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Cardiovascular nurses and organizational well-being: a systematic review. 心血管病护士与组织福祉:系统综述。
IF 2.9 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-12 DOI: 10.1093/eurjcn/zvad078
Francesco Zaghini, Jacopo Fiorini, Philip Moons, Alessandro Sili

Aims: This systematic review assesses the organizational well-being of nurses working in cardiovascular settings and identifies environmental variables influencing it.

Methods and results: The Joanna Briggs Institute's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been followed. The search was conducted, from the database inception up to and including 1 December 2022, on Medline (via PubMed), Cumulative Index of Nursing and Allied Health, Cochrane Library, and Scopus. Critical appraisal and data extraction were conducted using standardized tools. Six articles of high quality were included. These mostly concerned cross-sectional studies, conducted in heterogeneous contexts, which highlight the peculiarity of the cardiovascular nursing setting. Three thematic areas were identified: stressors of cardiovascular settings; outcomes of stressors on nurses; and coping strategies used by cardiovascular nurses to deal with such stress factors. Identified stress factors included a lack of autonomy, conflicts between professional and family roles, high workloads, and stressful relationships with patients and caregivers. These organizational variables could generate nurses' burnout, depression, irritability, and/or sleep disorders. In trying to cope with such stressors, cardiovascular nurses used different strategies for compensating, avoiding, escaping, or ignoring the problem, or, in other cases, became somewhat aggressive.

Conclusion: Considering the limited data, cardiovascular nursing coping strategies should be further investigated, so that effective pathways for preventing or limiting stress factors can be identified and applied by the organizations. Monitoring and intervening on stress factors in this care setting could improve cardiovascular nurses' organizational well-being and accordingly patients' outcomes.

Registration: PROSPERO: CRD42022355669.

目的:本系统综述评估了在心血管环境中工作的护士的组织幸福感,并确定了影响组织幸福感的环境变量:研究遵循乔安娜-布里格斯研究所(Joanna Briggs Institute)的方法和系统综述与元分析首选报告项目(PRISMA)指南。从数据库建立之初到 2022 年 12 月 1 日(含 2022 年 12 月 1 日),在 Medline(通过 PubMed)、Cumulative Index of Nursing and Allied Health、Cochrane Library 和 Scopus 上进行了检索。使用标准化工具进行了严格评估和数据提取。共纳入六篇高质量文章。这些文章大多是在不同背景下进行的横断面研究,突出了心血管护理环境的特殊性。研究确定了三个主题领域:心血管护理环境的压力因素;压力因素对护士的影响;心血管护理人员应对这些压力因素的策略。确定的压力因素包括缺乏自主权、职业角色与家庭角色之间的冲突、高工作量以及与患者和护理人员之间的紧张关系。这些组织变量可能导致护士产生职业倦怠、抑郁、烦躁和/或睡眠障碍。为了应对这些压力,心血管科护士采用了不同的策略来补偿、回避、逃避或忽视问题,或者在其他情况下变得有些激进:考虑到数据有限,应进一步研究心血管护理人员的应对策略,从而确定预防或限制压力因素的有效途径,并由组织加以应用。在这一护理环境中对压力因素进行监测和干预,可以提高心血管护理人员的组织幸福感,从而改善患者的治疗效果:prospero:CRD42022355669。
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引用次数: 0
Digital healthcare consumption: lessons about online information. 数字医疗消费:关于在线信息的经验教训。
IF 2.9 3区 医学 Q1 Nursing Pub Date : 2024-04-12 DOI: 10.1093/eurjcn/zvad079
Faye Forsyth, Philip Moons
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引用次数: 0
Characterizing atrial fibrillation symptom improvement following de novo catheter ablation. 新导管消融术后心房颤动症状改善的特征。
IF 2.9 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-12 DOI: 10.1093/eurjcn/zvad068
Meghan Reading Turchioe, Alexander Volodarskiy, Winston Guo, Brittany Taylor, Mollie Hobensack, Jyotishman Pathak, David Slotwiner

Aims: Atrial fibrillation (AF) symptom relief is a primary indication for catheter ablation, but AF symptom resolution is not well characterized. The study objective was to describe AF symptom documentation in electronic health records (EHRs) pre- and post-ablation and identify correlates of post-ablation symptoms.

Methods and results: We conducted a retrospective cohort study using EHRs of patients with AF (n = 1293), undergoing ablation in a large, urban health system from 2010 to 2020. We extracted symptom data from clinical notes using a natural language processing algorithm (F score: 0.81). We used Cochran's Q tests with post-hoc McNemar's tests to determine differences in symptom prevalence pre- and post-ablation. We used logistic regression models to estimate the adjusted odds of symptom resolution by personal or clinical characteristics at 6 and 12 months post-ablation. In fully adjusted models, at 12 months post-ablation patients, patients with heart failure had significantly lower odds of dyspnoea resolution [odds ratio (OR) 0.38, 95% confidence interval (CI) 0.25-0.57], oedema resolution (OR 0.37, 95% CI 0.25-0.56), and fatigue resolution (OR 0.54, 95% CI 0.34-0.85), but higher odds of palpitations resolution (OR 1.90, 95% CI 1.25-2.89) compared with those without heart failure. Age 65 and older, female sex, Black or African American race, smoking history, and antiarrhythmic use were also associated with lower odds of resolution of specific symptoms at 6 and 12 months.

Conclusion: The post-ablation symptom patterns are heterogeneous. Findings warrant confirmation with larger, more representative data sets, which may be informative for patients whose primary goal for undergoing an ablation is symptom relief.

目的:心房颤动(房颤)症状缓解是导管消融术的主要适应症,但房颤症状缓解的特征并不明显。研究目的是描述消融术前后电子病历(EHR)中的房颤症状记录,并确定消融术后症状的相关因素:我们利用 2010 年至 2020 年在一个大型城市医疗系统接受消融术的房颤患者(n = 1293)的电子病历进行了一项回顾性队列研究。我们使用自然语言处理算法(F score:0.81)从临床笔记中提取了症状数据。我们使用 Cochran's Q 检验和事后 McNemar 检验来确定消融术前后症状发生率的差异。我们使用逻辑回归模型来估算消融术后 6 个月和 12 个月时根据个人或临床特征调整后的症状缓解几率。在完全调整模型中,与无心衰患者相比,心衰患者在消融术后 12 个月时呼吸困难缓解的几率[几率比 (OR) 0.38,95% 置信区间 (CI) 0.25-0.57]、水肿缓解的几率(OR 0.37,95% CI 0.25-0.56)和疲劳缓解的几率(OR 0.54,95% CI 0.34-0.85)明显较低,但心悸缓解的几率(OR 1.90,95% CI 1.25-2.89)较高。65岁及以上、女性、黑人或非裔美国人、吸烟史和使用抗心律失常药物也与6个月和12个月时特定症状缓解的几率较低有关:结论:消融术后的症状模式多种多样。结论:消融术后的症状模式多种多样,需要更大规模、更具代表性的数据集来证实研究结果。
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引用次数: 0
Psychosocial adaptation profiles in young and middle-aged patients with acute myocardial infarction: a latent profile analysis. 急性心肌梗塞中青年患者的社会心理适应概况:潜伏概况分析。
IF 2.9 3区 医学 Q1 Nursing Pub Date : 2024-04-12 DOI: 10.1093/eurjcn/zvad071
Jia-Ming Xiong, Jin Su, Qi-Qi Ke, Yao-Xia Li, Ni Gong, Qiao-Hong Yang

Aims: We sought to explore the latent classifications of psychosocial adaptation in young and middle-aged patients with acute myocardial infarction (AMI) and analyse the characteristics of different profiles of AMI patients.

Methods and results: A cross-sectional study was performed in 438 Chinese young and middle-aged patients with AMI. The investigation time was 1 month after discharge. Three different self-report instruments were distributed to the participants, including the Psychosocial Adjustment to Illness Scale, the Perceived Stress Scale, and the Social Support Rating Scale. The seven dimensions of the Psychosocial Adjustment to Illness Scale were then used to perform a latent profile analysis. All participants signed informed consent forms in accordance with the ethical principles of the Declaration of Helsinki. Finally, a total of 411 young and middle-aged AMI patients were enrolled. Three distinct profiles were identified, including the 'well-adapted group' (44.8%), 'highlight in psychological burdens group' (25.5%), and 'poorly adapted group' (29.7%). The influencing factors included stress perception, social support, occupational type, and marital status (P < 0.05).

Conclusion: The psychosocial adaptation of young and middle-aged AMI patients can be divided into three profiles. Clinical nurses can carry out individualized psychological interventions according to the characteristics of patients in different potential profiles to improve the psychosocial adaptation of patients and the prognosis of their disease.

目的:我们试图探索急性心肌梗死(AMI)中青年患者社会心理适应的潜在分类,并分析AMI患者的不同特征:对 438 名中国中青年急性心肌梗死患者进行了横断面研究。调查时间为出院后 1 个月。向参与者发放了三种不同的自我报告工具,包括疾病社会心理适应量表、知觉压力量表和社会支持评分量表。然后利用疾病社会心理适应量表的七个维度进行潜在特征分析。根据《赫尔辛基宣言》的伦理原则,所有参与者都签署了知情同意书。最后,共招募了 411 名中青年 AMI 患者。结果发现了三种不同的情况,包括 "适应良好组"(44.8%)、"心理负担突出组"(25.5%)和 "适应不良组"(29.7%)。影响因素包括压力感、社会支持、职业类型和婚姻状况(P < 0.05):中青年 AMI 患者的社会心理适应可分为三种情况。结论:中青年 AMI 患者的社会心理适应可分为三种类型,临床护士可根据不同潜在类型患者的特点进行个体化心理干预,以改善患者的社会心理适应和疾病预后。
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引用次数: 0
Vulnerability to environmental and climatic health provocations among women and men hospitalized with chronic heart disease: insights from the RESILIENCE TRIAL cohort. 因慢性心脏病住院的女性和男性易受环境和气候健康因素影响的程度:RESILIENCE TRIAL 队列的启示。
IF 2.9 3区 医学 Q1 Nursing Pub Date : 2024-04-12 DOI: 10.1093/eurjcn/zvad076
Simon Stewart, Sheila K Patel, Terase F Lancefield, Thalys S Rodrigues, Nicholas Doumtsis, Ashleigh Jess, Emily-Rose Vaughan-Fowler, Yih-Kai Chan, Jay Ramchand, Paul A Yates, Jason C Kwong, Christine F McDonald, Louise M Burrell

Aims: We aimed to recruit a representative cohort of women and men with multi-morbid chronic heart disease as part of a trial testing an innovative, nurse-co-ordinated, multi-faceted intervention to lower rehospitalization and death by addressing areas of vulnerability to external challenges to their health.

Methods and results: The prospective, randomized open, blinded end-point RESILIENCE Trial recruited 203 hospital inpatients (mean age 75.7 ± 10.2 years) of whom 51% were women and 94% had combined coronary artery disease, heart failure, and/or atrial fibrillation. Levels of concurrent multi-morbidity were high (mean Charlson Index of Comorbidity Score 6.5 ± 2.7), and 8.9% had at least mild frailty according to the Rockwood Clinical Frailty Scale. Including the index admission, 19-20% of women and men had a pre-existing pattern of seasonally linked hospitalization (seasonality). Detailed phenotyping revealed that 48% of women and 40% of men had ≥3 physiological factors, and 15% of women and 16% of men had ≥3 behavioural factors likely to increase their vulnerability to external provocations to their health. Overall, 61-62% of women and men had ≥4 combined factors indicative of such vulnerability. Additional factors such as reliance on the public health system (63 vs. 49%), lower education (30 vs. 14%), and living alone (48 vs. 29%) were more prevalent in women.

Conclusion: We successfully recruited women and men with multi-morbid chronic heart disease and bio-behavioural indicators of vulnerability to external provocations to their health. Once completed, the RESILIENCE TRIAL will provide important insights on the impact of addressing such vulnerability (promoting resilience) on subsequent health outcomes.

Registration: ClinicalTrials.org: NCT04614428.

目的:我们的目标是招募一批具有代表性的多病慢性心脏病男女患者,作为试验的一部分,测试一种创新的、由护士协调的多方面干预措施,通过解决患者健康易受外部挑战影响的方面,降低再住院率和死亡率:前瞻性、随机开放、终点盲法的 "RESILIENCE 试验 "招募了 203 名住院患者(平均年龄为 75.7 ± 10.2 岁),其中 51% 为女性,94% 合并冠心病、心力衰竭和/或心房颤动。同时患有多种疾病的患者比例较高(平均夏尔森合并症指数评分为 6.5 ± 2.7),根据洛克伍德临床虚弱量表,8.9% 的患者至少患有轻度虚弱。包括入院指标在内,19%-20%的女性和男性在入院前已存在与季节相关的住院模式(季节性)。详细的表型分析表明,48%的女性和 40% 的男性有≥3 个生理因素,15% 的女性和 16% 的男性有≥3 个行为因素,这些因素可能会增加他们在健康受到外部刺激时的脆弱性。总体而言,61%-62%的女性和男性的综合因素≥4个,表明他们的健康易受外界因素的影响。此外,依赖公共卫生系统(63% 对 49%)、教育程度较低(30% 对 14%)和独居(48% 对 29%)等因素在女性中更为普遍:我们成功招募了患有多病慢性心脏病的女性和男性,他们的生物行为指标表明,他们的健康很容易受到外界因素的影响。一旦完成,"恢复力试验 "将为了解解决这种脆弱性(促进恢复力)对后续健康结果的影响提供重要见解:注册:ClinicalTrials.org:注册:ClinicalTrials.org:NCT04614428。
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引用次数: 0
“Working me to life” – Longitudinal Perceptions from Adults with Heart Failure with Preserved Ejection Fraction Enrolled in an Exercise Training Clinical Trial "让我的生活充满活力"--参加运动训练临床试验的射血分数保留型心力衰竭成人的纵向感知
IF 2.9 3区 医学 Q1 Nursing Pub Date : 2024-04-08 DOI: 10.1093/eurjcn/zvae049
Erin Salahshurian, Bunny J Pozehl, Scott W Lundgren, Sara Bills, Ambarish Pandey, Salvatore Carbone, Windy W Alonso
Aims Adults with heart failure with preserved ejection fraction (HFpEF) responded more favorably to an exercise intervention compared to those with reduced ejection fraction. This study explores factors that contributed to this response focusing on the qualitative perceptions of adults with HFpEF enrolled in an exercise intervention. Methods and results This qualitative descriptive study is a secondary analysis of longitudinal interviews collected at 3, 6, 12, and 18-months from participants with HFpEF enrolled in a randomized controlled trial testing an intervention to promote adherence to exercise. We included participants with at least 2 interviews. Interviews were examined across and within participants and time points using thematic analysis. Analyses included 67 interviews from 21 adults with HFpEF enrolled in the intervention arm. The sample was 52% (11/21) male and over 47% (10/21) non-White. Mean age at enrollment was 63.7 ± 9.9 years. We identified 4 major themes: 1. Overcoming negative attitudes, barriers, and injury, 2. Motivations to exercise, 3. Exercise - the panacea for HFpEF symptoms and quality of life, and 4. Advice for others with HFpEF. Conclusions Our findings suggest that for many adults with HFpEF, initial hesitancy, fear, and negative attitudes about exercise can be overcome. Exercise coaching using social cognitive constructs, medical fitness center memberships, and heart rate self-monitoring are successful strategies of engaging adults with HFpEF in long-term unsupervised exercise training. Registration This study is registered at ClinicalTrials.gov, NCT01658670
目的 与射血分数降低的患者相比,射血分数保留型心力衰竭(HFpEF)患者对运动干预的反应更为积极。本研究通过对参加运动干预的高射血分数保留型心力衰竭成人的定性分析,探讨了导致这种反应的因素。方法与结果 本定性描述性研究是对参加随机对照试验的高频血友病患者在 3、6、12 和 18 个月时进行的纵向访谈的二次分析,该试验测试了促进坚持锻炼的干预措施。我们纳入了至少接受过两次访谈的参与者。我们采用主题分析法对不同参与者和不同时间点的访谈进行了研究。分析包括来自 21 名参加干预组的高频心衰成人的 67 篇访谈。样本中有 52% (11/21)为男性,47% 以上(10/21)为非白人。注册时的平均年龄为 63.7 ± 9.9 岁。我们确定了 4 大主题:1.克服消极态度、障碍和伤害;2.锻炼的动机;3.锻炼--改善高频心衰症状和生活质量的灵丹妙药;4.对其他高频心衰患者的建议。给其他高频低氧血症患者的建议。结论 我们的研究结果表明,对于许多患有高频血友病的成年人来说,最初对运动的犹豫、恐惧和消极态度是可以克服的。利用社会认知建构、医疗健身中心会员资格和心率自我监测进行运动指导,是吸引高血脂症成人患者参与长期无监督运动训练的成功策略。注册 本研究已在 ClinicalTrials.gov 注册,编号为 NCT01658670
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引用次数: 0
What are the determinants of change in walking fitness in patients with a history of depression following cardiac rehabilitation? 有抑郁症病史的患者在接受心脏康复治疗后,其步行能力变化的决定因素是什么?
IF 2.9 3区 医学 Q1 Nursing Pub Date : 2024-04-08 DOI: 10.1093/eurjcn/zvae047
Serdar Sever, Alexander Harrison, Patrick Doherty
Aims This study aims to investigate the demographic, clinical and service level factors determining change in walking fitness in cardiac rehabilitation (CR) patients with a history of depression following the CR programme. Methods and results National Audit of Cardiac Rehabilitation (NACR) clinical data were used to identify 1476 patients with a history of depression who had their pre and post incremental shuttle walk test (ISWT) recorded between 1st Jan 2016 and 31st Jan 2020. A multiple linear regression was conducted to examine the determinants of change in walking fitness (m) following CR. Mean age was 61 (SD 10.45) and mean ISWT distance at baseline and outcome were 352.06m (SD 169.48) and 463.43m (SD 197.65), respectively. Multivariate analysis revealed that change in walking distance reduced by 1.6m for each year increase in age at baseline (P &lt; 0.001). Females and unemployed patients had less improvement in walking fitness (23.1m and 21.5m, respectively). Having a body mass index &gt;30 was associated with lower improvement (24.2m, p &lt; 0.001), while physically active patients had 14.6m higher change. Higher baseline ISWT quintiles were associated with less improvement, and increased waiting time to start CR was associated with reduced change in walking fitness following CR. Conclusion Older age, female gender, unemployment, higher baseline BMI, longer waiting time, and lower physical activity were associated with reduced walking fitness improvement in patients with a history of depression. Targeted intervention and prompt access to CR can optimize outcomes.
研究目的 本研究旨在调查决定有抑郁症病史的心脏康复(CR)患者在接受 CR 项目后步行体能变化的人口、临床和服务水平因素。方法与结果 利用国家心脏康复审计(NACR)的临床数据,确定了在 2016 年 1 月 1 日至 2020 年 1 月 31 日期间记录了增量穿梭步行测试(ISWT)前后情况的 1476 名有抑郁症病史的患者。我们进行了多元线性回归,以研究 CR 后步行体能(米)变化的决定因素。平均年龄为61岁(标清10.45岁),基线和结果时的平均ISWT距离分别为352.06米(标清169.48米)和463.43米(标清197.65米)。多变量分析显示,基线年龄每增加一岁,步行距离的变化就会减少1.6米(P&lt;0.001)。女性和失业患者的步行能力改善较少(分别为 23.1 米和 21.5 米)。体重指数为 30 的患者改善幅度较小(24.2 米,P&;lt;0.001),而积极参加体育锻炼的患者改善幅度则高出 14.6 米。基线ISWT五分位数越高,改善幅度越小,开始CR的等待时间越长,CR后步行体能的变化越小。结论 年龄较大、女性、失业、基线体重指数较高、等待时间较长和体力活动较少与有抑郁症病史的患者步行体能改善程度降低有关。有针对性的干预和及时获得 CR 可以优化治疗效果。
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引用次数: 0
A practical guide to living evidence: Reducing the knowledge-to-practice gap 活证据实用指南:缩小知识与实践之间的差距
IF 2.9 3区 医学 Q1 Nursing Pub Date : 2024-04-08 DOI: 10.1093/eurjcn/zvae048
Sabine M Allida, Maree L Hackett, Richard Lindley, Kelvin Hill, Caleb Ferguson
Living evidence involves continuous evidence surveillance to incorporate new relevant evidence into systematic reviews and clinical practice guideline recommendations as soon as it becomes available. Thus, living evidence may improve the timeliness of recommendation updates and reduce the knowledge-to-practice gap. When considering a living evidence model, several processes and practical aspects need to be explored. Some of these include identifying the need for a living evidence model, funding, governance structure, time, team skills and capabilities, frequency of updates, approval and endorsement and publication and dissemination.
活证据包括持续的证据监测,以便在获得新的相关证据后立即将其纳入系统性综述和临床实践指南建议中。因此,活证据可提高建议更新的及时性,减少知识与实践之间的差距。在考虑活证据模式时,需要探讨几个过程和实际方面。其中包括确定对活体证据模式的需求、资金、管理结构、时间、团队技能和能力、更新频率、批准和认可以及出版和传播。
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引用次数: 0
Factors affecting women's participation in cardiovascular research: a scoping review. 影响女性参与心血管研究的因素:范围界定综述。
IF 2.9 3区 医学 Q1 Nursing Pub Date : 2024-03-12 DOI: 10.1093/eurjcn/zvad048
Stacey Matthews, Samantha Cook, Tim Clayton, Sarah Murray, Rochelle Wynne, Julie Sanders

Aims: Women are underrepresented in cardiovascular trials. We sought to explore the proportional representation of women in contemporary cardiovascular research and the factors (barriers and enablers) that affect their participation in cardiovascular studies.

Methods and results: Multiple electronic databases were searched between January 2011 and September 2021 to identify papers that defined underrepresentation of women in cardiovascular research and/or reported sex-based differences in participating in cardiovascular research and/or barriers for women to participate in cardiovascular research. Data extraction was undertaken independently by two authors using a standardised data collection form. Results were summarised using descriptive statistics and narrative synthesis as appropriate.From 548 identified papers, 10 papers were included. Of those, four were conducted prospectively and six were retrospective studies. Five of the retrospective studies involved secondary analysis of trial data including over 780 trials in over 1.1 million participants. Overall, women were reported to be underrepresented in heart failure, coronary disease, myocardial infarction, and arrhythmia trials, compared to men. Barriers to participation included lack of information and understanding of the research, trial-related procedures, the perceived health status of the participant, and patient-specific factors including travel, childcare availability, and cost. A significantly higher likelihood of research participation was reported by women following a patient educational intervention.

Conclusion: This review has highlighted the underrepresentation of women in a range of cardiovascular trials. Several barriers to women's participation in cardiovascular studies were identified. Researchers could mitigate against these in future trial planning and delivery to increase women's participation in cardiovascular research.

Registration: The protocol was published on the public Open Science Framework platform on 13th August 2021 (no registration reference provided) and can be accessed at https://osf.io/ny4fd/.

目的:妇女在心血管试验中的代表性不足。我们试图探究女性在当代心血管研究中的比例以及影响她们参与心血管研究的因素(障碍和促进因素):在 2011 年 1 月至 2021 年 9 月期间,对多个电子数据库进行了检索,以确定哪些论文定义了女性在心血管研究中的代表性不足和/或报告了参与心血管研究的性别差异和/或女性参与心血管研究的障碍。数据提取由两位作者使用标准化数据收集表独立完成。在 548 篇已确定的论文中,有 10 篇论文被收录。其中,4 篇为前瞻性研究,6 篇为回顾性研究。其中五项回顾性研究涉及对试验数据的二次分析,包括 780 多项试验,参与人数超过 110 万。总体而言,与男性相比,女性在心力衰竭、冠心病、心肌梗死和心律失常试验中的代表性不足。参与试验的障碍包括缺乏信息和对研究的了解、试验相关程序、参与者认为的健康状况以及患者的具体因素,包括旅行、能否照顾孩子和费用。据报告,妇女在接受患者教育干预后参与研究的可能性明显增加:本综述强调了一系列心血管试验中女性参与人数不足的问题。研究发现了女性参与心血管研究的几个障碍。研究人员可以在未来的试验规划和实施中减少这些障碍,从而提高女性在心血管研究中的参与度:该协议已于 2021 年 8 月 13 日在公共开放科学框架平台上发布(未提供注册编号),可通过 https://osf.io/ny4fd/ 访问。
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引用次数: 0
Stroke disease-specific quality of life trajectories and their associations with caregivers' anxiety, depression, and burden in stroke population: a longitudinal, multicentre study. 脑卒中患者特定疾病的生活质量轨迹及其与照顾者焦虑、抑郁和负担的关系:一项纵向多中心研究。
IF 2.9 3区 医学 Q1 Nursing Pub Date : 2024-03-12 DOI: 10.1093/eurjcn/zvad054
Davide Bartoli, Agostino Brugnera, Andrea Grego, Rosaria Alvaro, Ercole Vellone, Gianluca Pucciarelli

Aims: The aims of this study were to: (i) test if there are clusters of stroke survivors who experience distinct trajectories of quality of life (QOL) from hospital rehabilitation discharge to 12-month follow-up; (ii) test if any sociodemographic or clinical variables predict this class membership; and (iii) examine the associations between the clusters of stroke survivors' and their caregivers' trajectories of anxiety, depression, and burden over time.

Methods and results: A total of 415 stroke survivors and their caregivers were recruited in Italy for this 1-year, longitudinal, multicentre prospective study, filling out a survey at five time points. We found two distinct trajectories of change in stroke survivors' psychological QOL (i.e. Memory, Communication, Emotion, and Participation). The first trajectory (86% of the survivors) included those who started with greater levels of QOL and improved slightly to markedly in all psychological domains, while the second trajectory (14% of the survivors) comprised those who started with lower overall levels of psychological QOL and experienced a worsening or no changes at all in these dimensions up to 12-month follow-up. Very few clinical and sociodemographic variables at baseline predicted class membership. Finally, caregivers of those patients who experienced no change or a worsening in psychological QOL reported greater distress and burden over time.

Conclusion: Our results highlight the need for more tailored interventions to improve patients' psychological QOL and consequently their caregivers' well-being. This requires a shift from a stroke survivor-centred approach to a stroke survivor- and caregiver-centred one.

目的:本研究旨在(i) 检验从康复出院到 12 个月随访期间是否存在经历不同生活质量(QOL)轨迹的中风幸存者群组;(ii) 检验是否有任何社会人口学或临床变量可预测该群组成员;(iii) 检验中风幸存者群组及其照顾者的焦虑、抑郁和负担轨迹随时间变化的关联:这项为期 1 年的纵向多中心前瞻性研究在意大利共招募了 415 名中风幸存者及其照护者,他们在五个时间点填写了调查问卷。我们发现中风幸存者的心理 QOL(即记忆、沟通、情感和参与)有两种不同的变化轨迹。第一种轨迹(86% 的幸存者)包括那些开始时心理 QOL 水平较高,并且在所有心理领域都有轻微到明显改善的幸存者,而第二种轨迹(14% 的幸存者)包括那些开始时心理 QOL 总体水平较低,并且在 12 个月的随访中这些方面的情况有所恶化或没有任何变化的幸存者。基线时的临床和社会人口学变量很少能预测患者的类别。最后,随着时间的推移,那些心理 QOL 无变化或恶化的患者的护理人员报告了更大的痛苦和负担:我们的研究结果突出表明,有必要采取更有针对性的干预措施来改善患者的心理 QOL,进而改善其照护者的福祉。这需要从以中风幸存者为中心的方法转变为以中风幸存者和照护者为中心的方法。
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引用次数: 0
期刊
European Journal of Cardiovascular Nursing
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