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Zimmerman L, Pozehl B, Vuckovic K, Barnason S, Schulz P, Seo Y, Ryan CJ, Zerwic JJ, DeVon HA. Selecting symptom instruments for cardiovascular populations. Heart Lung 2016; 45:475-496. [PMID: 27686695 DOI: 10.1016/j.hrtlng.2016.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/24/2016] [Accepted: 08/31/2016] [Indexed: 01/11/2023]
Abstract
The purpose of this review is to provide a guide for researchers and clinicians in selecting an instrument to measure four commonly occurring symptoms (dyspnea, chest pain, palpitations, and fatigue) in cardiac populations (acute coronary syndrome, heart failure, arrhythmia/atrial fibrillation, and angina, or patients undergoing cardiac interventions). An integrative review of the literature was conducted. A total of 102 studies summarizing information on 36 different instruments are reported in this integrative review. The majority of the instruments measured multiple symptoms and were used for one population. A majority of the symptom measures were disease-specific and were multi-dimensional. This review summarizes the psychometrics and defining characteristics of instruments to measure the four commonly occurring symptoms in cardiac populations. Simple, psychometrically strong instruments do exist and should be considered for use; however, there is less evidence of responsiveness to change over time for the majority of instruments.
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Affiliation(s)
- Lani Zimmerman
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA.
| | - Bunny Pozehl
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Karen Vuckovic
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Susan Barnason
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Paula Schulz
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Yaewon Seo
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Catherine J Ryan
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Julie J Zerwic
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Holli A DeVon
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
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Al-Daakak ZM, Ammouri AA, Isac C, Gharaibeh H, Al-Zaru I. Symptom management strategies of Jordanian patients following coronary artery bypass grafting surgery. Int J Nurs Pract 2016; 22:375-83. [PMID: 27241589 DOI: 10.1111/ijn.12445] [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: 06/25/2015] [Revised: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 11/30/2022]
Abstract
The aim of this study was to explore the symptom management strategies utilized by post coronary artery bypass graft (CABG) patients and its associations with demographic variables. A clear understanding of the use of symptom management strategies following CABG surgery may help nurses in developing educational program and interventions that help patients and their families during recovery period after discharge. A cross-sectional, descriptive design was utilized. A convenience sample of 100 Jordanian patients post CABG surgery selected from five hospitals was surveyed between November 2012 and June 2013 using the Cardiac Symptom Survey. Chi squared analyses were used to examine the associations between the symptoms management strategies and selected demographic variables. Frequency of symptom management strategies utilized by post CABG patients revealed that most frequently employed strategies were use of medications (79%), repositioning (54%) and the rest (45%). Symptom management strategies utilized for poor appetite, sleeping problem and fatigue had significant associations with demographic variables. By providing information about the symptoms expected after surgery and possible ways to manage them, will strengthen the patients psychologically and will make CABG experience within the realm of self-management and coping.
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Affiliation(s)
- Zaher Mohammed Al-Daakak
- Department of Emergency and public Safety, Ministry of Interior General Head Quarters, Abu Dhabi, United Arab Emirates
| | | | - Chandrani Isac
- College of Nursing, Sultan Qaboos University, Muscate, Oman
| | - Huda Gharaibeh
- College of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ibtisam Al-Zaru
- College of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Symptoms Experienced by Jordanian Men and Women After Coronary Artery Bypass Graft Surgery. Dimens Crit Care Nurs 2016; 35:125-32. [DOI: 10.1097/dcc.0000000000000175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Thomson P, Niven CA, Peck DF, Eaves J. Patients' and partners' health-related quality of life before and 4 months after coronary artery bypass grafting surgery. BMC Nurs 2013; 12:16. [PMID: 23829859 PMCID: PMC3744164 DOI: 10.1186/1472-6955-12-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 07/03/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients having coronary artery bypass grafting (CABG) often depend on their partners for assistance before and after surgery. Whilst patients' physical and mental health usually improves after surgery little is known about the partners' health-related quality of life (HRQoL) in CABG. If the partners' physical and emotional health is poor this can influence their caregiving role and ability to support the patient. This study aimed: to increase understanding of patients' and partners' HRQoL before and after CABG; to explore whether patients' and partners' pre-operative socio-demographics and HRQoL predict their own, and also partners' HRQoL 4 months after CABG. METHODS This prospective study recruited 84 dyads (patients 84% males, aged 64.5 years; partners 94% females, aged 61.05 years). Patients' and partners' perceived health status was assessed using the Short-Form 12 Health Survey. Patients' physical limitation, angina symptoms and treatment satisfaction were assessed using the Seattle Angina Questionnaire. Partners' emotional, physical and social functioning was assessed using the Quality of Life of Cardiac Spouses Questionnaire. Data were analysed using hierarchical multiple (logistic) regressions, repeated measures analysis of variance, paired t test and Chi square. RESULTS Patients most likely to have poorer physical health post-operatively were associated with partners who had poorer pre-operative physical health. Partners most likely to have poorer emotional, physical and social functioning post-operatively were associated with patients who had poorer pre-operative mental health. Patients" and partners' poorer post-operative HRQoL was also explained by their poorer pre-operative HRQoL. CONCLUSION The partners' involvement should be considered as part of patients' pre-operative assessment. Special attention needs be paid to patients' pre-operative mental health since it is likely to impact on their post-operative mental health and the partner's emotional, physical and social functioning.
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Affiliation(s)
- Patricia Thomson
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
| | - Catherine A Niven
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
| | - David F Peck
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
| | - Jennifer Eaves
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
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Sawatzky JAV, Christie S, Singal RK. Exploring outcomes of a nurse practitioner-managed cardiac surgery follow-up intervention: a randomized trial. J Adv Nurs 2013; 69:2076-87. [DOI: 10.1111/jan.12075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2012] [Indexed: 01/18/2023]
Affiliation(s)
- Jo-Ann V. Sawatzky
- Associate Dean & Faculty Development Coordinator - Graduate Programs; Faculty of Nursing; University of Manitoba; Winnipeg Canada
| | - Sandra Christie
- Cardiac Sciences Program; St. Boniface Hospital; Winnipeg Manitoba Canada
| | - Rohit K. Singal
- Cardiac Sciences Program; St. Boniface Hospital; Winnipeg Manitoba Canada
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Abstract
LEARNING OBJECTIVES After participating in this educational activity, the reader should be better able to measure the risk of depression before and after coronary artery bypass graft (CABG) surgery; examine the course of depression after CABG; and apply the results of the study to the treatment of patients. OBJECTIVE Depression is highly comorbid with coronary artery disease. Clinicians face the question of whether patients' depressive symptoms will improve after coronary artery bypass graft surgery (CABG). The objective of this meta-analysis is to determine the course of depressive symptoms after CABG. METHODS EMBASE, PubMed, and PsycINFO were searched for studies assessing depression before and after CABG. Meta-analyses were performed for depression at early (1-2 weeks), recovery (>2 weeks to 2 months), mid (>2 months to 6 months), and late (>6 months) postoperative time points. Heterogeneity and publication bias were analyzed. RESULTS Thirty-nine studies were included in the meta-analysis. Twelve reported dichotomous outcomes; 18 reported continuous outcomes; and 9 reported both. Risk of depression was increased early (relative risk [RR] = 1.27; 95% confidence interval [CI], 1.01-1.61). There was a significantly decreased risk of depression at recovery (RR = 0.78; 95% CI, 0.67-0.90), mid (RR = 0.64; 95% CI, 0.58-0.70), and late (RR = 0.68; 95% CI, 0.58-0.79) time points without heterogeneity. All studies reporting continuous depression scales had significant heterogeneity. CONCLUSIONS The risk of depression decreased post-CABG when depression was measured dichotomously. While depression improves overall and remits for some patients after CABG, the majority of patients will not experience remission of depression. Preoperative and postoperative depression monitoring is important.
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Patient recovery and transitions after hospitalization for acute cardiac events: an integrative review. J Cardiovasc Nurs 2012; 27:175-91. [PMID: 22210146 DOI: 10.1097/jcn.0b013e318239f5f5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite increased attention to providing seamless transitions after hospitalization, patients often feel unprepared, lack knowledge, and may be confused by what to expect during recovery at home after a cardiac event. Care transition after hospital discharge could be improved by informing and counseling patients more specifically about expected recovery after a cardiac event. Therefore, an integrative review of research was conducted to evaluate cardiac patients' trajectory of recovery after hospitalization. A total of 61 studies were included in this review. Studies included were those of cardiac patients who had been hospitalized for significant cardiac events and those focused on acute coronary syndrome (n = 18), percutaneous coronary intervention (PCI) (n = 12), cardiac surgery (coronary artery bypass surgery and valve surgery; n = 25), and heart failure (n = 6). Studies included quantitative, mixed-methods, and qualitative designs, with sample sizes ranging from 4 to 2121 participants. Notwithstanding the limitations of this review, findings demonstrated that patients' perceptions of their cardiac event evolved over time from uncertainty, fears, anxiety, and depression, which were often associated with a lack of knowledge of their cardiac condition, to a phase of self-management of their cardiac condition. Furthermore, patterns of commonly occurring symptoms and changes in functioning abilities during recovery after hospitalization were apparent among the different cardiac groups. These findings may be useful to both patients and clinicians to inform them about the recovery trajectory after a cardiac event to improve preparation for the transition from hospital to home.
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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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Kendel F, Dunkel A, Müller-Tasch T, Steinberg K, Lehmkuhl E, Hetzer R, Regitz-Zagrosek V. Gender differences in health-related quality of life after coronary bypass surgery: results from a 1-year follow-up in propensity-matched men and women. Psychosom Med 2011; 73:280-5. [PMID: 21364199 DOI: 10.1097/psy.0b013e3182114d35] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether the predictive value of gender for health-related quality of life (HRQoL) is independent of clinical health status and depression. Women undergoing coronary bypass surgery generally report a poorer HRQoL than men. METHODS A total of 990 (20% women) patients completed study questionnaires 1 day before coronary bypass surgery and 1 year after surgery. Physical aspects of HRQoL were assessed with the Short Form 36 Health Survey. Depression was measured with the self-reported Patient Health Questionnaire. Propensity score matching was applied to match men and women with respect to 65 clinical variables. Of 198 women, 157 (79.3%) could be matched to a partner, resulting in an excellent balance of clinical variables between the matched groups. RESULTS At baseline, propensity-matched men and women differed in physical functioning (p < .001) and role functioning (p = .007), but not in bodily pain and general health perception. In both men and women, HRQoL outcomes improved over 1 year. Preoperative depression predicted worse physical HRQoL in all outcomes, except general health perception 1 year after surgery. After adjusting for depression, gender lost its predictive power with respect to physical functioning. However, compared with women, men still reported a better role functioning. CONCLUSION Our data suggest that gender is a marker for role functioning, independent of the clinical health status and depression. Rehabilitation measures designed for the specific needs of women might help to improve their HRQoL.
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Affiliation(s)
- Friederike Kendel
- Institut für Medizinische Psychologie, Charité Centrum 1 für Human- und Gesundheitswissenschaften, Charité-Universitätsmedizin Berlin, Luisenstraße 57, 10117 Berlin, Germany.
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Murphy BM, Elliott PC, Worcester MUC, Higgins RO, Le Grande MR, Roberts SB, Goble AJ. Trajectories and predictors of anxiety and depression in women during the 12 months following an acute cardiac event. Br J Health Psychol 2010; 13:135-53. [PMID: 17535492 DOI: 10.1348/135910707x173312] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Many previous investigations of the recovery of emotional well-being, particularly the resolution of depression, following an acute cardiac event assume that all patients follow a similar, linear trajectory. However, it is possible that there are different groups of patients who follow different trajectories. This study tested for multiple trajectories of anxiety and depression and identified the characteristics of patients most at risk for persistent or worsening anxiety and depression in the 12 months following their cardiac event. METHOD A consecutive sample of 226 women was interviewed following either acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS). The Hospital Anxiety and Depression Scale were administered on four occasions over 12 months. Growth curve and growth mixture modelling were used to identify trajectories of change and univariate tests were employed to establish predictors of each trajectory. RESULTS Most women began with relatively low levels of anxiety and/or depression that improved over the 12 month period (84% women showed this trajectory for anxiety, 89% for depression). A smaller group began with relatively high levels of anxiety and/or depression that worsened over time (16% for anxiety, 11% for depression). Patients in the latter group were more likely to report high levels of loneliness, have a first language other than English, perceive their cardiac disease as more severe (anxiety group only) and have diabetes (depression group only). Trajectories were non-linear, with most change occurring in the initial 2-month period. CONCLUSION Growth modelling techniques highlight that change in anxiety and depression following an acute event follows neither a single nor linear trajectory. Most women showed early resolution of anxiety and depression following their event, indicative of a normal bereavement or adjustment response. A minority of women reported worsening anxiety and/or depression in the year following their cardiac event, particularly those who lacked social support or were from non-English speaking backgrounds. Intervention studies to explore support options for these women are warranted, both prior to and following their event.
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Elliott PC, Murphy BM, Oster KA, Le Grande MR, Higgins RO, Worcester MU. Changes in Mood States After Coronary Artery Bypass Graft Surgery. Eur J Cardiovasc Nurs 2010; 9:188-94. [DOI: 10.1016/j.ejcnurse.2009.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 10/29/2009] [Accepted: 11/15/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Peter C. Elliott
- Heart Research Centre, The University of Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
| | - Barbara M. Murphy
- Heart Research Centre, The University of Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
| | - Kerry A. Oster
- Heart Research Centre, The University of Melbourne, Australia
| | | | | | - Marian U.C. Worcester
- Heart Research Centre, The University of Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
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Gender comparison in depressive symptoms and use of antidepressant medications after acute coronary syndrome. Appl Nurs Res 2010; 23:73-9. [DOI: 10.1016/j.apnr.2008.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 04/01/2008] [Accepted: 04/27/2008] [Indexed: 11/23/2022]
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Fredericks S, Guruge S, Sidani S, Wan T. Patient Demographics and Learning Needs: Examination of Relationship. Clin Nurs Res 2009; 18:307-22. [DOI: 10.1177/1054773809341730] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Limited research has examined differences in patients’ learning needs in relation to demographic characteristics, such as age, gender, level of education, and culture. Yet such knowledge is essential to develop postoperative educational interventions that are tailored to patients’ needs. Study purpose: The purpose of this study was to examine the relationship between learning needs and the demographic characteristics of patients who have undergone coronary artery bypass graft (CABG) surgery. Method: A descriptive design was used.The sample of convenience included 38 patients who met eligibility criteria. Major results: Statistically significant relationships were found between the patients’ age, gender, and cultural background, and learning needs ( p < .05) and not between the learning needs and level of education. Application: These preliminary highlight the importance of attending to learning needs of patients with different backgrounds in order to improve self-management following CABG surgery.
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Affiliation(s)
- Suzanne Fredericks
- Daphne Cockwell School of Nursing, Ryerson University,Toronto,
Ontario, Canada,
| | - Sepali Guruge
- Daphne Cockwell School of Nursing, Ryerson University,Toronto,
Ontario, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University,Toronto,
Ontario, Canada
| | - Teresa Wan
- Daphne Cockwell School of Nursing, Ryerson University,Toronto,
Ontario, Canada
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Social support, depression, functional status, and gender differences in older adults undergoing first-time coronary artery bypass graft surgery. Heart Lung 2009; 38:306-17. [DOI: 10.1016/j.hrtlng.2008.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 10/15/2008] [Accepted: 10/17/2008] [Indexed: 11/24/2022]
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Barnason S, Zimmerman L, Nieveen J, Schulz P, Miller C, Hertzog M, Rasmussen D. Relationships between fatigue and early postoperative recovery outcomes over time in elderly patients undergoing coronary artery bypass graft surgery. Heart Lung 2008; 37:245-56. [PMID: 18620100 DOI: 10.1016/j.hrtlng.2007.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 09/04/2007] [Accepted: 09/06/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite successful coronary artery bypass graft (CABG) surgery, some patients continue to experience fatigue after their surgery. OBJECTIVE The purpose of this secondary analysis study was to examine the relationships of fatigue and early recovery outcomes (psychosocial and physiologic functioning, and physical activity) over time (6 weeks and 3 months) among older adult subjects, age 65 years and older, after CABG surgery. Comparison groups were those subjects who had fatigue at 3 weeks after surgery and nonfatigued subjects. DESIGN A prospective, comparative design was used for this secondary analysis study. SAMPLE Subjects in this study were drawn from the control group of subjects enrolled in the larger parent study. Subjects (N = 119) were dichotomized into fatigue (n = 66) and nonfatigued (n = 53) groups on the basis of their 3-week self-reports of postoperative fatigue. RESULTS At 6 weeks after surgery, fatigued subjects had significantly (P < .05) more impaired psychosocial functioning (role-emotional [t = 1.9], social [t = 2.6], and mental [t = 1.9] functioning) on the basis of the Medical Outcome Study Short Form 36. They had significantly (P < .005) higher mean hospital anxiety (t = -3.6) and depression (t = -2.9) subscale scores, respectively. Anxiety (t = -2.3, P < .05) remained significantly (P < .05) impaired at 3 months. At 6 weeks, role physical functioning, measured by the Medical Outcome Study Short Form 36, was significantly impaired (t = 2.4, P < .01). There were no significant differences in physical activity variables as measured by an RT3 accelerometer (Stayhealthy, Inc., Monrovia, CA) and self-report diary. CONCLUSIONS Persistent fatigue can hamper early recovery after CABG surgery. Tailored interventions are needed to address fatigue management and improve patient outcomes.
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Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center, College of Nursing-Lincoln Division, 1230 O Street, STE 131, PO Box 880220, Lincoln, NE 68588-0220, USA
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The role of sex in health-related quality of life after cardiac surgery: a prospective study. ACTA ACUST UNITED AC 2008; 15:448-52. [DOI: 10.1097/hjr.0b013e3282fbc95a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tung HH, Hunter A, Wei J. Coping, anxiety and quality of life after coronary artery bypass graft surgery. J Adv Nurs 2008; 61:651-63. [DOI: 10.1111/j.1365-2648.2007.04557.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The effects of a symptom management intervention on symptom evaluation, physical functioning, and physical activity for women after coronary artery bypass surgery. J Cardiovasc Nurs 2008; 22:493-500. [PMID: 18090191 DOI: 10.1097/01.jcn.0000297379.06379.b6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this subset analysis was to examine the effect of a symptom management (SM) intervention on postoperative symptom evaluation, physical functioning, and physical activity among the female participants (N = 40) of the larger parent study of coronary artery bypass graft patients aged 65 years and older. The intervention group (n = 23) had significantly lower fatigue scores at 6 weeks (Z = 1.96, P < .05) and higher levels of physical activity (Z = -1.71, P < .05) reflected in the expended kcal(-1) x kg x d(-1), as measured by the activity diary at 3 months after coronary artery bypass graft surgery. At 6 weeks and 3 months after surgery, there were significant correlations between cardiac surgery-related recovery symptoms (shortness of breath, fatigue, depression, incision pain, and sleep problems) and physical functioning (physical, vitality, and bodily pain functioning subscale scores), with correlations ranging from 0.31 to 0.46. Given that this was a subset analysis of a larger study, significant differences were not expected for all variables. Study findings support the need for a targeted (women-focused) and tailored (self-management recovery) intervention to assist females in recovering from coronary artery bypass graft surgery to improve symptom management, thereby enhancing physical functioning and physical activity outcomes.
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Ai AL, Park CL, Huang B, Rodgers W, Tice TN. Psychosocial mediation of religious coping styles: a study of short-term psychological distress following cardiac surgery. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2007; 33:867-82. [PMID: 17483394 DOI: 10.1177/0146167207301008] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although religiousness and religious coping styles are well-documented predictors of well-being, research on the mechanisms through which religious coping styles operate is sparse. This prospective study examined religious coping styles, hope, and social support as pathways of the influence of general religiousness (religious importance and involvement) on the reduced postoperative psychological distress of 309 cardiac patients. Results of structural equation modeling indicated that controlling for preoperative distress, gender, and education, religiousness contributed to positive religious coping, which in turn was associated with less distress via a path fully mediated by the secular factors of social support and hope. Furthermore, negative religious coping styles, although correlated at the bivariate level with preoperative distress but not with religiousness, were associated both directly and indirectly with greater post-operative distress via the same mediators.
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Affiliation(s)
- Amy L Ai
- University of Washington, Seattle, WA 98105-6299, USA.
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Koivunen K, Isola A, Lukkarinen H. Rehabilitation and guidance as reported by women and men who had undergone coronary bypass surgery. J Clin Nurs 2007; 16:688-97. [PMID: 17402950 DOI: 10.1111/j.1365-2702.2005.01516.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to describe the experience of rehabilitation reported by coronary artery disease patients who had undergone coronary artery bypass surgery. A further purpose was to describe the kind of guidance on rehabilitation that they were given during this period. METHODS The data consisted of thematic questionnaires completed by six women and eight men who had undergone coronary artery bypass surgery. They had recorded their experiences on these questionnaires at one-month intervals for a year after the surgery. The data were analysed using the method of content analysis. RESULTS On the basis of the results, women had experienced the most balanced period of physical, mental and social rehabilitation during the six months following surgery. Their recovery, however, suffered a setback after the first six months. On the basis of the results, men attained a better balance of physical, mental and social rehabilitation only after the six-month period following surgery. Even men had various problems in their rehabilitation, but their recovery proceeded more smoothly than that of women. Women hoped for more guidance throughout the process of rehabilitation. The support and help from wives had a positive impact on the process of men's recovery. Peer support was another significant source support. CONCLUSIONS A person undergoing rehabilitation needs special guidance from health care professionals, especially when his/her rehabilitation does not proceed optimally. The findings suggest that, especially, the guidance of women should be improved because women seemed to suffer from many problems during their process of rehabilitation, including loneliness, insecurity, uncertainty, fears, depression and anxiety. RELEVANCE TO CLINICAL PRACTICE Expanding the role of practical nurses to provide both preventive and rehabilitation guidance should be seen as an important strategy in health care. Individual needs, gender differences and support from families and peers should be taken into consideration when planning and implementing guidance.
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Affiliation(s)
- Kirsi Koivunen
- Department of Nursing Science and Health Administration, Faculty of Medicine, University of Oulu, Finland.
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Qvarnström M, Janket SJ, Nuutinen P, Furuholm J, Meurman JH. Salivary constituents and acidogenic microbial counts in coronary artery bypass graft patients from baseline to three-years after operation. Clin Oral Investig 2007; 11:217-23. [PMID: 17401589 DOI: 10.1007/s00784-007-0114-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 03/06/2007] [Indexed: 11/26/2022]
Abstract
Data on saliva in coronary artery bypass graft (CABG) surgery patients are sparse. Understanding salivary parameters, however, may aid clinical decision making. We hypothesized that cardiac surgery might affect patients' salivary flow rates and buffering, salivary proteins, and microbial counts. A 3-year, open follow-up study was conducted examining salivary flow, its chemical composition, and acidogenic microbial counts in 89 CABG surgery patients. The changes in salivary flow and proteins between baseline and 3-year post-CABG surgery were assessed using paired t-test and, with respect to the median of number of drugs used daily, by use of a nonparametric rank sum test. The results showed no long-term change in salivary flow rates and buffering capacity. With the exception of salivary urea, IgA and IgM concentration, and lysozyme output, the differences in salivary proteins between baseline and 3-year post-CABG were not statistically significant. No difference was observed in saliva values between patients taking drugs below or above the median number of drugs. Acidogenic microbial counts remained the same throughout the study. In conclusion, the salivary flow rates and constituents did not practically change in patients who underwent CABG surgery during the 3-year follow-up.
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Affiliation(s)
- Markku Qvarnström
- Department of Otorhinolaryngology, Oral and Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland
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Hahn KA, Strickland PAO, Hamilton JL, Scott JG, Nazareth TA, Crabtree BF. Hyperlipidemia guideline adherence and association with patient gender. J Womens Health (Larchmt) 2007; 15:1009-13. [PMID: 17125419 DOI: 10.1089/jwh.2006.15.1009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Gender disparities in cardiovascular disease (CVD) management have become increasingly apparent in recent years. Previous research has focused on inpatient disparities, but little is known about how patient gender affects assessment, treatment, and management of patients for hyperlipidemia and cardiovascular risk in primary care settings. Patients with coronary artery disease (CAD) and hyperlipidemia are at high risk for cardiovascular and cerebrovascular morbidity. We sought to examine the effect of patient gender on assessment, treatment, and target maintenance of hyperlipidemia among patients with CAD in a primary care setting. METHODS Chart abstraction was done for 715 patients with CAD in 55 family practices in New Jersey and eastern Pennsylvania as part of the Using Learning Teams for Reflective Adaptation (ULTRA) project. Hyperlipidemia assessment, treatment, and target adherence scores were determined for those at-risk patients based on National Heart, Lung, and Blood Institute (NHLBI) recommended National Cholesterol Education Program (NCEP) ATP III guidelines. Generalized linear models were used to determine the association of hyperlipidemia guideline adherence with patient gender, using comorbidities and age as confounders. RESULTS After controlling for comorbidities and age, women were less likely to be assessed for lipids (p = 0.0462). There was no difference in treatment (p = 0.1074) or target laboratory values (p = 0.3949). CONCLUSIONS Women with CAD are less often assessed for lipids than men in primary care practices. More intensive efforts may be necessary to educate physicians and patients about cardiovascular risk for women.
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Affiliation(s)
- Karissa A Hahn
- UMDNJ-Robert Wood Johnson Medical School, Department of Family Medicine, Somerset, New Jersey 08873, USA.
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23
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Association of Cardiac Drugs with Depression after Acute Coronary Syndrome. J Pharm Technol 2006. [DOI: 10.1177/875512250602200603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Depressive adverse effects of major cardiac medications in patients with cardiovascular disease have been suggested. Objective: To investigate the influence of the use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and/or β-blockers on subsequent depressive symptoms in patients hospitalized for acute coronary syndrome. Methods: A sample of 521 patients was followed for 8 months during 1,340 observations. Data were collected from structured telephone interviews and medical record chart reviews. Pooled time series generalized estimating equations regression models were used to evaluate depressive symptom scores, controlling for major clinical and sociodemographic patient characteristics. Results: No significant independent or interactive effects were found linking the use of these medications to subsequent depressive symptoms, despite changes in depressive symptoms over time. Factors that did affect subsequent depression included sociodemographic (eg, increased age, less education) and clinical characteristics (eg, higher composite comorbidity, prior history of depression and/or first myocardial infarction, higher postdischarge pain levels). Conclusions: Our results suggest that potential depressive adverse effects should not be considered a contraindication to the use of recommended cardiac medications. Observed increases in depressive symptoms after an acute cardiac injury will more likely be attributed to other patient characteristics independent of the use of major drug therapy prescribed to prevent further acute cardiac events.
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Abstract
BACKGROUND AND RESEARCH OBJECTIVE After coronary artery bypass graft (CABG), women are particularly vulnerable to depression because they are more socially isolated and are more likely to have preoperative mood disorders than men. The purpose of this study was to (1) describe the incidence and course of clinical depression in women during the first 6 months after CABG; (2) describe the frequency of depressive symptoms after CABG in women; and (3) identify factors associated with post-CABG depression in women. SUBJECTS AND METHODS Before hospital discharge, 75 women undergoing CABG for the first time participated in a semistructured interview to determine the presence of major or minor depression using the Diagnostic and Statistical Manual, Fourth Edition, criteria. In 55 women, additional interviews were conducted within the first month and at 6 months after discharge. Data were evaluated using frequencies, analysis of variance, Mann-Whitney U test, and logistic regression. RESULTS AND CONCLUSIONS Clinical depression occurred before hospital discharge, in the first month after discharge, and 6 months after discharge in 30.9%, 16.4%, and 12.8%, respectively, of the women who completed a 6-month follow-up. Younger women, those with more perioperative complications, and those with a history of depression were at greater risk for clinical depression. After hospital discharge, the occurrence of any clinical depression within the first month was associated with an increased occurrence of clinical depression 6 months later. Younger women, those with more perioperative complications and early depressive symptoms, and those with persistent occurrence of the most commonly reported symptoms (anhedonia, dysphoria, and fatigue) should be carefully evaluated.
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Affiliation(s)
- Lynn V Doering
- Acute Care, UCLA School of Nursing, Los Angeles, Calif 90095, USA.
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Aguado-Romeo MJ, Márquez-Calderón S, Buzón-Barrera ML. Diferencias entre mujeres y varones en el acceso a procedimientos cardiovasculares intervencionistas en los hospitales públicos de Andalucía. Rev Esp Cardiol 2006. [DOI: 10.1157/13091882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Okkonen E, Vanhanen H. Family support, living alone, and subjective health of a patient in connection with a coronary artery bypass surgery. Heart Lung 2006; 35:234-44. [PMID: 16863895 DOI: 10.1016/j.hrtlng.2005.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Revised: 10/18/2005] [Accepted: 11/08/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study's objective was to evaluate the connections among family support, living alone, and subjective health after coronary artery bypass surgery (CABS). DESIGN This was a prospective and comparative follow-up study. SETTING The study took place in surgical clinics in two university hospitals in Finland. PATIENTS A total of 279 patients underwent CABS. The sample comprised consecutive patients who were willing to participate. INTERVENTION The patients were asked to evaluate their subjective health before surgery (initial phase) and 6 months after surgery (follow-up phase). OUTCOME MEASURES Outcome was measured by the Chest Pain and Dyspnea Scale, Modified Beck Depression Inventory, Endler Anxiety Scale, Family Support Scale, and Hopelessness items. RESULTS Subjective health improved significantly after CABS. Those who had lower family support before surgery had more depressive symptoms, anxiety, and hopelessness than those who had more support. In the group with low family support, the subjective health of women was poorer than that of men, and those who had no vocational education described poorer health than others. In the group with high family support, those who had no vocational education had more chest pain and dyspnea than others. Patients who were living alone had initially more depressive symptoms and hopelessness compared with patients living with someone. At follow-up, those living alone reported more chest pain and depressive symptoms than those living with someone. Patients aged less than 65 years and living alone reported more depressive symptoms, anxiety, and hopelessness than the oldest age group during the follow-up. In those patients living with someone, the subjective health of female patients, patients aged less than 65 years, and patients who had no vocational education was poorer than others. CONCLUSIONS High family support seemed to protect health and promote recovery. In nursing it is important to take care of those who receive only limited amount of family support or who live alone. These results suggest that women, patients aged less than 65 years, and patients with no vocational education may need additional support and care.
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Affiliation(s)
- Eila Okkonen
- Finnish Association for Mental Health, Helsinki, Finland
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Panagopoulou E, Montgomery A, Benos A. Quality of life after coronary artery bypass grafting: evaluating the influence of preoperative physical and psychosocial functioning. J Psychosom Res 2006; 60:639-44. [PMID: 16731241 DOI: 10.1016/j.jpsychores.2005.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 10/18/2005] [Accepted: 11/22/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to determine the influence of preoperative physical and psychosocial functioning on quality of life 1 and 6 months after coronary artery bypass grafting (CABG). METHODOLOGY The study used a prospective design. A total of 157 patients admitted for elective CABG in a Greek city hospital participated in the study. RESULTS Results showed significant improvements in the quality of life of the patients after CABG [F(2, 95)=36.337; P<.001]. Structural equation modeling analyses showed that preoperative psychological distress was the only preoperative predictor of quality of life at 1 month (beta=-.22; P<.01) and at 6 months (beta=-.28; P<.001) after the operation. CONCLUSION Results highlight preoperative distress as a screening criterion to identify patients likely to benefit less from cardiac surgery.
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Affiliation(s)
- Efharis Panagopoulou
- Laboratory of Hygiene, Medical School, Aristotle University, Thessaloniki, Greece.
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Abstract
There is undeniable evidence for physical and psychosocial benefits of cardiac rehabilitation programs for individuals suffering from coronary heart disease. Yet, fewer women than men are referred to, begin, or complete cardiac rehabilitation programs. The numerous logistical, economic, and motivational barriers to healthy behavior change place women at risk for subsequent CHD events. To close this gender gap and improve outcomes, novel, efficacious, and individualized rehabilitative approaches for women with coronary heart disease are needed. The purpose of this article is to describe a theory-driven behavioral intervention designed exclusively for women with coronary heart disease. The 12-week intervention is being tested in a randomized controlled trial involving women referred to a cardiac rehabilitation program. The tenets of the Transtheoretical Model of behavior change and motivational interviewing guided the development and implementation of the stage-matched, individualized intervention to promote healthy behavior change for women with coronary heart disease. The ongoing trial will examine the efficacy of the intervention on physiological and psychosocial outcomes.
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Affiliation(s)
- Theresa M Beckie
- College of Nursing, University of South Florida, Tampa, Fla 33612-4766, USA.
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Abstract
Coronary artery disease in women is associated with higher morbidity and mortality than in men. The purpose of this article is to summarize recent literature concerning gender-based differences. Specific differences in pathophysiology, traditional and psychosocial risk factors, symptom presentation, treatments, and outcomes between women and men will be reviewed.
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Schulz P, Zimmerman L, Barnason S, Nieveen J. Gender differences in recovery after coronary artery bypass graft surgery. ACTA ACUST UNITED AC 2005; 20:58-64. [PMID: 15886548 DOI: 10.1111/j.0889-7204.2005.03868.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study examined the effect of gender on symptom evaluation, symptom response, and physical functioning following coronary artery bypass graft surgery. Symptom evaluation and symptom response were measured at baseline and 2, 4, and 6 weeks and 3 months following surgery, and physical functioning was measured at baseline, 6 weeks, and 3 months. The sample included 46 men and 19 women randomly assigned to the routine care group of a larger study examining symptom management intervention influence on recovery outcomes in elderly coronary artery bypass graft patients. No significant differences were found in symptom evaluation, symptom response, or physical functioning by gender over time. Women reported consistently higher symptom evaluation scores for shortness of breath, fatigue, depression, sleep disturbance, swelling, and anxiety and lower mean physical and vitality subscale scores than men at every time point. Gender-specific symptom management strategies should be developed and tested to address the differences in the reporting of symptoms by men and women.
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Affiliation(s)
- Paula Schulz
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE 68588, USA.
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Penckofer S, Ferrans CE, Fink N, Barrett ML, Holm K. Quality of life in women following coronary artery bypass graft surgery. Nurs Sci Q 2005; 18:176-83. [PMID: 15802751 DOI: 10.1177/0894318405274832] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine the effect of coronary artery bypass graft (CABG) surgery on the quality of life of women. Wilson and Cleary's conceptual model of health-related quality of life, which examines five major outcomes (biological variables, symptom status, functional status, general health perceptions, perceived quality of life), was used. Participants included 61 women who provided information by self-report questionnaires before and three months after surgery. The major findings of the study are that women had significantly improved quality of life (p = .004) due to increased satisfaction with health and functioning (p < .001) at three months following CABG surgery. They experienced less angina (p < .001) and shortness of breath (p = .014), although fatigue was unrelieved for the majority of women. Psychological well being improved after surgery for most women (p < .001), with lower anxiety levels (p < .001), greater levels of well being (p = .021), feelings of health (p < .001) and vitality (p = .023). Women reported less use of emotive coping (p = .043), indicating less emotional distress. Nevertheless, 25% of the sample continued to experience severe psychological distress three months after surgery, indicating the need for continued follow-up.
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Affiliation(s)
- Sue Penckofer
- School of Nursing, Loyola University Chicago, Chicago, IL, USA
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