Search PubMed⌕ Search

Biomedical subjects

K Dracup

Publications and source records attributed to K Dracup.

At least 91 records · Page 5Linked to original sources
PubMed1994

Management of heart failure. II. Counseling, education, and lifestyle modifications.

OBJECTIVE: This article reviews the role of counseling, education, dietary modifications, and exercise for patients with heart failure due to left ventricular systolic dysfunction. DATA SOURCE: We reviewed studies published in English between 1966 and 1993 and referenced in MEDLINE or EMBASE. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with terms for the specific areas of interest. Where data were lacking, we relied on opinions of panel members and peer reviewers. STUDY SELECTION AND DATA SYNTHESIS: Studies were reviewed to determine whether patients had heart failure due to systolic dysfunction (left ventricular ejection fraction, < 0.35 to 0.40) and whether clinical outcomes were reported. Studies that reported only intermediate outcomes (eg, hemodynamics) were not reviewed. CONCLUSION: Counseling and education can improve patient outcomes and decrease unnecessary hospitalizations. Patients with mild to moderate heart failure should be restricted to 3 g/d of sodium initially. Those who are unresponsive to this dosage or who have more severe disease should be advised to consume 2 g/d or less. Patients should be strongly advised to drink no more than 30 mL/d of alcohol or, preferably, to abstain completely. Exercise training is safe and can improve exercise duration and symptoms. Adherence to the treatment plan should be stressed and monitored at each visit. Clinicians should inform patients of the seriousness of their disease and their prognosis, but they should emphasize that patients can continue to remain active and enjoy a reasonable quality of life.

Counseling↗
PubMed1994

Making judgements about treatment effectiveness based on health outcomes: theoretical and practical issues.

ISSUES: This article considers the problem of deciding which health care outcomes are important and relevant for (1) developing management recommendations for clinical practice guidelines and (2) evaluating patients' responses to treatment. DECISIONS: The Heart Failure Guideline Panel sponsored by the Agency for Health Care Policy and Research (AHCPR) decided that for both purposes the relevant outcomes are those experienced directly by patients: mortality and health-related quality of life (HRQOL). Changes in intermediate outcomes, such as test results of various kinds, were deemed insufficient evidence of effectiveness. CONCLUSIONS: In the context of heart failure, mortality risk (prognosis) can be measured using a variety of biochemical and physiological variables, but changes in these variables do not appear to correspond to changes in prognosis. For this reason, the Heart Failure Guideline Panel recommended that patients' responses to treatment be guided by signs and symptoms, rather than test results (for example, echocardiographic measurement of left-ventricular function or exercise-tolerance testing). HRQOL is best assessed by direct patient self-reports. Although patients may be influenced by a host of other variables (for example, mood, adaptation to chronic disease, placebo effect), self-reports will probably always represent the "gold standard" in assessing HRQOL. The reliability and validity of these reports can be enhanced by using standardized instruments or by incorporating questions from such instruments into the history-taking aspect of patient evaluation and monitoring. Finally, physical examination and submaximal exercise testing can provide additional information that can supplement patient reports. Information from these sources must be evaluated carefully in light of patients' self-reported HRQOL.

Health Status↗
PubMed1994

The relationship of marital quality and psychosocial adjustment to heart disease.

Psychosocial adjustment to heart disease is variable. Some patients recover from a myocardial infarction or cardiac surgery quickly, return to work and leisure activities, and experience little emotional distress. Others suffer significant problems in psychosocial adaptation. We proposed and tested a theoretical model of adjustment that included the quality of the marital relationship, dysphoria, chronologic age, and time from the cardiac event (myocardial infarction or surgery) to identify the role that these variables play in adjustment. The study was conducted in 198 men diagnosed with coronary heart disease using the following instruments: the Spanier Dyadic Adjustment Scale, the Multiple Affect Adjective Checklist, and the Psychosocial Adjustment to Illness Scale. Data were collected on entry into the study and 3 months later to identify the stability of the relationships over time. The theoretical model was supported. Findings demonstrated that positive psychosocial adjustment to illness is influenced both by the quality of the patient's marriage and dysphoria. The spouse appears to influence psychosocial adjustment in an indirect manner by influencing the patient's experience of emotional distress or dysphoria. Nurses can enhance psychosocial adjustment to coronary heart disease by helping patients and spouses focus on ways to improve the quality of their marriage and by suggesting strategies to improve marital communication and decrease fear and misconceptions related to the illness.

Adult↗
PubMed1994

Is cardiopulmonary resuscitation training deleterious for family members of cardiac patients?

The purpose of the study was to determine the attitudes toward cardiopulmonary resuscitation (CPR) training and subsequent CPR use of 172 CPR-trained family members of cardiac patients. The majority (88.9%) reported positive attitudes. Only 14 (8.1%) reported feeling too responsible for their family member. One hundred and forty-one (81.9%) said that they would perform CPR if required to do so. Family members do not feel unduly burdened by learning CPR, and CPR training should be recommended to families of patients at risk for sudden cardiac death.

Adult↗
PubMed1994

To know what we do.

Explore the source record for details and available documents.

Clinical Nursing Research↗
PubMed1994

Factors influencing prehospital delay in patients experiencing chest pain.

BACKGROUND: Patients experiencing chest pain (or other cardiac symptoms) in the community delay hours, even days, in seeking medical care. Given the potential effectiveness of thrombolytic therapy, it is important to determine patterns of patient delay. OBJECTIVES: A descriptive study was conducted to determine the amount of time patients delayed in seeking medical care when experiencing chest pain and the characteristics of patients delaying longer than 3 hours. METHODS: Adult patients (N = 77) admitted to an emergency department with chest pain participated. Data were obtained using the Response to Symptoms Questionnaire and chart review. RESULTS: The mean prehospital delay times (ie, symptom onset to hospital arrival) was 25.4 hours (+/- 46.5), and the median was 5 hours. Delay groups were divided into those arriving less than 3 hours (n = 31 or 40%) and those arriving more than 3 hours (n = 46 or 60%) after symptom onset. Three hours was chosen based on a mean time, taken from the literature, of 84 minutes spent in the emergency department so that patients in the first group would be able to receive thrombolysis within 4 hours. Univariate statistical analyses revealed that advanced age, symptom onset with a family member present, and self-determination of symptoms as not being serious in nature all contributed to a delay of longer than 3 hours. CONCLUSIONS: Critical care nurses and physicians should focus on patients at high risk for prolonged delay and educate the public about action to take if a family member experiences cardiac symptoms.

Adult↗
PubMed1994

Waste!

Explore the source record for details and available documents.

Clinical Laboratory Techniques↗