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Background: Misplacement of the nasogastric tube in the respiratory tract could cause serious complications and even death. Thus, nasogastric tube verification is necessary for optimal patient safety and comfort. Although end-tidal carbon dioxide detection is considered an effective approach to determine nasogastric tube location, there is a paucity of up-to-date evidence., Objectives: To review the diagnostic accuracy of end-tidal carbon dioxide detection in determining inadvertent airway intubation and verifying correct placement of nasogastric tubes., Design: A systematic review and meta-analysis., Methods: We searched clinical trials that evaluated the diagnostic accuracy of colorimetric capnometry or capnography in detecting nasogastric tubes located in the airway and differentiating between inadvertent airway intubation and correct nasogastric tube placement in any adult care setting. Four English language databases - Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL - and four Chinese language databases - China Biomedical Literature Database, WanFang Data, China National Knowledge Infrastructure, and Airiti Library - were searched from July 2009 to March 2021. Clinical trial registration databases and reference lists of included studies and relevant reviews were also searched. Two reviewers extracted the data of all included studies using a data extraction form. Two reviewers assessed the methodological quality independently with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We conducted meta-analysis using the hierarchical bivariate model and estimated the pool sensitivity and specificity of capnography and colorimetric capnometry. Forest plots were generated to display the results. Heterogeneity was investigated by meta-regression. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluations framework., Results: Of 1,155 records identified, seven new studies were added to this update and a total of 16 studies were analysed in the systematic review. The total absolute number of true positive, false negative, true negative, and false positive observations were 142, 6, 1,500, and 65 respectively. Low to very low certainty of evidence indicated that the use of colorimetric capnometry or capnography is potentially an effective method in differentiating between respiratory and nasogastric tube placement for critically ill adult patients. Pooled results (13 studies, 1,541 intubations) for sensitivity and specificity were 0.96 (95% confidence interval [0.88, 0.99]) and 0.99 (95% confidence interval [0.96, 1.00]), respectively., Conclusions: Colorimetric capnometry and capnography may have the potential to be of high sensitivity and specificity for the detection of inadvertent airway nasogastric tube placements in critically ill adults. More evidence is required to generalize the updated findings to different types of patients and settings., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: Post-intensive care syndrome is a term used to describe new or worsening multidimensional impairments in physical, psychological cognitive and social status arising from critical illness and persisting beyond hospital discharge. It is associated with high morbidity among patients discharged from intensive care units. However, due to its complexities, which encompass physical, psychological, cognitive and social impairments, the exact nature of this condition has not been fully conceptualized. The aim of this analysis therefore was to define the concept of post-intensive care syndrome. This conceptual clarity provides a general definition that is essential for practitioners and researchers to gain a comprehensive understanding of the syndrome and provide for accurate measurement of its incidence and prevalence., Design: The Walker and Avant approach to concept analysis guided this investigation., Data Source: An electronic search of the literature using PubMed, CINHAL, PsycArticles, Academic search complete, Science Direct, MEDLINE and Health Source databases informed the analysis. The search included both quantitative and qualitative studies related to post-intensive care syndrome published in English between 2010 and 2020., Results: Of the 3948 articles identified, 24 ultimately met the inclusion criteria. Analysis identified the defining attributes of post-intensive care syndrome as: (1) new or worsening multidimensional impairments; (2) physical dysfunction; (3) psychological disorder; (4) cognitive impairment; (5) failed social reconstruction; and (6) persistent impaired multidimensional symptoms extending beyond intensive care and hospital discharge. Antecedents were divided into two categories: pre-existing and those related to the intensive care admission. Consequences were identified as both positive (for example the establishment of coping processes) and adverse (for example decreased quality of life and caregiver burden)., Conclusion: Post-intensive care syndrome affects more than half of patients discharged from intensive care units. This operational definition and conceptual understanding of this syndrome will help improve understanding and inform the design of preventative strategies to improve long-term consequences of the syndrome. Future research and standardized instrument development will serve to better understand the scope and characteristics of this syndrome and inform the development of possible preventative interventions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier Ltd.)

Background: People with intellectual and developmental disabilities (IDD) are at risk of developing long term health conditions, and a preventative health agenda research is emerging. However, little is known about the recruitment settings, delivery contexts, intervention techniques and outcomes of health promotion programmes for this population. Therefore, the aim of this review was to synthesize and evaluate these characteristics., Method: A systematic review of studies identified from multiple databases on healthy lifestyle interventions for adolescents and young people with IDD was conducted. Data were synthesized and evaluated using a logic model. Quality of rigour was also assessed., Results: Sixteen geographically diverse studies were selected and evaluated. Participants were most commonly recruited from schools, with interventions typically taking place in a gym setting and involving physical activity training., Conclusions: This review indicates that physical activity and dietary interventions in people with IDD may lead to lifestyle changes, however more robust evidence is required. Educational settings are conducive, with settings beyond schools requiring further consideration., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background and Objectives: Practices that include yoga asanas and mindfulness-based stress reduction for the management of stress are increasingly popular; however, the neurobiological effects of these practices on stress reactivity are not well understood. Many studies investigating the effects of such practices fail to include an active control group. Given the frequency with which people are selecting such interventions as a form of self-management, it is important to determine their effectiveness. Thus, this review investigates the effects of practices that include yoga asanas, with and without mindfulness-based stress reduction, compared to an active control, on physiological markers of stress., Materials and Methods: A systematic review and meta-analysis of randomised controlled trials published in English compared practices that included yoga asanas, with and without mindfulness-based stress reduction, to an active control, on stress-related physiological measures. The review focused on studies that measured physiological parameters such as blood pressure, heart rate, cortisol and peripheral cytokine expression. MEDLINE, AMED, CINAHL, PsycINFO, SocINDEX, PubMed, and Scopus were searched in May 2016 and updated in December 2016. Randomised controlled trials were included if they assessed at least one of the following outcomes: heart rate, blood pressure, heart rate variability, mean arterial pressure, C-reactive protein, interleukins or cortisol. Risk of bias assessments included sequence generation, allocation concealment, blinding of assessors, incomplete outcome data, selective outcome reporting and other sources of bias. Meta-analysis was undertaken using Comprehensive Meta-Analysis Software Version 3. Sensitivity analyses were performed using 'one-study-removed' analysis. Subgroup analysis was conducted for different yoga and control group types, including mindfulness-based stress reduction versus non-mindfulness-based stress reduction based interventions, different populations, length of intervention, and method of data analysis. A random-effects model was used in all analyses., Results: Forty two studies were included in the meta-analysis. Interventions that included yoga asanas were associated with reduced evening cortisol, waking cortisol, ambulatory systolic blood pressure, resting heart rate, high frequency heart rate variability, fasting blood glucose, cholesterol and low density lipoprotein, compared to active control. However, the reported interventions were heterogeneous., Conclusions: Practices that include yoga asanas appear to be associated with improved regulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal system in various populations., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Meditation is a popular form of stress management, argued to mediate stress reactivity. However, many studies in this field commonly fail to include an active control group. Given the frequency with which people are selecting meditation as a form of self-management, it is important to validate if the practice is effective in mediating stress-reactivity using well-controlled studies. Thus, we aimed to conduct a meta-analysis investigating the neurobiological effects of meditation, including focused attention, open monitoring and automatic self-transcending subtypes, compared to an active control, on markers of stress. In the current meta-analysis and systematic review, we included randomised controlled trials comparing meditation interventions compared to an active control on physiological markers of stress. Studied outcomes include cortisol, blood pressure, heart-rate, lipids and peripheral cytokine expression. Forty-five studies were included. All meditation subtypes reduced systolic blood pressure. Focused attention meditations also reduced cortisol and open monitoring meditations also reduced heart rate. When all meditation forms were analysed together, meditation reduced cortisol, C - reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha. Overall, meditation practice leads to decreased physiological markers of stress in a range of populations., (Copyright © 2017. Published by Elsevier Ltd.)

Objectives: The study aims were to (a) describe the experiences of Chinese Australians with heart disease following discharge from hospital for an acute cardiac event; (b) identify patterns and cultural differences of Chinese Australians following discharge from hospital; and (c) illustrate the illness/health seeking behaviors and health beliefs of Chinese Australians., Design: Qualitative study., Methods: Interview data were obtained from the following sources: (a) focus groups of Chinese community participants without heart disease; (b) interviews with patients recently discharged from hospital following an admission for an acute cardiac event; and (c) interviews with Chinese-born health professionals working in Australia. Qualitative thematic analysis was undertaken., Results: Study themes generated from the data were: (1) linking traditional values and beliefs with Western medicine; (2) reverence for health professionals and family; and (3) juxtaposing traditional beliefs and self-management., Conclusions: Considering the influence of cultural values in developing health care plans and clinical decision making is important., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To review the diagnostic accuracy of end-tidal carbon dioxide detection in detecting inadvertent airway intubation and verifying correct placement of nasogastric tubes., Design: We undertook a meta-analysis of diagnostic studies., Study Selection: All clinical trials that evaluated the diagnostic accuracy of the colorimetric capnometry or capnography in detecting inadvertent airway intubation and differentiating between respiratory and gastrointestinal tube placement in adults were included. Electronic databases including MEDLINE, CINAHL, EMBASE, All EBM Reviews, WanFang Data, China Journal Net, Chinese Medical Current Contents, and Index to Chinese Periodical Literature were searched from inception to July 2009. DATA EXTRACTION AND QUALITY ASSESSMENT: Data were extracted using a form piloted prior to use. Two reviewers independently extracted data relating to purpose of the trial, sample, measurements used, index test results and reference standard. Methodological quality of eligible trials was assessed independently by two reviewers using a modified version of the Quality Assessment of Diagnostic Accuracy Studies for assessing studies of diagnostic accuracy. The accuracy of diagnostic tests is presented in terms of sensitivity, specificity, predictive values, and likelihood ratios., Data Synthesis: Nine clinical trials were eligible for inclusion in the meta-analysis. Eight trials were undertaken in intubated and mechanically ventilated patients and two trials also involved participants who were alert or awake. Eight involving a total of 456 nasogastric feeding tube placements investigated the diagnostic accuracy of either colorimetric capnometry or capnography to detect feeding tube placement. One trial involving 195 gastric tube insertions compared the diagnostic accuracy of simultaneous use of a colorimetric carbon dioxide detector and capnography to detect feeding tube placement. The use of colorimetric capnometry or capnography had a sensitivity ranging from 0.88 to 1.00, specificity 0.95 to 1.00, positive likelihood ratio 15.22 to 283.35, negative likelihood ratio 0.01 to 0.25. A summary receiver operator characteristics (SROC) curve was constructed and showed an area under the curve was 0.9959. Three trials reported significant cost savings using end-tidal carbon dioxide detectors., Conclusions: There is evidence to support the use of capnography or colorimetric capnometry for the identification of nasogastric feeding tube placement in mechanically ventilated patients., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Effective self-care is the cornerstone of the successful management of heart failure (HF). The European Heart Failure Self-care Behaviour Scale is a brief, reliable and valid scale to measure this important construct among patients with HF. Although the EHFScBS has been translated to different languages, no Chinese version is available. Indeed, previous findings investigating the psychometric properties of EHFScBS indicated ambiguity of the conceptual structure of this scale., Aim: The aim of this study was to translate the European Heart Failure Self-care Behaviour Scale (EHFScBS) into Chinese and to test its psychometric properties in the Chinese patients with HF., Methods: The EHFScBS (English Version) was translated to Chinese using Brislin's forward and backward translation method. Panel review was used to examine its semantic equivalence and content validity. The EHFScBS (Chinese Version) was then tested with a convenience sample of 143 Chinese HF patients who attended a specialist clinic from January to September 2007., Results: The content validity index (CVI) of the EHFScBS (Chinese version) was satisfactory (Item CVI=0.96; Scale CVI=0.89), with Cronbach's alpha 0.82. Convergent validity was supported by a moderate relationship, statistical significant with a measure for social support (r=-0.36, p<0.001). However, the findings did not support the hypothesised three-factor structure of the EHFScBS (Chinese Version). Instead, all items except one fit well a two-factor structure to measure help-seeking and regimen-complying behaviours., Conclusion: The adequate psychometric properties and clear conceptual structure of EHFScBS (Chinese Version) warrant its use in Chinese patients with HF., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: Type D personality predicts poor prognosis in coronary heart disease (CHD) but little is known about Type D in non-Western cultures. We examined the (a) validity of the Type D construct and its assessment with the DS14 scale in the Chinese culture, (b) prevalence of Type D, and (c) gender vs. Type D discrepancies in depression/anxiety, among Chinese patients with CHD., Method: Patients with CHD (N=326) completed the Chinese version of the DS14. The NEO Five Factor Inventory (NEO-FFI), Hospital Anxiety and Depression Scale (HADS), and Stress Symptom Checklist (SSC) were administered to subsamples to establish construct and discriminant validity. Administration of the DS14, HADS, and SSC was repeated at 1 month after hospital discharge in 66 patients, and stability of the DS14 was examined in another subsample of 100 patients., Results: The theoretical structure of the Type D construct in the Chinese culture was supported (chi(2)/df=2.89, root mean square error of approximation=0.08, normal fit index=0.91, non-normal fit index=0.91, comparative fit index=0.93). The Negative Affectivity (NA) and Social Inhibition (SI) subscales of the DS14 in the entire sample were internally consistent (Cronbach's alpha=0.89/0.81), measured stable traits (3-month test-retest ICC=0.76/0.74), and correlated significantly with the neuroticism (NA/neuroticism, r=0.78, P<.001) and extraversion subscales (SI/extraversion, r=-0.64, P<.001) of the NEO-FFI, respectively. The prevalence of Type D personality was 31%. Type D was not related to transient emotional states. However, Chinese patients with a Type D personality were at increased concurrent risk of anxiety (P=.002) and depression (P=.016)., Conclusion: Type D personality is a cross-culturally valid construct, is associated with an increased risk of anxiety and depression, and deserves prompt attention in estimating the prognostic risk of Chinese CHD patients., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to investigate the diagnostic performance of biochemical tests used to determine placement of nasogastric (NG) tubes after insertion in adults., Design: A systematic review of diagnostic studies was undertaken., Data Sources: A literature search of the bibliographic databases and the World Wide Web was performed to locate original diagnostic studies in English or Chinese on biochemical markers for detecting NG tube location., Review Methods: Studies in which one or more different tests were evaluated with a reference standard, and diagnostic values were reported or could be calculated were included. Two reviewers independently checked all abstracts and full text studies for inclusion criteria. Included studies were assessed for their quality using the QUADAS tool. Study features and diagnostic values were extracted from the included studies., Results: Of the 10 studies included in this review, seven investigated the diagnostic accuracy of pH, one investigated the diagnostic accuracy of pH and bilirubin respectively, two a combination of pH and bilirubin and one a combination of pH, pepsin and trypsin levels in identifying NG tube location. All studies used X-rays as the reference standard for comparison. Pooled results demonstrated that a pH of

Background: There is a growing use of multisensory therapy in enhancing sense of well-being and reducing challenging or stereotypic self-stimulating behaviour in people with a developmental disability., Objectives: This review aimed to present the best available evidence on the effect of multisensory therapy in adult clients with developmental disabilities on the frequency of challenging behavior, stereotypic self-stimulating behavior, and positive behaviour; and changes of physiological measures., Design: Systematic review., Data Sources: A search of electronic databases of published research studies (January 1985-December 2008) was conducted, using appropriate search terms. The reference lists and bibliographies of retrieved articles were reviewed to identify research not located through other search strategies., Review Methods: Studies that investigated the effects of multisensory environment in relation to outcomes were examined. Data were extracted independently by two reviewers. Methodological quality was also assessed by two reviewers against key quality criteria., Findings: One hundred and thirty-two studies were identified from database search of which 17 met the inclusion criteria for review. The evidence supports that participants' had displayed more positive behaviour after multisensory therapy sessions. There is no strong evidence supporting that multisensory therapy could help in reducing challenging behaviour or stereotypic self-stimulating behaviour., Conclusions: This systematic review demonstrates a beneficial effect of multisensory therapy in promoting participants' positive emotions. While the reviewers acknowledge the difficulty in carrying out randomized controlled trial in people with developmental disabilities and challenging behavior, the lack of trial-derived evidence makes it difficult to arrive at a conclusion of the effectiveness of the multisensory therapy. Future study should use well-designed randomised controlled trials to evaluate the short and long term effectiveness of multisensory therapy. There is also a need for qualitative studies which allow the clients to tell the stories of their experiences.

Objective: This study aimed to evaluate the validity, reliability, and cultural relevance of the Cardiac Depression Scale (CDS) as a disease-specific screening tool for Chinese cardiac patients., Methods: The language equivalency and content validity of the Chinese version of the CDS (C-CDS) were evaluated. Measurement performance was tested on 200 Chinese cardiac patients and repeated on 40 patients for test-retest reliability., Results: One item pertaining to sexual activity was removed from the Chinese version due to poor cultural relevance. The C-CDS demonstrated acceptable internal consistency (Cronbach's alpha of .91 for the total scale and .53-.78 for the subscales). The high correlation (r=.64-.89) between items and the remainder of their own scale provides further evidence of internal consistency. The test-retest reliability was satisfactory with intraclass correlation coefficients of .94 for the overall scale and .73-.92 for the six subscales. The total and subscale scores that were not significantly different (P>.05) over a 2-week period further support the stability of the instrument. There was acceptable concurrent validity with moderate (r>or=.3, P<.001) correlations between the C-CDS and the Chinese version of the Hospital Anxiety and Depression Scale. Principal component analysis revealed six factors, and one dimension was extracted from the data set, which closely resembles the structure of the original instrument., Conclusion: Empirical data support the C-CDS as a valid and reliable disease-specific tool in assessing depressed mood in Chinese-speaking patients with cardiac disease.

Objective: The aim of this study is to examine the association between changes in misconceived or maladaptive beliefs about angina and patients' functional and psychological status., Method: The method used was a prospective follow-up study over 1 year of 133 people with angina., Results: Beliefs about angina were significantly associated with functional and psychological status. People with more misconceived or maladaptive beliefs were more anxious and physically limited than were people with fewer such beliefs, with differences in physical functioning that were clinically significant. Change in angina beliefs over 1 year was the most significant predictor for physical functioning at follow-up, after controlling for the effects of demographic variables and the outcome variable at baseline, whereas change in the frequency of angina did not contribute significantly to this model., Conclusion: Misconceived and maladaptive beliefs about angina are associated with reductions in both functional and psychological status. These beliefs are easily and quickly identified using a simple questionnaire and should be corrected.

Objective: The aim of this study was to examine the extent to which illness perceptions predict attendance at cardiac rehabilitation and quality of life following myocardial infarction (MI)., Methods: The illness perceptions of 194 MI patients were assessed whilst the patients were still in hospital following an MI. The mean age was 63.3 years (S.D. = 10.6), and 142 of the patients were men. Cardiac rehabilitation attendance and quality of life were assessed via a postal questionnaire 6 months later., Results: In contrast to previous work reported in this area, illness perceptions were not significantly associated with attendance at cardiac rehabilitation. Illness perceptions measured within 24 h of an acute MI were predictive of quality of life 6 months later., Conclusion: Previous reports may have overestimated the extent to which illness perceptions predict attendance at cardiac rehabilitation. The relationship between illness perceptions and quality of life at 6 months suggests that interventions to alter illness perceptions, especially perceptions of consequences, may be useful in improving health-related quality of life (HRQoL) following an MI.

Objective: High levels of psychological distress have been reported in patients with congestive heart failure (CHF), resulting in increased morbidity and mortality. Yet, little is known about its associated factors. The purpose of this study is to identify the significant demographic, clinical and psychosocial correlates of psychological distress in CHF patients., Methods: Cross-sectional data were obtained from a sample of a consecutive series of hospitalized CHF patients (n = 227) with measures of psychological distress, functional status, symptom status, social support and health perception. Objective clinical variables were obtained from the hospital records., Results: High levels of psychological distress, in particular, depression, were found in patients with CHF. In hierarchical regression analysis, poorer perceived emotional-informational support, higher levels of fatigue, poorer health perception and not living with family were identified as the significant correlates of psychological distress. These correlates, in total, explained 49% of the variance for the scores of psychological distress. None of the objective clinical variables demonstrated a significant contribution that accounted for psychological distress in CHF patients., Conclusion: The findings highlight the importance of addressing social support for CHF patients. Assisting this vulnerable patient group to cope with fatigue and to cultivate a positive health perception are also highly prioritized treatment goals.

This randomized controlled trial examined the effectiveness of a 12-session mutual support group conducted over 3-months for Chinese family caregivers of a relative with schizophrenia compared with routine family support services in Hong Kong. Forty-eight family caregivers from two psychiatric outpatient clinics were allocated randomly to an experimental (mutual support and usual outpatient care) group (n = 24) or a control (usual outpatient care only) group (n = 24). Data were collected prior to, 1 week and 3 months after the intervention. Families allocated to the mutual support group experienced decreased levels of family burden and increased family functioning and these changes were significantly greater than those of the controls at both post-intervention time points. The experimental group also showed a significant decrease in the duration of patient re-hospitalization (the total number of days of psychiatric hospitalization) at 3 months compared with the control group. This suggests that the mutual support group provided a more responsive service for patients than standard care. However, there was no significant difference in family service utilization between the two groups. The findings indicate that a mutual support group can provide benefits for family caregivers of people with schizophrenia that go beyond those provided by routine family support., (Copyright 2004 Elsevier Ltd.)

The study identified barriers to research implementation experienced by nurses, midwives and health visitors in five trusts and one health authority in Yorkshire, UK. Funk et al. (Appl. Nurs. Res. 4(1) (1991a) 39, Appl. Nurs. Res. 4(2) (1999b) 90) developed the BARRIERS to research utilisation questionnaire over 10 years ago, but no replication, in size (n = 1989) and extent, of that study appeared to have occurred. The staff population (n = 4501) were sent the BARRIERS questionnaire. 44.6% (n = 2009) were returned. Findings suggested nurses need time to read and apply research; authority to change practice; critical appraisal skills, an understanding of statistics and support of managers and peers (particularly doctors) to achieve successful practice change., (Copyright 2002 Elsevier Science Ltd.)

Objective: To examine the characteristics, subsequent resource use and outcome of a consecutive cohort of admissions with acute chest pain not due to myocardial infarction., Methods: Subjects (N=356) identified in the course of a epidemiological study of myocardial infarction were interviewed and completed HAD, SF-36 and other self-report information in hospital and at 3 months and 1 year. Hospital casenotes were reviewed at 1 year., Results: A total of 218 subjects were given cardiac diagnoses and 138 noncardiac diagnoses. Cardiac subjects were more distressed and disabled and used more resources. Those in the noncardiac group reported distress and disability and resource use comparable to infarct admissions., Conclusion: Awareness of psychosocial variables would aid in the assessment and management of those with and without ischaemic heart disease.

Objectives: To determine the effectiveness of individualised educational behavioural treatment delivered by cardiac nurses in hospital compared to usual care for patients following acute myocardial infarction., Methods: One hundred and fourteen consecutive patients were randomised to receive the intervention or usual care. Outcome assessment was by self-report questionnaire (the Hospital Anxiety and Depression Scale and Dartmouth COOP Health Status), interview at 1 month, and self-report at 3 and 12 months. The primary outcome was improvement in the Dartmouth COOP total score from baseline to 3 months., Results: Four patients needed to be treated to give an additional patient with improvement in health status at 3 months (number needed to treat [NNT] 4, 95% confidence intervals [CIs] 3 to 12). The intervention group were more confident about returning to activities 1 month after discharge from hospital. Treated patients had fewer further treatment needs., Conclusions: An individualised educational behavioural treatment delivered by cardiac nurses in hospital may have substantial benefits. A large-scale pragmatic RCT is needed.

This paper describes the experiences of initiating and developing a coherent programme of research and development in cardiac rehabilitation. It charts the evolution of the research programme from its origins in a few small scale studies and sets the context in which this research was carried out. The paper goes on to describe the valuable lessons learned in undertaking clinical research, such as serving an apprenticeship, receiving supervision and working as a member of a team. Finally, the paper, in acknowledging the importance of research training, shows how this has culminated in the author leading and managing a programme of research, bringing together a research team, disseminating and implementing research and collaborating with colleagues from other disciplines.

This study describes the development of a classification system for the clarification, understanding and measurement of nurses' work methods. The theoretical basis of the classification system is described. The system offered distinguishes between three common work methods: primary, team and task nursing; the strength of opportunity for nurse-patient interaction in each method being determined as either 'strong', 'moderate' or 'weak', according to how effectively they are practised. Preliminary testing of the system on 32 wards in 13 hospitals is described. It is concluded that further testing and possible refinement is required for validation of the system.

Self-ratings of anxiety and depression were studied over six months in 60 male patients, under 66 yr of age, who were admitted to a coronary care unit with a first time acute myocardial infarction. Patients were randomly assigned to either a treatment group, where they received a simple programme of in-hospital counselling in addition to routine care, or to a control group, where they received routine care only. All patients completed the Hospital Anxiety and Depression scale and a battery of visual analogue scales measuring anxiety on a range of topics related to recovery from a myocardial infarction. Patients who received in-hospital counselling reported statistically significantly less anxiety and depression than those who received routine care alone. This effect was sustained for six months after leaving hospital. It is concluded that a simple programme of in-hospital counselling, provided by a coronary care nurse, is efficacious and should be routinely offered to first myocardial infarction patients in hospital.

Self-ratings of anxiety and depression were studied over six months in 60 wives of first time myocardial infarction patients. Couples were randomly assigned to either a treatment group, where they received a simple programme of education and psychological support in addition to routine care, or to a control group, where they received routine care only. All wives completed the Hospital Anxiety and Depression scale and a battery of visual analogue scales measuring anxiety on a range of topics related to recovery from a heart attack. Wives in the treatment group reported statistically significantly less anxiety than controls. This effect was sustained for six months after the counselling. It is concluded that a simple programme of in hospital counselling is efficacious and should be routinely offered to the wives of coronary patients.

This paper reviews the debate concerning the relationship between dietary fats and heart disease. The paper also addresses the questions "should nurses persuade patients with heart disease to follow a low-fat, low-cholesterol diet?", "If so, will patients be less liable to a heart attack?" and "are such recommendations based on valid scientific evidence?". The author examines the recent evidence which is critical of such dietary regimens, and claims that much of the dietary advice given by nurses to these patients is biased, misleading and scientifically unfounded.

This study was designed as an approximate replication of a recent Canadian study on a sample of 20 nurses from the coronary care unit of a large teaching hospital in the U.K. Results from this study indicate that knowledge and experience are the two most important factors influencing rapid decision making, and nurses make many rapid decisions in emergency situations prior to seeking medical help. These results are in agreement with those of the original study.