Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 65-68).

Background Coronary heart disease deprives millions of lives in the world annually and this number has increased steadily in recent years. In Hong Kong, coronary heart disease claimed 4360 lives in 2009 and it is one of the major burdens of the healthcare system. In order to reduce cardiac mortality and morbidity and to enhance patients’ quality of life, cardiac rehabilitation program is developed. Exercise training is a pivotal part of the cardiac rehabilitation program. Objective The main objective of this translational nursing research is to translate quality research evidences regarding the effects of exercise training in improving quality of life of patients with coronary heart disease to the local setting. This is achieved by developing an evidence-based protocol. Methods A systematic search of literature was conducted in 5 electronic databases. 8 relevant randomized controlled trials were eventually obtained. Then, the 8 identified studies were summarized to form a table of evidence and the critical appraisal was performed using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. After performing the quality assessment, evidences were assembled for synthesis and recommendations are made for developing the evidence-based protocol. Since the implementation potential of the proposed exercise training program is considered to be high, an evidence-based protocol is developed for the local context. In order to implement the evidence-based protocol smoothly, implementation plan is developed in which a communication plan and a pilot test are included. Lastly, evaluation plan is established to assess the effectiveness of the program in fulfilling its objectives. Results In total, 7 recommendations are made based on the 8 appraised studies. According to the SIGN’s “Grades of recommendation”, all the recommendations in the protocol are graded with “A”. The significance of this evidence-based protocol is that it adds a symptom-limited exercise test for evaluating participant’s level of exercise tolerance before the start of exercise training, so that exercise intensity can be tailored. It is relatively safer than the current practice. Conclusion A 6-week exercise training program for patients with coronary heart disease is effective in improving their quality of life and increasing their level of physical activity. Since the program has a high implementation potential in the local context and is safer than the current practice, the evidence-based exercise training protocol is worthwhile to be introduced to the cardiac units in Hong Kong. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Osteoporosis is a serious health problem worldwide and most commonly affects postmenopausal women (World Health Organization, 1994). Of the variety of complications associated with osteoporosis in postmenopausal women, osteoporotic fracture is the most prevalent and serious one. It affects their quality of life and puts heavy burden on the healthcare system in Hong Kong. Since osteoporosis exercise program can help to reduce bone loss, it seems to be an effective strategy to prevent and manage osteoporosis in postmenopausal women. The purpose of this study is to develop an evidence-based osteoporosis exercise education program for postmenopausal women, based on the best available evidence, with an aim of helping them to prevent and manage osteoporosis through the prevention and reduction of bone loss and its related fractures. A search of literature from four databases, including Pubmed (1997 to August 2011), CINAHL Plus (1937 to August 2011), Cochrane Library (1996 to Issue 8 of 2011) and EMBASE Classic + EMBASE (1947 to August 2011), was done to identify relevant randomized controlled trials (RCTs). The methodology checklist for RCTs developed by the Scottish Intercollegiate Guidelines Network (SIGN, 2008) was used to evaluate the quality of the selected studies. A total of nine studies met the inclusion criteria and did not violate the exclusion criteria. The findings of these studies showed that exercise intervention or program significantly reduced postmenopausal women’s likelihood of having fracture and also improved their bone mass density slightly. Among the reviewed studies, programs were most commonly implemented within a 12-month period and two 60-minute supervised exercise sessions were delivered per week. The potential of implementing the proposed program, based on the evidence from the literature review, to local practice was assessed. Based on the assessment, the proposed program is necessary and beneficial for postmenopausal women. An evidence-based osteoporosis exercise education program is developed based on the best available evidence. The SIGN grading system was utilized to provide grades for the recommendations in the guideline. An effective and adequate communication with potential stakeholders to gain their support and cooperation for the proposed program is essential. In addition, a tailor-made pilot test is also crucial for ensuring the successful implementation of the proposed program. The pilot study will be conducted in a local practice and the targeted participants are 124 postmenopausal women. Data analysis will be done by the paired t-test. The proposed evidence-based osteoporosis exercise education program will be considered as effective if (1) there is a reduction of bone loss and an increase in physical activity level in postmenopausal women, and (2) there is an increase of confidence and self-perceived skill on the prevention of management of osteoporosis in nurses. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background: Despite growing utilization of mobile phones and websites for consumers seeking health care advice, the area is largely understudied. A niche market for these applications is in diabetes care. Since diabetes is a chronic condition requiring daily monitoring it is a good candidate for consumer health informatics and especially interactive websites and mobile phone applications. As the obesity epidemic continues, so too the prevalence of type 2 diabetes continues to rise. This chronic condition can lead to major complications and high medical cost. It is on the rise in countries all over the world, and beginning to impact people at younger ages. Low cost interventions are being explored to mitigate these complications and cost. Objective: To examine the effectiveness of consumer health informatics, such as websites, personal digital assistants, and mobile phone applications that claim to help people with diabetes self-monitor diet and exercise behaviours to lose weight. Methods: A search for relevant literature was conducted using PUBMED, Cochrane, and IEEE Xplore, with the search terms: (mhealth OR mobile health OR phone OR web* OR ehealth OR internet OR ICT) AND diabetes AND (diet* OR exercise OR physical activity). Also, a bibliographic search was done to identify any studies that were missed in the initial search. The search was not limited to any date range, but articles were identified from the time period of September 2000 through April 2012. Only articles in English were included. Studies were included if the program included an interactive logging feature for diet and/or physical activity. Studies that looked at type 1 disbetes were excluded. Results: A total of 10 original studies were found that met the inclusion criteria. Including 2 qualitative design, 1 randomized trial, and 7 randomized control trials. There was a great deal of heterogeneity among the studies. Delivery methods varies, studies including the following are: *  Mobile device only: 3 *  Website only: 6 *  Website plus mobile device: 1 Many different outcome measures were used across the studies including: behavioural, physiological, psychosocial, as well as usability and satisfaction. Overall, adherence and follow up were low. Dietary tracking generally appears not to be as effective as broad goals such as, “each more fruits and vegetables”. Exercise tracking was more effective at increasing physical activity. Message boards and peer support did not show an increase in effectiveness, but personal online coaches and personalized emails showed promising results. Usability and satisfaction was high in those that reported it, but the large number of dropouts are not considered in this. Conclusions: At this time, consumer health informatics does not seem to be an effective solution in facilitating significant behavior change for people who have type 2 diabetes. Future programs should look at ways to increase adherence and usage of the programs because the people who did use the programs daily benefited more than sporadic users. Components that showed promising results are access to a personal online coach, personalized weekly emails, integration with a pedometer that automatically uploads to a tracking program, and broader food related goals. Further testing is necessary to determine if this type of intervention is effective. / published_or_final_version / Public Health / Master / Master of Public Health

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Recorded on July 27, 2007 by Eugene Barsky, Physiotherapy Outreach Librarian, UBC / N/A

Recorded on July 27, 2007 by Eugene Barsky, Physiotherapy Outreach Librarian, UBC / N/A