Guozhen Sun

Objective: This study aimed to understand the experiences and feelings of patients undergoing lower limb vein harvesting for coronary artery bypass grafting (CABG). Design: Qualitative, phenomenological research methodology with purposive sampling. Semistructured interview data were analysed using Colaizzi’s seven-step method with the NVivo 12 Plus software. Setting: A single-centre study in a Grade A hospital in Nanjing, China. Participants: A total of 23 patients who underwent CABG with saphenous vein harvesting between October 2024 and March 2025. Results: The participants’ experiences were summarised into four themes: preoperative cognitive differences influencing decision-making, postoperative physiological changes triggering psychological distress, diverse coping strategies and support needs, and reconstruction of body image and identity. Conclusion: Medical staff should pay attention to the feelings of patients undergoing CABG with vein harvesting from the lower limbs. By actively implementing shared decision-making, promoting high-quality nursing services, improving multidimensional support systems, and enhancing patients’ psychological and social adaptability, healthcare professionals can improve patients’ perioperative experiences and promote their comprehensive recovery.

Objective: The study aims to investigate the configuration path of influencing factors of exercise adherence in chronic heart failure (CHF) patients based on the Capability, Opportunity, Motivation-Behavior (COM) model.Background: The effectiveness of exercise rehabilitation in patients with CHF depends upon their sustained adherence over the long term. Exercise adherence is influenced by a combination of antecedent conditions; however, the mechanisms underlying adherence to exercise in CHF patients remain unclear.Design: Cross-sectional study.Method: Convenience sampling was used to recruit patients with CHF from 3 tertiary-level hospitals in China, between January and May 2024. Latent profile analysis (LPA) was conducted to identify the latent profile of exercise adherence in patients with CHF. Fuzzy-set qualitative comparative analysis (fsQCA) was then employed by conducting necessity and sufficiency analysis.Results: A total of 219 patients with CHF participated in the study. The LPA results categorized exercise adherence among these patients into three profiles: low (28.3%), moderate (54.3%), and high (17.4%) adherence. The necessity analysis revealed that the perception of benefits was a necessary condition for achieving high exercise adherence, whereas no singular factor was deemed necessary for low exercise adherence. Furthermore, the sufficiency analysis identified four distinct configurational pathways leading to high exercise adherence and two pathways leading to low exercise adherence.Conclusion: Patients with CHF display varied exercise adherence behaviors, influenced by a range of antecedent conditions that interact synergistically, leading to diverse adherence patterns. Enhancing intrinsic motivation is essential for improving exercise adherence in this population. The exercise adherence behaviors of patients with CHF reflect distinct preferences, suggesting that healthcare providers can implement targeted interventions based on specific configurational pathways.Patient or public contribution: In the data collection phase, patients with CHF were recruited to participate in the survey.

BACKGROUND: The main treatment method for end-stage renal disease (ESRD) is maintenance hemodialysis (MHD). With the continuous improvement of dialysis technology, the survival period of MHD patients has been effectively prolonged, but dialysis technology still cannot completely replace renal function. OBJECTIVE: To study the dietary compliance and its correlation with thirst in MHD patients and to provide guidance for clinical development of corresponding intervention countermeasures. METHODS: A total of 90 patients who received MHD treatment from March 2021 to March 2022 were selected as objects. The Renal Adherence Attitudes Questionnaire (RAAQ) and the Renal Adherence Behaviour Questionnaire (RABQ) were used to analyze the dietary compliance and thirst status of patients. Pearson correlation analysis was used to analyze the correlation between diet compliance and thirst. RESULTS: Positive correlations were found between VAS and DTI, SXI and TDS (P< 0.05). Social restrictive attitude was positively correlated with VAS, DTI, SXI, TDS, acceptance attitude and compliance in facing difficulties (P< 0.05), and negatively correlated with self-care compliance (r=-0.35, P< 0.05). Health attitude was positively correlated with VAS, DTI and SXI (P< 0.05). Acceptance attitude was positively correlated with DTI, SXI and TDS (P< 0.05). High RAAQ was associated with high VAS (b= 0.11, 95% CI: 0.05, 0.18), DTI (b= 0.28, 95% CI: 0.17, 0.38), SXI (b= 0.24, 95% CI: 0.14, 0.34) and TDS (b= 0.26, 95% CI: 0.13, 0.4). CONCLUSION: The overall performance of dietary compliance in patients with MHD is at a moderate level, and dietary compliance is negatively correlated with disease perception.

Background: Chronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation is suboptimal, a frequently low engagement in rehabilitation programs has been found globally.Objective: To quantify diverse CR-engaged processes and elucidate associated factors of the various levels of CR engagement in CHF patients.Methods: Discharged patients admitted from cardiology departments between May 2022 to July 2022 were enrolled by mobile phone text messaging, CHF patients from same department between August 2022 to December 2022 were enrolled by face-to-face. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®). We obtained sociodemographic characteristics and clinical data from medical records. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases.Results: A total of 684 patients were included in the study. 52.49% patients were in the Adhesion phase. At the multivariate level, compared with the blackout phase process anxiety, monthly income (RMB yuan) equal to or more than 5,000 were the most important factor impacting CHF patients CR engagement. Compared with the Blackout phase, regular exercise or not, severe depression, previous cardiac-related hospitalizations 1 or 2 times, Age influenced patient CR engagement in the Arousal phase. Besides, compared with the Blackout phase, outcome anxiety and activation level were independent factors in the Eudaimonic Project phase.Conclusion: This study characterized CR engagement, and explored demographic, medical, and psychological factors—with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The associated factors of CR engagement were not identical among different phases. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.

ObjectiveLittle is known about the morbidity and mortality of infusion Adverse drug reactions (ADRs) in the emergency department. We sought to evaluate the epidemiology of emergency infusion ADRs.Materials and MethodsThis was a prospective study of infusion ADRs in the emergency infusion unit (EIU) of a tertiary hospital from 1 January 20201 January 2020, to 31 December 2021w31 December 2021. Emergency infusion ADRs were identified as intravenous drug-related ADRs that the causality was determined using the Naranjo algorithm. The incidence, severity and preventability of these ADRs were assessed using other standard criteria.ResultsA total of 327 ADRs were recorded for 320 participants, antibiotics were the class of drugs most commonly involved, and 76.15% of ADRs occurred within the first hour. The most common symptoms observed were skin manifestations, accounting for 46.04% of ADRs. Mild reactions accounted for 85.32% based on the Hartwig and Siegel scale. In 89.30% of the reports, the ADRs were evaluated as not preventable based on the modified Schumock and Thornton scale. The causality and severity of ADRs were related to Charlson Comorbidity Index score and age (P < 0.05).ConclusionThis epidemiological study described the pattern of emergency infusion ADRs in East China in detail. These findings may be useful to compare patterns among different centers.

Background: Chronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation was suboptimal, a frequently low engagement in rehabilitation programs has been found globally. Objective: To quantify diverse CR-engaged processes and elucidate predictors of the various levels of CR engagement in CHF patients. Methods: CHF patients admitted or discharged from cardiology departments between May 1 2022 to November 1 2022 were enrolled. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®) We obtained sociodemographic characteristics and clinical data from medical records. The survey was distributed via mobile phone text messaging or face-to-face completed. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases. Results: A total of 684 patients were included in the study. Univariate analysis showed that only kinesiophobia had no correlation with engagement phases besides socio-demographic and clinical variables. Multivariate logistic regression analysis revealed that compared with the blackout phaseprocess anxiety (Arousal: OR 0.829, 95%CI: 0.73 ~ 0.94; Adhesion: OR 0.725, 95%CI: 0.64 ~ 0.82; Eudaimonic Project: OR 0.674, 95%CI: 0.59 ~ 0.77), monthly income (RMB yuan) equal to or more than 5,000 (Arousal: OR 6.342, 95%CI: 1.30 ~ 31.01; Adhesion: OR 5.226, 95%CI: 1.09 ~ 24.96; Eudaimonic Project: OR 6.658, 95%CI 1.26 ~ 34.76) were the most important factor impacting CHF patients CR engagement. In the Arousal phase, versus the Blackout phase, regular exercise or not (OR 3.29, 95% CI: 1.19 ~ 9.10), severe depression (OR 0.019, 95% CI: 0.00 ~ 0.813), previous cardiac-related hospitalizations 1 or 2 times (OR 3.75, 95% CI: 1.19 ~ 11.86), Age (OR 0.958, 95% CI: 0.92 ~ 0.998) influenced patient CR engagement. Besides, compared to the Blackout phase, outcome anxiety (OR 1.269, 95% CI: 1.11 ~ 1.46) and activation level (level 2: OR 9.357, 95% CI: 1.44 ~ 60.68; level 3: OR 29.96, 95% CI: 3.67 ~ 244.92; level 4: OR 29.71, 95% CI: 3.62 ~ 243.61) were independent factors predicting the Eudaimonic Project phase. Conclusions: This study characterized CR engagement, and explored demographic, medical, and psychological factors— with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The predictor factors of CR engagement were not identical among different phases which strongly indicates a significant role in quantifying CR engagement. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.

Background: In the fight against heart failure (HF), informal caregivers are an indispensable part of the team. As a protective factor against stress, resilience can help to enhance caregivers’ psychological adaptation and ultimately increase the quality of care during the HF caregiving period. Recognizing its predictors and exploring how these variables interact could promote tailored strategies to enhancing caregivers’ resilience of HF patients. Thus, this study aimed to identify promoting and risk factors of resilience in informal caregivers of HF patients from the Chinese context and to understand the interactions between these factors and resilience. Methods: This cross-sectional study was conducted from December, 2020 to March, 2022 among 210 caregivers in Nanjing, China. The General Information Questionnaire, the Connor-Davidson Resilience Scale, the General Self-Efficacy Scale, the Perceived Social Support Scale, the Positive and Negative Affect Scale, the Simplified Coping Style Questionnaire and the Family Hardiness Index were used in this survey. Data were analysed with Pearson’s correlation analysis, the multiple linear regression model and the structural equation modeling (SEM). Results: The resilience of 210 Chinese HF caregivers was at the moderate and higher level (66.40± 15.08). The SEM had a good fit (root mean square error of approximation=0.047, comparative fit index=0.994, Tucker-Lewis index=0.987). Perceived social support (β=0.390, P< 0.001), positive coping style (β=0.159, P=0.019) and self-efficacy (β=0.332, P< 0.001) had positive direct effects on resilience among HF caregivers, separately. Both perceived social support (β=0.04, P< 0.001) and self-efficacy (β=0.07, P< 0.001) indirectly influenced resilience through positive coping style. Conclusion: We recommended that multi-dimensional and greater social support, higher self-efficacy and especially, positive coping strategies should be offered or encouraged during the caregiving period, which may contribute to enhancing HF caregivers’ resilience.

Aim: This study aimed to synthesize qualitative evidence on experiences of patients with atrial fibrillation (AF) during the course of diagnosis and treatment. We addressed three main questions: (a) What were the experiences of patients with AF during the course of diagnosis and treatment? (b) How did they respond to and cope with the disease? (c) What were the requirements during disease management?Design: In this study, qualitative evidence synthesis was performed using the Thomas and Harden method.Data Sources: Electronic databases, including PubMed, the Cochrane Library, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the China Biomedical Database, the WanFang Database, Chinese National Knowledge Infrastructure and VIP, were searched. The databases were searched from inception to August 2021.Review Methods: Two researchers independently selected studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis.Results: A total of 2627 studies were identified in the initial search and 15 studies were included. Five analytical themes were generated: ‘Diagnosing AF’; ‘The impact of AF on the patients’; ‘Self‐reorientation in the therapeutic process’; ‘Living with AF and QoL’; and ‘External support to facilitate coping strategies.’Conclusions: Our findings point out unique experiences of patients across the trajectory of AF related to delayed diagnosis, feelings of nonsupport, disappointment of repeated treatment failure and multiple distress associated with unpredictable symptoms. Future research and clinical practice are expected to improve the quality of medical diagnosis and treatment, optimize administrative strategy and provide diverse health support for patients with AF.Impact: Understanding the experiences and needs of patients with AF in the entire disease process will inform future clinical practice in AF integrated management, which would be helpful in improving the professionalism and confidence of healthcare providers. In addition, our findings have implications for improving the effectiveness of AF diagnostic and treatment services.Patient or Public Contribution: This paper presents a review of previous studies and did not involve patients or the public.

Objective: This study aims to explore the influence of patient activation (PA) and relational aspects on the quality of life (QoL) in patients with Atrial Fibrillation (AF) for developing measures to improve PA and QoL.Methods: A cross-sectional study was undertaken in 2021 among 190 AF patients in Nanjing, China. Research instruments included a self-designed social-demographic characteristics scale, the Patient Activation Measure (PAM), the Atrial Fibrillation Effect on Quality of Life (AFEQT). The data analysis was performed using IBM SPSS 25.0. Spearman correlation analysis, multiple linear regression analysis, and Wilcoxon rank-sum tests were used to assess the association accordingly.Results: The average AFEQT score for the 190 AF patients was 69.32 ± 14.52. The distribution of activation Levels 1, 2, 3, and 4, were where 4.7, 34.2, 47.4, and 13.7%, respectively. The multiple linear regression analysis revealed that patient activation, work status, and cardiac rehabilitation of AF patients predicted AF-related QoL (β = 0.270, −0.205, and 0.183, respectively; all P < 0.05). The influences of PA level on subdimensions of AF-related QoL were as follows: symptoms, daily activities and treatment concern.Conclusion: The level of QoL of patients with AF was moderate. Higher levels of patient activation in those with AF were associated with milder symptoms, more positive daily activities and fewer treatment concern. Based on our findings, we suggest that healthcare personnel should encourage AF patients to take active participation in cardiac rehabilitation, disease self-management and foster progression of PA level. Future research is warranted to develop tailor-made interventions aimed at the activation level.