Heart & Lung最新文献

Effects of intubation and hypoxemia on intraventricular hemorrhage in preterm infants during the first week: An observational study. 插管和低氧血症对早产儿第一周脑室内出血的影响：观察研究。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-10-04 DOI: 10.1016/j.hrtlng.2024.09.013

Yu-Ting Chen, Hsiang-Ping Wu, Hsiang-Yun Lan, Hsueh-Fang Peng, Shyi-Jou Chen, Ti Yin, Jen-Jiuan Liaw, Yue-Cune Chang

Background: Preterm infants with intraventricular hemorrhage (IVH) are at a risk of developing neurodevelopmental disabilities. Few studies have examined the effects of oxygen saturation (SpO₂) changes and intubation procedures on the risk of IVH.

Objectives: We examined the effects of intubation and the rates of three thresholds of hypoxemia on the occurrence of IVH in preterm infants during their first week in the neonatal intensive care unit (NICU).

Methods: In this prospective observational cohort study, preterm infants with a gestational age (GA) of <37 weeks were included from two Level III NICUs in Taiwan. Continuous electrocardiography was used to monitor SpO₂ changes, and cranial ultrasonography was used to monitor IVH. Thresholds of hypoxemia (SpO₂ levels of <80 %, <85 %, and <90 %) were screened by digitally sampling data at 10-s intervals. Generalized estimating equations were used with logistic regression to analyze the effects of intubation and the rates of the three thresholds of hypoxemia on the risk of IVH during the first week after birth.

Results: In all preterm infants (N = 73), the mean GA was 31.55 weeks, and the mean birth weight was 1508.86 g. Intubation within 3 days of birth, duration of mechanical ventilation and oxygen use, hypoxemia rate, and maternal use of magnesium sulfate before and during delivery were significantly associated with IVH. A multivariate analysis revealed that intubation was a key factor associated with the occurrence of IVH across different thresholds of hypoxemia (p = 0.004).

Conclusions: Although the rate of hypoxemia, duration of mechanical ventilation and oxygen use, and maternal use of magnesium sulfate were significantly associated with IVH, intubation within 3 days of birth was the key factor responsible for increased IVH risk.

背景：早产儿脑室内出血（IVH）有可能导致神经发育障碍。很少有研究探讨氧饱和度（SpO2）变化和插管程序对 IVH 风险的影响：我们研究了早产儿在新生儿重症监护室（NICU）的第一周内插管和三种低氧血症阈值对 IVH 发生率的影响：在这项前瞻性观察队列研究中，胎龄（GA）为2的早产儿发生了变化，并使用头颅超声波检查来监测IVH。结果：所有早产儿（N = 73）的平均胎龄为 31.55 周，平均出生体重为 1508.86 克。出生后 3 天内插管、机械通气和吸氧持续时间、低氧血症发生率以及产妇在分娩前和分娩过程中使用硫酸镁与 IVH 显著相关。多变量分析显示，在不同的低氧血症阈值下，插管是与 IVH 发生相关的关键因素（p = 0.004）：结论：尽管低氧血症发生率、机械通气和吸氧持续时间以及产妇使用硫酸镁与 IVH 有显著相关性，但分娩后 3 天内插管是导致 IVH 风险增加的关键因素。

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引用次数: 0

Association between diet-derived antioxidants and asthma: Insights from the NHANES survey 2003-2018 and Mendelian randomization analysis. 膳食抗氧化剂与哮喘之间的关系：从 2003-2018 年 NHANES 调查和孟德尔随机分析中获得的启示。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-10-01 DOI: 10.1016/j.hrtlng.2024.09.014

Linjie Chen, Congjie Chen, Mingyu Lin, Shiying Li, Xue Yi, Tongsheng Chen

Background: Many studies have reported correlations between diet-derived antioxidants and asthma. Nevertheless, the probable association between diet-derived antioxidants and asthma remains a matter of discussion.

Objectives: We explored the association between Diet-Derived Antioxidants and Asthma.

Methods: We used data from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) to assess the relationship between diet-derived antioxidants and asthma and a two-sample Mendelian randomization (MR) study was employed to assess the causal associations between lifelong diet-derived circulating antioxidant levels and the risk of asthma.

Results: Participants with asthma were more likely to be young-to-middle-aged females, smokers, have lower income, belong to non-Hispanic Black ethnicity, have a high school education, have a BMI over 30. The dietary intakes of vitamin C, zinc, selenium, and CDAI were negatively associated with asthma risk (Vitamin C: OR = 0.76, 95 % CI: 0.63-0.91, P = 0.032; Zinc: OR = 0.86, 95 % CI: 0.75-1.00, P = 0.046; Selenium: OR = 0.85, 95 % CI: 0.73-0.98, P = 0.004; CDAI: OR = 0.80, 95 % CI: 0.65-0.97, P = 0.027). There was a significant nonlinear relationship between the dietary intake of vitamin C, zinc, and selenium and the risk of asthma (P_non-_linear < 0.05). However, no causal link between circulating antioxidants and asthma risk was found in the MR analysis. Sensitivity analyses supported the robustness of the results.

Conclusion: In the observational study, we identified a negative correlation between the dietary intake of vitamin C, zinc, selenium, and CDAI and asthma risk, while our MR analyses did not find evidence to support a causal relationship between diet-derived antioxidants and the risk of asthma.

背景：许多研究报告称，膳食中的抗氧化剂与哮喘之间存在相关性。然而，膳食中的抗氧化剂与哮喘之间可能存在的关联仍有待讨论：我们探讨了膳食中的抗氧化剂与哮喘之间的关联：我们利用2003-2018年美国国家健康与营养调查（NHANES）的数据来评估膳食来源的抗氧化剂与哮喘之间的关系，并采用双样本孟德尔随机化（MR）研究来评估终身膳食来源的循环抗氧化剂水平与哮喘风险之间的因果关系：结果：哮喘患者多为中青年女性、吸烟者、低收入者、非西班牙裔黑人、高中学历、体重指数超过 30。膳食中维生素 C、锌、硒和 CDAI 的摄入量与哮喘风险呈负相关（维生素 C：OR=0.85，95% CI：0.73-0.98，P=0.004；CDAI：OR=0.80，95% CI：0.65-0.97，P=0.027）。膳食中维生素 C、锌和硒的摄入量与哮喘风险之间存在明显的非线性关系（Pnon-linear < 0.05）。然而，在磁共振分析中没有发现循环抗氧化剂与哮喘风险之间的因果关系。敏感性分析支持了结果的稳健性：在观察性研究中，我们发现膳食中维生素 C、锌、硒和 CDAI 的摄入量与哮喘风险之间存在负相关，而我们的 MR 分析并未发现证据支持膳食中的抗氧化剂与哮喘风险之间存在因果关系。

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引用次数: 0

Effectiveness and safety of emergency transcatheter aortic valve replacement in patients with severe aortic stenosis complicated by cardiogenic shock: A systematic review and meta-analysis 严重主动脉瓣狭窄并发心源性休克患者紧急经导管主动脉瓣置换术的有效性和安全性：系统综述和荟萃分析

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-09-24 DOI: 10.1016/j.hrtlng.2024.09.011

Background

The application of transcatheter aortic valve replacement (TAVR) has been developed on different populations in many clinical studies. However, research dedicated to the application of emergency TAVR in patients with aortic stenosis (AS) experiencing cardiogenic shock is limited.

Objective

To investigate the safety and effectiveness of emergency TAVR in AS patients with circulatory collapse.

Methods

Studies on the application of emergency TAVR in AS patients with cardiogenic shock were screened from PubMed, Web of Science, and Embase databases. Two researchers independently screened the literature-extracted data and conducted a meta-analysis was conducted using STATA 16.0 software.

Results

17 studies comprising 36,886 patients undergoing emergency TAVR and 8,530 patients undergoing emergency SAVR or BAV. Emergency TAVR showed no difference in valve implantation success rate compared to elective TAVR. At 30-day endpoints comparison, emergency TAVR exhibited significantly higher all-cause mortality and readmission rates than elective TAVR (RR=2.73 95 %CI 2.04–3.65, P < 0.01; RR=1.2 95 %CI 0.9–1.6, P < 0.01), but reduced mortality risk compared to emergency SAVR/BAV (RD=-0.15 95 %CI -0.25 to -0.04, P = 0.005). At one year post-operation, people with emergency TAVR continued to have higher all-cause mortality than elective TAVR (RR=1.55 95 %CI 1.37–1.74, P < 0.01) but similar with emergency SAVR/BAV (RD=-0.04 95 %CI -0.33 to 0.25, P = 0.796). Rates of severe bleeding and new-onset renal dialysis were higher after emergency TAVR, compared to elective TAVR, while the incidences of permanent pacemaker implantation, severe paravalvular leakage and stroke were similar.

Conclusion

Despite emergency TAVR having higher readmission and mortality rates compared to elective TAVR, it is a relatively safe and effective treatment in cases of cardiogenic shock compared to emergency BAV/SAVR.

背景经导管主动脉瓣置换术（TAVR）已在许多临床研究中应用于不同人群。方法从PubMed、Web of Science和Embase数据库中筛选有关主动脉瓣狭窄（AS）伴心源性休克患者应用急诊TAVR的研究。结果17项研究包括36886名接受急诊TAVR的患者和8530名接受急诊SAVR或BAV的患者。与择期 TAVR 相比，急诊 TAVR 的瓣膜植入成功率没有差异。在30天终点比较中，急诊TAVR的全因死亡率和再入院率明显高于择期TAVR（RR=2.73 95 %CI 2.04-3.65，P< 0.01；RR=1.2 95 %CI 0.9-1.6，P< 0.01），但与急诊SAVR/BAV相比，死亡率风险降低（RD=-0.15 95 %CI -0.25至-0.04，P = 0.005）。术后一年，急诊TAVR患者的全因死亡率仍高于择期TAVR（RR=1.55 95 %CI 1.37-1.74，P = 0.01），但与急诊SAVR/BAV相似（RD=-0.04 95 %CI -0.33至0.25，P = 0.796）。尽管急诊TAVR的再入院率和死亡率高于择期TAVR，但与急诊BAV/SAVR相比，急诊TAVR是一种相对安全有效的心源性休克治疗方法。

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引用次数: 0

Understanding attendance patterns and determinants in cardiac, pulmonary, and ICU Rehabilitation/Recovery programs: A systematic review and meta-analysis 了解心脏、肺部和重症监护室康复/恢复项目的出勤模式和决定因素：系统回顾和荟萃分析。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-09-21 DOI: 10.1016/j.hrtlng.2024.09.010

Background

Cardiac, pulmonary, and intensive care unit (ICU) rehabilitation/recovery programs are health promotion interventions designed to improve physical recovery, psychological well-being, and quality of life after acute illness while reducing the risk of adverse events.

Objective

Identify the difference in attendance rates for patients invited to a cardiac rehabilitation, pulmonary rehabilitation, or ICU recovery program and factors influencing attendance.

Methods

We conducted a systematic review and meta-analysis by searching PubMed, EMBASE, CINAHL, Web of Science, and manual reference lists from inception to June 3, 2024. We included studies reporting patient attendance rates in eligible programs following acute illness hospitalization. Two team members independently screened articles and extracted data, with a third member reviewing and achieving consensus when necessary. Our main outcomes focused on the proportion of attendance in eligible programs among patients referred.

Results

Of 3,446 studies screened, 179 studies (N = 4,779,012 patients) were included across cardiac rehabilitation (n = 153 studies), pulmonary rehabilitation (n = 11 studies), and ICU recovery (n = 15 studies) programs. Pooled attendance rates were 53 % (95 % CI: 48-57 %) for cardiac rehabilitation, 56 % (95 % CI: 42-70 %) for pulmonary rehabilitation, and 61 % (95 % CI: 51-70 %) for ICU recovery programs. Significant attendance heterogeneity was present (cardiac I²=100 %, p < 0.001; pulmonary I²=100 %, p < 0.001; ICU I²=94 %, p < 0.01). Barriers to attendance included transportation, distance, work conflicts, and patient factors (e.g., comorbidities, older age). Facilitators included male gender, younger age, higher education, income, provider recommendations, and flexible scheduling. Individual factors represented the primary domain affecting attendance.

Conclusions

The results indicate comparable attendance rates and factors shaping attendance across acute illness rehabilitation/recovery programs, with ICU recovery programs being the most well-attended on average.

Registration

PROSPERO CRD42022357261

背景：心脏、肺部和重症监护室（ICU）康复/恢复计划是一种健康促进干预措施，旨在改善急性病后的身体恢复、心理健康和生活质量，同时降低不良事件的风险：确定受邀参加心脏康复、肺部康复或重症监护室康复计划的患者出席率的差异以及影响出席率的因素：我们通过检索 PubMed、EMBASE、CINAHL、Web of Science 和手册参考文献列表，对从开始到 2024 年 6 月 3 日的研究进行了系统回顾和荟萃分析。我们纳入了在符合条件的项目中报告急性病住院后患者出勤率的研究。两名团队成员独立筛选文章并提取数据，必要时由第三名成员进行审核并达成共识。我们的主要结果集中在转诊患者中符合条件的项目的就诊率：在筛选出的 3,446 项研究中，有 179 项研究（N = 4,779,012 名患者）纳入了心脏康复（n = 153 项研究）、肺康复（n = 11 项研究）和重症监护室康复（n = 15 项研究）项目。汇总的就诊率分别为：心脏康复项目 53 %（95 % CI：48-57 %），肺康复项目 56 %（95 % CI：42-70 %），重症监护室康复项目 61 %（95 % CI：51-70 %）。参加人数存在显著的异质性（心脏康复 I2=100 %，p < 0.001；肺康复 I2=100 %，p < 0.001；重症监护室康复 I2=94 %，p < 0.01）。就诊障碍包括交通、距离、工作冲突和患者因素（如合并症、年龄较大）。促进因素包括男性、年轻、高学历、收入、医疗服务提供者的建议以及灵活的时间安排。个人因素是影响出勤率的主要因素：结果表明，急性病康复/恢复项目的参加率和影响参加率的因素具有可比性，其中重症监护室恢复项目的平均参加率最高：注册：PROCROPERO CRD42022357261。

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引用次数: 0

The effects of exercise-based prehabilitation in patients undergoing coronary artery bypass grafting surgery: A systematic review of randomized controlled trials 以运动为基础的术前康复训练对冠状动脉旁路移植手术患者的影响：随机对照试验的系统回顾。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-09-21 DOI: 10.1016/j.hrtlng.2024.09.007

Background

Postoperative exercise-based rehabilitation improves the physical performance and health-related outcomes of patients undergoing coronary artery bypass grafting (CABG). However, the effectiveness of exercise-based prehabilitation in patients undergoing CABG remains unknown.

Objective

The purpose of this systematic review was to investigate the effects of exercise-based prehabilitation on functional exercise capacity, postoperative complications, anxiety, depression, self-efficacy, quality of life, length of hospital and intensive care unit stay, frailty, and endothelial function in patients undergoing CABG surgery.

Methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol is recorded in the PROSPERO database (registration number CRD42023488530). PubMed, the Physiotherapy Evidence Database (PEDro), Google Scholar, Web of Science, Scopus, and the Cochrane Library were searched from inception to December 2023. The titles and abstracts of the studies were screened using Rayyan Ai software. After full-text screening, randomized controlled trials that met the inclusion criteria were included.

Results

Five randomized controlled trials involving 616 participants were included. The systematic review suggests strong evidence that exercise-based prehabilitation improved functional capacity and moderate evidence that it reduced postoperative complications and length of hospital stay. Although there was conflicting evidence regarding the effects of exercise-based prehabilitation on quality of life, there was limited evidence of its effects on physical activity, anxiety, depression, self-efficacy, frailty, and endothelial function.

Conclusions

Exercise-based prehabilitation can be recommended for improvements in functional capacity, postoperative complications, and length of hospital stay in patients undergoing CABG.

背景：术后运动康复可改善冠状动脉旁路移植术（CABG）患者的体能表现和健康相关结果。然而，在接受冠状动脉旁路移植术的患者中，以运动为基础的术前康复的有效性仍不为人所知：本系统性综述旨在研究运动前康复对接受冠状动脉旁路移植手术患者的功能锻炼能力、术后并发症、焦虑、抑郁、自我效能、生活质量、住院时间和重症监护室住院时间、虚弱程度和内皮功能的影响：本系统综述遵循系统综述和元分析首选报告项目 (PRISMA) 指南。研究方案记录在 PROSPERO 数据库中（注册号 CRD42023488530）。对 PubMed、物理治疗证据数据库 (PEDro)、Google Scholar、Web of Science、Scopus 和 Cochrane 图书馆进行了从开始到 2023 年 12 月的检索。使用 Rayyan Ai 软件对研究的标题和摘要进行筛选。全文筛选后，纳入了符合纳入标准的随机对照试验：结果：共纳入了 5 项随机对照试验，涉及 616 名参与者。系统综述显示，有确凿证据表明以运动为基础的术前康复可提高患者的功能能力，也有中等程度的证据表明运动可减少术后并发症和住院时间。虽然关于运动康复对生活质量的影响存在相互矛盾的证据，但有有限的证据表明运动康复对身体活动、焦虑、抑郁、自我效能、虚弱和内皮功能有影响：结论：建议进行以运动为基础的术前康复，以改善接受 CABG 患者的功能能力、术后并发症和住院时间。

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引用次数: 0

Corrigendum to “The association between food environment and cardiovascular disease outcomes: A systematic review” [Heart & Lung, volume 68 (2024), Pages 359-366/YMHL2427] 食物环境与心血管疾病结果之间的关联：系统综述》[《心肺》，第 68 卷（2024 年），第 359-366 页/YMHL2427] 更正

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-09-20 DOI: 10.1016/j.hrtlng.2024.09.009

引用次数: 0

Modifiable risk factors and motivation for lifestyle change of CVD patients starting cardiac rehabilitation: The BENEFIT study 开始心脏康复治疗的心血管疾病患者的可改变风险因素和改变生活方式的动力：BENEFIT 研究

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-09-17 DOI: 10.1016/j.hrtlng.2024.09.008

Background

To improve lifestyle guidance within cardiac rehabilitation (CR), a comprehensive understanding of the motivation and lifestyle-supporting needs of patients with cardiovascular disease (CVD) is required.

Objectives

This study's purpose is to evaluate patients’ lifestyle and their motivation, self-efficacy and social support for change when starting CR.

Methods

1782 CVD patients (69 % male, mean age 62 years) from 7 Dutch outpatient CR centers participated between 2020 and 2022. Modifiable risk factors were assessed with a survey and interviews by healthcare professionals during CR intake.

Results

Most patients exhibited an elevated risk in 3–4 domains. Elevated risks were most prominent in domains of (1) waist circumference and BMI (2) physical exercise (3) healthy foods intake and (4) sleep duration. Most patients chose to focus on increasing physical exercise, but about 20 % also wanted to focus on a healthy diet and/or decrease stress levels. Generally, motivation, self-efficacy and social support to reach new lifestyle goals were high. However, patients with an unfavorable risk profile had lower motivation and self-efficacy to work on lifestyle changes, while patients with lower social support had a higher chance to quit the program prematurely.

Conclusions

Our results underscore the need to begin CR with a comprehensive lifestyle assessment and highlight the importance of offering lifestyle interventions tailored to patients’ specific modifiable risk factors and lifestyle-supporting needs, targeting multiple lifestyle domains. Expanding the current scope of CR programs to address diverse patient needs and strengthening support may enhance motivation and adherence and lead to significant long-term benefits for cardiovascular health.

Clinical trial registration number

Netherlands Trial Register; registration number NL8443

背景为了改善心脏康复（CR）中的生活方式指导，需要全面了解心血管疾病（CVD）患者的动机和生活方式支持需求。方法来自荷兰 7 家门诊 CR 中心的 1782 名心血管疾病患者（69% 为男性，平均年龄 62 岁）在 2020 年至 2022 年期间参与了这项研究。结果大多数患者在 3-4 个方面表现出风险升高。风险升高最突出的领域是：（1）腰围和体重指数（BMI）；（2）体育锻炼；（3）健康食品摄入量；（4）睡眠时间。大多数患者选择将重点放在增加体育锻炼上，但也有约 20% 的患者希望将重点放在健康饮食和/或降低压力水平上。一般来说，实现新生活方式目标的动机、自我效能感和社会支持都很高。结论我们的研究结果强调了在开始 CR 时进行全面生活方式评估的必要性，并强调了针对患者的特定可改变风险因素和生活方式支持需求，针对多个生活方式领域提供量身定制的生活方式干预的重要性。扩大目前 CR 项目的范围以满足患者的不同需求并加强支持，可能会提高患者的积极性和依从性，并为心血管健康带来显著的长期益处。临床试验注册号荷兰试验注册；注册号 NL8443

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引用次数: 0

Effects of aerobic exercise-based pulmonary rehabilitation on quality of life in pediatric asthma: A systematic review and meta-analysis 以有氧运动为基础的肺康复对小儿哮喘患者生活质量的影响：系统回顾和荟萃分析

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-09-13 DOI: 10.1016/j.hrtlng.2024.09.005

Background

Pediatric asthma poses a significant global health burden, impacting the well-being and daily lives of affected children. Aerobic exercise-based pulmonary rehabilitation emerges as a promising intervention to address the multifaceted challenges faced by pediatric asthma patients.

Objectives

The purpose of this systematic review and meta-analysis was to comprehensively evaluate the effects of aerobic exercise-based pulmonary rehabilitation on pulmonary function and quality of life in pediatric asthma patients.

Methods

Randomized controlled trials (RCTs) involving pediatric participants (5–18 years) were included. Aerobic exercise program-based pulmonary rehabilitation interventions were assessed for their impact on actual and percentage predicted values of lung volumes and flow rates such as forced vital capacity (FVC), maximum mid-expiratory flow (FEF25–75), peak expiratory flow (PEF), forced expiratory volume in one second (FEV1), FEV1/FVC, and on quality of life (QoL) measures. A systematic search of databases, hand-searching, and consultation with experts identified relevant studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines guided study selection, data extraction, and quality assessment.

Results

The systematic review included 20 studies with diverse exercise interventions and outcomes. The meta-analysis using fixed-effects model showed that there was a significant improvement in FVC (% predicted) [SMD= 0.30, 95 %CI: 0.13, 0.48] and FEF25–75 (% predicted) [SMD= 0.31, 95 %CI: 0.03, 0.58] in the experimental group compared with the control group. Furthermore, using a random-effects model involving 12 studies, significant increases in the QoL [SMD= 0.70, 95 %CI: 0.14, 1.26] were found in the exercise group. Due to inter-study heterogeneity, additional analyses were conducted. Publication bias analysis indicated robustness, with no significant asymmetry in funnel plots.

Conclusion

Aerobic exercise-based pulmonary rehabilitation significantly enhances pulmonary function and quality of life in pediatric asthma patients. The findings, supported by improvements in FVC and FEF25–75, demonstrate the efficacy of these interventions. Quality of life measures also showed notable improvements. Despite inter-study heterogeneity, the results are robust, suggesting that aerobic exercise should be considered a valuable non-pharmacological strategy in managing pediatric asthma.

背景小儿哮喘给全球健康带来沉重负担，影响着患儿的身心健康和日常生活。本系统综述和荟萃分析的目的是全面评估基于有氧运动的肺康复对小儿哮喘患者肺功能和生活质量的影响。方法纳入了涉及小儿参与者（5-18 岁）的随机对照试验（RCT）。评估了基于有氧运动项目的肺康复干预对肺活量和肺流量的实际值和预测值百分比的影响，如用力肺活量（FVC）、最大呼气中流量（FEF25-75）、呼气峰值流量（PEF）、一秒钟内用力呼气量（FEV1）、FEV1/FVC，以及对生活质量（QoL）测量的影响。通过对数据库进行系统检索、手工检索以及咨询专家，确定了相关研究。系统综述和荟萃分析首选报告项目（PRISMA）指南指导研究的选择、数据提取和质量评估。使用固定效应模型进行的荟萃分析表明，与对照组相比，实验组的 FVC（预测百分比）[SMD= 0.30，95 %CI：0.13，0.48] 和 FEF25-75 （预测百分比）[SMD= 0.31，95 %CI：0.03，0.58] 有显著改善。此外，利用涉及 12 项研究的随机效应模型，发现运动组的 QoL 显著增加[SMD= 0.70，95 %CI：0.14，1.26]。由于研究间存在异质性，因此还进行了其他分析。结论以有氧运动为基础的肺康复治疗能显著提高小儿哮喘患者的肺功能和生活质量。FVC和FEF25-75的改善证明了这些干预措施的有效性。生活质量也有明显改善。尽管研究间存在异质性，但结果是可靠的，这表明有氧运动应被视为治疗小儿哮喘的一种有价值的非药物策略。

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引用次数: 0

Timing and content of serious illness conversations for patients with advanced heart failure in a specialty-aligned palliative care service 在专科联盟姑息关怀服务中与晚期心力衰竭患者进行重症谈话的时间和内容

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-09-11 DOI: 10.1016/j.hrtlng.2024.09.004

Background

Patients with advanced heart failure (AHF) desire communication around values and goals prior to treatment decisions.

Objectives

To evaluate the timing and content of the first serious illness communication (SI conversation) for patients with AHF after referral to a specialist palliative care (PC) team (HeartPal).

Methods

In this retrospective cohort study, we used electronic health records to identify patients referred to HeartPal and their first SI conversations at a tertiary care hospital between October 2018 and September 2021. We used natural language processing and predetermined codes to quantify prevalence of prior goals of care conversations by the cardiology team within six months preceding the HeartPal consultation and the prevalence of hopes, fears, and seven conversation content codes. Consecutive SI conversations and patient outcomes were followed until March 2022.

Results

Of 468 patients (mean age: 64 years, 72 % male, 66 % referred for goals of care conversation), 25.2 % had prior documented goals of care conversations preceding the HeartPal consultation. During the study period, 206 (44.0 %) patients died (median time from initial SI conversation to death: 65 days, IQR 206) and 43.2 % engaged in multiple SI conversations before death. SI conversation analysis (n = 324) revealed that patients hoped to “be at home” (74.1 %, n = 240), “be independent” (65.7 %, n = 213) and “live as long as possible” (53.4 %, n = 173). Conversation content included goals of care (83.0 %), strengths (83.0 %), decision-making (79.3 %), spirituality (71.0 %), coping (52.2 %), and prognostic communication (43.5 %).

Conclusion

Specialist PC service provides documentation of goals and values and offers longitudinal follow-up for patients with AHF.

背景晚期心力衰竭（AHF）患者希望在治疗决策前围绕价值观和目标进行交流。目的评估转诊至专科姑息治疗（PC）团队（HeartPal）后，AHF 患者首次重症交流（SI）的时间和内容。方法在这项回顾性队列研究中，我们使用电子健康记录识别了转诊至 HeartPal 的患者，以及他们在 2018 年 10 月至 2021 年 9 月期间在一家三级医院进行的首次 SI 对话。我们使用自然语言处理和预先确定的代码来量化心脏病学团队在HeartPal会诊前六个月内进行的护理目标会话的普遍性，以及希望、恐惧和七个会话内容代码的普遍性。结果在 468 名患者（平均年龄：64 岁，72% 为男性，66% 转诊为护理目标谈话）中，25.2% 的患者在接受 HeartPal 会诊前曾有过有记录的护理目标谈话。在研究期间，206 名患者（44.0%）死亡（从首次 SI 对话到死亡的中位时间：65 天，IQR 206），43.2% 的患者在死亡前进行了多次 SI 对话。SI 对话分析（n = 324）显示，患者希望 "在家"（74.1%，n = 240）、"独立"（65.7%，n = 213）和 "尽可能长寿"（53.4%，n = 173）。谈话内容包括护理目标（83.0%）、优势（83.0%）、决策（79.3%）、灵性（71.0%）、应对（52.2%）和预后沟通（43.5%）。

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引用次数: 0

Integrating frailty management into cardiac intensive care unit nursing practice: A qualitative study 将虚弱管理纳入心脏重症监护室护理实践：定性研究

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-09-10 DOI: 10.1016/j.hrtlng.2024.09.006

Background

Frailty is prevalent among older patients in intensive care units (ICUs) and poses significant challenges to recovery. Despite its importance, there is limited research on effective nurse-led frailty management strategies in this context.

Objective

The purpose of this qualitative study was to explore nurses' perceptions of frailty management in cardiac ICUs through the lens of the Wuli-Shili-Renli (WSR) system approach.

Methods

Sixteen nurses from two tertiary hospitals in Shandong province, China, participated in semi-structured interviews. Participants were selected based on their involvement in frailty training, educational background, and cardiac ICU work experience. Thematic analysis was conducted to identify key themes and sub-themes.

Results

Analysis in three categories revealed the need for foundational support, including the need for appropriate screening tools, updated evidence-based practices, and institutional support. Closed-loop management involved frailty screening, personalized program implementation, information management, and follow-up assessment. Personnel training and coordination emphasized enhancing nurses' professionalism, multidisciplinary teamwork, and cooperation from patients and their caregivers.

Conclusion

The insights gained can inform evidence-based practices and improve the quality of care provided to frail patients in cardiac ICUs. There is a need for future research to empirically investigate these strategies.

背景虚弱在重症监护病房（ICU）的老年患者中十分普遍，对患者的康复构成了巨大挑战。本定性研究旨在从五里-十里-仁里（WSR）系统方法的角度探讨护士对心脏重症监护病房虚弱管理的看法。根据他们参与虚弱培训的情况、教育背景和心脏重症监护室的工作经验选择参与者。结果分析表明，患者需要基础支持，包括需要适当的筛查工具、最新的循证实践和机构支持。闭环管理涉及虚弱筛查、个性化项目实施、信息管理和后续评估。人员培训和协调强调提高护士的专业水平、多学科团队合作以及患者及其护理人员的配合。今后需要对这些策略进行实证研究。

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引用次数: 0