Medical management of the patient with angina pectoris: an overview of the problem

Effect of transitional care stroke case management interventions on caregiver outcomes: the MISTT randomized trial

This study reports on outcomes for 169 caregivers enrolled in the Michigan Stroke Transitions Trial (MISTT), an RCT of social work case management for stroke patients returning home. A mixed-model approach examined the mean change from 7- to 90-days post-discharge with group-by-time interactions for differences between treatment groups. Caregivers reported few life changes or depressive symptoms from caregiving. There was no significant change over time or treatment effects. Negative aspects of stroke caregiving may take longer to develop. Focused caregiver assessment at discharge and a better understanding of how caregiving develops over time may improve the type and timing of support.

Distress correlates with the degree of chest pain: a description of patients awaiting revascularisation

AIM

To describe various symptoms other than pain among consecutive patients on the waiting list for possible coronary revascularisation in relation to estimated severity of chest pain.

DESIGN

All patients were sent a postal questionnaire for symptom evaluation.

SUBJECTS

All patients in western Sweden on the waiting list in September 1990 who had been referred for coronary angiography or coronary revascularisation (n = 904).

RESULTS

88% of the patients reported chest pain symptoms that limited their daily activities to a greater or lesser degree. Various psychological symptoms including anxiety and depression were strongly associated with the severity of pain (P < 0.001), as were sleep disturbances (P < 0.001), and dyspnoea and various psychosomatic symptoms (P < 0.001). Nevertheless only 44% of the patients reported chest pain as the major disruptive symptom, whereas the remaining 56% reported uncertainty about the future, fear, or unspecified symptoms as being the most disturbing.

CONCLUSIONS

In a consecutive series of patients on the waiting list for possible coronary revascularisation, half the participants reported that uncertainty and fear were more disturbing than chest pain.

The patient with transient ischemic attacks--is this the time for a new therapeutic approach?

Current and future improvements in treatment to prevent cerebral infarction among patients with transient ischemic attacks may reduce neurological morbidity but may not lead to a proportional improvement in life expectancy. Because the long-term primary cause of death in these patients is myocardial infarction, it is most likely that the most important way to prolong survival may be the vigorous investigation of their cardiac status and the treatment of their coronary artery disease, even if asymptomatic.