Rhayun Song

Effects of Tai Chi Exercise on glucose control, neuropathy scores, balance, and quality of life in patients with type 2 diabetes and neuropathy.

PURPOSE The aim of this study was to determine the effects of Tai Chi exercise on glucose control, neuropathy scores, balance, and quality of life in patients with type 2 diabetes and neuropathy. METHODS A pretest-posttest design with a nonequivalent control group was utilized to recruit 59 diabetic patients with neuropathy from an outpatient clinic of a university hospital. A standardized Tai Chi for diabetes program was provided, which comprised 1 hour of Tai Chi per session, twice a week for 12 weeks. Outcome variables were fasting blood glucose and glycosylated hemoglobin for glucose control, the Semmes-Weinstein 10-g monofilament examination scores and total symptom scores for neuropathy, single leg stance for balance, and the Korean version of the SF-36v2 for quality of life. Thirty-nine patients completed the posttest measures after the 12-week Tai Chi intervention, giving a 34% dropout rate. RESULTS The mean age of the participants was 64 years, and they had been diagnosed with type 2 diabetes for more than 12 years. The status was significantly better for the participants in the Tai Chi group (n=20) than for their control (i.e., nonintervention) counterparts (n=19) in terms of total symptom scores, glucose control, balance, and quality of life. CONCLUSION Tai Chi improved glucose control, balance, neuropathic symptoms, and some dimensions of quality of life in diabetic patients with neuropathy. Further studies with larger samples and long-term follow-up are needed to confirm the effects of Tai Chi on the management of diabetic neuropathy, which may have an impact on fall prevention in this population.

The cost-effectiveness of a special care unit to care for the chronically critically ill.

To assess the relative value of healthcare programs, technologic innovations, and clinical decisions, policymakers are searching for ways to evaluate cost-effectiveness. What constitutes cost-effectiveness and how should it be measured? The authors discuss ways in which the cost-effectiveness of clinical programs can be measured and describes various methods of assessing both costs and effectiveness. Comparison of the cost-effectiveness of a nurse managed special care unit with that of traditional intensive care units illustrates some of these methods.

Effects of a health-promotion program on cardiovascular risk factors, health behaviors, and life satisfaction in institutionalized elderly women

This study applied a 3-month health-promotion program to institutionalized elderly people to examine changes in cardiovascular risk factors, health behaviors, and life satisfaction. Twenty-one elderly women with an average age of 77 years participated in the program consisting of cardiovascular risk assessments, Korean traditional dance movements (KTDMs), and health education/counseling. Paired t-tests revealed that the participants exhibited significant reductions in total risk score, improvements in health behaviors and life satisfaction at the end of the program. However, the positive effects tend to decrease at 3 months after the program ended. In conclusion, the health-promotion program using KTDM exercises was safely applicable and beneficial to institutionalized elderly women.

Managing health habits for myocardial infarction (MI) patients

The study examined effects of the heart camp as a motivation enhancement program on cardiac risk reduction and behavioral modification in myocardial infarction (MI) patients. A total of 86 outpatients participated at the first heart camp and 45 returned to the second one in 8 weeks. The first and second heart camps were daylong programs consisted of health assessment, education classes, and Q&A session with interdisciplinary team approach. At the completion of the heart camp, the participants showed significantly lower scores in cardiac risk factors, and significant improvements in motivational variables, especially, perceived benefits and perceived barriers as well as in the performance of diet and exercise behaviors. The study results confirm that it is possible to enhance motivation for chronic patients like MI patients by even short period of comprehensive educational program.

Factors explaining quality of life in individuals with coronary artery disease

PURPOSE The study was done to compare quality of life by gender, and to identify factors which explain quality of life in individuals with coronary artery disease. METHODS For the survey, 91 individuals (53 men and 38 women) agreed to participate in the study. Cardiovascular risk factors, systolic blood pressure, body mass index, total cholesterol, triglyceride, high density lipoprotein-cholesterol, and low density lipoprotein-cholesterol, health behavior as well as quality of life, were measured. Descriptive statistics, t-test, correlation and hierarchical multiple regression with SPSS WIN 12.0 were used to analyze the data. RESULTS Significant gender differences were found for education, smoking status, chronic disease, perceived health status, and quality of life within sub-dimensions. Hierarchical regression analysis showed gender (men), age, perceived health status, cardiovascular risk scores, and health behaviors together explained 40.2% (adjusted R2) of variance in quality of life. CONCLUSION As the factors explaining quality of life in individuals with coronary artery disease have been identified as gender (men), age, perceived health status, and health behaviors, health promotion programs designed for this population should focus on these factors for effective behavioral modification, and consequent improvement in quality of life.

Effects of Tai Chi Exercise on Cardiovascular Risk Factors and Quality of Life in Post-menopausal Women

PURPOSE Natural menopause resulting in the decline in endogenous estrogen concentrations is responsible for an increased risk of coronary heart disease in postmenopausal women. The purpose of the study was to examine the effects of a 6-month Tai Chi exercise program on cardiovascular risk factors and quality of life in post-menopausal women. METHODS A quasi-experimental design with pretest and posttest measures was used. The participants in the study, 29 women in the Tai Chi group and 31 in the control group, were enrolled for 6 months. RESULTS After 6 months of Tai Chi exercise, total cholesterol (M=213 to 185), LDL-cholesterol (M=135 to 128), and their 10 yr cardiovascular disease risk (M=2.62 to 2.27) had improved significantly for the Tai Chi participants compared to the control group. Total scores for quality of life along with the sub-dimensions of health perception and mental functioning were also significantly higher in the Tai Chi participants. CONCLUSION Tai Chi exercise favorably affected cardiovascular health and quality of life in post-menopausal women after 6 months. Additional rigorous studies are needed to examine long term effects on the prevention of cardiovascular disease in this population.

Survival experience of chronically critically ill patients.

Intensive care unit (ICU) patients were randomly assigned to either a traditional ICU or a special care unit (SCU) for chronically critically ill patients. The SCU used a low-technology, family-oriented environment, nursing case management, no physician house staff, and a shared governance model. In comparison, the ICU used high technology, limited family visiting, primary care nursing, and a bureaucratic management model. The survival experience of chronically critically ill patients in the two environments during hospitalization, as well as after hospital discharge, was examined. Using survival analytic techniques, the 1-year cumulative mortality for all patients in the study was found to be 59.9%. Risk of death was significantly lower after discharge than during hospitalization. Similar mortality experiences were found for SCU and ICU patients. Thus, the high-technology ICU environment did not produce better outcomes than the SCU environment.

Feasibility and Effects of a Tai Chi Self-Help Education Program for Korean Gastric Cancer Survivors

PURPOSE/OBJECTIVES To determine the feasibility of conducting a study of a tai chi self-help education program in Korean adults with gastric cancer and to describe the effects of a six-month tai chi self-help education program on depression, health-related quality of life (HRQOL), and immune markers. DESIGN One-group, pre- and post-test design. SETTING Outpatient clinics of two large hospitals in the Republic of Korea. SAMPLE Convenience sample of 33 Korean adults with gastric cancer diagnoses after gastrectomy. METHODS The Korean gastric cancer survivors participated in a 24-week tai chi self-help education program. The participants completed the Center for Epidemiologic Studies-Depression (Korean version) and the Functional Assessment of Cancer Therapy-General (Korean version) for HRQOL and provided blood samples for immune markers. All measurements were conducted at baseline and at one week following the 24-week intervention. MAIN RESEARCH VARIABLES Feasibility was determined as the percentage of participants completing the 24-week protocol. Preliminary data on depression, HRQOL, and immune markers were obtained. FINDINGS The dropout rate was 36.4%; 21 of 33 survivors participated in the tai chi self-help education program for 24 weeks. No complications or injuries occurred to the participants during the program. No significant differences were noted in depression, HRQOL, and immune markers before and after the intervention. CONCLUSIONS Tai chi exercise, in combination with a self-help program, can be safe and feasible for Korean gastric cancer survivors. This feasibility study did not show that the tai chi self-help education program improves depression, HRQOL, and immune markers in Korean gastric cancer survivors. IMPLICATIONS FOR NURSING Additional studies are needed to determine the long-term impact relative to usual care.

Managing cardiovascular risks with Tai Chi in people with coronary artery disease

AIM The paper is a report of the study to determine the effects of the cardiovascular risk management programme with Tai Chi on cardiovascular risks, health behaviours and quality of life in individuals with coronary artery disease. BACKGROUND Many eligible patients with coronary artery disease do not participate in programmes for cardiovascular risk management, mainly because of lack of motivation, high cost or limited accessibility. Tai Chi has been introduced by health professionals to promote cardiovascular functioning and quality of life. METHODS A quasi-experimental design with a non-equivalent control group was used. Eighty-five people with a mean age of 66 years completed pretest and 6-month follow-up measures in the following three groups: Tai Chi with education (n = 33), Tai Chi only (n = 19) and control (n = 33). Analysis of covariance was used to compare outcome variables with pretest variables as covariates to adjust for baseline differences. The data were collected in 2005-2006. RESULTS In the Tai-Chi-with-education group there were statistically significant reductions in modifiable cardiovascular risk factors (F = 3.49, P = 0.035) and improvements in health behaviours (F = 6.12, P = 0.003), mental scores (F = 3.96, P = 0.023), and in the role-emotional (F = 7.30, P = 0.001) and vitality (F = 3.81, P = 0.026) dimensions of quality of life. CONCLUSION Tai Chi was safely implemented as an alternative form of exercise in a cardiovascular risk management programme. Whether the beneficial effects of Tai Chi in cardiovascular risk management are comparable with those induced by other types of aerobic exercise requires further investigation.

Do-not-resuscitate practices in the chronically critically ill

OBJECTIVES To determine the frequency of do-not-resuscitate (DNR) orders in the chronically critically ill; to identify the differences in clinical and demographic characteristics of chronically critically ill patients who have DNR orders and those who do not; to identify the differences in the cost of care between patients with and without DNR orders; and to identify the differences in DNR practices between an experimental special care unit and the traditional intensive care unit (ICU). DESIGN Randomized, prospective design with a block randomization scheme. SUBJECTS Two hundred twenty patients who met the following eligibility criteria for enrollment in a parent study of the special care unit: an ICU stay of at least 5 days, an absence of pulmonary artery monitoring, an absence of frequent titration of intravenous vasopressors, an Acute Physiology and Chronic Health Evaluation II score of less than 18, and a Therapeutic Intervention Scoring System score of less than 39. SETTING A large, urban academic medical center. MEASURES Clinical and demographic variables describing the study populations, mental status, and timing of DNR orders, mortality rates, and cost of hospitalization. RESULTS There was no difference in the frequency of DNR orders between the special care unit versus the intensive care unit--although patients in the special care unit had a longer interval between hospital admission and initiation of the DNR order. DNR patients differed from non-DNR in that they were older, less likely to be married, and had a higher Acute Physiology and Chronic Health Evaluation II score on admission to the study. The mortality rate in the DNR group was 71% versus 6% in the non-DNR group. There was no difference in total costs. DNR patients were also more likely to have an impaired mental status on admission, and more likely to have deterioration in mental status by the time of discharge than the non-DNR patients.