Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial.

BACKGROUND: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. PURPOSE: To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. METHODS: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. RESULTS: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. CONCLUSION: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

Tai chi qigong as a means to improve night-time sleep quality among older adults with cognitive impairment: a pilot randomized controlled trial.

PURPOSE: Age-related cognitivee decline is a growing public health concern worldwide. More than a quarter of adults with cognitive impairment experience sleep disturbance. The objective of this pilot study was to evaluate the preliminary effects of tai chi qigong (TCQ) on improving the night-time sleep quality of older adults with cognitive impairment. PARTICIPANTS: Older adults with cognitive impairment who complain of sleep disturbance. METHODS: A randomized controlled trial with two groups. Fifty-two subjects were recruited from two district elderly community centers and randomly assigned to either the TCQ group (n=27) or the control group (n=25). The intervention group received TCQ training consisting of two 60-minute sessions each week for 2 months. The control group was advised to maintain their usual activities. Sleep quality was measured by the Chinese Pittsburgh Sleep Quality Index. Quality of life was measured by Short-form 12, cognitive functions measured by mini-mental state examination, and subjective memory deficits measured by the memory inventory for Chinese. RESULTS: Data were collected at baseline, 2 months, and 6 months. Significant results were noted at 6 months in the Chinese Pittsburgh Sleep Quality Index global score (P=0.004), sleep duration (P=0.003), habitual sleep efficiency (P=0.002), and the Short-form 12 mental health component (P<0.001). The TCQ participants reported better sleep quality and a better (quality of life) mental health component than the control group. CONCLUSION: TCQ can be considered a useful nonpharmacological approach for improving sleep quality in older adults with cognitive impairment. CLINICAL TRIAL REGISTRATION: CUHK_CCT00448 (https://www2.ccrb.cuhk.edu.hk/registry/public/287).

Effects of a nurse-led heart failure clinic on hospital readmission and mortality in Hong Kong.

BACKGROUND: Heart failure (HF) is a physically and socially debilitating disease that carries the burden of hospital re-admission and mortality. As an aging society, Hong Kong urgently needs to find ways to reduce the hospital readmission of HF patients. This study evaluates the effects of a nurse-led HF clinic on the hospital readmission and mortality rates among older HF patients in Hong Kong. METHODS: This study is a retrospective data analysis that compares HF patient in a nurse-led HF clinic in Hong Kong compared with HF patients who did not attend the clinic. The nurses of this clinic provide education on lifestyle modification and symptom monitoring, as well as titrate the medications and measure biochemical markers by following established protocols. This analysis used the socio-demographic and clinical data of HF patients who were aged ≥ 65 years old and stayed in the clinic over a six-month period. RESULTS: The data of a total of 78 HF patients were included in this data analysis. The mean age of the patients was 77.38 ± 6.80 years. Approximately half of the HF patients were male (51.3%), almost half were smokers (46.2%), and the majority received ≤ six years of formal education. Most of the HF patients (87.2%) belonged to classes II and III of the New York Heart Association Functional Classification, with a mean ejection fraction of 47.15 ± 20.31 mL. The HF patients who attended the clinic (n = 38, 75.13 ± 5.89 years) were significantly younger than those who did not attend the clinic (n = 40, 79.53 ± 6.96 years) (P = 0.04), and had lower recorded blood pressure. No other statistically significant difference existed between the socio-demographic and clinical characteristics of the two groups. The HF patients who did not attend the nurse-led HF clinic demonstrated a significantly higher risk of hospital readmission [odd ratio (OR): 7.40; P < 0.01] than those who attended after adjusting for the effect of age and blood pressure. In addition, HF patients who attended the clinic had lower mortality (n = 4) than those who did not attend (n = 14). However, such a difference did not reach statistical significance when the effects of age and blood pressure were adjusted. A significant reduction in systolic blood pressure [F (2, 94) = 3.39, P = 0.04] and diastolic blood pressure [F (2, 94) = 8.48, P < 0.01] was observed among the HF patients who attended the clinic during the six-month period. CONCLUSIONS: The finding of this study suggests the important role of nurse-led HF clinics in reducing healthcare burden and improving patient outcomes among HF patients in Hong Kong.

Evolvement of left ventricular assist device: the implications on heart failure management.

Heart failure (HF) is a potentially fatal disease that affects increasing number of people worldwide. Although heart transplant is the "gold standard" therapy for HF, due to the limited availability of organs, many patients died when waiting for the transplant. Left ventricular assist device (LVAD), as a mechanical circulatory support, has become a new light for patients with HF. With the technical advancements, LVADs work not only as a bridge to transplant, but also assist heart recovery and even as a destination therapy in long-term treatment. This observation paper reviewed the development of LVAD and its clinical roles. The challenges and possible solutions in nursing care for patients with LVAD at different stage of implantation were discussed. The healthcare professionals could obtain a better understanding about the LVAD treatment for HF patients.

Symptom clusters and quality of life among patients with advanced heart failure.

OBJECTIVES: To identify symptom clusters among patients with advanced heart failure (HF) and the independent relationships with their quality of life (QoL). METHODS: This is the secondary data analysis of a cross-sectional study which interviewed 119 patients with advanced HF in the geriatric unit of a regional hospital in Hong Kong. The symptom profile and QoL were assessed by using the Edmonton Symptom Assessment Scale (ESAS) and the McGill QoL Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Hierarchical regression analysis was used to examine the independent relationships with their QoL, after adjusting the effects of age, gender, and comorbidities. RESULTS: The patients were at an advanced age (82.9 ± 6.5 years). Three distinct symptom clusters were identified: they were the distress cluster (including shortness of breath, anxiety, and depression), the decondition cluster (fatigue, drowsiness, nausea, and reduced appetite), and the discomfort cluster (pain, and sense of generalized discomfort). These three symptom clusters accounted for 63.25% of variance of the patients' symptom experience. The small to moderate correlations between these symptom clusters indicated that they were rather independent of one another. After adjusting the age, gender and comorbidities, the distress (ß = -0.635, P < 0.001), the decondition (ß = -0.148, P = 0.01), and the discomfort (ß = -0.258, P < 0.001) symptom clusters independently predicted their QoL. CONCLUSIONS: This study identified the distinctive symptom clusters among patients with advanced HF. The results shed light on the need to develop palliative care interventions for optimizing the symptom control for this life-limiting disease.

Retracted: Can the transtheoretical model motivate patients with coronary heart disease to exercise?

Li-Xia Zhu, Shuk-Ching Ho, Janet WH Sit and Hong-Gu He The above article from Nursing & Health Sciences, "Can the transtheoretical model motivate patients with coronary heart disease to exercise?" by Li-Xia Zhu, Shuk-Ching Ho, Janet WH Sit and Hong-Gu He, published online on 4th June 2014 on Wiley Online Library (wileyonlinlibrary.com) DOI: 10.1111/nhs.12150, has been retracted by agreement between the lead author, the journal's Editor in Chief, Teresa Stone, and Wiley Publishing Asia Pty Ltd. The retraction has been agreed due to the main study having been previously published. References to the previously published articles: Zhu L-X, Ho S-C, Sit JWH, He H-G. The effects of a transtheoretical model-based exercise stage-matched intervention on exercise behavior in patients with coronary heart disease: A randomized controlled trial. Patient Educ. Couns. 2014; 95: 384-392. http://www.pec-journal.com/article/S0738-3991(14)00129-3/abstract Zhu L-X, Ho S-C, Sit JWH, He H-G. Effects of a transtheoretical model-based exercise stage-matched intervention on exercise behaviour and quality of life in patients with coronary heart disease: a randomized controlled trial. J. Adv. Nurs. 2014. doi:10.1111/jan.12469 http://onlinelibrary.wiley.com/doi/10.1111/jan.12469/abstract Zhu L-X, Ho S-C, Sit JWH, He H-G. Effect of a transtheoretical model-based stage-matched exercise intervention on exercise behavior and angina in patients with coronary heart disease: a randomized controlled trial. J. Cardiovasc. Nurs. 2014. DOI: 10.1097/JCN.0000000000000162. http://journals.lww.com/jcnjournal/Citation/publishahead/Effect_of_a_Transtheoretical_Model_Based.99700.aspx.