Significant Higher Improvement Research Articles

Residual difference in LDL cholesterol as an indicator of adherence to lifestyle changes during cardiac rehabilitation

Abstract Background Cardiac Rehabilitation can help achieve target LDL by optimization of pharmacological lipid-lowering therapy and lifestyle changes after ST-segment elevation myocardial infarction (STEMI). Purpose To study the characteristics of patients with suboptimal LDL reduction after STEMI in a Phase 2 ambulatory Cardiac Rehabilitation Program (aCRP) and describe the relative contribution of adherence to lifestyle changes to this instance. Methods We studied 41 STEMI patients who completed an exercise-based Phase 2 aCRP. Conventional or cardiopulmonary exercise testing (C/CPET) was performed before and after Phase 2 and peak oxygen consumption (peak VO2) was assessed. Several questionnaires were used to analyse quality of life (SF-36), adherence to Mediterranean diet (PREDIMED), weekly physical activity (IPAQ) and therapeutic adherence (Morisky-Green). Lipid-lowering therapy and LDL were registered before STEMI, at the start of Phase 2, and at the end of Phase 2. At the end of Phase 2, we analysed the difference between measured and theoretical LDL (LDL before STEMI minus expected LDL reduction by prescribed lipid-lowering therapy), which was defined as "residual difference in LDL" (RD-LDL). Comparisons were performed between patients with positive RD-LDL (lower than theoretically expected) and patients with negative RD-LDL (higher than theoretically expected). A p<0.05 was considered statistically significant. Results Mean age of the cohort was 60.1±10.2 years and most patients were male (82.9%). Most patients (n=33, 80.5%) underwent lipid-lowering therapy up-titration during Phase 2 aCRP, and an LDL<55mg/dL target was achieved in 31 (75.6%) patients. During Phase 2 aCRP, 25 (61%) patients depicted higher than expected LDL reduction (negative RD-LDL) and 16 (39%) patients showed lower than expected LDL reduction (positive RD-LDL). Patients with positive RD-LDL reported less weekly physical activity before Phase 2 aCRP (957±1130.34 vs. 2202.3±2749.7 METS/week, p=0.04) and were less likely to achieve LDL<55mg/dL (50% vs. 92%, p=0.002). No differences were found in adherence to Mediterranean diet or pharmacological treatment at the end of Phase 2. However, a significant higher improvement in quality of life (+18.4±29.2 vs. +2.1±17.2 points in SF-36, p=0.03) and in weekly physical activity (4436.4±4116.3 vs. 1557.7±2267.4 METS/week, p=0.02) was noted compared to patients with negative RD-LDL. Peak VO2 increased similarly in both groups at the end of Phase 2 (mean increase of 4.64±5.67 vs. 3.81±3.95 ml/kg/min, p=0.83). Conclusions Up-titration of lipid-lowering therapy is required in most patients throughout our Phase 2 aCRP to achieve target LDL. More than a third of patients showed lower than expected LDL reduction (positive residual difference in LDL), which cannot be attributed to worse adherence to Mediterranean diet, pharmacological treatment, or physical exercise recommendations.Residual difference in LDL cholesterol.

Effects of a biopsychosocial-spiritual group therapy on quality of life among institutionalized older adults with disabilities: A randomized controlled trial.

The traditional biomedical care approach has been unsatisfactory to meet the complex needs of seniors with long-term multimorbidity and irreversible disability, particularly for those living in residential LTC facilities. This study aimed to develop and evaluate the effectiveness of an 8-week biopsychosocial-spiritual (BPS-S) group intervention with the attempt to enhance quality of life (QoL) and meaning in life among senior residents with disability. This single-blind randomized controlled trail was conducted in eight residential LTC facilities. The primary outcome, 'participants' overall and subdomain QoL', and the secondary outcome, 'meaning in life', were repeatedly assessed, including four time points: before, mid- and post-intervention, and at a 1-month follow-up. A generalized linear mixed model (GLMM) was used to assess between-group differences over time. The post-intervention differences indicated significant higher improvement on senior residents' overall and all 4 domains of QoL, as well as their meaning in life, between the baseline and both times of post-intervention and 1-month follow-up. On the other hand, participants' family QoL have improved immediately in the midst of intervention. This study provides preliminary evidence to support the feasibility and effectiveness of an 8-week BPS-S group therapy. We recommend the BPS-S be integrated into routine institutional care activities to help maximize senior residents' own capacity for self-healing, achieve a state of harmonious balance between body, mind, social and spiritual relationships; and in turn, enhance holistic health of this group.

Role of Interventional Radiology in Management of Chronic Shoulder Pain

Abstract Background: The shoulder pain is a frequent musculoskeletal condition in the overall population, with incidence of 6.7 –66.7 percent. Aim of the work: The aim of this research was to estimate the interventional radiology role in management of chronic shoulder pain. The Patients and Methods: This prospective study included (60) patients with chronic shoulder pain. Regional injection had been done guided by ultrasound, fluoroscopy &/or CT for e.g: hydrodilatation of the gleno-humeral capsule, hydro-dissection of the subacromial bursa, neurolysis of suprascapular & subaxillary nerves. Results: The full technique has a significant higher improvement in VAS, ROM and SPADI than partial technique. High volume injection has a significant higher improvement in VAS, ROM and SPADI than Low volume injection. Intra-articular injection has a significant higher improvement in VAS, ROM and SPADI than Extra-articular injection. Conclusion: We can conclude that interventional radiology has an effective role in chronic shoulder pain treatment.

Left ventricular remodelling and prognosis after discharge in new-onset acute heart failure with reduced ejection fraction.

AimsThis study aimed to investigate the left ventricular (LV) remodelling and long‐term prognosis of patients with new‐onset acute heart failure (HF) with reduced ejection fraction who were pharmacologically managed and survived until hospital discharge. We compared patients with ischaemic and non‐ischaemic aetiology.Methods and resultsThis cohort study consisted of 111 patients admitted with new‐onset acute HF in the period 2008–2016 [62% non‐ischaemic aetiology, 48% supported by inotropes, vasopressors, or short‐term mechanical circulatory devices, and left ventricular ejection fraction (LVEF) at discharge 28% (interquartile range 22–34)]. LV dimensions, LVEF, and mitral valve regurgitation were used as markers for LV remodelling during up to 3 years of follow‐up. Both patients with non‐ischaemic and ischaemic HF had significant improvement in LVEF (P < 0.001 and P = 0.004, respectively) with significant higher improvement in those with non‐ischaemic HF (17% vs. 6%, P < 0.001). Patients with non‐ischaemic HF had reduction in LV end‐diastolic and end‐systolic diameters (6 and 10 mm, both P < 0.001), but this was not found in those with ischaemic HF [+3 mm (P = 0.09) and +2 mm (P = 0.07), respectively]. During a median follow‐up of 4.6 years, 98 patients (88%) did not reach the composite endpoint of LV assist device implantation, heart transplantation, or all‐cause mortality, with no difference between with ischaemic and non‐ischaemic HF [hazard ratio 0.69 (95% confidence interval 0.19–2.45)].ConclusionsPatients with new‐onset acute HF with reduced ejection fraction discharged on optimal medical treatment have a good prognosis. We observed a considerable LV remodelling with improvement in LV function and dimensions, starting already at 6 months in patients with non‐ischaemic HF but not in their ischaemic counterparts.

Using Flipped Learning Model in Teaching English Language among Female English Majors in Majmaah University

This study aims at investigating the effect of using Flipped Learning Model in teaching English language among female English majors in Majmaah University on their achievement in two different English courses and identifying their feelings and satisfaction about flipping their classes. The study used a pre-post test design and included two experimental groups (n=62). A comparison of students’ scores in pre and post experimentation were carried to identify the effect of the model and size of improvement in students’ achievement. An analysis of students’ responses to an online questionnaire was conducted to reveal their feelings towards the flipped model. Results affirmed the hypotheses of the study and there was a significant higher improvement in students’ scores in post-tests. Students also favored the flipped learning model and had positive feelings towards it.

Application of the systematized health education in nursing for pulmonary tuberculosis disease patients

Objective To study the clinical nursing experiences for pulmonary tuberculosis patients and explore the application value of the systematization health education for the nursing measures. Methods 40 cases of pulmonary tuberculosis were selected and randomly divided into the observation group and the control group, 20 cases for each group, the control group used conventional health nursing method, while the observation group implemented the systematized health education based on control group' s nursing foundation, through multiaspect education methods as well as system' s education content (in hospital, during hospitalization, discharge from hospital), all patients should be investigated the pulmonary tuberculosis disease knowledge situation 6 months before and after discharge from hospital. Results Through the systematized health education, compared to the control group, the observation group patients had significant higher improvement in understanding pulmonary tuberculosis knowledge, obeying the doctors'advices, and the latter 6-month-long clinical curative effect after discharge from hospital. Conclusion With the systematized health education carrying on the health education to pulmonary tuberculosis patients, we may not only enhance patients' understanding pulmonary tuberculosis knowledge rate, promoting their obeying the medicaladvice,but may also raise the cure rate and their degree of satisfaction. Key words: Pulmonary tuberculosis; Systematization; Health education; Nursing

L’arthroscopie du coude

This symposium of the French Arthroscopic Society is the 2005 state of the art of elbow arthrosocpy in France. A survey reports 499 cases during 2 years with a rate of complication higher than the arthroscopies of other joints (6% of minor and 1% of major complications). The main indication is the removal of loose bodies. They can come from arthritis, chondromatosis, osteochondritis or fracture. The most accurate radiologic examination is an arthroCTscan. The main pronostic factor is the cartilage status. Arthrolysis is the second indication. We performed a retrospective and a prospective studies to compare open and arthroscopic surgery. Results are almost similar with a significant higher improvement in flexion (7°) in the open group. Open surgery seems more efficient but with a franck loss of motion in the postoperative course. However, in this group elbows were preoperatively stiffer in relation with a trauma event instead of sport related microtrauma in the arthroscopically treated group. Removal of necrotic fragment combined with abrasion in osteochondritis of the capitulum yelds to good results with 82% of patients resuming to sports. Long term prognosis is unknown as the joint line is narrowed at a 3 years follow up. Arthroscopy is usefull in synovial diseases as resection of synovial folds or removal of tumors like villonodular synovitis. In the treatment of epicondylitis, the results of our retrospective study are not so good as those reported in the literature. But in our comparative study the results are similar to the open surgery group. The numerous procedures and the different follow up in these two groups did not allow to give statistical analysis. Elbow arthroscopy is a hyper specialty with more and more advanced procedures.

Motor and functional recovery in patients with post-stroke depression

Purpose: Depression is very common following stroke. Correlation between post-stroke depression (PSD) and functional outcome has been shown, but differential impact both on functional and motor recovery has not been deeply investigated. This study evaluates the influence of PSD on motor and functional outcome.Method: One hundred and seventeen acute stroke patients were selected in an intensive rehabilitation department, and divided into two groups according to the presence of PSD (PSD + and PSD −). Screening measures were DSM-IV criteria, the Geriatric Depression Scale and the Cornell Scale. Outcomes were evaluated on the basis of the Barthel Index (BI) and the Fugl – Meyer Assessment Scale (FMA). Measurements were performed at admission to the department (T1), discharge (T2) and follow up (T3) in a whole period of 3 months from stroke.Results: Both groups showed a significant improvement in all outcome measures. Improvement differences were not significant on FMA scores in either group at each assessment; the PSD group had a significant higher improvement on BI score at follow-up. According to the logistic model, from T1 to T2 and from T1 to T3, only motor recovery shows a significant relation with functional recovery; from T2 to T3 PSD is the only significant factor related to functional recovery.Conclusions: PSD is not an influencing factor for motor recovery. Results show a negative impact of PSD on the functional recovery process after discharge and not during hospitalisation. Discharge appears to be a critical step for management of PSD.