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To critically assess the impact of theory-guided positive psychological interventions on the quality of life of breast cancer patients and survivors.
Systematic review and meta-analysis.
A comprehensive literature search was conducted across seven electronic databases from inception to August 2024. Randomised controlled trials that examined the effects of theory-guided positive psychological interventions on adult breast cancer patients or survivors and reported quality of life outcomes were included. Screening, data extraction and critical appraisal were independently performed by the reviewers using the revised Cochrane risk-of-bias tool (RoB2). A meta-analysis was conducted using RevMan Web. The study was reported following the PRISMA 2020 Statement.
Five randomised controlled trials were included. Only two of these studies showed a low risk of bias across all quality measures. The meta-analysis demonstrated a significant improvement in quality of life following theory-guided positive psychological interventions, with low heterogeneity. Subgroup analyses revealed that interventions lasting either less than or longer than 3 weeks, and both group-based and individual-based formats, had positive effects on quality of life. Additional psychological benefits were observed including reductions in depressive symptoms, anxiety, perceived stress and improvements in post-traumatic growth, resilience, hope and perceived benefits. One study also reported improvements in sleep quality.
The findings demonstrate that theory-guided positive psychological interventions can potentially significantly improve quality of life in breast cancer patients. However, the limited number of studies underscores the need for further high-quality research to validate these findings and identify the most effective intervention characteristics.
Our systematic review highlights that theory-guided positive psychological interventions show promise as an effective strategy for improving the quality of life in breast cancer patients. These interventions can enhance psychosocial support strategies, paving the way for better-informed approaches that lead to improved patient outcomes.
No patient or public contribution.
The systematic review and meta-analysis had been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration ID number: CRD42024581382
by Xi Cao, Bi-ting Zhu, Cai-peng Xie, Jing-yue Cai, Ding-guo Dong, Miao-ting Chen, Cheng-zhao Huang, Yong-chun Lin
To explore the risk factors influencing vancomycin trough concentration (Cvg−min) overexposure in critically ill patients with mechanical ventilation and rank the factors, the medical records of 194 mechanically ventilated critically ill patients hospitalized from 12/10/2021–06/10/2024 were analyzed. Among 194 critically ill patients, 77.83% were male and 22.17% were female. Univariate analysis showed that oxygenation index (OI), activated partial thromboplastin time (APTT), urea nitrogen (UN), septic shock, heart disease, congestive heart failure (CHF), moderate/severe chronic kidney disease (CKD), etc. were statistically different (P P P CI) and consistency ratio (CR) of analytic hierarchy process (AHP) was 0.0796 and 0.0885, respectively, which meets the consistency test standard. The contributions of APTT, OI, CHF and moderate to severe CKD to the overexposure of Cvg−min were 0.0584, 0.1899, 0.1614 and 0.5902, respectively. The overexposure rates of Cvg−min in patients with moderate/severe CKD and CHF were 95.12% and 95.23%, respectively. With regard to OI, when the cutoff value of OI was less than 245, the Cvg−min overexposure rate was 83%, otherwise, the overexposure rate was 60.97%. The risk factors for excessive exposure of Cvg−min in critically ill patients with mechanical ventilation were ranked as follows: moderate/severe CKD > OI > CHF > APTT.Disease severity negatively affects health-related quality of life (HRQOL) among people with heart failure (HF). However, the underlying mechanisms remain underexplored. Illness perceptions and depression serve as potential mediators of this relationship, but the evidence supporting this is limited.
To investigate the relationships among disease severity, illness perceptions, depression and HRQOL in people with HF, as well as to explore the mediating roles of illness perceptions and depression in the relationship between disease severity and HRQOL.
People with HF were recruited from a tertiary hospital in China between January and May 2023. All the participants were assessed for disease severity, illness perceptions, depression, HRQOL and sociodemographic and clinical characteristics. The mediation analysis was performed using PROCESS macro in SPSS. The STROBE checklist was followed.
This study recruited 164 subjects. Disease severity had a significant total effect on HRQOL (β = 0.716, 95% CI: 4.475, 12.068). The results showed that illness perceptions mediated the relationship between disease severity and HRQOL (β = 0.172, 95% CI: 0.042, 0.337), accounting for 24.02% of the total effect. However, a significant mediating role of depression in this relationship was not found. Furthermore, we found that illness perceptions and depression sequentially mediated the relationship between disease severity and HRQOL (β = 0.194, 95% CI: 0.005, 0.395), which accounted for 27.09% of the total effect.
The effect of disease severity on HRQOL is sequentially mediated by illness perceptions and depression. Illness perceptions are important predictors of HRQOL. Targeted interventions should be employed to improve illness perceptions, thereby enhancing HRQOL among people with HF.
Medical staff can carefully assess patient's illness perceptions and implement appropriate strategies to enhance these illness perceptions, thereby improving their HRQOL.
No patient or public contribution.
The triglyceride glucose (TyG) index has been confirmed a predictive value for type 2 diabetes mellitus (T2DM). However, no research has yet confirmed whether there is a linear correlation between the TyG index and MACCEs in DFUs. The present study aimed to delve into the association between the TyG index and the risk of MACCEs in patients with DFUs. A total of 960 inpatients with DFUs were recruited. All participants were followed up every 6 months for 11 years with a median of 83 months. According to the cut-off value of the TyG index acquired from receiver operating characteristic (ROC) analysis, the subjects were divided into two groups: low-level (<9.12, n = 480) and high-level (≥9.12, n = 480). The relationship between the TyG index and MACCEs was evaluated by the multivariable Cox regression model, restricted cubic spline (RCS) model, stratified analysis and the Kaplan–Meier survival analysis. Out of 960 participants, 271 experienced MACCEs (28.22%), of whom 79 (29.15%) died. ROC analysis got the optimal TyG index cut-off value of 9.12. Multivariable Cox regression analysis combined with the RCS model showed that the TyG index was positively associated with MACCEs in an S-shaped non-linear dose-dependent manner within the range of TyG index 7.5–9.5 (p < 0.001). The Kaplan–Meier survival analysis indicated the higher the TyG index, the greater the cumulative incidence of MACCEs (log-rank, p < 0.001). The study first confirmed an S-shaped non-linear dose-dependent positive relationship between the TyG index and the risk of MACCEs in DFUs. Consequently, lowering the TyG index level aids in improving the prognosis of patients with DFUs.
This study aims to explore the association between the triglyceride-glucose (TyG) index and all-cause mortality in patients with diabetic foot ulcers (DFUs) through an ambispective cohort study. A total of 555 inpatients with DFUs were qualified to participate in the trial study from 2013 to 2022. Throughout a median 63-month period, all subjects were followed up every 6 months. According to the three quantiles of the TyG index, participants were divided into three groups: low-level (≤8.75, n = 185), moderate-level (8.76–9.33, n = 185) and high-level (≥9.34, n = 185). The association between the TyG index and all-cause mortality in patients with DFUs was then assessed. During the follow-up period, out of 555 patients with DFUs, 116 died (20.9%). After adjusting for confounding factors, the TyG index was positively associated with all-cause mortality in patients with DFUs (HR = 1.733; 95% CI = 1.341–2.241; p < 0.001). Compared with the low-level TyG index, the moderate-level TyG index (HR = 1.685; 95% CI = 1.011–2.810; p = 0.045) and the high-level TyG index (HR = 2.769; 95% CI = 1.678–4.568; p < 0.001) were positively correlated with all-cause mortality in patients with DFUs. Additionally, in subgroup analysis, both females (HR = 1.905; 95% CI = 1.250–2.904; p = 0.003), males (HR = 1.729; 95% CI = 1.240–2.409; p = 0.001), younger (<65 years old) (HR = 1.467; 95% CI = 1.008–2.135; p = 0.046) and elderly (≥ 65) (HR = 1.933; 95% CI = 1.339–2.791; p < 0.001) showed a positive correlation between TyG index and all-cause mortality rate in patients with DFUs. Furthermore, in the high-level TyG index group compared, males (HR = 2.699; 95% CI = 1.457–4.998) and participants aged <65 years (HR = 2.031; 95% CI = 0.972–4.242), with the TyG index level increase by 1.0, the risk for all-cause mortality increased 3.277-fold in females (HR = 4.277; 95% CI = 1.645–11.124) and 1.909-fold in elderly aged ≥65 years (HR = 2.909; 95% CI = 1.486–5.695), respectively. Kaplan–Meier survival curve analysis showed that the higher the TyG index level, the higher risk of all-cause mortality in patients with DFUs (log-rank, all p < 0.001). Briefly, this study implies a strong positive correlation between the TyG index and all-cause mortality in patients with DFUs, especially in older women. Therefore, special attention should be paid to elderly females with DFUs because they have a higher TyG index level and risk of all-cause mortality than other populations in daily clinical practice.
To estimate the effects of nurse-led self-care interventions on people with heart failure (HF).
Research evidence of the effects of nurse-led HF self-care interventions on patient outcomes is scant.
A systematic review and meta-analysis of randomised controlled trials (RCTs).
Six databases (MEDLINE, Embase, Web of Science, CENTRAL, CINAHL and PsycINFO) were searched from the inception to December 2022 to identify eligible studies.
RCTs published in English that evaluated the impact of nurse-led HF self-care interventions on quality of life, anxiety, symptom burden, sleep quality, healthcare service utilisation and mortality were included. The risk of bias in included studies was assessed using RoB 2.0. We conducted data syntheses using the R software and graded the quality of the evidence using the GRADE approach. The systematic review was conducted in accordance with the PRISMA.
Twenty-five studies with 2746 subjects were included. Our findings demonstrated, that compared to the controls, nurse-led self-care interventions improved QOL (SMD: .83, 95% CI: .50–1.15, moderate evidence), anxiety (MD: 1.39, 95% CI: .49–2.29, high evidence) and symptom burden (SMD: .81, 95% CI: .24–1.38, low evidence) in people with HF. No significant effects were found in all-cause hospital readmission and all-cause emergency department visit. Research evidence on sleep quality, cardiac-related hospital readmission, cardiac-related emergency department visit and all-cause mortality remained unclear.
Our review suggests that nurse-led HF self-care interventions have favourable effects on the QOL, anxiety and symptom burden. Further, well-designed RCTs are warranted to address the gaps identified in this review.
The results indicated that nurse-led HF self-care interventions could improve QOL, anxiety and symptom burden in people with HF. Nurse-led self-care intervention could be integrated into current HF management practices.
To develop and validate a behavioural driving model for adherence to home-based cardiac rehabilitation exercise in patients with chronic heart failure, and to explain the potential driving mechanism of social support on exercise adherence.
Despite the benefits of home-based cardiac rehabilitation exercise, adherence among patients with chronic heart failure remains suboptimal. Several factors contributing to adherence have been confirmed; however, the specific pathway mechanisms by which these factors impact exercise adherence have not been thoroughly explored.
An exploratory sequential mixed-methods study was conducted in this study.
A total of 226 patients with chronic heart failure were recruited using convenience sampling. Quantitative data were collected using a series of self-report questionnaires. Hierarchical regression analysis was performed to verify multiple pathways. Subsequently, 12 patients with chronic heart failure were drawn from the quantitative stage. The interview data were thematically analysed. This study followed the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines (Appendix S1).
Perceived social support had a direct positive predictive effect on exercise adherence. Importantly, exercise self-efficacy and exercise fear played a chain-mediating role between perceived social support and exercise adherence. As a result of the qualitative phase, scale, tightness and homogeneity of social support networks emerged as potential drivers of the effectiveness of social support on exercise adherence.
This study reveals a potential pathway mechanism for social support to improve adherence to home-based cardiac rehabilitation exercises. Social support network plays a crucial role in the effect of social support on exercise adherence.
To enhance exercise adherence in home-based cardiac rehabilitation for patients with chronic heart failure, establishing a social support network is recommended. This strategy has the potential to promote exercise self-efficacy and alleviate exercise fear.
None.
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