Examining Symptom Trajectories That Predict Worse Outcomes in Post-CABG Patients

Background: Coronary artery bypass grafting is one of the most common interventional revascularisation procedures used to treat coronary artery disease worldwide. With a wide variability in postoperative cardiac symptoms, identification of symptom trajectories during the 3-month postoperative recovery period may improve clinicians’ abilities to support symptom recovery. Aims: To identify distinct trajectories of cardiac symptoms seen over time in a cohort of patients during the 3-month post-coronary artery bypass grafting period, and determine clinical characteristics associated with different symptom trajectories postoperatively. Methods: A prospective trial used the cardiac symptom survey to determine patient symptoms at baseline prior to surgery, and at 1 week, 6 weeks and 3 months following coronary artery bypass grafting. A latent class growth model and multivariate logistic regression analyses were used. Results: Data were obtained from patients (N=198) undergoing coronary artery bypass grafting in six medical centres of Taiwan, through patient medical records and interviews. Based on their frequency, trajectories were explored for the six most common postoperative symptoms including angina, dyspnoea, fatigue, depression, sleep problems and anxiety. We identified two to three distinct classes of trajectories for each symptom. Age, longer intensive care unit stay, fewer vessels bypassed, off-pump coronary artery bypass grafting, smoking history and lack of regular exercise were associated with worse symptom outcome trends over time. Conclusions: Using this unique trajectories-based research method, we are able to achieve a better understanding of symptom recovery patterns over time among coronary artery bypass grafting patients. Recognising risk factors and potential recovery patterns prior to surgery may allow healthcare providers to deliver targeted discharge planning and individualised care after coronary artery bypass grafting

Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease

[[abstract]]Background.  Traditional Chinese acupressure is a noninvasive technique that employs pressure and massage to acupoints in order to stimulate the balance of life energy that promotes health and comfort. Sleep disturbance is common in patients with end-stage renal disease but no intervention studies have addressed this problem. Aim.  The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life. Methods.  The study was a randomized control trial. A total of 98 end-stage renal disease patients with sleep disturbances were randomly assigned into an acupressure group, a sham acupressure group, and a control group. Acupressure and sham acupressure group patients received acupoints or no acupoints massage three times a week during haemodialysis treatment for a total of 4 weeks. The measures included the Pittsburgh Sleep Quality Index, Sleep Log, and the Medical Outcome Study – Short Form 36. Findings.  The results indicated significant differences between the acupressure group and the control group in Pittsburgh Sleep Quality Index subscale scores of subjective sleep quality, sleep duration, habitual sleep efficiency, sleep sufficiency, and global Pittsburgh Sleep Quality Index scores. Sleep log data revealed that the acupressure group significantly decreased wake time and experienced an improved quality of sleep at night over the control group. Medical Outcome Study – Short Form 36 data also documented that acupressure group patients experienced significantly improved quality of life. Conclusion.  This study supports the effectiveness of acupoints massage in improving the quality of sleep and life quality of end-stage renal disease patients, and offers a noninvasive therapy for sleep-disturbed patients

Effects of acupressure therapy for patients with prolonged mechanical ventilation support.

[[abstract]]Keywords: acupressure;anxiety;chronic obstructive pulmonary disease;dyspnoea;nursing;ventilator Aims.  This paper reports an investigation of the effects of acupressure therapy on dyspnoea, anxiety and physiological indicators of heart rate and respiratory rate in patients with chronic obstructive pulmonary disease having mechanical ventilation support. Background.  Patients with chronic obstructive pulmonary disease who are using mechanical ventilation often experience dyspnoea and anxiety, which affects successful ventilator use. Methods.  The study had an experimental blocking design, using sex, age and length of ventilator use as a blocking factor. Qualified patients in two intermediate respiratory intensive care units were randomly assigned to an acupressure group and a comparison group. A total of 52 patients with chronic obstructive pulmonary disease in northern Taiwan participated. Those in the experimental group received daily acupressure therapy and massage treatment for 10 days. Patients in the comparison group received massage treatment and handholding. The primary outcome measures were the visual analogue scales for dyspnoea and anxiety, and physiological indicators of heart rate and respiratory rate. Data were collected every day from baseline (day 1), during the treatment (days 2–10) and follow-up (days 11–17). Data were analysed using generalized estimation equations. The study was carried out in 2003. Results.  Patients with chronic obstructive pulmonary disease who were using prolonged mechanical ventilatory support experienced high levels of dyspnoea and anxiety. Dyspnoea (P = 0·009), anxiety (P = 0·011) and physiological indicators (P < 0·0001) in the acupressure group improved statistically significantly over time when compared with those of the comparison group. Conclusions.  This results support the suggestion that acupressure therapy could decrease sympathetic stimulation and improve perceived symptoms of dyspnoea and anxiety in patients with chronic obstructive pulmonary disease who are using prolonged mechanical ventilation

Acupressure and Tanscuteneous Electrical Acupoints Stimulation improving fatigue, sleep quality and depression in hemodialysis patients.

[[abstract]]The purpose of this study was to test the effectiveness of acupressure and Transcutaneous Electrical Acupoint Stimulation (TEAS) on fatigue, sleep quality and depression in patients who were receiving routine hemodialysis treatment. The study was a randomized controlled trial; qualified patients were randomly assigned to acupressure, TEAS or control groups. Patients in the acupressure and TEAS groups received 15 minutes of treatment 3 times a week for 1 month, whereas patients in the control group only received routine unit care. A total of 106 patients participated in the study. Methods of measurement included the revised Piper Fatigue Scale (PFS), the Pittsburgh Sleep Quality Index and the Beck Depression Inventory. Data were collected at baseline, during the intervention and post-treatment. The results indicated that patients in the acupressure and TEAS groups had significantly lower levels of fatigue, a better sleep quality and less depressed moods compared with patients in the control group based upon the adjusted baseline differences. However, there were no differences between acupressure and TEAS groups in outcome measures. This study provides an alternative method for health care providers in managing dialysis patients with symptoms of fatigue, poor sleep or depression

Empowerment of patients with end-stage renal disease--a randomized controlled trial

[[abstract]]The purpose of the study is to investigate the effectiveness of an empowerment program on empowerment level, self-care self-efficacy and depression in patients with end-stage renal disease. The study was a randomized controlled trial; qualified patients in two dialysis centers of major hospitals in southern Taiwan were randomly assigned into an empowerment group (n=25) and a control group (n=25). The empowerment program included identification of problem areas for self-management; exploration of emotions associated with these problems; development of a set of goals and strategies to overcome these problems to achieve these goals; creation and implementation of behavioral change plans; and stress management. The outcomes measured were the Empowerment Scale, the Strategies Used by People to Promote Health and the Beck Depression Inventory. Data were collected at baseline and 6 weeks following intervention. Primary statistical analysis was by means of t-test and analysis of covariance. The results indicated that scores of the empowerment (t(48)=6.54, p<0.001), self-care self-efficacy (F(1,47)=10.82, p=0.002) and depression (t(48)=2.49, p=0.03) in the empowerment group have a significantly greater improvement than the control group

Self-care self-efficacy, depression, and quality of life among patients receiving hemodialysis in Taiwan

[[abstract]]The purpose of this study is to examine relationships among self-care self-efficacy, depression, and quality of life in 160 patients receiving hemodialysis. The study is a descriptive, correlational design. Measures include Strategies Used by People to Promote Health, the Geriatric Depression Scale, and the Quality of Life Index. Results indicate that self-care self-efficacy and depression are the significant predictors of quality of life after controlling for the effect of age. Self-care self-efficacy explains 47.5% of the variance (beta=0.52, p<0.001) and depression (beta=-0.29, p<0.001) explains an additional 5.5% of variance in quality of life. The study provides important information for health care providers as they design interventions for patients receiving hemodialysis

Effects of reflexology on acute postoperative pain and anxiety among patients with digestive cancer

[[abstract]]Even after receiving analgesia, patients with gastric and liver cancer still report moderate levels of postoperative pain. The purpose of the study was to investigate the efficacy of foot reflexotherapy as adjuvant therapy in relieving pain and anxiety in postoperative patients with gastric cancer and hepatocellular cancer. The study design was a randomized controlled trial. Data were collected from 4 surgical wards of a medical center in 2005 in Taipei, Taiwan. Sixty-one patients who had received surgery for gastric cancer or hepatocellular carcinoma were randomly allocated to an intervention (n = 30) or control (n = 31) group. Patients in the intervention group received the usual pain management plus 20 minutes of foot reflexotherapy during postoperative days 2, 3, and 4. Patients in the control group received usual pain management. Outcome measures included the short-form McGill Pain Questionnaire, visual analog scale for pain, summary of the pain medications consumed, and the Hospital Anxiety and Depression Scale. Results demonstrated that studied patients reported moderately high levels of pain and anxiety postoperatively while patients were managed with patient-controlled analgesia. Using generalized estimation equations and controlling for confounding variables, less pain (P < .05) and anxiety (P < .05) over time were reported by the intervention group compared with the control group. In addition, patients in the intervention group received significantly less opioid analgesics than the control group (P < .05). Findings from this study provide nurses with an additional treatment to offer postoperative digestive cancer patients

Self-efficacy training for patients with end-stage renal disease

[[abstract]]Background. Patients with end-stage renal disease often fail to follow a prescribed diet and fluid regimen, which undermines the effectiveness of care and leads to unpredictable progression of the disease and greater likelihood of complications. Aim. The purpose of this randomized controlled study was to examine the effectiveness of self-efficacy training on fluid intake compliance. Methods. This study took place in northern Taiwan. Eligible patients were receiving routine haemodialysis; 20–65 years of age; living in a community setting; able to read and write; and willing to participate. Sixty-two end-stage renal disease patients participated in the study. Those in the experimental group (n = 31) received 12 sessions of structured self-efficacy training; the control group patients (n = 31) received only routine care. The intervention was based on Bandura's theory and included an educational component, performance mastery, experience sharing, and stress management. The outcome measure was the mean body weight gain between dialysis sessions. Data were collected at baseline, 1, 3 and 6 months following the intervention and analysed by a descriptive and repeated-measures anova. Results. Experimental group mean weight gains decreased gradually following self-efficacy training. However, control group mean weight gains decreased only slightly over time. These results were statistically significant when baseline differences controlled for (P < 0·05). Conclusions. The study supports the effectiveness of the self-efficacy training in controlling mean body weight gains of end-stage renal disease patients receiving haemodialysis

Effects of an adaptation-training program on stress, depression and quality of life in patients with end-stage renal disease

[[abstract]]Keywords: end-stage renal disease; adaptation training; stress; depression; quality of life; nursing Aims.  This paper reports a study investigating the effectiveness of an adaptation training programme (ATP) to help patients with end-stage renal disease (ESRD) to cope with illness-related stresses and, thus, to alleviate depression and improve quality of life. Background.  Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors. The ability of these patients to cope with and adapt to these stresses, whether related to their medical regimen or to the demands of daily life, has an important influence on physical and psychological well-being. Methods.  The study was a randomized controlled trial using a convenience sample of 57 eligible, fully informed and consenting patients with ESRD who were assigned to experimental (ATP plus usual care) or control (usual care) groups. Participants in the ATP took part in weekly small group sessions over an 8-week period and monthly follow-up to help them to cope with stressors. A clinical nurse specialist and an experienced psychotherapist led them in three small groups (8–10 per group). Participants in the usual care group received routine care. Instruments comprised the Haemodialysis Stressor Scale, Beck Depression Inventory and Medical Outcomes Study SF-36. Data were collected at baseline and at three months following the intervention. Results.  The major stressors for these patients were limitations on time and place related to employment, limitations on fluid intake, transport difficulties, loss of bodily function, length of dialysis treatment, and limitation of physical activities. The ATP had a beneficial effect on perceived stress (P = 0·005), depression (P = 0·001) and quality of life (P = 0·02) 3 months after the intervention. Conclusions.  This study supports the effectiveness of an ATP to decrease stress and depression levels, and to improve the quality of life of ATP patients receiving haemodialysis

Acupressure and quality of sleep in patients with end-stage renal disease--a randomized controlled trial

[[abstract]]The purpose of the study is to test the effectiveness of acupressure on sleep quality of end-stage renal disease patients. The study was a randomized controlled trial; qualified patients in the dialysis centers of four major hospitals were randomly assigned into an acupressure group, a sham acupressure group, and a control group. A total of 98 participants were included in the study. The main outcomes measured were the Pittsburgh sleep quality index (PSQI) and the sleep log. Data were collected at pretreatment and following treatment. Primary statistical analysis was by means of Analysis of Covariance, the Kruskal-Wallis Test and repeated measure ANOVA. The results indicated that PSQI scores of the acupressure group have a significantly greater improvement (p0.05). Subscales of PSQI were further analyzed. Results demonstrated significant differences between the acupressure group and the control group in subjective sleep quality (p=0.009), sleep duration (p=0.004), habitual sleep efficiency (p=0.001), and sleep sufficiency (p=0.004). Significant differences in the subscale of subjective sleep quality (p=0.003) between the sham acupressure group and the control group were also observed. Sleep log data showed that the acupressure group significantly decreased awake time and improved quality of sleep over time more than the control group (p<0.01). The improvement could be seen as soon as the acupoints massage was implemented, and it was maintained through the post intervention