Impact of Volume Management on Volume Overload and Rehospitalization in CAPD Patients.

Heart failure due to volume overload is a major reason for rehospitalization in continuous ambulatory peritoneal dialysis patients. Strict volume control provides better cardiac functions and blood pressure in this population. Volume management, which is a volume control strategy, may decrease volume overload and related complications. Using a quasi-experimental design, 66 continuous ambulatory peritoneal dialysis patients were randomly assigned to the intervention group ( n = 34) and control group ( n = 32). The patients were followed up for 6 months with scheduled clinic and/or telephone visits; the intervention group adopted volume management strategy, while the control group adopted conventional care. Volume overload and cardiac function were compared between the two groups at the baseline and at 6 months. At Month 6, the intervention group resulted in significant improvement in volume overloaded status, cardiac function, and volume-overload-related rehospitalization. Volume management strategy allows for better control of volume overload and is associated with fewer volume-related readmissions.

Development and Testing of Self-Management Scale for PD Patients.

OBJECTIVES: To develop and evaluate the self-management scale for peritoneal dialysis (PD) patients. METHODS: The item pool was formulated based on literature reviews and in-depth interviews. An initial scale containing five factors and 44 items was constructed through two rounds of Delphi expert consultation and a preliminary test. A total of 313 PD patients from the Jiangsu-Zhejiang-Shanghai area were surveyed to test the reliability and validity of the scale. RESULTS: Five factors, namely solution bag replacement, troubleshooting during operation, diet management, complication monitoring, emotion management and return to social life, were extracted by exploratory factor analysis: the 28 items could explain 64.567% of the total variance; the content validity index was 0.963; the Cronbach's α coefficient and split-half coefficient were 0.926 and 0.960 respectively; and test-retest reliability was 0.937. CONCLUSION: The scale has been proved to be a reliable and valid tool which allows PD nurses to evaluate the self-management ability of PD patients. The evaluation outcomes can serve as a basis for individualized nursing plans and interventions so as to provide highly effective nursing care.

Establishment of a Weight Management Scale for Patients with Congestive Heart Failure.

PURPOSE: The aim of this study was to develop a rating scale for the weight management of patients with congestive heart failure (CHF). METHODS: The original pool of items was created through in-depth interviews and a literature review. Scale validity was analyzed based on face validity, content validity, and structure validity. The content validity and structure validity were evaluated. The overall internal consistency reliability were assessed by using Cronbach's alpha and retest reliability test. RESULTS: A total of 190 CHF patients were enrolled but 5 refused. The original 19 items were then refined to a scale of 16 items. The final scale included four factors (weight monitoring, knowledge, confidence, and behaviours related to weight management), which accounted for 58.7% of the variance. Content validity ratio on the content validity was 0.88. The Cronbach's alpha was 0.843 and the retest reliability was 0.833. CONCLUSIONS: The Chinese CHF-related weight management scale developed has high reliability and validity. KEY WORDS: Congestive heart failure; Reliability; Scale; Validity; Weight management.

Reduction of heart failure rehospitalization using a weight management education intervention.

BACKGROUND: Previous investigators have demonstrated that patient adherence to optimal weight monitoring resulted in fewer heart failure (HF)-related rehospitalizations. OBJECTIVE: The aim of this study was to determine whether a weight management (WM) intervention can improve patients' WM ability and cardiac function and reduce HF-related rehospitalizations. METHODS: Heart failure patients were randomly assigned to an intervention group (n = 32) or a control group (n = 34). The intervention group received the WM intervention, including education about regular daily weight monitoring and coping skills when detecting sudden weight gain, with a WM booklet and scheduled telephone visits. Patients' WM ability was measured by the Weight Management Questionnaire (WMQ). We compared scores on the WMQ, New York Heart Association (NYHA) classification, and HF-related rehospitalizations between the 2 groups at enrollment and at 6 months. We also analyzed the association of adherence to weight monitoring and rehospitalization in the intervention group during the 6-month follow-up. RESULTS: There were no significant differences in weight monitoring adherence, WM ability, and NYHA classification between the 2 groups at baseline. At 6 months, scores on all 4 subscales of the WMQ significantly increased within the intervention group, and the WM-practice subscale significantly improved within the control group. Adherence to weight monitoring was significantly improved in the intervention group compared with the control group (81.25% vs 11.76%; P < .01). At 6 months, there was a significant improvement in NYHA class in the intervention group compared with the control group (P = .03). Rehospitalizations related to HF were also fewer in the intervention group (0.28 ± 0.63 vs 0.79 ± 1.18; P = .03) during the follow-up duration. In the intervention group, those who weighed themselves regularly reported less HF-related rehospitalizations than did those who did not (0.23 ± 0.43 vs 0.50 ± 1.23; P = .62). CONCLUSION: This study demonstrates that the WM intervention had a positive impact on patients' adherence to weight monitoring, WM ability, and NYHA classification and reduced HF-related rehospitalization.

Recruitment of phosphoinositide 3-kinase defines a positive contribution of tyrosine kinase signaling to E-cadherin function.

Classical cadherin adhesion molecules can function as adhesion-activated cell-signaling receptors. One key target for cadherin signaling is the lipid kinase phosphoinositide (PI) 3-kinase, which is recruited to cell-cell contacts and activated by E-cadherin. In this study, we sought to identify upstream factors necessary for E-cadherin to activate PI 3-kinase signaling. We found that inhibition of tyrosine kinase signaling blocked recruitment of PI 3-kinase to E-cadherin contacts and abolished the ability of E-cadherin to activate PI 3-kinase signaling. Tyrosine kinase inhibitors further perturbed several parameters of cadherin function, including cell adhesion and the ability of cells to productively extend nascent cadherin-adhesive contacts. Notably, the functional effects of tyrosine kinase blockade were rescued by expression of a constitutively active form of PI 3-kinase that restores PI 3-kinase signaling. Finally, using dominant negative Src mutants and Src-null cells, we identified Src as one key upstream kinase in the E-cadherin/PI 3-kinase-signaling pathway. Taken together, our findings indicate that tyrosine kinase activity, notably Src signaling, can contribute positively to cadherin function by supporting E-cadherin signaling to PI 3-kinase.