Limited data are available on the long-term effects of contemporary drug-eluting stents versus contemporary bare-metal stents on rates of death, myocardial infarction, repeat revascularization, and ...stent thrombosis and on quality of life.
We randomly assigned 9013 patients who had stable or unstable coronary artery disease to undergo percutaneous coronary intervention (PCI) with the implantation of either contemporary drug-eluting stents or bare-metal stents. In the group receiving drug-eluting stents, 96% of the patients received either everolimus- or zotarolimus-eluting stents. The primary outcome was a composite of death from any cause and nonfatal spontaneous myocardial infarction after a median of 5 years of follow-up. Secondary outcomes included repeat revascularization, stent thrombosis, and quality of life.
At 6 years, the rates of the primary outcome were 16.6% in the group receiving drug-eluting stents and 17.1% in the group receiving bare-metal stents (hazard ratio, 0.98; 95% confidence interval CI, 0.88 to 1.09; P=0.66). There were no significant between-group differences in the components of the primary outcome. The 6-year rates of any repeat revascularization were 16.5% in the group receiving drug-eluting stents and 19.8% in the group receiving bare-metal stents (hazard ratio, 0.76; 95% CI, 0.69 to 0.85; P<0.001); the rates of definite stent thrombosis were 0.8% and 1.2%, respectively (P=0.0498). Quality-of-life measures did not differ significantly between the two groups.
In patients undergoing PCI, there were no significant differences between those receiving drug-eluting stents and those receiving bare-metal stents in the composite outcome of death from any cause and nonfatal spontaneous myocardial infarction. Rates of repeat revascularization were lower in the group receiving drug-eluting stents. (Funded by the Norwegian Research Council and others; NORSTENT ClinicalTrials.gov number, NCT00811772 .).
Aims
To consider the scope and quality of mixed methods research in nursing.
Design
Focused mapping review and synthesis (FMRS).
Data sources
Five purposively selected journals: International Journal ...of Nursing Studies, Journal of Nursing Scholarship, Journal of Advanced Nursing, Worldviews on Evidence‐Based Nursing, and Journal of Mixed Methods Research.
Review methods
In the target journals, titles and s from papers published between 2015–2018 were searched for the words or derivative words ‘mixed methods’. Additional keyword searches were undertaken using each journal's search tool. We included studies that investigated nursing and reported to use a mixed methods approach. Articles that met the inclusion criteria were read in full and information was extracted onto a predetermined pro forma. Findings across journals were then synthesized to illustrate the current state of mixed methods research in nursing.
Results
We located 34 articles that reported on mixed methods research, conducted across 18 countries. Articles differed significantly both within and across journals in terms of conformity to a mixed methods approach. We assessed the studies for the quality of their reporting as regard the use of mixed methods. Nineteen studies were rated as satisfactory or good, with 15 rated as poorly described. Primarily, a poor rating was due to the absence of stating an underpinning methodological approach to the study and/or limited detail of a crucial integration phase.
Conclusions
Our FMRS revealed a paucity of published mixed methods research in the journals selected. When they are published, there are limitations in the detail given to the underpinning methodological approach and theoretical explanation.
摘要
目标
探讨护理学中混合方法研究的范围和质量。
设计
集中映射审查和合成(FMRS)。
数据来源
五本精选期刊:《国际护理研究杂志》,《护理学术期刊》,《高等护理学期刊》,《循证护理世界观》,《混合方法研究杂志》。
评审方法
在目标期刊中,对2015年至2018年间发表的论文标题和摘要进行搜索,以查找“混合方法”一词或其衍生词。使用每本期刊的搜索工具进行额外的关键词搜索。我们将调查护理的研究全部囊括在内,并报告使用混合方法的方式。符合入选标准的文章进行全文阅读,并以预定的形式摘取相关信息。然后,综合各期刊的研究发现,用以说明护理学中混合方法研究的现状。
结果
我们找到34篇在18个国家和地区进行的混合方法研究做出报告的文章。在对混合方法的方式一致性方面,期刊内和期刊间的文章存在显著差异。我们评估了这些研究在使用混合方法方面的报告质量。19篇研究被评为满意或良好,15篇被评为描述差评。差评主要是由于缺乏说明研究的基本方法论和/或关键整合阶段的细节有限。
结论
我们的集中映射审查和合成方法显示,精选期刊中发表混合方法研究的极少。在出版时,对基础方法论和理论解释的细节存在局限性。
Abstract
Background
Patient and public involvement (PPI) is increasingly considered an integral part of health research, and the focus has shifted from
why
we need PPI to
how
users can be involved in ...a meaningful way. The rationale for investigating experiences with PPI from the perspective of occupational therapy (OT)‐trained researchers' originates in the interrelationship between the inclusive approach to knowledge production, and participation and inclusion as core tenets of OT. The aim of this study was to explore PPI in health research from the perspective of OT‐trained researchers.
Method
Semi‐structured individual interviews were conducted online with nine Norwegian researchers. The interviews were analysed using reflexive thematic analysis.
Results
Professional background and clinical experience from person‐centred OT formed the foundation for how these researchers approached and facilitated PPI in their research. Valuing experiential knowledge and facilitating PPI to be meaningful for public collaborators were highlighted as essential for PPI to have an impact. The need to balance mutual expectations, requirements for research, and what might be possible to achieve within a research study were found to be vital.
Conclusion
Collaborative clinical experience constituted a sound foundation for implementing PPI in research. The occupational perspective underlines the importance of acknowledging experiential knowledge as essential to facilitating meaningful PPI. Challenges related to requirements for research and culture for implementing PPI were addressed by clarifying roles and expectations.
Patient or Public Contribution
Three public collaborators were involved in developing the aims, the interview guide, and the data analysis. They all had previous experience being involved in research.
Mentors play an important role in the practical education of critical care nursing students in intensive care units, yet little is known about the mentoring competencies of critical care nurses.
The ...aim of this study was to assess Norwegian critical care nurses' competence in mentoring students in intensive care units.
This study has a descriptive, cross-sectional design, utilising a self-administered online survey.
The study population consisted of critical care nurses who mentor students in Norwegian intensive care units.
178 critical care nurses participated in the study. The participants were recruited by contacting the units directly, through social media, and at a national critical care nursing conference.
The study utilised the Mentors' Competence Instrument, a self-evaluation tool for evaluating mentoring competence.
The Norwegian critical care nurses generally evaluated their mentoring competence as middle to high level. The “reflection during mentoring” dimension was rated as the highest and “student-centered evaluation” as the lowest competence dimension. The critical care nurses who had formal mentoring education reported significantly higher mentoring competences, but the other demographic characteristics were not related to mentoring competence. Regardless of previous mentoring education, most participants reported a need to further develop their mentoring competencies.
Employers should collaborate with educational institutions to establish a system for continuous competence development for critical care nurse mentors.
•Critical care nurses evaluate their own mentoring competence as high.•Critical care nurses with mentoring education report higher mentoring competences.•Critical care nurses report a desire for more mentoring competence.•Employers should facilitate regular mentoring education for critical care nurses.
Background Anxiety and depression are related to coronary heart disease, and psychological support is recommended in cardiac rehabilitation. Purpose The aims of this study were: to compare the ...prevalence of anxiety and depression with respect to cardiac rehabilitation participation among patients who have been treated with percutaneous coronary intervention; to examine prevalence of anxiety and depression among percutaneous coronary intervention patients compared to the general population; and to identify predictors of symptomatic anxiety and depression among percutaneous coronary intervention patients. Methods We included 9013 patients undergoing first-time percutaneous coronary intervention. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale in a representative sample of 775 patients at baseline and after three years of follow-up, and in the entire cohort at three-year follow-up. Results Cardiac rehabilitation participants had more anxiety and depression than cardiac rehabilitation non-participants at baseline, and both groups had a more anxiety than the general population. The levels of anxiety and depression fell significantly during three years of follow-up, but the changes did not differ between cardiac rehabilitation participants and cardiac rehabilitation non-participants. Three years after percutaneous coronary intervention the prevalence of anxiety was 32% ( p < 0.001), higher among cardiac rehabilitation participants compared to cardiac rehabilitation non-participants. Female gender and younger age were associated with anxiety, whereas older age, lower levels of education and cardiovascular morbidity were associated with depression. Conclusion The levels of anxiety and depression were prevalent among percutaneous coronary intervention patients and the levels were not affected by cardiac rehabilitation participation. Anxiety is prevalent among female and younger patients, whereas depression is related to older age and cardiovascular co-morbidity.
Vocational support is recommended for patients in cardiac rehabilitation (CR), as returning to work is important in patients social readjusting after an acute coronary event. Information is lacking ...on whether CR leads to higher long-term employment after percutaneous coronary intervention (PCI).
The aims of this study were to determine employment status three years after PCI, to compare employment status between CR participants and CR non-participants and to assess predictors for employment.
We included first-time PCI patients from the NorStent trial, who were of working age (<63 years;
= 2488) at a three-year follow-up. Employment status and CR participation were assessed using a self-report questionnaire. Propensity score method was used in comparing employment status of CR participants and CR non-participants.
Seventy per cent of participants who were <60 years of age at the index event were employed at follow-up and CR participation had no effect on employment status. Being male, living with a partner and attaining higher levels of education were associated with a higher chance of being employed, while being older, prior cardiovascular morbidity and smoking status were associated with lower chance of being employed at follow-up.
Because a significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization, updated incentives should be implemented to promote vocational support. Such programmes should focus on females, patients lacking higher education and patients who are living alone, as they are more likely to remain unemployed.
Health-related quality of life (HRQOL) questionnaires are increasingly used as outcome measures in research and clinical practice to assess treatment effectiveness in coronary heart disease (CHD) ...alongside traditional outcome measures. The Coronary Revascularisation Outcome Questionnaire (CROQ) is a patient-reported outcome measure (PROM) to evaluate health outcomes and HRQOL before and after coronary artery bypass grafting surgery (CABG) and percutaneous coronary intervention (PCI).
To translate the CROQ-PCI from English into Norwegian and test its psychometric properties.
Independent forward and backward translation was done following international guidelines. The CROQ was then pretested with both healthcare professionals and patients before the psychometric properties were field tested in a sample of patients who had undergone PCI. Psychometric testing included an evaluation of: acceptability; tests of scaling assumptions; reliability; content validity; construct validity based on within-scale analyses; and construct validity based on comparisons with external measures.
171 of 258 (66%) invited patients participated. The CROQ was acceptable to patients (low proportion of missing data and good response rate), reliable (good internal consistency and test-retest reliability for all scales), had good content validity (reported by both patients and healthcare professionals) and good construct validity (convergent validity with the SF-12 and Seattle Angina Questionnaire, known groups validity and factor analysis).
The Norwegian version of CROQ-PCI is a reliable and valid PROM for assessing HRQOL in CHD patients. Further testing of its responsiveness and ability to detect change is needed before recommending its use in Norwegian clinical practice and research.
The purpose of this study was to estimate the proportion of Norwegian coronary heart disease patients participating in cardiac rehabilitation programmes after percutaneous coronary intervention, and ...to determine predictors of cardiac rehabilitation participation.
Participants were patients enrolled in the Norwegian Coronary Stent Trial. We assessed cardiac rehabilitation participation in 9013 of these patients who had undergone their first percutaneous coronary intervention during 2008-2011. Of these, 7068 patients (82%) completed a self-administered questionnaire on cardiac rehabilitation participation within three years after their percutaneous coronary intervention.
Twenty-eight per cent of the participants reported engaging in cardiac rehabilitation. Participation rate differed among the four regional health authorities in Norway, varying from 20%-31%. Patients undergoing percutaneous coronary intervention for an acute coronary syndrome were more likely to participate in cardiac rehabilitation than patients with stable angina (odds ratio 3.2; 95% confidence interval 2.74-3.76). A multivariate statistical model revealed that men had a 28% lower probability ( p<0.001) of participating in cardiac rehabilitation, and the odds of attending cardiac rehabilitation decreased with increasing age ( p<0.001). Contributors to higher odds of cardiac rehabilitation participation were educational level >12 years (odds ratio 1.50; 95% confidence interval 1.32-1.71) and body mass index>25 (odds ratio 1.19; 95% confidence interval 1.05-1.36). Prior coronary artery bypass graft was associated with lower odds of cardiac rehabilitation participation (odds ratio 0.47; 95% confidence interval 0.32-0.70) Conclusion: The estimated cardiac rehabilitation participation rate among patients undergoing first-time percutaneous coronary intervention is low in Norway. The typical participant is young, overweight, well-educated, and had an acute coronary event. These results varied by geographical region.
Rehabilitation after acute myocardial infarction (AMI) presupposes that patients are provided with sufficient information and education to cope with the consequences of the disease. Furthermore, ...patient information is an important premise for patient satisfaction.
To explore and describe the relationship between received information and satisfaction with health care after AMI. In addition, we wanted to describe areas for improvement of patients' health care.
A questionnaire comprising 1) the Information Questionnaire and 2) the Patient Experience Questionnaire was sent to AMI patients, 6 weeks after discharge from hospital. One hundred and eleven patients participated.
In general patients were highly satisfied with their health care and the more information the patient reported to receive, the more satisfied he/she was with the hospital stay. Patients were least satisfied with information about medication and possible future problems. These were the areas that patients received least information about and were also identified as the areas with greatest potential for improvement. Amount of information received was not associated to length of hospital stay. Although, younger patients reported receiving more information than older patients during the hospital stay, it was the youngest that missed information after discharge.
The results indicate that it is necessary to examine the current provision of in-hospital information and education to AMI patients. Patients want more information at discharge and after returning home.
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