Patients after myocardial infarction have impaired vascular function. However, effects of lifestyle, e.g., physical activity level, on endothelial function and arterial stiffness remain scarce. The ...aim of our study was to investigate effects of physical activity level and risk factors on endothelial function and arterial stiffness.
In this cross-sectional study, we ultrasonographically assessed parameters of vascular function, namely flow mediated dilation (FMD) of the brachial artery and carotid artery stiffness in patients after myocardial infarction referred to the cardiac rehabilitation. The International Physical Activity Questionnaire (IPAQ) was obtained from all participants. Based on the IPAQ, patients were classified into three groups: vigorous, moderate, and low physical activity engagement. ANOVA was used for comparison among three groups using Bonferroni correction to determine differences between two sub-groups.
One hundred and eight patients after myocardial infarction (mean age 53 ± 10 years) were included. There were significant differences in terms of FMD (8.2 vs. 4.2 vs. 1.9%,
< 0.001) and pulse wave velocity (PWV), a measure of arterial stiffness (6.1 vs. 6.4 vs. 6.9 m/s,
= 0.004) among groups of vigorous, moderate, and low physical activity engagement, respectively. However, in younger patients only FMD remained associated with physical activity level, while arterial stiffness was not. Low physical activity engagement was a significant predictor of both FMD and PWV in univariate and multivariate models, adjusted for age, sex, and other risk factors.
Low physical activity level is associated with impaired endothelial function and increased arterial stiffness in patients after myocardial infarction. Future studies are warranted to address this issue in a context of cardiac rehabilitation protocols optimization in order to improve vascular function in these patients.
Adherence to the Mediterranean lifestyle—as captured by the Medlife Index Questionnaire (i.e., encompassing a Mediterranean diet as well as other aspects of healthy living, such as food preparation, ...physical activity, and socializing)—has been associated with reduced cardiovascular events in healthy individuals. In the present study, we sought to determine the adherence to, and the effect of comprehensive cardiac rehabilitation on, Mediterranean lifestyle adherence in patients after myocardial infarction. We included 121 patients (mean age, 55 years; women, 37%) undergoing comprehensive cardiac rehabilitation—i.e., exercise training 3 times per week for 12 weeks plus dedicated workshops promoting the Mediterranean lifestyle. Before and after cardiac rehabilitation, patients completed the Medlife Index Questionnaire. High baseline adherence was associated with favourable glucose (5.39 vs. 6.1 mmol/L; p < 0.001), triglycerides (1.1 vs. 1.5 mmol/L; p = 0.002), and HDL cholesterol levels (1.32 vs. 1.12 mmol/L; p = 0.032). More importantly, the Medlife Score significantly improved following comprehensive cardiac rehabilitation in patients with low baseline adherence (from 13.8 to 16.7 points; p < 0.001), but not in patients with high baseline adherence (from 19.4 to 18.8 points; p = 0.205). Our findings suggested that Mediterranean lifestyle promotion during cardiac rehabilitation improved adherence to the Mediterranean lifestyle, especially in low-adherence patients.
Za zaščito in promocijo primernega hranjenja dojenčkov in majhnih otrok je bil leta 1981 sprejet Mednarodni kodeks o trženju nadomestkov materinega mleka. Glavni namen Kodeksa j e zagotoviti varno in ...ustrezno prehrano vsem dojenčkom. Danes, kar 40 let po sprejetju Kodeksa, se težave z njegovim kršenjem zaradi neustreznega trženja nadaljujejo. V narativnem pregledu literature želimo prepoznati ter opredeliti obseg, naravo in prakse na področju kršitev Kodeksa. Pri pripravi pregleda literature smo si pomagali z objavami v podatkovnih bazah CINAHL, PubMed in Science-Direct. Ugotovili smo številne in raznovrstne kršitve Kodeksa in jih razvrstili v dve kategoriji – neposredne kršitve in posredne kršitve. Zdravstveni delavci imajo pomembno vlogo pri zaščiti, spodbujanju in podpiranju dojenja. Ob tem morajo opozarjati na kršitve Kodeksa, pri čemer morajo upoštevati moralno-etične, pravne in poklicne standarde. V Sloveniji bomo dosegli uspešne prakse, ko bomo Kodeks v celoti implementirali na vse ravni zdravstvenega varstva in javnega zdravja.
Abstract Introduction Poor adoption of electronic health records among healthcare workers can diminish their impact. Healthcare informatics solutions development should diligently acknowledge ...end-user needs. This study compares a user experience and perceived quality of the nursing process integration in two different applications for electronic documentation of the nursing care plan. Both applications were designed and tested in Slovenia. Methods In the first phase, final year undergraduate nursing students were recruited (n=73) and randomly assigned into two groups. Each group used one of the applications for a duration of five hours. A survey among students was conducted. In the second phase, additional students were recruited (n=40) and invited to participate in qualitative analysis of the unfavourably rated application. Results The modern, visually improved application was favourably rated by students in terms of all aspects of application usability. However, students reported a significant number of inadequacies regarding the nursing process methodology integration. On the contrary, the students using the poorly rated and visually outdated application reported no such concerns. Qualitative analysis of student reflections identified additional positive features of software design that were not detected in survey results analysis. Conclusion This study showed that a user-centred approach can be used to compare diverse electronic solutions. Detected discrepancies in findings using qualitative and quantitative analysis show the importance of integrating diverse research approaches for adequate evaluation of software solutions. Furthermore, this study design promotes empowerment of healthcare workers to participate in the development and critical evaluations of software solutions.
The unambiguous and consistent representation of the healthcare domain is the foundation of modernized healthcare (eg, electronic medical records). However, the nursing domain often fails to meet ...this requirement. In this article, we address this challenge by presenting a three-stage methodological approach that can be used to (1) capture knowledge in a nursing domain; (2) design a nursing ontology, composed of data models linked with terminology concepts in a multirelational property graph; and (3) implement and (4) evaluate the ontology. Through the feasibility, development, and evaluation phases of our methodological approach, we modeled a nursing domain (ontology) and the indices that partition the domain into an efficient, searchable space, where the solution to a nursing problem is seen as abstractly defined traversals through its graph vertices and edges. Thus, the use of the three-phase ontology development process and multirelational property graph was sufficiently comprehensive for achieving the representation of a nursing domain ontology and its instantiation.
Digital competences are among the most important competences in modern society, with the education system playing a key role in the acquisition of digital competences by youths. As a rule, digital ...competences of students in general secondary schools in the EU are not optimal and vary considerably. As EU states are autonomous regarding secondary schools, their education organisation varies. Therefore, attempts are being made to implement certain standards of learning outcomes to be attained by secondary school students. Such standards are being prepared, and systematic implementation of the acquisition of digital competences in schools will begin as soon as there are enough trained teachers, for who in 2017 in the framework of DigCompEdu, a European framework of digital competences of educators was developed, with concrete advice for their work in the education process. We have prepared several education scenarios that can be used to enhance digital competences of students in general secondary schools where there are no professional subjects in which the students could acquire digital competences. Since the education scenarios are described by a large number of parameters, we prepared a hierarchical multi-attribute decision model for their evaluation and grading. Experts from the ministry, from professional services and secondary schools, cooperated in the preparation and validation of the model. The model is an aid to decision-makers who are looking for best scenarios, and also allows schools to evaluate their status and recognise what has to be done to attain a certain level of digital competences of students.
Supervised exercise training (walking) is recommended in patients with intermittent claudication, both as a means to improve symptoms (walking distance and quality of life QoL) and as a means to ...improve general cardiovascular health (including vascular function and heart rate variability HRV). Our aim was to compare two types of supervised training (moderate-pain and pain-free walking) with comparable intensity based on heart rate, in terms of walking capacity, QoL, vascular function, biomarkers, and HRV in patients with intermittent claudication.
Thirty-six adults with intermittent claudication were randomized to either moderate-pain or pain-free exercise training (36 sessions, two or three times a week) or usual care (no supervised exercise). Initial walking distance and absolute walking distance using treadmill testing, flow-mediated vasodilation and pulse wave velocity using ultrasound, N-terminal pro-B-type natriuretic peptide and fibrinogen levels, HRV, and QoL (36-Item Short Form Health Survey questionnaire) were determined at baseline and after the intervention period.
Twenty-nine patients (mean age, 64 ± 9 years; 72% male) completed the study. Both training programs similarly improved walking capacity. Initial walking distance and absolute walking distance significantly increased with either moderate-pain walking (median, 50 m to 107 m P = .005 and 85 m to 194 m P = .005, respectively) or pain-free walking (median, 53 m to 128 m P = .003 and 92 m to 163 m P = .003, respectively). QoL also similarly improved with both training modalities, whereas only moderate-pain walking was also associated with a statistically significant improvement in the vascular parameters flow-mediated vasodilation (4.4% to 8.0%; P = .002) and pulse wave velocity (6.6 m/s to 6.1 m/s; P = .013). Neither training program was associated with changes in biomarker levels and HRV.
Both moderate-pain and pain-free training modalities were safe and similarly improved walking capacity and health-related QoL. Conversely, vascular function improvements were associated with only moderate-pain walking.
Ventilator-associated pneumonia is a hospital-acquired infection of the lungs occurring in mechanically ventilated patients. An active risk management approach can prevent the occurrence of the ...disease and promote positive organizational changes, subsequently decreasing mortality and hospitalization costs. Using scientific and clinical practice knowledge, a risk evaluation model was developed to identify patients more at risk of developing the disease. For this purpose, a Decision Expert qualitative multi-criteria decision method was used, in which alternatives are evaluated according to predetermined hierarchically arranged criteria. Characteristics of each evaluated alternative are described by the members of an interdisciplinary expert team and are represented by the values of the basic criteria. Values of hierarchically higher aggregated criteria are computed in an upwards fashion according to utility functions, which are defined as simple logical rules. This method is integrated into a software solution, DEXi. The approach is applicable to vastly diverse decision problems and has been successfully used before for health-related decision support. The designed model was tested using actual clinical data. Evaluations of alternatives that most distinctly demonstrated the functionality of the evaluation model were selected and are presented in the results. The evaluation model is intended to assist a holistic evaluation of the risk of developing ventilator-associated pneumonia, by considering patient-related risk factors and the use of preventive measures. The model incorporates nursing-specific data that have hitherto been poorly utilized in preventing ventilator-associated pneumonia and promotes the active engagement of nurses in confronting this interdisciplinary healthcare problem, which has gained more prominence with the onset of COVID-19 disease.
Population ageing together with the greater prevalence of multimorbidity add to the need for and complexity of healthcare services. This makes it important to encourage and empower patients with ...chronic diseases to take care of themselves. An associated goal of such efforts is to significantly reduce the burden on healthcare systems and positively impact patients’ health outcomes and quality of life. The paper presents a multi-criteria decision model for assessing the health and self-care of patients with chronic diseases in the home environment. The model is based on the DEX methodology and was tested on ten cases. The model assists with the timely recognition of relevant symptoms and signs in decision-making about health and self-care. It can be used to promote patients taking on an active role with respect to caring for their health and well-being. The model could be integrated into self-care processes. It might also serve as a basis for an interprofessional approach to supporting older patients with chronic diseases living as fully and independently as possible in the environment in which they feel most comfortable.
PDF
