Clinical Nursing Research最新文献

Poor sleep quality is prevalent among patients with chronic heart failure (HF), with fear of progression being one of its independent predictors. However, the pathways through which it exerts its influence have not been fully elucidated. A total of 246 patients with chronic HF, hospitalized in the cardiology department of a hospital from January to June 2024, were selected for this study using a convenience sampling method. Data were collected using the General Information Questionnaire, Social Connectedness Scale, the Fear of Progression Questionnaire-Short Form, and the Pittsburgh Sleep Quality Index. Stratified regression analysis was conducted to assess the effects of fear of progression and social connectedness on sleep quality. The mediating effect of social connectedness in fear of progression and sleep quality was tested by SPSS PROCESS. The mean age of the patients in this study was 73.84 years (SD, 11.53), with 52.4% being female. The study revealed that patients with chronic HF had sleep quality, fear of progression, and social connectedness had mean scores of 11.83 (SD, 3.76), 29.52 (SD, 7.03), and 3.51 (SD, 0.67), respectively. Regression analysis showed that fear of progression positively predicted poor sleep quality (β = .539, p < .001) and social connectedness negatively predicted poor sleep quality (β = -.301, p < .001). Furthermore, fear of progression exerted an indirect effect on sleep quality through its influence on social connectedness. Social connectedness exerts a significant influence on the relationship between fear of progression (FoP) and sleep quality among chronic HF patients. Enhancing social connectedness potentially offers an effective intervention to ameliorate sleep quality in chronic HF patients exhibiting a high level of FoP.

The influence of patient delay on prognosis in patients with ischemic stroke remains unclear. We conducted a systematic review and meta-analysis to determine the association of patient delay with the prognostic outcome of ischemic stroke. PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, Wanfang Database, and VIP Database were comprehensively searched from inception to July 24, 2022. All case-control studies, cohort studies, and randomized controlled trials that met the inclusion criteria were retrieved; additionally, manual retrieval and literature tracing were performed. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias in the included studies. Revman 5.3.5 software was used for meta-analysis. We included 14 studies (11 cohort studies and 3 case-control studies) involving 25,337 patients. The results of meta-analysis revealed that the delayed visit group of patients with ischemic stroke had a higher mortality rate, readmission rate, stroke recurrence rate, and adverse outcomes rate than the timely visit group. Among them, mortality (OR = 2.03, 95% CI [1.13, 3.65], p = .02), readmission (OR = 8.17, [4.70, 14.21], p < .001), stroke recurrence rate (OR = 2.66, [1.51, 4.69], p < .001), and adverse outcomes rate (OR = 2.07, [1.18, 3.61], p < .001), respectively. There was no statistical difference in the National Institute of Health Stroke Scale score difference between the delayed visit group and the timely visit group (MD = 1.12, [-0.62, 2.86], p = .21). Patient delay affects the prognosis of patients with ischemic stroke and increases the risk of death, readmission, stroke recurrence, and adverse outcomes. In the future, more in-depth research is needed to verify and expand our research results.

Family carer involvement in inpatient mental health care is considered beneficial to patient outcomes. Carers and families of patients in inpatient behavioral units often seek basic information about the unit in terms of visiting protocols, communication with staff, questions about the discharge process, and information on local social supports. Recent national and state laws strongly concur that all caregivers, 26% of whom care for those with mental health illness (American Association of Retired Persons [AARP] and National Alliance for Caregiving [NAC]). Recognize, assist, include, support, and engage (RAISE) Family Caregiver Act 2017 directs the Department of Health and Human Services (HHS) to create and make public a road map to support caregivers that includes sharing information. The purpose of this integrative review is to explore the needs and information gaps of carers of individuals hospitalized with mental illness. An integrative review where a detailed search strategy of databases through MeSH and associated terms was conducted between 2017 and 2025. Literature was included if it discussed carer-family, patient, and staff communication in the setting of inpatient behavior health hospitalization. Nine papers met the inclusion criteria and found that current carer information needs are not being met. The following themes were explored: information gap, need for basic information, and empowering caregivers with information. This literature review shows that there is a lack of information and support provided to carers of hospitalized patients with severe mental illness. The literature found that the carer should be treated with respect through the pre-arrangement of carer staff time, listening to carers, and focusing on the provision of recovery-oriented language. Future research should focus on determining if changes to involve families in care, staff training, information packets, required staff meetings or calls to carers, or creating or rewording unit literature to reflect recovery-oriented language would help to meet carer information needs. By addressing information gaps and empowering carers, mental health services can enhance care quality, improve patient outcomes, and strengthen the pivotal role of families in the healing process.

The most frequently reported post-coronavirus disease of 2019 (COVID-19) symptoms include shortness of breath, fatigue, and cognitive disturbances, with reports of persistent dyspnea ranging between 26% and 41%. There is an urgent need to understand the risk factors and predictors for persistent COVID-19 dyspnea in individuals at all levels of COVID-19 illness severity, to enable the implementation of targeted interventions for those likely to be most affected with persistent dyspnea. Thus, the purpose of this systematic review is to explore the risk factors and predictors that are associated with persistent dyspnea in the post-COVID-19 population. This review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered prospectively in PROSPERO as CRD42023466713. A search strategy was conducted across PubMed, CINAHL, Web of Science, and EMBASE databases, that included studies conducted from 2020 to March 2024. The Covidence platform was used for screening studies, scoring methodologic quality, and performing data extraction using a two-step independent review process. This review included 33 studies, addressing 83,920 participants across 20 countries. The strongest predictive risk factors for persistent dyspnea included the following: female sex, elevated body mass index, pulmonary comorbidities, pre-existing anxiety and depression, pre-COVID-19 physical limitations, the severity of the COVID-19 illness, and socioeconomic differences. Potential risk factors included increased age, smoking history, and COVID-19 variant type. The presence of biomarkers for persistent dyspnea in the post-COVID-19 population can be used by clinicians to prospectively identify those individuals who should be flagged. Early identification may then be leveraged for timely referral for prophylactic and rehabilitative interventions for dyspnea. A personalized plan to target those risk factors that are modifiable should follow.

A growing body of literature highlights the involvement of nurses in the application of involuntary commitment and treatments in psychiatry. The violence underlying these coercive practices is often discussed, as they infringe on human rights and have negative effects on both patients and healthcare staff. The current state of knowledge on this subject, however, fails to inform us of what characterizes and influences these practices in psychiatric nursing. A situational analysis was conducted to gain a better understanding of this issue. This qualitative research aims to explore the characteristics of nursing care during involuntary commitment and treatments. In all, 10 nurses (n = 10) and 11 patients (n = 11) participated in semi-structured interviews and completed a sociodemographic questionnaire. Data analysis followed a grounded theory approach, involving a process of coding, conceptualizing, categorizing, constant comparison, and relational mapping, accompanied by analytical memos. Four conceptual categories emerged from data analysis: (1) Psychiatry as a waiting room, (2) nurses as subordinates, (3) nothing else but medication, and (4) resisting undignifying care. The results suggest that clinical issues surrounding involuntary commitment and treatments can be explained by how care is conceived. The psychiatric nursing practice seems to be limited to the application of coercive power, such as forced administration of medication. The distress potentially induced by involuntary commitment and treatments in patients comes to be ignored in favor of compliance with the legal procedures. The results describe a situation where patients felt abandoned to those procedures as if refusing to be hospitalized or treated were incompatible with any other form of care. Several participants also report having suffered negative consequences following one or more coerced psychiatric episodes. For them, refusal of care therefore seems to be associated with a resistance against the current violence of biomedical psychiatry, rather than a refusal to obtain help and support.

With the progress and development of medicine, the emergence of new treatment methods brings hope to patients with lung cancer. However, it is accompanied by high treatment costs. At present, the research on the financial toxicity of lung cancer by medical staff needs to be improved. The study was to describe and analyze the status and risk factors of financial toxicity in lung cancer patients. This was a cross-sectional study. The study recruited 218 lung cancer patients from the 2 hospitals in Qingdao and Tianjin. Lasso regression and random forest were combined to identify significant factors of financial toxicity. A nomogram was used to visualize the model. The discrimination, calibration, and clinical applicability of the nomogram were evaluated by the receiver operating characteristic curves, area under the curve, and decision curve analysis. Educational level, residence, family monthly income, out-of-pocket expenses, chemotherapy history, and radiotherapy history were found to be significant factors of financial toxicity. The area under the curve of the training set was 0.930, while that of the test set was 0.939. The risk prediction model of financial toxicity has high predictive discrimination, calibration, and clinical practicality, which is helpful for medical staff to screen for early financial toxicity risk in lung cancer patients. The financial toxicity of lung cancer patients is common and affected by many factors. Medical staff can formulate personalized intervention measures according to the patient's own situation and assessment results.

Music is one nonpharmacological intervention to reduce anxiety and stress for mechanically ventilated patients. Efficient delivery of a music listening intervention can be enhanced through digital tools such as a mobile application (app) loaded onto an electronic tablet device. The objective of this study is to describe the iterative development and deployment of a novel app (Soundese) to deliver, record, and retrieve data associated with a two-arm randomized, blinded clinical trial testing music listening intervention compared to control silence condition on delirium severity among critically ill intensive care unit (ICU) older adult patients receiving mechanical ventilatory support. The Soundese mobile app was developed to deliver either experimental music listening intervention or a silence control listening condition to a sample of older adults receiving mechanical ventilatory support in the ICU and retrieve all protocol data. The Soundese app was developed using the Swift software language and is compatible with all iOS devices. The Soundese app consists of two components: (1) a mobile app that delivers the assigned, blinded listening intervention from an iPad through headphones to each subject and automatically logs each listening session, its duration, the randomization arm, and uploads these data to a server, and (2) an analysis app that generates a spreadsheet with summarized data of the respective listening session, music details, and reports for further analyses. A Dropbox application programmer interface enabled the secure storage of files on a designated Dropbox account. After initial field testing and iterative development changes based on research staff feedback, the Soundese app delivers the assigned experimental listening condition or silence control condition when deployed remotely in the field. The app's mobile nature allows for immediate and automatic data capture, which is summarized for statistical analysis. There is no need for any manual recording of any intervention data by busy ICU staff, including listening time or music selections. The Soundese mobile app efficiently delivers the research protocol with fidelity and collects the necessary data for an ICU-based clinical trial. The app may be useful in other clinical trials testing music listening interventions in various settings or for deploying other audio-based interventions.

Atherosclerotic cardiovascular disease (ASCVD) risk calculators estimate the 10-year incident risk of myocardial infarction (MI), coronary artery disease (CAD) death, or stroke; however, they lack comprehensiveness and accuracy. Carotid intima-media thickness (CIMT) is a surrogate marker that may improve risk estimation acumen. The objective of this study was to derive ASCVD risk scores from historical data and determine whether these risk scores are associated with the history of subclinical CAD and CIMT. This retrospective cross-sectional study used an existing dataset of individuals with prediabetes. Subclinical CAD history was defined as the history of CAD, coronary plaque, or coronary revascularization without a history of MI. The online ASCVD Risk Estimator Plus calculator was used to derive individual risk scores. Chi-square or Fisher's exact tests for categorical variables and ANOVA for continuous variables detected differences among ASCVD risk categories. Linear regression of CIMT measurements on ASCVD risk scores ascertained ASCVD risk scores' utility in predicting CIMT measurements. The sample included 86 participants, 28% with a history of CAD, 60% male, and 95% White. No differences in risk scores existed between participants with or without CAD. Individuals with higher ASCVD risk scores were older (p ≤ .001) and had higher systolic blood pressure (p ≤ .001), CIMT arterial age (p = .003), mean IMT common (p ≤ .001), mean IMT maximum (p ≤ .001), and plaque burden (p = .02) measurements. ASCVD risk scores were significantly associated and moderately correlated with CIMT measurements. ASCVD risk scores were not associated with CAD history but were associated with CIMT measurements. While risk calculators provide a starting point for ASCVD risk estimation, physical tools like CIMT can diagnose ASCVD, categorize plaque quality, and track intervention efficacy. CIMT may be used for more direct ASCVD risk estimation. Risk scores are easily imputed from existing records but are only intended for incident risk, and their accuracy relies on the variables' availability and validity and the boundaries of the calculators.

The hypoxia-inducible factor-1 alpha (HIF-1 alpha) is a major regulator of adaptive response to hypoxia, common in patients with severe coronavirus disease 2019 (COVID-19). In addition, HIF-1 alpha regulates the expression of the most important proteins necessary for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of cells. The study included 129 hospitalized COVID-19 patients. Genotypes of HIF-1A gene polymorphisms rs11549465 and rs2057482 were determined by the RT-PCR method. We have observed lower mean platelet counts in carriers of HIF-1A rs11549465CC genotype (p = .050) and a significant association of thrombocytopenia with rs11549465CC/rs2057482CT HIF-1A genotypes combination (p = .037) in the group of patients under the age of 40. HIF-1A rs11549465CC genotype and rs11549465CC/rs2057482CT genotype combination could be predictive markers for thrombocytopenia in COVID-19 patients. Identification of such predictive markers for severe disease may contribute to a more efficient response of health systems to the SARS-CoV-2 pandemic.

Post-COVID-19 condition (PCC) is a serious debilitating condition that develops after the resolution of an acute infection of severe acute respiratory syndrome-associated coronavirus 2. Some commonly reported symptoms include fatigue and cognitive deficits. Multiple lines of evidence have indicated fatigue to be associated with cognitive deficits in the general population. Herein, we perform a secondary analysis of the effects of fatigue on subjective and objective cognition in persons with PCC using a generalized linear model. In this study, fatigue was measured using the Fatigue Severity Scale (FSS) and cognition was measured using the Digit-Symbol Substitution Test (DSST) and the Trails Making Test parts A and B (TMT-A/B). FSS had a statistically significant negative correlation with DSST and TMT-A/B scores. Fatigue serves as a possible target for the development of PCC therapeutics. Fatigue and cognition correlates should be further investigated for underlying neurobiological substrates in persons with PCC.