Improving self-care efficacy and quality of life with a self-management program among patients with chronic obstructive pulmonary disease: A quasi-experimental study.

Self-management helps patients understand their illnesses and learn about disease-related skills so they can better manage their situation. However, published studies on the effectiveness of self-management for chronic obstructive pulmonary disease (COPD) are heterogeneous. Quasi-experimental design was used to investigate the effectiveness of a self-management program in self-care efficacy and quality of life in patients with COPD. Sixty participants who had experienced COPD were assigned to control group (usual care) or experimental group (self-care program) (1:1 ratio) according to a purposeful sampling at a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self-Efficacy Scale, the Clinical COPD Questionnaire were used to analyze data. The Medical Research Council dyspnea scale was more significant improvement in the 2 months after discharge in the experimental group than in the control group. The COPD Self-Efficacy Scale and Clinical COPD Questionnaire scores in the experimental group within 3 months after discharge were significantly improved compared with the control group. These findings demonstrate the application and initial effect of this self-management program.

[Early Warning System for Illness Deterioration in Critically Ill Patients].

Monitoring the current and ongoing health status of patients with critical illnesses is an important function in critical care. Science-based assessments permit the early detection of deterioration in patient condition and the early implementation of medical care interventions. In this article, the empirical literature on this topic is reviewed and common early warning systems used currently and previously to detect deterioration in critically ill patients, including the disease severity assessment system, the early warning scoring tool, and the sequential organ failure assessment, are introduced. It is hoped that nursing staffs in acute and intensive care units use the information in this article to apply and validate early warning systems in order to improve the care and prognosis of critically ill patients.

The effects of a self-care program on patients with heart failure.

BACKGROUND: A lack of adequate knowledge and misconceptions by heart failure (HF) patients can lead to the improper use of self-care skills, as well as a lack of confidence in those same self-care skills. The existing literature suggests that care providers using a video-tape or a teaching booklet to educate HF patients, combined with telephone or telemonitoring counseling can effectively promote self-care and reduce readmission rates, and in turn promote overall patient health. The aim of the present study was to investigate the effects of self-care programs in patients with HF. METHODS: A quasi-experimental design was used to investigate the effectiveness of a self-care program in HF patients. The patients were allocated into either the control group (usual care, n = 75) or the experimental group (self-care program, n = 56). The extent of patient knowledge about congestive HF (CHF) was tested at both the pre- and posteducation stages. We measured the self-care of HF index (SCHFI) and the New York Heart Association (NYHA) functional class a total of four times for each participant. Furthermore, hospital readmissions and mortality rates were also collected. RESULTS: The experimental group showed a significantly higher mean score in the knowledge of CHF during posteducation testing than the control group. The results of the self-care evaluation also revealed significant differences between the two groups by repeated general linear model measurement analysis. Self-care maintenance, self-care management, and self-care confidence significantly improved after the self-care program was completed. The NYHA functional class in the experimental group showed a significant improvement after hospital discharge when compared with those in the control group. However there was no significant difference in hospital readmission or mortality rate between the two groups. CONCLUSION: Our study reveals that self-care programs administered by HF patients can reinforce educational objectives and improve patient ability to effectively perform self-care.

Comparison of the effect of intensive versus conventional insulinotherapy in patients with cardiac surgery after cardiopulmonary bypass.

Hyperglycemia occurs commonly in clinically ill patients. Insulin therapy and glycemic control have been recommended for patients with septic shock. The present study investigated the effect of intensive (INIT) versus conventional insulinotherapy (COIT) in cardiac surgery patients who received cardiopulmonary bypass (CPB). In this quasi-experimental study, a total of 50 patients undergoing coronary artery bypass grafting (CABG) were recruited into the INIT and COIT groups. Study measures included serum glucose levels, cardiac output, cytokines, C-reactive protein (CRP), duration of mechanical ventilation and length of stay in the intensive care unit (ICU), and ICU mortality rate. In the INIT group, mean blood glucose level during the first two postoperative days was significantly lower than that in the COIT group. Cardiac output was significantly greater at the second postoperative days in the INIT patients than those in the COIT group. There were no differences in cytokines, CRP levels and the outcome data between two groups. Intensive insulinotherapy reduced the blood glucose and led to improve cardiac output after CABG in comparison with conventional insulinotherapy.

"Inflammatory response to colloids compared to crystalloid priming in cardiac surgery patients with cardiopulmonary bypass".

"Cardiac surgery with cardiopulmonary bypass (CPB) induces a systemic inflammatory response syndrome that may contribute to postoperative morbidity and mortality. We investigated the in-flammatory responses to colloids compared to crystalloid priming in cardiac surgery patients with cardiopulmonary bypass. Thirty patients undergoing coronary artery bypass grafting (CABG) preparing for CPB were randomized into Ringer's solution (RS), 10% hydroxyethyl starch (HES) or 25% human albumin (HA) group. Serum concentrations of tumor necrosis factor-α (TNF-α), interleukin-1 ß (IL-1ß ), interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured before CPB, at the end of CPB and 1, 6 and 12 h after CPB. Serum C-reactive protein (CRP) was determined pre-operatively and then daily for 2 days. Body-weight gain was significantly decreased on the day after surgery in the HES group than in the RS group. Volume priming in CPB for CABG patients using HA or HES preparation had less tendency for intense inflammatory response with lower levels of TNF-α, IL-1 ß , IL-6 and higher levels of IL-10 compared to patients treated with RS. HES prime had lower levels of circulating CRP than in patients treated with HA or Ringer prime on the second post-operative day. Our data indicate that volume priming using colloid during CPB in CABG patients might exert beneficial effects on inflammatory responses."

Niacinamide mitigated the acute lung injury induced by phorbol myristate acetate in isolated rat's lungs.

BACKGROUND: Phorbol myristate acetate (PMA) is a strong neutrophil activator and has been used to induce acute lung injury (ALI). Niacinamide (NAC) is a compound of B complex. It exerts protective effects on the ALI caused by various challenges. The purpose was to evaluate the protective effects of niacinamide (NAC) on the PMA-induced ALI and associated changes. METHODS: The rat's lungs were isolated in situ and perfused with constant flow. A total of 60 isolated lungs were randomized into 6 groups to received Vehicle (DMSO 100 µg/g), PMA 4 µg/g (lung weight), cotreated with NAC 0, 100, 200 and 400 mg/g (lung weight). There were 10 isolated lungs in each group. We measured the lung weight and parameters related to ALI. The pulmonary arterial pressure and capillary filtration coefficient (Kfc) were determined in isolated lungs. ATP (adenotriphosphate) and PARP [poly(adenosine diphophate-ribose) polymerase] contents in lung tissues were detected. Real-time PCR was employed to display the expression of inducible and endothelial NO synthases (iNOS and eNOS). The neutrophil-derived mediators in lung perfusate were determined. RESULTS: PMA caused increases in lung weight parameters. This agent produced pulmonary hypertension and increased microvascular permeability. It resulted in decrease in ATP and increase in PARP. The expression of iNOS and eNOS was upregulated following PMA. PMA increased the neutrophil-derived mediators. Pathological examination revealed lung edema and hemorrhage with inflammatory cell infiltration. Immunohistochemical stain disclosed the presence of iNOS-positive cells in macrophages and endothelial cells. These pathophysiological and biochemical changes were diminished by NAC treatment. The NAC effects were dose-dependent. CONCLUSIONS: Our results suggest that neutrophil activation and release of neutrophil-derived mediators by PMA cause ALI and associated changes. NO production through the iNOS-producing cells plays a detrimental role in the PMA-induced lung injury. ATP is beneficial, while PARP plays a deteriorative effect on the PMA-induced ALI. NAC exerts protective effects on the inflammatory cascade leading to pulmonary injury. This B complex compound may be applied for clinical usage and therapeutic regimen.

[Factors related to self-care in heart failure patients].

Effective self-care behaviour is important to help patients and their families learn to live successfully with heart failure. Factors that may affect self-care include patient characteristics, disease condition, mental status, social support, treatment related issues and healthcare system issues. Interventions must be practical enough for an individual to use independent of outside assistance, flexible enough to respond to the specific and differing needs of heart failure patients, and adequately effective in order to impact clinical outcomes positively. We know that increased knowledge alone is unlikely to improve self-care or clinical prognosis and that effective interventions should clearly achieve improved self-care efficacy in heart failure patients. In this article, heart failure physiology and diagnosis, interventions, and self-care and factors affecting self-care in heart failure patients are described.

The involvement of nitric oxide, nitric oxide synthase, neutrophil elastase, myeloperoxidase and proinflammatory cytokines in the acute lung injury caused by phorbol myristate acetate.

Phorbol myristate acetate (PMA) causes acute lung injury (ALI). The present study was designed to elucidate the role of nitric oxide (NO), inducible NO synthase (iNOS), neutrophil elastase (NE) and other mediators in the ALI caused by PMA. In isolated rat's lungs, PMA at various doses (1, 2 and 4 mug/g lung weight) was added into the lung perfusate. Vehicle group received dimethyl sulfoxide (the solvent for PMA) 100 mug/g. We measured the lung weight changes, pulmonary arterial pressure, capillary filtration coefficient, exhaled NO, protein concentration in bronchoalveolar lavage (PCBAL) and Evan blue dye leakage. Nitrate/nitrite, methyl guanidine, proinflammatory cytokines, NE and myeloperoxidase (MPO) in lung perfusate were determined. Histopathological examination was performed. We detected the iNOS mRNA expression in lung tissue. PMA caused dose-dependent increases in variables for lung changes, and nitrate/nitrite, methyl guanidine, proinflammatory cytokines, NE and MPO in lung perfusate. The pathology was characterized by alveolar hemorrhagic edema with inflammatory cell infiltration. Scanning electron microscopy revealed endothelial damage. PMA upregulated the expression of iNOS mRNA. Our results suggest that neutrophil activation by PMA causes release of NE, upregulation of iNOS and a series of inflammatory responses leading to endothelial damage and ALI.

Physiological, psychological and autonomic responses to pre-operative instructions for patients undergoing cardiac surgery.

Several studies have reported that the experience may induce emotional reactions before and after surgery. Various Studies have demonstrated that effective pre-operative information reduces stress and anxiety levels. However, little is known about the effect of pre-operative instruction on autonomic responses as measured by heart rate variability (HRV) before cardiac surgery. Ninety-one patients were randomly assigned to video-tape viewing and teaching booklet group. Electrocardiogram was monitored before and after pre-operative instruction. HRV was analyzed with spectral analysis of frequency domains of heart rate and categorized into low and high frequency (LF and HF). After pre-operative instruction, subjects completed a score of perceived stress and helpfulness. In this study, we found that pre-operative instruction with video-tape was similarly effective as teaching booklets on patients' perceived stress, perceived helpfulness and recovery outcomes. The decrease in HF% and increase in LF/HF ratio of HRV indicate a change in sympathovagal balance toward a lower parasympathetic activity after pre-operative instruction in subjects of both groups. However, the perceived helpfulness of pre-operative instruction may often be associated with a relatively less sympathetic activity. Further studies are needed to determine the optimal timing to enhance the positive effects on the sympathovagal balance after pre-operative instruction.

Insulin attenuates endotoxin-induced acute lung injury in conscious rats.

OBJECTIVES: To investigate the effects of insulin on the acute lung injury induced by lipopolysaccharide using a conscious rat model. DESIGN: Prospective, randomized, controlled animal study. SETTING: University research laboratory. SUBJECTS: A total of 190 adult male Sprague-Dawley rats weighing 250-300 g. INTERVENTIONS: Endotoxemia was induced by intravenous infusion of lipopolysaccharide. Lipopolysaccharide at various doses (0, 1, 5, 10, 20, and 30 mg/kg, n=10 for each dose) was administered intravenously in 20 mins. Insulin infusion at doses of 0.5, 1, and 5 microU/kg/min was given 5 mins before lipopolysaccharide administration. Plasma glucose was clamped at 90-110 mg/dL by infusion of 10-80% glucose solution. Insulin and glucose infusion (0.01 mL/min) was started 5 mins before lipopolysaccharide and continued for 120 mins. The rats received a total of 60, 120, and 600 microU/kg insulin as well as 0.12, 0.36, and 0.96 g of glucose in respective groups. The animals were then observed for 4 hrs. MEASUREMENTS AND MAIN RESULTS: The extent of acute lung injury was evaluated by lung weight/body weight ratio, lung weight gain, protein concentration in bronchoalveolar lavage, and exhaled nitric oxide. We also measured plasma nitrate/nitrite and methyl guanidine. In addition, histopathologic changes of the lung were examined. Lipopolysaccharide caused systemic hypotension and severe acute lung injury with increases in plasma nitrate/nitrite and methyl guanidine. Pretreatment with insulin infusion at doses of 0.5, 1, and 5 microU/kg/min mitigated or prevented systemic hypotension and the development of acute lung injury, depending on the dose. Insulin also attenuated the lipopolysaccharide-induced increases in nitrate/nitrite and methyl guanidine. CONCLUSIONS: Insulin is effective in reducing or preventing the lipopolysaccharide-induced increases in plasma nitrate/nitrite and methyl guanidine and the occurrence of acute lung injury.