RESUMEN
BACKGROUND: Takotsubo cardiomyopathy is a reversible condition mimicking acute myocardial infarction. The phenomenon is associated with emotional and physical stressful trigger events. Evidence-based patient counselling should be based on disease-specific knowledge of patient experiences. AIM: The aim of the study was to describe women's experiences of Takotsubo cardiomyopathy in a short-term perspective. DESIGN: The study design was explorative and descriptive. METHOD: Semi-structured interviews were conducted with 14 women diagnosed with Takotsubo cardiomyopathy, 1 day to 9 months after hospitalisation. The transcriptions underwent qualitative content analysis. FINDINGS: The main theme that emerged was Takotsubo cardiomyopathy as a continuous process of making sense and adapting. To begin with, understanding and coping with signs and symptoms were described as having a diversity of signs and symptoms, taking actions towards signs and symptoms, receiving treatment for suspected ST/non ST-elevation myocardial infarction diagnosis and finally being diagnosed with Takotsubo cardiomyopathy. Understanding the context of illness was expressed as getting treated for Takotsubo cardiomyopathy diagnosis and having previous stressful conditions of life. The changing perspective that emanated was a combination of having prospects and expectations and experiencing limitations. Finally, managing to live with Takotsubo cardiomyopathy was manifested as returning home with the illness and receiving follow-up health care. CONCLUSION: Information on regaining prior health status and capacity within a short-term perspective may not be accurate. These women struggle and require education and counselling from healthcare professionals to comprehend and manage having a Takotsubo cardiomyopathy diagnosis. Women experiencing Takotsubo cardiomyopathy may be a target group for holistic and individual health care with a longer duration of follow-up.
Asunto(s)
Adaptación Psicológica , Infarto del Miocardio/fisiopatología , Estrés Psicológico/complicaciones , Cardiomiopatía de Takotsubo/etiología , Anciano , Demografía , Femenino , Humanos , Acontecimientos que Cambian la Vida , Persona de Mediana Edad , Investigación Cualitativa , Estrés Psicológico/fisiopatología , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/fisiopatologíaRESUMEN
BACKGROUND: The aim of this randomized study was to compare patient-reported outcome after laparoscopic versus open donor nephrectomy during 1 year follow-up. The evidence base has so far not allowed for a decision as to which method is superior as seen from a long-term quality of life-perspective. METHODS: The donors were randomized to laparoscopic (n=63) or open (n=59) nephrectomy, with follow-up at 1, 6, and 12 months. Primary outcomes were health status (SF-36) and overall quality of life (QOLS-N). Secondary outcomes were donor perception of the surgical scar, the donation's impact on personal finances, and whether the donor would make the same decision to donate again. RESULTS: There was a significant difference in favor of laparoscopic surgery regarding the SF-36 subscale bodily pain at 1 month postoperatively (P<0.05). Analysis based on intention to treat revealed no long-term differences between groups in SF-36 scores. When subtracting the reoperated/converted donors of the laparoscopic group, significant differences in favor of laparoscopy were revealed in the subscales bodily pain at 6 months (P<0.05) and social functioning at 12 months (P<0.05). No significant differences were found in QOLS-N scores between groups. CONCLUSIONS: Laparoscopic donor nephrectomy is an attractive alternative to open donor nephrectomy because of less postoperative pain. However, long-term comparison only revealed significant differences in favor of laparoscopy when adjusting for reoperations/conversions. Both groups reached baseline scores in most SF-36 subscales at 12 months and this may explain why possible minor benefits are hard to prove.
Asunto(s)
Laparoscopía , Donadores Vivos , Nefrectomía/métodos , Calidad de Vida , Adulto , Femenino , Estado de Salud , Humanos , Relaciones Interpersonales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/fisiopatología , Periodo Posoperatorio , Factores de TiempoRESUMEN
BACKGROUND: Our aim was to investigate the existence of a reciprocal relationship between patients' assessment of quality of life and their appraisal of health. If present, this relationship will interfere with the interpretation of heart surgery's effect on overall quality of life. METHODS: Path analysis was used to investigate reciprocal causal relationships between general health perceptions and overall quality of life before and after heart surgery. Longitudinal data from a study of coronary artery bypass surgery were used to model lagged, cross-lagged, and simultaneous paths over four time-points of assessment from before surgery to one year afterwards. The conceptual framework for the analysis was the Wilson and Cleary causal pathway model. General health perceptions were measured with the Short Form 36. Overall quality of life was measured with i) a single question regarding life satisfaction and ii) the multi-item Quality of Life Survey. RESULTS: Acceptable model fit was obtained for reciprocal causation between general health perceptions and overall quality of life. Regression coefficients changed over different phases of rehabilitation. Serial correlation accounted for much of the variance within variables over time. CONCLUSION: The present analysis demonstrates that unidirectional models of causality are inadequate to explain the effect of heart surgery on overall quality of life. Overall quality of life can causally influence as well as be an outcome of health status after coronary artery bypass surgery.
Asunto(s)
Actitud Frente a la Salud , Puente de Arteria Coronaria/psicología , Evaluación de Resultado en la Atención de Salud/métodos , Psicometría/instrumentación , Calidad de Vida/psicología , Perfil de Impacto de Enfermedad , Causalidad , Vías Clínicas , Estado de Salud , Humanos , Noruega , Satisfacción Personal , Análisis de Regresión , Encuestas y CuestionariosAsunto(s)
Objetivos , Desarrollo Sostenible , Curriculum , Salud Global , Humanos , Investigación en Educación de EnfermeríaRESUMEN
BACKGROUND: Very few randomized studies on laparoscopic (L) versus open (O) living-donor nephrectomy (LDN) have been presented. The largest randomized series reported so far included 80 donors. In 2000, an Australian safety group concluded that the evidence base for L-LDN is inadequate to make recommendations regarding safety and efficacy. METHODS: With this background, at our single national center, 122 donors were randomized to left-sided L-LDN (n=63) or O-LDN (n=59), from February 2001 to May 2004. This article summarizes our experiences, in particular regarding complications and safety. RESULTS: There were significant differences in favor of O-LDN regarding operative time, warm ischemia time, and vessel lengths, whereas the analgesic requirements and pain data were significantly in favor of the laparoscopic procedure. In the L-LDN group, there were five major postoperative complications resulting in reoperations (8%), including two intestinal perforations. No major complications occurred in the O-LDN group. CONCLUSIONS: These results from our randomized study do suggest that conventional O-LDN is a very secure procedure, superior to L-LDN regarding donor safety. There has been an unacceptably high rate of reoperations in our L-LDN series but without mortality or significant sequelae. A careful look at some other L-LDN series also suggests increased morbidity/mortality. Our data do, however, support the view that a perfect, uncomplicated L-LDN appears to be the superior procedure, and the laparoscopic procedure is still evolving. Donor safety may be improved by avoiding obese donors, stapling of the renal artery (not clipping), and perhaps by hand assistance. Furthermore, we will consider the retroperitoneal approach.
Asunto(s)
Laparoscopía/métodos , Laparoscopía/normas , Donadores Vivos , Nefrectomía/métodos , Complicaciones Posoperatorias/epidemiología , Analgésicos/uso terapéutico , Pérdida de Sangre Quirúrgica , Humanos , Nefrectomía/normas , Complicaciones Posoperatorias/prevención & control , Periodo Posoperatorio , SeguridadRESUMEN
BACKGROUND: Although controversial, physical restraints are commonly used in adult critical care units in the United States to prevent treatment interference and self-inflicted harm. Use of physical restraints in Norwegian hospitals is very limited. In the United States, an experimental design for research on use of restraints has not seemed feasible. However, international research provides an opportunity to compare and contrast practices. OBJECTIVES: To describe the relationship between patients' characteristics, environment, and use of physical restraints in the United States and Norway. METHODS: Observations of patients and chart data were collected from 2 intensive care units (n = 50 patients) in Norway and 3 (n = 50 patients) in the United States. Sedation was measured by using the Sedation-Agitation Scale. The Nine Equivalents of Nursing Manpower Use Score was used to indicate patients' acuity level. RESULTS: Restraints were in use in 39 of 100 observations in the United States and not at all in Norway (P = .001). Categories of patients were balanced. In the Norwegian sample, the median Nine Equivalents of Nursing Manpower Use Score was higher (37 vs 27 points, P < .001), patients were more sedated (P < .001), and nurse-to-patient ratios were higher (1.05:1 vs 0.65:1, P < .001). Seven incidents of unplanned device removal were reported in the US sample. CONCLUSIONS: Critical care units with similar technology and characteristics of patients vary between nations in restraint practices, levels of sedation, and nurse-to-patient ratios. Restraint-free care was, in this sample, safe in terms of treatment interference.
Asunto(s)
Cuidados Críticos , Diversidad Cultural , Restricción Física/estadística & datos numéricos , Adulto , Humanos , Unidades de Cuidados Intensivos , Noruega , Estados UnidosRESUMEN
OBJECTIVE: Although health status after coronary artery bypass grafting improves at the group level, individual outcomes demonstrate variation. We aimed to evaluate relative importances of changes in cardiac and cognitive function and symptom status regarding physical and mental health at 1 year after coronary artery bypass grafting. METHODS: Outcomes in multivariable regression analysis (n = 86) were self-reported physical and mental health (Medical Outcomes Study 36-Item Short Form) at 12 months' follow-up, adjusting for baseline. Independent variables were change in exercise capacity (staged ergometer protocol), cognitive function (neurocognitive test battery), and self-reported improvement of angina. Graft patency was evaluated by angiography (82/86 patients). RESULTS: After surgery, health status was comparable to the age- and sex-matched population norm. Improvement of angina was associated with gain in physical health in the range of 0.5 SD (beta = 0.23, P = .012). Change in observed physical exercise capacity (mean +/- SD 199 +/- 426 W x min) accounted for 9% of variance in physical health (beta = 0.42, P = .001). Positive change in cognitive function was significantly related to mental (beta = 0.52, P = .007) but not physical health. Graft occlusion (22/82 patients) was not significantly related to health status. CONCLUSIONS: Individual variation in objective functional performance and symptom relief is significant for self-reported health status, beyond the predictive ability of preoperative health status, sex, and graft patency. Awareness of the extent and impact of outcome variation is important when counseling patients before and after coronary artery bypass grafting.
Asunto(s)
Angina de Pecho/prevención & control , Cognición , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Tolerancia al Ejercicio , Grado de Desobstrucción Vascular , Anciano , Angina de Pecho/etiología , Angina de Pecho/fisiopatología , Angina de Pecho/psicología , Distribución de Chi-Cuadrado , Angiografía Coronaria , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/psicología , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/psicología , Prueba de Esfuerzo , Femenino , Indicadores de Salud , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Análisis de Regresión , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Kidney transplantation is an essential part of care for patients with end-stage renal disease. The introduction of laparoscopic living-donor nephrectomy (LLDN) has made live donation more advantageous because of less postoperative pain, earlier return to normal activities, and a consequent potential to increase the pool of kidney donors. However, the cost effectiveness of LLDN remains unknown. The aim of this study was to explore the health and cost consequences of replacing open-donor nephrectomy by LLDN. METHODS: Kidney donors were randomized to laparoscopic (n=63) or open surgery (n=59). We obtained data on operating time, personnel costs, length of stay, cost of analgesic, disposable instruments and complications, and indirect costs. Quality of life was captured before the operation and at 1, 6, and 12 months postdonation by means of short form-36. The scores were translated into utilities by means of Brazier's 6D algorithm. RESULTS: The cost per patient was U.S. $55,292 with laparoscopic and U.S. $29,886 with open surgery. The greatest cost difference was in costs attributed to complications (U.S. $33,162 vs. U.S. $4,573). The 1-year quality-adjusted life years (QALYs) were 0.780 and 0.765, respectively for laparoscopic and open surgery. This implies a cost of U.S. $1,693,733 per QALY at 12 months follow-up. Sensitivity analyses indicated that the cost of the major complications in the laparoscopic group and magnitude of QALY gain had the greatest impact on cost effectiveness. CONCLUSIONS: The LLDN is an attractive alternative because it, in general, entails less postoperative pain than open surgery, but it is cost effective only with relatively low rates of complications.
Asunto(s)
Laparoscopía/economía , Donadores Vivos , Nefrectomía/economía , Recolección de Tejidos y Órganos/economía , Adulto , Anciano , Análisis Costo-Beneficio , Empleo/economía , Familia , Femenino , Humanos , Tiempo de Internación/economía , Masculino , Persona de Mediana Edad , Noruega , Complicaciones Posoperatorias/economía , Distribución Aleatoria , Arteria Renal/cirugía , Reoperación/economía , Recolección de Tejidos y Órganos/métodosRESUMEN
Very few studies have prospectively followed living kidney donors the first year after donor surgery. In 2003, we in-depth interviewed living kidney donors one wk after donation to explore their immediate experiences of going through nephrectomy. The aim of the current investigation was to explore experiences regarding physical and psychosocial health during the first year after donor surgery. Twelve donors going through open donor nephrectomy were interviewed by telephone at one yr after donation. The analysis was carried out with an empirical phenomenological method. All participants expressed an overall positive experience about being a donor a year after transplantation. However, several participants experienced physical disincentives longer than expected post-donation. Emotional distress, such as mild depression and a feeling of loss, was also part of the donor experiences. Donors experiencing unsuccessful recipient outcome reported severe physical and mental reactions. This study provides insights on the physical and mental cost to living kidney donation. Awareness of how donors may experience their situations can help transplantation professionals in their efforts to understand and provide support.
Asunto(s)
Entrevistas como Asunto/métodos , Trasplante de Riñón/métodos , Donadores Vivos , Nefrectomía/psicología , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Trasplante de Riñón/psicología , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Estudios RetrospectivosRESUMEN
BACKGROUND: After more than a decade of experience with off-pump coronary bypass surgery, still no consensus exists concerning its benefit on clinical outcome compared to the on-pump technique. In this 12-month follow-up, we compare off-pump and on-pump surgery on the appearance of graft patency, myocardial function, and clinical outcome. METHODS: One hundred twenty patients were randomized to off-pump or on-pump coronary surgery. Angiography was performed intraoperatively, at 3 and 12 months. Global myocardial function was estimated by magnetic resonance imaging (MRI) preoperatively and 12 months postoperatively, as well as functional class and stress testing. RESULTS: After 12 months internal mammary artery patency was 94% in the off-pump group and 96% in the on-pump group. Vein graft patency was 80% and 87%, respectively. No statistically significant difference between the two groups existed. There were no differences in exercise capacity improvement and attenuation of symptoms between the groups. CONCLUSIONS: At 12-months follow-up, off-pump coronary bypass surgery provided the same angiographic graft patency as the on-pump technique. Improvement in functional class and exercise capacity was the same in both groups.
Asunto(s)
Angiografía Coronaria , Puente de Arteria Coronaria Off-Pump/estadística & datos numéricos , Reestenosis Coronaria/epidemiología , Anciano , Angina de Pecho/epidemiología , Reestenosis Coronaria/diagnóstico por imagen , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/epidemiología , Humanos , Anastomosis Interna Mamario-Coronaria , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Miocardio/patología , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Vena Safena/trasplante , Método Simple Ciego , Resultado del TratamientoRESUMEN
In Norway living kidney donors account for approximately 40% of all renal transplants. There is a shortage of information about how living kidney donors experience the donation process during the initial recovery from surgery. The aim of this study was to explore physical and psychosocial issues related to the experiences of living kidney donors 1 wk after open donor nephrectomy. A total of 12 living kidney donors participated in the study. Data were collected by individual in-depth interviews and analysed using empirical phenomenological method. Being a living kidney donor is a complex experience. The informants expressed strong feelings of responsibility and obligation concerning the recipients and had a positive attitude towards the donation. On the other hand, the donors experienced it strange to be a fit individual and go through a major operation. Several of the donors reported that it was painful to go through donor surgery and regarded the recovery period as troublesome. Some donors also reported the double role of being both a patient and a relative to be a stressful experience. This study reveals the importance of being aware of the complex situation of living kidney donors. Health professionals need to understand the nature of the donation process and the donors' needs. It is essential to focus on physical, mental and interpersonal factors when counselling potential living kidney donors.
Asunto(s)
Relaciones Interpersonales , Trasplante de Riñón/psicología , Donadores Vivos/psicología , Nefrectomía/psicología , Adolescente , Adulto , Altruismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , NoruegaRESUMEN
BACKGROUND: Risk assessment is integral to patient selection and counseling before coronary artery revascularization. We studied the predictive ability of cerebral magnetic resonance imaging of preoperative and postoperative cerebral ischemic injury on self-reported physical and mental health at 3 months after coronary artery bypass surgery with or without use of cardiopulmonary bypass. METHODS: In a prospective clinical trial comparing on-pump and off-pump surgery, 120 patients responded to a questionnaire for self-report of angina (Canadian Cardiovascular Society scale) and physical and mental health status (Short Form 36) at baseline before preoperative cerebral magnetic resonance imaging. Preoperative sets of both magnetic resonance imaging and self-assessments were available for 103 (85.8%) patients. These patients were grouped according to classification of preoperative cerebral magnetic resonance imaging findings. Analysis of covariance determined the association of (1) preoperative magnetic resonance imaging status, (2) new postoperative cerebral lesions, and (3) actual use of cardiopulmonary bypass to physical and mental health. RESULTS: At 3 months after surgical intervention, 98 of 103 patients completed follow-up. The analysis revealed an interaction effect of preoperative cerebral ischemic injury and use of cardiopulmonary bypass on physical health (F = 9.07, P = .003) independent of age. No independent effects on health status were found of baseline magnetic resonance imaging or new cerebral lesions at 3 months. CONCLUSIONS: This study strongly suggests that the combination of preoperative cerebral ischemic injury and use of cardiopulmonary bypass can predict postoperative health status at 3 months. Cerebral magnetic resonance imaging might be a more specific indicator than age for preoperative assessment of vulnerability or resilience during rehabilitation after on-pump cardiac surgery.
Asunto(s)
Isquemia Encefálica/diagnóstico , Puente de Arteria Coronaria , Estado de Salud , Imagen por Resonancia Magnética , Adulto , Anciano , Anciano de 80 o más Años , Puente Cardiopulmonar , Puente de Arteria Coronaria/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Clinical experience with off-pump coronary artery bypass surgery raises the question of a patient experienced benefit compared with on-pump surgery. This prospective and randomized study compared patient-reported outcome between surgical groups, as change scores at 3 months after surgery and longitudinally as time-averaged change from baseline through the first year after surgery. METHODS: In all, 120 patients were randomly assigned to on- or off-pump coronary artery surgery. A questionnaire for patient self-report of angina (Canadian Cardiovascular Society scale), health status (Short Form 36, sleep and sexual difficulty), and overall quality of life (Quality of Life Scale) was administered at baseline and at 3, 6, and 12 months after surgery. RESULTS: Patient groups were comparable with regard to age, symptoms, comorbidity, and surgical characteristics. Both groups experienced a median of two classes relief of angina at 3 months (p < 0.0005), maintained throughout follow-up. Paired t tests revealed significant improvement on all Short Form 36 subscales at 3 months after surgery, with the exception of physical role functioning in the on-pump group. No independent main effects of surgical group were observed in the between-groups covariance models. The longitudinal effect of sex was significant in four Short Form 36 subscales: physical functioning, bodily pain, and role limitation due to physical or emotional problems. Overall quality of life scores were stable in both groups. CONCLUSIONS: Both on-pump and off-pump patients reported less angina and improved health status after surgery. There were no significant differences between surgical groups in health status or overall quality of life, neither cross-sectionally nor longitudinally.