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Huet O, Gargadennec T, Oilleau JF, Rozec B, Nesseler N, Bouglé A, Kerforne T, Lasocki S, Eljezi V, Dessertaine G, Amour J, Chapalain X. Prevention of post-operative delirium using an overnight infusion of dexmedetomidine in patients undergoing cardiac surgery: a pragmatic, randomized, double-blind, placebo-controlled trial. Crit Care 2024; 28:64. [PMID: 38419119 PMCID: PMC10902989 DOI: 10.1186/s13054-024-04842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND After cardiac surgery, post-operative delirium (PoD) is acknowledged to have a significant negative impact on patient outcome. To date, there is no valuable and specific treatment for PoD. Critically ill patients often suffer from poor sleep condition. There is an association between delirium and sleep quality after cardiac surgery. This study aimed to establish whether promoting sleep using an overnight infusion of dexmedetomidine reduces the incidence of delirium after cardiac surgery. METHODS Randomized, pragmatic, multicentre, double-blind, placebo controlled trial from January 2019 to July 2021. All adult patients aged 65 years or older requiring elective cardiac surgery were randomly assigned 1:1 either to the dexmedetomidine group or the placebo group on the day of surgery. Dexmedetomidine or matched placebo infusion was started the night after surgery from 8 pm to 8 am and administered every night while the patient remained in ICU, or for a maximum of 7 days. Primary outcome was the occurrence of postoperative delirium (PoD) within the 7 days after surgery. RESULTS A total of 348 patients provided informed consent, of whom 333 were randomized: 331 patients underwent surgery and were analysed (165 assigned to dexmedetomidine and 166 assigned to placebo). The incidence of PoD was not significantly different between the two groups (12.6% vs. 12.4%, p = 0.97). Patients treated with dexmedetomidine had significantly more hypotensive events (7.3% vs 0.6%; p < 0.01). At 3 months, functional outcomes (Short-form 36, Cognitive failure questionnaire, PCL-5) were comparable between the two groups. CONCLUSION In patients recovering from an elective cardiac surgery, an overnight infusion of dexmedetomidine did not decrease postoperative delirium. Trial registration This trial was registered on ClinicalTrials.gov (number: NCT03477344; date: 26th March 2018).
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Affiliation(s)
- Olivier Huet
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France.
| | - Thomas Gargadennec
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
| | - Jean-Ferréol Oilleau
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
| | - Bertrand Rozec
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Laennec, University Hospital Centre Nantes, Nantes, France
| | - Nicolas Nesseler
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, University Hospital of Rennes, Rennes, France
| | - Adrien Bouglé
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Thomas Kerforne
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine CHU de POITIERS, Poitiers, France
| | - Sigismond Lasocki
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, CHU de ANGERS, I, Angers, France
| | - Vedat Eljezi
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, Clermont Ferrand, France
| | - Géraldine Dessertaine
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Amour
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Privé Jacques Cartier, Massy, France
| | - Xavier Chapalain
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
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Sun V, Raz DJ, Erhunmwunsee L, Ruel N, Carranza J, Prieto R, Ferrell B, Krouse RS, McCorkle R, Kim JY. Improving family caregiver and patient outcomes in lung cancer surgery: Study protocol for a randomized trial of the multimedia self-management (MSM) intervention. Contemp Clin Trials 2019; 83:88-96. [PMID: 31279090 PMCID: PMC6661176 DOI: 10.1016/j.cct.2019.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the study protocol of the Multimedia Self-Management (MSM) intervention to prepare patients and family caregivers (FCGs) for lung cancer surgery. DESIGN The study is a five-year, single site, randomized controlled trial of 160 lung cancer surgery FCG and patient dyads (320 total participants), comparing intervention and attention control arms. SETTING One National Cancer-Institute (NCI) designated comprehensive cancer center in Southern California. PARTICIPANTS Patients who are scheduled to undergo lung cancer surgery and their FCGs are enrolled as dyads only. INTERVENTION Based on the Chronic Care Self-Management Model (CCM), the intervention is a nurse-led, caregiver-based, multimedia care program for lung cancer surgery. Its primary focus is to help FCGs develop self-management skills related to their caregiving role through goal setting, proactive planning, building problem-solving skills, and accessing family support services. The intervention also supports dyads to prepare for surgery and post-operative recovery at home. It includes videos, print, web-based, and post-discharge telephone support. MAIN OUTCOME MEASURES FCG and patient psychological distress and QOL; FCG burden and preparedness for caregiving; FCG and patient healthcare resource use (in-home nursing care, urgent care/ER visits, readmissions). ANALYSIS Repeated measures ANCOVA statistical design will be used, removing variances prior to examining mean squares for the group by occasion interactions, and co-varying the baseline scores. In addition, structured equation modeling (SEM) will assess whether mediating and moderating factors are associated with outcomes. ClinicalTrials.gov Identifier: NCT03686007.
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Affiliation(s)
- Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, United States of America.
| | - Dan J Raz
- Division of Thoracic Surgery, Department of Surgery, United States of America
| | | | - Nora Ruel
- Biostatistics and Mathematical Modeling Core City of Hope, Duarte, CA, United States of America
| | - Jacqueline Carranza
- Division of Nursing Research and Education, Department of Population Sciences, United States of America
| | - Rosemary Prieto
- Division of Nursing Research and Education, Department of Population Sciences, United States of America
| | - Betty Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, United States of America
| | - Robert S Krouse
- Surgical Services, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States of America; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Ruth McCorkle
- School of Nursing, Yale University, New Haven, CT, United States of America
| | - Jae Y Kim
- Division of Thoracic Surgery, Department of Surgery, United States of America
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Yan W, Shah P, Hiebert B, Pozeg Z, Ghorpade N, Singal RK, Manji RA, Arora RC. Long-term non-institutionalized survival and rehospitalization after surgical aortic and mitral valve replacements in a large provincial cardiac surgery centre. Interact Cardiovasc Thorac Surg 2018; 27:131-138. [PMID: 29462406 DOI: 10.1093/icvts/ivy018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/14/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Long-term quality of life following open surgical valve replacement is an increasingly important outcome to patients and their caregivers. This study examines non-institutionalized survival and rehospitalization within our surgical aortic valve replacement (AVR) and mitral valve replacement (MVR) populations. METHODS A retrospective single-centre study of all consecutive open surgical valve replacements between 1995 and 2014 was undertaken. Clinical data were linked to provincial administrative data for 3219 patients who underwent AVR, MVR or double (aortic and mitral) valve replacement with or without concomitant coronary artery bypass grafting (CABG). Non-institutionalized survival and cumulative incidence of rehospitalization was examined up to 15 years. RESULTS Follow-up was complete for 96.9% of the 2146 patients who underwent AVR ± CABG (66.7% of the overall cohort), 878 who underwent MVR ± CABG (27.3%) and 195 who underwent double (aortic and mitral) valve replacement ± CABG (6.0%) with a median follow-up time of 5.6 years. Overall non-institutionalized survival was 35.4% at 15 years, and the cumulative incidence of rehospitalization was 34.4%, 63.2% and 87.0% at 1, 5 and 15 years, respectively, without significant differences between valve procedure cohorts. Both non-institutionalized survival and cumulative incidence of rehospitalization improved in more recent eras, despite increasing age and comorbidities. CONCLUSIONS Non-institutionalized survival and rehospitalization data for up to 15 years suggest good functional outcomes long after surgical AVR and/or MVR. Continued improvements are seen in these metrics over the past 2 decades. This provides a unique insight into the quality of life after surgical valve replacement in the ageing demographics with valvular heart disease.
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Affiliation(s)
- Weiang Yan
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Pallav Shah
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Brett Hiebert
- Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Zlatko Pozeg
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Nitin Ghorpade
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Rohit K Singal
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Rizwan A Manji
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
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Brown SM, Wilson E, Presson AP, Zhang C, Dinglas VD, Greene T, Hopkins RO, Needham DM. Predictors of 6-month health utility outcomes in survivors of acute respiratory distress syndrome. Thorax 2017; 72:311-317. [PMID: 27440140 PMCID: PMC5518323 DOI: 10.1136/thoraxjnl-2016-208560] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/03/2016] [Accepted: 06/18/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND With improving short-term mortality in acute respiratory distress syndrome (ARDS), understanding and improving quality of life (QOL) outcomes in ARDS survivors is a clinical and research priority. We sought to identify variables associated with QOL, as measured by the EQ-5D health utility score, after ARDS using contemporary data science methods. METHODS Analysis of prospectively acquired baseline variables and 6-month EQ-5D health utility scores for adults with ARDS enrolled in the ARDS Network Long-Term Outcomes Study (ALTOS). Penalised regression identified predictors of health utility, with results validated using 10-fold cross-validation. RESULTS Among 616 ARDS survivors, several predictors were associated with 6-month EQ-5D utility scores, including two lifestyle factors. Specifically, older age, female sex, Hispanic/Latino ethnicity, current smoking and higher body mass index were associated with lower EQ-5D utilities, while living at home without assistance at baseline and AIDS were associated with higher EQ-5D utilities in ARDS survivors. No acute illness variables were associated with EQ-5D utility. CONCLUSIONS Acute illness variables do not appear to be associated with postdischarge QOL among ARDS survivors. Functional independence and lifestyle factors, such as obesity and tobacco smoking, were associated with worse QOL. Future analyses of postdischarge health utility among ARDS survivors should incorporate measures of demographics and functional independence at baseline. TRIAL REGISTRATION NUMBERS NCT00719446 (ALTOS), NCT00434993 (ALTA), NCT00609180 (EDEN/OMEGA), and NCT00883948 (EDEN); Post-results.
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Affiliation(s)
- Samuel M. Brown
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT
- Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT
- Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT
| | - Emily Wilson
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT
- Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT
| | - Angela P. Presson
- Study Design and Biostatistics Center and Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Chong Zhang
- Study Design and Biostatistics Center and Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Victor D. Dinglas
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Tom Greene
- Study Design and Biostatistics Center and Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Ramona O. Hopkins
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT
- Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT
| | - Dale M. Needham
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
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Lapum JL, Fredericks S, Liu L, Yau TM, Retta B, Jones VM, Hume S. Facilitators and Barriers of Heart Surgery Discharge. J Cardiovasc Nurs 2016; 31:350-6. [DOI: 10.1097/jcn.0000000000000253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thomson Mangnall LJ, Sibbritt DW, Fry M, Windus M, Gallagher RD. Health-related quality of life of patients after mechanical valve replacement surgery for rheumatic heart disease in a developing country. HEART ASIA 2014; 6:172-8. [PMID: 27326199 PMCID: PMC4832766 DOI: 10.1136/heartasia-2014-010562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/28/2014] [Accepted: 11/04/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the health-related quality of life (HRQoL) of people in Fiji (n=128) undergoing heart valve replacement (VR) surgery for rheumatic heart disease (RHD), conducted by Open Heart International. METHODS Patients who had undergone surgery from 1991 to 2009 (n=72) and patients undergoing surgery for the years 2010-2012 (n=56) were surveyed prospectively, preoperatively and/or postoperatively (the mean follow-up time 5.9 years) using the standard recall Short-Form 36, V.2 (SF-36v2) HRQoL Survey. RESULTS The sample had a mean age of 26.7 years and 56% (n=72) were women. Preoperative HRQoL is impaired but by early postoperative (1 year) there is significant improvement across all domains (p<0.05) apart from mental health (p=0.081). At mid-term (2 years), HRQoL remained substantially improved from preoperative measurement with mental health now significantly better (p=0.028). However, compared with the early follow-up outcomes, at mid-term physical function (p=0.001), role-physical (p=0.002) and role-emotional (p=0.042) domains significantly declined. By late follow-up (>2 years), all HRQoL domains, except for mental health, were significantly better than preoperative (p=0.066 ). Predictors of less improved HRQoL included having an isolated mitral valve replacement (MVR) (for six of eight health domains, p<0.05), older age (three domains; role-physical, vitality and bodily pain, p<0.05) and male gender (in the role-emotional domain, p<0.05). CONCLUSIONS This first investigation of the HRQoL of people in a developing country after VR surgery for RHD found significant improvement from surgery with this improvement generally sustained. The lack of improvement in mental health requires further exploration as does the influence of an isolated MVR, age and gender.
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Affiliation(s)
- Linda J Thomson Mangnall
- Cardiothoracic Surgical and Medical Telemetry Unit, Sydney Adventist Hospital, Wahroonga, Australia; Faculty of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia
| | - David W Sibbritt
- Faculty of Health , University of Technology , Sydney, New South Wales , Australia
| | - Margaret Fry
- Faculty of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia; University of Technology, Sydney, Broadway, New South Wales, Australia
| | - Melanie Windus
- Flow Manager; Open Heart International Coordinator (Fiji), Sydney Adventist Hospital , Wahroonga, New South Wales , Australia
| | - Robyn D Gallagher
- Charles Perkins Centre and Sydney Nursing School, University of Sydney , Camperdown, New South Wales , Australia
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SATISCORE: un cuestionario para valorar la satisfacción del paciente tras cirugía cardiaca. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Thomson Mangnall LJ, Gallagher RD, Sibbritt DW, Fry MM. Health-related quality of life of patients after mechanical valve replacement surgery: an integrative review. Eur J Cardiovasc Nurs 2014; 14:16-25. [PMID: 24634389 DOI: 10.1177/1474515114528126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Heart valve replacement surgery is undertaken to improve cardiac function and health-related quality of life (HRQoL). Mechanical valves are typically used for younger people (aged <65 years). Implantation of these valves comes with life-long health self-management requirements which potentially impact on HRQoL. AIMS The purpose of this study was to identify the short and long-term impact on HRQoL after mechanical valve replacement surgery. METHODS Multiple electronic databases were searched for peer-reviewed studies published between 2000-2013, which focused on patients who had mechanical valve replacement, aged <65 years, and used a valid measure of HRQoL. RESULTS Eight papers were included, all of which used the Short-Form 36 Health Survey (SF-36). Preoperatively, HRQoL was impaired, particularly in the SF-36 health domains of role-physical, physical-functioning, vitality and role-emotional. Postoperatively, most people had positive and sustained HRQoL improvement. In the early postoperative period all data showed significant improvement in at least four of eight health domains (physical function, role-physical, vitality, social function). Two-thirds of people also had significant improvement in an additional two health domains (general and mental-health). Whilst most people sustained HRQoL over time, one-third of younger adults (age <24 years) showed impairment in three domains (physical-function, mental-health and general-health). CONCLUSIONS Mechanical valve replacement surgery results in important and sustained improvements in HRQoL. Future research should include investigation of HRQoL outcomes after mechanical valve replacement for specific groups such as younger adults and people in developing countries, and include evaluations of the potential impact of valve-specific factors and health self-management requirements.
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Affiliation(s)
| | | | | | - Margaret M Fry
- University of Technology, Sydney, Australia University of Sydney, Australia
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Jerofke T, Weiss M, Yakusheva O. Patient perceptions of patient-empowering nurse behaviours, patient activation and functional health status in postsurgical patients with life-threatening long-term illnesses. J Adv Nurs 2013; 70:1310-22. [DOI: 10.1111/jan.12286] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Teresa Jerofke
- College of Nursing; Marquette University; Milwaukee Wisconsin USA
| | - Marianne Weiss
- College of Nursing; Marquette University; Milwaukee Wisconsin USA
| | - Olga Yakusheva
- Department of Economics; Marquette University College of Business and Graduate School of Management; Marquette University; Milwaukee Wisconsin USA
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Barolia R, Ali F, Jaffar S, Sami S. Coronary artery bypass grafting: quality of life of patients in Karachi. ACTA ACUST UNITED AC 2012; 21:349-55. [DOI: 10.12968/bjon.2012.21.6.349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Elliott D, Denehy L, Berney S, Alison JA. Assessing physical function and activity for survivors of a critical illness: A review of instruments. Aust Crit Care 2011; 24:155-66. [DOI: 10.1016/j.aucc.2011.05.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/09/2011] [Accepted: 05/31/2011] [Indexed: 01/22/2023] Open
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Lapum J, Angus JE, Peter E, Watt-Watson J. Patients' discharge experiences: Returning home after open-heart surgery. Heart Lung 2011; 40:226-35. [DOI: 10.1016/j.hrtlng.2010.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/11/2009] [Accepted: 01/08/2010] [Indexed: 10/19/2022]
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Abstract
UNLABELLED DEFINITION OF QUALITY OF LIFE: In recent years, quality of life has become a very important measure of treatment of disease and successful therapy, regarding not only general health of an individual patient but also of the whole population. In 1993 the WHO proclaimed "Vision of health for all", as "Add years to life" but also "Add life to years", emphasizing quality of life to be as important as life duration. Although the remaining life expectancy in patients with cardiovascular disease is prolonged, there is still medical challenge: "How to improve quality of life in these patients?". MEASUREMENT OF QUALITY OF LIFE Quality of life can be defined as the patient's perception of impact of disease and concomitant therapy and procedures on his physical and working capacity, emotional role, social communication and general health. DIFFERENT TYPES OF STANDARDIZED QUESTIONNAIRES FOR QUALITY OF LIFE EVALUATION It can be measured by general health questionnaires and specified questionnaires for disease. Questionnaire SF-36 is regarded as one of the most reliable, considering the great number of publications. CONCLUSION The most important step in complicated evaluation of quality of life is the adequate selection of questionnaire with a high confidence.
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Taghipour HR, Naseri MH, Safiarian R, Dadjoo Y, Pishgoo B, Mohebbi HA, Daftari Besheli L, Malekzadeh M, Kabir A. Quality of life one year after coronary artery bypass graft surgery. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:171-7. [PMID: 22737458 PMCID: PMC3371947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 11/05/2010] [Accepted: 11/15/2010] [Indexed: 12/04/2022]
Abstract
BACKGROUND Coronary artery bypass graft (CABG) is a treatment strategy to relieve the symptoms of coronary artery disease (CAD). Based on determining the long term outcome of CABG using SF-36 Health Related Quality Of Life (HRQOL) questionnaire, the present study was conducted in our center to determine the CABG results one-year after the operation. METHODS Between March 2005 and August 2009, 112 patients with coronary heart disease (CHD) who underwent coronary artery bypass graft (CABG) were enrolled. Patients completed SF-36 HRQOL general health status questionnaire. Stepwise multiple linear regression models were used to detect independent variables predicting changes in each eight subscales of SF-36 questionnaire. RESULTS The mean age of patients was 61.4±0.9 years and most of them were male with three vessel diseases that were on pump CABG. The mean physical and mental component summary scores were 59.5±0.9 and 60.2±0.9, respectively. Physical functioning (PF) and role physical (RP) improved in males. Regression models showed that there were some statistical models with low R-square to predict role emotional (RE), general health (GH), PF and RP according to ejection fraction after surgery, diabetes, pump type of CABG and male gender. CONCLUSION CABG has led to higher and more satisfactory outcomes for PF, RP and RE but lower in other scales comparing with normative data of the society and one-year post-operative scores of other studies. It could mostly be attributed to unmodified risk factors and progression of existing comorbidities.
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Affiliation(s)
- H R Taghipour
- Trauma Research Center, Department of Cardiology and Cardiothoracic Surgery, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - M H Naseri
- Trauma Research Center, Department of Cardiology and Cardiothoracic Surgery, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - R Safiarian
- Trauma Research Center, Department of Cardiology and Cardiothoracic Surgery, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - Y Dadjoo
- Trauma Research Center, Department of Cardiology and Cardiothoracic Surgery, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - B Pishgoo
- Trauma Research Center, Department of Cardiology and Cardiothoracic Surgery, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - H A Mohebbi
- Trauma Research Center, Department of Cardiology and Cardiothoracic Surgery, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - L Daftari Besheli
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Malekzadeh
- Trauma Research Center, Department of Cardiology and Cardiothoracic Surgery, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - A Kabir
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Center for Educational Research in Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Ali Kabir, MD, MPH, Nikan Health Researchers Institute, Poonak Square, Tehran, Iran. Tel.: +98-21-66516995, Fax: +98-21-44476796, E-mail:
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Kato T, Tomita S, Handa N, Ueno YI. Health-related quality of life evaluated by the eight-item short form after cardiovascular surgery. Gen Thorac Cardiovasc Surg 2010; 58:612-6. [DOI: 10.1007/s11748-010-0663-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 06/15/2010] [Indexed: 11/29/2022]
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Barnason S, Zimmerman L, Nieveen J, Schulz P, Miller C, Hertzog M, Tu C. Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery. Heart Lung 2010; 38:364-76. [PMID: 19755186 DOI: 10.1016/j.hrtlng.2009.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Revised: 01/13/2009] [Accepted: 01/28/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study objective was to examine the effect of a symptom management (SM) telehealth intervention on physical activity and functioning and to describe the health care use of older adult patients (aged > 65 years) after coronary artery bypass surgery (CABS) by group (SM intervention group and usual care group). METHODS A randomized clinical trial design was used. The study was conducted in 4 Midwestern tertiary hospitals. The 6-week SM telehealth intervention was delivered by the Health Buddy (Health Hero Network, Palo Alto, CA). Measures included Modified 7-Day Activity Interview, RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA), physical activity and exercise diary, Medical Outcomes Study Short-Form 36, and subjects' self-report and provider records of health care use. Follow-up times were 3 and 6 weeks and 3 and 6 months after CABS. RESULTS Subjects (N = 232) had a mean age of 71.2 (+4.7) years. There were no significant interactions using repeated-measures analyses of covariance. There was a significant group effect for average kilocalories/kilogram/day of estimated energy expenditure as measured by the RT3 accelerometer, with the usual care group having a higher estimated energy expenditure. Both groups had significant improvements over time for role-physical, vitality, and mental functioning. Both groups had similar health care use. CONCLUSION Subjects were able to return to preoperative levels of functioning between 3 and 6 months after CABS and to increase their physical activity over reported preoperative levels of activity. Further study of those patients undergoing CABS who could derive the most benefit from the SM intervention is warranted.
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Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center, Lincoln, 68588-0220, USA
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Expectations, anxiety, depression, and physical health status as predictors of recovery in open-heart surgery patients. J Cardiovasc Nurs 2010; 24:454-64. [PMID: 19858954 DOI: 10.1097/jcn.0b013e3181ac8a3c] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Recovery after open-heart surgery is a complex process that presents psychosocial and physical challenges that continue well after discharge. The purpose of this study was to examine the relationship among expectations, anxiety, depression, and physical health status (PHS) and to determine predictors of postoperative PHS in open-heart surgery patients. PARTICIPANTS AND METHODS A convenience sample (N = 54) was recruited from 2 hospitals in rural regions from 2 different mid-Atlantic states. The sample included participants who underwent coronary artery bypass graft or valve replacement surgery for the first time. The study used a longitudinal design, and data were collected preoperatively in the hospital or surgeons' offices and 4 weeks postoperatively by telephone interviews. Participants were interviewed using the following questionnaires: the Future Expectations Regarding Life with Heart Disease scale, the Hospital Anxiety and Depression scale, and the Medical Outcomes Study 36-Item Short Form Health Survey. Repeated-measures analysis of variance, Pearson product-moment correlations, and multiple regression were used for data analyses. RESULTS AND CONCLUSIONS Statistical analysis revealed that anxiety (P = .002) and depression (P = .026) scores decreased postoperatively. Significant relationships were found among the preoperative and postoperative variables: expectations, anxiety, depression, and PHS. Analyses also found that preoperative expectations, anxiety, depression, and PHS contributed 38% of the variance of postoperative PHS (P < .001). However, the postoperative variables were not significant predictors of postoperative PHS (P = .075). The findings support the need for interventions to assist patients in developing realistic expectations and for clinicians to screen patients for anxiety and depression before and after surgery. Future research needs to measure PHS at various times postoperatively to identify continued limitations after surgery.
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Gois CFL, Dantas RAS, Torrati FG. Qualidade de vida relacionada à saúde, antes e seis meses após a revascularização do miocárdio. Rev Gaucha Enferm 2009; 30:700-7. [DOI: 10.1590/s1983-14472009000400017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A cirurgia de revascularização do miocárdio (CRM) visa melhorar a qualidade de vida relacionada à saúde (QVRS), aliviar sintomas e aumentar a sobrevida. Objetivou-se comparar a QVRS antes e seis meses após CRM e avaliar a sua relação com idade, sexo, escolaridade e estado civil. Estudo descritivo e longitudinal que utilizou o SF-36 para avaliar a QVRS. Entre os 54 sujeitos, 53,7% eram homens, 66,7% casados, com idade média de 57,3+9,7 anos e 5,7+4 anos de escolaridade. Após a CRM as médias dos domínios do SF-36 variaram de 62 a 74,2 sendo o intervalo anterior de 17,1 a 58,1. Homens apresentaram melhor avaliação da QVRS antes e após a CRM do que as mulheres, mas as diferenças foram estatisticamente significantes apenas para Estado geral de saúde e Dor. Não se constatou associação entre QVRS, escolaridade e estado civil. Concluiu-se que a CRM melhorou a QVRS dos participantes.
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Koch CG, Khandwala F, Blackstone EH. Health-related quality of life after cardiac surgery. Semin Cardiothorac Vasc Anesth 2009; 12:203-17. [PMID: 18805855 DOI: 10.1177/1089253208323411] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Health-related quality of life (HRQOL) assessments are designed to reflect a patient's perspective of how a disease has affected their overall health status. Patient-centered outcomes are of value both for risk assessment and as an outcome measure. Strategies for analyzing HRQOL data are inconsistent primarily because the data frequently do not meet underlying assumptions of traditional methods for statistical analyses and require a careful analytic approach.
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Health-related quality of life and subjective neurocognitive function three months after coronary artery bypass graft surgery. Heart Lung 2008; 37:161-72. [DOI: 10.1016/j.hrtlng.2007.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 05/31/2007] [Indexed: 11/22/2022]
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Supervised Moderate Intensity Exercise Improves Distance Walked at Hospital Discharge Following Coronary Artery Bypass Graft Surgery—A Randomised Controlled Trial. Heart Lung Circ 2008; 17:129-38. [DOI: 10.1016/j.hlc.2007.09.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 07/30/2007] [Accepted: 09/06/2007] [Indexed: 01/22/2023]
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