Biomedical subjects

D Ulmer

Publications and source records attributed to D Ulmer.

15 recordsLinked to original sources

PubMed1996

Stress management for the cardiovascular patient: a look at current treatment and trends.

Recent research findings in psychoneurobiology are increasing our clinical knowledge of how emotions and mental stress impact the cardiovascular system. Clinical trial results strongly suggest that morbidity and mortality in cardiac patients can be improved when stress management is a part of a comprehensive treatment plan. This article discusses the state of stress management in current treatment and examines some of the newer interventions and techniques being used to address this risk factor. Recommendations for integration of stress reduction into cardiovascular treatment are outlined, with an emphasis on the role of the nurse.

Adaptation, Psychological↗

PubMed1987

Effect of discontinuance of type A behavioral counseling on type A behavior and cardiac recurrence rate of post myocardial infarction patients.

Three hundred post infarction participants who had received type A behavioral counseling in the Recurrent Coronary Prevention Project, (RCPP) agreed to be followed for 1 additional year after stopping 4.5 years of continuous type A behavioral counseling. One hundred fourteen participants who had served for 4.5 years as controls in the RCPP Study, thus receiving no type A behavioral counseling, volunteered to receive such counseling for 1 year. Eleven of the 300 previously type A counseled RCPP participants were lost to follow-up at the end of the additional year. The remaining 289 subjects at risk were found to have maintained their previously reduced intensity of type A behavior. Their previously observed relatively low cardiac recurrence rate during the additional year also did not significantly change. Ten of the 114 previous control RCPP participants were lost to follow-up at the end of the additional year. The remaining 104 subjects who had received a year's type A behavioral counseling showed a significantly reduced intensity of type A behavior and a similar significant decrease in both the cardiac mortality and morbidity rate. These results suggest that the decline in the intensity of type A behavior and also in the cardiac recurrence rate previously observed in post infarction subjects exposed to type A behavioral counseling persists for at least 1 year after cessation of such counseling.

Counseling↗

PubMed1986

Alteration of type A behavior and its effect on cardiac recurrences in post myocardial infarction patients: summary results of the recurrent coronary prevention project.

One thousand thirteen post myocardial infarction patients were observed for 4.5 years to determine whether their type A (coronary-prone) behavior could be altered and the effect such alteration might have on the subsequent cardiac morbidity and mortality rates of these individuals. Eight hundred sixty-two of these individuals were randomly assigned either to a control section of 270 participants who received group cardiac counseling or an experimental section of 592 participants who received both group cardiac counseling and type A behavioral counseling. The remaining 151 patients, serving as a "comparison group," did not receive group counseling of any kind. Using the "Intention-to-Treat" principle, we observed markedly reduced type A behavior at the end of 4.5 years in 35.1% of participants given cardiac and type A behavior counseling compared with 9.8% of participants given only cardiac counseling. The cumulative 4.5-year cardiac recurrence rate was 12.9% in the 592 participants in the experimental group that received type A counseling. This recurrence rate was significantly less (p less than 0.005) than either the recurrence rate (21.2%) observed in the 270 participants in the control group or the recurrence rate (28.2%) in those of the comparison group not receiving any special treatment. After the first year, a significant difference in number of cardiac deaths between the experimental and control participants was observed during the remaining 3.5 years of the study. Overall, the results of this study demonstrate for the first time, within a controlled experimental design, that altering type A behavior reduces cardiac morbidity and mortality in post infarction patients.

Behavior Therapy↗

PubMed1985

Reduction in type A behavior in healthy middle-aged American military officers.

One hundred eighteen senior officer-students of the U.S. Army War College who were healthy but exhibited type A behavior volunteered to be randomly selected and enrolled into (1) a section of 62 officers who received group type A behavior counseling for 9 months and (2) a control section of 56 officers who received no counseling of any kind. Marked or profound reduction in type A behavior at the end of 9 months was observed in 41.9% of the 62 participants who initially were enrolled to receive type A counseling; marked or profound reduction in type A behavior, however, was observed in only 8.9% of the 56 initially enrolled control subjects. No adverse effects on the military leadership qualities of type A counseled participants were observed by their classmates. Serum total cholesterol and plasma high-density lipoprotein (HDL) cholesterol measurements were obtained monthly. The serum cholesterol of the total cohort of subjects rose significantly during a month of considerable emotional tension and stress. Those subjects who underwent a profound reduction in the intensity of their type A behavior pattern also exhibited a significantly lower serum cholesterol value as the study continued than those subjects who exhibited no change in their type A behavior. No significant changes in plasma HDL cholesterol concentrations were observed in the total cohort during the above-mentioned period of stress, nor were any differences in this particular measurement noted between the type A counseled and the control participants.

Adult↗

PubMed1984

Alteration of type A behavior and reduction in cardiac recurrences in postmyocardial infarction patients.

Eight hundred sixty-two postmyocardial infarction patients volunteered to be randomly selected and enrolled into: (1) a control section of 270 patients, who received group cardiologic counseling; and (2) an experimental section of 592 patients, who received group type A behavior counseling in addition to group cardiologic counseling. Reduction in type A behavior at the end of 3 years was observed in 43.8% of the 592 participants, who initially were enrolled to receive group cardiologic and type A behavioral counseling. This degree of behavioral reduction was significantly greater than that observed in participants who initially were enrolled to receive only group cardiologic counseling. The 3-year cumulative cardiac recurrence rate was 7.2% in participants who initially were enrolled to receive group cardiologic and type A behavioral counseling. This was significantly less (p less than 0.005) than that (13%) observed in participants who initially were enrolled to receive only cardiologic counseling. This difference in recurrence rates was due to a lesser incidence of nonfatal infarctions in the patients who had been enrolled in the section receiving type A behavioral as well as cardiologic counseling. These data suggest that type A behavior can be altered in a sizable fraction of postinfarction patients and that such alteration is associated with a significantly reduced rate of nonfatal myocardial infarctions.

Behavior↗

PubMed1982

Feasibility of altering type A behavior pattern after myocardial infarction. Recurrent Coronary Prevention Project Study: methods, baseline results and preliminary findings.

We studied 1035 consecutive postinfarction patients to determine the feasibility of altering type A behavior and the effect such alteration might have on subsequent rates of infarction and cardiovascular death. Approximately 300 subjects were enrolled in small groups and primarily received cardiologic counseling on the usually accepted coronary risk factors. Six hundred subjects received, in addition to cardiologic counseling, advice and instructions designed to diminish the intensity of their type A behavior. The remaining subjects, serving as controls, received no counseling, but were examined and interviewed annually, as were those who dropped out of counseling groups. More than 98% of the 1035 subjects exhibited moderate-to-severe type A behavior during a videotaped structured interview. After the first year of this 5-year study, the rates of infarction and cardiovascular death were lower (p less than 0.01 and p less than 0.05, respectively) among subjects who received both cardiologic and behavioral counseling than among the control subjects. The rate of nonfatal infarction was lower (p less than 0.05) among subjects who received behavioral counseling than among those who received only cardiologic counseling or those who dropped out of either counseling group. The circumstances that most often preceded recurrent infarction or cardiovascular death were emotional crisis, excess physical activity, ingestion of a single fatty meal or a combination of these phenomena.

Adult↗

PubMed1982

The recurrent coronary prevention project: initial findings.

A behavioural treatment programme, designed to modify type A behaviour, has been compared with cardiological measures (e.g. diet, exercise and adherence to medication), and with 'no treatment', for its ability to prevent reinfarction in patients who had suffered a myocardial infarct at least six months previously. Provisional results show fewer reinfarctions and greater modification of type A behaviour in the group receiving behavioural treatment. In the third year, to date, the difference favouring behavioural over cardiological measures was statistically significant (P less than 0.01), and other factors seem unlikely to be responsible. The five-year study still has two years to run.

Behavior↗

PubMed1972