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Biomedical subjects

K Dracup

Publications and source records attributed to K Dracup.

At least 127 records · Page 7Linked to original sources
PubMed1989

Heart transplantation may not improve quality of life for patients with stable heart failure.

Heart transplantation is a therapeutic option for many patients with end-stage heart failure. Vigorous medical therapy has evolved so that many patients eligible for heart transplantation can now be discharged and stabilized with medical therapy. Heart transplantation improves survival, but it has not been compared previously with sustained medical therapy with regard to quality of life. We compared quality of life for 24 patients who survived at least 6 months after heart transplantation with that for 20 patients clinically similar at baseline who survived at least 6 months with sustained medical therapy. Quality of life was assessed by using three questionnaires. Both groups were similar in psychosocial functioning, with patients receiving medical therapy reporting greater dysfunction in social activities, as compared with those who underwent heart transplantation. No differences were seen in 6-minute walking distances and employment status. Survival benefits are expected with heart transplantation; however, quality of life for survivors may not be different than that for patients who survive with sustained medical therapy.

Female↗
PubMed1989

Can family members of high-risk cardiac patients learn cardiopulmonary resuscitation?

The immediate delivery of bystander-administered cardiopulmonary resuscitation (CPR), coupled with the rapid delivery of advanced cardiac life support, can significantly reduce mortality from out-of-hospital cardiac arrest. Because the majority of sudden cardiac deaths occur in the victim's home with family members present, family members of cardiac patients at high risk for sudden death are the logical focus of CPR training. However, previous research has shown that only a small minority of family members of cardiac patients actually learn CPR and that health care professionals have failed to recommend CPR training in this population, in part due to concerns about their ability to learn CPR. The purpose of this study was to describe learning capabilities in this population and to identify characteristics of unsuccessful learners. To this end, we taught CPR to 83 family members of cardiac patients who were at risk for sudden cardiac death. Subjects had no CPR training within the past two years. Eighty-one percent of the subjects successfully learned CPR. Of the demographic and psychological characteristics examined, only gender, age, and depression were significant in explaining differences in CPR skills attainment ability. The elderly, the depressed, and males were more likely to be unsuccessful in demonstrating adequate CPR skills. Our results suggest that the majority of family members of cardiac patients can learn CPR successfully. Specific training strategies may need to be developed and tested to enhance CPR training in those family members of cardiac patients predicted to have difficulty learning CPR.

Adult↗
PubMed1988

Adult cardiology and the expanding supply of physicians.

The number of cardiologists can be projected with considerable accuracy into the next century. The total cardiology pool of physicians will increase until the year 2015 at which time those entering and leaving the pool will come into equilibrium. At that time the ratio of active cardiologists to the population will have greatly increased. This nation's future need for cardiologists is difficult to assess with any degree of precision. Therefore, this is the time for updating practice profile studies. Such studies today could be formulated in a manner to provide more detailed information on the cardiologist's daily activities. In addition, a data base developed through methodology such as the consensus formation approach must be developed and updated on a periodic basis. Through such analyses it will be possible to quantitate the future needs of cardiovascular manpower.

Adult↗
PubMed1987

Integration of nursing diagnoses in the critical care nursing literature.

It has been almost 15 years since the start of the nursing diagnosis movement. Consensus development, research, and infiltration have been slow but progressive. However, integration of nursing diagnoses into the critical care literature has not progressed as much as have other components of the movement. All three nursing diagnosis activities are interdependent, and without infiltration the whole process is slowed. We believe that the process of infiltration through the literature could be greatly accelerated if the recommendations presented here were implemented. This increasing infiltration of nursing diagnoses through the literature would then have a positive effect on all other concurrent activities involved in the nursing diagnosis movement.

Critical Care↗
PubMed1987

Critical care nursing.

The research pertaining to the delivery of nursing care in the ICU was reviewed to describe: the impact of the unit structure and organization, including policies and procedures, on patients, nurses, and families; the process of critical care nursing; the outcomes of critical care nursing; some of the ethical issues germane to the care of the critically ill patient. Although these areas of inquiry are quite diverse, a number of similarities can be identified. The most obvious of the similarities was that, with few exceptions, the studies pertaining to delivery of nursing care were performed by researchers from a variety of disciplines other than nursing, including medicine, psychology, public health, and economics. In many instances, such as the studies of patients' stress experiences in ICUs, these efforts enhanced our knowledge of the phenomena and complemented or replicated the efforts of nurse researchers. Unfortunately, in some areas nurse researchers were quite absent, with the result that the studies lacked a nursing perspective. For example, the large body of knowledge related to the effects of critical care on patient outcome reflected medicine's orientation toward cure. While it is important to measure the effect of nursing care in the ICU on patient survival, the effect of nursing efforts on short- and long-term quality of life, functional status, and health maintenance is also critical and remains unknown. Nurse researchers need to build on the data base already acquired about critical care. Even more important, they need to fashion programs of research focused on the concepts central to the discipline of nursing. A second similarity relates to the increasing quality of the reported research over the past decade. In general, early descriptive studies were conducted in a single critical care unit with a small and often biased sample. These gave way to more carefully designed, multicenter studies, although lack of randomization procedures continued to be a significant problem. Increasing attention was paid to the psychometric properties of instruments, and the validity and reliability of these instruments were appropriately discussed by the researchers using them. However, the area of family stress is a remarkable exception to this positive trend. Investigators also began to address the problem of sample homogeneity in some of the areas of inquiry by replicating their work outside the often favored CCU. The third and final similarity lies with the preponderance of descriptive studies in all areas reviewed.(ABSTRACT TRUNCATED AT 400 WORDS)

Critical Care↗
PubMed1986

Cardiopulmonary resuscitation (CPR) training. Consequences for family members of high-risk cardiac patients.

A prospective, controlled trial was conducted to document the psychological risks and benefits of teaching cardiopulmonary resuscitation (CPR) techniques to family members of patients at high risk for a sudden death event. Clinical outcomes for the high-risk patients were also measured. Cardiac patients (n = 65) and their family members (n = 69) were randomized to one of three groups: CPR training, risk factor education, and control. Patients did not attend either intervention group. No adverse psychological effects for family members were documented. The patients in the CPR group, however, were more anxious at three months' follow-up than patients in either the educational or control groups. Patients in both CPR and risk factor education groups reported poorer adjustment to illness at six months' follow-up than did control patients. These results suggest that CPR training for family members may have an adverse psychological effect on high-risk cardiac patients.

Adaptation, Psychological↗
PubMed1984

Group counseling in cardiac rehabilitation: effect on patient compliance.

A multicenter clinical trial was conducted to evaluate the effects on compliance of a group counseling program for cardiac patients and spouses. The sample comprised 58 couples in which one of the partners had documented atherosclerotic heart disease and was enrolled in an outpatient cardiac rehabilitation program. The experimental intervention involved a ten-week series of group sessions based on symbolic interactionist role theory. The research used a quasi-experimental, three-group, time-series design: Experimental group 1 consisted of 17 patients and their spouses who participated in group counseling; experimental group 2 consisted of 22 patients and their spouses, but only the patients participated in the group series; the control group consisted of 19 patients and their spouses who did not participate in the experimental program. Data were collected at baseline, ten weeks, and six months on four cardiac risk factors: weight loss, blood pressure, exercise, and smoking. Repeated measures analysis of variance showed a significant difference (P less than 0.01) in mean body fat among treatment groups, with experimental group 2 having the greatest decrease over time. Patients in both experimental groups demonstrated lowered blood pressure, with a significant decrease (P less than 0.05) in systolic blood pressure. Again, the largest decrease was in experimental group 2. Changes in weekly exercise level were not significantly different among groups, although the highest compliance was reported by experimental group 1 patients. Results support the efficacy of group counseling based on an interactionist role theory framework to increase compliance. The anticipated effect of spouse participation was not confirmed.

Counseling↗
PubMed1984

Left ventricular stroke volume determinations from radionuclide ventriculograms: the effects of photon attenuation.

To improve the accuracy of scintigraphic ventricular volume determination, which is limited by photon attenuation between the heart and the gamma camera, a method was developed for directly measuring the photon attenuation of radioactivity delivered as a bolus through a Swan-Ganz catheter into the right atrium. Comparison of the count rate recovered from this bolus with the total ex vivo measured activity determined by imaging an aliquot of the administered activity allowed calculation of the attenuation factor. Left ventricular stroke volumes determined scintigraphically by the count method in gated blood pool studies and then corrected with this attenuation factor correlated well with stroke volumes determined from thermodilution cardiac output and heart rate (r = 0.92; SEE, 6.1 ml). The agreement between the two measurements was markedly less when an average attenuation factor was employed for correction of scintigraphic volumes (r = 0.52; SEE, 14.8 ml). The results indicate that correction for photon attenuation is needed for accurate measurement of left ventricular volumes. Correction of left ventricular counts based on body weight or body surface area improves the accuracy of volume estimates.

Adult↗
PubMed1984

Family-focused cardiac rehabilitation. A role supplementation program for cardiac patients and spouses.

A review of the literature yields general agreement among investigators regarding the responses of both patients and spouses to a cardiac event. Anxiety, depression, low self-esteem, marital and sexual dysfunction, and psychosomatic symptoms have been consistently documented up to 1 year following a myocardial infarction or cardiac surgery. Although the patient's physiologic status sets limits on the potential level of recovery, psychosocial variables are new recognized as playing a critical role in the rehabilitation process for both patients and their families. Our 3-year experience with patient-spouse groups supports the view that spouses must be involved throughout the rehabilitative process and that effective participation is provided within the context of a role supplementation program. Such a program facilitates direct and consistent communication as well as flexibility within and between roles. Both end points are critical to the re-establishment of family equilibrium and the ultimate recovery of the cardiac patient.

Adaptation, Psychological↗