Diet quality indices and odds of metabolic dysfunction-associated fatty liver disease: a case-control study.

Objectives: There are only limited studies investigating the impact of dietary quality indicators, such as dietary quality index (DQI), dietary diversity score (DDS), and alternative healthy eating index (AHEI), on metabolic dysfunction-associated fatty liver disease (MASLD). Furthermore, these indicators may have different components that could lead to varying results. Therefore, this study aims to assess the nutritional quality indicators and their potential association with MASLD. Methods: The study included 128 recently diagnosed MASLD patients and 256 controls aged between 20 and 60 years. The dietary intake of participants was evaluated using a validated semi-quantitative food frequency questionnaire that consisted of 168 items. In this study, the method used to evaluate dietary diversity was based on five main food groups, specifically bread and grains, vegetables, fruits, meat, and dairy. The AHEI-2010 was computed using data collected from the FFQ. Results: After adjusting for confounders in the fully adjusted model, a significant negative correlation was observed between DDS and the risk of MASLD (OR 0.41, 95% CI 0.20, 0.97). Participants in the top quartile of AHEI had a 76% lower risk of MASLD compared with those in the bottom quartile after controlling for all potential confounders in the fully adjusted model (OR 0.24, 95% CI 0.12, 0.56). Conclusion: The results of our study suggest that there is a significant association between adherence to a high-diversity diet and a reduced likelihood of developing MASLD. Similarly, we observed a similar association between adherence to the AHEI diet and a lower risk of MASLD.

Are older patients' cardiac rehabilitation needs being met?

AIMS: The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme. BACKGROUND: Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake. DESIGN: Mixed methods. METHODS: A purposive sample of 31 older men and women (> or =65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face-to-face audio-taped interview. RESULTS: Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0.01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: 'The sensible thing to do', 'Assessing the impact' and 'Nothing to gain'. CONCLUSIONS: Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed. RELEVANCE TO CLINICAL PRACTICE: Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older person's perspective could help guide more appropriate intervention strategies.

Accuracy of patient recall of preoperative symptom severity (angina and breathlessness) at one year following aorta-coronary artery bypass grafting.

AIM AND OBJECTIVE: The accuracy with which patients recall their cardiac symptoms prior to aorta-coronary artery bypass grafting is assessed approximately one year after surgery together with patient-related factors potentially influencing accuracy of recall. BACKGROUND: This is a novel investigation of patient's rating of preoperative symptom severity before and approximately one year following aorta-coronary artery bypass grafting. DESIGN: Patients undergoing aorta-coronary artery bypass grafting (n = 208) were recruited preoperatively and 177 of these were successfully followed up at 16.4 (SD 2.1) months after surgery and asked to describe current and recalled preoperative symptoms using a 15-point numerical scale. METHOD: Accuracy of recall was measured and correlated (Pearson's correlation) with current and past symptoms, health-related quality of life and coronary artery disease risk factors. Hypothesis tests used Student's t-test and the chi-squared test. RESULTS: Respective angina and breathlessness scores were recalled accurately by 16.9% and 14.1% while 59% and 58% were inaccurate by more than one point. Although the mean preoperative and recalled scores for severity of both angina and breathlessness and were not statistically different, patients who recalled most accurately their preoperative scores had, on average, significantly higher preoperative scores than those with less accurate recall. Patients whose angina and breathlessness symptoms were relieved by operation had significantly better accuracy of recall than patients with greater levels of symptoms postoperatively. CONCLUSION: Patient's rating of preoperative symptom severity before and one year following aorta-coronary artery bypass grafting was completely accurate in approximately one sixth of patients with similar proportions of the remaining patients overestimating and underestimating symptoms. The extent to which angina and breathlessness was relieved by operation was a significant factor in improving accuracy of recall. RELEVANCE TO CLINICAL PRACTICE: Factors associated with accuracy of recall of symptoms provide useful insights for clinicians when interpreting patients' views of the effectiveness of aorta-coronary artery bypass grafting for the relief of symptoms associated with coronary heart disease.

Coronary artery bypass graft operation: Patients' experience of health and well-being over time.

BACKGROUND: The aim of the coronary artery bypass graft operation is to relieve anginal symptoms and improve functional ability, quality of life and survival. However, having the surgery does not always have the desired outcomes. Although numerous studies have investigated the outcomes of coronary artery bypass graft operation, little attention has been given to patients' perceptions of the outcomes or effects of the operation on health and well-being over time. AIM: To explore patients' perspectives on the effects of coronary artery bypass surgery on health and well-being over time. METHODS: As part of a larger mixed methods study, 62 in-depth audio-taped interviews with men and women who had undergone coronary artery bypass approximately 7 years earlier were conducted. Interviews were audio-taped and transcribed. Data were analysed thematically. This paper reports the findings from the qualitative component of the larger study. FINDINGS: The four main themes: 'Recovery and Rehabilitation', 'Seven Years On', 'Maintaining a Positive Approach', and 'Health Behaviour Change' reflect the main areas of focus emerging across the interviews and provide credible overarching descriptors of the sub-themes they encompass. The 11 sub-themes identified were recognised as central to the patients' experiences of their health and well-being over the longer-term. CONCLUSIONS: Although most patients report improved health and well-being after coronary artery bypass operation, many have described their recovery and rehabilitation as a complex process with both short and long term effects. The insights provided by participants help improve our understanding of the impact of the operation on patients' health and well-being over time. We believe these insights will help us to anticipate the possible needs of future patients and enable us develop appropriate interventions that may facilitate self-management for optimal recovery and health maintenance.

Understanding why older people participate in clinical trials: the experience of the Scottish PROSPER participants.

BACKGROUND: over the next 20 years it is anticipated that there will be a significant increase in those aged 75 and over, and a consequent increase in cardiovascular disease, cancer and chronic illness. As this shift takes effect, there will be an increased need for treatment strategies that are of known benefit to this age group and a consequent rise in demand for clinical trials that are conducted specifically with the older population. Because factors that motivate older individuals to participate in clinical trials may differ from those that influence younger adults, it is important to evaluate the strategies used to encourage recruitment and retention and to determine how appropriate these are. AIM: evaluation of the reasons why subjects agree to participate in a controlled clinical trial of vascular disease prevention and the strategies used to improve compliance and protocol adherence. SETTING: Scotland. SUBJECTS: 2,520 Prospective Study of Pravastatin in the Elderly at Risk participants, aged 70-82 with either pre-existing vascular disease or at least one major vascular risk factor (hypertension, cigarette smoking, or diabetes mellitus). DESIGN OF STUDY: two-stage iterative survey. Stage I was exploratory. RESULTS: curiosity, or an interest in finding out more about the study, 'a desire to support research', and anticipated personal benefits, such as health screening, were the most important motivators for generating initial interest in the trial. Ongoing health monitoring was the most important recruitment and retention motivator (P = 0.001). CONCLUSIONS: curiosity, self interest and altruism may act as motivators at different points in the study time-line. However, fostering positive relationships between staff and recruits, and keeping recruits informed about the progress of the study are likely to maximise the retention of older subjects to long-term trials.

Patients' perspectives on statin therapy for treatment of hypercholesterolaemia: a qualitative study.

BACKGROUND: Health Care Practitioners' attempts to implement secondary prevention targets for coronary heart disease (CHD) may be restricted by low rates of persistence with statin therapy. There is a need to understand why some patients, despite having established CHD and elevated cholesterol, do not comply with their prescribed statin regimen. AIM: To explore patients' perspectives on compliance with statin therapy. SETTING: Primary care, West of Scotland. METHODS: The research approach was qualitative. Thirty-three patients prescribed statin therapy and identified as having different patterns of compliance (poor moderate and good) were interviewed. The in-depth interviews were conducted on a one to one basis. Patients prescribed statin therapy for less than three months were excluded. Data were analysed thematically with the assistance of QSR Nudist. FINDINGS: From analysis of the narrative data, two broad categories, i.e. 'Patient-health care provider communication' and 'Health beliefs' were identified. These categories encompassed six main themes: 'Initiation of therapy'; 'Subsequent feedback'; 'Sources of misconceptions'; 'Unconditional acceptance'; 'Conditional acceptance'; 'Deferment and Rejection'. Acceptance of and compliance with statin therapy appeared to be associated with the provision, interpretation and feedback of information during patient-practitioner consultations, and patients' beliefs about personal health status, cholesterol, and recommended cholesterol-lowering strategies. CONCLUSIONS: Patients' beliefs and understanding about cholesterol, and the role of cholesterol modifying strategies should be determined prior to the initiation of therapy and at appropriate intervals thereafter.

Evaluating Emergency Nurse Practitioner services: a randomized controlled trial.

BACKGROUND: Emergency Nurse Practitioners (ENP) are increasingly managing minor injuries in Accident and Emergency departments across the United Kingdom. This study aimed to develop methods and tools that could be used to measure the quality of ENP-led care. These tools were then tested in a randomized controlled trial. METHODS: A convenience sample of 199 eligible patients, over 16 years old, and with specific minor injuries was randomized either to ENP-led care (n = 99) or Senior House Officer (SHO)-led care (n = 100) and were diagnosed, treated, referred or discharged by this lead clinician. Following treatment, patients were asked to complete a patient satisfaction questionnaire related to the consultation. Clinical documentation was assessed using a 'Documentation Audit Tool'. A follow-up questionnaire was sent to all patients at 1 month. Return visits to the department and missed injuries were monitored. RESULTS: Patients were satisfied with the level of care from both ENPs and SHOs. However, they reported that ENPs were easier to talk to (P = 0.009); gave them information on accident and illness prevention (P = 0.001); and gave them enough information on their injury (P = 0.007). Overall they were more satisfied with the treatment provided by ENPs than with that from SHOs (P < 0.001). ENPs' clinical documentation was of higher quality than SHOs (P < 0.001). No differences were found in recovery times, level of symptoms, time off work or unplanned follow-up between groups. Missed injuries were the same for both groups (n = 1 in each group). CONCLUSION: The study was sufficiently large to demonstrate higher levels of patient satisfaction and clinical documentation quality with ENP-led than SHO-led care. A larger study involving 769 patients in each arm would be required to detect a 2% difference in missed injury rates. The methods and tools used in this trial could be used in Accident and Emergency departments to measure the quality of ENP-led care.