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Tye SK, Razali NS, Ahmad Shauqi SA, Azeman NA, Basran NF, Liew JHJ, Leong MC. Perception towards palliative care among patients with pulmonary hypertension in malaysia: a correlation with disease status. Cardiol Young 2024; 34:900-905. [PMID: 37965721 DOI: 10.1017/s1047951123003773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES This study aimed to describe the perception of Malaysian patients with pulmonary hypertension towards palliative care and their receptivity towards palliative care. METHODS This was a cross-sectional, single-centre study conducted via questionnaire. Patients aged 18 years old and above, who were diagnosed with non-curable pulmonary hypertension were recruited and given the assessment tool - perceptions of palliative care instrument electronically. The severity of pulmonary hypertension was measured using WHO class, N-terminal pro B-type natriuretic peptide and the 6-minute walking test distance. RESULTS A total of 84 patients [mean age: 35 ±11 years, female: 83.3%, median N-terminal pro B-type natriuretic peptide: 491 pg/ml (interquartile range: 155,1317.8), median 6-minute walking test distance: 420m (interquartile range: 368.5, 480m)] completed the questionnaires. Patients with a higher WHO functional class and negative feelings (r = 0.333, p = 0.004), and cognitive reaction to palliative care: hopeless (r = 0.340, p = 0.003), supported (r = 0.258, p = 0.028), disrupted (r = 0.262, p = 0.025), and perception of burden (r = 0.239, p = 0.041) are more receptive to palliative care. WHO class, N-terminal pro B-type natriuretic peptide, and 6-minute walking test distance were not associated with higher readiness for palliative care. In logistic regression analyses, patients with positive feelings (β = 2.240, p = < 0.05), and practical needs (β = 1.346, p = < 0.05), were more receptive to palliative care. CONCLUSIONS Disease severity did not directly influence patients' readiness for palliative care. Patients with a positive outlook were more receptive to palliative care.
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Affiliation(s)
- Sue Kiat Tye
- Counselling and Chaplaincy Department, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Norazlina Susila Razali
- Pulmonary Hypertension Unit, Patient Education Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | | | | | - Janet Huey Jing Liew
- Paediatric & Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Ming Chern Leong
- Paediatric & Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
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2
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Bay A, Lämås K, Berghammer M, Sandberg C, Johansson B. Enablers and barriers for being physically active: experiences from adults with congenital heart disease. Eur J Cardiovasc Nurs 2020; 20:276–284. [PMID: 33611356 DOI: 10.1177/1474515120963314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 08/27/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND In general, adults with congenital heart disease have reduced exercise capacity and many do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and to counteract acquired cardiovascular disease, therefore enablers and barriers for being physically active are important to identify. AIM To describe what adults with complex congenital heart diseases consider as physical activity, and what they experience as enablers and barriers for being physically active. METHODS A qualitative study using semi-structured interviews in which 14 adults with complex congenital heart disease (seven women) participated. The interviews were analysed using qualitative content analysis. RESULTS The analysis revealed four categories considered enablers and barriers - encouragement, energy level, approach and environment. The following is exemplified by the category encouragement as an enabler: if one had experienced support and encouragement to be physically active as a child, they were more positive to be physically active as an adult. In contrast, as a barrier, if the child lacked support and encouragement from others, they had never had the opportunity to learn to be physically active. CONCLUSION It is important for adults with congenital heart disease to have the opportunity to identify barriers and enablers for being physically active. They need knowledge about their own exercise capacity and need to feel safe that physical activity is not harmful. This knowledge can be used by healthcare professionals to promote, support and eliminate misconceptions about physical activity. Barriers can potentially be transformed into enablers through increased knowledge about attitudes and prerequisites.
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Affiliation(s)
- Annika Bay
- Department of Public Health and Clinical Medicine, Umeå University, Sweden.,Department of Nursing, Umeå University, Sweden
| | | | - Malin Berghammer
- Department of Health Science, University West, Sweden.,Department of Paediatrics, The Queen Silvia Children's Hospital, Sweden
| | - Camilla Sandberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
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3
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The emerging psychosocial profile of the adult congenital heart disease patient. Curr Opin Organ Transplant 2020; 25:506-512. [DOI: 10.1097/mot.0000000000000802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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4
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Moola FJ. Passive on the periphery: Exploring the experience of physical activity among children and youth with congenital heart disease using the draw-and-write technique. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2020.101662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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5
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Farr SL, Klewer SE, Nembhard WN, Alter C, Downing KF, Andrews JG, Collins RT, Glidewell J, Benavides A, Goudie A, Riehle-Colarusso T, Overman L, Riser AP, Oster ME. Rationale and design of CH STRONG: Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG. Am Heart J 2020; 221:106-113. [PMID: 31986287 DOI: 10.1016/j.ahj.2019.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
Studies of outcomes among adults with congenital heart defects (CHDs) have focused on those receiving cardiac care, limiting generalizability. The Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) will assess comorbidities, health care utilization, quality of life, and social and educational outcomes from a US population-based sample of young adults living with CHD. METHODS Individuals with CHD born between 1980 and 1997 were identified using active, population-based birth defects surveillance systems from 3 US locations (Arkansas [AR]; Arizona [AZ]; and Atlanta, Georgia [GA]) linked to death records. Individuals with current contact information responded to mailed survey materials during 2016 to 2019. Respondents and nonrespondents were compared using χ2 tests. RESULTS Sites obtained contact information for 74.6% of the 9,312 eligible individuals alive at recruitment. Of those, 1,656 returned surveys, either online (18.1%) or via paper (81.9%), for a response rate of 23.9% (AR: 18.3%; AZ: 30.7%; Atlanta, GA: 28.0%; P value < .01). For 20.0% of respondents, a proxy completed the survey, with 63.9% reporting that the individual with CHD was mentally unable. Among respondents and nonrespondents, respectively, sex (female: 54.0% and 47.3%), maternal race/ethnicity (non-Hispanic white: 74.3% and 63.0%), CHD severity (severe: 33.8% and 27.9%), and noncardiac congenital anomalies (34.8% and 38.9%) differed significantly (P value < .01); birth year (1991-1997: 56.0% and 57.5%) and presence of Down syndrome (9.2% and 8.9%) did not differ. CONCLUSIONS CH STRONG will provide the first multisite, population-based findings on long-term outcomes among the growing population of US adults with CHD.
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Svensson MK, Wahlberg A, Gislason GH. Chronic Paradoxes: A Systematic Review of Qualitative Family Perspectives on Living With Congenital Heart Defects. QUALITATIVE HEALTH RESEARCH 2020; 30:119-132. [PMID: 31526075 DOI: 10.1177/1049732319869909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There have been substantial advances in the diagnostics and treatment of congenital heart defects (CHDs) in recent decades, and this has improved survival significantly. Consequently, there is a growing interest in how CHDs affect the daily lives of children and youth. We examine life with CHDs as a particular kind of living from the perspectives of both children and youth with CHDs and their families through a systematic review of existing qualitative research. Based on a meta-ethnographic analysis of 20 articles (identified through PubMed, EMBASE, EBSCOhost, PSYCHinfo, Scopus, and Web of Science from January 7 to 12, 2016), we argue that living with CHDs is characterized by chronic paradoxes arising out of the transitions, normalities, and futures that families have to navigate.
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Affiliation(s)
- Marie Kofod Svensson
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Ayo Wahlberg
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar H Gislason
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
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Neurocognition in Adult Congenital Heart Disease: How to Monitor and Prevent Progressive Decline. Can J Cardiol 2019; 35:1675-1685. [DOI: 10.1016/j.cjca.2019.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022] Open
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8
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Nursing Care for Patients with Congenital Heart Disease During Follow-Up: Transfer and Transition. CONGENIT HEART DIS 2019. [DOI: 10.1007/978-3-319-78423-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Keir M, Bailey B, Lee A, Kovacs AH, Lucy Roche S. Narrative analysis of adults with complex congenital heart disease: Childhood experiences and their lifelong reverberations. CONGENIT HEART DIS 2018; 13:740-747. [PMID: 30047244 DOI: 10.1111/chd.12647] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/14/2018] [Accepted: 06/10/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND With access to surgical care, >90% of today's infants with congenital heart disease (CHD) will reach adulthood. During childhood, survivors accrue a wealth of health care experience and develop strategies for navigating life with a chronic disease. METHODS Seeking to learn from this individualized process, we invited adults with complex CHD to participate in narrative analysis-an established qualitative research method for studying how individuals derive meaning from their personal stories. Audio recordings of 2-4 hour free-form interviews were transcribed and iteratively analyzed to identify common themes and detect similarities or differences in language, viewpoint and interpretation. Recruitment continued until saturation was reached (n = 10). RESULTS While each narrative was unique, CHD had a pervasive effect on the autobiography of all participants. Seven themes were discussed consistently: (1) parental/sibling relationships, (2) physical limitations, (3) embarrassment/denial, (4) memories of pediatric health care, (5) transition to adult care, (6) education and career choices, and (7) relationship and reproductive choices. While some of the recalled experiences were negative, all participants also spoke positively about the effect of CHD on their lives. CONCLUSIONS Adults with CHD provide the voices of expert witnesses; illuminating how the pediatric journey influences their identity, choices, personal relationships and adult health care interactions. These narratives could inform and improve the contemporary care of children with heart disease.
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Affiliation(s)
- Michelle Keir
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Bailey
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Angela Lee
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Adrienne H Kovacs
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada.,Knight Cardiovascular Institute, Oregon Heath & Science University, Portland, Orgeon, USA
| | - S Lucy Roche
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
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10
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Bay A, Lämås K, Berghammer M, Sandberg C, Johansson B. It’s like balancing on a slackline-A description of how adults with congenital heart disease describe themselves in relation to physical activity. J Clin Nurs 2018; 27:3131-3138. [DOI: 10.1111/jocn.14507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Annika Bay
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
- Department of Nursing; Umeå University; Umeå Sweden
| | | | - Malin Berghammer
- Department of Health Science; University West; Trollhättan Sweden
- Department of Pediatrics; The Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Camilla Sandberg
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy; Umeå University; Umeå Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
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11
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Callus E, Pravettoni G. The Role of Clinical Psychology and Peer to Peer Support in the Management of Chronic Medical Conditions - A Practical Example With Adults With Congenital Heart Disease. Front Psychol 2018; 9:731. [PMID: 29899714 PMCID: PMC5989349 DOI: 10.3389/fpsyg.2018.00731] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 04/26/2018] [Indexed: 01/23/2023] Open
Abstract
Clinical psychology services and peer to peer support can both contribute in increasing the psychological wellbeing of patients with chronic medical conditions. In this perspective paper, indications are given about the provision these services for the specific case of adults with congenital heart disease. These patients are at an increased risk of psychological distress, neurocognitive deficits, and social challenges. The psychosocial characteristics and mental health treatment preferences of these patients are briefly described, followed by guidelines and indications for the implementation of clinical psychology services. The most structured peer to peer program available for this population is subsequently illustrated and finally, specific benefits and challenges when it comes to the integration of both services are reported.
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Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia s.r.l., Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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12
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Nakamura M, Kita S, Kikuchi R, Hirata Y, Shindo T, Shimizu N, Inuzuka R, Oka A, Kamibeppu K. A Qualitative Assessment of Adolescent Girls' Perception of Living with Congenital Heart Disease: Focusing on Future Pregnancies and Childbirth. J Pediatr Nurs 2018; 38:e12-e18. [PMID: 29153935 DOI: 10.1016/j.pedn.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Congenital heart disease (CHD) is the most common birth anomaly in Japan, occurring in approximately 10.6 of every 1,000 live births. Advancements in medical and surgical care have increased births by women diagnosed with CHD. The study's purpose was to examine the perceptions of pregnancy and childbirth among adolescent girls with CHD. DESIGN AND METHODS Twelve semi-structured interviews were conducted, and the data were analyzed using a modified grounded-theory approach. RESULTS Three categories and 16 subcategories were extracted. Adolescent girls with CHD reported feelings of distress and anxiety while struggling with their disease, and feared how their disease might negatively influence their future pregnancy. These concerns were related to a desire to become familiar with CHD. The girls also explored how their disease would be managed during pregnancy and childbirth. Overall, these perceptions were influenced by the girls' acceptance of their disease, and support from family, friends, and healthcare professionals. CONCLUSIONS Healthcare professionals might assess adolescent girls' awareness of their disease before discussing pregnancy and childbirth risks. To encourage them to understand and cope with their disease, healthcare professionals might provide interventions tailored to the timing, stage, and degree of pregnancy and childbirth awareness. This could allow safer life planning, especially concerning pregnancy and childbirth decisions. PRACTICE IMPLICATIONS To address adolescent girls' needs, healthcare professionals should continuously assess their awareness of pregnancy and childbirth as well as their psychological status, alongside CHD issues.
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Affiliation(s)
- Mayumi Nakamura
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan.
| | - Sachiko Kita
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan.
| | - Ryota Kikuchi
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan.
| | | | | | | | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo, Japan.
| | - Akira Oka
- Department of Pediatrics, The University of Tokyo, Japan.
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan.
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Abstract
Advancements in medical and surgical treatment have increased the life expectancy of patients with CHD. Many patients with CHD, however, struggle with the medical, psychosocial, and behavioural challenges as they transition from childhood to adulthood. Specifically, the environmental and lifestyle challenges in school are very important factors that affect children and adolescents with CHD. This study aimed to evaluate school-related adjustments depending on school level and disclosure of disease in children and adolescents with CHD. This was a descriptive and exploratory study with 205 children and adolescents, aged 7-18 years, who were recruited from two congenital heart clinics from 5 January to 27 February, 2015. Data were analysed using the Student's t-test, analysis of variance, and a univariate general linear model. School-related adjustment scores were significantly different according to school level and disclosure of disease (p<0.001) when age, religion, experience being bullied, and parents' educational levels were assigned as covariates. The school-related adjustment score of patients who did not disclose their disease dropped significantly in high school. This indicated that it is important for healthcare providers to plan developmentally appropriate educational transition programmes for middle-school students with CHD in order for students to prepare themselves before entering high school.
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Gallagher R, Potter E, Thomson Mangnall L, Ladak L, Gallagher P, Neubeck L. The power in being together for young adults who have heart disease - the photoshoot experience. Heart Lung 2017; 46:199-204. [PMID: 28366291 DOI: 10.1016/j.hrtlng.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The study aimed to determine perceived motivations and benefits of photoshoot participation for young adults who have heart disease. BACKGROUND Feeling isolated and different can have lifelong affects on quality of life in heart disease survivors. Photoshoots, where people create a photographic image of themselves, promote positive interpretation of their cardiac illness experience, but participant experiences remain under-investigated. METHODS Young adult heart disease support group members completing a photoshoot were interviewed and data were thematically analyzed. RESULTS Seven females and one male aged 20-47 years participated. The main theme, People Like Me, emphasized feelings of being different, isolated and uncertain due to the heart disease. Other themes related to support gained from people who were not like them, gaining and providing support to their peers. The photoshoot enabled a highly valued collective feeling. CONCLUSIONS For young adult heart disease survivors, the photoshoot provides a fun, social opportunity to reduce isolation and share experiences.
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Affiliation(s)
- Robyn Gallagher
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Rm 2210, Lvl 2, Bld 17, Camperdown, NSW 2007, Australia; Faculty of Health, University of Technology, Sydney, 15 Broadway, Ultimo, NSW 2007, Australia.
| | - Ellen Potter
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Rm 2210, Lvl 2, Bld 17, Camperdown, NSW 2007, Australia
| | - Linda Thomson Mangnall
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Rm 2210, Lvl 2, Bld 17, Camperdown, NSW 2007, Australia; Cardiac Telemetry Unit, Sydney Adventist Hospital, 185 Fox Valley Rd Wahroonga, NSW 2076, Australia
| | - Laila Ladak
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Rm 2210, Lvl 2, Bld 17, Camperdown, NSW 2007, Australia
| | | | - Lis Neubeck
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Rm 2210, Lvl 2, Bld 17, Camperdown, NSW 2007, Australia; The George Institute of Global Health, Lvl 3, 50 Bridge St, Sydney, NSW 2000, Australia
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Types of social supports predicting health-related quality of life among adult patients with CHD in the Institut Jantung Negara (National Heart Institute), Malaysia. Cardiol Young 2017; 27:46-54. [PMID: 26911553 DOI: 10.1017/s1047951116000068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The objectives of this study were to examine which types of social supports - emotional/informational support, tangible support, affectionate support, and positive interactions - are the predictors of health-related quality of life (HRQoL) in adult patients with CHD and to assess the influence of demographic variables and clinical factors on these variables. METHODS In total, 205 adult patients with CHD from the National Heart Institute, Malaysia, were recruited. Patients were first screened by cardiology consultants to ensure they fit the inclusion criteria before filling in questionnaires, which were medical outcome studies - social support survey and AQoL-8D. Results/conclusions All social supports and their subscales were found to have mild-to-moderate significant relationships with physical dimension, psychological dimension, and overall HRQoL; however, only positive interaction, marital status, and types of diagnosis were reported as predictors of HRQoL. Surprisingly, with regard to the physical dimension of quality of life, social supports were not significant predictors, but educational level, marital status, and types of diagnosis were significant predictors. Positive interaction, affectionate support, marital status, and types of diagnosis were again found to be predictors in the aspects of the psychological dimension of quality of life. In conclusion, positive interaction and affectionate support, which include elements of fun, relaxation, love, and care, should be included in the care of adult patients with CHD.
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Klindtworth K, Oster P, Hager K, Krause O, Bleidorn J, Schneider N. Living with and dying from advanced heart failure: understanding the needs of older patients at the end of life. BMC Geriatr 2015; 15:125. [PMID: 26470713 PMCID: PMC4608315 DOI: 10.1186/s12877-015-0124-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 10/09/2015] [Indexed: 12/05/2022] Open
Abstract
Background Heart failure (HF) is a life-limiting illness and patients with advanced heart failure often suffer from severe physical and psychosocial symptoms. Particularly in older patients, HF often occurs in conjunction with other chronic diseases, resulting in complex co-morbidity. This study aims to understand how old and very old patients with advanced HF perceive their disease and to identify their medical, psychosocial and information needs, focusing on the last phase of life. Methods Qualitative longitudinal interview study with old and very old patients (≥70 years) with severe HF (NYHA III-IV). Interviews were conducted at three-month intervals over a period of up to 18 months and were analysed using qualitative methods in relation to Grounded Theory. Results A total of 95 qualitative interviews with 25 patients were conducted and analysed. The following key categories were developed: (1a) dealing with advanced heart failure and ageing, (1b) dealing with end of life; (2a) perceptions regarding care, and (2b) interpersonal relations. Overall, our data show that older patients do not experience HF as a life-limiting disease. Functional restrictions and changed conditions leading to problems in daily life activities were often their prime concerns. The needs and priorities of older HF patients vary depending on their disease status and individual preferences. Pain resulting in reduced quality of life is an example of a major symptom requiring treatment. Many older HF patients lack sufficient knowledge about their condition and its prognosis, particularly concerning emergency situations and end of life issues, and many expressed a wish for open discussions. From the patients’ perspective, there is a need for improvement in interaction with health care professionals, and limits in treatment and medical care are not openly discussed. Conclusion Old and very old patients with advanced HF often do not acknowledge the seriousness and severity of the disease. Their communication with physicians predominantly focuses on curative treatment. Therefore, aspects such as self-management of the disease, dealing with emergency situations and end-of-life issues should be addressed more prominently. An advanced care planning (ACP) programme for heart disease in older people could be an option to improve patient-centred care.
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Affiliation(s)
- Katharina Klindtworth
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
| | - Peter Oster
- AGAPLESION Bethanien Hospital, Geriatric Centre at the University, Heidelberg, Germany.
| | - Klaus Hager
- Diakoniekrankenhaus Henriettenstiftung, Centre for Geriatrics, Hannover, Germany.
| | - Olaf Krause
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany. .,Diakoniekrankenhaus Henriettenstiftung, Centre for Geriatrics, Hannover, Germany.
| | - Jutta Bleidorn
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
| | - Nils Schneider
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
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Berghammer MC, Brink E, Rydberg AM, Dellborg M, Ekman I. Committed to Life: Adolescents' and Young Adults' Experiences of Living with Fontan Circulation. CONGENIT HEART DIS 2015; 10:403-12. [PMID: 25564938 DOI: 10.1111/chd.12244] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Malin C. Berghammer
- Institute of Medicine; Sahlgrenska Academy; Gothenburg Sweden
- Institute of Caring, Health and Culture; University West; Trollhättan Sweden
- Centre for Person-Centred Care; University of Gothenburg; Gothenburg Sweden
| | - Eva Brink
- Institute of Caring, Health and Culture; University West; Trollhättan Sweden
- Centre for Person-Centred Care; University of Gothenburg; Gothenburg Sweden
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Annika M. Rydberg
- Department of Clinical Sciences; Pediatrics; University of Umeå; Umeå Sweden
| | - Mikael Dellborg
- Institute of Medicine; Sahlgrenska Academy; Gothenburg Sweden
- Adult Congenital Heart Unit; Sahlgrenska University Hospital/Östra; Gothenburg Sweden
| | - Inger Ekman
- Centre for Person-Centred Care; University of Gothenburg; Gothenburg Sweden
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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18
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Chiang YT, Chen CW, Su WJ, Wang JK, Lu CW, Li YF, Moons P. Between invisible defects and visible impact: the life experiences of adolescents and young adults with congenital heart disease. J Adv Nurs 2014; 71:599-608. [PMID: 25296699 DOI: 10.1111/jan.12546] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2014] [Indexed: 12/01/2022]
Abstract
AIM To describe the life experiences of adolescents and young adults with congenital heart disease. BACKGROUND Owing to medical advances, most children with congenital heart disease are expected to survive into adulthood. The transitional development from adolescence to adult is the critical period for fostering self-care. DESIGN Descriptive phenomenological study. METHODS Thirty-five patients of 15-24 years old with congenital heart disease were recruited from paediatric cardiology clinics by purposive sampling. They were individually interviewed between October 2012-February 2013 using a semi-structured interview guideline and joined adult congenital heart disease clinics at two medical centres in northern Taiwan. The data were analysed using descriptive phenomenological method developed by Giorgi. FINDINGS The essence of the life experience of adolescents and young adults with congenital heart disease involves a dynamic process of moving between invisible defects and coexistence with the disease. Six themes emerged: (1) invisible defects: the existence of imperfect understanding; (2) conflict: interpersonal frustrations; (3) imbalance: the loss of self-balance; (4) suffering: increasing anxiety; (5) encounters: meeting needs; and (6) coexistence: positive coping strategies. CONCLUSION As patients with congenital heart disease transition from adolescence into adulthood, they must learn about their disease, overcome frustration and anxiety and develop self-care strategies for coexisting with congenital heart disease. Results of this study may serve as clinical care guidelines for adolescents and young adults with congenital heart disease and give a reference for developing transitional intervention strategies.
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Affiliation(s)
- Yueh-Tao Chiang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
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Sluman MA, de Man S, Mulder BJM, Sluiter JK. Occupational challenges of young adult patients with congenital heart disease. Neth Heart J 2014; 22:216-24. [PMID: 24563394 PMCID: PMC4016332 DOI: 10.1007/s12471-014-0540-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Despite improved survival of adults with congenital heart disease (CHD), higher rates of unemployment and work-related problems are seen, especially among younger adults. This study was performed to gain insight into current barriers and facilitating experiences at work among young adult patients with CHD. Methods This qualitative study consisted of semi-structured face-to-face interviews, based on a self-constructed model from several existing models, which were held among outpatients with CHD from a large tertiary referral centre. Verbatim transcribed audio-taped data were analysed using a directed model-based content analysis approach. Results Fifteen patients had been interviewed when data saturation was reached. Work was important for all participants. Several barriers and facilitating factors were identified. Barriers were mostly on physical aspects and lack of opportunities for recovery. Important facilitating factors were good relationships with colleagues and employer and having sufficient opportunities for recovery. Most of these factors are also seen among patients with other chronic diseases, but with a different priority. Conclusion This is the first study that has identified qualitative factors at work of young adult CHD patients. Work is important to them. Challenges are dealing with the physical barriers and getting enough support from colleagues. Specific coaching or a tailored group intervention could thereby be helpful. Future research should aim at the aetiology of problems and identifying patients who would benefit most from specific coaching.
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Affiliation(s)
- M. A. Sluman
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
- Department of Cardiology, Academic Medical Center, Room B2-215, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - S. de Man
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, the Netherlands
| | - B. J. M. Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
- Department of Cardiology, Academic Medical Center, Room B2-240, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - J. K. Sluiter
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, the Netherlands
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Callus E, Quadri E, Ricci C, Passerini C, Tovo A, Pelissero G, Chessa M. Update on psychological functioning in adults with congenital heart disease: a systematic review. Expert Rev Cardiovasc Ther 2014; 11:785-91. [DOI: 10.1586/erc.13.9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kovacs AH, McCrindle BW. So hard to say goodbye: transition from paediatric to adult cardiology care. Nat Rev Cardiol 2013; 11:51-62. [DOI: 10.1038/nrcardio.2013.172] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bulkley J, McMullen CK, Hornbrook MC, Grant M, Altschuler A, Wendel CS, Krouse RS. Spiritual well-being in long-term colorectal cancer survivors with ostomies. Psychooncology 2013; 22:2513-21. [PMID: 23749460 DOI: 10.1002/pon.3318] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/24/2013] [Accepted: 05/03/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Spiritual well-being (SpWB) is integral to health-related quality of life. The challenges of colorectal cancer (CRC) and subsequent bodily changes can affect SpWB. We analyzed the SpWB of CRC survivors with ostomies. METHODS Two-hundred-eighty-three long-term (≥ 5 years) CRC survivors with permanent ostomies completed the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O) questionnaire. An open-ended question elicited respondents' greatest challenge in living with an ostomy. We used content analysis to identify SpWB responses and develop themes. We analyzed responses on the three-item SpWB sub-scale. RESULTS Open-ended responses from 52% of participants contained SpWB content. Fifteen unique SpWB themes were identified. Sixty percent of individuals expressed positive themes such as "positive attitude", "I am fortunate", "appreciate life more", and "strength through religious faith". Negative themes, expressed by only 29% of respondents, included "struggling to cope", "not feeling 'normal' ", and "loss". Fifty-five percent of respondents expressed ambivalent themes including "learning acceptance", "an ostomy is the price for survival", "reason to be around despite suffering", and "continuing to cope despite challenges". The majority (64%) had a high SpWB sub-scale score. CONCLUSIONS Although CRC survivors with ostomies infrequently mentioned negative SpWB themes as a major challenge, ambivalent themes were common. SpWB themes were often mentioned as a source of resilience or part of the struggle to adapt to an altered body after cancer surgery. Interventions to improve the quality of life of cancer survivors should contain program elements designed to address SpWB that support personal meaning, inner peace, inter connectedness, and belonging.
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Affiliation(s)
- Joanna Bulkley
- The Center for Health Research, Northwest/Hawaii/Southeast, Kaiser Permanente Northwest, Portland, OR, USA
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Lee S, Kim SS. The life experiences of Korean children and adolescents with complex congenital heart disease: a qualitative study. Nurs Health Sci 2013; 14:398-404. [PMID: 22950619 DOI: 10.1111/j.1442-2018.2012.00709.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This exploratory study analyzed the life experiences of Korean children and adolescents with complex congenital heart disease in a sociocultural context and undertook in-depth interviews. Participants were 10 patients who ranged in age from 14 to 22 years, who were recruited at a hospital in Seoul, Korea. Our content analysis showed that the participants were initially unaware of the true nature of their conditions. After entering school, they realized that they were different from peers because of their physical limitations and their parents' overprotectiveness. Generally, health providers tend to convey information about congenital heart disease to parents, and not the patients. Therefore, most of our participants lacked knowledge about their disease and its management, and tended to have feelings of isolation and guilt. Healthcare providers of children and adolescents should provide disease and management information not only to parents, but also to patients, and should set aside specific times for communication with patients with complex congenital heart disease.
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Affiliation(s)
- Sunhee Lee
- College of Nursing, the Catholic University, Seocho-gu, Korea
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Tobler D, Greutmann M, Colman JM, Greutmann-Yantiri M, Librach LS, Kovacs AH. End-of-life in adults with congenital heart disease: A call for early communication. Int J Cardiol 2012; 155:383-7. [PMID: 21094550 DOI: 10.1016/j.ijcard.2010.10.050] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/22/2010] [Accepted: 10/23/2010] [Indexed: 10/18/2022]
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Self-reported health status (EQ-5D) in adults with congenital heart disease. Int J Cardiol 2011; 165:537-43. [PMID: 22051437 DOI: 10.1016/j.ijcard.2011.10.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 09/08/2011] [Accepted: 10/09/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE Today, more patients with congenital heart disease (CHD) reach adulthood. There are conflicting findings concerning the relationship between quality of life (QoL) or health state for adults with CHD and the complexity of their CHD. The aim of the study was, firstly, to compare the reported health status and health perception of adult patients with CHD and, secondly, to investigate what variables influenced the patients' health status and health perception. METHODS Data from 1435 patients completing the EQ-5D questionnaire, which includes reported health status and health perception, were analyzed. RESULTS Valid EQ-5D data were reported by 1274 patients, showing overall results indicating a good health status. Problems were most frequently reported in the dimension "pain/discomfort" (31.9%) and "anxiety/depression" (29.8%). Higher occurrence of problems were reported by patients with complex disease i.e. single ventricle (p<0.001) and by female patients (p<0.0001). Symptomatic patients reported a lower health status (p<0.0001) and a lower perceived health on EQ-VAS (p<0.0001). Of the asymptomatic patients, 20.5% nevertheless reported problems in "pain/discomfort" and 22.2% in the "anxiety/depression" dimension. CONCLUSION The health status of adults with CHD is influenced by symptoms, NYHA-classification, age and gender. Adults with CHD report a lower occurrence of problems in comparison to previously published results from a general population, but the importance of actively asking about the patient's experience is demonstrated by the high degree of asymptomatic patients reporting problems on EQ-5D.
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Dahan-Oliel N, Majnemer A, Mazer B. Quality of life of adolescents and young adults born at high risk. Phys Occup Ther Pediatr 2011; 31:362-89. [PMID: 21599571 DOI: 10.3109/01942638.2011.572151] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Research on quality of life (QoL) of adolescents and young adults born preterm and those with congenital heart disease (CHD) was systematically reviewed, and factors associated with QoL were identified. Forty-five studies met the inclusion criteria for review. Although the majority of studies found that self-reported QoL of adolescents and young adults born preterm did not differ from term controls, several studies reported lower QoL among individuals born preterm, especially those who had additional impairments. Most studies on adolescents and young adults with CHD reported lower QoL compared with healthy peers, which may be in part due to real or perceived physical activity limitations of individuals with CHD. Overall, parents reported that their adolescents born at high risk had a less favorable QoL compared with those who served as controls. Encouraging age-appropriate, safe, and enjoyable physical activity and avoiding unnecessary restrictions and overprotection are considerations for optimizing QoL.
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Affiliation(s)
- Noémi Dahan-Oliel
- School of Physical and Occupational Therapy, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada.
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Lee S, Kim SS. [The life of adolescent patients with complex congenital heart disease]. J Korean Acad Nurs 2010; 40:411-22. [PMID: 20634632 DOI: 10.4040/jkan.2010.40.3.411] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE In the present study, an analysis of the life of adolescents with complex congenital heart disease (CHD) was done using grounded theory. Consideration was given to the socio-cultural context of Korea. METHODS After approval from the institutional review board of Y hospital, 12 patients ranging in age from 14 to 35 were recruited. Data were gathered using in-depth interviews. Theoretical sampling was performed until the concepts were saturated. RESULTS The results confirmed the life of adolescents with complex CHD as a 'journey to finding uniqueness of oneself as a person with CHD'. The life consisted of 3 stages. In the crisis stage, participants had a feeling of threat to self-existence, and made an effort to be the same as others. In the self-recognition stage, participants who had sufficient role-performance built self-esteem while those who did not fell into self-accusation. In the self-establishment stage, participants who reached sufficiency in independence and knowledge planned the future, whereas those who did not conformed to the realities of life. CONCLUSION The results of present study provide help in understanding the experiences of adolescents with CHD and provide a basis for developing nursing intervention strategies for these patients.
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Affiliation(s)
- Sunhee Lee
- College of Nursing, Eulji University, Seongnam, Korea
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Callus E, Quadri E, Chessa M. Elements of psychocardiology in the psychosocial handling of adults with congenital heart disease. Front Psychol 2010; 1:34. [PMID: 21833204 PMCID: PMC3153753 DOI: 10.3389/fpsyg.2010.00034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 06/30/2010] [Indexed: 11/17/2022] Open
Abstract
When it comes to the role of the clinical psychology in the cardiac settings, or psychocardiology, there is often a focus on acquired cardiac illnesses in the rehabilitation settings. However, the increase of adults with congenital heart disease due to technological advances in cardiology and cardiac surgery have created a new emergency. It is thus necessary to reflect upon the elements of psychocardiology adapting them to this new population, also when it comes to interventional hospital settings of cardiology and cardiac surgery. This perspective article is an effort in this direction.
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Affiliation(s)
- Edward Callus
- Department of Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS Policlinico San Donato San Donato Milanese, Italy
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Eriksson M, Asplund K, Svedlund M. Patients' and Their Partners' Experiences of Returning Home after Hospital Discharge Following Acute Myocardial Infarction. Eur J Cardiovasc Nurs 2009; 8:267-73. [DOI: 10.1016/j.ejcnurse.2009.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 02/13/2009] [Accepted: 03/30/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Monica Eriksson
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Kenneth Asplund
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Marianne Svedlund
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
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Uehara M, Funabashi N, Yasukawa K, Terai M, Komuro I. Coarctation of the descending aorta, patent ductus arteriosus, deficiency of right superior vena cava, and persistent left superior vena cava in a five-month infant demonstrated by multislice computed tomography. Int J Cardiol 2007; 122:61-3. [PMID: 17156869 DOI: 10.1016/j.ijcard.2006.08.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Accepted: 08/12/2006] [Indexed: 11/23/2022]
Abstract
A 5-month-old female presented in our hospital with cyanosis, peripheral psychroesthesia, and significantly lower blood pressure of lower limbs compared with the upper limbs; suggesting aortic coarctation. The presence of patent ductus arteriosus (PDA) and persistent left superior vena cava (PLSVC) was suspected by echocardiogram. Before surgery, we performed multislice computed tomography to determine the spatial relationship between the site of aortic coarctation, PDA, and PLSVC. Although contrast material was injected from the right cubital vein, PLSVC was exclusively enhanced; therefore, deficiency of right superior vena cava was diagnosed. Coarctation of the DAo was observed in the right posterior direction of PLSVC and PDA was observed just distal to the coarctation site of the DAo and located at the right posterior direction of PLSVC. Therefore, the spatial relationship of PLSVC, coarctation of DAo and PDA could be evaluated and a direct anastomosis of the DAo and ligation of PDA were performed.
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