Evaluating emotional distress and health-related quality of life in patients with heart failure and their family caregivers: Testing dyadic dynamics using the Actor-Partner Interdependence Model.

PURPOSE: 1) To compare levels of emotional symptoms and health-related quality of life between patients with heart failure and their family caregivers; and 2) to examine whether patients' and caregivers' emotional symptoms were associated with their own, as well as their partner's health-related quality of life. METHOD: In this cross-sectional study, 41 patients-caregiver dyads (78% male patients, aged 68.6 years; and 83% female caregivers, aged 65.8 years) completed all nine dimensions of the Brief Symptom Inventory and the Minnesota Living with Heart failure Questionnaire. Dyadic data were analysed for 6 sub-scales of the Brief Symptom Inventory, using the Actor-Partner Interdependence Model. RESULTS: There were no statistically significant differences in emotional symptoms and health-related quality of life between patients with heart failure and their caregivers. Patients' and caregivers' emotional symptoms were associated with their own health-related quality of life. Caregivers' anxiety, phobic anxiety, obsession-compulsion, depression and hostility negatively influenced their partner's (i.e. the patient's) health-related quality of life. There were no partner effects of patients' emotional symptoms on the health-related quality of life of caregivers. CONCLUSIONS: The results of this study suggest that patients may be particularly vulnerable to the emotional distress, i.e. thoughts, impulses and actions of their caregivers. It may be possible to improve patients' health-related quality of life by targeting specific detrimental emotional symptoms of caregivers.

Evaluating Perceptions of Self-efficacy and Quality of Life in Patients Having Coronary Artery Bypass Grafting and Their Family Caregivers.

BACKGROUND: Self-efficacy is a critical factor for quality of life in patients who undergo coronary artery bypass grafting, as well as for their family caregivers. However, there is lack of knowledge about whether patients' self-efficacy and caregivers' perceptions of patient self-efficacy are associated with quality of life in patient and caregiver dyads. OBJECTIVES: The aims of this study were to compare self-efficacy and quality of life between patients and family caregivers and to examine whether patients' and caregivers' perceptions of patient self-efficacy were associated with their own and their partner's quality of life in patient and caregiver dyads who were waiting for patients' coronary artery bypass grafting. METHODS: In this cross-sectional study, 84 dyads (85% male patients and 87% female caregivers) completed the Cardiac Self-efficacy Scale, which consists of self-efficacy for controlling symptoms and self-efficacy for maintaining function subscales, and the Short-Form 12 Health Survey for quality of life. Data were analyzed using the Actor-Partner Interdependence Model. RESULTS: Caregivers rated patient self-efficacy for maintaining function higher than did patients themselves and caregivers' perceptions were positively correlated with patients' physical health. Patients' self-efficacy for maintaining function exhibited an actor effect on their own mental health. There were no other actor or partner effects of self-efficacy on quality of life. CONCLUSIONS: Differences between patients' and caregivers' perceptions of patient self-efficacy for maintaining function should be addressed before surgery to reduce discordance. Patients' self-efficacy for maintaining function was associated with their own quality of life. There was no partner (relationship) effect of self-efficacy on quality of life. More research is needed in this area.

Reflexology has no immediate haemodynamic effect in patients with chronic heart failure: a double blind randomised controlled trial.

AIMS: This study measured the effects of reflexology in 12 reflexology-naive patients with chronic heart failure in a placebo-controlled, double blind randomised controlled study design. METHOD: Outcomes included 'beat-to-beat' non-invasive continuous measurement of cardiovascular parameters and measurement of state of anxiety and pain/discomfort. RESULTS: There were no changes in any of the haemodynamic parameters measured (all p > 0.05). Perceived state of anxiety was significantly reduced post treatment in the control group only (p = 0.03). CONCLUSIONS: Reflexology applied to the feet of patients with chronic heart failure appears to have no immediate haemodynamic effects. While any long term treatment effect is uncertain, it would appear that reflexology is safe for use in this patient group.

Coronary heart disease risk factors: concordance between patients and partners before and after bypass grafting surgery.

BACKGROUND: Coronary heart disease (CHD) risk factor reduction is required to maximize the benefits to be gained from coronary artery bypass grafting. Risk factor reduction after surgery, however, is often incomplete and adherence rates are poor. The health behaviors of the cardiac partner can be supportive or can act to undermine the patient's motivation for change in risk factors. Concordance in health behaviors in couples can make it more difficult for patients to engage in positive lifestyle changes. OBJECTIVES: The aims of this study were to increase understanding of the role of concordance in CHD risk factors and common medical conditions in patients and partners before and 4 months after bypass grafting and to examine changes in the pattern of concordance over time. METHODS: A prospective study of patients' and partners' CHD risk factors was conducted in the outpatient clinic before and at home 4 months after bypass grafting. RESULTS: There was significant concordance for preoperative physical activity, body mass index, and diabetes mellitus, and postoperatively, there was significant concordance for smoking status, physical activity, body mass index, cholesterol, and diabetes mellitus. There were significant associations between patients' preoperative and postoperative physical activity and cholesterol and between the partners' preoperative and postoperative physical activity. There was a significant change in the pattern of concordance for physical activity from preoperation to postoperation, with more patients but not partners increasing their physical activity levels. CONCLUSIONS: Results revealed significant concordance in CHD risk factors and common medical conditions in patients and partners before and 4 months after coronary artery bypass grafting. This indicates that the behaviors of some couples can make it more difficult for patients to change their lifestyle. The health professionals involved in educating patients before and after bypass grafting need to target the patient and partner as a couple to help achieve more successful risk factor reduction.

Can the theory of planned behaviour predict the physical activity behaviour of individuals?

The theory of planned behaviour (TPB) can identify cognitions that predict differences in behaviour between individuals. However, it is not clear whether the TPB can predict the behaviour of an individual person. This study employs a series of n-of-1 studies and time series analyses to examine the ability of the TPB to predict physical activity (PA) behaviours of six individuals. Six n-of-1 studies were conducted, in which TPB cognitions and up to three PA behaviours (walking, gym workout and a personally defined PA) were measured twice daily for six weeks. Walking was measured by pedometer step count, gym attendance by self-report with objective validation of gym entry and the personally defined PA behaviour by self-report. Intra-individual variability in TPB cognitions and PA behaviour was observed in all participants. The TPB showed variable predictive utility within individuals and across behaviours. The TPB predicted at least one PA behaviour for five participants but had no predictive utility for one participant. Thus, n-of-1 designs and time series analyses can be used to test theory in an individual.

A cohort study reporting clinical risk factors and individual risk perceptions of prostate cancer: implications for PSA testing.

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Prostate cancer has three known clinical risk factors: age, ethnicity and family history. Men's knowledge of prostate cancer is low. This study demonstrates that men rely on family and friends to learn about prostate cancer and help them interpret their risk. The findings suggest the need for tailored prostate cancer education, through social networks, to encourage risk-stratified PSA testing, which will lead to earlier diagnosis for those most at risk. OBJECTIVES: To determine men's perceptions of their risk of developing prostate cancer. To consider the implications for PSA testing based on individual risk perceptions. PATIENTS AND METHODS: The research adopted an embedded mixed-method design, using clinical records and a retrospective postal survey. Patients (N = 474) diagnosed with prostate cancer in a two-year period (2008-2009) in Greater Glasgow were identified from pathology records. In all, 458 men received a postal survey (16 deceased patients were excluded); 320 men responded (70%). RESULTS: Analysis indicates that there is no association between known clinical risk factors and men's perceptions of their own risk. Older men did not display increased perceived risk. Men with a family history of prostate cancer (11%) had no increase in their own perception of risk. PSA tests are not requested by those who are at greater risk. The subsample of patients who had requested a test were no more likely to have a family history of prostate cancer. They were more likely, however, to perceive themselves to be at high risk, to have friends with prostate cancer, to be affluent and to have a low grade tumour. CONCLUSIONS: GPs need to balance men's risk perceptions in discussions about known clinical risk factors. Men's knowledge of prostate cancer stems largely from interpersonal sources (such as friends/family). Social networks may consequently offer an additional opportunity to increase awareness of risk-stratified testing.

Reflexology has an acute (immediate) haemodynamic effect in healthy volunteers: a double-blind randomised controlled trial.

UNLABELLED: Reflexologists claim that massage to specific points of the feet increases blood supply to internal organs. This study measured changes in cardiovascular parameters in subjects receiving reflexology to areas of their feet thought to correspond to the heart (intervention) compared with other areas which are not (control). METHOD: 16 reflexology-naive healthy volunteers received an active and control reflexology treatment in an RCT, double-blind repeated measures study. MAIN OUTCOME MEASURES: 'Beat-to-beat' continuous measurement of selected cardiovascular parameters, State Anxiety Inventory. RESULTS: Cardiac index decreased significantly in the intervention group during left foot treatment (LFT) (baseline mean 2.6; standard deviation (SD) 0.75; 95% CI ± 0.38 vs. LFT mean 2.45; SD 0.68; CI 0.35), effect size (p = 0.035, omega squared effect (w2) = 0.002; w = 0.045). CONCLUSION: Reflexology massage applied to the upper part of the left foot may have a modest specific effect on the cardiac index of healthy volunteers.

Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study.

OBJECTIVE: To test the effectiveness of educational interventions in improving detection rates and management of dementia in primary care. DESIGN: Unblinded, cluster randomised, before and after controlled study. SETTING: General practices in the United Kingdom (central Scotland and London) between 1999 and 2002. INTERVENTIONS: Three educational interventions: an electronic tutorial carried on a CD Rom; decision support software built into the electronic medical record; and practice based workshops. PARTICIPANTS: 36 practices participated in the study. Eight practices were randomly assigned to the electronic tutorial; eight to decision support software; 10 to practice based workshops; and 10 to control. Electronic and manual searches yielded 450 valid and usable medical records. MAIN OUTCOME MEASURES: Rates of detection of dementia and the extent to which medical records showed evidence of improved concordance with guidelines regarding diagnosis and management. RESULTS: Decision support software (P = 0.01) and practice based workshops (P = 0.01) both significantly improved rates of detection compared with control. There were no significant differences by intervention in the measures of concordance with guidelines. CONCLUSIONS: Decision support systems and practice based workshops are effective educational approaches in improving detection rates in dementia.