Valentina Biagioli

Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis

Background: Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients. Objectives: The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient’s sociodemographics, clinical variables, quality of life, and hospitalizations. Methods: This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and &khgr;2 test were used to examine the characteristics of each cluster. Results: Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates. Conclusion: The 4 clusters identified in this study and their associated characteristics could be used to tailor interventions aimed at improving self-care behaviors in HF patients.

The experiences of protective isolation in patients undergoing bone marrow or haematopoietic stem cell transplantation: systematic review and metasynthesis

&NA; Protective isolation is aimed at preventing infection in neutropenic patients, but it is implemented inconsistently across centres and is supported by recommendations with poor evidence. This review and metasynthesis explored the experiences and the psychological implications of protective isolation in patients with haematological malignancies undergoing bone marrow (BMT) or haematopoietic stem cell transplantation (HSCT). A systematic search of multiple databases for qualitative studies exploring BMT or HSCT patients’ experiences of protective isolation was completed. The metasynthesis followed the meta‐aggregative method from the Joanna Briggs Institute, with four procedural steps: (1) comprehensive search, (2) quality appraisal, (3) extraction of relevant findings and (4) synthesis of the identified findings. Twenty‐six findings were extracted from 11 articles included in the review. The synthesising process yielded seven categories, aggregated into three synthesised findings: (1) isolation is a source of suffering, (2) isolation can lead to relating with oneself and (3) the person does not close the door to the outside world. This metasynthesis sheds light on patients’ suffering from being isolated, and the possibility of overcoming this suffering thanks to relationships that patients have with themselves and with the external world. Healthcare providers should reconsider this practise in order to avoid unnecessary patient suffering.

Cross-validation of the Self-care Ability Scale for Elderly (SASE) in a sample of Italian older adults

The assessment of self-care among older adults is important as it permits the tailoring of educational interventions directed to prevent health deterioration and contrast the effects of ageing. The Self-care Ability Scale for the Elderly (SASE) was developed to assess the perceived self-care ability in older adults. Its psychometric properties were tested only in Scandinavian countries and China. This research was a cross-validation of the SASE on 402 Italian adults aged 65 and older recruited in hospitals, clinics and homes, from September 2016 to February 2017. We performed exploratory and confirmatory factor analyses on two subsamples and identified three factors, self-care ability to perform ADLs, self-care ability to achieve well-being and self-care ability to set personal goals, with a good model fit (CFI > 0.93; RMSEA = 0.07; SRMR = 0.06). We eliminated four items, however, to improve the structural validity. Internal consistency for the three factors of the Italian version of the SASE (SASE-I) ranged from 0.72 to 0.92. The test-retest reliability indicated good stability of the scale (ICC coefficient = 0.92). We assessed convergent validity by comparing the SASE-I with the Katz Index of Independence in Activities of Daily Living and the Lawton Instrumental Activities of Daily Living Scale, showing moderate-to-strong correlations. In addition, the SASE-I discriminated the self-care ability in groups with different ages, levels of education and settings. Our study produced a 13-item version of the SASE with good psychometric properties that could be recommended for use in clinical practice and research after further validation on different populations and settings.

Propolis in the prevention of oral mucositis in breast cancer patients receiving adjuvant chemotherapy: A pilot randomised controlled trial

&NA; Chemo‐induced oral mucositis (OM) is associated with significant symptoms, treatment delays and increased costs. This pilot randomised controlled trial aimed at evaluating the safety, tolerability and compliance with propolis in breast cancer patients receiving doxorubicin and cyclophosphamide, testing preliminary clinical efficacy of propolis in the prevention of OM, and prospectively evaluating the incidence of OM. Sixty patients were randomised to receive either a dry extract of propolis with 8%‐12% of galangin plus mouth rinsing with sodium bicarbonate (experimental arm), or mouth rinsing with sodium bicarbonate (control arm). OM was evaluated with the NCI‐CTCAE v4.0 after 5, 10, 15 and 21 days of treatment. Compliance with, tolerability of propolis and adverse events were recorded. The incidence of OM was also prospectively evaluated for 6 months. Two patients (6.7%) manifested a suspected skin reaction to propolis. No patient in the experimental arm developed OM > G1, while in the control arm OM > G1 was 16.7% (p = .02). The incidence of OM ≥ G1 at the end of cycles 2‐8 was higher at the second (25%) and fifth cycles (45.8%). Propolis plus bicarbonate was safe, well tolerated and promisingly effective in the prevention of OM in patients with breast cancer.

Psychometric testing of the modified Care Dependency Scale (Neuro-CDS)

BACKGROUND Effective measures of nursing care dependency in neurorehabilitation are warranted to plan nursing interventions to help patients avoid increasing dependency. OBJECTIVE The Care Dependency Scale (CDS) is a theory-based, comprehensive tool to evaluate functional disability. This study aimed to modify the CDS for neurological and neurorehabilitation patients (Neuro-CDS) and to test its psychometric properties in adult neurorehabilitation inpatients. METHODS Exploratory factor analysis (EFA) was performed using a Maximum Likelihood robust (MLR) estimator. The Barthel Index (BI) was used to evaluate concurrent validity. Stability was measured using the Intra-class Correlation Coefficient (ICC). RESULTS The sample included 124 patients (mean age = 69.7 years, 54% male). The EFA revealed a two-factor structure with good fit indexes, Factor 1 (Physical care dependence) loaded by 11 items and Factor 2 (Psycho-social care dependence) loaded by 4 items. The correlation between factors was 0.61. Correlations between Factor 1 and the BI and between Factor 2 and the BI were r = 0.843 and r = 0.677, respectively (p <  0.001). The Cronbachs alpha coefficients were 0.99 and 0.88 (Factor 1 and 2). The ICC was 0.98. CONCLUSIONS The Neuro-CDS is multidimensional, valid, reliable, straightforward, and able to measure care dependence in neurorehabilitation patients as a basis for individualized and holistic care.