Rhonda Griffiths

Persistence of coronary risk factor status in participants 12-18 months following percutaneous coronary intervention

BACKGROUND Percutaneous coronary intervention (PCI) is a widely performed revascularization technique for coronary heart disease; however, there is limited research investigating the risk factor status of patients 1 year after the procedure. OBJECTIVE This cross-sectional study was conducted to investigate the self-reported risk factor status by patients who had undergone a PCI at a major teaching hospital in Sydney, Australia. SUBJECTS : Two hundred seventy participants who underwent PCI between April 2003 and March 2004 and who met the inclusion criteria were followed up 1 year after the PCI. METHODS After obtaining informed consent, a follow-up self-administered questionnaire was mailed to participants. Information was collected relating to the following coronary risk factors: smoking, and physical activity status, blood pressure and cholesterol levels, body mass index, depression, anxiety, and stress levels. RESULTS Two hundred two participants (75%) returned a completed questionnaire. Approximately one third of participants had at least two modifiable risk factors. The most common cardiovascular risk factors identified were physical inactivity, increased body mass index, high blood pressure, and high cholesterol. Approximately half the women (46%) and a quarter of the men had at least two modifiable risk factors. Only a minority (11%) of the participants continued to smoke at 1-year follow up. Participating in physical activity for a total time of 150 minutes or more per week was reported by only 42% of the participants. Depression and anxiety were present in 25% and stress in 17% of the participants. A third of the participants (n = 64) erroneously believed that they had no heart problems. CONCLUSIONS The findings reveal inadequate management of modifiable risk factors among post-PCI participants 12 to 18 months after revascularization, which highlights a need for tailored secondary prevention interventions to address factors contributing to cardiovascular risk. The evidence obtained from this study will inform the development of an intervention to address cardiovascular risk factor modification.

Cardiac rehabilitation coordinators' perceptions of patient-related barriers to implementing cardiac evidence-based guidelines

Background: Coronary heart disease remains the leading cardiovascular cause of mortality and morbidity globally. Implementing evidence-based guidelines after a coronary event is vital to prevent recurrence of an acute episode. However, various barriers to guideline implementation have been identified. Objective: This article presents the perspective of cardiac rehabilitation (CR) coordinators regarding patient-related barriers to implementing the evidence-based guidelines after an acute cardiac event. Methods: Twenty CR coordinators from 4 geographic regions of New South Wales, Australia, participated in the study. A semistructured interview using open-ended questions was used to obtain the CR coordinators perspectives of the patient-related barriers to guideline implementation. Interviews were transcribed, and content analysis was undertaken. Findings: The most frequently identified patient-related barriers were (a) coming to terms with a diagnosis of heart disease, (b) challenges in changing behavior, (c) having heart disease is costly, and (d) other personal barriers. Conclusions: Despite CR coordinators having positive attitudes toward implementing evidence-based guidelines, several patient-related barriers were identified that obstructed the implementation process. The findings have important implications for nursing practice in terms of directing efforts at increasing participation in CR and engaging commitment of the patient to behavior change. Changes to health service policies that address identified barriers could further facilitate the provision of evidence-based care to patients with coronary heart disease.

Validation of the revised cardiac rehabilitation preference form in patients with post-percutaneous coronary intervention.

background Challenges in achieving optimal participation rates in cardiac rehabilitation (CR) are well described and include factors pertaining to health system and patient and clinical characteristics. Of note, participation rates of patients following percutaneous coronary intervention (PCI) are low. aim The aim of this study was to examine the psychometric properties of the Revised Cardiac Rehabilitation Preference Form (CRPF-R) in an Australian sample following a PCI and to determine the preferences of PCI patients in relation to CR. Methods One hundred forty participants who had PCI completed the self-administered CRPF-R scale. Principal component factor analysis was performed to detect underlying dimensionality of the scale. The internal consistency of the total scale and the subscales was tested with the Cronbach α analysis. Comparison for differences in CRPF-R scores, as well as demographic characteristics and CR attendance, was performed. Results Factor analysis revealed 2 distinct factors, supporting the validity of a 2-factor structure CRPF-R. Cronbach α coefficient values were high, with .87 for the total CRPF-R, .85 for factor 1 (program features), and .81 for factor 2 (convenience features). Women were more likely to place greater importance in the convenience features of a CR program than men. Those who were recommended by a healthcare professional to attend CR were more likely to place greater importance in the program features than those who were not. Conclusions This study has demonstrated the acceptability and utility of the CRPF-R in the Australian setting. In addition, the study also identified important considerations in the structuring and delivery of CR programs.

The health-related quality of life trajectory in patients after percutaneous coronary intervention

PURPOSE: The purpose of this study was to describe the trajectory of cardiac patients perceptions of health-related quality of life (HRQoL) during a 24-month period in a community-based population. METHODS: After obtaining informed consent, a self-administered questionnaire was mailed to participants. Using the MacNew questionnaire, which assesses the emotional, physical, social, and global domains, HRQoL outcomes were assessed. RESULTS: Completed questionnaires were received from 202 participants (75%). Improvements in the emotional, physical, social, and global HRQoL scores were observed until 15 to 17 months after the index percutaneous coronary intervention, after which a decline was observed. However, the scores in all HRQoL domains remained high when compared with the scores at 12 months. No clinical or sociodemographic predictors for HRQoL were identified. CONCLUSIONS: The information obtained from this study will enable clinicians to further understand the process of recovery and adjustment of patients after percutaneous coronary intervention and the development of tailored strategies for patient management.

Knowledge and practices of diabetes care providers in oral health care and their potential role in oral health promotion: A scoping review

AIMnOral health complications are common in people with diabetes yet very little is reported about the oral health care provided in diabetes care setting. This study reviewed global evidence on the oral health care knowledge and practices of diabetes care providers and the role of non-dental health professionals in oral health promotion.nnnMETHODSnA systematic search of five databases was undertaken with key search terms using a scoping review framework. Relevant studies published till October 2016 in the English language were included (n=30) and no restrictions were placed on the study design, quality or setting.nnnRESULTSnMost diabetes care providers are not addressing oral health care with the main barriers being time constraints and limited oral health knowledge. Diabetes educators (DEs) could engage in oral health promotion with few studies showing this model of care can translate into improved patient outcomes. However, no appropriate oral health training programs and assessment tools exist for DEs. With proper training, non-dental professionals like nurses have successfully incorporated oral healthcare in other settings.nnnCONCLUSIONSnDEs are well placed to promote oral health in diabetes care setting. Further research is needed to identify barriers and oral health resources to support DEs in this role.

Intensive insulin therapy in the primary school setting : a meta-ethnographic synthesis

Aim: To explore how intensive insulin therapy is integrated into the primary school setting, to identify support strategies in order to inform policy and practice. Data sources: Articles between 2005 and 2015, children aged 4–12 years. Review methods: A meta-ethnographic comparative approach, using reciprocal translation and line of argument synthesis. Findings: Fourteen studies with qualitative data were included. Seven major metaphors were identified: Oh, its needles, cover your back, worried about safety, great expectations, Im not a diabetes expert, like everyone else and working together. Conclusion: A line of argument and conceptual model was developed from the metaphors and identified; competent diabetes care, risk management and a sense of normality and understanding as key areas that required addressing to improve integration of intensive insulin therapy. Collaboration and planning between the home, health, education and legal systems is also essential.

Oral health knowledge, attitudes and care practices of people with diabetes: a systematic review

BackgroundPeople with uncontrolled diabetes are at greater risk for several oral health problems, particularly periodontal (gum) disease. Periodontal disease also impacts diabetes control. Good oral hygiene and regular dental visits are recommended to prevent and manage oral health problems. Several studies have been conducted to assess the oral health knowledge, attitudes, and practices of people with diabetes yet a review of these findings has not yet been undertaken. The aim of this systematic review was to synthesize current evidence on the knowledge, attitudes and practices of people with diabetes in relation to their oral health care.MethodsA systematic search of all literature was carried out in five databases using key search terms. The inclusion criteria were: 1) published in the English language; 2) from 2000 to November, 2017; 3) conducted on persons with any type of diabetes and of all ages; 4) explored at least one study outcome (knowledge or attitude or practices toward oral health care); and 5) used quantitative methods of data collection. No restrictions were placed on the quality and setting of the study.ResultsA total of 28 studies met the inclusion criteria. The studies included a total of 27,894 people with diabetes and were conducted in 14 countries. The review found that people with diabetes have inadequate oral health knowledge, poor oral health attitudes, and fewer dental visits. They rarely receive oral health education and dental referrals from their care providers. Provision of oral health education by diabetes care providers and referral to dentists when required, was associated with improved oral health behaviours among patients.ConclusionsOverall, people with diabetes have limited oral health knowledge and poor oral health behaviours. It is therefore essential to educate patients about their increased risk for oral health problems, motivate them for good oral health behaviours and facilitate access to dental care.

Perceptions and Practices of Diabetes Educators in Providing Oral Health Care: A Qualitative Study

Purpose The purpose of this study was to explore the current perceptions and practices of diabetes educators (DEs) in providing oral health care to people with diabetes. Methods A qualitative study design involving focus groups was used to gather data. Purposive sampling was used to recruit DEs working across 3 metropolitan hospitals in South Western Sydney, Australia. Results Fourteen DEs participated in 3 focus groups. Participants had a mean ± SD age of 44.4 ± 9.2 years and 5.2 ± 5.3 years of work experience in diabetes care. Four main themes were identified: perceptions about oral health care and diabetes current oral health care practices, perceptions on incorporating oral health, and suggested model of care. DEs agreed that promoting oral health in diabetes clinics is important, and they reported seeing patients frequently with oral health problems. However, the majority do not include oral health care in consultations, primarily because they have limited knowledge in this area and have not received any formal oral health education or training. Additional barriers were the lack of referral pathways and resources for patient education. DEs were receptive to incorporating oral health provided that the current barriers were addressed. DEs also suggested a multidisciplinary team care approach to promote oral health. Conclusions Current practices of DEs in oral health care are limited, but they are willing to address oral health. A suggested model of oral health care should include capacity building of diabetes care providers, appropriate dental referral pathways, and a team approach within multidisciplinary diabetes care.