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Elliott AE, Elliott PC, Cook R. Postpartum maternal distress: a multidimensional illness requiring a multilevel, multidiscipline response. Aust J Prim Health 2020; 26:222-226. [PMID: 32340663 DOI: 10.1071/py19180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/11/2020] [Indexed: 11/23/2022]
Abstract
Australia's federal, state, territory and local governments all have responsibilities, often overlapping, for policy and delivery of primary mental health care to postpartum women. Identification and treatment of postpartum distress is carried out by a broad range of professionals from diverse disciplines. Although there is evidence to show that anxiety and stress are important aspects of postpartum distress, substantially greater emphasis has been given to identification and treatment of depression. In addition, relatively little attention has been given to incorporating positive and negative social experiences in healthcare policy and practice. This study aimed to extend the postpartum literature by: (1) comparing the levels of depression, anxiety and stress (i.e. distress indicators) in a non-clinical sample of postpartum mothers to those in the general non-clinical population; (2) comparing the prevalence of anxiety and stress to that of depression in postpartum mothers; and (3) examining the consequences of negative social exchange, alongside perceived social support, on postpartum distress indicators. A self-report survey was completed by 242 postpartum women assessing levels of perceived social support, frequency of negative social exchange and distress indicators. Postpartum mothers were found to have significantly higher depression, anxiety and stress than the general population, and had anxiety and stress levels that were similar in severity to depression. In addition, both negative social exchanges and perceived social support were found to be important for postpartum depression, anxiety and stress. These findings suggest that Australia's primary postpartum mental health care policy and practice guidelines, delivered through a broad range of professionals, may benefit from giving anxiety and stress equal weight to depression and by embracing the important effects, for good and for ill, of positive and negative social interactions.
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Affiliation(s)
- Angela E Elliott
- School of Health Sciences, Swinburne University of Technology, PO Box 218, H29, Hawthorn, Vic. 3122, Australia
| | - Peter C Elliott
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Level 3, 161 Barry Street, Carlton, Vic. 3053, Australia; and Corresponding author. ,
| | - Roger Cook
- School of Health Sciences, Swinburne University of Technology, PO Box 218, H29, Hawthorn, Vic. 3122, Australia
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Worcester MU, Goble AJ, Elliott PC, Froelicher ES, Murphy BM, Beauchamp AJ, Jelinek MV, Hare DL. Mild Depression Predicts Long-Term Mortality After Acute Myocardial Infarction: A 25-Year Follow-Up. Heart Lung Circ 2019; 28:1812-1818. [DOI: 10.1016/j.hlc.2018.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022]
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Rushford N, Murphy BM, Worcester MUC, Goble AJ, Higgins RO, Le Grande MR, Rada J, Elliott PC. Recall of information received in hospital by female cardiac patients. ACTA ACUST UNITED AC 2016; 14:463-9. [PMID: 17568250 DOI: 10.1097/hjr.0b013e3280ac1507] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The type and source of health information supplied to patients following cardiac events significantly improve adherence and health behaviours. The impact of health information upon female patients, however, is not well documented. This study investigates women's recall of the type and source of information provided to them in hospital about resuming daily activities after a cardiac event. It also identified women least likely to recall receiving information. METHODS Interviews were conducted with female cardiac patients consecutively admitted to four metropolitan hospitals after acute myocardial infarction or for coronary artery bypass graft surgery. The women were interviewed on admission and at 2, 4 and 12 months after discharge. Participants were asked about in-hospital information provision at the 2-month interview (n=224). RESULTS Most women recalled receiving verbal information about medication, exercise and smoking cessation, but few recalled receiving verbal information about gardening, sexual activity, driving or sport. Women who were obese or physically inactive recalled limited advice about diet and physical activity, whereas women with diabetes or hypertension were no more likely than others to recall receiving information about medication, despite the personal relevance of this information. Older women were most at risk of recalling limited advice, including information about cardiac rehabilitation. Over half of the women attended a cardiac rehabilitation programme, with uptake being related to information provision. CONCLUSIONS The findings support other research suggesting that advice about activities after a cardiac event is inadequate for some women and confirms the influence of information provision on participation in cardiac rehabilitation.
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Affiliation(s)
- Nola Rushford
- Department of Psychology, The University of Melbourne, Parkville, Victoria, Australia
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Le Grande MR, Murphy BM, Higgins RO, Worcester MUC, Parkinson A, Brown SL, Elliott PC, Goble AJ. Physical activity and negative emotional response after percutaneous coronary intervention. ACTA ACUST UNITED AC 2016; 13:254-60. [PMID: 16575281 DOI: 10.1097/01.hjr.0000189808.22224.b0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aims of this study were to investigate the association between negative emotional response (NER) and physical activity levels in percutaneous coronary intervention (PCI) patients, and to examine the extent to which physical activity levels were influenced by factors such as the patients' age, sex, and attendance at a cardiac rehabilitation (CR) programme. METHODS A consecutive series of 200 PCI patients [mean age 59.0 (+/-10.1) years] completed telephone interviews 2 weeks and 6 months after their procedure. NER was assessed using 12 items addressing patients' perceptions and concerns regarding symptoms, diagnosis and prognosis. Physical activity was assessed by asking four questions relating to the frequency and duration of walking and of moderate activity. CR attendance, medical history and sociodemographic data were also collected. Hierarchical linear regression was used to assess the association between NER and physical activity over time. RESULTS After controlling for baseline levels of moderate activity and other covariates, NER significantly predicted change in moderate activity over 6 months. Only baseline walking levels predicted the duration and frequency of walking at 6 months. CONCLUSION NER can be considered an inhibitive factor towards increased moderate activity uptake after PCI. Walking after PCI does not appear to be affected by NER. These findings highlight the need to focus on improving the emotional aspects of patients' recovery.
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Worcester MU, Elliott PC, Turner A, Pereira JJ, Murphy BM, Le Grande MR, Middleton KL, Navaratnam HS, Nguyen JK, Newman RW, Tatoulis J. Resumption of Work After Acute Coronary Syndrome or Coronary Artery Bypass Graft Surgery. Heart Lung Circ 2014; 23:444-53. [DOI: 10.1016/j.hlc.2013.10.093] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/04/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
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Le Grande MR, Elliott PC, Worcester MU, Murphy BM, Goble AJ, Kugathasan V, Sinha K. Identifying illness perception schemata and their association with depression and quality of life in cardiac patients. PSYCHOL HEALTH MED 2012; 17:709-22. [DOI: 10.1080/13548506.2012.661865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Turner A, Murphy BM, Higgins RO, Elliott PC, Le Grande MR, Goble AJ, Worcester MUC. An integrated secondary prevention group programme reduces depression in cardiac patients. Eur J Prev Cardiol 2012; 21:153-62. [DOI: 10.1177/2047487312467747] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Alyna Turner
- Heart Research Centre, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | - Barbara M Murphy
- Heart Research Centre, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | | | - Peter C Elliott
- Heart Research Centre, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | | | | | - Marian UC Worcester
- Heart Research Centre, Victoria, Australia
- The University of Melbourne, Victoria, Australia
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Murphy BM, Grande MRL, Navaratnam HS, Higgins RO, Elliott PC, Turner A, Rogerson MC, Worcester MUC, Goble AJ. Are poor health behaviours in anxious and depressed cardiac patients explained by sociodemographic factors? Eur J Prev Cardiol 2012; 20:995-1003. [DOI: 10.1177/2047487312449593] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Barbara M Murphy
- Heart Research Centre, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
| | | | | | | | - Peter C Elliott
- Heart Research Centre, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
| | - Alyna Turner
- Heart Research Centre, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
| | | | - Marian UC Worcester
- Heart Research Centre, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
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Murphy BM, Elliott PC, Worcester MUC, Higgins RO, Le Grande MR, Roberts SB, Goble AJ. Trajectories and predictors of anxiety and depression in women during the 12 months following an acute cardiac event. Br J Health Psychol 2010; 13:135-53. [PMID: 17535492 DOI: 10.1348/135910707x173312] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Many previous investigations of the recovery of emotional well-being, particularly the resolution of depression, following an acute cardiac event assume that all patients follow a similar, linear trajectory. However, it is possible that there are different groups of patients who follow different trajectories. This study tested for multiple trajectories of anxiety and depression and identified the characteristics of patients most at risk for persistent or worsening anxiety and depression in the 12 months following their cardiac event. METHOD A consecutive sample of 226 women was interviewed following either acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS). The Hospital Anxiety and Depression Scale were administered on four occasions over 12 months. Growth curve and growth mixture modelling were used to identify trajectories of change and univariate tests were employed to establish predictors of each trajectory. RESULTS Most women began with relatively low levels of anxiety and/or depression that improved over the 12 month period (84% women showed this trajectory for anxiety, 89% for depression). A smaller group began with relatively high levels of anxiety and/or depression that worsened over time (16% for anxiety, 11% for depression). Patients in the latter group were more likely to report high levels of loneliness, have a first language other than English, perceive their cardiac disease as more severe (anxiety group only) and have diabetes (depression group only). Trajectories were non-linear, with most change occurring in the initial 2-month period. CONCLUSION Growth modelling techniques highlight that change in anxiety and depression following an acute event follows neither a single nor linear trajectory. Most women showed early resolution of anxiety and depression following their event, indicative of a normal bereavement or adjustment response. A minority of women reported worsening anxiety and/or depression in the year following their cardiac event, particularly those who lacked social support or were from non-English speaking backgrounds. Intervention studies to explore support options for these women are warranted, both prior to and following their event.
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Elliott PC, Murphy BM, Oster KA, Le Grande MR, Higgins RO, Worcester MU. Changes in Mood States After Coronary Artery Bypass Graft Surgery. Eur J Cardiovasc Nurs 2010; 9:188-94. [DOI: 10.1016/j.ejcnurse.2009.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 10/29/2009] [Accepted: 11/15/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Peter C. Elliott
- Heart Research Centre, The University of Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
| | - Barbara M. Murphy
- Heart Research Centre, The University of Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
| | - Kerry A. Oster
- Heart Research Centre, The University of Melbourne, Australia
| | | | | | - Marian U.C. Worcester
- Heart Research Centre, The University of Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
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Veitch NC, Elliott PC, Kite GC, Lewis GP. Flavonoid glycosides of the black locust tree, Robinia pseudoacacia (Leguminosae). Phytochemistry 2010; 71:479-86. [PMID: 19948349 DOI: 10.1016/j.phytochem.2009.10.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 10/30/2009] [Accepted: 10/30/2009] [Indexed: 05/06/2023]
Abstract
Four flavone glycosides isolated from extracts of the leaves of Robinia pseudoacacia (Leguminosae) were characterised by spectroscopic and chemical methods as the 7-O-beta-d-glucuronopyranosyl-(1-->2)[alpha-l-rhamnopyranosyl-(1-->6)]-beta-d-glucopyranosides of acacetin (5,7-dihydroxy-4'-methoxyflavone), apigenin (5,7,4'-trihydroxyflavone), diosmetin (5,7,3'-trihydroxy-4'-methoxyflavone) and luteolin (5,7,3',4'-tetrahydroxyflavone). Assignment of glycosidic (1)H and (13)C resonances in their NMR spectra was facilitated by (2)J(HC) correlations detected using the H2BC (heteronuclear two-bond correlation) pulse sequence. Spectroscopic analysis of two known triglycosides, acacetin 7-O-beta-d-glucopyranosyl-(1-->2)[alpha-l-rhamnopyranosyl-(1-->6)]-beta-d-glucopyranoside (previously unrecorded from this species) and acacetin 7-O-beta-d-xylopyranosyl-(1-->2)[alpha-l-rhamnopyranosyl-(1-->6)]-beta-d-glucopyranoside ('acacetin trioside'), enabled inconsistencies in the literature relating to these structures to be resolved. Comparison of the flavonoid chemistry of leaves and flowers of R. pseudoacacia using LC-UV and LC-MS showed that flavone 7-O-glycosides, particularly of acacetin, predominated in the former, whereas the latter comprised mainly flavonol 3,7-di-O-glycosides, including several examples new to this species. Tissue dependent differences in flavonoid chemistry were also evident from the glycosylation patterns of the compounds.
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Affiliation(s)
- Nigel C Veitch
- Royal Botanic Gardens, Kew, Richmond, Surrey TW9 3AB, UK.
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Elliott PC, Smith G, Ernest CS, Murphy BM, Worcester MUC, Higgins RO, Le Grande MR, Goble AJ, Andrewes D, Tatoulis J. Everyday Cognitive Functioning in Cardiac Patients: Relationships Between Self-report, Report of a Significant Other and Cognitive Test Performance. Aging, Neuropsychology, and Cognition 2009; 17:71-88. [DOI: 10.1080/13825580903009089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Le Grande MR, Elliott PC, Worcester MUC, Murphy BM, Goble AJ. An Evaluation of Self-report Physical Activity Instruments Used in Studies Involving Cardiac Patients. J Cardiopulm Rehabil Prev 2008; 28:358-69. [DOI: 10.1097/hcr.0b013e31818c3d90] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Murphy BM, Elliott PC, Higgins RO, Le Grande MR, Worcester MU, Goble AJ, Tatoulis J. Anxiety and depression after coronary artery bypass graft surgery: most get better, some get worse. ACTA ACUST UNITED AC 2008; 15:434-40. [DOI: 10.1097/hjr.0b013e3282fbc945] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Barbara M. Murphy
- Heart Research Centre, Melbourne
- Department of Psychiatry, The
University of Melbourne
| | - Peter C. Elliott
- Heart Research Centre, Melbourne
- Australian Centre for Posttraumatic
Mental Health, The University of Melbourne
| | | | | | - Marian U.C. Worcester
- Heart Research Centre, Melbourne
- Department of Psychology, The
University of Melbourne
| | | | - James Tatoulis
- Department of Cardiothoracic
Surgery, The Royal Melbourne Hospital, Victoria, Australia
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Higgins RO, Murphy BM, Goble AJ, Le Grande MR, Elliott PC, Worcester MUC. Cardiac rehabilitation program attendance after coronary artery bypass surgery: overcoming the barriers. Med J Aust 2008; 188:712-4. [DOI: 10.5694/j.1326-5377.2008.tb01852.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 12/18/2007] [Indexed: 11/17/2022]
Affiliation(s)
| | - Barbara M Murphy
- Heart Research Centre, Melbourne, VIC
- Department of Psychiatry, University of Melbourne, Melbourne, VIC
| | | | | | - Peter C Elliott
- Heart Research Centre, Melbourne, VIC
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC
| | - Marian U C Worcester
- Heart Research Centre, Melbourne, VIC
- Department of Psychology, University of Melbourne, Melbourne, VIC
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Ernest CS, Elliott PC, Murphy BM, Le Grande MR, Goble AJ, Higgins RO, Worcester MUC, Tatoulis J. Predictors of cognitive function in candidates for coronary artery bypass graft surgery. J Int Neuropsychol Soc 2007; 13:257-66. [PMID: 17286883 DOI: 10.1017/s1355617707070282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 09/12/2006] [Accepted: 09/13/2006] [Indexed: 11/07/2022]
Abstract
Candidates for coronary artery bypass graft surgery have been found to exhibit reduced cognitive function prior to surgery. However, little is known regarding the factors that are associated with pre-bypass cognitive function. A battery of neuropsychological tests was administered to a group of patients listed for bypass surgery (n = 109). Medical, sociodemographic and emotional predictors of cognitive function were investigated using structural equation modeling. Medical factors, namely history of hypertension and low ejection fraction, significantly predicted reduced cognitive function, as did several sociodemographic characteristics, namely older age, less education, non-English speaking background, manual occupation, and male gender. One emotional variable, confusion and bewilderment, was also a significant predictor whereas anxiety and depression were not. When significant predictors from the three sets of variables were included in a combined model, three of the five sociodemographic characteristics, namely age, non-English speaking background and occupation, and the two medical factors remained significant. Apart from sociodemographic characteristics, medical factors such as a history of hypertension and low ejection fraction significantly predicted reduced cognitive function in bypass candidates prior to surgery.
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Ernest CS, Murphy BM, Worcester MUC, Higgins RO, Elliott PC, Goble AJ, Le Grande MR, Genardini N, Tatoulis J. Cognitive Function in Candidates for Coronary Artery Bypass Graft Surgery. Ann Thorac Surg 2006; 82:812-8. [PMID: 16928490 DOI: 10.1016/j.athoracsur.2006.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2006] [Revised: 04/02/2006] [Accepted: 04/03/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND While many studies have investigated cognitive impairments in patients after coronary artery bypass graft surgery, very few have closely evaluated presurgical cognitive functioning of bypass candidates. METHODS A battery of neuropsychologic tests was administered to a consecutive series of patients listed for bypass surgery (n = 109). Cognitive function of bypass candidates was compared with that of a healthy control group (n = 25) and published test norms. RESULTS Cognitive test scores in candidates for bypass were significantly lower than those of the control group on tests of attention, information processing speed, and verbal memory. Additionally, bypass candidates' cognitive test scores were significantly reduced compared with expected values derived from validated test norms, on all but one cognitive test. CONCLUSIONS Cognitive performances of candidates for bypass were significantly lower than those of a healthy control group and published cognitive test norms.
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Le Grande MR, Elliott PC, Murphy BM, Worcester MUC, Higgins RO, Ernest CS, Goble AJ. Health related quality of life trajectories and predictors following coronary artery bypass surgery. Health Qual Life Outcomes 2006; 4:49. [PMID: 16904010 PMCID: PMC1560373 DOI: 10.1186/1477-7525-4-49] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 08/13/2006] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Many studies have demonstrated that health related quality of life (HRQoL) improves, on average, after coronary artery bypass graft surgery (CABGS). However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS. METHODS 182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36), Profile of Mood States (POMS) and the Everyday Functioning Questionnaire (EFQ). These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL. RESULTS For both the physical component summary scale (PCS) and the mental component summary scale (MCS) of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified (improvers and non-improvers). A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non-improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class; for the MCS the most significant predictors of non-improver membership were higher scores on POMS depression-dejection and manual occupation. CONCLUSION It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of each patient, and those post-operative symptoms that could be possible targets for intervention to improve HRQoL outcomes.
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Affiliation(s)
- Michael R Le Grande
- Heart Research Centre Melbourne, Box 2137 Post Office, The Royal Melbourne Hospital, VIC 3050, Australia
| | - Peter C Elliott
- Heart Research Centre Melbourne, Box 2137 Post Office, The Royal Melbourne Hospital, VIC 3050, Australia
- The Australian Centre for Posttraumatic Mental Health, The University of Melbourne, Australia
| | - Barbara M Murphy
- Heart Research Centre Melbourne, Box 2137 Post Office, The Royal Melbourne Hospital, VIC 3050, Australia
| | - Marian UC Worcester
- Heart Research Centre Melbourne, Box 2137 Post Office, The Royal Melbourne Hospital, VIC 3050, Australia
- Department of Psychology, The University of Melbourne, Australia
| | - Rosemary O Higgins
- Heart Research Centre Melbourne, Box 2137 Post Office, The Royal Melbourne Hospital, VIC 3050, Australia
| | - Christine S Ernest
- Heart Research Centre Melbourne, Box 2137 Post Office, The Royal Melbourne Hospital, VIC 3050, Australia
| | - Alan J Goble
- Heart Research Centre Melbourne, Box 2137 Post Office, The Royal Melbourne Hospital, VIC 3050, Australia
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Ernest CS, Worcester MUC, Tatoulis J, Elliott PC, Murphy BM, Higgins RO, Le Grande MR, Goble AJ. Neurocognitive Outcomes in Off-Pump Versus On-Pump Bypass Surgery: A Randomized Controlled Trial. Ann Thorac Surg 2006; 81:2105-14. [PMID: 16731138 DOI: 10.1016/j.athoracsur.2006.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 12/22/2005] [Accepted: 01/03/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cognitive difficulties have been reported after coronary artery bypass graft surgery using cardiopulmonary bypass. However, the cognitive benefit of off-pump surgery remains unclear. METHODS Consecutively listed candidates for elective bypass were randomly assigned to either off-pump or on-pump techniques (n = 107). A battery of 11 standardized neuropsychological tests was administered before surgery, and again at 2 and 6 months after surgery. The two groups were compared using a range of statistical procedures, including growth modeling. RESULTS There were no significant differences in cognitive test scores between the off-pump and on-pump groups using t tests at any of the time points. There were no differences between off-pump and on-pump groups in the incidence of cognitive deficits at 2 months or 6 months, with the exception that fewer off-pump patients showed impairment on one test of verbal fluency at 6 months. When the pattern of cognitive change over time between the two groups was compared using sophisticated modeling techniques, the two groups were again comparable, except for results on the test of verbal fluency, in which the off-pump group showed more rapid postsurgical cognitive gains than the on-pump group. CONCLUSIONS The off-pump group appears to be generally comparable to the on-pump group in terms of short-term and long-term postsurgical neurocognitive outcomes.
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