Effects of a self-management education program on self-efficacy in patients with COPD: a mixed-methods sequential explanatory designed study

BACKGROUND

Self-management education programs (SMEPs) are potentially effective in the symptomatic management of COPD. Little is presently known about the effectiveness of these programs in Chinese COPD patients. The objective of this study was to evaluate the effectiveness of a specifically designed SMEP on levels of self-efficacy in Chinese patients with COPD.

MATERIALS AND METHODS

Based on the Medical Research Council framework for evaluating complex interventions, an exploratory phase randomized controlled trial was employed to examine the effects of an SMEP. Self-efficacy was the primary outcome using the COPD Self-efficacy Scale, measured at baseline and 6 months after the program. Qualitative data were sequentially collected from these patients via three focus groups to supplement the quantitative findings.

RESULTS

The experimental group displayed significant improvement in their general self-efficacy (Z =-2.44, P=0.015) and specifically in confronting 1) physical exertion (Z =-2.57, P=0.01), 2) weather/environment effects (Z =-2.63, P<0.001) and 3) intense emotions (Z =-2.54, P=0.01). Three themes emerged from the focus groups: greater disease control, improved psychosocial well-being and perceived incapability and individuality. The connection of the quantitative and qualitative data demonstrated that individual perceptual constancy of patients could be a determining factor modulating the effectiveness of this type of intervention.

CONCLUSION

These findings highlight the potential putative benefits of an SMEP in Chinese patients with COPD. Further attention should be given to cultural considerations when developing this type of intervention in Chinese populations with COPD and other chronic diseases.

Cold and Spleen-Qi Deficiency Patterns in Korean Medicine Are Associated with Low Resting Metabolic Rate

Background. Korean medicine (KM) patterns such as cold, heat, deficiency, and excess patterns have been associated with alterations of resting metabolic rate (RMR). However, the association of KM patterns with accurately measured body metabolic rate has not been investigated. Methods. Data on cold (CP), heat (HP), spleen-qi deficiency (SQDP), and kidney deficiency (KDP) patterns were extracted by a factor analysis of symptoms experienced by 954 participants. A multiple regression analysis was conducted to determine the association between KM patterns and RMR measured by an indirect calorimeter. Results. The CP and SQDP scores were higher and the HP score was lower in women. The HP and SQDP scores decreased with age, while KDP scores increased with age. A multiple regression analysis revealed that CP and SQDP scores were negatively associated with RMR independently of gender and age, and the CP remained significantly and negatively associated with RMR even after adjustment for fat-free mass. Conclusions. The underlying pathology of CP and SQDP might be associated with the body's metabolic rate. Further studies are needed to investigate the usefulness of RMR measurement in pattern identification and the association of CP and SQDP with metabolic disorders.

The ginseng's fireness is associated with the lowering activity of liver Na(+)-K(+)-ATPase

ETHNOPHARMACOLOGICAL RELEVANCE

Ginseng is an herbal medicine used worldwide that possesses a wide range of pharmacological activities. However, its side effects are rarely discussed. The experience of Chinese medicine has revealed that taking ginseng at a high dose chronically can cause fireness, i.e., the ginseng-abuse syndrome. Here, we explored the mechanism of ginseng's fireness by comparing the energy metabolism of mice affected by red ginseng (RG), ginseng (GS), ginseng leaves (GL) and American ginseng (AG), which exhibit different drug properties according to the theory of TCM.

MATERIALS AND METHODS

KM mice were randomly divided into five groups (n≥30 per group) and administered distilled water or drugs, respectively. Mice receiving RG, GS, or GL received 4.5g/(kgday), while the mice receiving AG received 3g/(kgday). Control mice received distilled water. The duration of exposure for all groups was 31 days. The mice's physical characteristics, such as eye condition, rectal temperature, saliva secretion, urine, stool weight, blood coagulation time and swimming time, were measured at different times after administration. Energy metabolism indexes were measured via TSE phenoMaster/LabMaster animal monitoring system, including the mice' 24h oxygen consumption (VO2), carbon dioxide production (VCO2), heat production (H) and energy expenditure (EE). Biochemical indices were measured by ultraviolet spectrophotometer and microplate reader, including pyruvic acid content in serum and succinate dehydrogenase (SDH) activity, lactate dehydrogenase (LDH) activity, the Na(+)-K(+)-ATPase activity and the content of glycogen in the liver tissue.

RESULTS

After 31 days of drug administration, mice in the RG and GS groups exhibited obviously more eye secretions, less saliva secretion and less urine. Compared with the control group, the swimming times of mice in the GS, AG and GL groups were significantly prolonged; the clotting time of mice in the GL was extended significantly; VCO2, H and EE of mice in the GS group were obviously increased; Pyruvate content of mice in the RG group showed an initial decrease followed by an increase; SDH activity of mice in the AG and GL groups was significantly inhibited; LDH activity of the mice showed no significant difference among different groups; Na(+)-K(+)-ATP enzyme activity of the RG and GS groups showed up-regulation initially and then down-regulation; the content of hepatic glycogen of mice in the GS and GL groups increased significantly.

CONCLUSION

The results demonstrated that RG and GS with their warm drug nature could enhance the body's energy metabolism to produce their dryness to the body. The liver Na(+)-K(+)-ATP enzyme activity may be the primary index for indicating the fireness of ginseng. In addition, our results demonstrated that ginseng, especially red ginseng, is not suitable for long time application with a higher dose.