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Dağcan N, Özden D, Gürol Arslan G. Pain perception of patients in intensive care unit after cardiac surgery: A qualitative study using Roy's Adaptation Model. Nurs Crit Care 2024; 29:512-520. [PMID: 37527978 DOI: 10.1111/nicc.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/24/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Although research on postoperative pain has increased, postoperative pain management is still a problem today. Most patients experience moderate to severe pain after cardiac surgery. As a result of pain, patients show inefficient adaptation behaviour in physiologic, role function, self-concept, and interdependence modes. AIM This study was conducted to examine the pain perceptions of intensive care patients after cardiac surgery according to Roy's Adaptation Model (RAM). STUDY DESIGN A qualitative design with a phenomenological approach was used in the study. The research data were collected by using a "descriptive information form", a "semi-structured interview form", and the "numerical rating scale" through the "in-depth interview method". The study sample consisted of 16 patients who were aged 18 years or older, had undergone cardiac surgery, experienced pain post-operatively in the intensive care unit at least once, and had intensive care experience. Patients with neuropathic or chronic pain or neurological or psychiatric disorders were not included in the study. Data were classified into physiologic, self-concept, and interdependence modes according to RAM. RESULTS The themes and sub-themes that emerged included physiologic modes (pain responses), self-concept modes (pain self-management), role-function modes (effects of pain), and interdependence modes (support systems in pain). CONCLUSIONS The results of our study can enable patients and nurses to communicate effectively about pain. In future studies, the effect of model-based pain management programs on cardiac surgery patients can be investigated. RELEVANCE TO CLINICAL PRACTICE Examining the pain perceptions of intensive care patients after cardiac surgery according to RAM will guide the improvement and development of pain management. It is thought that the model addresses intensive care patients experiencing pain holistically.
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Affiliation(s)
- Necibe Dağcan
- Nursing Department, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Dilek Özden
- Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylul University, Izmir, Turkey
| | - Gülşah Gürol Arslan
- Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylul University, Izmir, Turkey
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Karahan E, Demirtaş H, Çelik S, Dolu İ. Relationships between sleep, quality of life and anxiety in patients undergoing cardiac surgeries. Rev Lat Am Enfermagem 2024; 32:e4122. [PMID: 38655934 DOI: 10.1590/1518-8345.6964.4122] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 08/08/2023] [Accepted: 11/27/2023] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE the objective of this study is to examine the relationships between sleep, quality of life and anxiety in patients undergoing cardiac surgeries during the preoperative period, at discharge, two weeks after discharge and three months after discharge. METHOD this study had a prospective, descriptive and correlational design and was conducted in a single center. The sample consisted of 68 patients who had undergone cardiac surgeries. The data were collected using an Information Form, the State-Trait Anxiety Inventory, the Richard-Campbell Sleep Questionnaire and the Nottingham Health Profile. RESULTS the patients' sleep quality increased from moderate to good at each measurement moment after the surgeries, when compared to sleep quality measured at their first hospitalization. While the state anxiety scores decreased at discharge and 2 weeks after the initial hospitalization, they increased to a moderate level 3 months after discharge. There was no significant relationship between anxiety levels and sleep quality at any measurement moment. Additionally, the patients' quality of life was significantly improved 2 weeks and 3 months after discharge. CONCLUSION The results of this study showed that the sleep quality of patients who had undergone cardiac surgeries was improved during the postoperative period, and that this improvement exerted a positive effect on their quality of life.
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Affiliation(s)
- Elif Karahan
- Bartın University, Faculty of Health, Department of Nursing, Bartın, Türkiye
| | - Hüseyin Demirtaş
- Gazi University, Faculty of Medicine, Department of Cardiovascular Surgery, Ankara, Türkiye
| | - Sevim Çelik
- Bartın University, Faculty of Health, Department of Nursing, Bartın, Türkiye
| | - İknur Dolu
- Bartın University, Faculty of Health, Department of Nursing, Bartın, Türkiye
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Wan Q, Li S, Hu J. Association of smoking with postoperative atrial fibrillation in patients with cardiac surgery: A PRISMA-compliant article. Medicine (Baltimore) 2021; 100:e26179. [PMID: 34115000 PMCID: PMC8202588 DOI: 10.1097/md.0000000000026179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/13/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cigarette smoking is an important modifiable risk factor for incident atrial fibrillation. However, the impact of smoking on postoperative atrial fibrillation in patients undergoing cardiac surgery remains controversial. We performed this meta-analysis to explore the association of smoking with postoperative atrial fibrillation in patients with cardiac surgery. METHODS We systematically searched 2 computer-based databases (PubMed and EMBASE) up to July 2019 for all relevant studies. A random-effects model was selected to pool the odds ratios (ORs) and 95% confidence intervals (CIs). In this meta-analysis, the protocol and reporting of the results were based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. RESULTS A total of 36 studies were included in this meta-analysis. Overall, smoking was not associated with an increased risk of postoperative atrial fibrillation in patients undergoing cardiac surgery (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.79-1.02). The corresponding results were stable in the subgroup analyses. Specifically, smoking was not associated with an increased risk of postoperative atrial fibrillation regardless of the type of cardiac surgery: coronary artery bypass grafting (OR = 0.91; 95% CI 0.77-1.07), valve surgery (OR = 0.15; 95% CI 0.01-1.56), and coronary artery bypass grafting+valve surgery (OR = 0.91; 95% CI 0.70-1.18). CONCLUSIONS Based on currently published studies, smoking was not associated with an increased risk of postoperative atrial fibrillation in patients undergoing cardiac surgery.
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Affiliation(s)
- Qin Wan
- Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang of Jiangxi
| | - Siyuan Li
- Grade 2017, The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Jian Hu
- Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang of Jiangxi
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Sellwood C. Running a marathon was easier than getting back to work. BMJ 2020; 371:m4331. [PMID: 33268346 DOI: 10.1136/bmj.m4331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fasihizadeh H, Nasiriani K. Effect of Spiritual Care on Chest Tube Removal Anxiety and Pain in Heart Surgery in Muslim Patients (Shia and Sunni). J Pastoral Care Counsel 2020; 74:234-240. [PMID: 33228496 DOI: 10.1177/1542305020948189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The process of removal of a chest tube can cause pain and anxiety. Spiritual care can be considered as a component of nursing care, especially in the pain and anxiety relating to such procedures. This study was a randomized clinical trial. Eighty patients completed the study. The findings showed significant differences in anxiety and pain between groups (p = 0.001). Spiritual care reduced anxiety and pain caused by chest tube removal in patients (Shia and Sunni Islam) undergoing heart surgery.
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Affiliation(s)
- Hossin Fasihizadeh
- Department of Nursing, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences and Health Services, Iran
| | - Khadijeh Nasiriani
- Department of Nursing, Research Center for Nursing and Midwifery Care, Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Iran
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Sigdel S, Ozaki A, Basnet M, Kobashi Y, Pradhan B, Higuchi A, Uprety A. Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study. Medicine (Baltimore) 2020; 99:e19302. [PMID: 32118748 PMCID: PMC7478669 DOI: 10.1097/md.0000000000019302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Perioperative anxiety could negatively affect surgery outcomes, and cardiac diseases have long been known to be an independent risk factor for anxiety development. However, little is known about preoperative anxiety in Nepalese adult cardiac patients waiting for surgery. The primary objectives of this study were to: (1) clarify the levels of preoperative anxiety in Nepalese adult cardiac patients waiting for open heart surgery; (2) identify factors associated with preoperative anxiety; and (3) evaluate any possible factors associated with patients' desire to obtain information related to their heart surgery.This is a prospective observational study for patients already scheduled for cardiac surgery at a core medical institution in Kathmandu, Nepal. We collected sociodemographic and clinical characteristics of the patients from their medical charts, and assessed their preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale. We performed descriptive analyses of the collected data. Further, we employed regression models to assess to the objectives of the study.In total, 140 patients participated, and data of 123 (87.9%) were used for analysis. 58.5% of the participants had preoperative anxiety. Female gender (OR 0.31, 95% CI 0.15-0.65, P < .001) and past anesthesia exposure (OR 2.38, 95% CI 1.01-5.62, P < .05) were identified as risk factors for developing anxiety before cardiac surgery. Further, female gender (IRR 0.80, 95% CI 0.67-0.94, P < .001), higher education levels (IRR 1.18, 95% CI 1.01-1.40, P < .05), and higher preoperative anxiety (IRR 1.44, 95% CI 1.21-1.73, P < .001) could lead to higher levels of desire to acquire information related to the procedure.The study concluded that more than a half of the cardiac surgery patients experiences preoperative anxiety; female gender and having past anesthesia exposure are the risk factors. Anxious patients have more desire to acquire knowledge about the procedure. Thus, the evaluation and adequate management of preoperative anxiety should be proposed in high-risk groups.
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Affiliation(s)
- Shailendra Sigdel
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Akihiko Ozaki
- Department of Breast Cancer, Jyoban Hospital of Tokiwa Foundation, Iwaki
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma
| | - Madindra Basnet
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Yurie Kobashi
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima
- Department of Anesthesia, Jyoban Hospital of Tokiwa Foundation, Iwaki
| | - Bishwas Pradhan
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Asaka Higuchi
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima
- Medical Governance Research Institute, Tokyo, Japan
| | - Anup Uprety
- Department of Anesthesiology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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Cromhout PF, Berg SK, Moons P, Damgaard S, Nashef S, Thygesen LC. Updating EuroSCORE by including emotional, behavioural, social and functional factors to the risk assessment of patients undergoing cardiac surgery: a study protocol. BMJ Open 2019; 9:e026745. [PMID: 31272975 PMCID: PMC6615815 DOI: 10.1136/bmjopen-2018-026745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Conventional risk assessment in cardiac surgery focus on medical and physiological factors and have been developed to predict mortality. Other relevant risk factors associated with increased risk of poor outcomes are not included. Adding non-medical variables as potential prognostic factors to risk assessments direct attention away from specific diagnoses towards a more holistic view of the patients and their predicament. The aim of this paper is to describe the method and analysis plan for the development and validation of a prognostic screening tool as a supplement to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) to predict mortality, readmissions and prolonged length of admission in patients within 90 days after cardiac surgery, as individual outcomes. METHODS AND ANALYSIS The development of a prognostic screening tool with inclusion of emotional, behavioural, social and functional factors complementing risk assessment by EuroSCORE will adopt the methods recommended by the PROGnosis RESearch Strategy Group and report using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis statement. In the development stage, we will use data derived from three datasets comprising 1143, 3347 and 982 patients for a prospective cohort study of patients undergoing cardiac surgery, respectively. We will construct logistic regression models to predict mortality, prolonged length of admission and 90-day readmissions. In the validation stage, we will use data from a separate sample of 333 patients planned to undergo cardiac surgery to assess the performance of the developed prognostic model. We will produce validation plots showing the overall performance, area under the curve statistic for discrimination and the calibration slope and intercept. ETHICS AND DISSEMINATION The study will follow the requirements from the Ethical Committee System ensuring voluntary participation in accordance with the Helsinki declarations. Data will be filed in accordance with the requirements of the Danish Data Protection Agency.
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Affiliation(s)
| | - Selina Kikkenborg Berg
- Heart Centre, Rigshospitalet, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenborg, Gothenborg, Sweden
| | - Sune Damgaard
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Lau Caspar Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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McGillion MH, Henry S, Busse JW, Ouellette C, Katz J, Choinière M, Lamy A, Whitlock R, Pettit S, Hare J, Gregus K, Brady K, Dvirnik N, Yang SS, Parlow J, Dumerton-Shore D, Gilron I, Buckley DN, Shanthanna H, Carroll SL, Coyte PC, Ebrahim S, Isaranuwatchai W, Guerriere DN, Hoch J, Khan J, MacDermid J, Martorella G, Victor JC, Watt-Watson J, Howard-Quijano K, Mahajan A, Chan MTV, Clarke H, Devereaux PJ. Examination of psychological risk factors for chronic pain following cardiac surgery: protocol for a prospective observational study. BMJ Open 2019; 9:e022995. [PMID: 30826789 PMCID: PMC6398732 DOI: 10.1136/bmjopen-2018-022995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Approximately 400 000 Americans and 36 000 Canadians undergo cardiac surgery annually, and up to 56% will develop chronic postsurgical pain (CPSP). The primary aim of this study is to explore the association of pain-related beliefs and gender-based pain expectations on the development of CPSP. Secondary goals are to: (A) explore risk factors for poor functional status and patient-level cost of illness from a societal perspective up to 12 months following cardiac surgery; and (B) determine the impact of CPSP on quality-adjusted life years (QALYs) borne by cardiac surgery, in addition to the incremental cost for one additional QALY gained, among those who develop CPSP compared with those who do not. METHODS AND ANALYSES In this prospective cohort study, 1250 adults undergoing cardiac surgery, including coronary artery bypass grafting and open-heart procedures, will be recruited over a 3-year period. Putative risk factors for CPSP will be captured prior to surgery, at postoperative day 3 (in hospital) and day 30 (at home). Outcome data will be collected via telephone interview at 6-month and 12-month follow-up. We will employ generalised estimating equations to model the primary (CPSP) and secondary outcomes (function and cost) while adjusting for prespecified model covariates. QALYs will be estimated by converting data from the Short Form-12 (version 2) to a utility score. ETHICS AND DISSEMINATION This protocol has been approved by the responsible bodies at each of the hospital sites, and study enrolment began May 2015. We will disseminate our results through CardiacPain.Net, a web-based knowledge dissemination platform, presentation at international conferences and publications in scientific journals. TRIAL REGISTRATION NUMBER NCT01842568.
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Affiliation(s)
- Michael H McGillion
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shaunattonie Henry
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Carley Ouellette
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Manon Choinière
- Centre de recherche de Centre hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - Andre Lamy
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Richard Whitlock
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shirley Pettit
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jacqueline Hare
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Krysten Gregus
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Katheryn Brady
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Nazari Dvirnik
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Su Yang
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Joel Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - D Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Sandra L Carroll
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shanil Ebrahim
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Denise N Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Hoch
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - James Khan
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - J Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Howard-Quijano
- Department of Anesthesiology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Aman Mahajan
- Department of Anesthesiology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Matthew T V Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hance Clarke
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - P J Devereaux
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Myles PS, Viira D, Hunt JO. Quality of Life at Three Years after Cardiac Surgery: Relationship with Preoperative Status and Quality of Recovery. Anaesth Intensive Care 2019; 34:176-83. [PMID: 16617637 DOI: 10.1177/0310057x0603400220] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 12/24/2022]
Abstract
A reduction in symptoms, increased longevity, and improved quality of life (QoL), are goals of cardiac surgery. We measured QoL in 108 adult cardiac surgical patients at about three years after cardiac surgery, and assessed the predictive ability of a 40-item quality of recovery (QoR-40) score. Our follow-up rate was 86% (n=93). When compared with preoperative status, QoL was improved at three years after surgery (P<0.0005). The dimensions of QoL that were most affected were physical functioning, role limitations due to physical problems, vitality, social functioning, and role limitations due to emotional problems (all P<0.005). There was a mild correlation between the day 3 QoR-40 and the three year SF-36, r=0.23 (P=0.029). There was a strong correlation between the three year QoR-40 and the three year SF-36, r=0.73 (P<0.0005). The QoR-40 and SF-36 done at three years after cardiac surgery demonstrated good internal consistency, QoR-40 α=0.86 (P<0.0005), SF-36 α=0.91 (P<0.0005). A poor quality recovery in the days after surgery can predict a poor QoL at three years after surgery. The QoR-40 is a valid and reliable measure of quality of recovery after surgery and anaesthesia. The QoR-40 is a useful, patient-oriented method of assessing recovery from anaesthesia and surgery.
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Affiliation(s)
- P S Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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Packiasabapathy S, Susheela AT, Mueller A, Patxot M, Gasangwa DV, O’Gara B, Shaefi S, Marcantonio ER, Yeh GY, Subramaniam B. Guided meditation as an adjunct to enhance postoperative recovery after cardiac surgery: study protocol for a prospective randomized controlled feasibility trial. Trials 2019; 20:39. [PMID: 30635064 PMCID: PMC6329114 DOI: 10.1186/s13063-018-3103-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 12/04/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cardiac surgical procedures are associated with postoperative neurological complications such as cognitive decline and delirium, which can complicate recovery and impair quality of life. Perioperative depression and anxiety may be associated with increased mortality after cardiac surgeries. Surgical prehabilitation is an emerging concept that includes preoperative interventions to potentially reduce postoperative complications. While most current prehabilitation interventions focus on optimizing physical health, mind-body interventions are an area of growing interest. Preoperative mind-body interventions such as Isha Kriya meditation, may hold significant potential to improve postsurgical outcomes. METHODS This is a prospective, randomized controlled feasibility trial. A total of 40 adult patients undergoing cardiac surgery will be randomized to one of three study groups. Participants randomized to either of the two intervention groups will receive meditative intervention: (1) commencing two weeks before surgery; or (2) commencing only from the day after surgery. Meditative intervention will last for four weeks after the surgery in these groups. Participants in the third control group will receive the current standard of care with no meditative intervention. All participants will undergo assessments using neurocognitive, sleep, depression, anxiety, and pain questionnaires at various time points in the perioperative period. Blood samples will be collected at baseline, preoperatively, and postoperatively to assess for inflammatory biomarkers. The primary aim of this trial is to assess the feasibility of implementing a perioperative meditative intervention program. Other objectives include studying the effect of meditation on postoperative pain, sleep, psychological wellbeing, cognitive function, and delirium. These will be used to calculate effect size to design future studies. DISCUSSION This study serves as the first step towards understanding the feasibility of implementing a mind-body intervention as a prehabilitative intervention to improve postoperative surgical outcomes after cardiac surgery. TRIAL REGISTRATION Clinicaltrials.gov, NCT03198039 . Registered on 23 June 2017.
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Affiliation(s)
- Senthil Packiasabapathy
- Department of Anesthesia, Critical Care and Pain Medicine, Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN 46202 USA
| | - Ammu T. Susheela
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| | - Melissa Patxot
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
| | - Doris-Vanessa Gasangwa
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
| | - Brian O’Gara
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| | - Edward R. Marcantonio
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
| | - Gloria Y. Yeh
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
| | - Balachundhar Subramaniam
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
- Beth Israel Deaconess Medical Center, 375 Longwood Avenue, W/MASCO-414, Boston, MA 02215 USA
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Rodrigues HF, Furuya RK, Dantas RAS, Rodrigues AJ, Dessotte CAM. Association of preoperative anxiety and depression symptoms with postoperative complications of cardiac surgeries. Rev Lat Am Enfermagem 2018; 26:e3107. [PMID: 30517589 PMCID: PMC6280174 DOI: 10.1590/1518-8345.2784.3107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/08/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE to investigate the associations of preoperative anxiety and depression symptoms with postoperative complications and with sociodemographic and clinical characteristics of patients submitted to the first coronary artery bypass graft. METHOD observational, analytical and longitudinal study. A consecutive non-probabilistic sample consisted of patients submitted to coronary artery bypass graft. To evaluate the symptoms, the Hospital Anxiety and Depression Scale was used. tracheal intubation for more than 48 hours, hemodynamic instability, sensorineural deficit, agitation, hyperglycemia, infection, nausea, vomiting, pain and death were classified as complications. The Mann-Whitney and Spearman Correlation tests were used, with a significance level of 0.05. RESULTS a total of 75 patients participated. The group that presented hemodynamic instability in the postoperative period had a greater median for the anxiety symptoms (p = 0.012), as well as the women (p = 0.028). The median of the depression symptoms was higher in the group presenting nausea (p = 0.002), agitation (p <0.001), tracheal intubation for more than 48 hours (p = 0.018) and sensorineural deficit (p = 0.016). CONCLUSION there was association of the symptoms of preoperative anxiety with hemodynamic instability in the postoperative period and with the female gender, as well as association of depression symptoms with the following complications: nausea, agitation, time of intubation in the postoperative period and sensorineural deficit.
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Affiliation(s)
| | | | - Rosana Aparecida Spadoti Dantas
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Alfredo José Rodrigues
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Carina Aparecida Marosti Dessotte
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
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Kim DH, Mahesri M, Bateman BT, Huybrechts KF, Inouye SK, Marcantonio ER, Herzig SJ, Ely EW, Pisani MA, Levin R, Avorn J. Longitudinal Trends and Variation in Antipsychotic Use in Older Adults After Cardiac Surgery. J Am Geriatr Soc 2018; 66:1491-1498. [PMID: 30125337 PMCID: PMC6217828 DOI: 10.1111/jgs.15418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate temporal trends and between-hospital variation in off-label antipsychotic medication (APM) use in older adults undergoing cardiac surgery. DESIGN Retrospective cohort study. SETTING National administrative database including 465 U.S. hospitals. PARTICIPANTS Individuals aged 65 and older without known indications for APMs who underwent cardiac surgery from 2004 to 2014 (N=293,212). MEASUREMENTS Postoperative exposure to any APMs and potentially excessive dosing were examined. Hospital-level APM prescribing intensity was defined as the proportion of individuals newly treated with APMs in the postoperative period. RESULTS The rate of APM use declined from 8.8% in 2004 to 6.2% in 2014 (p<.001). Use of haloperidol (parenteral 7.0% to 4.5%, p<.001; oral: 1.9% to 0.5%, p<.001), and risperidone (1.1% to 0.3%, p<.001) declined, whereas quetiapine use tripled (0.6% to 1.9%, p=.03). Hospital APM prescribing intensity varied widely, from 0.3% to 35.6%, across 465 hospitals. Treated individuals at higher-prescribing hospitals were more likely to receive APMs on the day of discharge (highest vs lowest quintile: 15.1% vs 9.6%; p<.001) and for a longer duration (4.8 vs 3.7 days; p<.001) than those at lower-prescribing hospitals. Delirium was the strongest risk factor for APM exposure (odds ratio=9.73, 95% confidence interval=9.02-10.5), whereas none of the hospital characteristics were significantly associated. The rate of potentially excessive dosing declined (60.7% to 44.9%, p<.001), and risk factors for potentially excessive dosing were similar to those for any APM exposure. CONCLUSIONS Our findings suggest highly variable prescribing cultures and raise concerns about inappropriate use, highlighting the need for better evidence to guide APM prescribing in hospitalized older adults after cardiac surgery.
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Affiliation(s)
- Dae Hyun Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Brian T. Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Sharon K. Inouye
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Edward R. Marcantonio
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shoshana J. Herzig
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - E. Wesley Ely
- Division of Allergy, Pulmonology, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Veterans Affairs Tennessee Valley Geriatric Research Education Clinical Center, Nashville, TN
| | - Margaret A. Pisani
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale-New Haven Hospital, New Haven, CT
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Jerry Avorn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
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Grand N, Bouchet JB, Zufferey P, Beraud AM, Awad S, Sandri F, Campisi S, Fuzellier JF, Molliex S, Vola M, Morel J. Quality of Life After Cardiac Operations Based on the Minimal Clinically Important Difference Concept. Ann Thorac Surg 2018; 106:548-554. [PMID: 29580777 DOI: 10.1016/j.athoracsur.2018.02.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 09/19/2017] [Revised: 02/07/2018] [Accepted: 02/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is an increasingly important issue in assessing the consequences of any surgical or medical intervention. Our study aimed to evaluate change in HRQOL 6 months after elective cardiac operations and to identify specific predictors of poor HRQOL. METHODS In this prospective, single-center study, HRQOL was evaluated before and 6 months after the operation using the Medical Outcome Study 36-Item Short Form Health Survey questionnaire and its two components: the Physical Component Summary and the Mental Component Summary. We distinguished patients with worsening of HRQOL according to the minimal clinically important difference. All consecutive adult patients undergoing cardiac operations were included. RESULTS The preoperative and postoperative 36-Item Short Form Health Survey questionnaires were completed by 326 patients, and 24 patients died before completing follow-up questionnaires. On the basis of the definition used, clinically significant deterioration of HRQOL was observed in 93 patients (26.6%) for the Physical Component Summary and in 99 patients (28.2%) for the Mental Component Summary. Renal replacement for acute renal failure and mechanical ventilation for longer than 48 hours were independent risk factors for Physical Component Summary and Mental Component Summary worsening or death. CONCLUSIONS Although our study showed overall improvement of quality of life after cardiac operations, more than one-quarter of the patients manifested deterioration of HRQOL at 6 months postoperatively. The findings from this study should help clinicians to inform patients about their likely postoperative functional status and quality of life.
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Affiliation(s)
- Nathalie Grand
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Jean Baptiste Bouchet
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Paul Zufferey
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Anne Marie Beraud
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Sahar Awad
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Fabricio Sandri
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Salvator Campisi
- Department of Cardiac Surgery, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Jean François Fuzellier
- Department of Cardiac Surgery, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Serge Molliex
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Marco Vola
- Department of Cardiac Surgery, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Jerome Morel
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France.
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Rezaei-Nodehi M, Bagheri-Nesami M, Shorofi SA, Yazdani-Charati J, Ghafari R. Effects of pleasant olfactory mental imagery on the arterial oxygenation in patients with open heart surgery: A randomized controlled trial. Complement Ther Clin Pract 2017; 29:194-200. [PMID: 29122260 DOI: 10.1016/j.ctcp.2017.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Arterial hypoxemia is one of the most common respiratory complications following cardiac surgery. This study was intended to examine the effects of pleasant olfactory mental imagery on postoperative hypoxemia in patients undergoing open heart surgery. MATERIALS AND METHODS This is a randomized controlled clinical trial. The sample consisted of 80 patients who were randomly assigned to either practice olfactory mental imagery (experimental group) or receive routine care (control group). A card with the image of roses was given to patients and they were asked to look at the image, visualize the scent of roses in the mind, and then sniff as much as possible, hold their breath for 2 s and eventually exhale slowly through the nose. This procedure was consecutively repeated five times. After a fifteen-minute break, patients proceeded to practice olfactory mental imagery with other fruit images. The experimental group executed the olfactory mental imagery for two hours in the morning and two hours in the afternoon on postoperative days 1 and 2. RESULTS No statistically significant differences were observed between the experimental and control groups regarding sociodemographic characteristics, medical and surgical information. This study also demonstrated that the mean Spao2 was significantly higher in the experimental group (97.400 ± 1.70) than the control group (96.465 ± 1.70) (p = 0.015). CONCLUSION The results of this study suggest that olfactory mental imagery can improve arterial oxygenation in patients with cardiac surgery.
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Affiliation(s)
- Masoud Rezaei-Nodehi
- Student Research Committee, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Bagheri-Nesami
- Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Afshin Shorofi
- Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran; Flinders University, Adelaide, Australia.
| | | | - Rahman Ghafari
- Department of Cardiac Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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De Bleser L, Budts W, Sluysmans T, De Wolf D, Massin M, Gewillig M, Suys B, Moons P. Self-reported physical activities in patients after the Mustard or Senning operation: Comparison with healthy control subjects. Eur J Cardiovasc Nurs 2016; 6:247-51. [PMID: 17197242 DOI: 10.1016/j.ejcnurse.2006.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/01/2006] [Revised: 11/04/2006] [Accepted: 11/06/2006] [Indexed: 11/28/2022]
Abstract
Background Some decades ago, the Mustard or Senning operation was used to treat patients who were born with Transposition of the Great Arteries (TGA). Although life expectancy is good, previous studies have demonstrated limitations in exercise capacity. To what extent these limitations affect day-to-day functioning of the patients is not yet known. Aims We therefore investigated self-reported physical activities in patients after the Mustard or Senning operation, compared this with those of matched, healthy counterparts, and explored potential associations with age, gender and complexity of the TGA. Methods Seventy patients were matched with healthy controls. Habitual physical activity was measured using the Baecke questionnaire, resulting in a work, sports, and leisure time index, which ranges from 1 to 5. Results The median index scores of patients were 2.63 for work, 2.50 for sports; and 2.75 for leisure time. Only for sports, a significantly lower index score was found in patients. Furthermore, we found that older patients were less frequently engaged in sport activities (Spearman's rho=–0.38; p=0.02). Conclusion The results showed that the level of physical activities of patients after the Mustard and Senning operation is normal, except for sport activities. This indicates that patients after a Mustard or Senning operation tend to partake in all activities that they can comfortably perform.
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Affiliation(s)
- Leentje De Bleser
- Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium
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Ivarsson B, Larsson S, Sjöberg T. Patients' Experiences of Support while Waiting for Cardiac Surgery. A Critical Incident Technique Analysis. Eur J Cardiovasc Nurs 2016; 3:183-91. [PMID: 15234322 DOI: 10.1016/j.ejcnurse.2004.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 10/08/2003] [Revised: 12/29/2003] [Accepted: 03/15/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients waiting for cardiac surgery experience the period from decision about surgery to the operation as long, heavy and dreary. AIMS The aim was to describe patients' experiences of support in the form of important events during the waiting period. METHODS The design was qualitative and the 'critical incident' technique was used. Incidents were collected via interviews with 26 patients waiting for heart surgery. The selection of patients was strategic. RESULTS In all, 223 important events, both positive and negative, were identified in the interviews and two main areas emerged in the analysis: internal factors and external factors. Internal factors describe how an experience of support was influenced by changes in life style and by finding strength from within. External factors describe how experiences of support was influenced by being allowed to participate in care management, by receiving attention, as well as by the health care organisation and the social network. CONCLUSION By identifying factors that influence patients' experiences of support while they wait for heart surgery, institutional and non-institutional health-care services can improve the organisation of the entire health care process, and develop patient-focused support programmes.
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Affiliation(s)
- Bodil Ivarsson
- Department of Cardiothoracic Surgery, University Hospital of Lund, Barngatan 2, SE-221 85 Lund, Sweden.
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Abstract
The aim of this study was to understand experiences of wait time among patients awaiting scheduled orthopaedic or cardiac surgery. Using a qualitative approach, 32 patients completed two interviews each regarding their wait time experiences, including effects of waiting. Patient experiences of wait time varied regardless of actual wait time and included reports of restriction, uncertainty, resignation, coping and opportunity. Participants' waiting experiences indicate a complex relationship between greater symptom severity and less tolerance for wait time. We suggest healthcare resources focus on alleviating the deleterious effects of waiting for certain patients rather than reducing absolute wait times.
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Ai AL, Peterson C, Tice TN, Bolling SF, Koenig HG. Faith-based and Secular Pathways to Hope and Optimism Subconstructs in Middle-aged and Older Cardiac Patients. J Health Psychol 2016; 9:435-50. [PMID: 15117542 DOI: 10.1177/1359105304042352] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This study was designed to fill gaps in the new field of positive psychology. Using data from two sequential interviews, this study examined the effect of faith-based and secular pathways to hope and optimism among 226 middle-aged and older patients facing a major medical crisis—cardiac surgery. Structural equation modeling demonstrated that religious faith factors contributed to the agency component of hope and dispositional optimism indirectly through the use of prayer as a coping strategy. Other sociodemographically resourcable factors affected both the agency and pathway components of hope as well as dispositional optimism and dispositional pessimism directly or indirectly through their effects on emotional distress.
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Affiliation(s)
- Amy L Ai
- Universities of Washington Health Science, Seattle, Washington, USA.
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Karlsson AK, Johansson M, Lidell E. Fragility—The Price of Renewed Life. Patients Experiences of Open Heart Surgery. Eur J Cardiovasc Nurs 2016; 4:290-7. [PMID: 15886056 DOI: 10.1016/j.ejcnurse.2005.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 09/27/2004] [Revised: 03/08/2005] [Accepted: 03/27/2005] [Indexed: 11/25/2022]
Abstract
Background: Open heart surgery often implies a threat to life and is associated with fear and anxiety. It is also a strong encroachment on body and integrity and adjusting life afterwards could be difficult. Despite improvements in treatment the patients' reactions appear to be unchanged. Introducing a lifeworld perspective would supply a different kind of knowledge based upon the patients' own experiences coloured by their linguistic usage and bodily expressions. Aim: The aim of this study was to describe patients' experiences of open heart surgery in a lifeworld perspective. Method: Fourteen patients treated with coronary artery bypass surgery and/or heart valve operation were in-depth interviewed in 2003. The phenomenological method was used for the interviews as well as for the analysis. The informants reflected on their experiences of the illness, meetings with health care, family relations and wishes for the future. Findings: The essence of the phenomenon was fragility. Fragility was understood through the following categories: distance, uncertainty, vulnerability, reliance and gratitude. Conclusions: Patients want to be treated as unique individuals. They ask for more dialogues with the staff. Awareness of their supposed lifelong fragility implies that health care staff acquires an open and holistic approach.
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Ivarsson B, Sjöberg T, Larsson S. Waiting for Cardiac Surgery—Support Experienced by Next of Kin. Eur J Cardiovasc Nurs 2016; 4:145-52. [PMID: 15904885 DOI: 10.1016/j.ejcnurse.2004.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 06/07/2004] [Revised: 11/16/2004] [Accepted: 11/17/2004] [Indexed: 10/26/2022]
Abstract
Background: Next of kin (NoK) play a crucial role for patients waiting for cardiac surgery. Aim: To describe experience of support, in the form of important events, by next of kin while their intimates were waiting for a heart operation. Methods: The design was qualitative and the “critical incident” technique was used. Incidents were collected via interviews with 23 next of kin to patients waiting for heart surgery and the informants were chosen by the patient themselves. Findings: In all, 224 important events, both positive and negative, were identified in the interviews and two main areas emerged in the analysis: internal factors and external factors. Positive internal factors were associated with finding strength, whereas negative factors were associated with uncomfortable feelings. Positive external factors were associated with participating in care and receiving attention, whereas negative factors were associated with dissatisfaction with the health-care organization and failing social network. Conclusion: This study shows that next of kin experienced positive support when they received attention and information and felt involvement in the care. An important implication for the health-care professionals and public authorities is the understanding of the experience of support expressed by next of kin, to provide them with optimal information and support.
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Affiliation(s)
- Bodil Ivarsson
- Department of Cardiothoracic Surgery, University Hospital of Lund, SE-221 85 Lund, Sweden.
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Klypa TV, Antonov IO, Vavakin AS. [THE COGNITIVE STATUS DYNAMIC OF CARDIOSURGICAL PATIENTS AND THE PREDICTORS OF ITS DISTURBANCE]. Anesteziol Reanimatol 2016; 61:18-23. [PMID: 27192849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED AIM OF RESEARCH: To estimate the cognitive status dynamics ofpatients during the early postoperative period after cardiac interventions and to reveal predictors of cognitive functions deterioration at this category of patients. MATERIALS AND METHODS 118 cardiac patients were tested of neurocognitive functions one days before operation, and then for the 2-3rd days after operation by means of the MMSE test, the FAB test, Shulte's test, a questionnaire of a depression of CES-D, the BATTERY OF FRONTAL DYSFUNCTION TEST. Data of the perioperation's period was analyzed. RESULTS Deterioration of results in the 2nd and more tests were registered at 61% of patients. The main distinctions between patients with postoperative deterioration of testing results and without it were: parameters of mehanical ventilation (tidal volume/ideal body weight, airways pressure), initial condition and existence of signs of initial deficit of blood circulation (decrease in the cardiac index and O2 delivery, increase of level of a lactate), decrease in cerebral oksimetry, existence of respiratory alkalosis dekompensation during CPB. Administration of the Dopamine before CPB and use of Desfluran demonstrated the positive influence to the cognitive status. CONCLUSIONS 1) Neurocognitive dysfunction during the early postoperative period after cardiac surgery is tipical for 30-70% of patients. 2) The most significant predictors of deterioration of neurocognitive function in the postoperative period are the excessive depth of anesthesia and significant intraoperative decrease in the cerebral oxygenation. 3) Influence of the mehanical ventilation parameters on postoperative neurocognitive function is revealed, use of the large tidal volumes is especially negative. 4) Existence of the blood circulation deficit and decrease in oxygen delivery without timely intraoperative correction, and also an intraoperative hyperglycemia worsen a neurocognitive function in the postoperative period. 5) Desfluran administration has positive impact on the neurocognitive function.
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Twibell RS, Craig S, Siela D, Simmonds S, Thomas C. Being there: inpatients' perceptions of family presence during resuscitation and invasive cardiac procedures. Am J Crit Care 2015; 24:e108-15. [PMID: 26523015 DOI: 10.4037/ajcc2015470] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 11/01/2022]
Abstract
BACKGROUND Although patients' families want to be invited to the bedside of hospitalized loved ones during crisis events, little is known about patients' perceptions of family presence. OBJECTIVE To explore adult inpatients' perceptions of family presence during resuscitation, near-resuscitation, and unplanned invasive cardiac procedures shortly after the life-threatening event. METHODS In this qualitative study, data were collected by interviews at least 13 hours after a crisis event and before hospital discharge. Data were audio recorded, transcribed, and analyzed for themes. RESULTS From the bedside interviews (N = 48), the overarching theme of "being there" was explained more specifically as "being there is beneficial," "being there is hard," "families in the way," and "desire for control." Most participants preferred family presence, although preferences varied with types of crisis events, patients' predictions of family members' responses, and the nature of family relationships. New perspectives emerged about patients' decision making related to family presence. CONCLUSIONS This study extends existing knowledge about factors that influence the decision-making processes of hospitalized patients regarding family presence during a crisis event. Health care professionals can provide support as patients ponder difficult decisions about who to have present and can reduce patients' fears that families might interfere with the life-saving efforts.
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Affiliation(s)
- Renee Samples Twibell
- Renee Samples Twibell is an associate professor at Ball State University School of Nursing and a nurse researcher at Indiana University Health Ball Memorial Hospital, Muncie, Indiana. Shannon Craig is a faculty member at Ball State University School of Nursing and a staff nurse at Indiana University Health Ball Memorial Hospital. Debra Siela is an associate professor at Ball State University School of Nursing. Sherry Simmonds is a clinical research coordinator at Indiana University Health Ball Memorial Hospital. Cynthia Thomas is an associate professor at Ball State University School of Nursing.
| | - Shannon Craig
- Renee Samples Twibell is an associate professor at Ball State University School of Nursing and a nurse researcher at Indiana University Health Ball Memorial Hospital, Muncie, Indiana. Shannon Craig is a faculty member at Ball State University School of Nursing and a staff nurse at Indiana University Health Ball Memorial Hospital. Debra Siela is an associate professor at Ball State University School of Nursing. Sherry Simmonds is a clinical research coordinator at Indiana University Health Ball Memorial Hospital. Cynthia Thomas is an associate professor at Ball State University School of Nursing
| | - Debra Siela
- Renee Samples Twibell is an associate professor at Ball State University School of Nursing and a nurse researcher at Indiana University Health Ball Memorial Hospital, Muncie, Indiana. Shannon Craig is a faculty member at Ball State University School of Nursing and a staff nurse at Indiana University Health Ball Memorial Hospital. Debra Siela is an associate professor at Ball State University School of Nursing. Sherry Simmonds is a clinical research coordinator at Indiana University Health Ball Memorial Hospital. Cynthia Thomas is an associate professor at Ball State University School of Nursing
| | - Sherry Simmonds
- Renee Samples Twibell is an associate professor at Ball State University School of Nursing and a nurse researcher at Indiana University Health Ball Memorial Hospital, Muncie, Indiana. Shannon Craig is a faculty member at Ball State University School of Nursing and a staff nurse at Indiana University Health Ball Memorial Hospital. Debra Siela is an associate professor at Ball State University School of Nursing. Sherry Simmonds is a clinical research coordinator at Indiana University Health Ball Memorial Hospital. Cynthia Thomas is an associate professor at Ball State University School of Nursing
| | - Cynthia Thomas
- Renee Samples Twibell is an associate professor at Ball State University School of Nursing and a nurse researcher at Indiana University Health Ball Memorial Hospital, Muncie, Indiana. Shannon Craig is a faculty member at Ball State University School of Nursing and a staff nurse at Indiana University Health Ball Memorial Hospital. Debra Siela is an associate professor at Ball State University School of Nursing. Sherry Simmonds is a clinical research coordinator at Indiana University Health Ball Memorial Hospital. Cynthia Thomas is an associate professor at Ball State University School of Nursing
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Yamaguchi A. [Informed consent for patients undergoing surgery for ischemic cardiomyopathy]. Nihon Geka Gakkai Zasshi 2014; 115:253-258. [PMID: 25549432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The prognosis of patients with ischemic cardiomyopathy after medical treatment remains poor, despite advances in various therapeutic strategies. In addition to the poorer prognosis, they face higher operative risk, and complex, unestablished operative procedures should be addressed when obtaining preoperative informed consent from patients with ischemic cardiomyopathy. Although the established indications for revascularization in patients with ischemic heart failure pertain to those with angina and significant coronary artery disease, the management of patients with ischemic heart failure without angina is a challenge because of the lack of evidence in this population. The possibility of combining myocardial revascularization with surgical ventricular reconstruction (SVR) to reverse left ventricular remodeling or with mitral valve plasty to repair the incompetence of mitral valve coaptation has been examined in many trials, although little difference in the long-term outcomes between the simple revascularization and the combined procedure groups have been observed. The therapeutic guidelines for patients with ischemic cardiomyopathy state that choosing to add SVR and/or mitral surgery to revascularization should be based on a precise, careful evaluation and should be performed only by surgeons with a high level of surgical expertise.
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Ishii Y. [Informed consent for the Maze Procedure for atrial fibrillation]. Nihon Geka Gakkai Zasshi 2014; 115:266-269. [PMID: 25549435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
It is important to explain the benefits and risks of surgery thoroughly to patients and their families. This paper describes the benefits and risks of the Maze procedure for atrial fibrillation (AF). The purpose of the Maze procedure is the restoration of sinus rhythm from AF, recovery of cardiac function by atrial contraction, and prevention of stroke. The AF cure ratio is 70-90% after the Maze procedure. It was reported that atrial function improves due to atrial contraction after surgery, and the risk of a stroke is reduced to about 2-4 events per 1,000 patients per year after surgery. On the other hand, bleeding is the most common complication after the Maze procedure. The use of alternative surgical ablation devices instead of the cut-and-sew technique decreases the risk of bleeding. Pacemakers are implanted in 5-10% of patients after the Maze procedure due to sick sinus syndrome. In approximately 40% of patients, transient AF occurs during the first month after surgery. However, the addition of the Maze procedure to cardiac surgery for structural heart disease does not increase the surgical risk.
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Affiliation(s)
- Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
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Oka N, Miyaji K. [Informed consent in congenital defect heart surgery]. Nihon Geka Gakkai Zasshi 2014; 115:270-274. [PMID: 25549436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In pediatric cardiac surgery, informed consent is often obtained from the patient's parents. The parents are commonly under great stress due to being in a situation where they have to make the important decision of whether their child will undergo cardiac surgery. Cardiac surgery does not necessarily determine the patient's prognosis if he or she has other organ anomalies or systemic diseases. In such cases, communication among the cardiac surgeon, pediatrician, and family becomes even more crucial. In pediatric cardiac surgery, it is important to obtain informed consent with adequate explanations, an understanding of the parents' stressful situation, and knowledge of the patient's background. In this article, we introduce two examples of obtaining informed consent for two common pediatric cardiac operations, atrial septal defect closure and ventricular septal defect closure.
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Affiliation(s)
- Norihiko Oka
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Abstract
OBJECTIVE The critical importance of a secure mother-infant attachment relationship for long-term physical and mental health of the child is well established. Our study aim was to explore mothers' subjective experience of the mother-infant relationship after discharge from hospital following neonatal cardiac surgery. DESIGN Participants were 97 infants who underwent cardiac surgery before the age of 3 months and their mothers. Mothers completed Maternal Postnatal Attachment Scale (MPAS) and Edinburgh Postnatal Depression Scale (EPDS) questionnaires and were interviewed after the infant had been discharged home for 4 weeks. Interviews were analysed using inductive thematic analysis. RESULTS Mean sores on the MPAS were similar to community norms (84.5 (SD 7.2) vs 84.6 (SD 7), p=0.47). 66/91 mothers interviewed described impacts which encompassed four themes; enhanced emotional ties (n=34, 37%), 'bonding' difficulties (n=22, 23%), anxiety and worry (n=17, 19%), and caregiving behaviours (n=10, 11%). Mothers who described bonding difficulties had lower MPAS scores (mean 80.6 (SD 10) vs 85.7 (SD 5.7), p=0.0047), were more likely to have a prenatal diagnosis of the cardiac abnormality (OR 2.6, 95% CI 0.89 to 8.9) and higher EPDS score (9.1 (SD 5.3) vs 6.2 (SD 3.9), p=0.01). Higher EPDS scores were associated with lower MPAS scores (r=-0.44, p=0.0001). CONCLUSIONS Most mothers report a positive relationship with their infant following cardiac surgery but almost a quarter have difficulties forming a strong emotional tie. Clinical care (including prenatal) of the infant with congenital heart disease requiring surgery should include screening, assessment and appropriate referral for early intervention if mothers are struggling to form a bond with their infant.
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Guo P, East L, Arthur A. Thinking outside the black box: the importance of context in understanding the impact of a preoperative education nursing intervention among Chinese cardiac patients. Patient Educ Couns 2014; 95:365-370. [PMID: 24666774 DOI: 10.1016/j.pec.2014.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/19/2014] [Accepted: 03/02/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE In a randomized controlled trial of a preoperative education intervention conducted for Chinese cardiac patients, we observed a greater effect on symptoms of anxiety and depression than that reported with regard to similar interventions in western care settings. The objective of this qualitative study was to help explain the findings of the trial by exploring Chinese patients' experience of seeking and receiving information before cardiac surgery. METHODS Semi-structured interviews were conducted with a purposive sample of 20 trial participants before discharge (ten from the preoperative education group; ten from the usual care control group). Data were analyzed using a thematic analysis approach. RESULTS A total of five themes were generated: the role of reputation and hierarchy; gaining strength from knowledge; information as a low priority; being kept in the dark; and learning through peer support. CONCLUSION In health care systems where service users are given relatively little information, interventions designed to inform patients about their treatment are likely to have a much greater impact on their psychological health. PRACTICE IMPLICATIONS Providers of services for patients undergoing cardiac surgery in China should be encouraged to incorporate information giving into routine practice, tailored according to individual need.
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Affiliation(s)
- Ping Guo
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, UK; The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
| | - Linda East
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Antony Arthur
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, UK
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Abstract
This study investigates the prevalence and predictors of using complementary and alternative medicine (CAM) among middle-aged and older patients prior to cardiac surgery. Additionally, it addresses the correlates of using 10 commonly used CAM therapies. The influence of religion on itemized CAM usage is also explored. Comprehensive data were collected from adult patients undergoing cardiac surgery through a preoperative survey 2 weeks prior to surgery, followed by a telephone interview the day before surgery. More than two-thirds of participants (80.9 %) indicated at least one CAM use. Income, religiosity, education, BMI, employment, and congestive heart failure predicted greater CAM utility. After multiple controls, major cardiac indicators were significantly positively associated with greater utility of CAM. There was also a significant positive association between religiosity and CAM use. Findings suggest considerable CAM use in this cardiac sample and certain associations among cardiac conditions, religiosity, and itemized CAM utilization. Future research is needed to investigate the potential joint therapeutic and adverse effects of drug and herbal remedies in cardiac patients.
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Affiliation(s)
- Ethel G Nicdao
- Department of Sociology, University of the Pacific, 3601 Pacific Avenue, Stockton, CA, 95211, USA,
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Pruteanu LM. Predictors of postsurgical stress among cardiac patients. Rev Med Chir Soc Med Nat Iasi 2014; 118:508-513. [PMID: 25076723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To explore the role of stress vulnerability, dispositional optimism, fears of surgery and negative affective disposition in prediction of postsurgical stress among cardiac patients who underwent heart surgery. MATERIAL AND METHODS The sample included 60 cardiac patients (39 males and 21 females, aged 58.50 +/- 10.97 years). All patients completed two sets of standardized questionnaires. Before surgical intervention, stress vulnerability, dispositional optimism and negative affective disposition were measured with N6-Scale (from NEO Personality Inventory-Revised Form), Life Orientation Test-Revised Form and Mental Health Index-5, respectively. Fear of surgery among patients was measured with an 8-item questionnaire designed for the current study. After intervention, patients completed a short postsurgical data form along with the Perceived Stress Scale. RESULTS There was no significant difference in postsurgical stress between the female and male cardiac patients (t = 0.96; p = 0.34). A similar result was obtained when the presence/absence of postsurgical complications was considered as an independent variable (t = 1.30; p = 0.19). As expected, a higher level of postsurgical stress was associated with higher stress vulnerability, surgery-related fear, negative affective disposition, and with a lower dispositional optimism score. Moreover, stress vulnerability and negative affective disposition were significant predictors of postsurgical stress. CONCLUSIONS Cardiac patients who are prone to stress and negative affective disposition are also at higher risk for postsurgical stress. On its turn, this psychological condition interferes with time and quality of postsurgical recovery. A careful assessment of psychological condition along with counseling before surgical intervention is needed in order to reduce the risk of postsurgical stress and improve medical recovery in cardiac patients.
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Kurfirst V, Mokráček A, Krupauerová M, Čanádyová J, Bulava A, Pešl L, Adámková V. Health-related quality of life after cardiac surgery--the effects of age, preoperative conditions and postoperative complications. J Cardiothorac Surg 2014; 9:46. [PMID: 24618329 PMCID: PMC3995816 DOI: 10.1186/1749-8090-9-46] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 02/04/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Factors influencing the postoperative health-related quality of life (HRQOL) after cardiac surgery have not been well described yet, mainly in the older people. The study's aim was to explore differences in clinical conditions and HRQOL of patients before and after cardiac surgery taking into account the influence of age and to describe factors influencing changes of HRQOL in the postoperative period. METHODS This was a prospective consecutive observational study with two measurements using the SF-36 questionnaire before surgery and 1 year after surgery. It considered main clinical characteristics of participants prior to surgery as well as postoperative complications. RESULTS At baseline assessment the study considered 310 patients, predominantly male (69%). Mean age was 65 (SD 10.4) years and 101 patients (33%), who were older than 70, constituted the older group. This older group showed greater comorbidity, higher cardiac operative risk and lower HRQOL in the preoperative period as well as a higher prevalence of postoperative complications than the younger group. Thirty-day mortality was 1.4% in the younger group and 6.9% in the older group (p < 0.001). One year mortality was 3.3% in the younger group and 10.9% in the older group (p < 0.001). There was a significant improvement in all 8 health domains of the SF-36 questionnaire (p < 0.001) in the overall sample. There was no significant difference in change in a majority of HRQOL domains between the younger and the older group (p > 0.05). Logistic multivariate analysis identified a higher values of preoperative PCS (Physical component summary) scores (OR 1.03, CI 1.00 - 1.05, p = 0.0187) and MCS (Mental component summary) scores (OR 1.02, CI 0.997 - 1.00, p = 0.0846) as the only risk factors for potential non-improvement of HRQOL after cardiac surgery after correction for age, gender and type of surgery. CONCLUSIONS Older patients with higher operative risk have lower preoperative HRQOL but show a similar improvement in a majority of HRQOL domains after cardiac surgery as compared with younger patients. The multivariate analysis has shown the higher preoperative HRQOL status as a only significant factor of potential non-improvement of postoperative HRQOL.
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Affiliation(s)
- Vojtěch Kurfirst
- Cardiac Surgery Department, Boženy Němcové str. 54, Hospital České Budějovice, České Budějovice, Czech Republic
| | - Aleš Mokráček
- Cardiac Surgery Department, Boženy Němcové str. 54, Hospital České Budějovice, České Budějovice, Czech Republic
| | - Martina Krupauerová
- KardioECHO Cardiology Outpatients Department, České Budějovice, Czech Republic
| | - Júlia Čanádyová
- Cardiac Surgery Department, Boženy Němcové str. 54, Hospital České Budějovice, České Budějovice, Czech Republic
| | - Alan Bulava
- Department of Cardiology, Hospital České Budějovice, České Budějovice, Czech Republic
- Faculty of Health and Social Studies, University of South Bohemia, České Budějovice, Czech Republic
| | - Ladislav Pešl
- Department of Cardiology, Hospital České Budějovice, České Budějovice, Czech Republic
| | - Věra Adámková
- Faculty of Health and Social Studies, University of South Bohemia, České Budějovice, Czech Republic
- Preventive Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Efthimiadis GK, Pitsis A, Pagourelias ED, Kamperidis V, Kelpis T, Meditskou S, Hadjimiltiades S, Ninios V, Mezilis N, Maron BJ, Styliadis IH. Surgical septal myectomy for hypertrophic cardiomyopathy in Greece: a single-center initial experience. Hellenic J Cardiol 2014; 55:132-138. [PMID: 24681791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Surgical septal myectomy is thought to be the gold standard of treatment for obstructive hypertrophic cardiomyopathy (HCM) with obstruction symptoms refractory to optimal medical therapy. In Europe, during the last 2 decades, myectomy has been set aside, while alcohol septal ablation has been widely promoted. In this paper, we analyze our first experience of surgical septal myectomy in a small cohort of patients with HCM coming from a single tertiary center. METHODS Thirty-two patients (16 male, 50%) with a mean age of 58.1 ± 14.4 (range 12-79 years) underwent myectomy for HCM symptoms refractory to negative inotropic agents. The technique used for the myectomy was the one introduced by Andrew Morrow. Mean follow-up time after procedure was 16.8 ± 13.3 months with a median of 13 months (range 4-58 months). RESULTS Post-myectomy, there was a significant improvement in patients' NYHA class (from 3.3 ± 0.46 to 1.38 ± 0.49, p<0.0005), while interventricular septum thickness was reduced from 2.3 ± 0.4 cm to 1.6 ± 0.4 cm (p<0.0005), and peak gradient at the site of obstruction from 94.9 ± 29 to 16.7 ± 7.9 mmHg (p<0.0005). During the follow-up period, only 1 out of 32 patients died, from non-cardiovascular causes, with the overall survival post-myectomy being 97.2% (95%CI: 94.5-99.9%) at 1-year follow up. CONCLUSIONS Surgical septal myectomy in patients with HCM and drug-refractory symptoms is a safe procedure that greatly improves symptoms and quality of life. Further follow-up of our patients is mandatory in order to determine whether the good survival rate achieved at 1 year will persist.
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Affiliation(s)
- Georgios K Efthimiadis
- Cardiomyopathies Center, First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Horne D, Kehler DS, Kaoukis G, Hiebert B, Garcia E, Chapman S, Duhamel TA, Arora RC. Impact of physical activity on depression after cardiac surgery. Can J Cardiol 2014; 29:1649-56. [PMID: 24267805 DOI: 10.1016/j.cjca.2013.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/04/2013] [Accepted: 09/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Physical activity is associated with a lower prevalence of depressive symptoms in cardiac patients. However, the benefits of physical activity on depression perioperatively are unknown. We sought to identify independent parameters associated with depression in patients undergoing cardiac surgery. METHODS Patients awaiting nonemergent cardiac surgery (n = 436) completed the Patient Health Questionnaire-9 (PHQ-9) to quantify depression (PHQ-9 score > 9). Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ-short) and accelerometry. Data collection occurred preoperatively (Q1, n = 436), at hospital discharge (Q2, n = 374), at 3 months (Q3, n = 318), and at 6 months (Q4, n = 342) postoperatively. Patients were categorized as "depression naive", "at risk" or "depressed" preoperatively. Physical inactivity was defined as < 600 metabolic equivalent min/wk. Independent perioperative variables associated with depression were identified with univariate and multivariate logistic regression. RESULTS Depression prevalence from Q1-Q4 was 23%, 37%, 21%, and 23%, respectively. Independent associations with depression were preoperative left ventricular ejection fraction < 50% (Q1, P < 0.05), physical inactivity (Q1, P < 0.05), baseline "at-risk" (Q2, P < 0.05), and baseline "depressed" groups (Q2-Q4, P < 0.05), hospital stay > 7 days (Q2, P < 0.05), postoperative stressful event (Q3 and Q4, P < 0.05), and cardiopulmonary bypass time > 120 minutes (Q4, P = 0.05). Newly depressed patients 6 months postoperatively reported lower IPAQ-short physical activity than depression-free patients (median change, -40 min/wk (interquartile range [IQR], -495 to +255) vs +213 min/wk (IQR, +150 to +830; P < 0.05). CONCLUSIONS Up to 40% of patients are depressed after cardiac surgery. Preoperative depression and postoperative stressful events were the strongest independent associations postoperatively. Physical inactivity was associated with preoperative depression and new depression 6 months postoperatively.
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Affiliation(s)
- David Horne
- Department of Surgery (Cardiac Surgery), University of Manitoba, Winnipeg, Manitoba, Canada
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Eremenko AA, Chernova EV. [Dexmedetomidine use for intravenous sedation and delirium treatment during early postoperative period in cardio-surgical patients]. Anesteziol Reanimatol 2013:4-8. [PMID: 24624849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE OF THE STUDY to analyze the efficiency and safety of Dexmedetomidine infusion for a short-term controlled sedation and treatment of delirium in the early postoperative period in patients after cardiac surgery. METHODS open, randomized, prospective study of 28 patients undergoing surgery on the heart or main blood vessels under general anaesthesia. In the early postoperative period all patients received an infusion of Dexmedetomidine (0.2-1.4 microg kg(-1) per hour) for sedation. The analgesia was carried out with Ketoprofen according to the protocol and Trimeperidine if VAS was > or = 3. Sedation and agitation levels were measured by Ramsay and RAAS scales, speed of awaking by Aldrete score. Duration of mechanical ventilation, length of stay in ICU, need for analgesics (VAS scale), type and frequency of side effects and vital signs (Harward standart) were recorded. Type of delirium, time of onset (days after surgery), dose and duration of psychomotor agitation were evaluated in patients with delirium (n = 9). RESULTS Dexmedetomidine infusion in the medium therapeutic doses resulted mild or moderate sedation remaining up to 12 hours after the infusion. More than 50% of patients had retrograde amnesia. The pain intensity did not exceed 1 point on VAS scale in 96% of patients. 23% of patients required an additional administration of Trimeperidine. The most common side effects were bradycardia (39%) and arterial hypotension (36%). The therapy with Dexmedetomidine provided the most optimal level of sedation compared to other combinations of drugs (haloperidol, midazolam, propofol) in patients with delirium according to sedation-agitation and awaking scales. CONCLUSIONS Dexmedetomidine provides dose-dependent sedation and retrograde amnesia without altering the verbal contact, does not cause respiratory depression. The drug has independent analgesic effect and proved to be effective in the treatment of delirium. The most frequent side effects of Dexmedetomidine are bradycardia and arterial hypotension.
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Spławska K. [Burnout symptoms of cardiosurgery nurses]. Pol Merkur Lekarski 2013; 35:94-99. [PMID: 24052989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED Changes in society, technological progress and time pressure cause irreversible changes in all health care professionals. Taking care of patient in severe condition can cause burnout syndrome among nurses. The aim of the study was to show the problem of burnout syndrome among nurses working in cardiac surgery ward. Those affect three main areas: psychological burnout syndrome, depersonalization, and job-related dissatisfaction. MATERIAL AND METHODS The study was conducted among 50 nurses working in The Intensive Cardiac Care Unit at the University Hospital of Lodz. Inquiry form used in the survey created the author. RESULTS The study showed, that nurses working in specific specialties are affected by burnout syndrome. Despite knowledge of the causes and consequences of this condition majority of nurses fail to recognize symptoms and independently deal with them. In the opinion of the respondents the main factors causing burnout syndrome are: inadequate non-material and material compensation, interpersonal relationships with patients. As a result more than half of the respondents would like to change jobs or consider changing profession. CONCLUSIONS Burnout syndrome was observed with a different intensivity and covers several areas in almost all surveyed nurses.
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Affiliation(s)
- Kinga Spławska
- Uniwersytecki Szpital Kliniczny im. Wojskowej Akademii Medycznej, Centralny Szpital Weteranów w Łodzi, Klinika Elektrokardiologii.
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Derakhshan I. Laterality of motor control and postoperative cognitive decline after cardiac surgery. Perfusion 2013; 28:567-8. [PMID: 23698498 DOI: 10.1177/0267659113487767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hevey D, McGee HM, Horgan JH. Comparative optimism among patients with coronary heart disease (CHD) is associated with fewer adverse clinical events 12 months later. J Behav Med 2013. [PMID: 23274764 DOI: 10.1007/s10865–012–9487–0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The current study evaluates the levels of comparative optimism among patients with coronary heart disease (CHD) and examines its relationship to health outcomes 12 months later. 164 patients completed self-report questionnaires at the end of cardiac rehabilitation and the number of adverse clinical events in the following 12 months were recorded. Comparative optimism was assessed in relation to a typical other who has not had cardiac event, a typical other who has had the same cardiac event as the respondent, and a typical member of the cardiac rehabilitation class. Clinical-demographic details and distress were assessed. Participants were comparatively optimistic in all three ratings. Logistic regression (controlling for age, gender, co-morbidities, and distress) revealed that higher levels of adverse events were associated with older age, being male, and lower levels of overall comparative optimism. Comparative optimism was associated with decreased risk of adverse clinical events in the year following cardiac rehabilitation attendance.
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Affiliation(s)
- David Hevey
- School of Psychology, Trinity College Dublin, Dublin 2, Ireland,
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Laferton JAC, Shedden Mora M, Auer CJ, Moosdorf R, Rief W. Enhancing the efficacy of heart surgery by optimizing patients' preoperative expectations: study protocol of a randomized controlled trial. Am Heart J 2013; 165:1-7. [PMID: 23237127 DOI: 10.1016/j.ahj.2012.10.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 06/14/2012] [Accepted: 10/05/2012] [Indexed: 12/19/2022]
Abstract
In coronary heart disease (CHD) and heart surgery, there is sound evidence for the relationship between patients' expectations and treatment outcome, especially for outcome variables such as disability and quality of life. In addition, patients' expectations have been shown to be modifiable through psychological interventions. Therefore, targeting patients' expectations might offer a promising opportunity to enhance heart surgery outcome. However, few studies have tried to actively change patients' expectations before surgery. The purpose of this clinical trial is to optimize patients' outcome expectations before undergoing coronary artery bypass graft surgery (CABG) through a brief psychoeducational program. The present article describes the study protocol and reports preliminary data on feasibility. Using a randomized controlled design, 180 patients who are scheduled to undergo elective CABG are randomly assigned to either (1) standard medical care (SMC) alone, (2) to an additional expectation manipulation intervention during the 2 weeks before surgery, and (3) to an additional attention-control group ("supportive therapy"). The main goal is to test (a) whether expectation manipulation intervention can optimize patients' expectations and (b) whether optimized expectations lead to enhanced surgery efficacy. The primary outcome variable is illness-related disability 6 months after surgery, whereas secondary outcome variables will be quality of life, return to work, physical activity, and medical outcome variables. First, feasibility data of 36 patients show that the patients appreciated the additional psychological intervention before CABG. Satisfaction of those who received psychological interventions was very high.
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Affiliation(s)
- Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, Marburg, Germany.
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Szwed K, Bieliński M, Drozdz W, Pawliszak W, Hoffmann A, Anisimowicz L, Borkowska A. [Cognitive dysfunction after cardiac surgery]. Psychiatr Pol 2012; 46:473-482. [PMID: 23045900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In spite of the progress in medicine post operative cognitive deficiency (POCD) remains an important clinical problem. Since the introduction of cardiac surgery there have been frequent reports of its adverse neurological outcomes. Recent technological advances have contributed to a lesser occurrence of clinically evident complications such as coma, stroke, epilepsy or blindness. This brought to attention a more common yet occult disorder--POCD. The above malady mostly concerns memory and executive functions. POCD has a negative impact on the quality of life and labor market attachment, however it's relation to mortality seems to be most disturbing. Prevalence of POCD is mainly associated with microembolisms, hipoperfusion and inflammatory reaction of the central nervous system following cardiac surgery. In addition many studies have shown the importance ofbiochemical disorders, cerebral oedema and the influence of comorbidities in the development of POCD. In the light of available evidence, there is no substantial difference between the cognitive outcomes of various types of cardiac surgery. Recent studies show that POCD in this clinical setting is mostly mild and transient. There are, however, patients who suffer from persisting POCD. Modern medicine has not developed standards for treatment of this complication. Setting up methods for prevention, detection and treatment of POCD should be the concern of both physicians and researchers in the following years.
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Affiliation(s)
- Krzysztof Szwed
- Katedra i Zakład Neuropsychologii Klinicznej Collegium Medicum UMK w Bydgoszczy
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Abstract
Marriage has long been linked to lower risk for adult mortality in population and clinical studies. In a regional sample of patients (n = 569) undergoing cardiac surgery, we compared 5-year hazards of mortality for married persons with those of widowed, separated or divorced, and never married persons using data from medical records and psychosocial interviews. After adjusting for demographics and pre- and postsurgical health, unmarried persons had 1.90 times the hazard of mortality of married persons; the disaggregated widowed, never married, and divorced or separated groups had similar hazards, as did men and women. The adjusted hazard for immediate postsurgical mortality was 3.33; the adjusted hazard for long-term mortality was 1.71, and this was mediated by married persons' lower smoking rates. The findings underscore the role of spouses (both male and female) in caregiving during health crises and the social control of health behaviors.
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Rempel GR, Blythe C, Rogers LG, Ravindran V. The process of family management when a baby is diagnosed with a lethal congenital condition. J Fam Nurs 2012; 18:35-64. [PMID: 22223497 DOI: 10.1177/1074840711427143] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The Family Management Style Framework (FMSF) was used as a conceptual basis for secondary data analysis of 55 previously conducted interviews with mothers and fathers of children with a lethal congenital condition from two surgical treatment eras. The directed content analysis was guided by a coding structure developed from family management dimensions identified in prior research of family response to childhood chronic conditions. Results indicated that application of the FMSF was helpful in differentiating families and their processes of family management at the onset of their infant's illness through to surviving the first surgery and going home. The dimensions of Illness View and Child Identity were central to the parents' capacity to manage their baby's illness demands within their family context. Applying a robust family framework to a complex neonatal condition at illness onset provides compelling direction for clinical interventions and their rigorous evaluation.
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Cossette S, Frasure-Smith N, Robert M, Chouinard MC, Juneau M, Guertin MC, Cournoyer A, Mailhot T, Kayser JW. A pilot randomized trial of a smoking cessation nursing intervention in cardiac patients after hospital discharge. Can J Cardiovasc Nurs 2012; 22:16-26. [PMID: 23488362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND One fifth of Canadians are smokers despite the availability of community-based smoking cessation programs. It was hypothesized that offering a post-discharge smoking cessation program to cardiac patients would decrease smoking rates at six months. METHOD This pilot randomized study explored the feasibility, acceptability and preliminary efficacy of a smoking cessation intervention delivered by a smoking cessation nurse specialist (SCNS) to cardiac patients after hospital discharge. SAMPLE Participants (N=40) were randomized to either a postdischarge telephone intervention delivered weekly for the first month and then monthly until the third month (experimental group [EG]), or referral to usual community care (control group [CG]). FINDINGS The researchers confirmed the feasibility of recruitment and acceptability of the intervention, but dfficulty with follow-up. The intention-to-treat analysis showed similar smoking cessation rates in both groups at six months (25% EG versus 30% CG; p = 0.72). CONCLUSION An intensifed follow-up protocol, or a more intensive, comprehensive and multidisciplinary intervention might be required, given the characteristics of the smokers.
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Affiliation(s)
- Sylvie Cossette
- Montreal Heart Institute Research Centre, R-2231, 5000, Bélanger est, Montreal, QC H1T 1C8.
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Tahirović E, Begić H, Tahirović H, Varni JW. Quality of life in children after cardiac surgery for congenital heart disease. Coll Antropol 2011; 35:1285-1290. [PMID: 22397273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of this study was to assess the quality of life children after cardiac surgery for congenital heart disease (CHD) and to compare these results with healthy children. To assess the quality of life children after surgery for CHD we performed a cross-sectional study of 114 patients who were patients at the Department of Paediatrics in Tuzla, between the ages of 2 and 18 years, of both sexes, and with one of their parents. We used the "PedsQL 4.0 Generic Core Scales", with both child self-report and parent proxy-reports. By self assessment, the PedsQL total scores for quality of life were statistically significantly different between children after cardiac surgery for ages 13 to 18 years and healthy children, while by parent report PedsQL total scores were statistically significantly different between children after cardiac surgery for ages 5 to 7 years and healthy children. By self assessment, children after cardiac surgery for ages from 5 to 7 and 13 to 18 years reported that they have a statistically significantly lower quality of life in the segment school functioning compared to the healthy children. By parental assessment, children after cardiac surgery for ages 2 to 4, 5 to 7 and 8 to 12 years have a statistically significantly lower quality of life in the segments of physical and psychosocial health, emotional, social and school functioning. The results of our study indicate that children after cardiac surgery for CHD by self and parent assessment have a lower quality of life than healthy children.
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Affiliation(s)
- Elnur Tahirović
- University of Sarajevo, Sarajevo University Clinical Center, Heart Center, Sarajevo, Bosnia and Herzegovina.
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Spyropoulos V, Ampleman S, Miousse C, Purden M. Cardiac surgery discharge questionnaires: meeting information needs of patients and families. Can J Cardiovasc Nurs 2011; 21:13-19. [PMID: 21361235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Tailoring discharge teaching information to the unique learning needs of cardiac surgery patients and their caregivers may improve information acquisition and retention and positively influence the transition home for these individuals. Two questionnaires were developed, one for adult cardiac surgery patients, and one for their caregivers, to explore their self-identified information needs regarding discharge teaching information. The questionnaires were adapted from the Patient Learning Needs Scale of Bubela et al. (1990). The content of the questionnaires was based on informal discussions with patients and their caregivers and nurses of the cardiac surgery department of a university teaching hospital. In addition, previous research exploring discharge teaching content post cardiac surgery and perceived discharge information needs of this population was reviewed. Preliminary testing of the tools indicated content validity. The questionnaires may enhance the efficiency and quality of discharge teaching, as they enable nurses to address the unique information needs of patients and caregivers. This, in turn, may assist patients and caregivers to cope with the transition home. Formal piloting and evaluation of the tools with all stakeholder groups is indicated, in order to determine the effectiveness of the questionnaires and to evaluate and validate their content and format.
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Affiliation(s)
- Vanessa Spyropoulos
- Montreal Neurological Hospital, McGill University Health Centre, 3801 University Street, Room 201E, Montreal, OC H3A 2B4.
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Jones RN, Rudolph JL, Inouye SK, Yang FM, Fong TG, Milberg WP, Tommet D, Metzger ED, Cupples LA, Marcantonio ER. Development of a unidimensional composite measure of neuropsychological functioning in older cardiac surgery patients with good measurement precision. J Clin Exp Neuropsychol 2010; 32:1041-9. [PMID: 20446144 PMCID: PMC2919652 DOI: 10.1080/13803391003662728] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this analysis was to develop a measure of neuropsychological performance for cardiac surgery and to assess its psychometric properties. Older patients (n = 210) underwent a neuropsychological battery using nine assessments. The number of factors was identified with variable reduction methods. Factor analysis methods based on item response theory were used to evaluate the measure. Modified parallel analysis supported a single factor, and the battery formed an internally consistent set (coefficient alpha = .82). The developed measure provided a reliable, continuous measure (reliability > .90) across a broad range of performance (-1.5 SDs to +1.0 SDs) with minimal ceiling and floor effects.
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Affiliation(s)
- Richard N Jones
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
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Spijkerboer AW, De Koning WB, Duivenvoorden HJ, Bogers AJJC, Verhulst FC, Helbing WA, Utens EMWJ. Medical predictors for long-term behavioral and emotional outcomes in children and adolescents after invasive treatment of congenital heart disease. J Pediatr Surg 2010; 45:2146-53. [PMID: 21034936 DOI: 10.1016/j.jpedsurg.2010.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 01/24/2010] [Revised: 05/31/2010] [Accepted: 07/16/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of the study was to test the following: (1) the predictive value of medical variables for long-term parent-reported behavioral and emotional problems in children and adolescents who underwent invasive treatment of congenital heart disease in infancy and (2) the relationship between parental psychological distress and parental reports on problems in children. METHODS The Child Behavior Checklist was used to investigate to what extent behavioral and emotional problems in 7- to 17-year-old children with congenital heart disease can be predicted by the following: (1) medical history, (2) therapeutic intervention and direct postinterventional course, (3) long-term medical course, (4) present contact with physicians, and (5) present medical status. The General Health Questionnaire was used to assess parental distress (especially anxiety). RESULTS Higher Child Behavior Checklist total problems scores were predicted by cardiac medication before therapeutic intervention. Palliative intervention (Rashkind procedure) before therapeutic intervention was associated with more favorable scores on total problems and externalizing. Long-term maternal distress was significantly related to parent-reported problems in children. CONCLUSION Long-term behavioral and emotional outcomes are only marginally predicted by medical variables. In counseling of children with congenital heart disease and their parents, attention should be paid to long-term maternal distress that has an influence on parent-reported problems in children.
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Affiliation(s)
- Alinda W Spijkerboer
- Department of Child and Adolescent Psychiatry, Erasmus Medical Centre-Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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Rudolph JL, Schreiber KA, Culley DJ, McGlinchey RE, Crosby G, Levitsky S, Marcantonio ER. Measurement of post-operative cognitive dysfunction after cardiac surgery: a systematic review. Acta Anaesthesiol Scand 2010; 54:663-77. [PMID: 20397979 DOI: 10.1111/j.1399-6576.2010.02236.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Post-operative cognitive dysfunction (POCD) is a decline in cognitive function from pre-operative levels, which has been frequently described after cardiac surgery. The purpose of this study was to examine the variability in the measurement and definitions for POCD using the framework of a 1995 Consensus Statement on measurement of POCD. Electronic medical literature databases were searched for the intersection of the search terms 'thoracic surgery' and 'cognition, dementia, and neuropsychological test.' Abstracts were reviewed independently by two reviewers. English articles with >50 participants published since 1995 that performed pre-operative and post-operative psychometric testing in patients undergoing cardiac surgery were reviewed. Data relevant to the measurement and definition of POCD were abstracted and compared with the recommendations of the Consensus Statement. Sixty-two studies of POCD in patients undergoing cardiac surgery were identified. Of these studies, the recommended neuropsychological tests were carried out in less than half of the studies. The cognitive domains measured most frequently were attention (n=56; 93%) and memory (n=57; 95%); motor skills were measured less frequently (n=36; 60%). Additionally, less than half of the studies examined anxiety and depression, performed neurological exam, or accounted for learning. Four definitions of POCD emerged: per cent decline (n=15), standard deviation decline (n=14), factor analysis (n=13), and analysis of performance on individual tests (n=12). There is marked variability in the measurement and definition of POCD. This heterogeneity may impede progress by reducing the ability to compare studies on the causes and treatment of POCD.
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Affiliation(s)
- J L Rudolph
- Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02130, USA.
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