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Lee T, Park J. Nonpharmacological Interventions for Managing Symptom Clusters in Adults: A Systematic Review. Biol Res Nurs 2024; 26:657-674. [PMID: 38899914 DOI: 10.1177/10998004241261258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Objectives: The complex effects of multiple co-occurring symptoms are a major cause of reduced quality of life; thus, it is necessary to identify symptom clusters experienced by patients and explore interventions. This study aimed to provide an overview of non-pharmacological interventions based on symptom clusters in adults to identify effective intervention strategies and methods. Methods. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. For the search databases, PubMed, Embase, Cochrane Library, CINAHL, RISS, KISS, and KISTI were used. It includes English and Korean experimental studies published up to May 2023. The literature quality was evaluated using the Joanna Briggs Institute Quality Assessment Tool. Results. Of the 18 studies selected, 15 were randomized controlled trials and three were quasi-experimental studies, all of which were conducted on patients with cancer. The symptom clusters-based interventions in the literature are classified as movement-based, relaxation-based, integrated, and miscellaneous interventions. Integrated interventions, which were effective in all studies, might prove to be very effective for managing symptom clusters. Movement-based intervention studies, which include dance, Qigong, and Tai Chi, might be very effective in improving health-related quality of life (HRQoL). Conclusions. This review demonstrates that non-pharmacological interventions reduce the occurrence and severity of symptom clusters, thereby improving HRQoL. Further studies are required to evaluate the effects of these interventions in patients with various chronic conditions other than cancer.
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Affiliation(s)
- Taekyeong Lee
- College of Nursing, Graduate School, Pusan National University, Yangsan, Republic of Korea
- Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jongmin Park
- College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan, Republic of Korea
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Brown RJL, Treat-Jacobson D, Schorr E, Lindquist R, Pruinelli L, Wolfson J. Symptom Descriptors in Individuals Living With Undiagnosed Lower Extremity Peripheral Artery Disease. West J Nurs Res 2024; 46:773-781. [PMID: 39206689 DOI: 10.1177/01939459241274275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Most individuals with lower extremity peripheral artery disease (PAD) experience symptoms other than claudication and live with undiagnosed PAD yet no tools exist to detect atypical PAD symptoms. The purpose of this study was to identify discriminating PAD symptom descriptors from a community-based sample of patients with no current diagnosis of PAD. METHODS Symptoms descriptors were obtained in a sample of 22 participants with persistent lower extremity symptoms pre/post exercise. An ankle brachial index with exercise was used to classify participants as "PAD" or "No PAD." RESULTS Thirteen (59%) participants had a positive ankle brachial index (<0.9, ≥20% drop postexercise, or 30 mmHg drop postexercise). Symptoms do not disappear while walking, trouble keeping up with friends/family, positive response to pain or discomfort while sitting, and pain outside of the calves and thighs were associated with a positive ankle brachial index. CONCLUSION Atypical symptoms were common among study participants. Symptoms while sitting and symptoms outside of the calf and thigh were negatively associated with a positive ankle brachial index. More precise descriptions of symptom characteristics are needed to improve PAD symptom recognition.
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Affiliation(s)
- Rebecca J L Brown
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, USA
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | | | - Erica Schorr
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Ruth Lindquist
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Lisiane Pruinelli
- University of Florida College of Nursing and College of Medicine, Gainesville, FL, USA
| | - Julian Wolfson
- University of Minnesota School of Public Health, Minneapolis, MN, USA
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Clifford C, Twerenbold R, Hartel F, Löwe B, Kohlmann S. Somatic symptom disorder symptoms in individuals at risk for heart failure: A cluster analysis with cross-sectional data from a population-based cohort study. J Psychosom Res 2024; 184:111848. [PMID: 38941711 DOI: 10.1016/j.jpsychores.2024.111848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE Identifying whether experienced symptom burden in individuals with medical predisposition indicates somatic symptom disorder (SSD) is challenging, given the high overlap in the phenomenology of symptoms within this group. This study aimed to enhance understanding SSD in individuals at risk for heart failure. SUBJECTS AND METHODS Cross-sectional data from the Hamburg City Health Study was analyzed including randomly selected individuals from the general population of Hamburg, Germany recruited from February 2016 to November 2018. SSD symptoms assessed with the Somatic Symptom Scale-8 and the Somatic Symptom Disorder-12 scale were categorized by applying cluster analysis including 412 individuals having at least 5% risk for heart failure-related hospitalization within the next ten years. Clusters were compared for biomedical and psychological factors using ANOVA and chi-square tests. Linear regressions, adjusting for sociodemographic, biomedical, and psychological factors, explored associations between clusters with general practitioner visits and quality of life. RESULTS Three clusters emerged: none (n = 215; 43% female), moderate (n = 151; 48% female), and severe (n = 46; 54% female) SSD symptom burden. The SSS-8 mean sum scores were 3.4 (SD = 2.7) for no, 6.4 (SD = 3.4) for moderate, and 12.4 (SD = 3.7) for severe SSD symptom burden. The SSD-12 mean sum scores were 3.1 (SD = 2.6) for no, 12.2 (SD = 4.2) for moderate, and 23.5 (SD = 6.7) for severe SSD symptom burden. Higher SSD symptom burden correlated with biomedical factors (having diabetes: p = .005 and dyspnea: p ≤ .001) and increased psychological burden (depression severity: p ≤ .001; anxiety severity: p ≤ .001), irrespective of heart failure risk (p = .202). Increased SSD symptoms were associated with more general practitioner visits (β = 0.172; p = .002) and decreased physical quality of life (β = -0.417; p ≤ .001). CONCLUSION Biomedical factors appear relevant in characterizing individuals at risk for heart failure, while psychological factors affect SSD symptom experience. Understanding SSD symptom diversity and addressing subgroup needs could prove beneficial.
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Affiliation(s)
- Caroline Clifford
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Germany.
| | - Friederike Hartel
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Germany.
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Sebastian Kohlmann
- Department of General Internal and Psychosomatic Medicine, University Medical Center Heidelberg, Germany.
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Petrova D, Garrido D, Catena A, Ramírez-Hernández JA, Blakoe M, Fernández-Martínez NF, Pérez-Gómez B, Sánchez MJ, Garcia-Retamero R. Anticipated prehospital decision delay in response to different symptom clusters in acute coronary syndrome: Results from the Spanish Cardiobarometer study. Soc Sci Med 2024; 359:117263. [PMID: 39232381 DOI: 10.1016/j.socscimed.2024.117263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 08/06/2024] [Accepted: 08/21/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Reducing patient decision delay - the time elapsed between symptom onset and the moment the patient decides to seek medical attention - can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters. METHODS We developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured help-seeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution. RESULTS Patient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay. DISCUSSION The diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Virgen de las Nieves University Hospital, Granada, Spain
| | - Dunia Garrido
- Faculty of Psychology, University of Granada, Spain.
| | | | - José Antonio Ramírez-Hernández
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Virgen de las Nieves University Hospital, Granada, Spain
| | - Mitti Blakoe
- Rigshospitalet, The Heart Center, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Beatriz Pérez-Gómez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - María José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Smith AB, Pressler SJ. Chronic Pain in Heart Failure: An Urgent Need for Improved Characterization and Treatment. J Cardiovasc Nurs 2024:00005082-990000000-00203. [PMID: 38915132 DOI: 10.1097/jcn.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Affiliation(s)
- Asa B Smith
- School of Nursing, Indiana University, Indianapolis
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Mao Y, Shi Y, Qiao W, Zhang Z, Yang W, Liu H, Li E, Fan H, Liu Q. Symptom clusters and unplanned hospital readmission in Chinese patients with acute myocardial infarction on admission. Front Cardiovasc Med 2024; 11:1388648. [PMID: 38832319 PMCID: PMC11144855 DOI: 10.3389/fcvm.2024.1388648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024] Open
Abstract
Backgroud Acute myocardial infarction (AMI) has a high morbidity rate, high mortality rate, high readmission rate, high health care costs, and a high symptomatic, psychological, and economic burden on patients. Patients with AMI usually present with multiple symptoms simultaneously, which are manifested as symptom clusters. Symptom clusters have a profound impact on the quality of survival and clinical outcomes of AMI patients. Objective The purpose of this study was to analyze unplanned hospital readmissions among cluster groups within a 1-year follow-up period, as well as to identify clusters of acute symptoms and the characteristics associated with them that appeared in patients with AMI. Methods Between October 2021 and October 2022, 261 AMI patients in China were individually questioned for symptoms using a structured questionnaire. Mplus 8.3 software was used to conduct latent class analysis in order to find symptom clusters. Univariate analysis is used to examine characteristics associated with each cluster, and multinomial logistic regression is used to analyze a cluster membership as an independent predictor of hospital readmission after 1-year. Results Three unique clusters were found among the 11 acute symptoms: the typical chest symptom cluster (64.4%), the multiple symptom cluster (29.5%), and the atypical symptom cluster (6.1%). The cluster of atypical symptoms was more likely to have anemia and the worse values of Killip class compared with other clusters. The results of multiple logistic regression indicated that, in comparison to the typical chest cluster, the atypical symptom cluster substantially predicted a greater probability of 1-year hospital readmission (odd ratio 8.303, 95% confidence interval 2.550-27.031, P < 0.001). Conclusion Out of the 11 acute symptoms, we have found three clusters: the typical chest symptom, multiple symptom, and atypical symptom clusters. Compared to patients in the other two clusters, those in the atypical symptom cluster-which included anemia and a large percentage of Killip class patients-had worse clinical indicators at hospital readmission during the duration of the 1-year follow-up. Both anemia and high Killip classification suggest that the patient's clinical presentation is poor and therefore the prognosis is worse. Intensive treatment should be considered for anemia and high level of Killip class patients with atypical presentation. Clinicians should focus on patients with atypical symptom clusters, enhance early recognition of symptoms, and develop targeted symptom management strategies to alleviate their discomfort in order to improve symptomatic outcomes.
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Affiliation(s)
- Yijun Mao
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Yuqiong Shi
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Wenfang Qiao
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Zhuo Zhang
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Wei Yang
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Haili Liu
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Erqing Li
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Hui Fan
- Department of Nursing, Xianyang Central Hospital, Shaanxi, China
| | - Qiang Liu
- Department of Orthopedic, Xianyang Central Hospital, Shaanxi, China
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Wang Y, Yang Q, Liu Y, Zheng G, Fan F, Tian H, Zhang X. Psychosomatic mechanisms of heart failure symptoms on quality of life in patients with chronic heart failure: A multi-centre cross-sectional study. J Clin Nurs 2024; 33:1839-1848. [PMID: 38044710 DOI: 10.1111/jocn.16955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/29/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
AIMS To determine the contributions of different kinds of symptoms to the quality of life and mediating effect of psychological and physical symptoms between heart failure symptoms and quality of life. DESIGN A multi-centre cross-sectional study. METHODS 2006 chronic heart failure patients from four cities were recruited in China from January 2021 to December 2022. Patients' symptoms and quality of life were self-reported, and data were analysed using correlation analysis, dominance analysis and mediating effects analysis. RESULTS The dominance analysis revealed that the overall mean contributions of heart failure, psychological and physical symptoms were .083, .085 and .111; 29.5%, 30.2% and 39.5% of the known variance. And heart failure symptoms could negatively affect quality of life through psychological and physical symptoms, accounting for 28.39% and 22.95% of the total effect. Heart failure symptoms could also affect quality of life through the chain-mediated effect of physical and psychological symptoms, accounting for 16.74%. CONCLUSIONS Physiological symptoms had the strongest effect on quality of life and heart failure symptoms had the weakest. Most of the effect for heart failure symptoms on quality of life in chronic heart failure patients was mediated by psychological and physiological symptoms. RELEVANCE TO CLINICAL PRACTICE It is important to design non-pharmacological intervention plans for the enhancement of physical and psychological symptoms' management skills, to reduce the adverse impact of heart failure symptoms on quality of life. REPORTING METHOD Study methods and results reported in adherence to the STROBE checklist. NO PATIENT OR PUBLIC CONTRIBUTION No patients or members of the public were involved in the study.
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Affiliation(s)
- Yu Wang
- Department of Nursing, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Qiaofang Yang
- Department of Nursing, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yancun Liu
- Structural Heart Disease Wards, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Gaigai Zheng
- Heart Failure Wards, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Fanghui Fan
- Coronary Care Unit, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Huan Tian
- Heart Failure Wards, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xin Zhang
- Henan International Travel Health Care Center, Zhengzhou, China
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Wang Z, Conley S, Redeker NS, Tocchi C. An Evolutionary Concept Analysis in People With Heart Failure-Symptom Clusters or Symptom Cluster Profiles? ANS Adv Nurs Sci 2024; 47:166-187. [PMID: 37185222 DOI: 10.1097/ans.0000000000000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The concept of symptom clusters in heart failure (HF) has been defined and measured inconsistently. We used Rodgers' evolutionary method to review related concepts in the HF literature. Symptom clusters and symptom cluster profiles are characterized by multiple symptoms, a synergistic relationship, and result in a myriad of poor outcomes. Researchers should carefully consider the conceptual differences underpinning symptom clusters and symptom cluster profiles and choose the appropriate concept aligned with their research questions, empirical methods, and target HF population.
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Affiliation(s)
- Zequan Wang
- Author Affiliations University of Connecticut School of Nursing, Storrs (Ms Wang and Drs Redeker and Tocchi); and The Mayo Clinic, Rochester, Minnesota (Dr Conley)
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Locatelli G, Iovino P, Pasta A, Jurgens CY, Vellone E, Riegel B. Cluster analysis of heart failure patients based on their psychological and physical symptoms and predictive analysis of cluster membership. J Adv Nurs 2024; 80:1380-1392. [PMID: 37788062 DOI: 10.1111/jan.15890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
AIM Patients with heart failure experience multiple co-occurring symptoms that lower their quality of life and increase hospitalization and mortality rates. So far, no heart failure symptom cluster study recruited patients from community settings or focused on symptoms predicting most clinical outcomes. Considering physical and psychological symptoms together allows understanding how they burden patients in different combinations. Moreover, studies predicting symptom cluster membership using variables other than symptoms are lacking. We aimed to (a) cluster heart failure patients based on physical and psychological symptoms and (b) predict symptom cluster membership using sociodemographic/clinical variables. DESIGN Secondary analysis of MOTIVATE-HF trial, which recruited 510 heart failure patients from a hospital, an outpatient and a community setting in Italy. METHODS Cluster analysis was performed based on the two scores of the Hospital Anxiety-Depression scale and two scores of the Heart-Failure Somatic Perception Scale predicting most clinical outcomes. ANOVA and chi-square test were used to compare patients' characteristics among clusters. For the predictive analysis, we split the data into a training set and a test set and trained three classification models on the former to predict patients' symptom cluster membership based on 11 clinical/sociodemographic variables. Permutation analysis investigated which variables best predicted cluster membership. RESULTS Four clusters were identified based on the intensity and combination of psychological and physical symptoms: mixed distress (high psychological, low physical symptoms), high distress, low distress and moderate distress. Clinical and sociodemographic differences were found among clusters. NYHA-class (New York Heart Association) and sleep quality were the most important variables in predicting symptom cluster membership. CONCLUSIONS These results can support the development of tailored symptom management intervention and the investigation of symptom clusters' effect on patient outcomes. The promising results of the predictive analysis suggest that such benefits may be obtained even when direct access to symptoms-related data is absent. IMPLICATIONS These results may be particularly useful to clinicians, patients and researchers because they highlight the importance of addressing clusters of symptoms, instead of individual symptoms, to facilitate symptom detection and management. Knowing which variables best predict symptom cluster membership can allow to obtain such benefits even when direct access to symptoms-data is absent. IMPACT Four clusters of heart failure patients characterized by different intensity and combination of psychological and physical symptoms were identified. NYHA class and sleep quality appeared important variables in predicting symptom cluster membership. REPORTING METHOD The authors have adhered to the EQUATOR guidelines STROBE to report observational cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION Patients were included only for collecting their data.
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Affiliation(s)
- Giulia Locatelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, New South Wales, Sydney, Australia
| | - Paolo Iovino
- Health Sciences Department, University of Florence, Florence, Italy
| | - Alessandro Pasta
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Corrine Y Jurgens
- Connell School of Nursing, Boston College, Massachusetts, Boston, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Riegel
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, New South Wales, Sydney, Australia
- School of Nursing, University of Pennsylvania, Pennsylvania, Philadelphia, USA
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Zhao H, Kwon O, Cha J, Jung IC, Jun P, Jang JY, Jang JH. Exploring Traditional Medicine Diagnostic Classification for Parkinson's Disease Using Hierarchical Clustering. Complement Med Res 2024; 31:160-174. [PMID: 38330930 DOI: 10.1159/000536047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/27/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Personalized diagnosis and therapy for Parkinson's disease (PD) are needed due to the clinical heterogeneity of PD. Syndrome differentiation (SD) in traditional medicine (TM) is a diagnostic method for customized therapy that comprehensively analyzes various symptoms and systemic syndromes. However, research identifying PD classification based on SD is limited. METHODS Ten electronic databases were systematically searched from inception to August 10, 2021. Clinical indicators, including 380 symptoms, 98 TM signs, and herbal medicine for PD diagnosed with SD, were extracted from 197 articles; frequency statistics on clinical indicators were conducted to classify several subtypes using hierarchical clustering. RESULTS Four distinct cluster groups were identified, each characterized by significant cluster-specific clinical indicators with 95% confidence intervals of distribution. Subtype 2 had the most severe progression, longest progressive duration, and highest association with greater late-stage PD-associated motor symptoms, including postural instability and gait disturbance. The action properties of the herbal formula and original SD presented in the data sources for subtype 2 were associated with Yin deficiency syndrome. DISCUSSION/CONCLUSION Hierarchical clustering analysis distinguished various symptoms and TM signs among patients with PD. These newly identified PD subtypes may optimize the diagnosis and treatment with TM and facilitate prognosis prediction. Our findings serve as a cornerstone for evidence-based guidelines for TM diagnosis and treatment. Einleitung Eine personalisierte Diagnose und Therapie des Morbus Parkinson (MP) ist angesichts der ausgeprägten klinischen Heterogenität des MP unerlässlich. Die Syndromdifferenzierung (SD) ist in der traditionellen Medizin (TM) eine diagnostische Methode für eine maßgeschneiderte Therapie, bei der verschiedene Symptome und systemische Syndrome umfassend analysiert werden. Es liegen jedoch nur begrenzt Forschungsergebnisse in Bezug auf eine SD-basierte Klassifikation des MP vor. Methoden Zehn elektronische Datenbanken wurden systematisch durchsucht, von der Einrichtung bis zum 10. August 2021. Klinische Indikatoren einschließlich von 380 Symptomen, 98 TM-Zeichen sowie pflanzlichen Heilmitteln für mittels SD diagnostiziertem MP wurden aus 197 Artikeln extrahiert, und Häufigkeitsstatistiken der klinischen Indikatoren wurden erstellt, um mittels hierarchischem Clustering eine Reihe von Subtypen zu klassifizieren. Ergebnisse Vier verschiedene Cluster-Gruppen wurden identifiziert, die jeweils durch signifikante, Cluster-spezifische klinische Indikatoren mit 95% Konfidenzintervall der Verteilung gekennzeichnet waren. Subtyp 2 hatte den schwersten Verlauf, die längste Progressionsdauer und die stärkste Assoziation mit einem höheren Ausmaß von motorischen Symptomen des MP im Spätstadium, darunter Haltungsinstabilität und Gangstörungen. Die Wirkungseigenschaften der pflanzlichen Formulierung sowie die ursprüngliche SD, die in den Datenquellen für Subtyp 2 genannt wurden, waren mit Yin-Mangel-Syndrom assoziiert. Diskussion/Schlussfolgerung Die hierarchische Clustering-Analyse hob verschiedene Symptome und TM-Zeichen bei Patienten mit MP hervor. Die neu identifizierten MP-Subtypen könnten die Diagnose und Behandlung mittels TM optimieren und zur Prognoseerstellung beitragen. Unsere Ergebnisse sind ein Fundament für eine evidenzbasierte Leitlinie für die TM-Diagnostik und -Therapie.
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Affiliation(s)
- HuiYan Zhao
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medical Science, University of Science and Technology, School of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ojin Kwon
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jiyun Cha
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Department of Internal Korean Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - In Chul Jung
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Purumea Jun
- KM Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jae Young Jang
- School of Electrical, Electronics, and Communication Engineering, Korea University of Technology and Education, Cheonan, Republic of Korea
| | - Jung-Hee Jang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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Taha YK, Dungan JR, Weaver MT, Xu K, Handberg EM, Pepine CJ, Bairey Merz CN. Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA). J Clin Med 2023; 12:5836. [PMID: 37762777 PMCID: PMC10531826 DOI: 10.3390/jcm12185836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/23/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
Identifying ischemic heart disease (IHD) in women based on symptoms is challenging. Women are more likely to endorse non-cardiac symptoms. More than 50% of women with suspected ischemia have no obstructive coronary disease (and thus, INOCA) and impaired outcomes during follow-up. We aimed to identify symptoms having predictive capacity for INOCA in women with clinical evidence of coronary ischemia. We included 916 women from the original WISE cohort (NCT00000554) who had coronary angiography performed for suspected ischemia and completed a 65-item WISE symptom questionnaire. Sixty-two percent (n = 567) had suspected INOCA. Logistic regression models using a best subsets approach were examined to identify the best predictive model for INOCA based on Score χ2 and AICc. A 10-variable, best-fit model accurately predicted INOCA (AUC 0.72, 95% CI 0.68, 0.75). The model indicated that age ≤ 55 years, left side chest pain, chest discomfort, neck pain, and palpitations had independent, positive relationship (OR > 1) to INOCA (p < 0.001 to 0.008). An inverse relationship (OR < 1) was observed for impending doom, and pain in the jaw, left or bilateral arm, and right hand, interpreted as INOCA associated with the absence of these symptoms (p ≤ 0.001 to 0.023). Our best-fit model accurately predicted INOCA based on age and symptom presentation ~72% of the time. While the heterogeneity of symptom presentation limits the utility of this unvalidated 10-variable model, it has promise for consideration of symptom inclusion in future INOCA prediction risk modeling for women with evidence of symptomatic ischemia.
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Affiliation(s)
- Yasmeen K. Taha
- College of Medicine, University of Florida, 1600 Southwest Archer Road, Gainesville, FL 32610, USA; (Y.K.T.); (E.M.H.); (C.J.P.)
| | - Jennifer R. Dungan
- College of Medicine, University of Florida, 1600 Southwest Archer Road, Gainesville, FL 32610, USA; (Y.K.T.); (E.M.H.); (C.J.P.)
- College of Nursing, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA;
| | - Michael T. Weaver
- College of Nursing, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA;
| | - Ke Xu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32611, USA;
| | - Eileen M. Handberg
- College of Medicine, University of Florida, 1600 Southwest Archer Road, Gainesville, FL 32610, USA; (Y.K.T.); (E.M.H.); (C.J.P.)
| | - Carl J. Pepine
- College of Medicine, University of Florida, 1600 Southwest Archer Road, Gainesville, FL 32610, USA; (Y.K.T.); (E.M.H.); (C.J.P.)
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
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12
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Johansen I, Småstuen MC, Løkkeberg ST, Kristensen VA, Høivik ML, Lund C, Olsen B, Strande V, Huppertz-Hauss G, Aabrekk TB, Bengtson MB, Ricanek P, Detlie TE, Frigstad SO, Jelsness-Jørgensen LP, Opheim R. Symptoms and symptom clusters in patients newly diagnosed with inflammatory bowel disease: results from the IBSEN III Study. BMC Gastroenterol 2023; 23:255. [PMID: 37501083 PMCID: PMC10373240 DOI: 10.1186/s12876-023-02889-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease report multiple symptoms, but the relationships among co-occurring symptoms are poorly understood. This study aimed to examine the prevalence of symptoms and explore symptom clusters and possible associations between symptom clusters and socio-demographic and clinical variables in patients newly diagnosed with inflammatory bowel disease. METHODS The IBSEN III study is a prospective population-based inception cohort of patients with inflammatory bowel disease. This study used patient data from the three largest hospitals in the study catchment area. The Memorial Symptom Assessment Scale was used to assess the prevalence of symptoms. Symptom clusters were identified using principal component analysis. Possible associations between socio-demographic and clinical variables and symptom cluster membership were estimated using regression analysis. RESULTS Of the 573 patients (age, ≥18 years) diagnosed with inflammatory bowel disease, 350 (61.1%) completed the questionnaire (responders). Eleven symptoms were reported by >50% of the responders. The three most prevalent symptoms were bloating (84%), drowsiness (81%), and lack of energy (81%). Three symptom clusters were identified: psychological (56% of the patients), impaired energy (28%), and physical (16%) clusters. Multinomial regression analysis revealed that vitamin D deficiency was significantly associated with the impaired energy cluster (odds ratio=2.49, 95% confidence interval [1.00-6.2], p=0.05). CONCLUSIONS We found high symptom prevalence in patients newly diagnosed with inflammatory bowel disease. Three distinct symptom clusters were identified, and the psychological cluster includes >50% of the patients. Vitamin D deficiency is the only factor associated with cluster membership, namely the impaired energy cluster.
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Affiliation(s)
- Ingunn Johansen
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Stine Torp Løkkeberg
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
| | | | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Lund
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Olsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Telemark Hospital Trust, Skien, Norway
| | - Vibeke Strande
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Gastroenterology, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Tone Bergene Aabrekk
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | - May-Bente Bengtson
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Petr Ricanek
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Trond Espen Detlie
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Svein Oskar Frigstad
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Baerum, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Fredrikstad, Norway
| | - Randi Opheim
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
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13
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Khater WA, Alfarkh MA, Allnoubani A. The Association Between Vitamin D Level and Chest Pain, Anxiety, and Fatigue in Patients With Coronary Artery Disease. Clin Nurs Res 2023; 32:639-647. [PMID: 36205377 DOI: 10.1177/10547738221126325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to assess the association between vitamin D deficiency (VDD) and chest pain, anxiety, and fatigue in patients with coronary artery disease (CAD). A cross-sectional study was conducted to collect data from a sample of 90 participants with CAD. Serum 25OHD3 was measured using a radioimmunoassay procedure. Chest pain was assessed using the Numeric Pain Rating Scale, anxiety using the Anxiety Subscale, and fatigue by the General Fatigue subscale. The majority of participants (80%) had VDD. Results showed that the level of vitamin D was significantly negatively associated with chest pain (r = -.43, p = .00); anxiety (r = -.466, p = .00); and fatigue (r = -.25, p = .018). Findings suggest the role of VDD in heightened central sensitivity in cardiac-related symptoms such as chest pain, anxiety, and fatigue. Patients with CAD should be monitored for VDD so that the condition can be corrected.
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14
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Characterizing fatigue phenotypes with other symptoms and clinically relevant outcomes among people with multiple sclerosis. Qual Life Res 2023; 32:151-160. [PMID: 35982203 DOI: 10.1007/s11136-022-03204-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Fatigue is a common symptom of multiple sclerosis (MS) and can adversely affect all aspect of quality of life. The etiology of fatigue remains unclear, and its treatments are suboptimal. Characterizing the phenotypes of fatigued persons with MS may help advance research on fatigue's etiology and identify ways to personalize fatigue interventions to improve quality of life. The purpose of this study was to identify fatigue phenotypes; examine phenotype stability overtime; and characterize phenotypes by health and function, social and environmental determinants, psychosocial factors, and engagement in healthy behaviors. METHODS We conducted a longitudinal study over a 3-month period with 289 fatigued participants with MS. To identify fatigue phenotypes and determine transition probabilities, we used latent profile and transition analyses with valid self-report measures of mental and physical fatigue severity, the mental and physical impact of fatigue, depression, anxiety, and sleep quality. We used ANOVAs and effect sizes to characterize differences among phenotypes. RESULTS The best fitting model included six subgroups of participants: Mild Phenotype, Mild-to-Moderate Phenotype, Moderate-to-Severe Phenotype, Severe Phenotype, Fatigue-dominant Phenotype, and Mental Health-dominant Phenotype. The transition analysis indicated that phenotypic membership was highly stable. Variables with a large eta squared effect size included environmental barriers, self-efficacy, and fatigue catastrophizing. CONCLUSION These results indicate that the magnitude of fatigue experienced may be more important to consider than the type of fatigue when characterizing fatigue phenotypes. Future research should explore whether tailoring interventions to environmental barriers, self-efficacy, and fatigue catastrophizing reduce the likelihood of transitioning to a more severe phenotype.
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15
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Liu H, Liu F, Ji H, Dai Z, Han W. A Bibliometric Analysis of High-Intensity Interval Training in Cardiac Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113745. [PMID: 36360625 PMCID: PMC9658065 DOI: 10.3390/ijerph192113745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 05/31/2023]
Abstract
As global quality of life has improved, the risk factors for cardiovascular diseases have gradually increased in prevalence. People have consequently sought to improve their health through physical exercise. High-intensity interval training (HIIT) is a cardiac rehabilitation (CR) tool that has been of great interest for several years. However, its feasibility and safety remain controversial. This study aimed to explore hot research topics and new directions regarding the role of HIIT in CR and to describe the dynamic development of the field. We used the Web of Science Core Collection database to develop visualizations using CiteSpace software (v.6.1.R2). The number of articles published, institutional collaboration networks, author partnerships, and keyword co-occurrence and clustering were used to analyze the impact of HIIT on CR. Our results showed that Norway, Canada, and the United States were the most prominent contributors to this field. Articles by Nigam, A and Juneau, M had the highest number of citations. The Norwegian University of Science and Technology had performed the most in-depth research in this area. The European Journal of Preventive Cardiology had published the most articles. The United States had the highest number of publishing journals. Relevant issues focused on coronary artery disease, exercise capacity, heart failure, cardiorespiratory fitness, and physical activity. HIIT in heart transplantation may be at the forefront of research in this field and future studies should focus on this topic. HIIT-based CR can therefore improve the exercise capacity and quality of life of cardiovascular patients and improve patient compliance in a safe manner.
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Affiliation(s)
- Haitao Liu
- College of Physical Education, Henan University, Kaifeng 475001, China
- Research Center of Sports Reform and Development, Henan University, Kaifeng 475001, China
- Institute of Physical Fitness and Health, Henan University, Kaifeng 475001, China
| | - Feiyue Liu
- College of Physical Education, Henan University, Kaifeng 475001, China
| | - Haoyuan Ji
- College of Physical Education, Henan University, Kaifeng 475001, China
| | - Zuanqin Dai
- College of Physical Education, Henan University, Kaifeng 475001, China
| | - Wenxiu Han
- College of Physical Education, Henan University, Kaifeng 475001, China
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16
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Harris CS, Dodd M, Kober KM, Dhruva AA, Hammer M, Conley YP, Miaskowski CA. Advances in Conceptual and Methodological Issues in Symptom Cluster Research: A 20-Year Perspective. ANS Adv Nurs Sci 2022; 45:309-322. [PMID: 35502915 PMCID: PMC9616968 DOI: 10.1097/ans.0000000000000423] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two conceptual approaches are used to evaluate symptom clusters: "clustering" symptoms (ie, variable-centered analytic approach) and "clustering" patients (ie, person-centered analytic approach). However, these methods are not used consistently and conceptual clarity is needed. Given the emergence of novel methods to evaluate symptom clusters, a review of the conceptual basis for older and newer analytic methods is warranted. Therefore, this article will review the conceptual basis for symptom cluster research; compare and contrast the conceptual basis for using variable-centered versus patient-centered analytic approaches in symptom cluster research; review their strengths and weaknesses; and compare their applications in symptom cluster research.
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Affiliation(s)
| | - Marylin Dodd
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Anand A. Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christine A. Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, CA, USA
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17
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Kim H, Bae SH, Lim SH, Park JH. Predictors of health-related quality of life after coronary artery bypass graft surgery. Sci Rep 2022; 12:16119. [PMID: 36167788 PMCID: PMC9515078 DOI: 10.1038/s41598-022-20414-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
Health-related quality of life (HRQOL) is a multifactorial concept in assessing physical and mental health. This study was performed to evaluate the HRQOL of patients undergoing coronary artery bypass graft (CABG) surgery and the predictors of HRQOL in patients until 1 year after surgery. This cross-sectional study included 110 consecutive patients who underwent elective CABG in a medical center in South Korea. The Short-Form Health Survey, cardiac symptom survey, cardiac self-efficacy, and the Interpersonal Support Evaluation List-12 were used to measure the HRQOL, symptom experience, self-efficacy, and social support, respectively. The regression model explained 42% of the variance in the participants' physical HRQOL. The predictors of the physical HRQOL include the presence of a spouse, post-CABG duration, symptom experience, and self-efficacy. The regression model explained 36% of the variance in the participants' mental HRQOL. The predictors of the mental HRQOL included perceived health status, self-efficacy, and social support. The predictive factors for HRQOL after CABG were the presence of a spouse, post-CABG duration, symptom experience, self-efficacy, and social support. Furthermore, a suitable program and nursing interventions could be implemented to improve the HRQOL of post-CABG patients.
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Affiliation(s)
- Hwasoon Kim
- College of Nursing, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Sun Hyoung Bae
- College of Nursing, Research Institute of Nursing Science, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Sang-Hyun Lim
- Department of Thoracic & Cardiovascular Surgery, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Jin-Hee Park
- College of Nursing, Research Institute of Nursing Science, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea.
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18
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Denfeld QE, Camacho SA, Dieckmann N, Hiatt SO, Davis MR, Cramer DV, Rupert A, Habecker BA, Lee CS. Background and Design of the Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure (BIOMES-HF) Study. J Card Fail 2022; 28:973-981. [PMID: 35045322 DOI: 10.1016/j.cardfail.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Symptoms, which often cluster together, are a significant problem in heart failure (HF). There is considerable heterogeneity in symptom burden, particularly in the vulnerable transition period after a hospitalization for HF, and the biological underpinnings of symptom during transitions are unclear. The purpose of this paper is to describe the background and design of a study that addresses these knowledge gaps, entitled "Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure" (BIOMES-HF). STUDY DESIGN AND METHODS BIOMES-HF is a prospective gender- and age-balanced longitudinal study of 240 adults during the 6-month transition period after a HF hospitalization. The aims are to: 1) identify clusters of change in physical symptoms, 2) quantify longitudinal associations between biomarkers and physical symptoms, and 3) quantify longitudinal associations between physical frailty and physical symptoms among adults with heart failure. We will measure multiple symptoms, biomarkers, and physical frailty at discharge and then at 1 week and 1, 3, and 6 months post-hospitalization. We will use growth mixture modeling and longitudinal mediation modeling to examine changes in symptoms, biomarkers, and physical frailty post-HF hospitalization and associations therein. CONCLUSIONS This innovative study will advance HF symptom science by utilizing a multi-biomarker panel and the physical frailty phenotype to capture the multifaceted nature of HF. Using advanced quantitative modeling, we will characterize heterogeneity and identify potential mechanisms of symptoms in HF. As a result, this research will pinpoint amenable targets for intervention to provide better, individualized treatment to improve symptom burden in HF. BRIEF LAY SUMMARY Adults with heart failure may have significant symptom burden. This study is designed to shed light on our understanding of the role of biological and physiological mechanisms in explaining heart failure symptoms, particularly groups of co-occurring symptoms, over time. We will explore how symptoms, biomarkers, and physical frailty changes after a heart failure hospitalization. The knowledge generated from this study will be used to guide the management and self-care for adults with heart failure.
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Affiliation(s)
- Quin E Denfeld
- Oregon Health & Science University School of Nursing, Portland, OR, USA; Oregon Health & Science University Knight Cardiovascular Institute Portland, OR, USA.
| | - S Albert Camacho
- Oregon Health & Science University Knight Cardiovascular Institute Portland, OR, USA
| | - Nathan Dieckmann
- Oregon Health & Science University School of Nursing, Portland, OR, USA; Oregon Health & Science University School of Medicine Division of Psychology, Portland, OR
| | - Shirin O Hiatt
- Oregon Health & Science University School of Nursing, Portland, OR, USA
| | | | - Daniela V Cramer
- Oregon Health & Science University School of Nursing, Portland, OR, USA
| | - Allissah Rupert
- Oregon Health & Science University School of Nursing, Portland, OR, USA
| | - Beth A Habecker
- Oregon Health & Science University Knight Cardiovascular Institute Portland, OR, USA; Oregon Health & Science University Department of Chemical Physiology & Biochemistry, Portland, OR, USA
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA; Australian Catholic University, Melbourne, Australia
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19
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Kalantar-Zadeh K, Lockwood MB, Rhee CM, Tantisattamo E, Andreoli S, Balducci A, Laffin P, Harris T, Knight R, Kumaraswami L, Liakopoulos V, Lui SF, Kumar S, Ng M, Saadi G, Ulasi I, Tong A, Li PKT. Patient-centred approaches for the management of unpleasant symptoms in kidney disease. Nat Rev Nephrol 2022; 18:185-198. [PMID: 34980890 DOI: 10.1038/s41581-021-00518-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/22/2022]
Abstract
Patients with chronic kidney disease (CKD) frequently experience unpleasant symptoms. These can be gastrointestinal (constipation, nausea, vomiting and diarrhoea), psychological (anxiety and sadness), neurological (lightheadedness, headache and numbness), cardiopulmonary (shortness of breath and oedema), dermatological (pruritus and dry skin), painful (muscle cramps, chest pain and abdominal pain) or involve sexual dysfunction, sleep disorders and fatigue. These symptoms often occur in clusters, with one of them as the lead symptom and others as secondary symptoms. Uraemic toxins (also called uremic toxins) are often considered to be the main cause of CKD-associated symptom burden, but treatment of uraemia by dialysis often fails to resolve them and can engender additional symptoms. Indeed, symptoms can be exacerbated by comorbid conditions, pharmacotherapies, lifestyle and dietary regimens, kidney replacement therapy and ageing. Patients with kidney disease, including those who depend on dialysis or transplantation, should feel actively supported in their symptom management through the identification and targeting of unpleasant symptoms via a tailored palliative care approach. Such an approach may help minimize the burden and consequences of kidney disease, and lead to improved patient outcomes including health-related quality of life and better life participation.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- The International Federation of Kidney Foundation - World Kidney Alliance (IFKF-WKA), Mexico City, Mexico. .,Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA.
| | - Mark B Lockwood
- Department of Behavioral Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL, USA
| | - Connie M Rhee
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA
| | - Ekamol Tantisattamo
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA
| | - Sharon Andreoli
- James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | | | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Siu-Fai Lui
- The International Federation of Kidney Foundation - World Kidney Alliance (IFKF-WKA), Mexico City, Mexico.,Hong Kong Kidney Foundation, Hong Kong, China
| | | | - Maggie Ng
- The International Federation of Kidney Foundation - World Kidney Alliance (IFKF-WKA), Mexico City, Mexico.,Hong Kong Kidney Foundation, Hong Kong, China
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol & Richard Yu PD Research Centre, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
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20
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Abstract
BACKGROUND Pain is a common but understudied symptom among patients with heart failure (HF) transported by emergency medical services (EMS). The aims were to determine explanatory factors of a primary complaint of pain and pain severity, and characterize pain among patients with HF transported by EMS. METHODS Data from electronic health records of patients with HF transported by EMS within a midwestern United States county from 2009 to 2017 were analyzed. Descriptive statistics, χ 2 , analysis of variance, and logistic and multiple linear regression analyses were used. RESULTS The sample (N = 4663) was predominantly women (58.1%) with self-reported race as Black (57.7%). The mean age was 64.2 ± 14.3 years. Pain was the primary complaint in 22.2% of the sample, with an average pain score of 6.8 ± 3.1 out of 10. The most common pain complaint was chest pain (68.1%). Factors associated with a primary pain complaint were younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.96-0.97), history of myocardial infarction (OR, 1.96; 95% CI, 1.55-2.49), and absence of shortness of breath (OR, 0.67; 95% CI, 0.58-0.77). Factors associated with higher pain severity were younger age ( b = -0.05, SE = 0.013), being a woman ( b = 1.17, SE = 0.357), and White race ( b = -1.11, SE = 0.349). CONCLUSIONS Clinical and demographic factors need consideration in understanding pain in HF during EMS transport. Additional research is needed to examine these factors to improve pain management and reduce transports due to pain.
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21
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Liyanage T, Toyama T, Hockham C, Ninomiya T, Perkovic V, Woodward M, Fukagawa M, Matsushita K, Praditpornsilpa K, Hooi LS, Iseki K, Lin MY, Stirnadel-Farrant HA, Jha V, Jun M. Prevalence of chronic kidney disease in Asia: a systematic review and analysis. BMJ Glob Health 2022; 7:e007525. [PMID: 35078812 PMCID: PMC8796212 DOI: 10.1136/bmjgh-2021-007525] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/25/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The burden of chronic kidney disease (CKD) is growing rapidly around the world. However, there is limited information on the overall regional prevalence of CKD, as well as the variations in national prevalence within Asia. We aimed to consolidate available data and quantify estimates of the CKD burden in this region. METHODS We systematically searched MEDLINE, Embase and Google Scholar for observational studies and contacted national experts to estimate CKD prevalence in countries of Asia (Eastern, Southern and South Eastern Asia). CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or the presence of proteinuria. For countries without reported data, we estimated CKD prevalence using agglomerative average-linkage hierarchical clustering, based on country-level risk factors and random effects meta-analysis within clusters. Published CKD prevalence data were obtained for 16 countries (of the 26 countries in the region) and estimates were made for 10 countries. RESULTS There was substantial variation in overall and advanced (eGFR <30 mL/min/1.73 m2) CKD prevalence (range: 7.0%-34.3% and 0.1%-17.0%, respectively). Up to an estimated 434.3 million (95% CI 350.2 to 519.7) adults have CKD in Asia, including up to 65.6 million (95% CI 42.2 to 94.9) who have advanced CKD. The greatest number of adults living with CKD were in China (up to 159.8 million, 95% CI 146.6 to 174.1) and India (up to 140.2 million, 95% CI 110.7 to 169.7), collectively having 69.1% of the total number of adults with CKD in the region. CONCLUSION The large number of people with CKD, and the substantial number with advanced CKD, show the need for urgent collaborative action in Asia to prevent and manage CKD and its complications.
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Affiliation(s)
- Thaminda Liyanage
- The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Medicine, University of Sydney, Sydney, NSW, Australia
- Armadale Kelmscott Memorial Hospital, East Metropolitan Health Service, Perth, WA, Australia
| | - Tadashi Toyama
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Carinna Hockham
- The George Institute for Global Health, Imperial College London, London, UK
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
| | - Vlado Perkovic
- The George Institute for Global Health, Newtown, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, Newtown, New South Wales, Australia
- The George Institute for Global Health, Imperial College London, London, UK
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Japan, Japan
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Kunitoshi Iseki
- Okinawa Heart and Renal Association (OHRA) and Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | - Vivekanand Jha
- The George Institute for Global Health, India, New Dehli, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- School of Public Health, Imperial College London, London, UK
| | - Min Jun
- The George Institute for Global Health, Newtown, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Brady V, Whisenant M, Wang X, Ly VK, Zhu G, Aguilar D, Wu H. Characterization of Symptoms and Symptom Clusters for Type 2 Diabetes Using a Large Nationwide Electronic Health Record Database. Diabetes Spectr 2022; 35:159-170. [PMID: 35668892 PMCID: PMC9160545 DOI: 10.2337/ds21-0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE A variety of symptoms may be associated with type 2 diabetes and its complications. Symptoms in chronic diseases may be described in terms of prevalence, severity, and trajectory and often co-occur in groups, known as symptom clusters, which may be representative of a common etiology. The purpose of this study was to characterize type 2 diabetes-related symptoms using a large nationwide electronic health record (EHR) database. METHODS We acquired the Cerner Health Facts, a nationwide EHR database. The type 2 diabetes cohort (n = 1,136,301 patients) was identified using a rule-based phenotype method. A multistep procedure was then used to identify type 2 diabetes-related symptoms based on International Classification of Diseases, 9th and 10th revisions, diagnosis codes. Type 2 diabetes-related symptoms and co-occurring symptom clusters, including their temporal patterns, were characterized based the longitudinal EHR data. RESULTS Patients had a mean age of 61.4 years, 51.2% were female, and 70.0% were White. Among 1,136,301 patients, there were 8,008,276 occurrences of 59 symptoms. The most frequently reported symptoms included pain, heartburn, shortness of breath, fatigue, and swelling, which occurred in 21-60% of the patients. We also observed over-represented type 2 diabetes symptoms, including difficulty speaking, feeling confused, trouble remembering, weakness, and drowsiness/sleepiness. Some of these are rare and difficult to detect by traditional patient-reported outcomes studies. CONCLUSION To the best of our knowledge, this is the first study to use a nationwide EHR database to characterize type 2 diabetes-related symptoms and their temporal patterns. Fifty-nine symptoms, including both over-represented and rare diabetes-related symptoms, were identified.
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Affiliation(s)
- Veronica Brady
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX
| | - Meagan Whisenant
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX
| | - Xueying Wang
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Vi K. Ly
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Gen Zhu
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - David Aguilar
- McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hulin Wu
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
- Corresponding author: Hulin Wu,
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Koleck TA, Topaz M, Tatonetti NP, George M, Miaskowski C, Smaldone A, Bakken S. Characterizing shared and distinct symptom clusters in common chronic conditions through natural language processing of nursing notes. Res Nurs Health 2021; 44:906-919. [PMID: 34637147 PMCID: PMC8641786 DOI: 10.1002/nur.22190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 01/08/2023]
Abstract
Data-driven characterization of symptom clusters in chronic conditions is essential for shared cluster detection and physiological mechanism discovery. This study aims to computationally describe symptom documentation from electronic nursing notes and compare symptom clusters among patients diagnosed with four chronic conditions-chronic obstructive pulmonary disease (COPD), heart failure, type 2 diabetes mellitus, and cancer. Nursing notes (N = 504,395; 133,977 patients) were obtained for the 2016 calendar year from a single medical center. We used NimbleMiner, a natural language processing application, to identify the presence of 56 symptoms. We calculated symptom documentation prevalence by note and patient for the corpus. Then, we visually compared documentation for a subset of patients (N = 22,657) diagnosed with COPD (n = 3339), heart failure (n = 6587), diabetes (n = 12,139), and cancer (n = 7269) and conducted multiple correspondence analysis and hierarchical clustering to discover underlying groups of patients who have similar symptom profiles (i.e., symptom clusters) for each condition. As expected, pain was the most frequently documented symptom. All conditions had a group of patients characterized by no symptoms. Shared clusters included cardiovascular symptoms for heart failure and diabetes; pain and other symptoms for COPD, diabetes, and cancer; and a newly-identified cognitive and neurological symptom cluster for heart failure, diabetes, and cancer. Cancer (gastrointestinal symptoms and fatigue) and COPD (mental health symptoms) each contained a unique cluster. In summary, we report both shared and distinct, as well as established and novel, symptom clusters across chronic conditions. Findings support the use of electronic health record-derived notes and NLP methods to study symptoms and symptom clusters to advance symptom science.
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Affiliation(s)
- Theresa A. Koleck
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, New York
- Data Science Institute, Columbia University, New York, New York
| | - Nicholas P. Tatonetti
- Data Science Institute, Columbia University, New York, New York
- Department of Biomedical Informatics, Columbia University, New York, New York
- Department of Systems Biology, Columbia University, New York, New York
- Department of Medicine, Columbia University, New York, New York
- Institute for Genomic Medicine, Columbia University, New York, New York
| | - Maureen George
- School of Nursing, Columbia University, New York, New York
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California
| | - Arlene Smaldone
- School of Nursing, Columbia University, New York, New York
- College of Dental Medicine, Columbia University, New York, New York
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York
- Data Science Institute, Columbia University, New York, New York
- Department of Biomedical Informatics, Columbia University, New York, New York
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Luo MY, Su JH, Gong SX, Liang N, Huang WQ, Chen W, Wang AP, Tian Y. Ferroptosis: New Dawn for Overcoming the Cardio-Cerebrovascular Diseases. Front Cell Dev Biol 2021; 9:733908. [PMID: 34858973 PMCID: PMC8632439 DOI: 10.3389/fcell.2021.733908] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/25/2021] [Indexed: 12/21/2022] Open
Abstract
The dynamic balance of cardiomyocytes and neurons is essential to maintain the normal physiological functions of heart and brain. If excessive cells die in tissues, serious Cardio-Cerebrovascular Diseases would occur, namely, hypertension, myocardial infarction, and ischemic stroke. The regulation of cell death plays a role in promoting or alleviating Cardio-Cerebrovascular Diseases. Ferroptosis is an iron-dependent new type of cell death that has been proved to occur in a variety of diseases. In our review, we focus on the critical role of ferroptosis and its regulatory mechanisms involved in Cardio-Cerebrovascular Diseases, and discuss the important function of ferroptosis-related inhibitors in order to propose potential implications for the prevention and treatment of Cardio-Cerebrovascular Diseases.
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Affiliation(s)
- Meng-Yi Luo
- Institute of Clinical Research, Affiliated Nanhua Hospital, University of South China, Hengyang, China
- Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Department of Physiology, Institute of Neuroscience Research, Hengyang Medical College, University of South China, Hengyang, China
| | - Jian-Hui Su
- Institute of Clinical Research, Affiliated Nanhua Hospital, University of South China, Hengyang, China
- Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Department of Physiology, Institute of Neuroscience Research, Hengyang Medical College, University of South China, Hengyang, China
| | - Shao-Xin Gong
- Department of Pathology, First Affiliated Hospital, University of South China, Hengyang, China
| | - Na Liang
- Department of Anesthesiology, Affiliated Nanhua Hospital, University of South China, Hengyang, China
| | - Wen-Qian Huang
- Institute of Clinical Research, Affiliated Nanhua Hospital, University of South China, Hengyang, China
- Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Department of Physiology, Institute of Neuroscience Research, Hengyang Medical College, University of South China, Hengyang, China
| | - Wei Chen
- Institute of Clinical Research, Affiliated Nanhua Hospital, University of South China, Hengyang, China
- Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Department of Physiology, Institute of Neuroscience Research, Hengyang Medical College, University of South China, Hengyang, China
| | - Ai-Ping Wang
- Institute of Clinical Research, Affiliated Nanhua Hospital, University of South China, Hengyang, China
- Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Department of Physiology, Institute of Neuroscience Research, Hengyang Medical College, University of South China, Hengyang, China
| | - Ying Tian
- Institute of Clinical Research, Affiliated Nanhua Hospital, University of South China, Hengyang, China
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Tabudlo JB. A Proposed Theory of Symptom Cluster Management. BELITUNG NURSING JOURNAL 2021; 7:78-87. [PMID: 37469941 PMCID: PMC10353591 DOI: 10.33546/bnj.1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 07/21/2023] Open
Abstract
Background Symptom cluster management is in its early stages in many chronic and debilitating illnesses. The development of a proposed theory should be an initial step in advancing this area of interest. Objective This article presents the development of a Proposed Theory of Symptom Cluster Management. Methods The concept analysis, statement synthesis, and theory synthesis by Walker and Avant were used in the development of this proposed theory. A search from July to September 2020 for published empirical and theoretical articles was conducted in scientific databases, expanded on the web, and secondary references from identified articles. Results The Proposed Theory of Symptom Cluster Management is both a descriptive and explanatory theory. The defining characteristics of symptom cluster management include the basic and effectiveness components. Antecedents for symptom cluster management include socio-demographic characteristics, symptom cluster characteristics, individual clinical characteristics, individual illness factors, and situational factors or symptom experience. The consequences are clustered as personal-related, health-related, social-related outcomes, and existential outcomes. Measurement tools for the antecedents and outcomes in symptom cluster management and the analytical and statistical strategies were considered. Relational statements were also identified. Theoretical assertions were advanced. Conclusion The Proposed Theory of Symptom Cluster Management may provide a holistic approach because it integrates both the symptom cluster and management strategies. The concepts, statements including the complete representation of the proposed theory identified in this article, may provide cues to policymakers and clinical researchers towards the development of tailored interventions and programs.
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Affiliation(s)
- Jerick B. Tabudlo
- University of the Philippines Manila, College of Nursing, Philippines
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Nunes Dos-Santos G, da-Conceição AP, Heo S, de-Lucena-Ferretti-Rebustini RE, Bottura Leite de-Barros AL, Batista Santos V, Takáo-Lopes C. Symptom Status Questionnaire - Heart Failure - Brazilian Version: cross-cultural adaptation and content validation. Heart Lung 2021; 50:525-531. [PMID: 33836442 DOI: 10.1016/j.hrtlng.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Brazil, there are no instruments available to measure the presence, frequency, severity and distress related to heart failure (HF) symptoms. AIMS To adapt the Symptom Status Questionnaire - HF (SSQ-HF) into Brazilian Portuguese and to examine the content validity of the adapted version. METHODS The instrument was translated, back-translated and evaluated by an expert committee for semantic, idiomatic, cultural, and conceptual equivalences. An agreement ≥80% was considered adequate. The adapted version was evaluated by both an expert committee (n = 9) for clarity, theoretical relevance and practical relevance (acceptable content validity coefficient (CVC): ≥0.70), and by a patient committee regarding understanding (n = 40). RESULTS The adapted version obtained 100% agreement regarding the equivalences. The total instrument CVC was 0.99. All patients understood the items. CONCLUSION The SSQ-HF-Brazilian version has satisfactory evidence of equivalence and content validity. Additional psychometric tests are deemed to confirm that the instrument can be used in Brazil.
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Affiliation(s)
- Gabriela Nunes Dos-Santos
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil; Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo, SP, Brazil
| | | | - Seongkum Heo
- Piedmont Healthcare Endowed Chair, Georgia Baptist College of Nursing of Mercer University, Atlanta, Georgia
| | | | - Alba Lucia Bottura Leite de-Barros
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo, SP, Brazil
| | - Vinicius Batista Santos
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo, SP, Brazil
| | - Camila Takáo-Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo, SP, Brazil.
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Fei F, Koffman J, Zhang X, Gao W. Chronic Obstructive Pulmonary Disease Symptom Cluster Composition, Associated Factors, and Methodologies: A Systematic Review. West J Nurs Res 2021; 44:395-415. [PMID: 33682534 PMCID: PMC8894625 DOI: 10.1177/0193945921995773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This systematic review details symptom clusters, their compositions, and associated factors and appraises the methodologies of studies that reported symptom clusters in patients with chronic obstructive pulmonary disease (COPD). Ten studies were eligible for inclusion in this study. Four common symptom clusters were identified. Two theoretical frameworks, four statistical methods, and various symptom assessment tools were used to identify symptom clusters. Factors associated with symptom clusters included demographic, clinical, and biological factors. No studies examined the subjective experiences of symptom clusters. Overall, inconsistencies were identified in the composition of symptom clusters across studies. This may be due to variations in study design, assessment tools, and statistical methods. Future studies should attempt to arrive at a common definition, especially that is theoretically derived, for symptom clusters, standardize the criteria for symptoms for inclusion in the clusters, and focus on patients' subjective experience to inform which clusters are clinically relevant.
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Affiliation(s)
- Fei Fei
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,School of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, Jiangsu, P.R. China
| | - Jonathan Koffman
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Xiaohan Zhang
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, Jiangsu, P.R. China
| | - Wei Gao
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Wang X, Tang L, Howell D, Zhang Q, Qiu R, Zhang H, Ye Z. Theory-guided interventions for Chinese patients to adapt to heart failure: A quasi-experimental study. Int J Nurs Sci 2020; 7:391-400. [PMID: 33195750 PMCID: PMC7644562 DOI: 10.1016/j.ijnss.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/20/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives To examine the effects of the Roy Adaptation Model-based interventions on adaptation in persons with heart failure. Methods A quasi-experimental study was conducted in Hangzhou, China, from March 2018 to November 2019. A convenience sample of 112 participants with heart failure from a multi-campus hospital was enrolled. Participants were allocated into an intervention group (n = 55) and a control group (n = 57) according to their hospitalized campus. A culturally-tailored care plan intervention based on the Roy Adaptation Model was performed in the intervention group. The control group received bedside patient education and a regular booklet for HF home care before discharge. Heart ultrasound, Minnesota Living with Heart Failure Questionnaire (MLHFQ), a knowledge survey, Self-care Heart failure Index (SCHFI), and Coping and Adaptation Processing Scale-Short Form (CAPS-SF) were used to measure patients’ levels of adaptation of physical function, self-concept, role function, and interdependence at baseline and six months after discharge. Results Ninety-one participants with complete data, 43 in the intervention group and 48 in the control group, were included in the analysis for the primary endpoints and showed adaptive improvement trends. Most patients in the intervention group completed 60% or more of the given interventions. At the sixth month after discharge, compared with the control group, the intervention group had improved adaptive behaviors showing higher scores of the MLHFQ (70.90 ± 22.45 vs. 54.78 ± 18.04), heart failure-related knowledge (13.79 ± 2.45 vs. 10.73 ± 4.28), SCHFI maintenance (57.67 ± 13.22 vs. 50.35 ± 10.88), and CAPS-SF (40.23 ± 4.36 vs. 38.27 ± 2.60) at the six-month follow-up (P < 0.05). There were no significant differences between the two groups in the scores of left ventricular ejection fraction, scores of SCHFI management and SCHFI confidence subscales (P > 0.05). Conclusions The findings reported evidence of positive adaptation in patients with heart failure, indicating that the Roy Adaptation Model is an effective guide for developing an implemented framework for the nursing practice of the patients. The culturally-tailored care plan intervention is helpful to improve adaptation of patients with heart failure.
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Affiliation(s)
- Xiyi Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.,Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Leiwen Tang
- Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Doris Howell
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Qi Zhang
- Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Ruolin Qiu
- Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Hui Zhang
- Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Zhihong Ye
- Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
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Hu Y, Jiang J, Xu L, Wang C, Wang P, Yang B, Tao M. Symptom clusters and quality of life among patients with chronic heart failure: A cross-sectional study. Jpn J Nurs Sci 2020; 18:e12366. [PMID: 32857469 DOI: 10.1111/jjns.12366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 12/28/2022]
Abstract
AIM This study aimed to identify symptom clusters among patients with chronic heart failure (HF) and examine their independent relationships with quality of life (QoL). METHODS A descriptive cross-sectional design was adopted, and 201 Chinese participants were recruited. Their symptom profiles and QoL were assessed using the Memorial Symptom Assessment Scale-Heart Failure and Minnesota Living with Heart Failure Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Pearson's correlation analysis and multiple regression analysis were conducted to examine their independent relationships with QoL. RESULTS Six distinct symptom clusters were identified: the fatigue, dyspneic, discomfort, congestive, ischemic, and emotional symptom clusters. These six symptom clusters accounted for 57.508% of the variance in patient symptom experiences and were positively related to their overall QoL. Moreover, the fatigue (β = .317, p < .001), dyspneic (β = .228, p < .001), congestive (β = .363, p < .001), and emotional (β = .200, p < .001) symptom clusters independently predicted QoL. CONCLUSION The six symptom clusters that were identified in this study and the relationships that they shared with QoL are expected to inform future approaches to symptom management. Interventions that target these symptom clusters will improve the QoL of patients with HF.
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Affiliation(s)
- Yinyi Hu
- School of Nursing, Zunyi Medical University, Zunyi, China.,Department of Nursing, Fourth People's Hospital of Guiyang, Guiyang, China
| | - Jiaoming Jiang
- School of Nursing, Zunyi Medical University, Zunyi, China
| | - Liyuan Xu
- School of Nursing, Zunyi Medical University, Zunyi, China
| | - Cui Wang
- Department of Pediatric Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Pengxiao Wang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Biwen Yang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ming Tao
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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31
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Assessing the quality of life and depression among patients with heart failure and heart attack. HEALTH PSYCHOLOGY REPORT 2020. [DOI: 10.5114/hpr.2020.95910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundHealth-related quality and of life and depression are major issues among patients with heart diseases. The aim of the current study was to assess the levels of quality of life and depression among patients with heart failure and heart attack as well as the correlation between these domains and the differences in both categories.Participants and procedureIn this cross-sectional study the following tools were used: a) the Missoula-VITAS Quality of Life Index (MVQoLI-15), which examines 5 domains of quality of life, and b) the Center for Epidemiological Studies Depression Scale (CES-D), which measures depression among patients. Finally, a questionnaire about sociodemographic elements was completed by the patients. Data were analyzed through IBM Statistics SPSS 20.0. The statistical level was set at 0.05%.ResultsThe mean value of CES-D Total and MVQoLI-15 were higher for the patients suffering from heart failure than those suffering from a heart attack. However, the dimensions of MVQoLI-15 Interpersonal Relationships, Well-Being and Transcendence were lower for heart failure patients compared to the levels of the patients suffering from a heart attack. According to the Pearson r test, there was a statistically significant negative correlation be-tween the quality of life and depression (p = .001) in the overall sample.ConclusionsPatients with heart failure experience more depression and lower quality of life than heart attack patients.
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Liu M, Taylor JL, Perrin NA, Szanton SL. Distinct clusters of older adults with common neuropsychological symptoms: Findings from the National Health and Aging Trends Study. Geriatr Nurs 2020; 41:222-228. [DOI: 10.1016/j.gerinurse.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 01/29/2023]
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Mental consequences and behavioral health 18 month after outpatient cardiac rehabilitation in three separated profiles at baseline. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Streur MM, Thompson EA, Dougherty CM. Multisymptom Profile Predicts Increased Risk of Poor Outcomes After Initial Placement of Implantable Cardioverter Defibrillator. J Pain Symptom Manage 2020; 59:658-667. [PMID: 31707069 PMCID: PMC7024646 DOI: 10.1016/j.jpainsymman.2019.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022]
Abstract
CONTEXT Patients with implantable cardioverter defibrillators (ICDs) are at risk for multiple physical and psychological symptoms. Identification of specific symptom profiles associated with poor outcomes may elucidate novel strategies to enhance symptom management. OBJECTIVES The objectives were to determine common symptoms after initial ICD implantation, identify classes of individuals with similar symptom profiles, describe patient characteristics associated with different symptom profiles, and determine if symptom profiles at hospital discharge predicted outcomes three and 12 months after implantation. METHODS This was a secondary data analysis of a randomized controlled trial that compared patient + partner versus patient-only interventions designed to help patients manage symptoms, prepare for ICD shocks, and resume daily activities. Symptoms were measured with the Patient Concerns Assessment. Latent class regression analysis was used to identify symptom classes at baseline, three-month, and 12-month follow-up. Associations between patient characteristics, class membership, and outcomes were examined using chi-square, analysis of variance, and Poisson regression. RESULTS The study included 301 patients (74% male, mean age 64 ± 11.9 years). Three classes were identified: Multi-Symptom (N = 119, 40%), Tired-Rundown (N = 130, 43%), and Mostly Asymptomatic (N = 52, 17%). Patients in the Multi-Symptom class were younger (59.9 years, P < 0.001) and reported more anxiety (P < 0.001) and depression (P < 0.01) than the other classes. Membership in the Multi-Symptom class predicted lower quality of life and resulted in nearly double the rate of hospitalizations after 12 months (P = 0.02, IRR 1.9). CONCLUSION Evaluation of symptom profiles after ICD implantation offers a promising strategy for identifying patients at risk for poor health outcomes.
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Affiliation(s)
- Megan M Streur
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Elaine A Thompson
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Cynthia M Dougherty
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA.
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Denfeld QE, Bidwell JT, Gelow JM, Mudd JO, Chien CV, Hiatt SO, Lee CS. Cross-classification of physical and affective symptom clusters and 180-day event-free survival in moderate to advanced heart failure. Heart Lung 2019; 49:151-157. [PMID: 31753526 DOI: 10.1016/j.hrtlng.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The relationship between physical and affective symptom clusters in heart failure (HF) is unclear. OBJECTIVES To identify associations between physical and affective symptom clusters in HF and to quantify outcomes and determinants of symptom subgroups. METHODS This was a secondary analysis of data from two cohort studies among adults with HF. Physical and affective symptom clusters were compared using cross-classification modeling. Cox proportional hazards modeling and multinomial logistic regression were used to identify outcomes and determinants of symptom subgroups, respectively. RESULTS In this young, mostly male sample (n = 274), physical and affective symptom clusters were cross-classified in a model with acceptable fit. Three symptom subgroups were identified: congruent-mild (69.3%), incongruent (13.9%), and congruent-severe (16.8%). Compared to the congruent-mild symptom group, the incongruent symptom group had significantly worse 180-day event-free survival. CONCLUSION Congruence between physical and affective symptom clusters should be considered when identifying patients at higher risk for poor outcomes.
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Affiliation(s)
- Quin E Denfeld
- Oregon Health & Science University School of Nursing, SN-ORD, 3455 S.W. U.S. Veterans Hospital Road Portland, OR 97239-2941, USA.
| | - Julie T Bidwell
- University of California Davis Betty Irene Moore School of Nursing, Sacramento, CA, USA
| | - Jill M Gelow
- Providence Heart & Vascular Institute, Portland, OR, USA
| | - James O Mudd
- Providence Sacred Heart Medical Center, Spokane, WA, USA
| | | | - Shirin O Hiatt
- Oregon Health & Science University School of Nursing, SN-ORD, 3455 S.W. U.S. Veterans Hospital Road Portland, OR 97239-2941, USA
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
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Zhu Z, Zhao R, Hu Y. Symptom Clusters in People Living With HIV: A Systematic Review. J Pain Symptom Manage 2019; 58:115-133. [PMID: 30951828 DOI: 10.1016/j.jpainsymman.2019.03.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/23/2019] [Accepted: 03/26/2019] [Indexed: 01/02/2023]
Abstract
CONTEXT An increasing number of studies regarding symptom management have begun to shift their focus from managing a single symptom to multiple symptom clusters. However, there is a lack of consistency of compositions among different studies and even in two different analyses reported in a single study within the same population. OBJECTIVES The aim of this systematic review was to summarize the compositions, measures, and data analysis techniques of symptom clusters in people living with HIV (PLWH). METHODS We conducted a comprehensive search to identify published studies about symptom clusters among PLWH. Databases including PubMed/MEDLINE, MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), Web of Science, and ProQuest Dissertations and Thesis were searched for studies published between January 2000 and December 2018. RESULTS Thirteen articles were eligible for inclusion. Five most commonly reported symptom clusters were found: 1) sad/depressed/loss of interest and nervous/anxious/worrying; 2) difficulty sleeping, problems with having sex, and fatigue/loss of energy; 3) fever/chills/sweat, nausea/vomiting, and loss of appetite; 4) numbness, muscle aches, and joint pain; and 5) dizziness and headache. CONCLUSION This systematic review summarized the compositions, measures, and analytical techniques of symptom clusters for PLWH. Although this review found unstable results on the compositions of symptom clusters and it was difficult to reach a definitive conclusion, the results still implicate the necessity of developing a threshold to decide what symptoms should be included in the clusters and the use of multiple data analysis techniques to obtain stable results.
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Affiliation(s)
- Zheng Zhu
- Fudan University School of Nursing, Shanghai, China; Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Rui Zhao
- Children's Hospital of Fudan University, Shanghai, China
| | - Yan Hu
- Fudan University School of Nursing, Shanghai, China; Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
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Haedtke CA, Moser DK, Pressler SJ, Chung ML, Wingate S, Goodlin SJ. Influence of depression and gender on symptom burden among patients with advanced heart failure: Insight from the pain assessment, incidence and nature in heart failure study. Heart Lung 2019; 48:201-207. [PMID: 30879736 PMCID: PMC7582916 DOI: 10.1016/j.hrtlng.2019.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/07/2019] [Accepted: 02/19/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Patients with advanced heart failure (HF) experience many burdensome symptoms that increase patient suffering. METHODS Comparative secondary analysis of 347 patients with advanced HF. Symptom burden was measured with the Memorial Symptom Assessment Scale-HF. Depression was measured using the Patient Health Questionnaire-9. RESULTS Mean number of symptoms was 13.6. The three most frequent symptoms were non-cardiac pain, shortness of breath, and lack of energy. Patients with depression reported higher symptom burden. Symptom burden differed when compared by gender. Women reported higher symptom burden for other pain, dry mouth, swelling of the arms and legs, sweats, feeling nervous, nausea, and vomiting. Men reported higher symptom burden with sexual problems. CONCLUSIONS Given the high rates of symptoms and distress, interventions are needed to alleviate the symptom burden of patients with advanced HF. Reported symptom burden in patients with advanced heart failure was higher when depressive symptoms were present. Women reported varied number and severity of symptoms than men.
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Affiliation(s)
- Christine A Haedtke
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - Debra K Moser
- University of Kentucky College of Nursing, 2201 Regency Road, Suite 403, Lexington, KY 40503, United States
| | - Susan J Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States
| | - Misook L Chung
- University of Kentucky College of Nursing, 2201 Regency Road, Suite 403, Lexington, KY 40503, United States
| | - Sue Wingate
- National Institutes of Health, Building 10 Room 2-1339, Bethesda, MD 20892, United States
| | - Sarah J Goodlin
- Patient-Centered Education and Research Portland, OR and Salt Lake City, UT, United States
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Zhu Z, Hu Y, Xing W, Guo M, Zhao R, Han S, Wu B. Identifying Symptom Clusters Among People Living With HIV on Antiretroviral Therapy in China: A Network Analysis. J Pain Symptom Manage 2019; 57:617-626. [PMID: 30465875 DOI: 10.1016/j.jpainsymman.2018.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 01/28/2023]
Abstract
CONTEXT There exists a research interest shift from separate symptoms to symptom clusters among people living with HIV (PLWH), which may provide a better understanding of symptom management in HIV/AIDS care. However, the symptom clusters among Chinese PLWH are still unknown. OBJECTIVES The aim of our study was to identify symptom clusters and to examine demographic and health-related factors associated with these symptom clusters among PLWH prescribing antiretroviral therapy (ART) in China. METHODS From April to September 2017, we recruited 1116 participants through a convenience sampling in five HIV/AIDS designated facilities in the eastern, middle, and southwest regions of China. The principal component analysis was used to identify the symptom clusters. Association network was adopted to describe the relationships among symptoms and clusters. A multiple linear model was used to investigate the associated factors for the severity of overall symptoms and the prevalence of each symptom clusters. RESULTS Five symptom clusters were identified, including cognitive dysfunction, mood disturbance, wasting syndrome, dizziness/headache, and skin-muscle-joint disorder. Cognitive dysfunction was the most central symptom cluster. Variables including primary caregiver during ART treatment, years of HIV diagnosis and ART use, having comorbidity, self-rated health, and quality of life were associated with the prevalence of these five symptom clusters. CONCLUSION Our study suggests that there is a need to evaluate symptom clusters for the improvement of symptom management among PLWH. It is particularly important to include assessment and treatment of cognitive symptoms as an essential component of the HIV care.
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Affiliation(s)
- Zheng Zhu
- Fudan University School of Nursing, Shanghai, China; Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Yan Hu
- Fudan University School of Nursing, Shanghai, China; Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
| | - Weijie Xing
- Fudan University School of Nursing, Shanghai, China; Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Mengdi Guo
- School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Rui Zhao
- Fudan University School of Nursing, Shanghai, China
| | - Shuyu Han
- Fudan University School of Nursing, Shanghai, China
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York City, New York, USA
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Streur M, Ratcliffe SJ, Callans D, Shoemaker MB, Riegel B. Atrial fibrillation symptom clusters and associated clinical characteristics and outcomes: A cross-sectional secondary data analysis. Eur J Cardiovasc Nurs 2018; 17:707-716. [PMID: 29786450 PMCID: PMC6212328 DOI: 10.1177/1474515118778445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Symptom clusters among adults with atrial fibrillation have previously been identified but no study has examined the relationship between symptom clusters and outcomes. AIMS The purpose of this study was to identify atrial fibrillation-specific symptom clusters, characterize individuals with each cluster, and determine whether symptom cluster membership is associated with healthcare utilization. METHODS This was a cross-sectional secondary data analysis of 1501 adults from the Vanderbilt Atrial Fibrillation Registry with verified atrial fibrillation. Self-reported symptoms were measured with the University of Toronto Atrial Fibrillation Severity Scale. We used hierarchical cluster analysis (Ward's method) to identify clusters and dendrograms, pseudo F, and pseudo T-squared to determine the ideal number of clusters. Next, we used regression analysis to examine the association between cluster membership and healthcare utilization. RESULTS Males predominated (67%) and the average age was 58.4 years. Two symptom clusters were identified, a Weary cluster (3.7%, n=56, fatigue at rest, shortness of breath at rest, chest pain, and dizziness) and an Exertional cluster (32.7%, n=491, shortness of breath with activity and exercise intolerance). Several sociodemographic and clinical characteristics varied by symptom cluster group membership, including age, gender, atrial fibrillation type, body mass index, comorbidity status, and treatment strategy. Women were more likely to experience either cluster ( p<0.001). The Weary cluster was associated with nearly triple the rate of emergency department utilization (incident rate ratio [IRR] 2.8, p<0.001) and twice the rate of hospitalizations (IRR 1.9, p<0.001). CONCLUSION We identified two symptom clusters. The Weary cluster was associated with a significantly increased rate of healthcare utilization.
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Affiliation(s)
- Megan Streur
- Corresponding author: University of Pennsylvania School of Nursing (institution at time research conducted), 418 Curie Boulevard, Philadelphia, Pennsylvania 19104-4217, USA, Post-doctoral fellow, University of Washington School of Nursing (Present address), Health Sciences Building, Box 357266, 1959 NE Pacific Street, T613, Seattle, WA 98195-7266, USA, Phone: 1-971-322-8844
| | - Sarah J Ratcliffe
- Professor of Biostatistics, University of Pennsylvania Perelman School of Medicine, Division of Biostatistics, 6423 Guardian Drive, Philadelphia, PA 19104-6021, USA,
| | - David Callans
- Professor of Medicine, Hospital of the University of Pennsylvania and the Presbyterian Medical, Center of Philadelphia, Cardiology Division, 3400 Spruce Street, Philadelphia, PA 19104, USA,
| | - M. Benjamin Shoemaker
- Assistant Professor of Medicine, Vanderbilt University Medical Center, Division of Cardiovascular Medicine, 1161 21st Avenue South, Nashville, TN 37232, USA,
| | - Barbara Riegel
- Professor of Nursing, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, Pennsylvania 19104-4217, USA,
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Lockwood MB, Chung S, Puzantian H, Bronas UG, Ryan CJ, Park C, DeVon HA. Symptom Cluster Science in Chronic Kidney Disease: A Literature Review. West J Nurs Res 2018; 41:1056-1091. [DOI: 10.1177/0193945918808766] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The purpose of this review was to synthesize evidence on symptom clusters in patients with chronic kidney disease (CKD). The quality of studies was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Twelve articles met inclusion criteria. Patients had CKD ranging from Stages 2 through 5. Most studies determined clusters using variable-centered approaches based on symptoms; however, one used a person-centered approach based on demographic and clinical characteristics. The number of clusters identified ranged from two to five. Several clusters were prominent across studies including symptom dimensions of fatigue/energy/sleep, neuromuscular/pain, gastrointestinal, skin, and uremia; however, individual symptoms assigned to clusters varied widely. Several clusters correlated with patient outcomes, including health-related quality of life and mortality. Identifying symptom clusters in CKD is a nascent field, and more research is needed on symptom measures and statistical methods for clustering. The clinical implications of symptom clusters remain unclear.
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Affiliation(s)
- Mark B. Lockwood
- College of Nursing, The University of Illinois at Chicago, IL, USA
| | - SeonYoon Chung
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Houry Puzantian
- College of Nursing, The University of Illinois at Chicago, IL, USA
| | - Ulf G. Bronas
- College of Nursing, The University of Illinois at Chicago, IL, USA
| | | | - Chang Park
- College of Nursing, The University of Illinois at Chicago, IL, USA
| | - Holli A. DeVon
- College of Nursing, The University of Illinois at Chicago, IL, USA
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Son YJ, Won MH. Symptom Clusters and Their Impacts on Hospital Readmission in Patients With Heart Failure: A Cross-Sectional Study. Res Theory Nurs Pract 2018; 32:311-327. [DOI: 10.1891/1541-6577.32.3.311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose:Readmissions after hospitalization due to multiple symptoms in heart failure (HF) are common and costly. Patients have difficulty differentiating HF symptoms from comorbid illness or aging. Therefore, early identification of symptom clusters could improve symptom recognition and reduce hospital readmission. However, little is known about the relationship between symptom clusters and readmission in HF patients. This study aimed to identify symptom clusters among Korean patients with HF and the relationship between symptom clusters and hospital readmission.Methods:This cross-sectional study included 306 HF outpatients within 12 months after discharge. Exploratory factor analysis was used to identify the symptom clusters. Multiple logistic regression analysis was used to examine the effect of symptom clusters on readmission, after adjusting for sociodemographic and clinical characteristics.Results:Three symptom clusters were identified in HF patients: the “respiratory distress” cluster, “bodily pain and energy insufficiency” cluster, and “circulatory and gastrointestinal distress” cluster. Patients with class III or IV of HF functional class experienced three symptom clusters at a higher level. This study showed that the “bodily pain and energy insufficiency” cluster was the strongest predictor of hospital readmission in HF patients (adjusted odds ratio = 6.59, 95% confidence interval (CI) [1.29, 32.79]).Implications for Practice:A higher level of “bodily pain and energy insufficiency” cluster was associated with hospital readmission in Korean HF patients. Health-care providers should be encouraged to consider patients’ cultural backgrounds to recognize differences in symptom clusters. Further studies are needed to evaluate symptom clusters across international cohorts and their impacts on patients’ outcomes.
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Kim HS, Eun SJ, Hwang JY, Lee KS, Cho SI. Symptom clusters and treatment time delay in Korean patients with ST-elevation myocardial infarction on admission. Medicine (Baltimore) 2018; 97:e0689. [PMID: 29742716 PMCID: PMC5959405 DOI: 10.1097/md.0000000000010689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Most patients with acute myocardial infarction (AMI) experience more than one symptom at onset. Although symptoms are an important early indicator, patients and physicians may have difficulty interpreting symptoms and detecting AMI at an early stage. This study aimed to identify symptom clusters among Korean patients with ST-elevation myocardial infarction (STEMI), to examine the relationship between symptom clusters and patient-related variables, and to investigate the influence of symptom clusters on treatment time delay (decision time [DT], onset-to-balloon time [OTB]). This was a prospective multicenter study with a descriptive design that used face-to-face interviews. A total of 342 patients with STEMI were included in this study. To identify symptom clusters, two-step cluster analysis was performed using SPSS software. Multinomial logistic regression to explore factors related to each cluster and multiple logistic regression to determine the effect of symptom clusters on treatment time delay were conducted. Three symptom clusters were identified: cluster 1 (classic MI; characterized by chest pain); cluster 2 (stress symptoms; sweating and chest pain); and cluster 3 (multiple symptoms; dizziness, sweating, chest pain, weakness, and dyspnea). Compared with patients in clusters 2 and 3, those in cluster 1 were more likely to have diabetes or prior MI. Patients in clusters 2 and 3, who predominantly showed other symptoms in addition to chest pain, had a significantly shorter DT and OTB than those in cluster 1. In conclusion, to decrease treatment time delay, it seems important that patients and clinicians recognize symptom clusters, rather than relying on chest pain alone. Further research is necessary to translate our findings into clinical practice and to improve patient education and public education campaigns.
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Affiliation(s)
- Hee-Sook Kim
- Division of Infectious Disease Control, Korea Centers for Disease Control and Prevention, Cheongju
- Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon
| | - Jin Yong Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju
| | - Kun-Sei Lee
- Department of Preventive Medicine, Konkuk University College of Medicine, Seoul, South Korea
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul
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McKee G, Mooney M, O'Donnell S, O'Brien F, Biddle MJ, Moser DK. A cluster and inferential analysis of myocardial infarction symptom presentation by age. Eur J Cardiovasc Nurs 2018; 17:637-644. [PMID: 29701067 DOI: 10.1177/1474515118772824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pre-hospital delay time in myocardial infarction is usually longer in older than in younger patients, with symptom presentation known to be a contributing factor. AIM The aim of this article is to examine symptom presentation differences, by age, in patients with myocardial infarction. METHODS This is a cross-sectional study using secondary analysis of a multi-site randomised controlled trial on pre-hospital delay time. Data were analysed using logistic regression and factor analysis. RESULTS Post-myocardial infarction patients were recruited prior to discharge ( n=1211), 54% were ≥65 years and 80% male. The average number of symptoms was three, with the ≥65 years age group reporting significantly less symptoms. Logistic regression controlling for gender, diabetes and diagnosis with 11 symptoms (χ2=52.09, p<0.001) was significant. Those ≥65 years had less chest symptoms, sweating, stomach upset and left arm pain, in addition to longer pre-hospital delay time. This group also had less symptom clustering and fewer symptoms within atypical clusters. Non-chest clusters occurred in 22% and 18% of the older and younger group respectively. Of note, two clusters 'atypical' (upset stomach/sweating) and 'typical arm' (right and left arm pain symptoms), accounted for 14% and 5% of myocardial infarction presentations in the ≥65 years group, within which 25% and 24% had no chest symptoms. CONCLUSIONS The results of this study indicate that myocardial infarction symptom presentation in older patients is likely to be less recognisable and more complex. Increased awareness of the presentation profile of older patients could expedite their triage, diagnosis and, consequently, their prognosis.
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Affiliation(s)
- Gabrielle McKee
- 1 School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Mary Mooney
- 1 School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Sharon O'Donnell
- 1 School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Frances O'Brien
- 1 School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Araújo C, Laszczyńska O, Viana M, Melão F, Henriques A, Borges A, Severo M, Maciel MJ, Moreira I, Azevedo A. Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study. BMJ Open 2018; 8:e018798. [PMID: 29476027 PMCID: PMC5855399 DOI: 10.1136/bmjopen-2017-018798] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Prompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS. DESIGN Data were collected within a prospective cohort study (EPIHeart). SETTING Patients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014. PARTICIPANTS Presenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview. OUTCOME MEASURES Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex. RESULTS Chest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001). CONCLUSIONS While there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice.
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Affiliation(s)
- Carla Araújo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Serviço de Cardiologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Hospital de São Pedro, Vila Real, Portugal
| | - Olga Laszczyńska
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Marta Viana
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Filipa Melão
- Serviço de Cardiologia, Centro Hospitalar São João, EPE, Porto, Portugal
| | - Ana Henriques
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Andreia Borges
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria Júlia Maciel
- Serviço de Cardiologia, Centro Hospitalar São João, EPE, Porto, Portugal
| | - Ilídio Moreira
- Serviço de Cardiologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Hospital de São Pedro, Vila Real, Portugal
| | - Ana Azevedo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Graven LJ, Higgins MK, Reilly CM, Dunbar SB. Heart Failure Symptoms Profile Associated With Depressive Symptoms. Clin Nurs Res 2018; 29:73-83. [PMID: 29441796 DOI: 10.1177/1054773818757312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Heart failure (HF) symptoms are known to influence depressive symptoms, yet a symptom profile has not been identified. HF symptoms relative to symptom experience (frequency, severity, interference with physical activity and enjoyment of life) associated with depressive symptoms were examined. Data from three HF studies (N = 308) which used the Heart Failure Symptom Survey were included in this cross-sectional secondary analysis. Supervised classification for and identification of symptoms most associated with depressive symptoms were accomplished using random forest algorithms via conditional inference trees. The HF symptom profile associated with depressive symptoms across all four symptom experience domains included fatigue, dizziness, and forgetfulness/difficulty concentrating. Abdominal bloating, worsening cough, and difficulty sleeping were also important, but did not consistently rank in the top 5 for symptom importance relative to all symptom experience domains. Symptom profiling may enhance early identification of patients at risk for depressive symptoms and inform symptom management interventions.
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Affiliation(s)
- Sara Wallström
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
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Abstract
Background Patterns of symptom clustering in midlife women may suggest common underlying mechanisms or may identify women at risk of adverse health outcomes or, conversely, likely to experience healthy aging. This paper assesses symptom clustering in the Study of Women’s Health Across the Nation (SWAN) longitudinally by stage of reproductive aging and estimates the probability of women experiencing specific symptom clusters. We also evaluate factors that influence the likelihood of specific symptom clusters and assess whether symptom clustering is associated with women’s self-reported health status. Methods This analysis includes 3289 participants in the multiethnic SWAN cohort who provided information on 58 symptoms reflecting a broad range of physical, psychological and menopausal symptoms at baseline and 7 follow-up visits over 16 years. We conducted latent transition analyses to assess symptom clustering and to model symptomatology across the menopausal transition (pre, early peri-, late peri- and post-menopausal). Joint multinomial logistic regression models were used to identify demographic characteristics associated with premenopausal latent class membership. A partial proportional odds regression model was used to assess the association between latent class membership and self-reported health status. Results We identified six latent classes that ranged from highly symptomatic (LC1) across most measured symptoms, to moderately symptomatic across most measured symptoms (LC2), to moderately symptomatic for a subset of symptoms (vasomotor symptoms, pain, fatigue, sleep disturbances and physical health symptoms) (LC3 and LC5) with one class (LC3) including interference in life activities because of physical health symptoms, to numerous milder symptoms, dominated by fatigue and psychological symptoms (LC4), to relatively asymptomatic (LC6). In pre-menopause, 10% of women were classified in LC1, 16% in LC2, 14% in LC3 and LC4, 26% in LC5, and 20% in LC6. Intensity of vasomotor and urogenital symptoms as well as sexual desire) differed minimally by latent class. Classification into the two most symptomatic classes was strongly associated with financial strain, White race/ethnicity, obesity and smoking status. Over time, women were most likely to remain within the same latent class as they transitioned through menopause stages (range 39–76%), although some women worsened or improved. The probability of moving between classes did not differ substantially by menopausal stage. Women in the highly symptomatic classes more frequently rated their health as fair to poor compared to women in the least symptomatic class. Conclusion Clear patterns of symptom clustering were present early in midlife, tended to be stable over time, and were strongly associated with self-perceived health. Notably, vasomotor symptoms tended to cluster with sleep disturbances and fatigue, were present in each of the moderate to highly symptomatic classes, but were not a defining characteristic of the symptom clusters. Clustering of midlife women by symptoms may suggest common underlying mechanisms amenable to interventions. Given that one-quarter of midlife women were highly or moderately symptomatic across all domains in the pre-menopause, addressing symptom burden in early midlife is likely critical to ameliorating risk in the most vulnerable populations. Electronic supplementary material The online version of this article (doi:10.1186/s40695-017-0021-y) contains supplementary material, which is available to authorized users.
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The Clinical Efficacy of Yindanxinnaotong Soft Capsule in the Treatment of Stroke and Angina Pectoris: A Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:2060549. [PMID: 28539962 PMCID: PMC5429936 DOI: 10.1155/2017/2060549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/02/2017] [Accepted: 03/20/2017] [Indexed: 11/17/2022]
Abstract
Objective. To systematically evaluate the clinical efficacy of Yindanxinnaotong (YD) soft capsule in adult patients with cardiovascular diseases (stroke and angina pectoris). Methods. We electronically searched databases including Medline, PubMed, Chinese National Knowledge Infrastructure (CNKI), Cqvip Database (VIP), and Wanfang Database for published articles of randomized controlled trials (RCTs) of YD capsule in treating stroke and angina pectoris. The meta-analysis was performed using RevMan 5.3 software. Results. 49 RCTs involving 6195 subjects with cardiovascular diseases (angina pectoris and stroke) were included. Compared with western conventional medicine (WCM) and/or other Chinese medicines, YD plus WCM therapeutic regimen could significantly improve the efficacy rate (RR = 1.21, 95% CI (1.17, 1.25), P < 0.00001 for angina pectoris, RR = 1.24, 95% CI (1.18, 1.31), P < 0.00001 for stroke), showing the clinical value. In addition, the therapeutic efficiency of WCM plus YD capsule regimen is better than that of WCM alone in improving CRP (MD = −2.07, 95% CI (−3.97, −0.17), P = 0.03 <0.05) and TG (MD = −0.37, 95% CI (−0.52, −0.23), P < 0.0001). Conclusion. YD is effective in the treatment of cardiovascular diseases (angina pectoris and stroke) in adults, and WCM plus YD therapeutic regimen can significantly improve the effective rate in the clinic.
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