ABSTRACT
Functional mitral regurgitation (MR; FMR) is the most common type of MR and its development is associated with increased morbidity and mortality. Leaflet tethering with apical shift of the papillary muscle due to adverse left ventricular remodeling and loss of normal leaflet coaptation is the principal mechanism of FMR. Echocardiography plays a central role in the assessment of the FMR. The development of 3D echocardiography has allowed for assessment of the geometric changes of mitral valve morphology and spatial relationship with the left ventricle that accompanies FMR. 2D/3D echocardiographic findings, clinical outcomes of FMR are reviewed and role of surgical intervention is discussed.
Subject(s)
Echocardiography, Three-Dimensional , Heart Valve Prosthesis Implantation , Hemodynamics , Mitral Valve Annuloplasty , Mitral Valve Insufficiency , Mitral Valve , Heart Valve Prosthesis Implantation/adverse effects , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Mitral Valve/surgery , Mitral Valve Annuloplasty/adverse effects , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Mitral Valve Insufficiency/surgery , Predictive Value of Tests , Recovery of Function , Treatment OutcomeABSTRACT
BACKGROUND: There has been little evaluation or development of nurse observation charts on psychiatric in-patient units since they were first introduced. AIM: We aimed to develop a new nursing chart that adds a functional and contextual assessment of the observed behaviour. We describe its initial evaluation in an in-patient setting. METHOD: A member of the staff coded a participant's behaviour as either an instance of an individual's daily life problem; or an improvement; or a non-clinically relevant behaviour. We evaluated the charts in 14 in-patients and compared the coding of the behaviour against that of one of the investigators. RESULTS: After brief training the inter-rater agreement resulted in Kappa = 0.496 with p < .001. Removal of a rating of neutral behaviours resulted in a higher Kappa = 0.546 with p < .001. CONCLUSIONS: The inter-rater reliability was only moderate for the Functional Analytical Nurse Observation Charts. Frequent training and support from management and therapy staff is required to maintain a psychologically informed environment and observation in an in-patient setting. An area for further research is to explore the impact that a FANOC has on staff satisfaction and an individual's experience of care, and whether it can assist in determining mediators of change before an improvement in symptoms.
