Eneida Rejane Rabelo-Silva

Lifestyle interventions reduce cardiovascular risk in patients with coronary artery disease: A randomized clinical trial

Background: Nurse-led interventions have proven beneficial to reduce estimated cardiovascular risk. Aim: The purpose of this study was to evaluate the effect of systematic, nurse-led individual lifestyle counseling sessions on the reduction of 10-year cardiovascular risk scores in patients with coronary artery disease (CAD). Methods: This was a randomized clinical trial of CAD patients treated at a tertiary referral hospital. The intervention group received nurse-led guidance by means of five face-to-face sessions and telephone contact over the course of one year, starting three months after hospital discharge. Exercise and dietary goals were set for each patient and monitored at each session. The control group received standard medical advice. Patients were stratified by Framingham risk score and compared at the end of the follow-up period. Results: The final sample comprised 74 patients, 38 in the intervention group and 36 in the control group. Mean age was 58±9 years; 74% of patients were male. A 1.7 point (−13.6%) reduction in risk score was recorded in the intervention group, vs a 1.2 point increase in risk score (+11%) in the control group (p=0.011). Significant between-group differences were detected for weight (intervention, 78±14 kg at baseline vs 77±14 kg at study end; control, 78±15 kg vs 79±15 kg; p=0.04), systolic blood pressure (intervention, 136±22 mm Hg vs 124±15 mm Hg; control, 126±15 mm Hg vs 129±16 mm Hg; p=0.005), and diastolic blood pressure (intervention, 82±10 mm Hg vs 77±09 mm Hg; control, 79±09 mm Hg vs 80±10 mm Hg; p=0.02). Conclusion: Structured and systematic nurse-led lifestyle counseling effectively reduced cardiovascular risk score.

Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC

OBJECTIVE The objective of the study is to evaluate the effectiveness of nursing interventions (NIC) using nursing outcomes (NOC) and based on NANDA-I nursing diagnoses in patients with heart failure in home care. METHOD In this longitudinal study, 23 patients with heart failure were followed for 6 months, in four home visits. During the visits, nursing diagnoses were established, outcomes assessed, and interventions implemented. RESULTS Of the 11 NIC interventions implemented, eight proved effective, that is, showed significant improvement between the first and the fourth visit, according to scores obtained for six outcomes: knowledge: treatment regimen, knowledge: medication, compliance behavior, symptom control, activity tolerance, and energy conservation. CONCLUSION NIC interventions health education, self-modification assistance, behavior modification, teaching: prescribed medication, teaching: disease process, nutritional counseling, telephone consultation, and energy conservation showed effective outcomes based on NOC scores, suggesting that the NANDA-I, NIC, and NOC linkage is useful in patients with heart failure in home care.

Dynamic changes in bioelectrical impedance vector analysis and phase angle in acute decompensated heart failure

OBJECTIVES To evaluate whether changes in hydration status (reflecting fluid retention) would be detected by bioelectrical impedance vector analysis (BIVA) and phase angle during hospitalization for acute decompensated heart failure (ADHF) and after clinical stabilization. METHODS Patients admitted to ADHF were evaluated at admission, discharge and after clinical stabilization (3 mo after discharge) for dyspnea, weight, brain natriuretic peptide, bioelectrical impedance resistance, reactance, and phase angle. Generalized estimating equations and chi-square detected variations among the three time points of evaluation. RESULTS Were included 57 patients: Mean age was 61 ± 13 y, 65% were male, LVEF was 25 ± 8%. During hospitalization there were improvements in clinical parameters and increase in resistance/height (from 250 ± 72 to 302 ± 59 Ohms/m, P < 0.001), reactance/height (from 24 ± 10 to 31 ± 9 Ohms/m, P < 0.001), and phase angle (from 5.3 ± 1.6 to 6 ± 1.6°, P = 0.007). From discharge to chronic stability, both clinical and BIVA parameters remained stable. At admission, 61% of patients had significant congestion by BIVA, and they lost more weight and had higher improvement in dyspnea during hospitalization (P < 0.05). At discharge, more patients were in the upper half of the graph (characterizing some degree of dehydration) while at chronic stability normal hydration status was more prevalent (P < 0.001). CONCLUSIONS BIVA and phase angle were able to detect significant changes in hydration status during ADHF, which paralleled the clinical course of recompensation, both acutely and chronically. The classification of congestion by BIVA at admission identified patients with more pronounced changes in weight and dyspnea during compensation.

Relationship between vascular endothelium and periodontal disease in atherosclerotic lesions: Review article

Inflammation and endothelial dysfunction are linked to the pathogenesis of atherosclerotic disease. Recent studies suggest that periodontal infection and the ensuing increase in the levels of inflammatory markers may be associated with myocardial infarction, peripheral vascular disease and cerebrovascular disease. The present article aimed at reviewing contemporary data on the pathophysiology of vascular endothelium and its association with periodontitis in the scenario of cardiovascular disease.

Effect of nitrate withdrawal on quality of life and adherence to treatment in patients with stable angina: evidence from a randomized clinical trial.

BackgroundLong-term nitrate treatment of stable angina is associated with side effects that can interfere with health-related quality of life (HRQoL) and medication adherence. The aim of the present study was to compare HRQoL and adherence to treatment in patients with stable angina undergoing nitrate withdrawal or maintenance. MethodsThis study is a randomized clinical trial. Patients were allocated to an intervention group (nitrate withdrawal followed by introduction of placebo) or a control group (nitrate maintenance). The assessments were made at baseline and 30 and 120 days using the Short Form Health Survey and the Seattle Angina Questionnaire. Treatment adherence was measured on the basis of the Morisky scale and pill count. ResultsA total of 105 patients with stable angina were randomized for replacement of nitrate with placebo (n=51) and for maintenance of treatment with nitrate (n=54). After 4 months, Short Form Health Survey scores increased for bodily pain (P=0.005) and general health (P=0.004) in the nitrate maintenance group. Decreased Seattle Angina Questionnaire scores were also noted for physical limitations (P=0.039) and angina frequency (P=0.011) in the nitrate maintenance group. However, the effect size was small (⩽0.44) when the intervention and control groups were compared. At the end of the study, adherence was significantly higher in the placebo group (P=0.041), but no difference was detected between the groups with the pill count method. ConclusionHRQoL was similar in patients with stable angina using nitrate regularly as compared with patients undergoing nitrate withdrawal. However, adherence to treatment was lower in nitrate users according to the Morisky scale.

A nurse-based strategy reduces heart failure morbidity in patients admitted for acute decompensated heart failure in Brazil: the HELEN-II clinical trial

Home‐based interventions for heart failure (HF) patients might be particularly effective in middle‐income countries, where social, cultural, and economic constraints limit the effectiveness of HF treatment outside the hospital environment.

The effect of periodontal therapy on C-reactive protein, endothelial function, lipids and proinflammatory biomarkers in patients with stable coronary artery disease: study protocol for a randomized controlled trial

BackgroundScarce information exists regarding the preventive effect of periodontal treatment in the recurrence of cardiovascular events. Prevention may be achieved by targeting risk factors for recurrent coronary artery disease (CAD) in patients with previous history of cardiovascular events. The aim of this trial is to compare the effect of two periodontal treatment approaches on levels of C-reactive protein, lipids, flow-mediated dilation and serum concentrations of proinflammatory and endothelial markers in stable CAD patients with periodontitis over a period of 12 months.Methods/designThis is a randomized, parallel design, examiner blinded, controlled clinical trial. Individuals from both genders, 35 years of age and older, with concomitant diagnosis of CAD and periodontitis will be included. CAD will be defined as the occurrence of at least one of the following events 6 months prior to entering the trial: documented history of myocardial infarction; surgical or percutaneous myocardial revascularization and lesion >50% in at least one coronary artery assessed by angiography; presence of angina and positive noninvasive testing of ischemia. Diagnosis of periodontitis will be defined using the CDC-AAP case definition (≥2 interproximal sites with clinical attachment loss ≥6 mm and ≥1 interproximal site with probing depth ≥5 mm). Individuals will have to present at least ten teeth present to be included. One hundred individuals will be allocated to test (intensive periodontal treatment comprised by scaling and root planing) or control (community periodontal treatment consisting of one session of supragingival plaque removal only) treatment groups. Full-mouth six sites per tooth periodontal examinations and subgingival biofilm samples will be conducted at baseline, 3, 6 and 12 months after treatment. The primary outcome of this study will be C-reactive protein changes over time. Secondary outcomes include levels of total cholesterol, LDL-C, HDL-C, triglycerides, IL-1β, IL-6, TNFα, fibrinogen, ICAM-1, VCAM-1 and E-selectin. These outcomes will be assessed at all time points over 12 months. Flow-mediated dilation will be assessed at baseline, 1, 3 and 6 months after periodontal therapy.DiscussionThis trial will provide new evidence regarding the effect of periodontal treatment on risk markers for recurrence of cardiovascular events in stable coronary artery disease patients.Trial registration numberClinicalTrials.gov Identifier, NCT01609725

Predictors of Better Self-Care in Patients with Heart Failure after Six Months of Follow-Up Home Visits

This study aimed to examine the predictors of better self-care behavior in patients with heart failure (HF) in a home visiting program. This is a longitudinal study nested in a randomized controlled trial (ISRCTN01213862) in which the home-based educational intervention consisted of a six-month followup that included four home visits by a nurse, interspersed with four telephone calls. The self-care score was measured at baseline and at six months using the Brazilian version of the European Heart Failure Self-Care Behaviour Scale. The associations included eight variables: age, sex, schooling, having received the intervention, social support, income, comorbidities, and symptom severity. A simple linear regression model was developed using significant variables (P ≤ 0.20), followed by a multivariate model to determine the predictors of better self-care. One hundred eighty-eight patients completed the study. A better self-care behavior was associated with patients who received intervention (P < 0.001), had more years of schooling (P = 0.016), and had more comorbidities (P = 0.008). Having received the intervention (P < 0.001) and having a greater number of comorbidities (P = 0.038) were predictors of better self-care. In the multivariate regression model, being in the intervention group and having more comorbidities were a predictor of better self-care.

Home-based nursing interventions improve knowledge of disease and management in patients with heart failure

OBJETIVO: verificar el conocimiento de los pacientes sobre insuficiencia cardiaca mediante dos Resultados de Enfermeria en ambiente domiciliario durante un seguimiento de seis meses y correlacionar el promedio de sus indicadores con un Cuestionario de Conocimiento sobre insuficiencia cardiaca.METODOS: en este estudio tipo antes-despues, pacientes con insuficiencia cardiaca recibieron cuatro visitas en domicilio durante un periodo de seis meses tras el alta hospitalario. En cada visita fueron implementadas Intervenciones de Enfermeria, mensurados los Resultados y aplicado el Cuestionario del Conocimiento.RESULTADOS: veinte y tres pacientes recibieron visitas en domicilio. En la visita 1, el Resultado Conocimiento: Medicacion alcanzo promedio de 2,27±0,14 y, en la visita 4 3,55±0.16 (P<0,001), y el Resultado Conocimiento: Regimen Terapeutico 2,33±0,13 en la visita 1 y 3,59±0,14 en la visita 4 (P<0,001). La correlacion entre el Cuestionario del Conocimiento y los scores de la Clasificacion de los Resultados de Enfermeria fue de magnitud fuerte en la visita en domicilio 1 (r=0.7, P<0,01), pero debil y no significativa en la visita 4.CONCLUSION: los resultados indicaron mejora del conocimiento sobre insuficiencia cardiaca y correlacion fuerte entre la Clasificacion de los Resultados de Enfermeria y los scores del Cuestionario del Conocimiento. La Clasificacion de los Resultados de Enfermeria se mostro efectiva en la evaluacion del conocimiento cuando comparados al instrumento validado.OBJECTIVE: to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire. METHODS: in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered. RESULTS: overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001); and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001). The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01), but weak and non significant at visit 4. CONCLUSION: the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument.

Validation of the quality of diagnoses, interventions, and outcomes (Q-DIO) instrument for use in Brazil and the United States

Purpose To assess the reliability and validity of Quality of Diagnoses, Interventions, and Outcomes (Q-DIO) in Brazil and in the United States. Methods The sample comprised 180 records: centers 1 (electronic records and standardized language) and 2 (paper-based records without standardized language in Brazil, and center 3 (electronic records without standardized language) in the United States. Reliability and discriminant construct validity was analyzed. Findings Cronbachs alpha for all 29 Q-DIO items were greater than or equal to 0.70 for all centers; construct validity was significantly different between the three study centers. Conclusions These results indicate that Q-DIO is valid and reliable for assessing the quality of nursing records. Implications for Nursing Practice The Q-DIO may be useful to assess the quality and accuracy of nursing records.PURPOSE To assess the reliability and validity of Quality of Diagnoses, Interventions, and Outcomes (Q-DIO) in Brazil and in the United States. METHODS The sample comprised 180 records: centers 1 (electronic records and standardized language) and 2 (paper-based records without standardized language in Brazil, and center 3 (electronic records without standardized language) in the United States. Reliability and discriminant construct validity was analyzed. FINDINGS Cronbachs alpha for all 29 Q-DIO items were greater than or equal to 0.70 for all centers; construct validity was significantly different between the three study centers. CONCLUSIONS These results indicate that Q-DIO is valid and reliable for assessing the quality of nursing records. IMPLICATIONS FOR NURSING PRACTICE The Q-DIO may be useful to assess the quality and accuracy of nursing records.