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  • Heart failure among South Asians: a narrative review of risk, nature, outcomes and management.

    29 June 2018

    Individuals of South Asian descent have a high prevalence of comorbidities that are risk factors for the development of heart failure (HF), including diabetes mellitus and metabolic syndrome. However, little is known about the prevalence of HF, its management and prognosis for this population compared to Caucasians. Therefore, a literature review relating to the nature, outcome and treatment of HF in South Asian patients compared to Caucasians was conducted. It was anticipated that collating existing studies in this manner would be useful for guiding professionals in managing HF within this ethnic group, given that to achieve optimal care, regimens need to take into account cultural differences that may impact on adherence. Reviewed literature showed that South Asians with HF were more likely to be younger and have diabetes and hypertension. These papers also implied that outcomes for South Asians with HF were similar or even better than for Caucasians. The review highlighted the under-representation of South Asians in HF trials, meaning that evidence-based recommendations tailored to this specific population are limited. This is an important consideration because ethnic differences in response to medication have been reported; it cannot be assumed that treatments shown to work for Caucasians will be efficacious for those from minority ethnic groups.

  • Otitis media with effusion: experiences of children with cleft palate and their parents.

    29 June 2018

    OBJECTIVE: To explore the views of children with cleft palate and their parents about daily life with otitis media with effusion and associated hearing loss. DESIGN: A qualitative study. Semistructured interviews were used to collect data from parents. Participatory techniques, including activities on a tablet computer, were used to collect data from children. Framework analysis was applied to interview transcripts. SETTING: Two English cleft units. PARTICIPANTS: A purposive sample of parents of 37 children aged 0 to 11 years with experience of otitis media with effusion. Their children also took part if aged 6 to 11 years (n = 22). RESULTS: Themes related to the following: (1) emotions (frustration, anger, sadness, happiness, anxiety), (2) educational experiences (struggling at school, having to sit at the front of the class, requiring extra support, missing lessons for appointments or due to ear infections), (3) social interactions (isolation, communication, reliance on siblings, participation in activities). CONCLUSIONS: A number of areas of interviewees' everyday life were affected by the presence of otitis media with effusion. Parents may need to be forewarned about the possible ongoing nature of this condition and its impact on a child's social and emotional experiences. Children may also benefit from age-appropriate information about otitis media with effusion and its treatment, including information on hearing tests, to help reduce any anxiety.

  • Body image and cystic fibrosis: a critical review.

    29 June 2018

    A slight frame and poor appetite are common among patients with cystic fibrosis (CF) yet healthy body weight has been related to a better prognosis. A review of studies exploring body image (BI) among adults and adolescents with CF was conducted. Seven electronic databases were searched for potential papers. They located 128 references, of which 24 were read in full and 12 included in the review. Accepted papers suggested females with CF had a better BI compared to males, but this could compromise survival, given their preference for a low body weight. Males may be more motivated to adhere to nutritional advice because they favor a larger form. Practitioners should broach the topic of BI at clinic appointments to ensure this does not have a detrimental impact on self-management, although more research is required to guide professionals in this task.

  • What strategies are effective for exercise adherence in heart failure? A systematic review of controlled studies.

    29 June 2018

    Physical activity is recommended for people with stable heart failure (HF), because it is known to improve quality of life and health outcomes. However, adherence to this recommendation has been poor in many studies. A systematic review was conducted to examine the effectiveness of strategies used to promote exercise adherence in those with HF. The following databases were searched for relevant literature published between January 1980 and December 2010: British Nursing Index; CINAHL; Cochrane Library; Embase; Medline and PsycINFO. Papers with a control group focused on adults with HF that measured exercise or physical activity adherence were included. Nine randomised controlled trials were identified, involving a total of 3,231 patients (range 16-2,331). Six of these studies were informed by specific psychological theories. Positive outcomes occurred in the short-term from interventions using approaches such as exercise prescriptions, goal setting, feedback and problem-solving. However, longer-term maintenance of exercise was less successful. There was some support for interventions underpinned by theoretical frameworks, but more research is required to make clearer recommendations. Addressing self-efficacy in relation to exercise may be a particularly useful area to consider in this respect.