Christian Health Association of Nigeria

Character strengths-based intervention (CSI) has the potential to enhance self-esteem and reduce depression, leading to improved quality of life (QoL) for breast cancer patients. To explore the effects of an evidence-based and culturally appropriate CSI among Chinese female patients with breast cancer and their perceptions of the CSI. This study was a multisite assessor-blinded randomized controlled trial. The CSI underwent multiple stages of modeling as cultural tailoring, supported by a self-produced booklet and self-monitoring tool for patients. The outcomes were assessed at baseline (T0), immediately postintervention (T1), and 1 month postintervention (T2). Qualitative interviews were conducted to explore the experience and opinions among the CSI group. One hundred twenty-two participants were randomly assigned to receive either the CSI (the CSI group; n = 61) or an "early memories" program (the control group; n = 61). The results showed that the CSI significantly increased self-esteem and QoL at T1 and T2. In addition, the CSI significantly reduced depressive symptoms at T1 and T2. The qualitative findings encompassed 5 themes: acceptability of the CSI, perceived benefits of the CSI, facilitators of application of the CSI, barriers to application of the CSI, and recommendations for the CSI. This study demonstrated that the CSI enhanced self-esteem and QoL and alleviated the depressive symptoms of the CSI group. This study highlights the viability of nurses serving as implementers of the CSI and reveals the importance of professional training and resource support for nurses.

Ambiguity and confusion persist around the goal and purpose of clinical experiences in nursing education. As a result of this ambiguity and confusion, the potential exists to waste valuable clinical time, to create ineffective learning objectives, to focus on the tasks of nursing rather than the competencies required for nursing practice, and to perpetuate a mismatch of in-person clinical experiences with simulation decreasing the ability to achieve clinical practice readiness. Nurse leaders across academia, regulation and accreditation agencies, and practice settings must establish consensus about the purpose and goals of clinical education in order to align learning outcomes and expectations of clinical practice readiness. This article synthesizes Dr Patricia Benner’s vast body of writings to create a universal “North Star” to align and guide all nurse educators and clinical education on appropriate learning outcomes, andragogies, and expectations for nursing students and new graduates to support clinical practice readiness and the formation of nurses’ skilled know-how, notions of good practice, clinical reasoning and more that are required for excellent nursing practice. Leaders in academia, regulation, accreditation, and practice should adopt the goals delineated in this “North Star” as being the end-points of practice formation, create learning experiences to support practice formation from novice to expert, and create meaningful evaluation strategies that go beyond traditional psychometric testing. When academia, regulation, accreditation, and practice all adopt these goals of clinical education, we contend that there will be congruence and more seamless transitions across the academic-regulation-accreditation-practice spectrum.

Because of technology developments, the ECG yields improved outcomes in the realm of biomedical science and research. The Electrocardiogram reveals basic the heart's electrical activity. Early detection of aberrant heart disorders is crucial for diagnosing cardiac problems and averting sudden cardiac deaths. Measurements on an electrocardiogram (ECG) among people with comparable cardiac issues are essentially equal. Analyzing the Electrocardiogram characteristics can help predict abnormalities. Medical professionals presently base the preponderance of their Electrocardiogram diagnosis on their unique particular areas of expertise, which places a substantial load on their shoulders and reduces their performance. The use of technology that automatically analyses ECGs as hospital personnel performs their duties will be advantageous. A suitable algorithm must be able to categories Input signal with uncertain awesome feature on just how much they approximate Input signal having known characteristics in order to speed up the identification of heart illnesses. A possibility of identifying a tachycardia is raised if this predictor can reliably recognize connections, and this technique may be helpful in lab settings. To accurately diagnose myocardial illness, a powerful machine learning technique should be used. Through using recommended method, the effectiveness of cardiovascular disease identification using ECG dataset was evaluated. The reliability, sensitivities, and validity obtained using the Svm algorithm were 99.314%, 97.60%, and 97.60% respectively.

Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.

To further improve measurement of work-related physical and mental health by updating the Work Disability Assessment Battery (WD-FAB). Cross-sectional study with 1024 disability claimants and 1000 working age (21 to 66 years) adults in the United States. Developed new items to replenish the WD-FAB and analyzed using factor analysis and item response theory (IRT). Computer adaptive testing (CAT) simulations evaluated the psychometric properties of the original versus updated WD-FAB. Analyses confirmed the structure of the WD-FAB. Twenty-three new items were added (basic mobility: 7, upper body function: 4, fine motor: 6, self-regulation: 1, resilience & sociability: 5 items). Findings support the WD-FAB as a robust, psychometrically sound assessment of work-related function. Extensive content coverage (331 items) represents eight physical and mental health domains. IRT/CAT methods allow administration in under 15 minutes. The WD-FAB may prove valuable for efficiently characterizing work-related function across work rehabilitation settings.

Concerns about death may alienate and negatively impact communication among family members of patients with life-threatening illness. Little is known about the relationship of death anxiety to quality of life in cancer family caregivers. The aim of this study was to examine relationships between sociodemographic and patient-related factors, social support, and religiosity with death anxiety and quality of life in Iranian cancer family caregivers. Three hundred thirty family caregivers from an urban regional cancer institute in Iran participated in a descriptive-correlational study that incorporated sociodemographic surveys and validated death anxiety (Templer Scale) and Quality of life (Family Version) instruments. Caregivers reported moderate levels of death anxiety and decrements in QOL. Quality of life was inversely associated with death anxiety (r = -0.30, P < .001). Female caregivers who were daughters had higher death anxiety, whereas male caregivers who were sons reported higher quality of life. Death anxiety is associated with lowered quality of life in Iranian family caregivers. Multiple factors may impact death anxiety and quality of life relevant to the socioreligious milieu. Addressing concerns that increase death anxiety may improve quality of life and lower stress associated with adapting to the family caregiver role. Caregiving responsibilities, added to challenges associated with personal, family, and professional life, impact multiple aspects of QOL. As nurses increasingly care for patients from diverse backgrounds, it becomes more imperative that support for family caregivers that promotes psychological adaptation and quality of life is needed.

Borderline personality disorder (BPD) has been demonstrated to be a reliable and valid construct in young people (adolescents and young adults). Both borderline- and mood-related psychopathology become clinically apparent from puberty through to young adulthood, frequently co-occur, can reinforce one another, and can be difficult to differentiate clinically. This Gordian knot of overlapping clinical features, common risk factors, and precursors to both BPD and mood disorders complicates clinical assessment, prevention, and treatment. Regardless of whether an individual crosses an arbitrary diagnostic threshold, a considerable proportion of young people with borderline- and mood-related psychopathology will develop significant and persistent functional, vocational, and interpersonal impairment and disability during this critical risk and developmental period. There is a clear need for early intervention, but spurious diagnostic certainty risks stigma, misapplication of diagnostic labels, inappropriate treatment, and unfavorable outcomes. This article aims to integrate early intervention for BPD and mood disorders in the clinical context of developmental and phenomenological change and evolution. "Clinical staging," similar to disease staging in general medicine, is presented as a pragmatic, heuristic, and trans-diagnostic framework to guide prevention and intervention. It acknowledges that the early stages of these disorders cannot be disentangled sufficiently to allow for disorder-specific preventive measures and early interventions. Clinical staging defines an individual's location along the continuum of the evolving temporal course of a disorder. Such staging aids differentiation of early or milder clinical phenomena from those that accompany illness progression and chronicity, and suggests the application of appropriate and proportionate intervention strategies.

Introduction: The 2012 AHA/ACCF consensus statement regarding cardiac evaluation of liver transplant (LT) candidates specifies 7 risk factors for identifying candidates for cardiac evaluation prior to LT. These include age &gt;60 yrs, hypertension, diabetes, smoking, dyslipidemia, prior cardiovascular disease, and left ventricular hypertrophy. The document issued a Class IIb, LOE C recommendation for noninvasive testing in asymptomatic LT candidates who have “multiple” risk factors but did not define the number of risk factors required to prompt evaluation, suggesting that ≥3 risk factors may be “reasonable”. Hypothesis: Risk factors set forth by the AHA/ACCF can predict significant coronary artery disease (CAD) in LT candidates. We sought to identify a threshold sum of risk factors that should prompt CAD evaluation. Methods: Consecutive LT recipients who underwent pre-operative coronary angiography were analyzed. Logistic regression model and ROC curves were used to determine the predictive value of the sum of risk factors in predicting presence of CAD. Results: Among 45 consecutive patients (44% female; mean age 57±8 yrs) with coronary angiogram prior to LT, 15 had significant CAD (≥50% stenosis) and 13 had severe CAD (≥70% stenosis). The sum of risk factors was strongly predictive of significant CAD (OR, 7.12 per 1 risk factor increment; CI, 2.13-23.73; P = 0.001). ROC analyses demonstrated that the sum of AHA/ACCF risk factors was associated with AUC of 0.89 and 0.88 for significant and severe CAD, respectively (Fig 1). A threshold of ≥2 risk factors provided 100% sensitivity and 60% specificity for severe CAD, while a threshold of ≥3 had inferior sensitivity (Fig 1). Conclusion: This study represents a diagnostic validation of the risk factors set forth by the 2012 AHA/ACCF consensus statement. A threshold of ≥2 risk factors seems optimal for identifying candidates for noninvasive cardiac evaluation in asymptomatic LT candidates.

To investigate the effect of sleep disturbances on functional and social outcomes after mild traumatic brain injury. Outpatient traumatic brain injury clinic in a tertiary trauma center. A total of 374 mild traumatic brain injury patients were assessed within 3 months of injury and followed up every 3 months for 1 year. Analysis of a historical cohort in a naturalistic clinical setting. At each visit, symptoms of concussion and psychological distress and indices of functional and social outcomes were measured with the Rivermead Postconcussion Questionnaire, 28-item General Health Questionnaire, and Rivermead Head Injury Follow-up Questionnaire, respectively. Changes in outcome scores over time were explored using repeated measures analysis of variance and compared between subjects with persistent (SD) and recovered (SR) sleep disturbances. Predictors of functional/social outcome were determined using linear regression. The percentages of subjects reporting sleep disturbances at each time point were 71.9%, 57.2%, 55.1%, and 53.7%, respectively. For functional and social outcomes, significant effects of time (F3,315 = 9.54; P < .001), group (SD vs SR) F1,317 = 5.32; P = .022, and time X group interaction F3,315 = 4.14; P = .007 were found. Persistent sleep disturbance (P = 0.011) and higher symptom burden at 6 months postinjury (P < .0001) were independent predictors of poorer outcome. Sleep disturbance, independent of psychological distress, is an important prognostic factor of functional and social outcomes after mild traumatic brain injury.

Objectives: While mortality following acute myocardial infarction (AMI) has decreased over time, subsequent hospitalizations due to unstable angina (UA) and coronary revascularization (CR) continue to be a great source of burden both from a patient’s and a societal perspective. It is unknown, however, how AMI patients who experience these additional readmissions value their health and what the associated costs are, beyond the hospitalization itself. Methods: From TRIUMPH, a 24-center observational AMI registry, we identified patients readmitted for unstable angina (UA) or unplanned CR ≥1 month following index AMI discharge. Propensity matching was used to compare (1) patients who were vs. were not readmitted for UA and (2) patients who were vs. were not readmitted for CR. We examined one-year quality-adjusted life-years (QALYs) using the EQ-5D measurements at 1, 6 and 12 months, as well as post-discharge costs (office visits, cardiac rehabilitation and cardiovascular readmissions, excluding costs for the UA/CR event). Confidence intervals were calculated via bootstrap analysis. Results: A total of 140 (4.26%) were readmitted for UA and 112 (3.41%) patients underwent CR after their AMI. Unadjusted mean 1-year QALYs for UA and non-UA patients were 0.743 and 0.821 [propensity-matched difference -0.076 (95% CI -0.100, -0.042)]. Unadjusted mean 1-year QALYs for CR and non-CR patients were 0.798 and 0.828 [propensity-matched difference -0.032 (95% CI -0.063, -0.003]. Mean differences in costs were $8009 (95% CI $3997, $14229) for UA vs. non-UA patients and $4498 (95% CI $4046, $4966) for CR vs. non-CR patients. Cardiovascular rehospitalizations contributed most to these costs (Table) . Conclusion: In this study, over the year following AMI, patients experiencing UA or unplanned coronary revascularization were challenged in maintaining their health status as compared with those not experiencing the respective event and had significantly higher health care costs.