Polly W.C. Li

Recognition of Atypical Symptoms of Acute Myocardial Infarction: Development and Validation of a Risk Scoring System.

Background: Atypical symptom presentation in patients with acute myocardial infarction (AMI) is associated with longer delay in care seeking and poorer prognosis. Symptom recognition in these patients is a challenging task. Objectives: Our purpose in this risk prediction model development study was to develop and validate a risk scoring system for estimating cumulative risk for atypical AMI presentation. Methods: A consecutive sample was recruited for the developmental (n = 300) and validation (n = 97) cohorts. Symptom experience was measured with the validated Chinese version of the Symptoms of Acute Coronary Syndromes Inventory. Potential predictors were identified from the literature. Multivariable logistic regression was performed to identify significant predictors. A risk scoring system was then constructed by assigning weights to each significant predictor according to their b coefficients. Results: Five independent predictors for atypical symptom presentation were older age (≥75 years), female gender, diabetes mellitus, history of AMI, and absence of hyperlipidemia. The Hosmer and Lemeshow test (&khgr;26 = 4.47, P = .62) indicated that this predictive model was adequate to predict the outcome. Acceptable discrimination was demonstrated, with area under the receiver operating characteristic curve as 0.74 (95% confidence interval, 0.67–0.82) (P < .001). The predictive power of this risk scoring system was confirmed in the validation cohort. Conclusions: Atypical AMI presentation is common. A simple risk scoring system developed on the basis of the 5 identified predictors can raise awareness of atypical AMI presentation and promote symptom recognition by estimating the cumulative risk for an individual to present with atypical AMI symptoms.

Psychometric evaluation of the Symptoms of Acute Coronary Syndromes Inventory in Chinese patients with acute coronary syndromes

Background: A systematic method of symptom assessment in patients with acute coronary syndromes is important for disease recognition and initiation of early treatment. However, such assessment in Chinese people is hindered by the lack of a psychometrically sound instrument. Aims: To develop the Chinese version of the Symptoms of Acute Coronary Syndromes Inventory (SACSI-C) and to evaluate its psychometric properties for Chinese patients. Methods: SACSI was translated from English into Chinese according to Brislin’s model. Its content validity and face validity were evaluated. A sample of 114 acute coronary syndromes patients was recruited from the cardiac units of two hospitals in Hong Kong. The reliability was assessed by one-day test-retest reliability. The known-groups validity was evaluated by its ability to differentiate patients with typical versus atypical symptom presentation in older (≥75 years) and younger (<75 years) groups. Results: The Item-Content Validity Index of the SACSI-C was computed as 0.88–1.00. The Scale-Content Validity Index was computed as 0.99. The intraclass correlation coefficients of all items of the symptom subscale were above 0.75, except for item 16. The kappa values of all items in the symptom location and quality subscales were above 0.663. The test-retest reliability was good. The known-groups validity was evident, as demonstrated by the results of Chi-square test (p=0.007) and logistic regression analysis (odds ratio=2.9, p=0.039), showing that older patients were significantly more likely to have atypical symptom presentation. Conclusion: The psychometric properties of the SACSI-C are satisfactory and could be used to assess acute coronary syndromes symptomatology in Chinese.

The effectiveness of physical exercise on cognitive and psychological outcomes in individuals with mild cognitive impairment: A systematic review and meta-analysis

OBJECTIVE Individuals with mild cognitive impairment (MCI) are at high risk for developing dementia. Physical exercise is a promising intervention for cognitive decline. Systematic reviews regarding the effects of physical exercise on cognitive and psychological outcomes among MCI patients are limited, and a systematic review exploring the effects of exercise modalities on the results has not been conducted. This study evaluated the effects of physical exercise on cognitive and psychological outcomes for MCI patients and attempted to identify which specific modality of exercise is more effective. DESIGN Systematic review and meta-analysis. DATA SOURCES A systematic search of Medline, CINAHL, EMBASE, PsycINFO, SPORTDiscus, and the China National Knowledge Infrastructure was performed. REVIEW METHODS Two reviewers independently assessed the study quality using the Effective Public Health Practice Project Quality Assessment Tool. Meta-analysis was conducted when data were available, with further subgroup analyses for exercise types. A series of sensitivity analyses were conducted to explore the influence of study quality and control types on the primary outcome. A narrative analysis was performed when statistical synthesis was inappropriate. RESULTS Eleven studies met the inclusion criteria. The exercise interventions can be classified into three types: (a) aerobic exercise, (b) resistance exercise, and (c) multi-modal exercise. Results showed that physical exercise had beneficial effects for global cognition [standard mean difference (SMD) = 0.30, 95% confidence interval (CI): 0.10-0.49, p = 0.002]. Further subgroup analysis demonstrated that aerobic exercise programmes are consistently associated with medium effect size (SMD: 0.54-0.58). However, the effects of physical exercise on domain-specific cognitive function and psychological outcomes in MCI patients remain inconclusive. Results of sensitivity analysis indicated that types of control exert influence on the outcomes. CONCLUSIONS Physical exercise, aerobic exercise in particular, benefits global cognition in MCI patients. The evidence of physical exercise on domain-specific cognitive function and psychological outcomes remains unclear, more trials with rigorous study design are necessary to provide the evidence.

Psychometric evaluation of the Perceived Barriers to Health Care-seeking Decision in Chinese patients with acute coronary syndromes.

OBJECTIVES This study aimed to develop the Chinese version of the Perceived Barriers to Health Care-seeking Decision (PBHSD-C) and evaluate its psychometric properties in Chinese patients with acute coronary syndromes (ACS). BACKGROUND The assessment of the level of perceived barriers in the care-seeking trajectory of ACS patients is important for the understanding of its impact on pre-hospital delay in seeking care. METHODS The psychometric properties of PBHSD-C were evaluated among 114 ACS patients in the cardiac unit of two major hospitals in Hong Kong. RESULTS The Content Validity Indexes were ranged from .88 to 1. The Cronbachs alpha of the PBHSD-C was .74. The intraclass correlation coefficients of all items were above .80. The convergent validity of the PBHSD-C was also supported. CONCLUSION The PBHSD-C is reliable and valid to be used to assess the level of perceived barriers in the care-seeking of Chinese patients with ACS.

Testing a Model to Reveal the Predictive Mechanism of Care-Seeking Decisions Among Patients With Acute Myocardial Infarction.

Background: Extensive research has been conducted to examine the factors affecting care-seeking decisions in patients with acute myocardial infarction (AMI). Such a decision-making process is multifactorial, and its underlying mechanism is yet to be determined. Objectives: Our aim was to test a theoretically integrated model to identify the mechanisms underlying patients’ care-seeking decisions in the context of AMI. Methods: On the basis of both empirical and theoretical evidence, we proposed that patients’ care-seeking decisions are driven by 2 sequential perceptual-cognitive processes concerned with illness labeling and interpretation, as well as the contextual influences of perceived barriers to care seeking and cues from others. A sample of 301 patients was recruited to test this model using structural equation modeling. Results: The model testing revealed good fit with the data (&khgr;2 = 38.48, df = 30, P = .72; root-mean-square error of approximation = 0.03, normed fit index = 0.96, nonnormed fit index = 0.98, and comparative fit index = 0.99) and explained 46% of the variance in AMI care-seeking delay. Successful action relied on whether patients could correctly attribute the symptom experience to AMI, were aware of their own susceptibility to the condition, and had a good understanding of how the disease manifested itself. Lowering perceived barriers and positive cues from others in advising care seeking played favorable roles to promote care-seeking behaviors. Conclusions: This integrative theoretical model is shown to be valid in explaining care-seeking delay among AMI patients and can guide the development of interventions to promote appropriate care-seeking behaviors among high-risk individuals.

Self-care among older Chinese people with chronic heart failure： the roles of cognitive and psychosocial characteristics

Chronic heart failure (CHF) is a complex clinical syndrome resulting from inefficient myocardial pumping, and is characterised by a typical progressively deteriorating trajectory punctuated by serious episodes of acute disease decompensation.[1] High prevalence of hospital admission has been reported.[2] However, around 40% of hospital admissions was avoidable if patients demonstrate consistent self-care.[3],[4]

Factors in the prioritization of information needs among Hong Kong Chinese breast cancer patients

Objective: The study aims to examine the prioritization of information needs in breast cancer patients, using the Information Needs Questionnaire (INQ); and to identify the demographic and clinical characteristics associated with that prioritization. Methods: A cross-sectional exploratory study was conducted, by means of consecutive sampling. The INQ was used to examine participants′ preferences on information needs. Their demographic and clinical characteristics were collected by means of a structured questionnaire and review of medical records. Backward multivariable logistic regression analysis was performed to examine the association between prioritization of patients′ information needs and their demographic and clinical characteristics. Results: A total of 275 breast cancer patients took part in the analysis. Of the nine INQ items, most participants ranked as their top four needs information about the likelihood of a cure (79%), extent of the disease (76%), treatment options (55%), and family risk of developing breast cancer (51%). Certain demographic and clinical characteristics-religious belief, whether living alone or not, household income, educational level, and time since cancer diagnosis-influenced patients′ prioritization of information needs. Conclusion: Understanding and meeting the information needs of breast cancer patients are crucial to improving their quality of care. Different patients are likely to have different priorities in information needs according to their demographic and clinical characteristics. An awareness of these associated factors will allow better tailor-made educational interventions to be provided to meet patients′ individual needs in a more adequate way.

The association between depression and mild cognitive impairment: A cross-sectional study

Mild cognitive impairment (MCI) and depression are common conditions affecting older adults. Recent studies that examined whether depression is associated with MCI obtained inconsistent results. This inconsistency may be due to the heterogeneity of sample characteristics and the variations of covariates controlled across studies. Accordingly, this study investigated the independent relationship between MCI and depression in a population‐based sample after comprehensively controlling for sociodemographic, health‐related, and lifestyle‐ related factors. Female 1.305 0.654‐2.602 .450 Lower education (illiterate and primary school) 1.958 0.988‐3.879 .054

22 Supportive cardiology: an innovative practice model to integrate palliative care into the management of advanced heart failure

Despite advances in evidence-based treatment to improve survivorship of patients with heart failure, the progressive deteriorating disease trajectory results in an expanding cohort of patients with advanced disease stage. Patients with advanced heart failure experience persistent physical and psychosocial symptoms despite optimal medical therapy. Frequent disease exacerbations require repeated hospitalisations, which heavily reduce the quality of life of patients and their families, and burden the healthcare system. The World Health Organisation advocates palliative care to improve the quality of life of patients with life-limiting diseases. However, palliative care is under-used in heart failure patients. Heart failure is characterised by its unpredictable progression and blurred boundaries between curative and palliative therapy. Therefore, international guidelines advocate an urgent need for a new care model to introduce supportive and palliative care early and gradually along the disease trajectory, overlapping and complementing active curative therapy. Preliminary research evidence is emerging to support the beneficial effects of palliative care interventions on symptom burden, quality of life and hospital service utilisation among patients with advanced heart failure. However, most of the studies focused on separate consultation by physicians or nurses, rather than an integrated heart failure and palliative care service, or providing transitional care in addition to the hospital-based palliative care service. There is no study examining the effects of integration of palliative care into heart failure management. A nurse-coordinated integrated heart failure-palliative care model is proposed.

Predictors of pre-hospital delay in Hong Kong Chinese patients with acute myocardial infarction

Background: The pre-hospital delay to seek care remains the most significant barrier for effective management of acute myocardial infarction. Many of the previous studies mainly took place in Western countries. Few data are available about the care-seeking behavior of Hong Kong Chinese. Aim: The purpose of this study was to identify the predictors of pre-hospital delay in care seeking among Hong Kong Chinese patients with acute myocardial infarction. Methods: Adult Chinese patients (n=301) with a confirmed diagnosis of acute myocardial infarction were recruited from the cardiac units of three regional hospitals in Hong Kong. Various socio-demographic, clinical, symptom presentation characteristics and patient perceptual factors were considered as potential predictors. Multivariate analysis was conducted to identify the independent predictors with pre-hospital delay in care-seeking among acute myocardial infarction patients. Results: Perceived barriers to care seeking constituted the most significant predictor for longer pre-hospital delay in acute myocardial infarction patients. Female gender was also significant in predicting longer delay, whereas a greater extent of symptom congruence and a greater extent of typical symptom presentation were significantly associated with a shorter delay. The final model accounted for 49.6% of the variance in pre-hospital delay as a whole. Conclusion: The most prominent predictors of pre-hospital delay are modifiable in nature, including the perceived barriers to care seeking and symptom congruence. Other sociodemographic and clinical factors also influence patients’ decision. Although these are non-modifiable, our findings provide important insight for educating high-risk individuals.