•Multiple factors influenced patients’ exercise levels after cardiac surgery.•The most common predictor of physical activity after cardiac surgery was male sex.•The main barrier to physical activity ...after cardiac surgery was health problems.
Physical activity can optimize patient outcomes after cardiac surgery, but postoperative patients’ physical activity generally has been inadequate. No review studies have focused on factors influencing cardiac patients’ postoperative physical activity.
To identify factors influencing physical activity in patients after cardiac surgery.
This study was conducted following Whittemore and Knafl's methodology. CINAHL, MEDLINE, PsychINFO, Scopus, and Embase were searched and selected studies were analyzed using the Matrix Method.
In 12 studies, factors facilitating physical activity included personal, socio-environmental, and intervention-related factors. Barriers to physical activity included personal, socio-environmental, and cardiac rehabilitation program-related factors. The most common predictor of physical activity was male sex, and the most frequent barrier was comorbidities.
This study revealed facilitators and barriers that significantly influenced physical activity after cardiac surgery. Healthcare providers and exercise guideline developers should consider our findings when devising physical activity strategies for postoperative cardiac patients.
Objective:
Fatigue is a pervasive and serious complaint among aging adults with type 2 diabetes. Anecdotally, hyperglycemia was thought to cause fatigue, but prior cross-sectional analyses failed to ...find any relationship between glucose levels and fatigue. However, study methodology may have caused this relationship to be missed. Our aim was to use concurrent and continuous data across 5 days to examine real-time momentary relationships between glucose and fatigue levels by week, day, and time of day. Additionally, we explored how these relationships differed by sex.
Method:
Participants (N = 54, 51% male, 54% non-White) wore continuous glucose monitors and wrist actigraphy into which they inputted fatigue ratings 6–8 times daily during waking hours across 5 days. Generalized estimation equation models were used to explore the relationship between glucose and fatigue when averaged by week, day, and time of day. Differences by sex were also explored.
Results:
HbA1c and baseline and real-time fatigue were higher in women than in men. Baseline HbA1c and self-reported general fatigue were unrelated. Fatigue levels averaged by day and time of day were higher in women than in men (p < .05). Glucose and fatigue were significantly related at all levels of data (weekly, daily, and time of day) in women but not men.
Conclusions:
Our findings suggest that, when measured concurrently, glucose excursions may affect fatigue levels in women.
A person's beliefs about their chronic condition (illness representations) influence health and treatment outcomes. Recently, researchers have used clustering approaches to identify subgroups with ...different patterns of beliefs about their illness, with some subgroups having more favorable health outcomes than others. To date, these findings have not been synthesized. The purpose of this systematic review of the literature was to synthesize results of studies that used clustering approaches to analyze illness representation in chronic disease populations, in order to characterize the clusters and their relationship to health outcomes. Using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines we searched CINAHL, PsycInfo, and PubMed. To be included, studies had to be (a) peer reviewed, (b) in English, (c) performing a cluster analysis (CA), latent class analysis (LCA), or latent profile analysis (LPA), (d) using only illness representation (IR) subscales to form clusters, (e) measuring illness representation with the Illness Perception Questionnaire (IPQ‐R), (f) in a chronic condition sample, and (g) measuring health‐related outcomes. Twelve studies were included. Across studies, the number of clusters found ranged from two to three. In all studies, an association was found between illness representation group and at least one of their health outcomes. Illness representation clusters associated with favorable outcomes usually included lower disease‐related consequences, fewer symptoms, less negative emotion, and a more stable disease pattern. The results of this review indicate that the relationship between the patterns of the illness representation profiles and health outcomes transcend diseases. Additionally, some dimensions of illness representation may be more important drivers of group membership than others.
Patients managed at a long-term acute-care hospital (LTACH) for weaning from prolonged mechanical ventilation are at risk for profound muscle weakness and disability.
To investigate effects of ...prolonged ventilation on survival, muscle function, and its impact on quality of life at 6 and 12 months after LTACH discharge.
This was a prospective, longitudinal study conducted in 315 patients being weaned from prolonged ventilation at an LTACH.
At discharge, 53.7% of patients were detached from the ventilator and 1-year survival was 66.9%. On enrollment, maximum inspiratory pressure (Pi
) was 41.3 (95% confidence interval, 39.4-43.2) cm H
O (53.1% predicted), whereas handgrip strength was 16.4 (95% confidence interval, 14.4-18.7) kPa (21.5% predicted). At discharge, Pi
did not change, whereas handgrip strength increased by 34.8% (
< 0.001). Between discharge and 6 months, handgrip strength increased 6.2 times more than did Pi
. Between discharge and 6 months, Katz activities-of-daily-living summary score improved by 64.4%; improvement in Katz summary score was related to improvement in handgrip strength (
= -0.51;
< 0.001). By 12 months, physical summary score and mental summary score of 36-item Short-Form Survey returned to preillness values. When asked, 84.7% of survivors indicated willingness to undergo mechanical ventilation again.
Among patients receiving prolonged mechanical ventilation at an LTACH, 53.7% were detached from the ventilator at discharge and 1-year survival was 66.9%. Respiratory strength was well maintained, whereas peripheral strength was severely impaired throughout hospitalization. Six months after discharge, improvement in muscle function enabled patients to perform daily activities, and 84.7% indicated willingness to undergo mechanical ventilation again.
The aim was to study the overall content and organisational aspects of pulmonary rehabilitation programmes from a global perspective in order to get an initial appraisal on the degree of ...heterogeneity worldwide. A 12-question survey on content and organisational aspects was completed by representatives of pulmonary rehabilitation programmes that had previously participated in the European Respiratory Society (ERS) COPD Audit. Moreover, all ERS members affiliated with the ERS Rehabilitation and Chronic Care and/or Physiotherapists Scientific Groups, all members of the American Association of Cardiovascular and Pulmonary Rehabilitation, and all American Thoracic Society Pulmonary Rehabilitation Assembly members were asked to complete the survey via multiple e-mailings. The survey has been completed by representatives of 430 centres from 40 countries. The findings demonstrate large differences among pulmonary rehabilitation programmes across continents for all aspects that were surveyed, including the setting, the case mix of individuals with a chronic respiratory disease, composition of the pulmonary rehabilitation team, completion rates, methods of referral and types of reimbursement. The current findings stress the importance of future development of processes and performance metrics to monitor pulmonary rehabilitation programmes, to be able to start international benchmarking, and to provide recommendations for international standards based on evidence and best practice.
The objectives of this descriptive study were (a) to determine the energy expenditure of activities commonly performed by individuals with a spinal cord injury (SCI) and summarize this information ...and (b) to measure resting energy expenditure and establish the value of 1 MET for individuals with SCI.
One-hundred seventy adults with SCI were partitioned by gender, anatomical level of SCI, and American Spinal Injury Association designations for motor function. Twenty-seven physical activities, 12 recreational/sport and 15 daily living, were performed, while energy expenditure was measured continuously via a COSMED K4b portable metabolic system. In addition, 66 adult males with SCI completed 30 min of supine resting energy testing in a quiet environment.
Results for the 27 measured activities are reported in kilocalories per minute (kcal·min(-1)) and VO2 (mL·min(-1) and mL·kg(-1)·min(-1)). One MET for a person with SCI should be adjusted using 2.7 mL·kg(-1)·min(-1). Using 2.7 mL·kg(-1)·min(-1), the MET range for persons in the motor incomplete SCI group was 1.17 (supported standing) to 6.22 (wheeling on grass), and 2.26 (billiards) to 16.25 (hand cycling) for activities of daily living and fitness/recreation, respectively. The MET range for activities of daily living for persons in the group with motor complete SCI was 1.27 (dusting) to 4.96 (wheeling on grass) and 1.47 (bait casting) to 7.74 (basketball game) for fitness/recreation.
The foundation for a compendium of energy expenditure for physical activities for persons with SCI has been created with the completion of this study. In the future, others will update and expand the content of this compendium as has been the case with the original compendium for the able-bodied.
Background In Western countries, factors contributing to breast cancer presentation delay have been identified, but little is known about presentation delay in China, where culture and healthcare ...systems are quite different. Objective To describe the delay interval among newly diagnosed breast cancer patients in China and to identify factors influencing delay, including the COVID-19 pandemic. Methods Using a cross-sectional design, we recruited 154 participants within 3 months of pathological diagnosis of breast cancer. Data were collected using standardized scales and open-ended questions. Results We found 44.8% of participants delayed ≥1 month, and 24.7% delayed ≥3 months before presentation, after self-discovery of symptoms. Logistic regression analysis showed that factors associated with longer delay (≥1 month) included preferring female physicians for breast examination, fewer negative emotions (afraid, anxious, distressed) regarding breast symptoms, more competing priorities, believing folk therapy can help treat lumps, and visiting a secondary or tertiary hospital instead of primary healthcare providers ( P < .05 for all). Interaction tests showed perceived seriousness of symptoms significantly predicted delay of ≥1 month only when perceived healthcare access or trust in physicians was low. Patients (14%) reported delaying due to fear of COVID-19 infection and inability to leave home. Conclusions Presentation delays were substantial and multilevel barriers to timely presentation were identified, which would be expected to contribute to later-stage cancer at diagnosis. Implications for practice Findings suggest that nursing interventions and improved health policies are urgently needed in China, including breast cancer education to increase awareness.
Background
Women veterans experience higher levels of stress-related symptoms than their civilian counterparts. Psychological stress is associated with greater inflammation and may increase risk for ...cardiovascular disease (CVD). Mindfulness-based stress reduction (MBSR) has been found to improve psychological well-being in other populations but no randomized controlled trials (RCT) have been conducted examining the impact of MBSR on well-being and inflammation in women veterans at risk for CVD.
Objective
Determine the effectiveness of MBSR in improving psychological well-being, cortisol, and inflammation associated with CVD in women veterans.
Design
The design is a RCT comparing MBSR to an active control condition (ACC) consisting of a health education program.
Participants
Women veterans (
N
=164) with risk factors for CVD from the Chicagoland area participated in the study.
Intervention
An 8-week MBSR program with weekly 2.5-h classes was compared to an ACC consisting of an 8-week health promotion education program with weekly 2.5-h classes.
Main Measures
The outcomes were psychological well-being perceived stress, depressive symptoms, loneliness, and post-traumatic stress disorder (PTSD) symptoms and stress-related markers, including diurnal salivary cortisol and cytokines interleukin-6 (IL-6) and interferon gamma (IFN-γ). Data were collected at baseline, 4 weeks (mid-point of intervention), 8 weeks (completion of intervention), and 6 months after completion of MBSR or ACC.
Key Results
Compared to the ACC, women who participated in MBSR reported less perceived stress, loneliness, and symptoms of PTSD. Although there were no significant differences between groups or changes over time in IL-6 or IFN-γ, participants in the MBSR program demonstrated a more rapid decline in diurnal salivary cortisol as compared to those in the ACC.
Conclusions
MBSR was found to improve psychological well-being and decrease diurnal salivary cortisol in women veterans at risk for CVD. Health care providers may consider MBSR for women veterans as a means by which to improve their psychological well-being.
•First study exploring a stress-reducing intervention and nursing presence.•The Mantram Repetition Program (MRP) resulted in positive outcomes for RNs.•The MRP increased perceived ability of nurses ...to be present to their patients.•Patients cared for by MRP-trained RNs experienced high levels of nursing presence.•Patients cared for by MRP-trained nurses were highly satisfied with their care.•Health policies should address impact of nurse burnout on patient outcomes.
The COVID-19 pandemic highlighted nurses’ compassionate presence during stressful conditions. Strategies to reduce workplace stress are needed.
The purpose of this study was to evaluate a stress reduction strategy, an Internet-based Mantram Repetition Program (MRP), for nurses caring for hospitalized Veterans.
A one group pre-/post-test design was used to assess change in nurses’ perceived outcomes after participating in the MRP. A post-test-only design was used to assess hospitalized Veterans’ perceptions of nursing presence and satisfaction with care. Qualitative interviews were used to supplement quantitative data.
Patients perceived high levels of presence and satisfaction with care. Post MRP, nurses perceived increased mindfulness, compassion satisfaction, spiritual well-being, and nursing presence. Increased mindfulness was associated with greater compassion satisfaction and less burnout.
For nurses working on the front lines of patient care, the potential for experiencing stress and burnout is a reality. Participating in a MRP could lessen these effects and facilitate nursing presence.
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