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Delirium is one of the most common and serious complications after cardiac surgery with cardiopulmonary bypass (CPB). A comprehensive assessment of independent risk factors for postoperative delirium (POD) is essential for early detection and prevention.
To investigate the incidence and independent associated factors of POD in adults undergoing cardiac surgery with CPB.
Prospective cohort design.
A total of 203 patients were enrolled in this study from October 2022 to December 2023 in China. Richmond agitation and sedation scale (RASS) and confusion assessment method-intensive care unit (CAM-ICU) were used for assessing delirium symptom. This study analysed various factors for POD, including demographic, physical, psychological, social, spiritual and environmental aspects. Using logistic regression analysis to identify the independent associated factors.
A totla of 60.1% (n = 122) of patients had POD. Of these cases, 86 (70.5%) were hypoactive delirium, 4 (3.3%) were hyperactive delirium and 32 (26.2%) were mixed delirium. Advanced age (OR = 1.069, 95% confidence interval [CI]: 1.031–1.107; p < 0.001), preoperative depression (OR = 1.847, 95% CI: 1.246–2.736; p = 0.002), postoperative albumin level (OR = 0.921, 95% CI: 0.851–0.997; p = 0.042) and duration of mechanical ventilation (OR > 1.000, 95% CI: 1.000–1.001; p < 0.001) were independent predictors of POD.
The incidence of POD in patients undergoing cardiac surgery with CPB was high. This study identified advanced age, preoperative depression, postoperative albumin level and duration of mechanical ventilation as significant and independent predictors of POD.
The study's findings highlight the urgent necessity for improved clinical vigilance and proactive management strategies.
No patient or public contribution.
The purpose of this study was to explore the relationship between symptom clusters and self-management among maintenance haemodialysis (MHD) patients.
MHD patients experience disease progression and multiple symptom burdens that severely impact quality of life, and self-management of symptoms may significantly improve patient-reported outcomes.
A cross-sectional study.
This cross-sectional descriptive study included 194 patients undergoing MHD. The patients were assessed using the Dialysis Symptom Index (DSI) and the Haemodialysis Self-Management Instrument (HD-SMI). We used descriptive analysis, exploratory factor analysis, Pearson's correlation analysis and linear regression analysis to examine (1) the level of individual self-management, (2) the presence of symptom clusters by symptom severity and (3) the correlation between symptom clusters and self-management behaviours. This study was conducted in accordance with the STROBE checklist.
The top five most severe symptoms among the patients were itching, feeling tired or lack of energy, difficulty sleeping, dry mouth and dry skin. We identified five groups of symptoms: (1) poor sleep, (2) neuromuscular, (3) gastrointestinal, (4) skin irritation and (5) psychological. In the present study, MHD patients reported low to moderate levels of self-management behaviours (50.84 ± 10.56), and low self-management ability was correlated with greater severity of the five symptom clusters (p < 0.01). Linear regression analysis revealed that all five symptom clusters were included in the regression equation, explaining 30% of the total variance in self-management skills among MHD patients.
Enhanced awareness of symptom clusters and comprehensive symptom management are necessary to improve patients' quality of life.
Nursing practices should incorporate comprehensive symptom assessments to help patients develop effective self-management strategies to improve quality of life.
Chronic obstructive pulmonary disease (COPD) causes airflow blockage and breathing-related issues. This chronic disease impacts people worldwide. Substantial evidence supports the use of cognitive behavioral therapy (CBT) to help patients with chronic illnesses cope with worrisome and painful symptoms. However, the impact of CBT on COPD outcomes is less understood.
In this study, we systematically summarized the effects of CBT on lung function, anxiety and depressive symptoms, and quality of life of patients with COPD.
Six English-language and four Chinese-language databases were systematically searched for relevant randomized controlled trials published through April 15, 2023. Studies in which CBT was the only difference in treatment administered to experimental and control groups were included in the review. The studies' risk of bias was evaluated using the Cochrane Criteria.
Sixteen studies (1887 participants) were included. The meta-analysis showed that CBT improved the percent-predicted forced expiratory volume in 1 second (FEV1%), forced vital capacity (FVC), FEV1/FVC ratio, maximal voluntary ventilation, peak expiratory flow, treatment compliance, and World Health Organization abbreviated quality of life, Self-rating Anxiety and Depression Scale, and St George's Respiratory Questionnaire scores compared with the control (all p < .05).
This review demonstrated that CBT improves the lung function, anxiety and depressive symptoms, treatment compliance, and quality of life of patients with COPD and can be used widely in the clinical treatment of this disease.
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