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Yazit NAA, Juliana N, Kadiman S, Hafidz KM, Mohd Fahmi Teng NI, Abdul Hamid N, Effendy N, Azmani S, Abu IF, Aziz NASA, Das S. Microarray Profiling of Differentially Expressed Genes in Coronary Artery Bypass Grafts of High-Risk Patients with Postoperative Cognitive Dysfunctions. Int J Environ Res Public Health 2023; 20:1457. [PMID: 36674212 PMCID: PMC9859359 DOI: 10.3390/ijerph20021457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Postoperative cognitive dysfunction (POCD) is cognitive decline after surgery. The authors hypothesized that gene-level changes could be involved in the pathogenesis of POCD. The present study evaluated the incidence of POCD and its associated differentially expressed genes. This was a prospective cohort study conducted on high-risk coronary artery bypass graft patients aged 40 to 75 years. POCD classification was based on a one standard deviation decline in the postoperative scores compared to the preoperative scores. The differentially expressed genes were identified using microarray analysis and validated using quantitative RT-PCR. Forty-six patients were recruited and completed the study. The incidence of POCD was identified using a set of neurocognitive assessments and found to be at 17% in these high-risk CABG patients. Six samples were selected for the gene expression analyses (3 non-POCD and 3 POCD samples). The findings showed five differentially expressed genes in the POCD group compared to the non-POCD group. The upregulated gene was ERFE, whereas the downregulated genes were KIR2DS2, KIR2DS3, KIR3DL2, and LIM2. According to the results, the gene expression profiles of POCD can be used to find potential proteins for POCD diagnostic and predictive biomarkers. Understanding the molecular mechanism of POCD development will further lead to early detection and intervention to reduce the severity of POCD, and hence, reduce the mortality and morbidity rate due to the condition.
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Affiliation(s)
- Noor Anisah Abu Yazit
- Faculty Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Norsham Juliana
- Faculty Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Suhaini Kadiman
- Anaesthesia and Intensive Care Unit, National Heart Institute, Kuala Lumpur 50400, Malaysia
| | | | | | - Nazefah Abdul Hamid
- Faculty Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Nadia Effendy
- Faculty Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Sahar Azmani
- Faculty Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Izuddin Fahmy Abu
- Institute of Medical Science Technology, Universiti Kuala Lumpur, Kajang 43000, Malaysia
| | | | - Srijit Das
- Department of Human & Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, Al-Khoud, Muscat 123, Oman
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Musa AF, Yasin MSM, Smith J, Yakub MA, Nordin RB. The Malay version of SF-36 health survey instrument: testing data quality, scaling assumptions, reliability and validity in post-coronary artery bypass grafting (CABG) surgery patients at the National Heart Institute (Institut Jantung Negara-IJN), Kuala Lumpur. Health Qual Life Outcomes 2021; 19:50. [PMID: 33563262 PMCID: PMC7874445 DOI: 10.1186/s12955-020-01658-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 12/21/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Short Form 36 (SF-36) is a scoring system comprising of 36 items categorized into eight constructs corresponding to patients' health-related quality of life. It has been used extensively in various countries on different sub-populations and used to indicate the health status and help to ascertain the effect of clinical interventions on the particular population. OBJECTIVE To examine the psychometric properties of the Malay version of SF-36 (Malay SF-36) summated rating scales and validate the scale among post-coronary artery bypass grafting surgery (CABG) patients at the National Heart Institute (IJN), Kuala Lumpur. METHODS Five hundred and nine post-CABG patients at the IJN, Malaysia completed the questionnaires between 1 July and 31 December 2017. Psychometric tests endorsed by the "International Quality of Life Assessment Project" were utilised. RESULTS The data quality was excellent with a high questionnaire completion rate (100%). As hypothesized, the ordering of item means within scales was clustered. In unison, scaling assumptions were satisfied. Good discriminant validity was shown between subsets of patients with various levels of health status. Notwithstanding, there were probably translation issues of the Physical Functioning scale which showed small ceiling effects. We clearly observed high ceiling and floor effects in both Role Physical and Role Emotional scale most probably attributed to the dichotomous style of their choice of responses. Cronbach alpha values of the eight scales ranged from 0.73 to 0.90, showing good internal consistency reliability. Confirmatory Factor Analysis (CFA) confirmed the 8-factor solution and Composite Reliability revealed internal consistency reliability except for Vitality and Social Functioning. Based on the Average Variance Extracted (AVE), convergent validity was adequate except for two domains. Discriminant Validity is good for the eight constructs as the √AVE are generally higher than the correlation coefficients between the latent constructs. CONCLUSION The scoring for the Malay SF-36 based on the summated ratings method was proven to be valid to be applied in our local clinical population. The CFA, fitness estimates, reliability and validity assessments suggest that the Malay version of SF36 is a valid and reliable instrument. However, further work is warranted to further refine the convergent validity and reliability of some scales.
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Affiliation(s)
- Ahmad Farouk Musa
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | | | - Julian Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
| | - Mohd Azhari Yakub
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Rusli Bin Nordin
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia
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Stanicki P, Szarpak J, Wieteska M, Kaczyńska A, Milanowska J. Postoperative depression in patients after coronary artery bypass grafting (CABG) - a review of the literature. Pol Przegl Chir 2020; 92:1-5. [PMID: 32945781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
<b>Introduction:</b> Ischemic heart disease is the most common cause of death in the world. The lives of patients with vascular defects can be saved by coronary artery bypass grafting (CABG). However, it is associated with an increased risk of developing depression after surgery. <br><b>Meterial and Methods:</b> The aim of the study is to present the results of the latest research on postoperative depression after CABG, including studies describing the course of the disease, its consequences for the patient's prognosis and treatment. The publications available on the PubMed platform published after 2011 were reviewed. <br><b>Results:</b> Depression before and after CABG affects 30-40% of patients, mostly women. Established after surgery and untreated, it persists for many years. The level of anxiety in patients decreases systematically after surgery. Indicators that may correlate with the patient's postoperative depression, including cortisol, high sensitivity C-reactive protein (hsCRP) and oxidative stress biomarkers, are being investigated. The occurrence of depression in patients after CABG has a number of negative consequences. Those include: weaker response to treatment, greater chance of relapse, and increased readmission frequency and mortality. Treatment of patients with this disorder involves the use of antidepressants (most often SSRIs - selective serotonin reuptake inhibitor) and/or various types of psychotherapy with cognitive behavioral therapy (CBT) at the forefront. <br><b>Conclusions:</b> Depression following CABG decreases the quality of life and worsens patient prognosis. It is necessary to detect this condition early after surgery and to apply treatment, taking into account the cardiological disorders of the patient.
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Affiliation(s)
- Paweł Stanicki
- Student Research Group of Applied Psychology, Medical University of Lublin
| | - Julita Szarpak
- Student Research Group of Applied Psychology, Medical University of Lublin
| | - Małgorzata Wieteska
- Student Research Group at the Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Poland
| | - Agnieszka Kaczyńska
- Student Research Group at the Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Poland
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Pačarić S, Turk T, Erić I, Orkić Ž, Petek Erić A, Milostić-Srb A, Farčić N, Barać I, Nemčić A. Assessment of the Quality of Life in Patients before and after Coronary Artery Bypass Grafting (CABG): A Prospective Study. Int J Environ Res Public Health 2020; 17:ijerph17041417. [PMID: 32098322 PMCID: PMC7068373 DOI: 10.3390/ijerph17041417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 01/21/2023]
Abstract
The aim of this study was to examine the quality of life and to report on the utility and QALY measures in patients before and after coronary artery bypass grafting (CABG); to investigate whether the SF-12 is comparable with the SF-36 for measuring health-related quality of life of patients with CABG; and to determine the impact of individual predictors on poor quality of life assessment after rehabilitation. This prospective study was conducted between January 2017 and December 2018 at the University Hospital Center Osijek, at three time points: pre-operation, 1 month after surgery, and after rehabilitation. The study was conducted with the SF-36 and SF-12 health questionnaires on 47 participants. After rehabilitation, there was a significant improvement in all domains of quality of life. The highest score was given to the change in pain (BP); mean scores were 63.8 (95% CI 56.9 to 70.6) (p = 0.001). The lowest grade (the lowest quality) after rehabilitation was in the domain of limitations due to physical difficulties (RP); arithmetic mean was 48.5 (95% CI 41 to 55.9) (p < 0.001). Quality-adjusted life-year was 0.41 (95% CI 0.38–0.44) after the CABG. The results of this study show that patients with coronary heart disease have poor quality of life before surgery. One month after the surgery, the quality of life improved, but was still inadequate. One year after surgery, satisfactory results were obtained in almost all subscales. The SF-36, SF-12, and its components, can be used effectively in patients with CABG. Age, gender, lifestyle, and risk factors in our sample of participants are not predictors of poor quality of life assessment after rehabilitation.
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Affiliation(s)
- Stana Pačarić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Tajana Turk
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
| | - Ivan Erić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
| | - Želimir Orkić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
| | - Anamarija Petek Erić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Andrea Milostić-Srb
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Nikolina Farčić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
- Correspondence: ; Tel.: +385-98-186-85-69
| | - Ivana Barać
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Ana Nemčić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
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Golaghaie F, Esmaeili-Kalantari S, Sarzaeem M, Rafiei F. Adherence to lifestyle changes after coronary artery bypass graft: Outcome of preoperative peer education. Patient Educ Couns 2019; 102:2231-2237. [PMID: 31337518 DOI: 10.1016/j.pec.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 06/19/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study was done to investigate the effect of preoperative peer education on patients' adherence to medication and lifestyle changes after Coronary Artery Bypass Graft (CABG). METHODS In this randomized clinical trial, the peers of CABG patients conducted preoperative educational sessions at the ward in groups of 4-5 (n = 36) while the control group (n = 34) received routine education by a nurse. Adherence of both groups to medication and recommendations for lifestyle modification including physical activity, smoking, and diet was measured one and two months after discharge. RESULTS A multivariate analysis of co-variance showed the significant effect of peer education on adherence (F = 32.586, p < 0.001; η2 = 0.671). Univariate ANCOVA revealed a significant difference in adherence to diet between the two groups (F = 62.316, p = 0 0.0001; η2 = 0.482). Based on the repeated measures ANOVA, peer education significantly improved the CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total adherence (F = 9.911, p = 0.002) compared to the control group. CONCLUSION Preoperative peer education had a significant effect on improving CABG patients' adherence to lifestyle changes after hospital discharge. PRACTICE IMPLICATION Peer education can be used as an effective method to improve the CABG patients ' adherence to lifestyle changes.
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Affiliation(s)
- Farzaneh Golaghaie
- Department of Community Health Nursing, Arak University of Medical Sciences, Arak, Iran.
| | | | - Mahmoodreza Sarzaeem
- Department of Cardiovascular Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rafiei
- Department of Biostatistics & Epidemiology, School of health, Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Salzwedel A, Reibis R, Heidler MD, Wegscheider K, Völler H. Determinants of Return to Work After Multicomponent Cardiac Rehabilitation. Arch Phys Med Rehabil 2019; 100:2399-2402. [PMID: 31054294 DOI: 10.1016/j.apmr.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To explore predictors of return to work in patients after acute coronary syndrome and coronary artery bypass grafting, taking into account cognitive performance, depression, physical capacity, and self-assessment of the occupational prognosis. DESIGN Observational, prospective, bicentric. SETTING Postacute 3-week inpatient cardiac rehabilitation (CR). PARTICIPANTS Patients (N=401) <65 years of age (mean 54.5±6.3y), 80% men. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Status of return to work (RTW) 6 months after discharge from CR. RESULTS The regression model for RTW showed negative associations for depression (odds ratio 0.52 per SD, 95% confidence interval 0.36-0.76, P=.001), age (odds ratio 0.72, 95% confidence interval 0.52-1.00, P=.047), and in particular for a negative subjective occupational prognosis (expected incapacity for work odds ratio 0.19, 95% confidence interval 0.06-0.59, P=.004; unemployment odds ratio 0.08, 95% confidence interval 0.01-0.72, P=.024; retirement odds ratio 0.07, 95% confidence interval 0.01-0.067, P=.021). Positive predictors were employment before the cardiac event (odds ratio 9.66, 95% confidence interval 3.10-30.12, P<.001), capacity to work (fit vs unfit) at discharge from CR (odds ratio 3.15, 95% confidence interval 1.35-7.35, P=.008), and maximum exercise capacity (odds ratio 1.49, 95% confidence interval 1.06-2.11, P=.022). Cognitive performance had no effect. CONCLUSIONS The patient's perception and expectation regarding the occupational prognosis play a crucial role in predicting return to work 6 months after an acute cardiac event and CR. These findings highlight the importance of the multimodal approach, in particular psychosocial components, of CR.
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Affiliation(s)
| | - Rona Reibis
- Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam
| | | | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg
| | - Heinz Völler
- Center of Rehabilitation Research, University of Potsdam; Klinik am See, Rehabilitation Center for Internal Medicine, Rüdersdorf, Germany
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Abstract
Thirty-six patients with angina were investigated by treadmill exercise testing and coronary angiography prior to coronary artery surgery. Severity of angina was judged by interview and self-assessment visual analogue scale and all patients were psychiatrically assessed. Further physical and psychiatric assessments were made at 3 and 6 months postoperatively. Eleven patients (31%) had significant psychiatric morbidity preoperatively and these had worse symptom scores and exercise tolerance compared with non-psychiatric cases, despite equivalent coronary angiographic findings and left ventricular function. Postoperatively, exercise tolerance improved equally in both groups but psychiatric cases remained significantly more symptomatic. Psychiatric morbidity remained unchanged throughout the study. We conclude that almost one third of patients with severe angina have psychiatric morbidity which is associated with a poor symptomatic response to coronary artery surgery, despite objective improvement in exercise tolerance. Ways of improving the symptomatic response to surgery in patients with coexisting psychiatric morbidity should be studied.
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Affiliation(s)
- K S Channer
- Department of Cardiology, Bristol Royal Infirmary
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Geulayov G, Novikov I, Dankner D, Dankner R. Symptoms of depression and anxiety and 11-year all-cause mortality in men and women undergoing coronary artery bypass graft (CABG) surgery. J Psychosom Res 2018; 105:106-114. [PMID: 29332626 DOI: 10.1016/j.jpsychores.2017.11.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the overall and the sex-specific association of preoperative and one-year post coronary artery bypass (CABG) surgery symptoms of depression and anxiety with 11-year all-cause mortality. METHODS A multicenter prospective study including 1125 patients who completed the Hospital Anxiety and Depression Scale (HADS) before an elective CABG surgery, of whom 850 completed the HADS again at one-year follow-up. Information on all-cause mortality was obtained through the Israeli Ministry of Internal Affairs Register. Multivariable adjusted Cox regression models quantified the association of symptoms of depression and anxiety with all-cause mortality. RESULTS Females comprised 22.7% of the cohort and were 5.5years older than males (70.0±9.3 and 64.4±10.3years, respectively). Controlling for sociodemographic and lifestyle factors, illness severity and post-surgery participation in cardiac rehabilitation, there was little evidence of an association between preoperative symptoms of depression and mortality in males [adjusted hazard ratio (aHRmales)=1.03, 95% CI 0.99-1.07, p=0.21] or females (aHRfemales=1.01, 95% CI 0.95-1.08, p=0.7). One-year postoperative symptoms of depression were associated with mortality in both males (aHRmales=1.05, 95% CI 1.01-1.10, p=0.03) and females (aHRfemales=1.07, 95% CI 1.02-1.13, p=0.013). Preoperative symptoms of anxiety were unrelated to mortality overall, but among females postoperative symptoms of anxiety predicted 11-year mortality (aHRfemales=1.07, 95% CI 1.00-1.14, p=0.049). There was no HADS by sex interaction (p for interaction=0.12-0.99). CONCLUSIONS Symptoms of depression one-year after surgery were positively related to mortality with little evidence for sex differences. These findings underscore the need for identification and treatment of psychiatric symptoms in patients undergoing CABG surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT00356863.
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Affiliation(s)
- Galit Geulayov
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Ilya Novikov
- Unit for Biostatistics, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Rachel Dankner
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; Division of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
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Aronov DM, Bubnova MG, Ioseliani DG, Krasnitsky VB, Shovkun TV, Novikova NK, Yarnykh EV. [The Complex Program of Rehabilitation of Patients With Ischemic Heart Disease After Coronary Artery Bypass Surgery in Ambulatory Cardiorehabilitational Department: Clinical Effects of Third Stage of Rehabilitation]. Kardiologiia 2017; 57:10-19. [PMID: 28762930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE to assess clinical efficacy of early post discharge rehabilitation of patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) in conditions of a polyclinical department of cardiological rehabilitation (stage III of cardiorehabilitation). MATERIAL AND METHODS We included in this study 36 men with IHD in 3-8 weeks (mean 7.8+/-1.6 weeks) after CABG. Patients were randomized in 2groups: patients of the main group attended special "School for patients recovering after CABG" [School] (60-80 min sessions once a week for 5 weeks) and participated in a program of monitored (up to 60 min 3 times a week for 4 months) and unmonitored (home based) exercise training. Patients of the control group attended School and were given advice to do physical exercises at home. Follow up duration was 1 year. RESULTS Main group. Compared with baseline values after 4 months exercise duration increased 32.6% (p<0.05), this effect persisted at 12 month; threshold exercise load increased 35.2% (p<0.05) after 4, 53.9% after 6, and 49.5% after 12 month. After 4 and 12 months of training some increases of left ventricular (LV) ejection fraction and stroke volume, and decrease of LV end systolic volume occurred. Physical training in this group was associated with improvement of parameters of quality of life. During 12 months of follow up there were no significant changes of concentrations of total and low density lipoprotein cholesterol (TC, LDLC). In the control group slight increase of exercise duration was observed only at 12 months (9.8%, p<0.05), and it was not accompanied by dynamics of exercise tolerance. Increases of concentrations of TC (10.2%, p<0.05) and LDLC (15.6%, p<0.05) were registered at 12 months. Serious cardiovascular complications in the main group (physical training + educational School) were three times less frequent than in the control group (attendance of School only) (11.1 vs. 39.2%, respectively.
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Affiliation(s)
- D M Aronov
- National Research Center for Preventive Medicine
- Moscow City Center of Interventional Cardioangiology, Moscow, Russia
| | - M G Bubnova
- National Research Center for Preventive Medicine
- Moscow City Center of Interventional Cardioangiology, Moscow, Russia
| | - D G Ioseliani
- National Research Center for Preventive Medicine
- Moscow City Center of Interventional Cardioangiology, Moscow, Russia
| | - V B Krasnitsky
- National Research Center for Preventive Medicine
- Moscow City Center of Interventional Cardioangiology, Moscow, Russia
| | - T V Shovkun
- National Research Center for Preventive Medicine
- Moscow City Center of Interventional Cardioangiology, Moscow, Russia
| | - N K Novikova
- National Research Center for Preventive Medicine
- Moscow City Center of Interventional Cardioangiology, Moscow, Russia
| | - E V Yarnykh
- National Research Center for Preventive Medicine
- Moscow City Center of Interventional Cardioangiology, Moscow, Russia
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Wilson BR, Tringale KR, Hirshman BR, Zhou T, Umlauf A, Taylor WR, Ciacci JD, Carter BS, Chen CC. Depression After Spinal Surgery: A Comparative Analysis of the California Outcomes Database. Mayo Clin Proc 2017; 92:88-97. [PMID: 27836112 PMCID: PMC5426910 DOI: 10.1016/j.mayocp.2016.06.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/11/2016] [Accepted: 06/20/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the relative incidence of newly recorded diagnosis of depression after spinal surgery as a proxy for the risk of post-spinal surgery depression. PATIENTS AND METHODS We used the longitudinal California Office of Statewide Health Planning and Development database (January 1, 2000, through December 31, 2010) to identify patients who underwent spinal surgery during these years. Patients with documented depression before surgery were excluded. Risk of new postoperative depression was determined via the incidence of newly recorded depression on any hospitalization subsequent to surgery. For comparison, this risk was also determined for patients hospitalized during the same time period for coronary artery bypass grafting, hysterectomy, cholecystectomy, chronic obstructive pulmonary disease, congestive heart failure exacerbation, or uncomplicated vaginal delivery. RESULTS Our review identified 1,078,639 patients. Relative to the uncomplicated vaginal delivery cohort, the adjusted hazard ratios (HRs) for newly recorded depression within 5 years after the admission of interest were 5.05 for spinal surgery (95% CI, 4.79-5.33), 2.33 for coronary artery bypass grafting (95% CI, 2.15-2.54), 3.04 for hysterectomy (95% CI, 2.88-3.21), 2.51 for cholecystectomy (95% CI, 2.35-2.69), 2.44 for congestive heart failure exacerbation (95% CI, 2.28-2.61), and 3.04 for chronic obstructive pulmonary disease (95% CI, 2.83-3.26). Among patients who underwent spinal surgery, this risk of postoperative depression was highest for patients who underwent fusion surgery (HR, 1.28; 95% CI, 1.22-1.36) or had undergone multiple spinal operations (HR, 1.22; 95% CI, 1.16-1.29) during the analyzed period. CONCLUSION Patients who undergo spinal surgery have a higher risk for postoperative depression than patients treated for other surgical or medical conditions known to be associated with depression.
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Affiliation(s)
| | | | - Brian R Hirshman
- Department of Neurosurgery, University of California, San Diego, CA
| | - Tianzan Zhou
- Department of Neurosurgery, University of California, San Diego, CA
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego, CA
| | - William R Taylor
- Department of Neurosurgery, University of California, San Diego, CA
| | - Joseph D Ciacci
- Department of Neurosurgery, University of California, San Diego, CA
| | - Bob S Carter
- Department of Neurosurgery, University of California, San Diego, CA
| | - Clark C Chen
- Department of Neurosurgery, University of California, San Diego, CA.
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11
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Abstract
The purposes of this investigation were to identify a zone of normality for ratings of perceived exertion (RPE) and to compare the RPE responses in patients with coronary artery disease to this zone. The zone was generated from RPE estimated during the last minute of each stage of a Bruce treadmill test in 44 normal adult men. RPE were regressed against the corresponding MET level for each exercise stage. The zone was established as the 95% confidence interval (CI) spanning the average RPE vs MET regression line. RPE estimated during the last 1.0 min. of a Bruce or Modified Balke treadmill test administered to adult men ( n = 37) with coronary artery disease were compared to the 95% CI zone. A total of 19 (51%) of the coronary artery disease patients estimated RPE during a progressively incremented treadmill test that were above the zone, indicating a comparatively greater than normal perception of strain for a given metabolic stress. The presently generated zone provides a practical use of RPE in the interpretation of clinical exercise tests.
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Affiliation(s)
- Fredric L Goss
- Center for Exercise and Health-Fitness Research, University of Pittsburgh. Pittsburgh, PA 15261, USA.
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12
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Weiser PC, Wojciechowicz V, Funck A, Robertson RJ. Perceived Effort Step-up Procedure for Self-Regulating Stationary Cycle Exercise Intensity by Patients with Cardiovascular Disease. Percept Mot Skills 2016; 104:236-53. [PMID: 17450985 DOI: 10.2466/pms.104.1.236-253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the strategy utilized by patients with cardiovascular disease to regulate exercise intensity using the Rating of Perceived Exertion (RPE) and tested if a step-up procedure would reduce overshoot of target heart rate (HR). Also the study investigated if Prescription Congruence and Intensity Discrimination, components of the Intensity Self-regulation Model, could be validated for these patients. An estimation and production paradigm was used. HR was measured at 2-min. intervals during 6-min. stationary cycle ergometer exercise trials. Data for four experimental trials were compared: (1) a work intensity set by experimenter to achieve a target RPE of 11 (Estimation 11), (2) an intensity set by experimenter to achieve a target RPE of 13 (Estimation 13), (3) an intensity varied by participant every 2 min. to produce a target RPE of 13 (Production 13), and (4) a Step-up Procedure with the intensity varied by participant, first producing a target RPE of 11 during the first 2 min., followed by producing a target RPE of 13 from min. 2 to 6 of exercise (Production 11 + 13). A very small effect size was found for HR between Production 13 and Estimation 13, and a moderate effect size was noted for the increased HR when patients produced a target RPE of 13 as compared to 11. The participants could be divided into 2 groups: 10 patients comprised a Higher group whose HR at 2 min. during Production 13 was greater than HR at 2 min. during Estimation 13, and 6 patients in a Lower group with HR at 2 min. during Production 13 less than or equal to HR during Estimation 13. A large effect size was found at 6 min. for the reductions of the Higher group's HR overshoot and for the Lower group's HR undershoot during Production 13. All participants in the Higher group ( n = 10) had a clinically significant 1ER overshoot of 5 beats · min.−1 at 2 min. during Production 13. Using a Step-up Procedure (Production 11 + 13), a large effect size was found for the reduced number of patients ( n = 3) with an overshoot of 5 beats · min.−1 at 2 min. This supports the ability of participants in cardiac rehabilitation programs to meet the Prescription Congruence and Intensity Discrimination components of the Intensity Self-regulation Model in the RPE 11–13 zone. Evidence was found for overshoot/undershoot of target HR at 2 min., supporting a proposed third component, Production Strategy, of the Intensity Self-regulation Model. The 2-min. Step-up Procedure reduced some patients' tendency to “overshoot” target intensity.
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13
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Dunckley M, Ellard D, Quinn T, Barlow J. Recovery after coronary artery bypass grafting: Patients’ and health professionals’ views of the hospital experience. Eur J Cardiovasc Nurs 2016; 6:200-7. [PMID: 17092777 DOI: 10.1016/j.ejcnurse.2006.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 07/10/2006] [Accepted: 09/18/2006] [Indexed: 12/01/2022]
Abstract
Background Increasing access to revascularisation procedures is a key aspect of a National Service Framework. Coronary artery bypass grafting (CABG) is effective in relieving symptoms and reducing mortality but some patients do not report an improved quality of life or experience a good recovery. Aims To describe the recovery trajectory after CABG and identify facilitators and barriers to recovery. Methods Semi-structured interviews were conducted with 11 patients who had previously undergone elective, isolated, first-time CABG and with 10 health professionals experienced in caring for these patients. Results Thematic analysis identified the following themes: definition and timeline of recovery, preparation for surgery including information provision, attitude to surgery and confidence in staff, clinical factors and the in-patient experience. The key finding is the different recovery trajectory between patients with severe versus mild pre-operative symptoms; patients with few pre-CABG symptoms reported a much longer recovery time. Conclusions This study has provided insights into the barriers and facilitators to recovery after CABG and the processes involved. Findings have indicated areas where health professionals can intervene to aid patients’ long-term recovery and thereby maximise the benefits of CABG.
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Affiliation(s)
- Maria Dunckley
- Interdisciplinary Research Centre in Health, Faculty of Health and Life sciences, Coventry University, Priory Street, Coventry, UK.
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14
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Tolmie EP, Lindsay GM, Belcher PR. Coronary Artery Bypass Graft Operation: Patients' Experience of Health and Well-Being Over Time. Eur J Cardiovasc Nurs 2016; 5:228-36. [PMID: 16627003 DOI: 10.1016/j.ejcnurse.2006.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Revised: 01/01/2006] [Accepted: 01/26/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of the coronary artery bypass graft operation is to relieve anginal symptoms and improve functional ability, quality of life and survival. However, having the surgery does not always have the desired outcomes. Although numerous studies have investigated the outcomes of coronary artery bypass graft operation, little attention has been given to patients' perceptions of the outcomes or effects of the operation on health and well-being over time. AIM To explore patients' perspectives on the effects of coronary artery bypass surgery on health and well-being over time. METHODS As part of a larger mixed methods study, 62 in-depth audio-taped interviews with men and women who had undergone coronary artery bypass approximately 7 years earlier were conducted. Interviews were audio-taped and transcribed. Data were analysed thematically. This paper reports the findings from the qualitative component of the larger study. FINDINGS The four main themes: 'Recovery and Rehabilitation', 'Seven Years On', 'Maintaining a Positive Approach', and 'Health Behaviour Change' reflect the main areas of focus emerging across the interviews and provide credible overarching descriptors of the sub-themes they encompass. The 11 sub-themes identified were recognised as central to the patients' experiences of their health and well-being over the longer-term. CONCLUSIONS Although most patients report improved health and well-being after coronary artery bypass operation, many have described their recovery and rehabilitation as a complex process with both short and long term effects. The insights provided by participants help improve our understanding of the impact of the operation on patients' health and well-being over time. We believe these insights will help us to anticipate the possible needs of future patients and enable us develop appropriate interventions that may facilitate self-management for optimal recovery and health maintenance.
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Affiliation(s)
- Elizabeth P Tolmie
- Nursing, Midwifery and Community Health, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK.
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15
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Abstract
The purpose of this study was to describe the experiences of persons whose spouses have newly diagnosed coronary artery disease (CAD). The purpose was to obtain knowledge that would help us to understand better the life of persons with a chronically ill spouse and to develop the education and rehabilitation of both the patients and their spouses. Data were collected from healthy spouses by an open-ended question. There were 146 informants. They were asked to write about their experiences of everyday life after their spouse had been diagnosed for CAD. The data were analyzed by methods of content analysis. The following categories were formulated to describe the healthy spouses' experiences: slow pace of life, limited life and unsure life. Slow pace of life meant that the disease had been adopted as a normal part of life. Life was organized in a new way, and the earlier busy and work-oriented lifestyle had been given up. The informants whose spouses had medication considered their personal freedom to be limited, because they had to assume responsibility for the care of their spouses. The spouses of the patients who had undergone bypass surgery (CABS) or angioplasty (PTCA) had a new role in the family. They had to monitor for symptoms, treat symptoms, take care, understand and support. They had to assume responsibility for everyday life. They felt themselves to be alone in that situation. They did not receive support from health care providers. All informants felt uncertainty due to financial problems, poorly planned care and unexpected changes in the course of the disease. As a conclusion, it can be said that life was limited by the sick spouse's needs. The disease caused changes in emotional balance, a need for continuous control of life, fears about a new myocardial infarction and worries about many issues of everyday life.
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Affiliation(s)
- Hannele Lukkarinen
- Department of Nursing and Health Administration, University of Oulu, Oulu University Hospital, P.O. Box 5300, University of Oulu 90014, Finland.
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16
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Mooney M, Fitzsimons D, Richardson G. “No More Couch-Potato!” Patients' Experiences of a Pre-Operative Programme of Cardiac Rehabilitation for Those Awaiting Coronary Artery Bypass Surgery. Eur J Cardiovasc Nurs 2016; 6:77-83. [PMID: 16831570 DOI: 10.1016/j.ejcnurse.2006.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 05/19/2006] [Accepted: 05/24/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The waiting period for coronary artery bypass surgery is a difficult time for patients and families. Pre-operative cardiac rehabilitation may be safe and effective, but there is limited evidence regarding patients' experience and perceptions of such intervention. AIM To describe patients' experiences of a pre-operative programme of cardiac rehabilitation developed specifically for those awaiting coronary artery bypass surgery. METHOD A convenience sample of eight patients awaiting non-urgent surgery who had completed a 12 week pilot programme of cardiac rehabilitation were invited to be interviewed using a descriptive phenomenological approach. Domicillary interviews using an open technique were taped, transcribed and analysed using Colaizzi's framework. RESULTS Participants described this programme as a useful means of improving exercise capacity and decreasing anxiety. Through the combination of exercise, advice and support participants stated that their initial fear that exercise would cause a heart attack was replaced with confidence, enabling them to become fitter and modify other risk factors. CONCLUSIONS Findings of this study suggest that the programme was acceptable and perceived as beneficial by participants. Further research is required to evaluate the efficacy of pre-operative rehabilitation on risk factor modification.
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Affiliation(s)
- Maria Mooney
- Regional Cardiology Unit, Belfast City Hospital, Belfast BT9 7AB, Ireland
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17
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Kattainen E, Meriläinen P, Jokela V. CABG and PTCA Patients' Expectations of Informational Support in Health-Related Quality of Life Themes and Adequacy of Information in 1-Year Follow-Up. Eur J Cardiovasc Nurs 2016; 3:149-63. [PMID: 15234319 DOI: 10.1016/j.ejcnurse.2004.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2003] [Revised: 12/29/2003] [Accepted: 01/19/2004] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to describe coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) patients' need for nursing informational support in health-related (HRQoL) items before and after coronary artery procedures. As well we present the adequacy of informational support from patients' viewpoint. The study sample (N=625) consisted of consecutive male (N=439) and female (N=176) patients with CAD who were treated with elective CABG or PTCA. The data were collected by structured interview before coronary artery procedures and by mailed questionnaires 6 and 12 months afterwards in 1999-2001. Patients in both groups reported needing the most information about recovery and psychosocial functioning before and after the treatments. Single HRQoL items identified that the expectations of women and men differed during the follow-up period. Women in the PTCA group needed more informational support than men before procedures, while men needed more support afterwards. Our results suggest that the content of informational support is different for male and female patients before and after the coronary artery procedures. The effects of nursing interventions and instruments for measuring change in patients' outcome resulting from nursing interventions should be developed further.
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Affiliation(s)
- Eija Kattainen
- Department of Nursing Science, University of Kuopio, P.O. Box 1627, FIN-70211 Kuopio, Finland.
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18
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Kidd T, Poole L, Ronaldson A, Leigh E, Jahangiri M, Steptoe A. Attachment anxiety predicts depression and anxiety symptoms following coronary artery bypass graft surgery. Br J Health Psychol 2016; 21:796-811. [PMID: 26999442 PMCID: PMC5082502 DOI: 10.1111/bjhp.12191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/27/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Depression and anxiety are associated with poor recovery in coronary artery bypass graft (CABG) patients, but little is known about predictors of depression and anxiety symptoms. DESIGN We tested the prospective association between attachment orientation, and symptoms of depression and anxiety in CABG patients, 6-8 weeks, and 12 months following surgery. METHOD One hundred and fifty-five patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring attachment, depression, and anxiety prior to surgery, then 6-8 weeks, and 12 months after surgery. RESULTS Attachment anxiety predicted symptoms of depression and anxiety at both follow-up time points, whereas attachment avoidance was not associated with depression or anxiety symptoms. The findings remained significant when controlling for baseline mood scores, social support, demographic, and clinical risk factors. CONCLUSION These results suggest that attachment anxiety is associated with short-term and long-term depression and anxiety symptoms following CABG surgery. These results may offer important insight into understanding the recovery process in CABG surgery. Statement of contribution What is already known on this subject? Depression and anxiety symptoms are twice more likely to occur in coronary artery bypass graft (CABG) populations than in any other medical group. Depression and anxiety are associated with poor recovery following cardiac surgery. Predictors of depression and anxiety in CABG patients have been underexplored. What does this study add? This study highlights the importance of close interpersonal relationships on health. Attachment anxiety was prospectively associated with higher levels of depression and anxiety. These results add to understanding mechanisms linked to recovery following CABG.
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Affiliation(s)
- Tara Kidd
- Department of Epidemiology and Public Health, University College London, UK
| | - Lydia Poole
- Department of Epidemiology and Public Health, University College London, UK.
| | - Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, UK
| | - Elizabeth Leigh
- Department of Epidemiology and Public Health, University College London, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St. George's Hospital, University of London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, UK
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19
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Feria MI, Sarrazin MV, Rosenthal GE. Perceptions of Care of Patients Undergoing Coronary Artery Bypass Surgery in Veterans Health Administration and Private Sector Hospitals. Am J Med Qual 2016; 18:242-50. [PMID: 14717382 DOI: 10.1177/106286060301800604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few studies have examined differences in patient perceptions of care between health care systems. This study compared the perceptions of male patients undergoing coronary artery bypass graft surgery in 43 Veterans Health Administration (VA) hospitals (N = 808) and 102 US private sector hospitals (N = 2271) from 1995 to 1998. Patient perceptions were measured by a validated survey that was mailed to patients after discharge. For 8 of the 9 dimensions assessed by the survey, VA patients were more likely (P < .001) than private sector patients to note a problem with care (eg, Coordination, 48% versus 40%; Patient Education and Communication, 50% versus 40%; Respect for Patient Preferences, 49% versus 41%). In comparisons limited to major teaching hospitals, VA patients were more likely to note a problem for 5 dimensions. The findings indicate that patient perceptions of care may be lower in VA than in private sector hospitals. Future studies should examine whether the VA's recent focus on improving patient satisfaction has narrowed these differences.
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Affiliation(s)
- Mary I Feria
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA
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20
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Poole L, Ronaldson A, Kidd T, Leigh E, Jahangiri M, Steptoe A. Pre-surgical depression and anxiety and recovery following coronary artery bypass graft surgery. J Behav Med 2016; 40:249-258. [PMID: 27552993 PMCID: PMC5332487 DOI: 10.1007/s10865-016-9775-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
We aimed to explore the combined contribution of pre-surgical depression and anxiety symptoms for recovery following coronary artery bypass graft (CABG) using data from 251 participants. Participants were assessed prior to surgery for depression and anxiety symptoms and followed up at 12 months to assess pain and physical symptoms, while hospital emergency admissions and death/major adverse cardiac events (MACE) were monitored on average 2.68 years after CABG. After controlling for covariates, baseline anxiety symptoms, but not depression, were associated with greater pain (β = 0.231, p = 0.014) and greater physical symptoms (β = 0.194, p = 0.034) 12 months after surgery. On the other hand, after controlling for covariates, baseline depression symptoms, but not anxiety, were associated with greater odds of having an emergency admission (OR 1.088, CI 1.010–1.171, p = 0.027) and greater hazard of death/MACE (HR 1.137, CI 1.042–1.240, p = 0.004). These findings point to different pathways linking mood symptoms with recovery after CABG surgery.
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Affiliation(s)
- Lydia Poole
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Tara Kidd
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Elizabeth Leigh
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, University of London, Blackshaw Road, London, SW17 0QT, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
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21
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Abstract
Human beings with unmet needs related to their health and illnesses are the central focus of the domain of nursing. It is proposed in this column that nurses who conduct their practice from a nursing theory base, while assisting individuals and families to meet their health needs, are more likely to provide comprehensive, individualized care that exemplifies best practices. The Neuman systems model has been widely acclaimed to guide practice, yet specific examples are few in the published literature. The purpose of this column is to present two case studies based upon Neuman systems model; one case is directed toward family care, and the other demonstrates care with an individual. Theory-based exemplars serve as teaching tools for students and practicing nurses. These case studies illustrate how nurses' actions, directed by Neuman's wholistic principles, integrate evidence-based practice and generate high quality care.
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22
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Abstract
Little is known about the symptom experience throughout the trajectory of recovery for patients after coronary artery bypass surgery (CABS). This study investigates the preoperative and postoperative symptoms experienced by younger (< 65 years) and older (= 65 years) patients (N= 102) who had undergone CABS. Reported preoperative symptoms were angina, shortness of breath, dizziness, and sweating. At 1 week post-CABS, symptoms were incisional pain, wound drainage, chest congestion, shortness of breath, dizziness, sweating, swollen feet, and loss of appetite; incisional pain and swollen feet were reported by a few patients at 6 weeks after CABS. The incidence and frequency of postoperative symptoms declined over time. There were several age-related differences in symptom reports prior to and at 1 and 6 weeks after the procedure. Such information can be used to plan the care of patients undergoing CABS, to prepare them for normal recovery, and to determine the need for symptom management by health care providers.
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Affiliation(s)
- Kathleen H Miller
- Graduate School of Nursing, University of Massachusetts at Worcester, USA
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23
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Abstract
This article introduces the concept of clinical life to capture a form of life produced in the pursuit and wake of medically achieved longevity. Relying on the retrospective accounts of 28 individuals over age 70 who have undergone cardiac bypass surgery, angioplasty or a stent procedure, as well as interviews with their families and with clinicians, we examine three features of clinical life. First, patients do not distinguish between clinical possibility and clinical promise, and thus assume that life can and will be improved by medical intervention in late life. Rather than anticipating a range of potential treatment outcomes, patients therefore expect the best-case scenario: that medical procedures will reverse aging, disease and the march of time. Second, patients then assess the value of their post-procedure lives in accordance with that expectation. Norms regarding what life ‘should be like’ at particular ages are continually recalibrated to the horizon of what is clinically possible. And third, the price of living longer entails a double-edged relationship with the clinic – it generates opportunities for bodily restoration and increased self-worth but also creates ambivalence about the value of life. This latter feature of clinical life is rarely publicly acknowledged in an environment that emphasizes medical promise.
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24
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Abstract
This study examined associations between social sharing of emotions, social support and preoperative psychological distress. Social sharing was operationalized in terms of quantity and quality. Quantity of social sharing was measured daily using a diary method. Quality of social sharing was measured with the Quality of Sharing Inventory. Participants were 157 hospitalized Greek patients. Hierarchical regression analysis showed that controlling for distress on admission, quality of social sharing was negatively related to distress one day before surgery ( p < .01). No effects were found for quantity of social sharing. Results emphasize the importance of studying qualitative aspects of emotional disclosure.
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25
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Abstract
Recovery symptoms and related mood states during early recovery after coronary artery bypass graft surgery (CABG) have never been assessed in Thailand. This cross-sectional descriptive correlational study was to identify the relationships between frequency of recovery symptoms and mood states of a convenience sample of 91 Thai CABG patients during 2 weeks after discharge. Standardized tools/procedures were used to measure the variables of interest. The most common recovery symptoms were chest and leg incision pain, having trouble sleeping, and neck and shoulder or back discomfort. The most common mood states were confusion, anxiety, and anger, respectively. In addition, Thai CABG patients who had more frequent recovery symptoms also had greater negative mood disturbance. These findings provide a beginning explanation about the phenomena of recovery symptoms and mood states in a specific culture, Thai CABG patients.
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26
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Lenzen M, Scholte op Reimer W, Norekvål TM, De Geest S, Fridlund B, Heikkilä J, Jaarsma T, Mårtensson J, Moons P, Smith K, Stewart S, Strömberg A, Thompson DR, Wijns W. Pharmacological Treatment and Perceived Health Status During 1-Year Follow Up in Patients Diagnosed with Coronary Artery Disease, But Ineligible for Revascularization: Results from the Euro Heart Survey on Coronary Revascularization. Eur J Cardiovasc Nurs 2016; 5:115-21. [PMID: 16530486 DOI: 10.1016/j.ejcnurse.2006.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Accepted: 01/04/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularization (EHSCR) provided an opportunity to assess pharmacological treatment and outcome in patients with proven CAD who were ineligible for revascularization. METHODS We performed a secondary analysis of EHS-CR data. After excluding patients with ST-elevation myocardial infarction and those in whom revascularization was not indicated, 4409 patients remained in the analyses. We selected two groups: (1) patients in whom revascularization was the preferred treatment option (n = 3777, 86%), and (2) patients who were considered ineligible for revascularization (n = 632, 14%). RESULTS Patient ineligible for revascularization had a worse risk profile, more often had a total occlusion (59% vs. 37%, p < 0.001), were treated more often with ACE-inhibitors (65% vs. 55%, p < 0.001) but less likely with aspirin (83% vs. 88%, p < 0.001). Overall, they had higher case-fatality at 1-year (7.0% vs. 3.7%, p < 0.001). Regarding self-perceived health status, measured via the EuroQol 5D (EQ-5D) questionnaire, these same patients reported more problems on all dimensions of the EQ-5D. Furthermore, in the revascularization group we observed an increase between discharge and 1-year follow up (utility score from 0.85 to 1.00) whereas patients ineligible for revascularization did not improve over time (utility score remained 0.80) CONCLUSION In this large cohort of European patients with CAD, those considered ineligible for revascularization had more co-morbidities and risk factors, and scored worse on self-perceived health status as compared to revascularized patients in the revascularization group. With the exception of ACE-inhibitors and aspirin, there were no major differences regarding drug treatment between the two groups. Given these clinically significant observations, there appears to be a role for nurse-led, multidisciplinary, rehabilitation teams that target clinically vulnerable patients whose symptoms remain refractory to standard medical care.
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Affiliation(s)
- Mattie Lenzen
- Department of Cardiology, Clinical Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
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27
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Kattainen E, Meriläinen P, Sintonen H. Sense of Coherence and Health-Related Quality of Life among Patients Undergoing Coronary Artery Bypass Grafting or Angioplasty. Eur J Cardiovasc Nurs 2016; 5:21-30. [PMID: 15950540 DOI: 10.1016/j.ejcnurse.2005.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Revised: 03/20/2005] [Accepted: 05/04/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Every year, 4 million people die from cardiovascular disease (CAD) in Europe. As many as 800,000 of them die before they reach the age of 65. The ischemic heart disease is also the most common cause of death in Finland. The invasive treatments of the CAD, coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) relieve symptoms and increase patient's health-related quality of life (HRQoL) in most of the cases. In this paper sense of coherence is discussed as related to health-related quality of life among CABG and PTCA patients in a one-year follow-up. SAMPLE The study sample consisted of consecutive male (N=439) and female (N=176) patients who were treated with the elective CABG or PTCA. The baseline data before the interventions were collected by structured interviews, the follow-up data by mailed self-administered questionnaires six and twelve months afterwards. MEASURES The sense of coherence was studied by using a 13-item SOC scale. HRQoL was measured by the 15D. It is a generic, multidimensional, standardized, self-administered instrument, which has both a profile and single index score property. The differences in both groups were defined by using T-tests. Follow-up outcomes were analysed by using analyses of variance for repeated measures. RESULTS Health-related quality of life increased in both groups during the follow-up. There was a correlation between health-related quality of life and sense of coherence in CABG and PTCA patients' group at baseline. The mean score of the 15D was lower in moderate sense of coherence tertile than in strong sense of coherence tertile in both groups. After six and twelve months the similar tendency existed in health-related quality of life and sense of coherence; patients who had poor or moderate sense of coherence had lower health-related quality of life than the patients with strong sense of coherence. CONCLUSIONS Sense of coherence was more stable among CABG patients than PTCA patients. In PTCA patients' group sense of coherence decreased during the follow-up time. In both patients' group the health-related quality of life increased statistically significant by 6 months. No significant change in health-related quality of life took place in either group from 6 to 12 months.
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Affiliation(s)
- Eija Kattainen
- Department of Nursing Science, University of Kuopio, FIN-70211 University of Kuopio, P.O. Box 1627, Finland.
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Mendonça da Cunha DM, Dos Anjos TS, Franca Lisboa Gois C, Tavares de Mattos MC, Vale Carvalho L, de Carvalho J, Aragão Silva F, Almeida Silveira Sobral D, de Mendonça Fialho K, Llapa Rodriguez EO. Depressive symptoms in patients with coronary artery disease. Invest Educ Enferm 2016; 34:323-328. [PMID: 28569936 DOI: 10.17533/udea.iee.v34n2a12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 04/28/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the presence of depressive symptoms in patients with coronary artery disease in the preoperative period for coronary artery bypass surgery (CABG) in Aracaju, Sergipe, Brazil. METHODS A cross-sectional study with 63 hospitalized patients prior to CABG. Two instruments were used for data collection; one for the sociodemographic and clinical characteristics, and the other to evaluate the presence of depressive symptoms, Beck Depression Inventory (BDI). RESULTS The mean age was 58 years; most were male (60.3%); with a partner (81%) low educational level (71.4% attended school through elementary school). Among the patients, 36.5% were classified with dysphoria, and 25.4% had some degree of depression (6.3% mild, 17.5% moderate, and 1.6% severe). The group of patients with lower educational level presented higher depressive symptoms. CONCLUSION Six of every ten patients with coronary artery disease showed dysphoria or some degree of depression. The results of this study can support the planning of nursing care for patients before and after CABG, as well as the development of public health policies to ensure complete, quality care for these patients, understanding depression as a variable that can interfere with recovery after cardiac surgery.
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Chernyavsky AM, Efanova OS, Efendiyev VU, Sirota DA, Alyapkina EM. [Quality of Life of Patients With Ischemic Heart Disease and Pronounced Dysfunction of Left Ventricular Myocardium With Medical and Surgical Treatments]. Kardiologiia 2015; 55:5-13. [PMID: 26502496 DOI: 10.18565/cardio.2015.4.5-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We assessed quality of life in 80 patients with ischemic heart disease and pronounced dysfunction of left ventricular myocardium. Forty patients underwent coronary bypass surgery and 40 patients received only medical therapy. Duration of follow-up was 7 years. Baseline quality of life was low in both groups. Degree of its lowering was positively related to functional class of angina and heart failure and negatively - to exercise tolerance. Incessant drug treatment was associated with moderate improvement of quality of life both in groups of patients subjected and not subjected to surgery.
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Yang PL, Huang GS, Tsai CS, Lou MF. Sleep Quality and Emotional Correlates in Taiwanese Coronary Artery Bypass Graft Patients 1 Week and 1 Month after Hospital Discharge: A Repeated Descriptive Correlational Study. PLoS One 2015; 10:e0136431. [PMID: 26291524 PMCID: PMC4546334 DOI: 10.1371/journal.pone.0136431] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/03/2015] [Indexed: 12/16/2022] Open
Abstract
Background Poor sleep quality is a common health problem for coronary artery bypass graft patients, however few studies have evaluated sleep quality during the period immediately following hospital discharge. Purpose The aim of this study was to investigate changes in sleep quality and emotional correlates in coronary artery bypass graft patients in Taiwan at 1 week and 1 month after hospital discharge. Methods We used a descriptive correlational design for this study. One week after discharge, 87 patients who had undergone coronary artery bypass surgery completed two structured questionnaires: the Pittsburgh Sleep Quality Index and the Hospital Anxiety and Depression Scale. Three weeks later (1 month after discharge) the patients completed the surveys again. Pearson correlations, t-tests, ANOVA and linear multiple regression analysis were used to analyze the data. Results A majority of the participants had poor sleep quality at 1 week (82.8%) and 1 month (66.7%) post-hospitalization, based on the global score of the Pittsburgh Sleep Quality Index. Despite poor sleep quality at both time-points the sleep quality at 1 month was significantly better than at 1-week post hospitalization. Poorer sleep quality correlated with older age, poorer heart function, anxiety and depression. The majority of participants had normal levels of anxiety at 1 week (69.0%) and 1 month (88.5%) as measured by the Hospital Anxiety and Depression Scale. However, some level of depression was seen at 1 week (78.1%) and 1 month (59.7%). Depression was a significant predictor of sleep quality at 1 week; at 1 month after hospital discharge both anxiety and depression were significant predictors of sleep quality. Conclusion Sleep quality, anxiety and depression all significantly improved 1 month after hospital discharge. However, more than half of the participants continued to have poor sleep quality and some level of depression. Health care personnel should be encouraged to assess sleep and emotional status in patients after coronary artery bypass surgery and offer them appropriate management strategies to improve sleep and reduce anxiety and depression.
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Affiliation(s)
- Pei-Lin Yang
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Guey-Shiun Huang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Sung Tsai
- Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Meei-Fang Lou
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Acker JE, MacMorran PR, Friedlob JW, Wade CC. Assessing psychological problems from a cardiologist's point of view. Adv Cardiol 2015; 31:218-22. [PMID: 6983820 DOI: 10.1159/000407148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Herbeck Belnap B, Schulberg HC, He F, Mazumdar S, Reynolds CF, Rollman BL. Electronic protocol for suicide risk management in research participants. J Psychosom Res 2015; 78:340-5. [PMID: 25592159 PMCID: PMC4422492 DOI: 10.1016/j.jpsychores.2014.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe an electronic, telephone-delivered, suicide risk management protocol (SRMP) that is designed to guide research staff and safely triage study participants who are at risk for self-harm. METHODS We tested the SRMP in the context of the NIH-funded randomized clinical trial "Bypassing the Blues" in which 302 patients who had undergone coronary artery bypass graft surgery (CABG) were screened for depression and assessed by telephone 2-weeks following hospital discharge and at 2-, 4-, and 8-month follow-up. We programmed the SRMP to assign different risk levels based on patients' answers from none to imminent with action items for research staff keyed to each of them. We describe frequency of suicidal thinking, SRMP use, and completion of specific steps in the SRMP management process over the 8-month follow-up period. RESULTS Suicidal ideation was expressed by 74 (25%) of the 302 study participants in 139 (13%) of the 1069 blinded telephone assessments performed by research staff. The SRMP was launched in 103 (10%) of assessments, and the suicidal risk level was classified as moderate or high in 10 (1%) of these assessments, thereby necessitating an immediate evaluation by a study psychiatrist. However, no hospitalizations, emergency room visits, or deaths ascribed to suicidal ideation were discovered during the study period. CONCLUSION The SRMP was successful in systematically and safely guiding research staff lacking specialty mental health training through the standardized risk assessment and triaging research participants at risk for self-harm. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00091962 (http://clinicaltrials.gov/ct2/show/NCT00091962?term=rollman+cabg&rank=1).
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Affiliation(s)
- Bea Herbeck Belnap
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Herbert C Schulberg
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, United States
| | - Fanyin He
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Sati Mazumdar
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Pietrzyk E, Gorczyca-Michta I, Michta K, Nowakowska M, Wożakowska-Kapłon B. [Depression in patients after coronary artery bypass grafting]. Psychiatr Pol 2015; 48:987-96. [PMID: 25639018 DOI: 10.12740/pp/24426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Surgical revascularization is a recognized method of treatment ofischaemic heart disease. The number of patients undergoing coronary artery bypass grafting (CABG) is constantly increasing, both in a population of young patients with coronary heart disease and in elderly patients. It is estimated that even one out of three patients undergoing CABG in the perioperative period can develop symptoms of depression. Numerous individual factors as well as factors related to the surgery have an impact on the occurrence of depression. The most common factors are: age, sex, socio-economic status, co-existing diseases, and the occurrence ofpreoperative depression. Researchers are currently looking for biochemical markers concentration of which before surgery could serve as a predicator for the occurrence of post-CABG depression. It is suggested that inflammatory response, particularly intense in the perioperative period, is linked to the occurrence of depression after surgical revascularization. Recognizing these factors is of utmost importance since it will help develop a stratification aiming at the identification of patients who are particularly prone to the occurrence of postoperative depression. Due to the fact that depression not only lowers the quality of life but also affects the short-term and long-term prognosis, identifying patients at risk is significantly important.
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Abstract
Research that informs nursing interventions across the care continuum is vital, especially with shortened hospital stays. Measuring Quality of Life (QOL) and Health Related Quality of Life (HRQOL) helps identfy health status improvements, but fails to provide insight into the effectiveness of nursing interventions aimed at continuity of care. Four research examples illustrate the need for complementary, qualitative studies of what patients and their families think, feel, need and want. These indicate a need to reconceptualise the research agenda in terms of the complexity and settings of nursing practice, and the need for informational as well as statistical significance.
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Affiliation(s)
- Anne McMurray
- Research Centre for Clinical Practice Innovation, Griffith University, Southport, Queensland
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Nunes JKVRS, de Figueiredo Neto JA, de Sousa RML, Costa VLXDC, Silva FDMAM, da Hora AFLT, da Silva ELC, Reis LMCB. Depression after CABG: a prospective study. Braz J Cardiovasc Surg 2014; 28:491-7. [PMID: 24598954 PMCID: PMC4389428 DOI: 10.5935/1678-9741.20130080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 09/10/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Depression during or shortly after hospitalization elevated two to three times the risk of mortality or nonfatal cardiac events, significantly increasing the morbidity and mortality of these patients. OBJECTIVE To assess the impact of revascularization on symptoms of depression in patients with coronary artery disease. METHODS A prospective cohort study of 57 patients of both sexes undergoing coronary artery bypass grafting between June 2010 and June 2011. We used the SF-36 to assess quality of life, and the Beck Depression Inventory to detect depressive symptoms, applied preoperatively and six months. RESULTS The prevalence of patients aged 60-69 years was 22 patients (38.60%), 39 men (68.42%), 26 described themselves as mixed race (45.61%), 16 literate (28.07 %) and 30 married (52.63%). The beck depression inventory score demonstrated increased after revascularization: 15 patients mild (26.32%) at time zero to 17 (29.82%) after. And with moderate, seven patients (12.28%) before and 10 (17.54%) after. In the categories of individuals with decreased minimum degree of 32 (56.14%) to 28 (49.12%), and severe of three (5.26%) for two (3.51%) patients. Association was observed between beck depression inventory, gender, age, lifestyle, comorbidities and quality of life. CONCLUSION There was a high prevalence of elevated beck depression inventory scores, lowest scores of depressive symptoms among men and association between the improvement of quality of life scores and beck depression inventory.
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Affiliation(s)
- Joana Kátya Veras Rodrigues Sampaio Nunes
- Postgraduate Program in Health Sciences, Universidade Federal do
Maranhão (UFMA), São Luís, MA, Brazil
- Correspondence address: Joana Kátya Veras Rodrigues Sampaio,
Universidade Federal do Maranhão, Av. dos Portugueses, 1966 - Bacanga - São Luís, MA,
Brazil - Zip code: 65080-805. E-mail:
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My husband is scheduled for heart bypass surgery and is worried he will suffer cognitive decline as a result of the operation. Is he worrying needlessly, or is there real cause for concern? Duke Med Health News 2014; 20:8. [PMID: 25362739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Suzuki T, Asai T. [Informed consent: coronary artery bypass grafting]. Nihon Geka Gakkai Zasshi 2014; 115:247-252. [PMID: 25549431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Coronary artery bypass graft surgery (CABG) is well-documented procedure. Despite the increased prevalence of percutaneous coronary intervention (PCI), surgical revascularization will continue to have a major role in patients with coronary artery disease. As shown in previous clinical studies, physicians can provide important information about risk-adjusted outcomes to patients. A number of databases have been used to develop risk models for predicting morbidity and mortality in patients undergoing CABG. Patients must make a choice between CABG and PCI based on physicians' explanations. Major trials demonstrated a marked survival benefit from CABG among those patients at high risk of death from the disease itself as defined by the severity of angina, number of diseased vessels, and left ventricular function. However, it is not clear that patients always receive the correct information on whether CABG or PCI is the more appropriate procedure. The initial informed consent should be obtained using the relevant guidelines by an independent adviser.
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Affiliation(s)
- Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan
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Cintosun U, Safer U. Comment on "depression after CABG: a prospective study.". Braz J Cardiovasc Surg 2014; 29:289-90. [PMID: 25140482 PMCID: PMC4389468 DOI: 10.5935/1678-9741.20140077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Horne D, Kehler DS, Kaoukis G, Hiebert B, Garcia E, Chapman S, Duhamel TA, Arora RC. Impact of physical activity on depression after cardiac surgery. Can J Cardiol 2014; 29:1649-56. [PMID: 24267805 DOI: 10.1016/j.cjca.2013.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/04/2013] [Accepted: 09/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Physical activity is associated with a lower prevalence of depressive symptoms in cardiac patients. However, the benefits of physical activity on depression perioperatively are unknown. We sought to identify independent parameters associated with depression in patients undergoing cardiac surgery. METHODS Patients awaiting nonemergent cardiac surgery (n = 436) completed the Patient Health Questionnaire-9 (PHQ-9) to quantify depression (PHQ-9 score > 9). Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ-short) and accelerometry. Data collection occurred preoperatively (Q1, n = 436), at hospital discharge (Q2, n = 374), at 3 months (Q3, n = 318), and at 6 months (Q4, n = 342) postoperatively. Patients were categorized as "depression naive", "at risk" or "depressed" preoperatively. Physical inactivity was defined as < 600 metabolic equivalent min/wk. Independent perioperative variables associated with depression were identified with univariate and multivariate logistic regression. RESULTS Depression prevalence from Q1-Q4 was 23%, 37%, 21%, and 23%, respectively. Independent associations with depression were preoperative left ventricular ejection fraction < 50% (Q1, P < 0.05), physical inactivity (Q1, P < 0.05), baseline "at-risk" (Q2, P < 0.05), and baseline "depressed" groups (Q2-Q4, P < 0.05), hospital stay > 7 days (Q2, P < 0.05), postoperative stressful event (Q3 and Q4, P < 0.05), and cardiopulmonary bypass time > 120 minutes (Q4, P = 0.05). Newly depressed patients 6 months postoperatively reported lower IPAQ-short physical activity than depression-free patients (median change, -40 min/wk (interquartile range [IQR], -495 to +255) vs +213 min/wk (IQR, +150 to +830; P < 0.05). CONCLUSIONS Up to 40% of patients are depressed after cardiac surgery. Preoperative depression and postoperative stressful events were the strongest independent associations postoperatively. Physical inactivity was associated with preoperative depression and new depression 6 months postoperatively.
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Affiliation(s)
- David Horne
- Department of Surgery (Cardiac Surgery), University of Manitoba, Winnipeg, Manitoba, Canada
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Affiliation(s)
- Leonard Shan
- Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria (L.S., A.S., A.N.); Cardiology Unit, South Eastern Sydney and Illawarra Health Network, Wollongong, NSW (A.S., R.M.); and University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (A.N.)
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Abstract
OBJECTIVES To assess modifiable cognitive and behavioral factors following cardiac events and their association to patients' 3-month survival expectations. METHODS Patients (N = 233, 71% male; mean age 68years) hospitalized following cardiac events completed study packets assessing mood, behavior change, health behavior domains, and medical recommendation adherence at hospital discharge and 3 months later. RESULTS In univariate analyses, baseline depression, health distress, behavior change, and adherence were associated with positive expectations at follow-up. Multivariate regression analysis found (Adj. R²=0.43) baseline expectations and adherence were significant predictors of expectations for recovery and survival at follow-up (p < .01). CONCLUSION Patients' perception of adherence following a cardiac event is a potent predictor of later expectations.
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Affiliation(s)
- Lisa A Howell
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
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Meybohm P, Renner J, Broch O, Caliebe D, Albrecht M, Cremer J, Haake N, Scholz J, Zacharowski K, Bein B. Postoperative neurocognitive dysfunction in patients undergoing cardiac surgery after remote ischemic preconditioning: a double-blind randomized controlled pilot study. PLoS One 2013; 8:e64743. [PMID: 23741380 PMCID: PMC3669352 DOI: 10.1371/journal.pone.0064743] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 04/13/2013] [Indexed: 11/18/2022] Open
Abstract
Background Remote ischemic preconditioning (RIPC) has been shown to enhance the tolerance of remote organs to cope with a subsequent ischemic event. We hypothesized that RIPC reduces postoperative neurocognitive dysfunction (POCD) in patients undergoing complex cardiac surgery. Methods We conducted a prospective, randomized, double-blind, controlled trial including 180 adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were randomized either to RIPC or to control group. Primary endpoint was postoperative neurocognitive dysfunction 5–7 days after surgery assessed by a comprehensive test battery. Cognitive change was assumed if the preoperative to postoperative difference in 2 or more tasks assessing different cognitive domains exceeded more than one SD (1 SD criterion) or if the combined Z score was 1.96 or greater (Z score criterion). Results According to 1 SD criterion, 52% of control and 46% of RIPC patients had cognitive deterioration 5–7 days after surgery (p = 0.753). The summarized Z score showed a trend to more cognitive decline in the control group (2.16±5.30) compared to the RIPC group (1.14±4.02; p = 0.228). Three months after surgery, incidence and severity of neurocognitive dysfunction did not differ between control and RIPC. RIPC tended to decrease postoperative troponin T release at both 12 hours [0.60 (0.19–1.94) µg/L vs. 0.48 (0.07–1.84) µg/L] and 24 hours after surgery [0.36 (0.14–1.89) µg/L vs. 0.26 (0.07–0.90) µg/L]. Conclusions We failed to demonstrate efficacy of a RIPC protocol with respect to incidence and severity of POCD and secondary outcome variables in patients undergoing a wide range of cardiac surgery. Therefore, definitive large-scale multicenter trials are needed. Trial Registration ClinicalTrials.gov NCT00877305
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Affiliation(s)
- Patrick Meybohm
- Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
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Miller PS, Evangelista LS, Giger JN, Dracup K, Doering LV. Clinical and socio-demographic predictors of postoperative vital exhaustion in patients after cardiac surgery. Heart Lung 2013; 42:98-104. [PMID: 23453010 PMCID: PMC4455925 DOI: 10.1016/j.hrtlng.2013.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/04/2013] [Accepted: 01/04/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vital exhaustion, a psychological state characterized by extreme fatigue, is an independent predictor of future cardiac events. However, the attributes of vital exhaustion following coronary artery bypass (CABG) surgery are poorly understood. OBJECTIVE The study objective was to assess correlates of vital exhaustion following CABG surgery. METHODS In a descriptive, exploratory study, 42 patients who had CABG surgery were evaluated for exhaustion 4-8 weeks post-hospital discharge. Demographic and clinical data were obtained from self-report and medical chart review. RESULTS Of the total sample (mean age 67.9 ± 12.5, 90% male, 70% Caucasian, 3.12 ± 1.3 grafts), approximately 41% reported exhaustion. When compared to their exhausted post-CABG counterpart, non-exhausted post-CABG patients had a significantly higher frequency of preoperative insulin use. Exhausted patients were significantly more likely to have higher left ventricular ejection fraction ([LVEF], OR: 1.07, p = 0.04), and elevated hemoglobin (OR: 2.98, p = 0.03) and eosinophils (OR: 1.02, p = 0.02) than those who were not exhausted. CONCLUSION Clinicians should evaluate all patients for exhaustion post-CABG surgery; patients with elevated LVEF, hemoglobin, and eosinophil levels warrant increased scrutiny.
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Affiliation(s)
- Pamela S. Miller
- Postdoctoral Scholar, School of Nursing, University of California, San Francisco, 2 Koret Way, N411Y, Box 0606, San Francisco, California, USA 94143-0606
| | - Lorraine S. Evangelista
- Associate Professor, Program in Nursing Science, College of Health Sciences, University of California, Irvine, 231 Irvine Hall, Irvine, California, USA 92697-3959
| | - Joyce Newman Giger
- Professor, School of Nursing, University of California, Los Angeles BOX 956919, 5-234 Factor Los Angeles, California, USA, 90095-6919
| | - Kathleen Dracup
- Professor, School of Nursing, University of California, San Francisco, 2 Koret Way, N631, Box 0610, San Francisco, California, USA 94143-0610
| | - Lynn V. Doering
- Professor, School of Nursing, University of California, Los Angeles BOX 956918, 4-250 Factor Los Angeles, California, USA, 90095-6918
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Trubnikova OA, Tarasova IV, Syrova ID, Mamontova AS, Kovalenko AV, Barbarash OL, Barbarash LS. [Neuropsychological status of patients with low and moderate carotid artery stenoses after the coronary artery bypass surgery]. Zh Nevrol Psikhiatr Im S S Korsakova 2013; 113:28-33. [PMID: 23612407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of the study was a comparative evaluation of a neurological and neuropsychological status of patients with and without carotid artery stenoses less than 50% after coronary artery bypass grafting. The study involved 65 patients divided into two groups: the first group included 35 patients (mean age 56.2±5.7 years) without carotid artery stenoses, the second group included 30 patients (56.8±5.5 years) with the presence of carotid artery stenoses. Initially, all patients had comparable clinical parameters. Before surgery, the high frequency of asthenic, vestibulopathic and vestibular-atactic syndromes was observed in patients with the presence of low and moderate stenoses of carotid arteries compared to patients without stenoses. After coronary artery bypass grafting, the neurological status of patients became worse in both groups. Patients with the presence of low and moderate stenoses of carotid arteries performed worse on neuropsychological tests one month after surgery.
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Sumin AN, Gaĭfulin RA, Mos'kin MG, Korok EV, Shcheglova AV, Raĭkh OI, Ivanov SV, Barbarash OL. [Quality of life of patients after coronary bypass surgery: effect of age and personality type D]. Kardiologiia 2013; 53:68-76. [PMID: 24090390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To study effect of age and presence of personality type D on quality of life (QL) of patients in one year after coronary bypass surgery (CBS). MATERIAL AND METHODS Assessment of QL before and after surgery was carried out in 408 patients. Two groups were formed: patients younger than 60 years (n=233) and older than 60 years (n=175). Quality of life and presence of personality type D was assessed by questionnaires SF-36 and DS-14, respectively. RESULTS In a year after CBS improvement of physical and psychological components of QL (p<0.05) was noted in both groups. Personality type D was more frequent among patients older than 60 years (p<0.01). Patients with personality type D had worse parameters of irrespective of age (p<0.01). Personality type D correlated directly with age QL (p=0.003) and inversely with parameters of QL (p<0.01). Presence of personality type D was an independent predictor of low level of physical (together with index of atherogenecity prior to surgery) and psychological components of QL at multiple logistic regression analysis. CONCLUSION Assessment of personality traits of patients before CBS can be helpful for targeted measures aimed at improvement of QL what is especially important for older age groups.
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Affiliation(s)
- A N Sumin
- Research Institute for Complex Issues of Cardiovascular Diseases of SB of the RAMS, Sosnovy boul. 6, 650002 Kemerovo, Russia
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Laferton JAC, Shedden Mora M, Auer CJ, Moosdorf R, Rief W. Enhancing the efficacy of heart surgery by optimizing patients' preoperative expectations: study protocol of a randomized controlled trial. Am Heart J 2013; 165:1-7. [PMID: 23237127 DOI: 10.1016/j.ahj.2012.10.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/05/2012] [Indexed: 12/19/2022]
Abstract
In coronary heart disease (CHD) and heart surgery, there is sound evidence for the relationship between patients' expectations and treatment outcome, especially for outcome variables such as disability and quality of life. In addition, patients' expectations have been shown to be modifiable through psychological interventions. Therefore, targeting patients' expectations might offer a promising opportunity to enhance heart surgery outcome. However, few studies have tried to actively change patients' expectations before surgery. The purpose of this clinical trial is to optimize patients' outcome expectations before undergoing coronary artery bypass graft surgery (CABG) through a brief psychoeducational program. The present article describes the study protocol and reports preliminary data on feasibility. Using a randomized controlled design, 180 patients who are scheduled to undergo elective CABG are randomly assigned to either (1) standard medical care (SMC) alone, (2) to an additional expectation manipulation intervention during the 2 weeks before surgery, and (3) to an additional attention-control group ("supportive therapy"). The main goal is to test (a) whether expectation manipulation intervention can optimize patients' expectations and (b) whether optimized expectations lead to enhanced surgery efficacy. The primary outcome variable is illness-related disability 6 months after surgery, whereas secondary outcome variables will be quality of life, return to work, physical activity, and medical outcome variables. First, feasibility data of 36 patients show that the patients appreciated the additional psychological intervention before CABG. Satisfaction of those who received psychological interventions was very high.
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Affiliation(s)
- Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, Marburg, Germany.
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Trede AK, Kramer RS. Depression and cardiac surgery: underrecognized and undertreated. J Extra Corpor Technol 2012; 44:233-4. [PMID: 23441565 PMCID: PMC4557566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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49
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Recovering from coronary bypass surgery. Here's what you can do to get back on your feet quickly. Harv Heart Lett 2012; 23:5. [PMID: 23476946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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50
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Tully PJ. Psychological depression and cardiac surgery: a comprehensive review. J Extra Corpor Technol 2012; 44:224-232. [PMID: 23441564 PMCID: PMC4557565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 11/15/2012] [Indexed: 06/01/2023]
Abstract
The psychological and neurological impact of cardiac surgery has been of keen empirical interest for more than two decades although reports showing the prognostic influence of depression on adverse outcomes lag behind the evidence documented in heart failure, myocardial infarction, and unstable angina. The paucity of research to date is surprising considering that some pathophysiological mechanisms through which depression is hypothesized to affect coronary heart disease (e.g., platelet activation, the inflammatory system, dysrhythmias) are known to be substantially influenced by the use of cardiopulmonary bypass. As such, cardiac surgery may provide a suitable exemplar to better understand the psychiatric mechanisms of cardiopathogenesis. The extant literature is comprehensively reviewed with respect to the deleterious impact of depression on cardiac and neuropsychological morbidity and mortality. Research to date indicates that depression and major depressive episodes increase major cardiovascular morbidity risk after cardiac surgery. The association between depressive disorders and incident delirium is of particular relevance to cardiac surgery staff. Contemporary treatment intervention studies are also described along with suggestions for future cardiac surgery research.
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Affiliation(s)
- Phillip J Tully
- Department of Surgery, Flinders Medical Centre and Flinders University of South Australia, Bedford Park, SA, Australia.
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