl, 96.87+/-68.83mg/L vs. 3.36+/-8.74ng/ml, 15.42+/-20.57ng/dl, 131.28+/-71.23mg/L) (p<0.05). The mortality rate was significantly higher in the abnormal group of troponin-I, lactate and CRP than in the normal group of troponin-I, lactate and CRP at 10th day(28.1%, 31.6%, 18.9% vs. 11.0%, 15.8 %, 0%) and 30th day(38.6%, 47.4%, 25.8% vs. 15.9%, 21.7%, 14.3%) (p<0.05). Troponin-I and lactate were significantly correlated with the SAPS II score(r2=0.254, 0.365, p<0.05). CONCLUSION: Measuring the troponin-I, lactate and CRP levels upon admission may be useful for predicting the outcome of critically ill non-cardiac patients.