Effects of a psychological intervention programme on mental stress, coping style and immune function in percutaneous coronary intervention patients

The effect of fear-avoidance intervention on kinesiophobia and self-efficacy in patients after percutaneous coronary intervention: study protocol for a clinical randomized controlled trial

BACKGROUND

Kinesiophobia after percutaneous coronary intervention (PCI) may lead to decreased compliance with rehabilitation exercises. Effective interventions are essential to overcome kinesiophobia after PCI. The aim of this trial is to investigate the clinical effects of an intervention based on the fear-avoidance model (FAM) on kinesiophobia in post-PCI patients.

METHODS

Eighty participants will be recruited in the Department of Cardiology in Hebei Provincial People's Hospital. And they will be randomly allocated to the test group and undergo a 5-day step-to-step intervention. The primary outcome will be the scores of a scale on kinesiophobia. Secondary outcome measures included self-efficacy for exercise, psychogenic anxiety, and the occurrence of cardiovascular adverse events. Primary and secondary outcome data will be collected at baseline (t0), on the day of discharge (t1), and one month after discharge (t2).

DISCUSSION

The effectiveness of an intervention based on the FAM to increase exercise self-efficacy and decrease kinesiophobia in post-PCI patients will be demonstrated. The findings of this study will facilitate post-PCI patients to participate in cardiac rehabilitation.

TRIAL REGISTRATION

ChiCTR2200065649 Effect of an intervention based on the fear-avoidance model on exercise fear in patients after percutaneous coronary intervention. Registered on November 10, 2022.

Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review

Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.

Hot spots and trends in PCI prognostic research: A bibliometric analysis with CiteSpace

BACKGROUND

The number of patients undergoing percutaneous coronary intervention (PCI) procedures is increasing along with the number of studies involving guidelines, prognostic assessments, and cardiac rehabilitation related to PCI strategies. However, fewer studies have reported the mapping of knowledge structure and hotspot analysis in this field. Our goal was to discuss and analyze the current status, hot spots and developmental trends associated with research into the prognosis of patients undergoing PCI, and to provide reference for PCI-related research.

METHODS

The Web of Science Core Collection and China Knowledge Network were searched for relevant literature from January 2003 to October 2022, and CiteSpace 6.1. R3 software was used to analyze the co-occurrence, clustering, and emerging authors, institutions, and keywords.

RESULTS

A total of 2666 English and 2010 Chinese publications were included. The number of publications showed a growing trend. The author with the maximum number of articles was Xu Bo. The institutions with high productivity were Peking Union Medical College and Capital Medical University. Although the number of Chinese articles was high, the cooperation between institutions was low and the impact was small. The results of the analysis suggest a shift in the focus of keywords from coronary artery disease and PCI to studies involving the assessment and intervention of risk factors associated with poor prognosis of PCI. Traditional Chinese Medicine and anxiety represent the emerging direction of PCI prognosis. The assessment of major adverse cardiovascular events and cardiac rehabilitation require careful analysis in post-PCI research.

CONCLUSION

The findings of this bibliometric study present a comprehensive and systematic overview of the PCI prognosis, based on the analysis of the current status and trends in research, which may facilitate the identification of hot topics and new directions for future research.

Investigating the effectiveness of tele-counseling for the mental health of staff in hospitals and COVID-19 clinics: a clinical control trial

OBJECTIVE

To investigate the effectiveness of tele-counseling for the mental health of staff working in hospitals and reference clinics during the COVID-19 outbreak.

METHODS

In the first stage of the study, using a convenience sampling strategy, 313 staff members working at Iran's hospitals and COVID-19 clinics answered a Hospital Anxiety and Depression Scale and the Short Health Anxiety Inventory online. In a second stage, 95 staff members who were willing to participate in the intervention were randomly assigned to the intervention (n = 51) or control (n = 44) groups. The intervention consisted of seven intensive tele-counseling sessions.

RESULTS

In the first stage, the percentages of anxiety and depression related to coronavirus were 79.2% and 82.1% and the mean health anxiety score was 17.42. In the intervention phase, anxiety related to coronavirus and to perceived risk of illness (likelihood of illness) were significantly lower in the intervention group in comparison with the control group (p = 0.001). Depression related to coronavirus and anxiety related to the negative consequences of infection were non-significantly reduced in the intervention group compared to the control group (p = 0.08 and 0.12; respectively).

CONCLUSION

Continuous monitoring of the negative psychological impacts on medical staff of outbreaks as well as implementation of appropriate interventions to respond to them should be emphasized in order to improve staff mental health.

Effectiveness of cognitive-behavioral therapy on perceived stress among patients undergoing percutaneous coronary intervention: A randomized controlled trial

PURPOSE

This study aimed to determine the effectiveness of cognitive-behavioral therapy on perceived stress of patients undergoing percutaneous coronary intervention (PCI).

DESIGN AND METHODS

This was a randomized clinical trial in which the patients under coronary intervention were allocated to two groups, intervention and control by using block randomization. The experiment group received eight sessions of cognitive-behavioral therapy. The patients' perceived stress was measured before, immediately, and 1-month post ntervention.

FINDINGS

The results showed the perceived stress scores changed significantly in the intervention group compared with the control group immediately and 1 month after the intervention. Therefore, the perceived stress level significantly reduced in the patients of the intervention group (p < 0.001).

PRACTICE IMPLICATIONS

Cognitive-behavioral therapy significantly reduced perceived stress in patients undergoing PCI.

Effects of early rehabilitation nursing intervention on nerve function and daily living in patients with stroke hemiplegia

OBJECTIVE

To explore the effects of early rehabilitation nursing on the rehabilitation of stroke hemiplegia patients.

METHODS

A total of 80 patients with stroke admitted to Ningxiang People's Hospital were selected as the research subjects for analysis. Among them, 40 patients received early rehabilitation nursing intervention after admission and were enrolled in the observation group. The other 40 patients received only general nursing intervention who were enrolled in the control group. National Institutes of Health Stroke Scale (NIHSS) and Ruminative responses scale (RRS) were used to evaluate the nerve function of the two groups of patients before and after treatment. Fugl-Meyer motor function assessment (FMA) was applied to evaluate their athletic ability, and activity of daily living (ADL) score and Barthel index were utilized to evaluate their living ability. The adverse reactions and nursing satisfaction were compared between the two groups.

RESULTS

After treatment, NIHSS score and RRS score in the observation group were lower than those in the control group (P<0.05). FMA score, ADL score and Barthel index were higher in the observation group than those of the control group (P<0.05). After treatment, NIHSS score and RRS score were both lower than those before treatment (P<0.05), while FMA score, ADL score and Barthel index were higher than those before treatment (P<0.05). There was no difference in the incidence of adverse reactions between the two groups (P>0.05). The nursing satisfaction of the observation group was higher than that of the control group (P<0.05).

CONCLUSION

Early rehabilitation nursing can effectively improve the nerve function, athletic ability and living ability of stroke hemiplegia patients, which is worth popularizing in clinic.

Puerarin alleviates coronary heart disease via suppressing inflammation in a rat model

BACKGROUND

Puerarin shows inhibitory effects on inflammation in chronic heart failure (CHF), but its efficacy in coronary heart disease (CHD) remained vague.

METHODS

Rat CHD model was constructed, and serum parameters were determined using a blood liquid biochemical analyzer. Also, contents of creatine kinase (CK), creatine kinase MB isoenzyme (CK-MB), lactate dehydrogenase (LDH) and cardiac troponin (cTnT) were measured using colorimetry. Histological examination was conducted with Hematoxylin-Eosin (H&E) staining, and cardiac function was assessed by Echocardiography. Cell apoptosis was detected using Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. Relative expressions were measured using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot as needed.

RESULTS

In CHD rats, the levels of TC, LDL and TG and the expressions of matrix metalloproteinase-9 (MMP-9), CD40 ligand (CD40L), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were increased while HDL level was decreased, accompanied with inflammatory cell infiltration and cardiac malfunction. Also, the contents of CK, CK-MB, LDH and cTnT, the percentage of apoptotic cells, the expressions of Bcl-2 associated X protein (Bax), cleaved Caspase-3, TNF-α, Interleukin-β (IL-β), IL-6 and Lipoprotein-associated Phospholipase A2 (Lp-PLA2) expressions and the levels of oxidized-(ox-)LDL and malondialdehyde (MDA) were upregulated, while the level of super oxidase dismutase (SOD) and the expressions of B cell lymphoma-2 (Bcl-2) and vascular endothelial growth factor (VEGF) were downregulated. However, Puerarin ameliorated the effects of CHD model construction, suppressed nuclear factor-(NF-)κB expression, and enhanced the expressions of Farnesoid X Receptor (FXR), phosphorylated-AKT (p-AKT) and phosphorylated-signal transducer and activator of transcription 3 (p-STAT3).

CONCLUSION

Puerarin alleviated CHD in rats via inhibiting inflammation, providing possible method for CHD treatment.

Psychosocial Interventions and Immune System Function: A Systematic Review and Meta-analysis of Randomized Clinical Trials

IMPORTANCE

Recent estimates suggest that more than 50% of all deaths worldwide are currently attributable to inflammation-related diseases. Psychosocial interventions may represent a potentially useful strategy for addressing this global public health problem, but which types of interventions reliably improve immune system function, under what conditions, and for whom are unknown.

OBJECTIVE

To address this issue, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) in which we estimated associations between 8 different psychosocial interventions and 7 markers of immune system function, and examined 9 potential moderating factors.

DATA SOURCES

PubMed, Scopus, PsycInfo, and ClinicalTrials.gov databases were systematically searched from February 1, 2017, to December 31, 2018, for all relevant RCTs published through December 31, 2018.

STUDY SELECTION

Eligible RCTs included a psychosocial intervention, immune outcome, and preintervention and postintervention immunologic assessments. Studies were independently examined by 2 investigators. Of 4621 studies identified, 62 were eligible and 56 included.

DATA EXTRACTION AND SYNTHESIS

Data were extracted and analyzed from January 1, 2019, to July 29, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Data were extracted by 2 investigators who were blind to study hypotheses and analyses, and were then analyzed using robust variance estimation. Analysis included 8 psychosocial interventions (behavior therapy, cognitive therapy, cognitive behavior therapy [CBT], CBT plus additive treatment or mode of delivery that augmented the CBT, bereavement or supportive therapy, multiple or combined interventions, other psychotherapy, and psychoeducation), 7 immune outcomes (proinflammatory cytokine or marker levels, anti-inflammatory cytokine levels, antibody levels, immune cell counts, natural killer cell activity, viral load, and other immune outcomes), and 9 moderating factors (intervention type, intervention format, intervention length, immune marker type, basal vs stimulated markers, immune marker measurement timing, disease state or reason for treatment, age, and sex).

MAIN OUTCOMES AND MEASURES

The primary a priori outcomes were pretest-posttest-control (ppc) group effect sizes (ppc g) for the 7 immunologic outcomes investigated.

RESULTS

Across 56 RCTs and 4060 participants, psychosocial interventions were associated with enhanced immune system function (ppc g = 0.30, 95% CI, 0.21-0.40; t50.9 = 6.22; P < .001). Overall, being randomly assigned to a psychosocial intervention condition vs a control condition was associated with a 14.7% (95% CI, 5.7%-23.8%) improvement in beneficial immune system function and an 18.0% (95% CI, 7.2%-28.8%) decrease in harmful immune system function over time. These associations persisted for at least 6 months following treatment and were robust across age, sex, and intervention duration. These associations were most reliable for CBT (ppc g = 0.33, 95% CI, 0.19-0.47; t27.2 = 4.82; P < .001) and multiple or combined interventions (ppc g = 0.52, 95% CI, 0.17-0.88; t5.7 = 3.63; P = .01), and for studies that assessed proinflammatory cytokines or markers (ppc g = 0.33, 95% CI, 0.19-0.48; t25.6 = 4.70; P < .001).

CONCLUSIONS AND RELEVANCE

These findings suggest that psychosocial interventions are reliably associated with enhanced immune system function and may therefore represent a viable strategy for improving immune-related health.

Mediating and regulating effects of self-efficacy on health literacy and quality of life in patients with gastric cancer undergoing chemotherapy

BACKGROUND

Quality of life and health literacy are the main factors influencing the quality of life of gastric cancer (GC) patients. The purpose of this study was to investigate the mediating and regulating effects of self-efficacy on health literacy and quality of life in patients with GC.

AIM

To investigate the mediating and regulating effects of self-efficacy on health literacy and quality of life in patients with GC undergoing chemotherapy.

METHODS

One hundred and thirty-six GC patients hospitalized at Yiwu Central Hospital of Zhejiang Province from January 2018 to November 2019 were selected as the study subjects. The Chinese version of general self-efficacy scale, health literacy scale, and quality of life index of patients with chronic diseases were used for questionnaire survey and statistical analysis.

RESULTS

Self-efficacy score was 22.95 ± 4.65, health literacy score was 85.94 ± 7.56, and quality of life score was 4.84 ± 0.52. Pearson correlation analysis showed that the self-efficacy of GC patients undergoing chemotherapy was positively correlated with health literacy and quality of life (P < 0.05). The mediating effect was analyzed by stratified regression method and three regression equations were established. The results showed that the quality of life and health literacy as well as self-efficacy and health literacy were statistically significant in step 1 and step 2 (P < 0.05). In step 3, self-efficacy was introduced and the influence of health literacy on quality of life was reduced (P < 0.05), indicating that self-efficacy had a partial mediating effect between health literacy and quality of life. The regulating effect analysis was carried out through multiple regression, and the health literacy and self-efficacy were centralized to generate the interaction terms of "health literacy × self-efficacy". The quality of life was taken as the dependent variable, and the health literacy, self-efficacy, and interaction terms were taken as the independent variables for the regression analysis. The results showed that the regression coefficient of "health literacy × self-efficacy" was statistically significant (β' = 0.018, t = 2.725; P < 0.01), and the regulating effect was significant (△R² = 0.018, P < 0.01).

CONCLUSION

Self-efficacy has mediating and regulating effects on health literacy and quality of life in patients with GC undergoing chemotherapy.

Nurse-led psychological intervention reduces anxiety symptoms and improves quality of life following percutaneous coronary intervention for stable coronary artery disease

OBJECTIVE

To study the effect of nurse-led counselling on the anxiety symptoms and the quality of life following percutaneous coronary intervention for stable coronary artery disease.

DESIGN

Randomised control trial.

SETTING

Rural and remote China.

PARTICIPANTS

Rural and remote patients were consecutively recruited from a medical centre located in China between January and December 2014.

INTERVENTIONS

The control group received standard pre-procedure information from a ward nurse on the processes of the hospitalisation and percutaneous coronary intervention, and post-procedural care. The intervention group received a structured 30-minute counselling session the day before and 24 hours after the percutaneous coronary intervention, by nurse consultants with qualifications in psychological therapies and counselling. The health outcomes were assessed by a SF-12 scale and the Seattle Angina Questionnaire at 6 and 12 months after percutaneous coronary intervention. The anxiety and depression symptoms were evaluated by a Zung anxiety and depression questionnaire.

MAIN OUTCOME MEASURES

Cardiac outcomes, quality of life and mental health status.

RESULTS

Eighty patients were randomly divided into control (n = 40) and intervention groups (n = 40). There was a significant increase in the scores of the three domains of Seattle Angina Questionnaire 12 months after percutaneous coronary intervention in the intervention group (P < .01). The mental health and physical health scores also increased (P < .01). In the control group, the mean scores of Zung self-rating anxiety scale 12 months following percutaneous coronary intervention were higher than the baseline scores, and higher than in the intervention group (P < .01).

CONCLUSIONS

Counselling by a clinician qualified in psychological therapies and counselling significantly reduces anxiety symptoms and improves quality of life.

Effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction in percutaneous coronary intervention: A cluster randomized controlled trial

Purpose

This study aimed to assess the effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction undergoing percutaneous coronary intervention.

Methods

We conducted the trial from June 2016 to December 2016. A total of one hundred and fifty patients with acute myocardial infarction after PCI who met the inclusion criteria were randomly divided into an experimental (n = 75) group and a control (n = 75) group. The participants in the experimental group received transitional health management for three months. The two groups of patients were evaluated for treatment adherence, quality of life, clinical indicators, adverse cardiovascular events and statistics regarding readmission rates at baseline and 6 months after discharge.

Results

Compared with the controls, patients in the intervention group demonstrated better medication adherence, reexamination adherence, healthy lifestyle and clinical indicators (all P<0.05) and lower rates of adverse cardiovascular events and readmission (all P<0.05).

Conclusion

Transitional health management effectively improved adherence in elderly patients with acute myocardial infarction after PCI, ameliorated clinical indicators, and effectively reduced the incidence of adverse cardiovascular events and readmission rates. Transitional health management was an effective intervention for PCI patients after discharge.

Intensive Patients’ Education and Lifestyle Improving Program in CAD Patients

The objective of this article is to investigate the effects of intensive patients’ education and lifestyle improving program (IPEL) on anxiety, depression, and overall survival (OS) in coronary artery disease (CAD) patients with anxiety and depression. In all, 224 CAD patients with anxiety and depression were randomly assigned to IPEL or control group. In Stage I, the IPEL group received IPEL and usual care, while the control group only received usual care. In Stage II, patients were further followed up and OS analysis was performed. Hospital Anxiety and Depression Scale–anxiety (HADS-A) and HADS–depression (HADS-D) were used to assess anxiety and depression. IPEL reduced HADS-A score at Month 9 (M9)/M12, and the percentage of anxiety at M12 and HADS-A score changed. IPEL reduced HADS-D score at M12, and the percentage of depression at M12 and HADS-D score changed compared with control. Patients with nonanxiety/nondepression at M12 in the IPEL group showed better OS. IPEL reduces anxiety and depression and improves OS in CAD patients.