Pre-surgical Caregiver Burden and Anxiety Are Associated with Post-Surgery Cortisol over the Day in Caregivers of Coronary Artery Bypass Graft Surgery Patients

Caregiver burden, family adaptation, partnership, growth, affection, and resolve, anxiety levels, and perceived social support in relatives of patients with open heart surgery

OBJECTIVE

The aim of this study was to examine the relationship between caregiver burden, family adaptation, partnership, growth, affection, and resolve score, anxiety levels, and the perceived social support of the relatives of patients who had open heart surgery.

METHODS

Volunteers among the relatives of patients who had open heart surgery in our cardiovascular surgery clinic and were followed up in the first 3 months were included in the study. The cardiovascular surgeons recorded the sociodemographic data of the relatives of the patients and directed them to a psychiatry clinic for further evaluation. The caregiver burden scale, family adaptation, partnership, growth, affection, and resolve scale, anxiety level scale, and perceived social support scale were applied to the relatives of the patients who participated in the study.

RESULTS

Within the scope of the study, a total of 51 individuals, 29.4% (n=15) men and 70.6% (n=36) women, were included in the evaluation. The participants' ages ranged from 32 to 68 years, with an average age of 48 years. There was a statistically significant relationship between the caregiving burden scale score and the scale scores other than age (p<0.05). There was a statistically significant difference in terms of caregiving burden scale score, working status, physical and psychological problems, changes in home life, and changes in family relationships (p<0.05).

CONCLUSION

The fact that the need for security and intimacy is related to anxiety and depression can be interpreted as the caregiving problems of the relatives of the patients who think that their patients are safe and feel closer to the intensive care personnel will decrease. Their depression and anxiety levels will also decrease.

Caregiver Distress and Coronary Artery Disease: Prevalence, Risk, Outcomes, and Management

PURPOSE OF REVIEW

Caregivers of patients with coronary artery disease (CAD) are integral to the health care system and contribute substantially to patients' management. The purpose of this review is to provide a narrative synthesis of existing research on caregiving for patients who experienced an acute coronary syndrome (MI/unstable angina) and/or coronary revascularization (PCI/CABG).

RECENT FINDINGS

Thirty-one articles are included in this review. Overall, caregiver distress is low to moderate, ranging from 6 to 67% of caregivers, and seems to dissipate over time for most caregivers. Interventions have demonstrated success in reducing the distress of caregivers of patients with CAD. Due to the heterogeneity in study samples, measurements used, and timing of assessments and programming, these results are far from definitive. Although evidence is accumulating, further advancement in caregiving science and clinical care is required to adequately understand and respond to the needs of caregivers throughout the patient's illness trajectory.

Attachment insecurities, caregiver burden, and psychological distress among partners of patients with heart disease

Caregiver psychological distress (i.e., depression and anxiety) is harmful to both caregiver and patient. Different affect-regulation strategies associated with attachment orientations may impact a caregiver’s perception of their caregiving role as a burden, thereby contributing to their psychological distress. The aim of the present investigation was to examine the links among attachment orientations, caregiver burden, and psychological distress in a cardiac context. Participants (N = 181, Mage = 61.79, SD = 10.49; males = 24.7%) were romantic partners of patients with heart disease (i.e., informal caregivers) who completed validated questionnaires. The majority of caregivers had partners with coronary artery disease (n = 127, 70. 2%). 66.3% of caregivers reported low burden, 87.6% reported low levels of depression and 89.9% reported low levels of anxiety. The mean anxious attachment score was 2.74 (SD = 1.37) and the mean avoidant attachment score was 2.95 (SD = 1.26). Four mediation analyses were run using PROCESS macro for IBM SPSS (version 26). Statistical models showed that the relationships between attachment anxiety and psychological distress were mediated by caregiver burden [abanxiety= 0.15, 95% C.I. (0.04, 0.29); abdepression = 0.15, 95% C.I. (0.05, 0.28)] and that attachment avoidance was not a significant covariate (cvanxiety = −0.02, p>0.05; cvdepression = 0.40, p>0.05). The relationships between attachment avoidance and psychological distress were also mediated by caregiver burden [abanxiety = 0.23, 95% C.I. (0.10, 0.42); abdepression = 0.21, 95% C.I. (0.09, 0.37]with attachment anxiety as a significant covariate (cvanxiety = 1.09, p<0.001; cvdepression = 1.09, p<0.001). Interventions for caregivers reporting attachment insecurity and burden should be explored to potentially lessen caregiver distress as they support their partners with heart disease.

Barriers to Successful Discharge After Cardiac Surgery: A Focus Group Study and Cross-Sectional Survey

At present, there is a lack of information on patient and caregiver values, and perceived priorities and barriers, to guide successful post-discharge recovery. This was a single center, multiple methods study that investigated patient, caregiver, and health care provider perceptions of the discharge process after cardiac surgery. Themes emerging from focus group discussions with patients and caregivers were used to develop surveys relating to values, barriers, and challenges relating to the discharge process. Thirty-two patients (n = 16) and caregivers (n = 16) participated in four separate focus groups. Four themes emerged from these discussions: (1) a lack of understanding about what the discharge process entails and when discharge is appropriate, (2) issues relating to the information provided to patients at the time of discharge, (3) participant experiences with the health care system, and (4) the experiences of caregivers. Seventy-eight patients, 34 caregivers, 53 nurses and/or other allied health professionals, and 8 surgeons completed the cross-sectional surveys. The most important component of the discharge process for patients and caregivers was "knowing what to do in an emergency." Health care providers less accurately identified what caregivers perceived as the most important aspects of the discharge process.Statements relating to informational barriers to discharge were the most discordant among patient and caregiver respondents. After discharge, patients and caregivers identified the need for longer-term follow up with the surgeon and more support in the community. Incorporation of patient and caregiver values to guide the post-cardiac surgery discharge process is essential to promote successful recovery.

Two-dimensional fluoroscopy-guided robot-assisted percutaneous endoscopic transforaminal discectomy: a retrospective cohort study

Percutaneous Endoscopic Transforaminal Discectomy (PETD) has been widely used for minimally invasive treatment of lumbar disc herniation (LDH), and percutaneous disc target puncture has a steep learning curve and high radiation exposure. Proper technology grafting can improve the surgical procedure and clinical outcomes. The changes brought by grafting surgical robots into PETD are worth investigating. A retrospective analysis was performed on the information of patients who received PETD in our hospital from March 2019 to July 2020. A total of 102 of patients who received 2D-guided robot-assisted PETD were included in Group A, and 102 of patients who received C-arm fluoroscopy-guided bare-handed PETD were included in Group B. The number of punctures, number of fluoroscopies, operation duration, intraoperative anxiety score, complications, and visual analogue scale (VAS) score and Oswestry disability index (ODI) before operation, on Day 1 after operation and at the last follow-up visit of the two groups were compared. All 204 patients received successful operations. Group A received 1.20±0.42 punctures, 10.49±2.16 fluoroscopies and 60.69±5.63 minutes of operation, significantly fewer than the 4.84±1.94 punctures, 17.41±3.23 fluoroscopies and 71.19±5.11 minutes of operation of Group B (all P<0.05), and Group A had significantly lower intraoperative anxiety scores and incidence of complications than Group B (both P<0.05). Both groups had comparable VAS and ODI scores on Day 1 after operation and at the last follow-up visit, which were both significantly higher than those before operation (P<0.05). 2D-guided robot-assisted PETD can enable precise planning of the puncture path, make it easier for operators to complete targeted punctures at pathogenic targets, reduce the number of punctures and fluoroscopies, shorten the operation duration to optimize the operation process, and reduce complications and alleviate intraoperative anxiety for better clinical results. Therefore it mayb be a better choice to assist PETD.

Comparison of the effectiveness of home visits and telephone follow-up on the self-efficacy of patients having un-dergone coronary artery bypass graft surgery (CABG) and the burden of their family caregivers: A randomized con-trolled trial

OBJECTIVES

This study aimed to compare home visits and telephone follow-up effectiveness on patients' self-efficacy undergoing Coro-nary Artery Bypass Graft Surgery -CABG- and caregivers' burden.

METHODS

In this randomized clinical trial, 114 patients undergoing CABG were assigned to the three groups of home visits, telephone follow-up, and control based on the stratified block randomization. The self-management program of the home visit group included four face-to-face 60-minute training sessions once a week, and for the telephone follow-up group, four 30-minute telephone counseling sessions twice each week for a month. The control group received routine care. Data were collected using the cardiac rehabilitation self-efficacy questionnaire and the caregiver burden scale before and after the interven-tion.

RESULTS

Before the study, there were no statistically significant differences between the three groups in terms of the means of self-efficacy and caregiver burden scores. However, there was a statistically significant difference between the home visit and control groups (p<0.001) and between the telephone follow-up and control groups (p<0.001) after the intervention, with in-creased self-efficacy and reduced caregiver burden reported. In contrast, there was no significant difference between the home visit and telephone follow-up groups regarding self-efficacy and caregiver burden scores.

CONCLUSIONS

Both methods of self-management education have similar effectiveness in increasing self-efficacy and reducing the care-giver burden after discharge for patients who have undergone CABG.

Comparison of the effectiveness of home visits and telephone follow-up on the self-efficacy of patients having un-dergone coronary artery bypass graft surgery (CABG) and the burden of their family caregivers: A randomized con-trolled trial

OBJECTIVES

This study aimed to compare home visits and telephone follow-up effectiveness on patients' self-efficacy undergoing Coro-nary Artery Bypass Graft Surgery -CABG- and caregivers' burden.

METHODS

In this randomized clinical trial, 114 patients undergoing CABG were assigned to the three groups of home visits, telephone follow-up, and control based on the stratified block randomization. The self-management program of the home visit group included four face-to-face 60-minute training sessions once a week, and for the telephone follow-up group, four 30-minute telephone counseling sessions twice each week for a month. The control group received routine care. Data were collected using the cardiac rehabilitation self-efficacy questionnaire and the caregiver burden scale before and after the interven-tion.

RESULTS

Before the study, there were no statistically significant differences between the three groups in terms of the means of self-efficacy and caregiver burden scores. However, there was a statistically significant difference between the home visit and control groups (p<0.001) and between the telephone follow-up and control groups (p<0.001) after the intervention, with in-creased self-efficacy and reduced caregiver burden reported. In contrast, there was no significant difference between the home visit and telephone follow-up groups regarding self-efficacy and caregiver burden scores.

CONCLUSIONS

Both methods of self-management education have similar effectiveness in increasing self-efficacy and reducing the care-giver burden after discharge for patients who have undergone CABG.