Journal of Cardiovascular Nursing最新文献

Background: Lower limb peripheral artery disease (PAD) is associated with poor outcomes including ulceration, gangrene, amputations, and mortality. Clinicians therefore routinely perform point-of-care tests in high-risk populations to identify PAD and subsequently implement cardiovascular management and appropriate interventions. Pulse oximetry has been suggested as a useful adjunct test for identifying PAD.

Objective: The aim of this systematic review was to determine the sensitivity and specificity of pulse oximetry in the lower limb for identifying PAD.

Methods: MEDLINE, EMBASE, and CINAHL were searched up until January 10, 2023, to identify studies of sensitivity and specificity of pulse oximetry that used criterion standard diagnostic imaging as a reference standard. Two authors screened articles for inclusion and appraised quality of included studies using the Quality Appraisal for Diagnostic Accuracy Studies, version 2.

Results: A total of 6371 records were screened, and 4 were included. The included studies had a total of 471 participants, with an age range of 41 to 80.6 years. All studies were cross-sectional and conducted in hospital settings. Sensitivity values for pulse oximetry compared with diagnostic imaging in identifying PAD ranged from 44% to 76%, and specificity values ranged from 85% to 96%. There was no consensus regarding measurement techniques and diagnostic thresholds for pulse oximetry, which precluded meta-analysis.

Conclusions: There is currently inadequate evidence to support the use of pulse oximetry for identifying PAD. Current evidence suggests that pulse oximetry has low levels of sensitivity and is therefore likely to miss PAD when it is present.

Background: Self-Care of Chronic Illness Inventory version 4c is a non-disease-specific self-care measure used in individuals with multiple chronic conditions. This instrument may be applied to patients with specific diseases such as stroke.

Objective: The aim of this study was to evaluate the psychometric properties of the Thai version of the Self-Care of Chronic Illness Inventory version 4c in patients with stroke.

Methods: This multicenter, cross-sectional study adhered to the COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) guidelines and enrolled patients with stroke from 16 primary care centers in southern Thailand. Structural validity was assessed using confirmatory factor analysis, internal consistency reliability using Cronbach α coefficient and global reliability index, and test-retest reliability using intraclass correlation coefficients.

Results: The final analysis included a total of 350 participants. Confirmatory factor analysis supported the 2-factor Self-Care Maintenance scale structure, although the item allocation to the dimensions differed from that of the original model. The Self-Care Monitoring scale demonstrated a 1-factor structure with permitted residual covariance. The Self-Care Management scale maintained a 2-factor structure, similar to that of the original model. Simultaneous confirmatory factor analysis of the combined items supported the general model with the 3 scales. The Self-Care Maintenance scale exhibited marginally adequate α (0.68) and ω (0.66) coefficients, and an adequate composite reliability index (0.79). The other 2 scales demonstrated adequate α (range, 0.79-0.86), ω (range, 0.75-0.86), and composite reliability (range, 0.83-0.86) indices. Intraclass correlation coefficients showed adequate test-retest reliability for all scales (range, 0.76-0.90).

Conclusions: The generic self-care measure, Self-Care of Chronic Illness Inventory version 4c, demonstrated strong psychometric properties in patients with stroke. This instrument may be a valuable tool for assessing stroke self-care in Thailand.

Background: In recent years, there has been an exponential increase in attention paid to the patient-reported outcome of self-care. Many investigators have used one of the families of self-care instruments freely available on the website www.self-care-measures.com . These self-care measures have been translated into many languages, which are also available on the website. The measures include both disease-specific and generic instruments, which are based on a common theoretical framework, the Middle Range Theory of Self-Care of Chronic Illness.

Purpose: The purpose of this article is to illustrate similarities among the instruments and to standardize their scoring, analysis, and use. We describe the Self-Care of Heart Failure Index, the Self-Care of Coronary Heart Disease Inventory, the Self-Care of Hypertension Inventory, the Self-Care of Diabetes Inventory, the Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care of Chronic Illness Inventory, and the Self-Care Inventory. Detailed guidance on scoring, translation, and analysis is provided. Complementary measures of self-care self-efficacy and those used to measure caregiver contributions to patient self-care are briefly described.

Conclusions: Many of the common questions of instrument users are answered in this article. Following this guidance will facilitate consistent use of the instruments, which will enable users to compare their results to those of others worldwide and facilitate future reviews and meta-analyses.Clinical ImplicationsThis review, emphasizing standard scoring and interpretation, is useful for clinicians and researchers across various populations and settings.

Background: Health-related quality of life (HRQoL) is an important indicator of patient's satisfaction about their disease course. Many factors are influential to life quality, such as dignity and resilience. Dignity is mostly explored in populations with cancer, but the understanding of dignity and its relationship with resilience and HRQoL is limited.

Objective: The aim of this study was to explore the relationships between dignity, resilience, and HRQoL among patients with cardiac disease.

Methods: A purposive sample of patients with cardiac disease with a cross-sectional design was used for this study. Four structured questionnaires were used for data collection. Dignity was measured by the Patient Dignity Inventory-Mandarin version; resilience was measured by the Chinese version of the Resilience Scale; HRQoL was measured by EuroQol 5 Dimensions. Partial least squares structural equation modeling was applied to test the hypothesized structural model. Reporting was consistent with the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

Results: The mean age of all 101 participants was 72.2 years, 88.1% had coronary artery disease, and the prevalence of heart failure was 43.0%. In patients with cardiac disease, their sense of dignity was significantly associated with HRQoL, and resilience was associated with both dignity and quality of life. Notably, resilience had a mediating effect between dignity and HRQoL; dignity and resilience explained 73.0% of the variance of HRQoL.

Conclusions: Dignity is a new concern in cardiac disease research, which is influential to patients' perception of disease and their HRQoL. Patients with cardiac disease with higher resilience tend to have a better HRQoL.

Background: Self-care in people with diabetes is poor, which could be influenced by positive and negative psychosocial factors. Self-efficacy is an important factor affecting self-care, and depressive symptoms and diabetes distress may directly and indirectly affect self-efficacy.

Objective: The aim of this study was to examine the relationships of depressive symptoms, diabetes distress, age, sex, self-compassion, resilience, self-esteem, and social support to diabetes self-efficacy and the mediating roles of diabetes distress and depressive symptoms in the relationships among people with diabetes.

Methods: In this cross-sectional, correlational study, data on all the psychosocial and demographic factors were collected (N = 148; 57.6 years old) through Research Electronic Data Capture in 2023. The PROCESS macro for SPSS was used to address the purpose.

Results: The mean score of diabetes self-efficacy was 28.6 (range, 8-40). In 1 model, depressive symptoms were directly and indirectly associated with diabetes self-efficacy through diabetes distress (direct effect, -3.524; t = -3.020, P = .003; indirect effect, -2.089; 95% bootstrap confidence interval, -3.494 to -0.911). In another model, diabetes distress was directly and indirectly associated with diabetes self-efficacy through depressive symptoms (direct effect, -3.778; t = -3.638, P < .001; indirect effect, -0.785; 95% bootstrap confidence interval, -1.868 to -0.089). In addition, self-esteem was associated with both depressive symptoms and diabetes distress. Resilience was associated with diabetes self-efficacy in 1 model.

Conclusions: Negative psychological factors were directly and indirectly associated with diabetes self-efficacy. Depressive symptoms, diabetes distress, self-esteem, and resilience can be important targets of interventions to improve diabetes self-efficacy.

Background: Chronic stress is associated with promotion of inflammation and development of metabolic syndrome, as well as deterioration of diet quality. Inflammation can be modified by changes in dietary intake.

Objective: The aim of this study was to test the hypothesis that diet quality mediates the relationship of chronic stress with inflammation in patients with metabolic syndrome.

Methods: Participants with metabolic syndrome (n = 73, 62 ± 12 years old, 71% female) completed questionnaires on chronic stress (Perceived Stress Scale-10) and diet quality (Healthy Eating Index-2020). The Perceived Stress Scale-10 was dichotomized. The Healthy Eating Index-2020 score was used as a continuous variable, and higher scores indicate better diet quality. Inflammation was assessed using plasma high-sensitivity C-reactive protein (log-transformed). We used PROCESS in SPSS to test the hypothesis.

Results: Patients in the higher stress group had lower Healthy Eating Index-2020 scores (worse diet quality) than those in the lower stress group (57 ± 13 vs 64 ± 10, P = .01). Diet quality mediated the relationship between chronic stress and inflammation (indirect effect, 0.211; 95% bootstrap confidence interval, 0.006-0.496). Higher stress was associated with lower diet quality (effect, -7.152; 95% confidence interval, -13.168 to -1.137) that was associated with increased inflammation (effect, -0.030; 95% confidence interval, -0.052 to -0.007).

Conclusions: Our findings show the important role of diet quality in the relationship of chronic stress with inflammation in patients with metabolic syndrome. Healthcare providers should encourage patients with higher stress to improve diet quality, which can decrease inflammation.

Background: The experiences and preferences of older patients regarding shared decision-making (SDM) for managing severe aortic stenosis (AS) and its impact on health outcomes are not well known.

Objective: The purpose of this study was to provide insight into the experiences, preferences, and needs for SDM of older patients with severe AS and the associations between perceived SDM levels and patients' quality of life, depression, and anxiety.

Methods: A descriptive, exploratory multiple-methods study was conducted using a survey, focus groups, and individual interviews with patients 70 years and older with severe AS. Data were collected at baseline and at 3-month follow-up. Quantitative data were analyzed using multivariate linear regression and quantitative data using qualitative thematic analysis.

Results: Quantitative analysis (n = 120) showed that 29.6% of patients reported maximum scores for the perceived SDM level. In addition, the perceived SDM level was significantly associated with the quality of life category environment ( B = 2.75; 95% confidence interval, 0.90-4.61; P = .004). Professionals' identification of discussion partners was reported by 41.3% of patients, and 52% of patients reported professionals' exploration of patients' daily lives. For future decision-making, 55.6% of patients preferred a collaborative role. Qualitative analysis of 2 focus groups (n = 10) and interviews (n = 7) revealed patients' preference for informal caregivers' support for decision-making. Patients expressed caution in sharing views on their daily lives and expectations and suggested better preparation and goal exploration for decision-making.

Conclusions: To align with SDM and personalize the decision-making process, healthcare professionals must foster patient input and engage informal caregivers. Patients must reflect on their daily activities to define their treatment goals.

Background: Although cardiac rehabilitation (CR) is an effective secondary prevention strategy, it remains underutilized worldwide. Barriers to accessibility and adherence to traditional hospital-based programs have led to the development of alternative models, such as home-based CR, to improve healthcare delivery and patient outcomes.

Objective: In this study, we aimed to map and synthesize evidence of effective home-based CR models for promoting secondary prevention in patients with coronary heart disease after percutaneous coronary intervention.

Methods: Following the Joanna Briggs Institute methodology, we conducted a scoping review across 7 databases: Cochrane, CINAHL, Scopus, MEDLINE, Embase, PubMed, and Web of Science, and gray literature sources. The search included primary English-language articles published in the last decade, with an update extending to October 2024. Reviewers independently assessed eligibility, and data extraction followed the Template for Intervention Description and Replication and PRISMA guidelines.

Results: Among the 3296 initially identified articles, 23 met the inclusion criteria. The identified home-based CR models varied in duration (6 weeks to 6 months) and used a range of technological tools, such as Internet platforms and telecommunication, for exercise supervision and patient communication. These programs include supplementary equipment and educational resources to enhance patient self-efficacy and cardiovascular disease awareness.

Conclusions: All identified home-based CR models showed positive patient outcomes, with high program enrollment and adherence to secondary prevention measures. Further research is needed to compare different home-based CR models and assess their feasibility in diverse settings.

Background: Depression is common in patients with coronary heart disease (CHD). The 9-item patient health questionnaire (PHQ-9) is an instrument for screening depression. However, evidence on the psychometric properties of the PHQ-9 in Italian populations with CHD is still lacking.

Objective: The objective of this study was to examine the psychometric properties and measurement invariance of the PHQ-9 in a large CHD sample.

Methods: This is a secondary analysis of 3-month follow-up data collected from a multicenter longitudinal study. Patients completed a battery of self-reported instruments that included the PHQ-9 and the generalized anxiety disorder scale-7 (GAD-7). Factorial validity was assessed with confirmatory factor analysis. Convergent validity was tested by inspecting the correlations between the PHQ-9 and GAD-7 scores, and other sociodemographic factors. Internal consistency was investigated with the model-based internal consistency reliability index. Measurement invariance was tested across sex and age (≥65 vs <65 years) with confirmatory multigroup factor analysis.

Results: We enrolled 427 patients (mean age, 64.41 years; 78.9% male; 66.7% married). The confirmatory factor analysis supported a bi-dimensional factor structure with the factors measuring somatic and cognitive symptoms. Convergent validity testing showed significant positive correlations of the PHQ-9 scores with the GAD-7 scores, gender, and perceived financial status. The model-based internal consistency reliability index was adequate at 0.80. Measurement invariance across age was confirmed at the scalar level, whereas invariance across sex was achieved at the metric level.

Conclusion: The PHQ-9 shows adequate psychometric and invariance properties across age groups in patients with CHD. Hence, this instrument can be used in clinical practice and research to assess the severity of depression in patients with CHD and to compare depression scores between younger and older individuals.